Howard Leventhal

Rutgers, The State University of New Jersey | Rutgers · Institute for Health, Health Care Policy and Aging Research

We describe the cognitive processes, illness‐specific prototypes, and deep‐level schemata (acute/episodic/chronic) that generate the mental representations (illness and treatment representations) guiding people's selection, performance, and evaluation of medically prescribed treatments or self‐selected actions to prevent and control illness threats...

Background Many of our daily behaviors are habitual, occurring automatically in response to learned contextual cues, and with minimal need for cognitive and self-regulatory resources. Behavioral habit strength predicts adherence to actions, including to medications. The time of day (morning vs. evening) may influence adherence and habit strength to...

Objective: This study examined the impact of a survivorship planning consultation (SPC) for patients with Hodgkin's lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) on quality of life (QOL). We specifically assessed two potential moderators, cancer worry and perceived empathy, of the intervention effects on QOL. Methods: This cluster rand...

Objective: To test the association of chronic obstructive pulmonary disease (COPD) illness and medication beliefs with those specific to hypertension or diabetes in patients with COPD and coexisting chronic conditions. Methods: A cross-sectional analysis of data collected from a sample of 282 adults with COPD and comorbid hypertension or diabete...

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin’s and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population. Research Approach: The pare...

Modelling the automatic and deliberative processes that interact and underlie common-sense perceptions and behaviors for managing health and illness requires prototypes at multiple levels; specific illnesses and treatments at the “surface” and generic acute, episodic and chronic prototypes at deeper levels. Models need to represent how multi-level...

Conceptual frameworks are useful in research because they can highlight priority research domains, inform decisions about interventions, identify outcomes and factors to measure, and display how factors might relate to each other to generate and test hypotheses. Discovery, translational, and implementation research are all critical to the overall m...

Background: Survivors of cancer often describe a sense of abandonment after treatment along with heightened uncertainty and limited knowledge of what lies ahead. This study examined the efficacy of a survivorship care plan (SCP) intervention to help physicians to address survivorship issues through communication skills training plus a new consulta...

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Co...

Self-monitoring of blood glucose (SMBG) has been recommended for people with type 2 diabetes mellitus. This trial tested an automated self-management monitor (ASMM) that reminds patients to perform SMBG, provides feedback on results of SMBG, and action tips for improved self-management. This delayed-start trial randomized participants to using the...

The Common-Sense Model of Self-Regulation (the “Common-Sense Model”, CSM) is a widely used theoretical framework that explicates the processes by which patients become aware of a health threat, navigate affective responses to the threat, formulate perceptions of the threat and potential treatment actions, create action plans for addressing the thre...

The present study examines how different chronic illnesses and mental illness comorbidity (chronic illness with complexity [CIC]) associate with components of advance care planning (ACP). We also explore the role self-perceived burden plays in the relationship between illness and ACP. Data were gathered from a cross-sectional survey of 305 elderly...

Our chapter has two primary goals. The first is to describe a model of the mechanisms underlying the ?common-sense processes? involved in the everyday management of health risks. The second, intertwined with the first, is to apply the model to decisions and management of cancers in three areas: screening, care seeking, and end-of-life planning. We...

Introduction Survivors of cancer often describe a sense of abandonment post-treatment, with heightened worry, uncertainty, fear of recurrence and limited understanding of what lies ahead. This study examines the efficacy of a communication skills training (CST) intervention to help physicians address survivorship issues and introduce a new consulta...

The Commonsense Model of Self-Regulation (CSM) has a history of over 50 years as a theoretical framework that explicates the processes by which individuals form cognitive, affective, and behavioral representations of health threats. This article summarizes the major components of individuals' "commonsense models", the underlying assumptions of the...

The majority of U.S. adults do not receive an annual influenza vaccination. Behavioral economics tools can be harnessed to encourage health behaviors. Specifically, scheduling patients by default for a flu shot appointment leads to higher vaccination rates at a medical practice than does merely encouraging flu shot appointments. It is not known, ho...

We outline five principles underlying the construction of representations of illness and treatments that create the framework for preferences, decisions, and actions to prevent and manage threats to health. Available prototypes of illnesses and dysfunction assign weights to the attributes of deviations from the normative self (e.g., symptom pattern...

Illness behavior, the belief that one is threatened by illness and in need of protective action, is typically initiated by changes in somatic experience and physical function that are interpreted as symptoms of an underlying threat to health. This interpretation involves matching of symptoms to schemas of illness. Schemas are products of personal e...

Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of pa...

To clarify the role of self-monitoring of blood glucose in the self-management of Type 2 diabetes from the patient's perspective, using in-depth interviews with non-insulin-treated adults to investigate how they learned to manage their diabetes effectively and whether self-monitoring of blood glucose played a significant role in this. Individual in...

Women with hereditary breast-ovarian cancer face decisions about screening (transvaginal ultrasound, CA125, mammography, breast exams) and proactive (before cancer) or reactive (after cancer) surgery (oophorectomy, mastectomy). The content of genetic counseling and its relation to these key health behaviors is largely unexamined. Ashkenazi Jewish w...

Background: Prostate cancer survivors with a rising prostate-specific antigen (PSA) level have few treatment options, experience a heightened state of uncertainty about their disease trajectory that might include the possibility of cancer metastasis and death, and often experience elevated levels of distress as they have to deal with a disease the...

Background: Patient-physician communication is critical for helping patients understand and complete the complex steps needed to diagnose stage and treat lung cancer. We assessed which domains of patient-physician communication about lung cancer and its treatment are associated with receipt of disease-directed, stage-appropriate treatment. Method...

Inflammation can be a consequence of acute ischemic stroke (AIS), and a possible risk for neurobehavioral recovery. Moreover, a subset of AIS patients develop post-stroke depression (PSD), which can slow recovery and increase risk of recurrent stroke and mortality. Because proinflammatory cytokines can induce depression-like symptoms, AIS-related i...

Background: Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Iden...

Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohor...

Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity. Objectives: To determine cultural factors associated with disparities...

Objectives To examine self-management behaviors, including medication adherence and inhaler technique, in older adults with asthma and their association with health literacy.DesignObservational cohort study.SettingPrimary care and pulmonary specialty practices in two tertiary academic medical centers and three federally qualified health centers in...

Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, a...

Based on the Common Sense Model of Self-Regulation, we examined if the relationship of trait NA to physical symptom reporting was moderated by life events and illness representations. This relationship was examined using a cross-sectional dataset of 554 elderly adults. A significant three-way interaction demonstrated that individuals who reported t...

People are often motivated to determine the causes of events: the more unexpected and disruptive the event, the more likely is the individual to ask, ‘Why did this happen?’ (Weiner, 1985). As the symptoms and diagnoses of illness are often unexpected and disruptive and may have threatening implications, we can expect health threats to stimulate pre...

Risky behaviours promote and healthy behaviours reduce disease risks The evidence is clear: risky behaviours can lead to health crises and healthy behaviours can delay and avoid health crises. Cigarette smoking increases the probability of multiple types of cancer in addition to lung cancer, including cancers in organs as far from the mouth and lun...

Inhaled medications, critical for asthma treatment, are self-administered through metered dose inhalers (MDI). Asthma self-management hinges on adherence to these medications and to proper MDI technique. To assess predictors of proper MDI technique, and MDI technique as a tool to identify patients with low adherence to inhaled medications. Prospect...

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics. Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1 s (FEV1)...

Purpose of the study: To evaluate the extent to which religious affiliation and self-identified religious importance affect advance care planning (ACP) via beliefs about control over life length and end-of-life values. Design and methods: Three hundred and five adults aged 55 and older from diverse racial and socioeconomic groups seeking outpati...

Depressive symptoms and depression are a common complication of childbirth, and a growing body of literature suggests that there are modifiable factors associated with their occurrence. We developed a behavioral educational intervention targeting these factors and successfully reduced postpartum depressive symptoms in a randomized trial among low-i...

Patients with breast cancer who need adjuvant treatments often fail to receive them. High-quality, community-based patient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant the...

OBJECTIVE This study used qualitative interviews with black and Latino participants with diabetes to further understanding about types of foods eaten, food preparation, sources of foods and meals, communication with providers, and effects of race and ethnicity on eating in this population.RESEARCH DESIGN AND METHODS Researchers recruited black and...

PurposeThis systematic review examined the relationship between self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes. The Common Sense Model of Self-Regulation (CSM) served as a theoretical framework for examining how, when (mediators), and for whom (moderators) SMBG improved glycemic control.Data SourcesFiv...

Palmar sweating was monitored on Ss faced with shocks over which they could exert varying control. Shocks were also varied so that some Ss could escape only after receiving shock and others could avoid shock entirely. Control-no control interacted with escape-avoidance, producing peaks in sweating when Ss could not control their escape and when the...

