ArticleLiterature Review

A systematic review of patients’ drawing of illness: Implications for research using the Common Sense Model

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Abstract

Recent research has examined patients’ drawings of their illness as a means to identify patients’ illness representations. The aim of this systematic review was to examine which representations are evident in patients’ drawings, and whether drawing assessments are associated with patient outcomes. Ten electronic databases were searched for published journal papers in English up to July 1 2017. Narrative synthesis summarized findings by participant characteristics, study design, illness representations, and associations with outcomes. There were 101 eligible studies, published across 29 different countries, with 27 different disease categories; 54 of the studies were with adults and 80 were cross-sectional. All core illness perception domains were evident; the most common being identity and related concepts (including symptoms, anatomy, pathophysiology), and emotional representations (including fear, denial, stigma). Perceptions of treatment and the clinical and social environment were evident. More organ damage drawn and larger drawing size were associated with worse perceptions and health outcomes, and drawings distinguished between patient groups. Limitations include the inability to conduct meta-analysis. In conclusion, patients’ drawings reveal additional domains of illness representations, specifically perceptions of pathophysiology, treatment and social environments, as well as illness pre-occupation. These findings expand theories of self-regulation and suggest image-based intervention strategies.

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... There is a growing corpus of qualitative studies that have used participant drawings to help convey difficult health experiences more fully (Broadbent et al., 2019). Drawings offer a more direct access to emotions (Kearney & Hyle, 2004); like metaphors, they can facilitate the expression of difficult feelings (Shinebourne & Smith, 2011); they also enable both reflexive and pre-reflexive insight, eliciting additional meaning making during interviews (Boden et al., 2018). ...
... Self drawings have been used in studies investigating various health conditions (Broadbent et al., 2019), but, to our knowledge, never to research CP. Being explicitly asked to make a drawing of yourself gives a specific focus to the act of drawing because it forces you to think about yourself, your situation and how others see you. ...
... This study also illustrated how drawings of self can elicit a deep sense making around illness and, occasionally, hot cognition, giving insight into the dynamic thought processes that characterize being ill (Smith, 2019). Thus, the recognized value of illness drawings (Broadbent et al., 2019) is extended and potentiated by drawings of self. Methodologically, IPA could be used with illness and self drawings to investigate the existential aspects of other chronic conditions, particularly those which are known to have a life changing physical or psychological impact. ...
Article
Background Chronic pain (CP) can be a disabling condition with impacts that affect the sense of identity of those who live with it. This article idiographically describes the longitudinal evolution of the sense of self of participants following their referral to a pain management service and participation in a pain management programme (PMP). Methods Participants were interviewed three times: before they attended a PMP, and 1 and 6 months after the PMP. Data included the drawings of themselves that participants created at each interview and the transcripts of the interviews guided by the drawings, analysed longitudinally using interpretative phenomenological analysis. Results This paper describes in detail the cases of four participants: two who experienced a positive albeit troubled trajectory following their PMP and two who did not experience any positive change. The results provide a nuanced account of how the impacts of CP on identity can evolve, with different people engaging with different aspects of a PMP and some people not engaging at all, and how pain self‐management strategies enable those that do engage to cope in times of difficulty. Conclusions Participant responses to PMP participation are idiosyncratic and interviews with drawings of self analysed longitudinally can help illustrate processes of change. Significance Not enough is understood about why some people get limited benefits from pain services. This idiographic longitudinal study illustrates how the impact of CP on identity can evolve when people are introduced to pain self‐management, with some embracing change and others resisting it. For clinicians, this study describes four detailed CP individual paths, showing the interaction between contextual and idiosyncratic aspects. This is also the first study to use multiple drawings of self to explore the impacts of illness on identity longitudinally. In a person‐centred approach to treatment, the drawings of self could also be adopted as a tool in clinician‐patient conversations to gain a deeper understanding of the impacts of living with CP.
... Patients' drawings of their illnesses have been used as a unique way of assessing illness perceptions in a wide range of diseases, including cardiac, respiratory, endocrine, and neurological conditions. 1,2 Patient drawings can reveal beliefs about the extent and effect of their illness that are hard to capture and interpret using standard questionnaires. Drawings can also reflect poorer adjustment to illness and recovery. ...
... For example, in patients following a heart attack, increases in the size of drawings of the heart at 3 months from discharge were associated with a slower return to work. 3 A previous systematic review found that larger patient drawings of the parts of their body affected by the illness are associated with increased focus and preoccupation with the associated health condition, and a decreased belief in the efficacy of treatment. 1 The review also showed that in addition to revealing illness perceptions, drawings have been associated with levels of stigma and engagement with medical professionals. 1 To date, no known studies have investigated the efficacy of using drawings to reveal the perceptions of patients diagnosed with gout. ...
... 1 The review also showed that in addition to revealing illness perceptions, drawings have been associated with levels of stigma and engagement with medical professionals. 1 To date, no known studies have investigated the efficacy of using drawings to reveal the perceptions of patients diagnosed with gout. ...
Article
Patients' drawings of their illnesses have been used as a unique way of assessing illness perceptions in a wide range of diseases, including cardiac, respiratory, endocrine, and neurological conditions. 1,2 Patient drawings can reveal beliefs about the extent and effect of their illness that are hard to capture and interpret using standard questionnaires. Drawings can also reflect poorer adjustment to illness and recovery. For example, in patients following a heart attack, increases in the size of drawings of the heart at 3 months from discharge were associated with a slower return to work. 3 A previous systematic review found that larger patient drawings of the parts of their body affected by the illness are associated with increased focus and preoccupation with the associated health condition, and a decreased belief in the efficacy of treatment. 1 The review also showed that in addition to revealing illness perceptions, drawings have been associated with levels of stigma and engagement with medical professionals. 1 To date, no known studies have investigated the efficacy of using drawings to reveal the perceptions of patients diagnosed with gout. Using patients' drawing of their gout could be a straightforward and effective method to identify patients' perceptions of their illness and could help identify individuals who are particularly concerned with the social stigma of gout. We tested this in a study focused on rural Māori patients living with gout. In Aotearoa/New Zealand, Māori (Indigenous New Zealanders) have a much higher prevalence of gout than non-Māori people. We investigated the utility of using patients' drawings of how they saw their feet and ankles before developing gout and during a gout flare, to reveal perceptions of their illness. The aim of the study was to investigate how differences in the size of drawings depicted are associated with beliefs about the condition and the burden of illness. We tested the hypothesis that larger patient drawings would be associated with more negative illness perceptions , greater anticipated and internalized stigma, and less optimism about health and confidence for managing gout in the future. We recruited 50 adults of Māori ethnicity with a doctor's diagnosis of gout, in Wairoa, New Zealand. Participants were asked to draw both their feet and ankles: first, how they remembered them to be before they developed gout, and second, during a typical gout flare. A standard-sized box provided for each drawing was 17.9 cm × 10.6 cm. Drawings were assessed by measuring the total drawing area (cm 2) using Image J (29) software. 4 Demographic and clinical information about gout included age of onset, disease duration and duration of medical treatment, medication use, number of gout flares over the past 12 months, and number of visits to the doctor for gout management over the past 12 months. Finally, participants were asked how confident they felt about managing their gout. This item was rated on an 11-point scale ranging from 0 to 10, where lower scores indicated less (or no) perceived confidence and higher scores indicated greater perceived confidence. The 9-item Brief Illness Perception Questionnaire, 5 specific to gout, was used to measure participants' perceptions of their condition. Participants were asked how optimistic they felt about the future of their health (11-point scale ranging from 0 to 10). Anticipated stigma was assessed using a modified version of the Chronic Illness Anticipated Stigma Scale. 6 Internalized stigma was assessed using a 6-item version of the Stigma Scale for Chronic Illness. 7 Participants' mean age was 56 years and most participants were male (76%). The average age of gout onset was 37 years and the average number of years on gout medication for gout was 17 years. Most participants (n = 31) were taking allopurinol and 5 patients were taking other long-term gout medication. The average number of flares over the past year was 6. The drawings of all 50 participants were analyzed. The Figure shows examples of participants' drawings. We investigated the size in area of patients' drawings of their feet and ankles (before gout developed and during a typical gout flare) in rela
... 6,[12][13][14][15] In previous studies, the combination of verbal and visual tools was found to help unravel the experiences of patients. [15][16][17][18][19] For instance, reviews by Broadbent et al. and Cheung et al. provide an overview of studies that explored patients' illness perceptions using drawings and conclude that drawings can aid in understanding the illness experience. 18,19 However, it should be noted that in most of the studies reviewed, the drawing instruction had a narrow focus-asking patients to draw themselves, the illness, the part of their body that is affected by the illness, or how the illness made them feel. ...
