Wednesday, January 16, 2013

Representations of Ilnesses

Individuals' perceptions of disease and illness contribute to their health behaviors, which, in turn predict health outcomes (Murray, Marks, Evans, & Estacio, 2011). These perceptions as well as the emotional processes associated with them directly contribute to how patients respond to illness. Illness representations are usually established prior to a diagnosis, and may evolve over time and with experience (Murray et al., 2011).

Implications for understanding illness representations

The implications of illness representations play a powerful role as predictors of patient outcomes (Murray, et al., 2011). Understanding patients' illness representations can help medical personnel as well as psychological professionals anticipate and intervene in altering patients' belief systems, to improve patient outcomes (Lee, Chaboyer, & Wallis, 2010). For example, understanding how health representations affect treatment compliance, can contribute to developing interventions to alter compliance, hence, improving health outcomes (Leventhal, Diefenbach, & Leventhal, 1992).

Common Example

As an example of representations of illness, the common cold presents similar experiences in most individuals. Using the common sense model, individuals identify the threat (stuffy head), recognize the timeline associated with a common cold (problematic for a few days to a week), perceive the consequences as minimal and know the cause was likely transmission of a virus from another person. Further, they know the cold is self-limiting and can be controlled easily by resting, drinking fluids, and taking a fever-reducing medication. The individuals' established beliefs about the common cold predict how they will behave. The emotional reaction to the cold is minimal, unless the individual has a known respiratory weakness, which may cause concern over the cold developing into bronchitis (illness coherence).

Alternatively, if individuals believe the common cold must run its course and nothing can be done to lessen it effects or its timeline, they may not make appropriate changes to their behavior, which may lengthen the course of the illness. In sum, individuals' established and evolving beliefs about their illness predicts their behavior, and may affect health outcomes Leventhal, et al., 1992).

Unlike the illness representations associated with the common cold, behaviors associated with serious illness may have more significant implications for outcomes. For example, if an individual believes he is having a heart attack, but does not realize earlier medical intervention produces more positive outcomes, he may delay seeking help, which may directly affect his recovery, or even his mortality (Farquharson, Johnston, & Bugge, 2012). Alternatively, Filipino women often delay seeking medical attention when they find a breast lump. A pervasive cultural belief in this population associates breast lumps with death, rather than the need to seek medical intervention (Wu & Bancroft, 2006). The implications for these beliefs are that breast cancer is the leading cause of death in Filipino women (Ho, Muraoka, Cuaresma, Guerrero, & Agbayani, 2010). If changes can be made in the perceptions of breast cancer in this population, patient outcomes can be improved, specifically, fewer women dying of breast cancer.

The implications of illness representations are far-reaching. Chaboyer, Lee, Wallis, Gillespie, and Jones, (2010) found illness representations predict quality of life more than does the patients' demographic contexts and clinical factors. Further, illness representations continued to decrease quality of life six months after the illness (Chaboyer, Lee, Wallis, Gillespie, & Jones, 2010). On the positive side, patients gained a sense of self control in regard to their illness when their perceptions allowed them to adapt to their illness (Karademas, Kynigopoulou, Aghathangelou, & Anestis, 2011). On the contrary, when patients could not adapt to the perceptions of their illness, or when they adapted in unhealthy ways, they were prone to creating a cyclical effect of helplessness contributing to worse health outcomes (Karademas, et al., 2011). Optimism, too, had an effect on mediating illness representations, which consequently affected overall outcomes (Karademas, et al., 2011).

As a final thought, people have a tendency to cling to beliefs even when evidence is contradictory (belief perseverance), so changing established illness representations may present a considerable challenge. Disseminating correct information may help resolve the detrimental health outcomes that begin with illness representations, although Castillo, Godoy-Iquierdo, Vazquez, and Godoy (2012) found some lay perceptions of illness (cancer) were generally medically accurate. From a cognitive perspective, understanding the power of illness representations may contribute to devising effective means of cognitive restructuring that may aid in healing and recovery.


Castillo, A., Godoy-Izquierdo, D., Vázquez, M., & Godoy, J. (2011). Illness Beliefs About Cancer Among Healthy Adults Who have and have not Lived with Cancer Patients. International Journal Of Behavioral Medicine, 18(4), 342-351. doi:10.1007/s12529-010-9141-6

Chaboyer, W., Lee, B., Wallis, M., Gillespie, B., & Jones, C. (2010). Illness representations predict health-related quality of life 6months after hospital discharge in individuals with injury: A predictive survey. Journal of Advanced Nursing, 66(12), 2743-2750. doi: 10.1111/j.1365-2648.2010.05431.x

Farquharson, B., Johnston, M., & Bugge, C. (2012). Appraisal and illness delay with symptoms of ACS: A questionnaire study of illness representations. British Journal Of Cardiac Nursing, 7(10), 493-499.

Ho, R., Muraoka, M., Cuaresma, C., Guerrero, R., & Agbayani, A. (2010). Addressing the excess breast cancer mortality in Filipino women in Hawai'i through AANCART, an NCI community network program. Hawaii Medical Journal, 69(7), 164-166.

Karademas, E. C., Kynigopoulou, E., Aghathangelou, E., & Anestis, D. (2011). The relation of illness representations to the 'end-stage' appraisal of outcomes through health status, and the moderating role of optimism. Psychology & Health, 26(5), 567-583. doi:10.1080/08870441003653488

Lee, B., Chaboyer, W., & Wallis, M. (2010). Illness representations in patients with traumatic injury: A longitudinal study. Journal of Clinical Nursing, 19(3-4), 556-563. doi: 10.1111/j.1365-2702.2009.02972.x

Leventhal, H., Diefenbach, M.A., & Leventhal, E. A. (1992). Illness Cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 143-163.

Marks, D. F., Murray, M., Evans, B., & Estacio, E. V. (2011). Health Psychology: Theory, Research, and Practice (3rd ed.). London: Sage.

Wu, T., & Bancroft, J. (2006). Filipino American Women's Perceptions and Experiences With Breast Cancer Screening. Oncology Nursing Forum, 33(4), 71-78. doi: 10.1188/06.ONF.E71-E78

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