Central to much research on illness beliefs and their relationship to outcome is the importance of a coherent model whereby beliefs about the illness are consistent with beliefs about treatment (Leventhal et al. 1997). For example, Horne and Weinman (2002) report that adherence is more likely to occur when illness beliefs and treatment beliefs are coherent with each other.
Similarly, Llewellyn et al. (2003) reported that adherence to medication for patients with haemophilia was also greater when beliefs about illness and treatment were matched. Examples of such coherence include the following: a belief that breathlessness is caused by smoking would relate to a decision to stop smoking, and a belief that asthma symptoms were caused by bronchial constriction would relate to adherence to a medication that caused bronchial dila-tion. Most research addressing the issue of coherence has focused on cross-sectional associ-ations between the different sets of beliefs. Recently, however, several studies have explored whether or not beliefs can be changed to be more in line with each other. For example, Hall et al. (2004) examined whether giving people a leaflet containing information about the link between smoking and cervical cancer, which provided them with a coherent model of this association, could change intentions to quit smoking. The results showed that the leaflet did increase women’s coherent model of the association between smoking and cervical cancer.
Further, the results showed that perceptions of vulnerability to cervical cancer were associated with intentions to quit smoking but only in those with a coherent model. Similarly, Ogden and Sidhu (2006) report how taking medication for obesity, which produces highly visual side effects, can result in both adherence and behaviour change if the side effects act as an education and bring people’s beliefs about the causes of their obesity in line with a behavioural solution (see Chapter 15 for further details). Both these studies illustrate the importance of coherence and the benefits of changing beliefs. In contrast, however, Wright et al. (2003) explored the impact of informing smokers about their genetic predisposition towards nicotine dependence on their choice of method for stopping smoking. In line with the studies described earlier, giving information did change beliefs. However, while those who believed that they were geneti-cally prone to dependency were more likely to choose a medical form of cessation (a drug to reduce cravings), they were likely to endorse relying upon their own willpower. Changing beliefs towards a more medical cause meant that smokers were less able to change their behavi-our on their own and more in need of medical support. These results illustrate the importance of a coherent model. But they also illustrate that changing beliefs may not always be beneficial to subsequent changes in behaviour.
FOR DISCUSSION 71
To conclude
In the same way that people have beliefs about health, they also have beliefs about illness. Such beliefs are often called ‘illness cognitions’ or ‘illness representations’. Beliefs about illness appear to follow a pattern and are made up of: (1) identity (e.g. a diagnosis and symptoms); (2) con-sequences (e.g. beliefs about seriousness); (3) time line (e.g. how long it will last); (4) cause (e.g.
caused by smoking, caused by a virus); and (5) cure/control (e.g. requires medical inter-vention). This chapter examined these dimensions of illness cognitions and assessed how they relate to the way in which an individual responds to illness via their coping and their appraisal of the illness. Further, it has described the self-regulatory model, its implications for under-standing and predicting health outcomes and the central role for coherence.
Questions
1 How do people make sense of health and illness?
2 Discuss the relationship between illness cognitions and coping.
3 Why is Leventhal’s model ‘self-regulatory’?
4 Symptoms are more than just a sensation. Discuss.
5 Discuss the role of symptom perception in adjusting to illness.
6 Discuss the role of coherence in illness representations.
7 Illness cognitions predict health outcomes. Discuss.
8 Design a research project to assess the extent to which illness severity predicts patient adjustment and highlight the role that illness cognitions may have in explaining this rela-tionship.
For discussion
Think about the last time you were ill (e.g. headache, flu, broken limb, etc.). Consider the ways in which you made sense of your illness and how they related to your coping strategies and how you recovered.
Assumptions in health psychology
The literature examining illness cognitions highlights some of the assumptions in health psychology:
1 Humans as information processors. The literature describing the structure of illness cognitions assumes that individuals deal with their illness by processing the different forms of information. In addition, it assumes that the resulting cognitions are clearly defined and consistent across different people. However, perhaps the information is not always processed rationally and perhaps some cognitions are made up of only some of the components (e.g. just time line and cause), or made up of other com-ponents not included in the models.
2 Methodology as separate to theory. The literature also assumes that the structure of cognitions exists prior to questions about these cognitions. Therefore it is assumed that the data collected are separate from the methodology used (i.e. the different components of the illness cognitions pre-date questions about time line, causality, cure, etc.). However, it is possible that the structure of these cognitions is in part an artefact of the types of questions asked. In fact, Leventhal originally argued that interviews should be used to access illness cognitions as this methodology avoided
‘contaminating’ the data. However, even interviews involve the interviewer’s own preconceived ideas which may be expressed through the structure of their questions, through their responses to the interviewee, or through their analysis of the tran-scripts.
Further reading
Cameron, L. and Leventhal, H. (eds) (2003) The Self-regulation of Health and Illness Behaviour.
London: Routledge.
This is a good book which presents a comprehensive coverage of a good selection of illness repre-sentations research and broader self-regulation approaches.
de Ridder, D. (1997) What is wrong with coping assessment? A review of conceptual and methodo-logical issues, Psychology and Health, 12: 417–31.
This paper explores the complex and ever-growing area of coping and focuses on the issues surrounding the questions ‘What is coping?’ and ‘How should it be measured?’
Ogden, J. and Sidhu, S. (2006) Adherence, behaviour change and visualisation: a qualitative study of patients’ experiences of obesity medication, The Journal of Psychosomatic Research, 62: 545–52.
Although this is one of my papers (!) I think it provides an example of how beliefs about a problem can be changed through experience and how coherence is a essential part of illness rep-resentations. It also illustrates a qualitative approach to illness reprep-resentations.
Petrie, K.J. and Weinman, J.A. (eds) (1997) Perceptions of Health and Illness. Amsterdam: Harwood.
This is an edited collection of projects using the self-regulatory model as their theoretical frame-work.
Taylor, S.E. (1983) Adjustment to threatening events: a theory of cognitive adaptation, American Psychologist, 38: 1161–73.
This is an excellent example of an interview-based study. It describes and analyses the cognitive adaptation theory of coping with illness and emphasizes the central role of illusions in making sense of the imbalance created by the absence of health.
Chapter overview
This chapter first examines the problem of compliance and then describes Ley’s (1981, 1989) cognitive hypothesis model of communication, which emphasizes patient understanding, recall and satisfaction. This educational perspective explains communication in terms of the transfer of knowledge from medical expert to layperson. Such models of the transfer of expert know-ledge assume that the health professionals behave according to their education and training, not their subjective beliefs. The chapter then looks at the role of information in terms of determining compliance and also in terms of the effect on recovery, and then reviews the adherence model, which was an attempt to go beyond the traditional model of doctor–patient communication. Next, the chapter focuses on the problem of variability and suggests that vari-ability in health professionals’ behaviour is not only related to levels of knowledge but also to the processes involved in clinical decision making and the health beliefs of the health profes-sional. This suggests that many of the health beliefs described in Chapter 2 are also relevant to