... [15][16][17][18][19] For instance, reviews by Broadbent et al. and Cheung et al. provide an overview of studies that explored patients' illness perceptions using drawings and conclude that drawings can aid in understanding the illness experience. 18,19 However, it should be noted that in most of the studies reviewed, the drawing instruction had a narrow focus-asking patients to draw themselves, the illness, the part of their body that is affected by the illness, or how the illness made them feel. 18,19 In addition, in all but one of these studies, drawings were made at only one moment in time. ...
... 18,19 However, it should be noted that in most of the studies reviewed, the drawing instruction had a narrow focus-asking patients to draw themselves, the illness, the part of their body that is affected by the illness, or how the illness made them feel. 18,19 In addition, in all but one of these studies, drawings were made at only one moment in time. [15][16][17][18][19] We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer. ...
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Background The combination of verbal and visual tools may help unravel the experiences of advanced cancer patients. However, most previous studies have focused on a specific symptom, at only one moment in time. We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer. Aims To examine whether the repeated use of RPs can make changes in subjective experiences of patients living with advanced cancer visible over time. Methods and results We performed a prospective study with a generic qualitative approach that was mostly informed by the process of grounded theory. We invited patients to make an RP twice, at the start of the study, and again after 2 months. Both RP drawing sessions were directly followed by a semi-structured interview. Patients with all types of solid tumors, above the age of 18, and with a diagnosis of advanced, incurable cancer, were eligible. Eighteen patients participated and 15 patients were able to draw an RP twice. In eight RP-sets, considerable differences between the first and second RP were noticeable. Two patterns were distinguished: (1) a change (decline or improvement) in physical health (five patients), and/or (2) a change in the way patients related to cancer (three patients). Conclusion RPs are a valuable qualitative research method that can be used to explore the experiences of patients with advanced cancer, not only at a single point in time but also over time.
... Illness perceptions are complex and increasingly there is the understanding that alternative and adjunctive means of collecting data relating to patients understanding of their condition should be explored [13]. The importance of utilising both verbal (e.g. ...
... questionnaire and qualitative information) and nonverbal means of assessing individual's illness perceptions, e.g. patient's drawings of their condition have been proposed [13,14], on the basis this may afford the opportunity to uncover idiosyncratic beliefs not readily accessible through more standard verbalising methods used in questionnaires or interviews. A number of studies reviewed by Broadbent and colleagues [13] have utilised patients' drawings as a method to understand individuals experiences of their particular condition, and have highlighted the utility of this method in identifying often quite challenging concepts for patients, such as poor understanding of pathophysiology. ...
... patient's drawings of their condition have been proposed [13,14], on the basis this may afford the opportunity to uncover idiosyncratic beliefs not readily accessible through more standard verbalising methods used in questionnaires or interviews. A number of studies reviewed by Broadbent and colleagues [13] have utilised patients' drawings as a method to understand individuals experiences of their particular condition, and have highlighted the utility of this method in identifying often quite challenging concepts for patients, such as poor understanding of pathophysiology. It is noted, however, that very few studies have been carried out in populations of individuals with cancer and of these, the majority have focused on children's experience of cancer and women with breast cancer [13]. ...
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BACKGROUND: There is a paucity of data regarding patient experiences of living with non-muscle-invasive bladder cancer (NMIBC). OBJECTIVES: To investigate patients’ beliefs about NMIBC utilising both a well-established verbal/linguistic method, the Brief Illness Perception Questionnaire (B-IPQ) in addition to a novel visual/perceptual method, that is, asking patients to draw their bladder as it is now and as they perceive it will be in the future. METHODS: Cross-sectional study of patients with NMIBC. Patients completed: (i) the B-IPQ, and (ii) 2 drawings of their bladder: as they perceived it currently and as they perceived it would look in 5 years’ time. RESULTS: A total of 118 patients completed the B-IPQ, of which 96 produced 2 bladder drawings. Forty-seven per cent of patients depicted no change in their bladder across time, 35% depicted improvements, while 18% drew their NMIBC as deteriorating between the two time points. Patients who drew their NMIBC worsening over time reported significantly stronger beliefs in the severity of current consequences from their NMIBC (F2,94 = 9.07, p < 0.001, m = 5.68 95% CI 4.38–6.88) and greater current concerns about their NMIBC (F2,94 = 6.17, p < 0.01, m = 7.06, 95% CI 5.47–8.66). This was unrelated to cancer grade, cancer stage, treatment or demographic variables. CONCLUSION: This is the first study to explore beliefs about NMIBC in a sample of patients with NMIBC attending routine clinics using both a well-established and a novel method of assessing patients’ perceptions. Results highlight the usefulness of a simple non-verbal technique, in identifying patients’ concerns about the condition. Almost one fifth of patients with NMIBC may experience significant concerns about the worsening of their condition, which appear to be independent of demographic, histopathological, and treatment related variables. Further exploration of the psychological concerns of individuals with NMIBC is required in order to appropriately plan for needs led multidisciplinary approach in their care.
... Please, draw the fi rst thing that comes to your mind when you think about illness. This instruction was formulated based on the fi ndings obtained by Lima & de Lemos (2014) and Broadbent et al., (2018), arguing that this personal manner of formulating the instructions given to children in order to study illness representations entail rich and important data, which may be triangled with other fi ndings (Ezan, Gollety, & Hemar-Nicolas, 2015). After you have fi nished drawing, please, write the words coming to your mind when you think about illness -This was the instruction given for free association. ...
... Since the age of 10 years old, a child perceives illness as the result of external contamination, of inadequate diet or clothing (Perrin and Gerrity, 1981). The best represented dimension of illness by the participants to this studyregardless of their age -was the one of identity, a fi nding similar to data recorded in the literature (Broadbent et al., 2018). From 14 years old, they are able to identify the psychological causes; they become aware that emotional state may have an impact upon physiological functioning; there is also a change at the level of personal control degree (Žaloudiková, 2010). ...
... The word "pain" ranks second, though, in the age groups 14 -15 and 17 -18, with physiological sensations following closely the emotional concerns of the subjects. After pointing out the physiological sensations and the emotional experiences (Broadbent et al., 2018), all three groups thought of a way to combat them, namely medication -a way to treat and control an illness. More precisely, besides outlining the identity of illness, the control dimension is the next to activate in the minds of subjects aged 10 -18. ...
