Why illness perceptions matter in patient support

Once a patient is diagnosed with an illness or injury, he or she generally develops an organised pattern of beliefs about his or her condition. These views are key determinants of the patient’s emotional reactions and behaviour directed at managing the illness, including their adherence to treatment. Despite their importance, the illness or symptom perceptions of patients are rarely sought during medical consultations or in disease management/patient support programmes.

Patients build mental models

Previous research has identified that when faced with a new health threat such as a new symptom or diagnosis, individuals will actively build cognitive models of this threat and this mental representation will determine how they will respond1. These models are based on an individual’s own medical knowledge or from personal experiences of others, such as family members with similar symptoms or diagnoses. The patient’s model of his or her illness will guide him or her to reduce the danger of the symptoms or illness, and will simultaneously guide the coping strategies and illness-specific behaviours designed to reduce the emotional response to the threat.

It is important to note that patients’ knowledge of medical concepts and the body is often rudimentary, and this can limit the accuracy and complexity of the models that patients build. Indeed, patients’ models are often incompatible with the accepted medical understandings of health and illness. For instance, we recently found less than 50 per cent of people could correctly identify the location of their heart, lungs, stomach and kidney on body charts when asked. Furthermore, patients with specific organ-related illnesses such as cardiology and renal patients, were generally no better at correctly identifying their disease-relevant organ than members of the general public2.

Components of illness perceptions

The perceptions that patients hold about their illness can generally be divided into the following areas components.

Firstly label of the illness and the symptoms the patient views as being part of the disease, secondly personal ideas about aetiology. It is also important to understand how long the patient believes the illness will last and the expected effects and outcome of the illness. Finally the patient’s perspective on how long one recovers from, or controls, the illness.

These components are unique factors that contribute to the way that patients make sense of their illness and are often not immediately obvious to practitioners and researchers. An understanding of these components through validated and empirically supported methods is highly important. It is not until a good understanding of the patient’s unique illness perceptions are developed that these perceptions can be the target of change.

Illness perceptions and clinical outcomes

Illness perceptions are increasingly being shown as being related to important outcomes in a number of illnesses. Evidence suggests that patients attending medical investigations who have already developed maladaptive illness perceptions of their condition are less reassured by findings showing no pathology3.

Such studies pose the question that if the illness perceptions of patients can be modified early in their recovery process, can their recovery be improved? A recent study attempted to answer this question by comparing whether a cognitive-behavioural intervention designed to alter the illness perceptions of patients following a heart attack would improve recovery when compared to standard care. The results showed that the intervention induced significant, positive changes in the illness beliefs of patients during their time in hospital, with the intervention patients returning to work at a significantly faster rate than control patients4.This study suggests that illness perceptions may be successfully altered by brief cognitive-based interventions and suggests that this approach may be useful in improving adjustment and functioning in other illnesses.

There is now an urgent need to develop effective and efficient methods for modifying dysfunctional illness beliefs, particularly at an early stage. What is also key, is ensuring that the information and support delivered by healthcare professionals is consistent with, and addresses the patient’s unique cognitive model of his or her condition. The positioning of information and support in this manner helps to ensure that the coping strategies and illness-specific behaviours adopted are concordant with treatment recommendations.

Conclusion

Once individuals are diagnosed with an illness or injury, they develop cognitive models to make sense of their condition. These illness perceptions are important in guiding coping strategies and illness-specific behaviours such as adherence to treatment. Over the past 10 years, a growing body of evidence has emerged to show that when patients hold more maladaptive views of their illness, these are associated with poorer outcomes.

Recent work suggests that illness perceptions can be changed. This offers considerable opportunity to improve the adjustment to, and self-management of patient illnesses in the future. It also provides the opportunity to tailor programmes and interventions to target non-adherent beliefs that could lead to an increase in overall effectiveness.

Evidence Applied in Patient Support:

Please contact Atlantis Healthcare regarding its AsthmaAIM project where addressing illness perceptions and medication beliefs has proven to significantly improve adherence in a Randomised Controlled Trial.

• References available on request

Keith J. Petrie Ph.D

Atlantis Healthcare Consultant

Professor of Health Psychology, University of Auckland, New Zealand

John Weinman Ph.D