Patient non-adherence to medication is a pervasive problem that contributes to poor patient health and high healthcare costs. Basic research and interventions have focused thus far on behaviour initiation factors, such as patients' illness and treatment beliefs. This paper proposes two processes that occur after behaviour initiation that are theori...

Objective: Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs. Methods: Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n=420). HL was measured with the Shor...

Objective: This study describes how pain practitioners can elicit the beliefs that are responsible for patients' judgments against considering a treatment change and activate collaborative decision making. Methods: Beliefs of 139 chronic pain patients who are in treatment but continue to experience significant pain were reduced to 7 items about...

Objective: To examine the impact of depressive symptoms on asthma outcomes and medication adherence in inner-city elderly patients with asthma. Methods: Cohort study of elderly asthmatics receiving primary care at three clinics in New York City and Chicago from 1 January 2010 to 1 January 2012. Depressive symptoms were ascertained with the Patie...

Introduction: Minority patients in the United States present with later stages of lung cancer and have poorer outcomes. Cultural factors, such as beliefs regarding lung cancer and discrimination experiences, may underlie this disparity. Methods: Patients with a new diagnosis of lung cancer were recruited from four medical centers in New York Cit...

Asthma is a growing cause of morbidity for elderly Americans and is highly prevalent among Hispanic people in the United States. The inability to speak English poses a barrier to patient-provider communication. To evaluate associations between limited English proficiency, asthma self-management, and outcomes in elderly Hispanic patients. Elderly pa...

Self-regulation theory focuses on the ways in which individuals direct and monitor their activities and emotions in order to attain their goals. It plays an increasingly important role in health psychology research. The Self-regulation of Health and Illness Behaviour presents an up-to-date account of the latest developments in the field. Individual...

Background: Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics. Objective: To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics. Design: An observational st...

Longitudinal data from older adults were analyzed to examine the impact of health factors on undesired and ideal self‐discrepancies; and the association of these 2 self‐discrepancies on moods. Results showed that after controlling for self‐assessed health (SAH), fatigue/lack of energy was associated with the undesired but not the ideal self. A seco...

The obesity epidemic is a threat to the health of millions and to the economic viability of healthcare systems, governments, businesses, and nations. A range of answers come to mind if and when we ask, "What can we, health professionals (physicians, nurses, nutritionists, behavioral psychologists), do about this epidemic?" In this paper, we describ...

Background: Disparities in lung cancer treatment and palliative care are well documented. However,the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung c...

Objectives. We report on the development and psychometric properties of a scale to measure perceived sensitivity to medicines (PSM). Design. The internal consistency, test–retest reliability, criterion-related, and predictive validity of the PSM Scale were evaluated using data collected as part of four previously published studies and one unpublish...

To estimate the effectiveness of a behavioral educational intervention to reduce postpartum depressive symptoms among minority mothers. We recruited 540 self-identified black and Latina mothers during their postpartum hospital stay and randomized them to receive a behavioral educational intervention or enhanced usual care. Those in the intervention...

We assessed whether distinct classes of depression symptoms could be identified. In addition, we determined how these classes differed in terms of health status. Data were analyzed with latent profile analysis. MANOVA tests were used to compare the health status of the various classes. A four-class model had the best fit. Classes were labeled accor...

The authors' objective was to gain a better understanding of minority patients' beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive black and Latino adults from 4 inner-city primary care clinics participated in focus groups to elucida...

Routine assessments of pain using an intensity numeric rating scale (NRS) have improved documentation, but have not improved clinical outcomes. This may be, in part, due to the failure of the NRS to adequately predict patients' preferences for additional treatment. To examine whether patients' illness perceptions have a stronger association with pa...

Postpartum depression negatively affects the quality of life and functioning of mothers and is particularly burdensome for minority women. We conducted a randomized controlled trial at a large urban hospital to evaluate the effectiveness of a behavioral educational intervention to prevent postpartum depression among self-identified black and Latina...

Interventions that address patients' illness and treatment representations have improved patient adherence and outcomes when administered by psychologists and/or health educators and focused on a single chronic illness. The current study assesses the potential feasibility/effectiveness of an intervention based on the common-sense self-regulation mo...