Article
There is a signifi cant increase in the studies investigating illness representation through quantitative methods, which is due to a certain extent to the valid psychometric instruments that measure this construct. This phenomenon is especially intense among people who have a certain diagnosis. Not the same can be said about the existing research for the study of the representation that healthy people have about illness, in which the qualitative methods predominate. The purpose of this study is to outline how adolescents perceive the disease, given that they go through a period of change with signifi cant implications for adult-related health behaviours. In this study, 132 adolescents aged between 11 and 18 were included (M =14.60; SD= 2.54). Because we wanted to obtain complex and accurate information, we chose to collect the data through three qualitative methods: drawing, the free association method, and the open-ended questionnaire. Based on the common-sense model, we were able to identify the most frequently cited causes of disease onset, which are the indicators of its occurrence, the eff ects adolescents perceive as occurring over time and how they think we can treat it. One of the most important dimensions represented through the three methods of data collection was that of emotions. This result draws attention to the importance that people attach to the emotional sphere when it comes to illness. Unfortunately, medical staff are well prepared for the assessment of biomedical aspects, but less so for understanding the psychosocial, social, and cultural dimensions of health and illness.
... While there is some evidence for improved knowledge and anatomical accuracy in patients' images in illness representations (Broadbent et al., 2019), there remains idiosyncratic differences in patient's drawings of their illnesses which may help to predict their health outcomes (Broadbent et al., 2019;Petrie & Weinman, 2012). For example, Petrie and Weinman (2012) describe the drawings made at three timepoints by two patients who had underwent heart bypass surgery; while both patients drew increasingly 'healthy/healing' pictures of hearts, one also focused also on the heart rhythm improving, which Petrie and Weinman (2012) highlight is an important indicator for recovery. ...
... While there is some evidence for improved knowledge and anatomical accuracy in patients' images in illness representations (Broadbent et al., 2019), there remains idiosyncratic differences in patient's drawings of their illnesses which may help to predict their health outcomes (Broadbent et al., 2019;Petrie & Weinman, 2012). For example, Petrie and Weinman (2012) describe the drawings made at three timepoints by two patients who had underwent heart bypass surgery; while both patients drew increasingly 'healthy/healing' pictures of hearts, one also focused also on the heart rhythm improving, which Petrie and Weinman (2012) highlight is an important indicator for recovery. ...
... For example, Petrie and Weinman (2012) describe the drawings made at three timepoints by two patients who had underwent heart bypass surgery; while both patients drew increasingly 'healthy/healing' pictures of hearts, one also focused also on the heart rhythm improving, which Petrie and Weinman (2012) highlight is an important indicator for recovery. In their systematic review of 101 papers published exploring patient drawings of illnesses, Broadbent et al. (2019) found evidence indicating that where patients had drawn larger images and more organ damage, outcomes and health perceptions were worse. Improvements to patient-practitioner understandings of the patient's image representations of their illness may therefore be helpful in improving outcomes and targeting psychoeducation where required to help improve illness behaviours related to recovery (Petrie & Weinman, 2012). ...
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If illness behaviour is to be fully understood, the social and behavioural sciences must work together to understand the wider forms in which illness is experienced and communicated with individuals and society. The current paper synthesised literature across social and behavioural sciences exploring illness experience and communication through physical and mental images. It argues that images may have the capacity to embody and influence beliefs, emotions, and health outcomes. While four commonalities exist, facilitating understandings of illness behaviour across the fields (i.e., understanding the importance of the patient perspective; perception of the cause, sense of identity with the illness, consequences, and level of control; health beliefs influencing illness experience, behaviours, and outcomes; and understanding illness beliefs and experiences through an almost exclusive focus on the written or spoken word), we will focus on exploring the fourth commonality. The choice to focus on the role of images on illness behaviour is due to the proliferation of interventions using image-based approaches. While these novel approaches show merit, there is a scarcity of theoretical underpinnings and explorations into the ways in which these are developed and into how people perceive and understand their own illnesses using image representations. The current paper identified that the use of images can elucidate patient and practitioner understandings of illness, facilitate communication, and potentially influence illness behaviours. It further identified commonalities across the social and behavioural sciences to facilitate theory informed understandings of illness behaviour which could be applied to visual intervention development to improve health outcomes.
... [10,12] Asking patients to draw their hair loss may reveal the impact of alopecia in a different way. [15] New insights might be created because patients are given the opportunity to choose how to draw their condition, instead of answering in limited categories in a questionnaire. A patient does not have to use words, like in an interview, which might make it easier for some people to express their feelings. ...
... A systematic review study on drawing research by Broadbent et al. lists 101 studies about patients' drawings of their illness. [15] Methods Patients Participants (n = 15) were recruited from the oncological day-care unit of Máxima Medical Centre, a regional teaching hospital in the Netherlands, between October and November 2017. Patients were included if they had the prospect of severe alopecia, if they had had at least two chemotherapy treatments with or without scalp cooling, and if the last treatment was not longer than 1 month ago. ...
... Drawings made with the new instructions are expected to reveal different domains of how patients experience alopecia and specifically the course of their perceptions about alopecia over time. [15] ...
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Objective: Individuals with cancer experience the impact of chemotherapy on hair loss in different ways. The aim of this pilot study was to explore patients' experiences of alopecia through patients' drawings. Methods: Fifteen female patients diagnosed with cancer and treated with chemotherapy were recruited at the oncological day-care unit of a teaching hospital in the Netherlands. Participants completed a semi-structured interview about alopecia. They drew their head and hair before and during chemotherapy and completed the Brief Illness Perception Questionnaire (B-IPQ). Results: The drawings revealed predominantly physical effects, rather than emotions. Emotions were evident in the text that patients wrote under the drawings and in the B-IPQ open question about the perceived consequences of alopecia. The overall impact of alopecia that emerged from the drawings and the B-IPQ corresponded to the information retrieved from the interviews, namely disappointment, insecurity, sadness, and confrontation. Conclusions: Drawings expose cognitive and emotional responses to alopecia that may be relatively unexplored when using traditional assessment methods such as questionnaires or interviews. In future research, the drawing instructions need to be more specifically focused on feelings in order to better capture emotional reactions to hair loss.
... Another suggestion for future research is to consider other types of measures that can be used in addition to questionnaires, to reduce high language demands and reporting bias. The use of drawings as a valid technique to explore illness perceptions has been supported in adults and children around the world (Broadbent, Schoones, Tiemensma, & Kaptein, 2018;Cheung, Saini, & Smith, 2016). Broadbent et al., (2018) reported in their recent systematic review that illness identity and emotional responses were the two most drawn categories of perceptions. ...
... The use of drawings as a valid technique to explore illness perceptions has been supported in adults and children around the world (Broadbent, Schoones, Tiemensma, & Kaptein, 2018;Cheung, Saini, & Smith, 2016). Broadbent et al., (2018) reported in their recent systematic review that illness identity and emotional responses were the two most drawn categories of perceptions. Drawings also provide aspects not captured in illness perception questionnaires, such as the person's social, familial, and clinical environment (Broadbent et al., 2018). ...
... Broadbent et al., (2018) reported in their recent systematic review that illness identity and emotional responses were the two most drawn categories of perceptions. Drawings also provide aspects not captured in illness perception questionnaires, such as the person's social, familial, and clinical environment (Broadbent et al., 2018). In concussion research, only a couple of studies using drawings were conducted in adults, showing associations between drawing characteristics at 1 month post-injury (greater damage) and more negative illness perceptions and post-concussive symptoms at 6 months (Jones et al., 2016) and at 4 years post-injury (Jones, Theadom, Barker-Collo, Broadbent, & Feigin, 2017). ...
