Living with Illness

Howard Leventhal proposed a currently widely used cognitive model of self-regulation that suggests that the cognitive representation of the illness formed by the individual before or during the onset of the illness also forms the coping style and procedures.

Mostly the illness beliefs are formed by information the patient has received before becoming ill. During the course of the illness, the beliefs may change depending on the patient's establishing a trustful relationship with the medical practitioner, and the participation in the available patient education programs or recommended self-education.

Illness representations are known to predict care practices especially in patients who's condition depends on personal discipline and motivation to change lifestyle (coronary diseases, diabetes etc.).

The perceptions which are guided by informed understandings produce significant improvement in patient's coping with the disease and overall condition. Representations of the illness are also affected by the age, personal experience and the previous history of the illness. Illness representations may also differ depending on the cultural background of the patient.

Illness representations refer also to the illness beliefs or perceptions which include five factors:
1. The “identity” of the illness refers to the patients recognition of the signs, symptoms and the illness label.
2. The “consequence” of the illness include the perceived physical, social, economic, and emotional outcomes and how the illness may influence the life of the patient.
3. The “causes” refers to the perceived causes of the illness.
4. The “timeline” describes the perceived development phase of the illness and the duration of the illness.
5. The “cure/control” describes the extent to which the illness is curable and manageable.
Having a positive illness representation allows the patient to accurately identify the symptoms and the causes of the disease, and to have a positive outlook on the course of the disease, its curability and controlability. The fact that illness representations turn out to be predictors of outcome, even when the baseline health status is statistically controlled, highlights the relevance of the illness representations.

Therefore, effective and efficient methods should be used for integrating patient's illness beliefs into the management of the illness as early as possible. Research of different groups of patients proves the validity of the illness representation theory, for example in patients with breast cancer, the positive outlook and the belief that the illness can be controlled and cured is one of the key factors for increasing the survival chances. In a study on recovery process of patients after myocardial infarction it was confirmed that the continued high morbidity and mortality may be due to a failure to address the role of psychosocial factors such as illness representation, depression, and anxiety in recovery.


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