Self-monitoring of blood glucose (SMBG) is used to regulate glucose control. It is unknown whether SMBG can motivate adherence to dietary recommendations. We predicted that participants who used more SMBG would also report lower fat and greater fruit and vegetable consumption. The present study was a cross-sectional study of 401 primarily minority...

Physicians are inaccurate in predicting non-adherence in patients, a problem that interferes with physicians': (1) appropriate prescribing decisions and (2) effective prevention/intervention of non-adherence. The purpose of the current study is to investigate potential reasons for the poor accuracy of physicians' adherence-predictions and condition...

Adequate assessment of adherence to medical treatment is critical for both research purposes and clinical practice. This study examined the factor structure and longitudinal invariance of the Medication Adherence Report Scale (MARS-A10) in a sample of asthmatic patients. We examined longitudinal data from 294 inner-city, adult participants with mod...

Medical practice in primary care settings calls for both biomedical and psychosocial expertise. The Common-Sense Model (CSM) of Self-Regulation describes the processes underlying how people represent illness threats and treatments, and how individuals generate action plans within their environments (e.g., adhere to treatment). We will provide an ov...

We describe the parallels between findings from cognitive science and neuroscience and Common-Sense Models in four areas: (1) Activation of illness representations by the automatic linkage of symptoms and functional changes with concepts (an integration of declarative and perceptual and procedural knowledge); (2) Action plans for the management of...

Background: Unmet needs may affect breast cancer patients' receipt of adjuvant therapy and quality of life. High quality community-based cancer assistance programs abound that can address women's informational, psychosocial and practical needs. We identified newly diagnosed and operated breast cancer patients' needs and randomized women to high qua...

Depression among postpartum women of color is understudied. As part of a randomized controlled trial, 460 self-identified Black and Latino postpartum mothers were interviewed during their postpartum hospital stay to assess depression (using Edinburgh Postnatal Depression Scale), anxiety, and other factors. The associations of early postpartum depre...

Chronic infection with the hepatitis C virus (HCV) is more prevalent than human immunodeficiency virus (HIV) infection, but more public health resources are allocated to HIV than to HCV. Given shared risk factors and epidemiology, we compared accuracy of health beliefs about HIV and HCV in an at-risk community. Between 2002 and 2003, we surveyed a...

Lay representations of illness and treatment are too often ignored because of the preconception that lay concepts are inherently unscientific and/or of interest only to anthropologists. The subtitle of this chapter, “A Framework for Action,” defines lay representations as perceptions and concepts that generate and specify the behavioral environment...

To examine the relationship between suboptimal asthma beliefs and inadequate health literacy among older adults with asthma. The authors interviewed 100 English- and Spanish-speaking asthmatics (ages >or=50 years) in a New York City primary care clinic (response, 83%). Outcomes included the belief that one does not have asthma when symptoms are abs...

6035 Background: Unmet needs may affect breast cancer patients' receipt of adjuvant therapy and quality of life. High quality community-based cancer assistance programs abound that can address women's informational, psychosocial and practical needs. We identified newly diagnosed and operated breast cancer patients' needs and randomized women to hig...

To examine variables associated with perceived diabetes control compared with an objective measure of glucose control (A1C). Beliefs about diabetes were assessed among 334 individuals with diabetes living in a primarily low-income, minority, urban neighborhood. Regression analyses tested associations between disease beliefs and both participants' p...

Prior research has not examined the association of patient expectations or preparation by providers for the postpartum experience with depressive symptoms. We investigated whether lack of preparation for the postpartum experience and physical health after uncomplicated childbirth were associated with early postpartum depressive symptoms. We conduct...

Background. Psychological stress has been linked in some studies to asthma prevalence and outcomes in children. The authors sought to evaluate the relationship between perceived stress and morbidity among inner-city adults with asthma. Methods. The authors interviewed a prospective cohort of 326 moderate-to-severe asthmatics receiving care at two l...

Complementary and alternative medicines (CAM), such as herbal remedies, are widely used by patients with chronic diseases, such as asthma. However, it is unclear whether use of the herbal remedies is associated with decreased adherence to inhaled corticosteroids (ICSs), a key component of asthma management. To examine the association among use of h...

IntroductionSelf-referral Delay: The Layperson as DiagnosticianFundamental Psychological Processes in Symptom PerceptionThe Common Sense Model (CSM) of Health and Illness BehaviorThe Role of Illness Representations in Common Sense Models of IllnessThe Role of Affect in Common Sense Models of IllnessSocial Context and Common Sense Models of IllnessT...