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Perceptions about the causes and consequences of concussion, and individual representations and interpretations of these factors, can influence the post-concussive recovery process. The goal of this project was to synthesize evidence on perceptions related to concussions as experienced by children, adolescents, and parents, and to evaluate how these perceptions impact post-concussive recovery in physical, behavioural, cognitive, and psychological domains. We undertook a systematic review based on the Cochrane Handbook, conducting a comprehensive search of six databases and Google Scholar. Duplicate, independent screening was employed and the quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 1552 unique records were identified, and six records (5 scientific articles and 1 thesis, published between 1990 and 2018; N = 26 to 412, age range from 2 to 18 years) were included. Perceptions about concussions were assessed differently between studies, with a range in types of measures and respondents. Some evidence suggested that perceptions could negatively impact concussion recovery, mostly post-concussive symptoms. However, results were not consistent between studies and the methodological quality was variable (and often low). There is limited evidence of the impact of perceptions of children, adolescents, and their parents on concussion recovery. Priorities for future research investigating concussion recovery should include recruiting representative samples, accounting for potential confounders, and measuring perceptions in children, adolescents and parents using validated measures. Higher quality studies are needed to better understand the role of perceptions in concussion recovery and to inform clinical care.
... Although of value, these methods might influence patients' answers due to social desirability. A personal drawing of the disease can illustrate the psychological and social impact of the disease of the individual patient and can reveal issues that remain unspoken during focus group discussions because of patient embarrassment, stigma and shame (Broadbent, Schoones, Tiemensma, & Kaptein, 2019). Indeed, a recent review revealed that drawings supplement and potentially outperform traditional data collection approaches (Broadbent et al., 2019). ...
... A personal drawing of the disease can illustrate the psychological and social impact of the disease of the individual patient and can reveal issues that remain unspoken during focus group discussions because of patient embarrassment, stigma and shame (Broadbent, Schoones, Tiemensma, & Kaptein, 2019). Indeed, a recent review revealed that drawings supplement and potentially outperform traditional data collection approaches (Broadbent et al., 2019). ...
... No further instructions were given regarding the drawing, and patients were not asked to draw a specific organ or whatsoever. Patients were asked to provide a brief written explanation of their drawing to make its content more readily identifiable (Broadbent et al., 2019). The dimensions of the BIPQ, the drawings and a priori formulated themes were used as a guideline during the focus group discussion (Figure 3). ...
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Objectives: This study explores illness perceptions, risk perceptions and degree of worry in patients with recently diagnosed systemic sclerosis (SSc). Specifically, it aims to answer whether and how early diagnosis in a stage that disease is relatively mild can impact patients' lives, and if and how disease severity associates with illness perceptions and risk perception. Methods: Patients with a diagnosis of SSc <2 years were invited to participate in a focus group discussion for in-depth exploration of illness perceptions, risk perceptions and worry. In addition, illness perceptions, risk perceptions and worries were evaluated with the use of questionnaires. To explore how patients perceive SSc, we asked them to draw their disease. Physician global assessment of disease severity was used to measure disease severity. Associations between disease severity, illness/risk perceptions, drawings and elements of the focus group were assessed. Results: We observed three dimensions of illness perception as most relevant for patients: personal control, concern and consequences. Patients with SSc experienced many symptoms and felt low personal control. Concerns about the future were often mentioned, and the majority of patients scored high on the worry questionnaire. None of the patients was preoccupied with prognosis or death. All drawings illustrate the impact of SSc on daily life and psychological well-being. Illness perceptions were highly variable between patients and did not associate with disease severity. Conclusion: This study showed that a diagnosis of early SSc had a significant impact on patients' lives, also in the absence of severe disease complications.
... An additional method to examining this resides in patients' drawings of their illness, the symptoms, and its medical management. Drawings produce data that help in understanding the patient's answer to the illness, which in turn -if incorporated in the medical management-could improve the quality of the clinical, medical response to the patient's plight 19 . In the field of Parkinson's disease however, it is unknown which metaphors are used in the illness narrative to describe the loss of autonomy and the self-perceived sense of stigmatization that may follow the physical attributes of disease nor whether they impact the course of illness. ...
... In the context of narrative medicine, a wide range of research methodologies is used compared to the ones used in biomedicine. In addition to quantitative research methods, qualitative approaches produce rich knowledge: drawings by patients of their illness and the impact of an illness on daily life (for a systematic review, see Ref. 19 ). Drawing of an illness not only serves diagnostic purposes into the subjective response to an illness, but intervention studies have shown how changes in patient drawings can identify medical outcomes 40 . ...
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Parkinson’s disease characteristics can create a self-perceived sense of stigmatization and disapproval by others, thereby affecting self-perceived autonomy. This study investigated the metaphors related to the loss of autonomy and stigma in stories and drawings of Parkinson’s disease. We compare a contemporary first-person illness narrative and -drawing from a person with Parkinson’s disease, with two novels (Jonathan Franzen’s The Corrections and Claudia Piñeiro ’s Elena Knows) , a graphic novel ( Peter Dunlap-Shohl’s My Degeneration: A Journey Through Parkinson’s) , a non-fiction book (Oliver Sacks’ Awakenings ) and a first-person illness narrative (John Palfreman’s The Bright Side of Parkinson’s ). Metaphors in the patient narrative, novels, and non-fiction work were reviewed and a list of themes or categorizations common to 2 of the metaphors was generated. Parkinson’s disease metaphors indicate a ‘Parkinson’s prism’ thereby depicting extreme experiences (24.4%) like a ‘fall by mischance’, a ‘tantrum of selfish misery’ or a ‘bottomless darkness and unreality’ (Table 1). Both novels signify a sense of ‘betrayal and disconnection’ in the Parkinson’s disease experience while non-fiction of Parkinsonism depicts a space in which one feels ‘caged and deprived’. This makes the Parkinson’s disease narrative a chaos story that could influence the decision to initiate treatment and treatment adherence. We conclude that narrative medicine can help to focus the medical consultations with affected individuals on issues that matter most to them, thereby improving self-perceived autonomy and stigma. As such, it is a critical component of the much-needed move towards personalized medicine in Parkinson’s disease, achieved through the reciprocity of thinking with stories.
... Art has been used in the teaching of medical humanities for over two decades, for example, paintings have served to enhance observational skills [32], increase the attention span when listening to patients [33], and deepen compassion for suffering [34]. A recent review indicated that drawings have been utilized in virtually all categories of chronic diseases among patients [35]. However, to our knowledge, this might be the first study in Taiwan clinical teaching where drawing has been used as a means to teach transitions of care; traditionally, it is mostly taught through lectures and clinical practice [4]. ...
... Drawing their home and life as older adults and answering questions about their patients help connect PGY residents with their patients, as drawings likely bypass issues of social desirability and personal views [35]. Drawings make parts of the self and/or levels of development visible [15]. ...
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Background The “draw-and-talk” technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan. Methods Before the conventional lecture on discharge planning, trainees were invited to draw their “home” and “life as older adults” and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected. Results Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of “home” and “elderly life” led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable. Conclusions Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients’ lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants’ real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents’ knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.
... Art therapists describe the use of art in therapy in practice in a range of settings. For example, in breast cancer patients (Puig et al., 2006) and for those with a physical illness (Broadbent et al., 2018) , with the arts activity suggested to be the catalyst to social engagement (Bungay et al., 2010). Thus, participatory arts fit within the engaging groups category of the arts and health diamond, which promote health through engagement with the arts⎯see figure 2.2, however, such projects also fit within the unity is health category as they aim to bring together individuals to engage socially in art creation practices and build communities. ...
... Both perspectives of wellbeing are important to consider within the FMH context due to the potentially volatile nature of the ward environment . Individuals may experience a loss of social roles within the institutional environment (Goffman, 1961) however, social connection can promote recovery (Wolfson, 2009), and provide meaning (Leamy et al., 2011 (Fancourt, 2017) which can promote social capital (Miles and Gibson, 2016), or focus on the individual and utilise art to promote wellbeing (Broadbent et al., 2018;Puig et al., 2006), it is proposed that creative practices that promote a shared mutual endeavour are more suited to facilitate mutual recovery. Within the secure setting, arts are utilised by occupational therapists as a way of promoting meaningful engagement (Fortuna, 2018) and skill development (Chacksfield, 2002;Creek and Lougher, 2011). ...
Thesis
This original research was funded institutionally as part of a larger AHRC/RCUK Connected Communities programme grant (AH/K003364/1), ‘Creative Practice as Mutual Recovery’ (CPMR) which critically investigated how creative practices may afford an opportunity for mutual recovery. The CPMR programme aimed to extend the notion of mental health recovery beyond individual patients to include other participating members, for example, informal carers, healthcare practitioners, volunteers. The notion that creative practices could foster and connect communities to enhance mental health and wellbeing was a central theme to the programme of research. This thesis focuses uniquely on the potential for creative practice to promote mutuality within a forensic mental health setting. The thesis adopts an ethnographic research design congruent with the exploratory nature of the aims of this project. The research design is purposely iterative, exploring the concepts such as creative practice, wellbeing, and the emergent concept of ‘mutual recovery’ within an interpretivist tradition. The thesis investigates creative practice across three units within one inpatient forensic mental health hospital in the UK. The methods include overt participant observation and semi-structured interviews. The thesis presents an innovative microsociological model for understanding mutuality through creative practices within forensic mental health. This new theoretical model draws on Interaction Ritual Theory to explore the creative practice rituals observed during the fieldwork and to consider their contribution to wellbeing, social connectedness, and mutuality. The observations and interviews established three key contextual features of life which were found to influence creative practices, wellbeing, social connectedness, and mutuality in the forensic setting: a) surveillance, security and risk; b) the emotive environment; and c) boundaried relationships. The study found that mutuality is constrained within the forensic mental health inpatient context. However, it also identified that when hierarchies are less prominent or foregrounded, engagement in creative practices can contribute to the wellbeing of residents and staff and promote social connectedness. This thesis argues that the forensic mental health environment can present challenges to creative practice and notions of mutuality due to a culture of risk, boundaried practices, and highly emotive interactions that occur there. Other societal influences, such as sexism and racism, also present challenges to creative practices and notions of mutuality within the therapeutic setting.
... Dolidze et al. (2013) evaluated emotional health through the drawings of Üstündağ, 2024 hospitalized children and similarly found that body parts were missing. Broadbent et al. (2019) examined the disease drawings of patients and found that in addition to emotional representations, perception of treatment; clinical and social environment; and organ damage was intensively drawn. In addition, the drawings were large, and poor perceptions were projected. ...
Article
Hospitalization can influence a child’s psychological well-being. This study aimed to evaluate the emotional well-being of hospitalized children using their own drawings. Sixty hospitalized children between the ages of 4 to 13 were used for this study, and data were collected using the pictures drawn by the children. The content analysis method was used to analyze data. Data analysis showed that hospitalized children generally did not show age-appropriate developmental characteristics at the drawing development stage; hospitalized children in the younger age groups used more colors and drew happier human figures; and older hospitalized children used fewer colors, and the emotions of figures were more negative. Another important finding was the presence of missing limbs in most drawings. This research emphasized the importance of appropriately meeting the psychological and psychosocial support needs of children in the hospital environment.
... The use of drawings facilitates the collection of rich data as it involves visualizing abstract ideas and embodying oneself in the sketch, which further elicits insightful exploration in understanding the illness experiences (Guillemin, 2004). The feasibility of applying drawings in understanding illness experiences has been demonstrated in previous systematic reviews (Broadbent et al., 2019;Cheung et al., 2016) and a local setting (Ho et al., 2010). ...
Article
Stroke-related deficits affect stroke survivors' perception of their bodies and possibly impede their progress in rehabilitation and well-being. This study adopted a pre-and post-test design to compare the changes in body perception among younger stroke survivors after participating in an 8-week Expressive Arts-based Intervention (EABI) (n = 32) with the control group (n = 30). Each participant partook in structured drawing interviews at baseline (T0) and 8-week follow-up/post-intervention (T1). The data were analyzed using content analysis. More EABI (n = 27) than control (n = 14) participants reported positive changes in body perception and applied lighter colours or created a more symmetrical drawing at T1. They shared that EABI promoted these positive changes by facilitating the reconnection with one's body and self. While some control participants experienced positive changes in body perception, others tended to apply darker colours or the same colour to show negative or no changes in body perception. More control (n = 8) than EABI (n = 3) participants reported negative thoughts about their bodies and negative influences from other individuals and the environment. The findings suggested that EABI can change stroke survivors' body perception. EABI can be considered one of the interventions that may help foster positive changes in body perception.
... Asimismo, el análisis de dibujos también resultó una herramienta útil para estudiar las percepciones del tratamiento y del entorno clínico y social en pacientes con enfermedades crónicas. Broadbent et al. (17), desde una revisión sistemática, analizaron dibujos corporales a través de diferentes perspectivas, como la medicina social, la antropología y el psicoanálisis. El estudio evidenció que a mayor daño en los órganos dibujados y un tamaño de dibujo más grande, existía una mayor asociación con peores percepciones y resultados de salud. ...
Article
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Introducción: La experiencia de la enfermedad por covid-19 en 2019/2020 tuvo un impacto abrumador en los trabajadores de la salud, incluidos los estudiantes de medicina de último año, en quienes se vio afectada negativamente su experiencia de aprendizaje en el internado y en su salud mental. Métodos: Estudio de investigación cualitativa, con un abordaje fenomenológico-interpretativo. Se realizaron entrevistas grupales y se solicitó a cada participante la realización de un dibujo que representara lo que vivieron durante la pandemia por covid-19. Resultados: Se identificaron mecanismos de defensa como la negación y la escisión; los sentimientos de ansiedad, angustia, tristeza y miedo, y las percepciones positivas de la pandemia. Aparecen así mismo categorías emergentes como el síndrome de agotamiento profesional, las herramientas de afrontamiento y las barreras educativas. Discusión: Los mecanismos de defensa inmaduros que los estudiantes de medicina emplearon durante el año de internado y su relación con mayores niveles de estrés y mayor agotamiento emocional, así como el relato de situaciones que les generaron ansiedad, angustia, tristeza y miedo, además de síntomas del síndrome de burnout, muestran el impacto negativo de la pandemia por covid-19 en la salud mental de esta población.
... No entanto, a utilização de uma taxa animal e sistema de pastejo adequados são de extrema importância para evitar a degradação e a perda de qualidade da pastagem (Holecheck;Galt, 2000). Uma alternativa é o sistema de pastoreio rotativo, no qual as pastagens são divididas em piquetes, onde os animais pastejam de forma rotacionada, possibilitando intervalos de recuperação antes de um novo pastejo (Broadbent et al., 2019). Estudos conduzidos em sistema rotativo nos campos do Bioma Pampa mostram um aumento da produção animal, conservando a diversidade da vegetação nativa (Barbieri et al., 2015). ...
Article
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A relação entre produção de alimentos e a preservação do meio ambiente tem se tornado um tema de debate internacional, principalmente relacionado a emissões de gases do efeito estufa. Desta forma, torna-se cada vez mais importante conhecer potenciais fontes e sumidouros destes gases, avaliando principalmente o balanço de Carbono em área de agricultura e pecuária. No Rio Grande do Sul a atividade agropecuária é extremamente importante, cultural e economicamente, ocupando grande parte do estado, principalmente dentro do bioma Pampa, este que conta com grandes áreas de pastagens naturais aptas a servirem de forragem para os animais. Neste trabalho, quantificamos as trocas de CO2 através da metodologia Eddy Covariance em dois sítios experimentais de pastagem nativa do bioma Pampa utilizados para criação de gado, no sistema rotativo, que visa manter a diversidade da pastagem nativa. Com dados de um ano, mostramos que ambos os sítios foram sumidouros de CO2, variando de -82,4 g C m-2 a-1 a -282,3 g C m-2 a-1, devido às diferenças nas condições ambientais e composição da vegetação. Assim, a criação de gado em pastagem natural do bioma pampa pode contribuir para compensar as emissões de gases do efeito estufa em outros setores da agropecuária.
... Our findings also indicate that aMi patients actively participate in an exploratory process to develop a personalized cR plan, which involves assessing stimuli, formulating coping responses, and engaging in a combination of instrumental and emotional adaptive tasks. aMi patients often experience recollections of cardiac arrest and medical emergencies [1,36], necessitating interventions that incorporate cultural clinical psychology and appropriate illness perception [37,38]. additionally, consistent with other studies, inadequate health literacy have been linked to negative emotions and a poorer quality of life among individuals with cardiovascular disease [39], and can hinder the understanding of the physiological and psychosocial benefits of cR [40]. ...
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Background While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.
... In the tree drawings, lonely trees in the pandemic context were larger than those in the regular context. A systematic review of 101 studies of patients' drawings of their illnesses found that the worse the patients' perceptions of their health status and future expectations, the larger their drawing size (Broadbent et al., 2019). Likewise, individuals in the pandemic context perceived greater health threats; therefore, they drew larger drawings. ...
Article
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Introduction This study aimed to investigate the effects of emotional themes and the COVID-19 pandemic context priming on the size and color of drawings. Methods A 3 (emotion: peacefulness, gratitude, loneliness) × 2 (context: pandemic, regular) mixed design was used and 113 university students in Shanghai were recruited to draw human figures and trees using 10 marker colors. Results The size of the drawings depicting loneliness was smaller than that of the those depicting peacefulness and gratitude. Drawings depicting loneliness used more cool and non-preferred colors; drawings depicting gratitude used more warm and preferred colors. Drawings in the pandemic context were larger, which may reflect the more significant threat perceived by individuals. Drawings in the pandemic context used more red colors, showing symbolic meanings such as danger. Discussion The drawing size and drawing color are influenced by emotional themes and the pandemic context priming.
... A terceira questão do questionário solicitou aos participantes a elaboração de um desenho simples, que melhor expressasse o seu sentimento dominante na pandemia. Com essa tarefa, as autoras pretenderam obter um conhecimento mais profundo sobre os sentimentos dos participantes, dado que os desenhos podem materializar um pensamento, um conceito, uma ideia ou uma emoção (BROADBENT et al., 2019;CHEUNG et al., 2016). Adicionalmente, o uso do desenho pode criar uma rede de segurança para os participantes expressarem abertamente questões que podem considerar difíceis de abordar (BODEN et al., 2019;CHEUNG et al., 2016). ...
... LaPenna and Tariman note that art therapy is "an integrative mental health intervention involving creative processes, application of psychological theories, and human experiences within a psychotherapeutic relationship," and has an extensive history in the treatment of trauma with results demonstrating improvement in patient anxiety, depression, and overall quality of life (Gordon 2009). Supported by research on the efficacy of art therapy to improve both psychological and physical trauma (Kaimal, Ray, and Muniz 2016;Hass-Cohen et al. 2019;Betensky 1995;Broadbent et al. 2018), CMBM's approach employs drawing in the first and last sessions of their eight-week curriculum. In session one, they give participants roughly five minutes per drawing to complete three drawings with brief directions between each one encouraging participants to let the drawings manifest uncensored and quickly in order to be "authentic, surprising, revealing" (Gordon 2019:61). ...
... Visual representations through patients' drawings of their illnesses have been shown to correlate with patients' illness perceptions as assessed by IPQ questionnaires and predict health outcomes (Broadbent, Ellis, et al., 2006;Broadbent et al., 2004Broadbent et al., , 2019Broadbent, Niederhoffer, et al., 2009;Reynolds et al., 2007). This body of work suggests that visual representations of illness could be an important component of illness perception interventions. ...
Thesis
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Type 2 diabetes (T2D) is a serious illness that is particularly prevalent in Saudi Arabia (SA). Its optimal management requires adherence to medication and self-care behaviours, yet non-adherence is a major issue. Studies have shown that the Common Sense Model (CSM) provides a useful framework for understanding how patients’ perceptions of their diabetes guide their adherence to self-care behaviours. To date, research into this model has been limited in SA, where differences in culture may affect results. Furthermore, intervention trials have used the CSM as a theoretical basis to increase adherence and improve glycaemic control, but this research has not been systematically reviewed. A systematic review may highlight gaps in the literature and illustrate ways to optimise interventions. This thesis had three aims: first, to investigate whether the CSM and associated psychological constructs were associated with adherence and glycaemic control in SA patients with T2D; second, to conduct a systematic review of illness perception interventions internationally; and third, to design and test the acceptability of a brief illness perception intervention in SA patients with T2D. To address these aims, two observational studies, a systematic review, and a mixed-methods feasibility study were conducted. Study one found cross-sectional relationships between the CSM and adherence to self-care behaviours and glycaemic control among 115 SA patients with T2D. Study two found that baseline perceptions of greater weight management control were associated with better glycaemic control at 6-12 month follow-up. This association, however, was not significant in the adjusted analysis. In the systematic review of CSM interventions for T2D, perceived personal control, treatment control, coherence, and chronic timeline perceptions were the most frequently modified perceptions. There was limited evidence for the effectiveness of illness perception interventions for improving glycaemic control among adults with T2D. Recommendations were made to include family members and use visualisations to optimise interventions. The final mixed-methods feasibility study developed and tested a brief visual intervention for patients with T2D and family members in both SA and New Zealand (NZ). Feedback from healthcare professionals was also sought. Findings showed that the brief visual intervention was acceptable and engaging. Preliminary findings suggested that the intervention may improve patients’ and family members’ perceptions in a short time frame. In conclusion, this thesis made several contributions. First, it demonstrated the applicability of the CSM to patients with T2D in SA. Second, it demonstrated the need for further investigation of longitudinal relationships using this model. Third, it synthesised research into illness perception interventions in T2D internationally and highlighted gaps in research to date. Finally, it designed a new brief visual intervention for patients with T2D and demonstrated its potential cross-cultural effectiveness in two different countries, SA and NZ. Further research is needed to test this intervention in a larger trial, with potential clinical implications.
... Pharmaceutical companies even hand out pre-printed schematic diagrams of, say, heart or lungs, to help explain the medical situation in the patient-doctor encounter. Although the history of using drawings by patients in (health) psychology research is quite long, Broadbent must be credited with exploring the topic of drawing in health psychology (Broadbent et al., 2019). The 2019 review shows how drawing research now covers almost any medical condition, giving room to patients to express their illness and its consequences in daily life. ...
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Background: Psychology as applied to health and illness has a relatively short history. Nevertheless, that history shows a rapid development of the theoretical models that guide the field over the past 60 years. Core theoretical approaches are concisely reviewed, in the context of Kaplan’s paper ‘Behavior as the central outcome in health care’ (1990), which is used as a model to examine the extent to which these approaches embrace Kaplan’s notions. Advances: Empirical studies from the health psychology domain are used, which demonstrate the gains in terms of quality of life and behavioural outcomes in patients with (chronic) somatic diseases. Over a period of some 60 years, theoretical models and core concepts in psychology as applied to health and illness have evolved from psychosomatic views to neuropsychology, quality of life, patient education, self-management, illness perceptions, patient-reported outcome measures (PROMs), shared decision-making (SDM) and health humanities (HH). The more recent models (SDM, HH) appear to align to a considerable degree with adopting ‘behavior as the central outcome an outcome in health care’; shared decision-making and health humanities focus on encouraging patients to make sense of and give meaning to their illness in order to attain optimal psychosocial adjustment. Conclusions: In addition to ‘behavior as the central outcome in health care’, a new definition of the concept of health (i.e. ‘the ability to adapt and to self-manage’ – Huber et al., 2011) seems to favour patients, healthcare providers, society, and health psychology. Incorporating this concept into medical care may be viewed as a challenge for health psychologists – and as a source of continual struggle with strong biomedical forces.
... A number of studies have looked at how leisure activities can affect personal transformation. For example, a large number of mixed-method studies have investigated how engagement with leisure activities can be used to understand experiences of one's own narrative and identity, particularly surrounding perceptions of health and illness via creative engagement and literature (322)(323)(324)(325)(326)(327). A smaller body of intervention studies have shown that leisure-time physical activity increases personal growth (328) and improves self-regulation (329). ...
Thesis
Social prescribing involves the referral of individuals to community activities, often to support their mental health and well-being. There is growing evidence on the efficacy of social prescribing to improve mental health, however less is known about how these groups bring about beneficial effects, or about barriers or enablers facing referrers. I addressed three distinct but complementary objectives. In Study 1 I conducted a review of ‘mechanisms of action’ underlying the impact of leisure activities on health, producing a multi-level ‘theory of change’ framework. I found leisure activities act through biological, psychological, social and behavioural mechanisms, to produce mental and physical health benefits. In Study 2, I used ethnographic methods to explore how four social prescribing community groups produced mental health benefits for individuals, often with severe mental health problems. Shared active ingredients included excellent facilitator inter-personal skills, high regularity of activities, creation of a safe space, high affordability/accessibility, and shared lived experience of mental health problems. Shared mechanisms were increased purpose/meaning, experience of pleasure/joy, increased social support, increased structure/routine, formation of friendships and reduced loneliness, and enhanced sense of community and belonging. Study 3 used qualitative interviews to explore barriers and enablers for GPs in engaging with social prescribing for individuals with mental health problems, mapping them onto the Capability, Opportunity, Motivation-Behaviour (COM-B) change model. My findings highlighted the need for increased formal GP training on how to engage with social prescribing effectively, and the benefits of active inter-organisational partnerships and hand-holding opportunities to accompany individuals to initial sessions. My findings support the conceptualisation of social prescribing as a complex intervention. Social prescribing however is not a single, clearly defined intervention and different community groups/activities will involve different mechanisms and active ingredients. In its broadest sense social prescribing reflects a more salutogenic, personalised, biopsychosocial and less individualised approach towards mental health.
... Second, all measures were self-reported, potentially introducing biases, such as social desirability. For measuring subjective illness perception, self-reports are commonly used and well suited (alternatively, illness perception can be operationalized through drawings, see, Broadbent et al., 2019). However, future studies should strive to acquire objective health outcomes (e.g., medical/ psychiatric assessments, sedentary behavior measured by accelerometry). ...
Article
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Symptoms may persist after an acute COVID-19 infection, a phenomenon termed long-COVID. Increasing attention is now directed toward these long-term effects, as many seem to be affected. So far, long-COVID was primarily discussed from a medical perspective, leaving psychological factors on health-related outcomes understudied. Thus, the present study contributes to the current literature by examining Leventhal’s common-sense model of self-regulation, investigating patients’ cognitive and emotional illness perceptions and their association with different health-related outcomes in the context of long-COVID. We examined 246 long-COVID patients (89.0% female, Mage = 45.29 ± 12.12 years), assessing illness perceptions, fatigue, depressive symptoms, anxiety, and quality of life in a cross-sectional survey study. Linear regression analyses were applied to model the unique effects of the illness perception dimension on health-related outcomes. More than half of the sample had elevated levels of depressive symptoms, anxiety, and fatigue. Illness perception dimensions explained between 28% and 37% of the variance across the analyzed health-related outcomes. More symptoms, higher perceived consequences, and higher emotional representation were related to worse health-related outcomes. In general, long-COVID was poorly understood (i.e., low coherence) and perceived as difficult to control (i.e., personal & treatment control). Health professionals involved in counseling should pay close attention to both cognitive and emotional illness perceptions to address possible ways of coping with long-COVID.
... Assessment of illness experience through drawings has been examined, for instance, in people with cardiovascular disease (Broadbent et al., 2006;Reynolds et al., 2007), brain injury (Jones et al., 2016), eating disorders (Guez et al., 2010), Cushing's syndrome (Tiemensma et al., 2012), and chronic pain disorders including headache (Broadbent et al., 2009), whiplash-associated disorders (Bernhoff et al., 2017), and fibromyalgia (Bojner Horwitz et al., 2006). These studies in patients with somatic problems indicated that drawings reveal clinical severity, illness perception and distress (Broadbent et al., 2018). Overall, however, the scientific evidence of projective assessment techniques, such as drawing-a-person or a figure-of-self, as a measure of psychological characteristics, is weak and difficult to interpret (e.g., Betts, 2006;Gigi, 2016;Lilienfeld et al., 2000). ...
Article
People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected ‘details’ in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this ‘details’ factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder.
... Based on the CSM-SR, one of the most coherent measures developed to understand an individual's illness beliefs is the Illness Perception Questionnaire (IPQ; (Weinman et al., 1996) and its modified versions, the IPQ-revised (IPQ-R; Moss-Morris et al., 2002) and the 9 item Brief-IPQ (B-IPQ; Broadbent et al., 2006Broadbent et al., , 2019. In the context of COVID-19 there have been a number of studies which have utilised the IPQ-R and B-IPQ, in the general population (Chong et al., 2020;Dias Neto et al., 2021;Perez-Fuentes et al., 2020;She et al., 2021;Skapinakis et al., 2020) and HCWs (Man et al., 2020;Shahzad et al., 2020) in attempts to understand the beliefs held and impact of COVID-19 on individuals. ...
Article
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The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.
... Con el objetivo de explorar las representaciones de la enfermedad de los pacientes, Broadbent y otros, (42) realizaron una revisión sistemática que abarcó 101 estudios publicados en 29 países, con 27 categorías de enfermedades diferentes. La síntesis narrativa mostró la presencia de dominios centrales como: el impacto de la enfermedad en la identidad, el estado emocional, las percepciones del tratamiento y el entorno clínico y social. ...
Article
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Introducción: La práctica de la cirugía genital es frecuente en infantes y adolescentes diagnosticados de intersexualidad. Una de sus principales consecuencias se refleja en la personalidad del paciente. Existen numerosos estudios en población adulta, pero son escasos en edades pediátricas. El dibujo constituye un instrumento valioso para la exploración psicológica en edades tempranas. Objetivo: Identificar las características psicológicas de infantes y adolescentes con tratamiento quirúrgico de los genitales, y de su desarrollo psicológico en el momento de la valoración. Métodos: Estudio transversal descriptivo y metodología cualitativa. La muestra la integraron 15 participantes entre 6 y 12 años, con hiperplasia adrenal congénita y cirugía genital. De ellos, 4 con asignación al sexo masculino y 11 con asignación femenina. Todos residentes en La Habana, Cuba y captados de las consultas de seguimiento de los servicios de Endocrinología del Instituto de Endocrinología y hospitales pediátricos. Se aplicaron las técnicas psicográficas (dibujo espontáneo, dibujo temático de la familia y dibujo temático “Así soy yo”). Resultados: El desarrollo psicológico se correspondió con la edad cronológica. El 100 % presentó un pensamiento coherente y estructurado. El 50 % presentó indicadores emocionales que aluden a insatisfacción con el propio yo, angustia (40 %), y falta de aceptación del propio cuerpo (70 %); además, expresaron dificultades en la comunicación familiar (60 %). Conclusiones: Los indicadores globales relevantes de los dibujos denotaron daño emocional, dificultades en la aceptación, percepción y representación del esquema corporal y también en la comunicación social y familiar. Resulta impostergable intervenir en las causas del malestar y los problemas psicológicos de los sujetos estudiados para evitar que se desarrollen enfermedades psiquiátricas en la edad adulta.
... A growing body of psychological research based on Leventhal's common sense model of self-regulation (CSM) [3,4] has shown that the way people perceive an illness (illness perceptions) play a role in how they cope with their illness [5][6][7][8]. These perceptions are grouped into five core domains, namely, illness identity (label and symptoms), timeline (perceived duration), consequences (perceived effects), controllability (whether the illness can be cured or controlled via treatment), and perceived causes. ...
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Background: Cross-sectional research demonstrates associations between illness perceptions and glycemic control in people with type 2 diabetes (T2D). Prospective studies are limited and show mixed findings. Aims: This study aimed to investigate (1) whether baseline illness perceptions predicted glycemic control (HbA1c levels) at 6–12-month follow-up and (2) possible differences in baseline illness perceptions between individuals who completed at least one HbA1c blood test during the 12-month follow-up and those who did not. Methods: A total of 115 individuals with T2D were recruited from an outpatient clinic. Demographic and clinical information and illness perceptions were assessed at baseline. HbA1c was assessed at baseline and 12 months later from clinical records. Hierarchical multiple linear regression examined associations between baseline illness perceptions and HbA1c levels at 6–12-month follow-up, controlling for age, sex, education, types of diabetes medication, and baseline HbA1c. Results: Univariate analysis showed perceived weight management effectiveness at baseline was associated with lower HbA1c at follow-up (rho = −.25, p = .04, n = 67). Adjusted multiple regression showed that HbA1c at baseline was the only significant predictor of HbA1c at 6–12-month follow-up (β = 0.51, p < .001). There were no significant differences in baseline illness perceptions between individuals who completed HbA1c blood tests during follow-up (n = 78) and those who did not (n = 34), p > .05. Conclusion: Illness perceptions at baseline did not predict longitudinal HbA1c in adjusted analyses, nor completion of HbA1c tests. Results may be due to temporal variability in HbA1c and barriers to accessing blood tests.
... The use of drawing in research to explore health and illness has been advocated as being particularly helpful in young children or in those who English is not their first language (Pridmore & Bendelow, 1995), which is the case for some children in the target population. Historically, drawing has also been used to explore beliefs about illness such as cancer, in older children (15 years) and therefore the patients', Drawing materials were offered within this study as a useful tool to aid expression of beliefs and experiences (James, 1993), and may be particularly useful for exploring their understanding of asthma and the biology of asthma and its treatments in relation to illness and treatment beliefs as outlined by the e-CSM (Broadbent, Schoones, Tiemensma, & Kaptein, 2018). The interviewer attended training in using this creative methodology with children in research prior to data collection. ...
Thesis
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Non-adherence to inhaled corticosteroids (ICS) is a key barrier in asthma management. However, few studies have explored patterns of non-adherence and the reasons for variations in adherence in young people with problematic asthma. The aim of this thesis is to explore the potentially modifiable determinants of non-adherence in young people with problematic severe asthma in a tertiary care setting. This PhD comprises a systematic review of interventions to improve adherence in children with asthma; an analysis of patterns of non-adherence; a qualitative study of patients with poor adherence; and an adaptation study of the Beliefs About Medicine Questionnaire (BMQ). Each of these informs identification of interventions to improve adherence. The review found that current interventions have limited effectiveness, with only half of the included trials able to improve ICS adherence (9/18). More complex interventions, tailored to the patient, which addressed both perceptions and practical aspects of non-adherence were more likely to be effective. Secondary analysis of electronic adherence data from this population (n=93) identified adherence patterns which have implications for intervention development. The interview study (n=20) identified perceptual determinants (e.g. poor understanding of asthma and ICS) and practical determinants (e.g. no routine and forgetfulness) of non-adherence. These findings informed an adaption of the BMQ to identify beliefs underlying treatment non-adherence in this population; initial piloting (n=30) revealed high overall internal reliability but further research is needed to validate the questionnaire. This PhD highlights the need for a tailored intervention for non-adherent young people with problematic asthma which addresses perceptual and practical barriers to adherence. The PhD identified new barriers to adherence including key differences between adults and young children. A belief-based questionnaire could be used to identify modifiable beliefs for inclusion in a tailored intervention addressing both perceptual and practical barriers for adherence to ICS.
... According to the authors, colors, shapes, and motifs can all represent the unconscious, ideas, distressful feelings and thoughts, concerns, and worries, adding layers of meaning to verbal content (Lev-Wiesel and Liraz, 2007;Goldner and Scharf, 2012;McInnes, 2019). Recently, researchers in social sciences have suggested that drawings serve as a powerful adjunct to traditional data collection approaches as they advance researchers' understanding regarding individuals' perceptions of pathology and well-being (Huss et al., 2012;Boden et al., 2019;Broadbent et al., 2019). ...
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Child abuse is an underreported phenomenon despite its high global prevalence. This study investigated how child abuse is perceived by children and adolescents as manifested in their drawings and narratives, based on the well-established notion that drawings serve as a window into children’s mental states. A sample of 97 Israeli children and adolescents aged 6–17 were asked to draw and narrate what child abuse meant to them. The drawings and narratives were coded quantitatively. The results indicated that participants did not perceive a distinction between abuse and violence and referred to them interchangeably. Almost half of the participants focused on emotional abuse. The most frequent type of abuse within the family was between parents and children, and the most frequent abuse outside the family was peer victimization. Most of the drawings were figurative and realistic and half of the drawings included words suggestive of the participants’ attempts to be heard and fully understood. The vast majority of drawings did not include the figure of the artist, about a third of the drawings employed dissociative techniques (i.e., included positive objects, were unrelated to abuse, used words alone, or did not follow the instructions), and almost half of the narratives were dissociative or characterized by negative resolution, describing feelings such as sadness, humiliation, and loneliness. These findings suggest the emotional pain associated with the abuse or violence and the use of dissociative mechanisms to bypass the pain. The findings are discussed in light of the literature on children’s disclosure.
... Research has shown that individuals' illness perceptions are related to health outcomes across a number of chronic conditions [1,2]. In diabetes, illness perceptions have been associated with adherence to self-care behaviours [3], glycaemic control as assessed by glycated haemoglobin (HbA1c) [4,5], clinic attendance [6], quality of life [7], depression, anxiety [8] and mortality [9]. ...
Article
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Aims: This systematic review sought to synthesize the evidence regarding the effectiveness of illness perception interventions compared with control conditions at changing illness perceptions and improving glycaemic control in individuals with Type 2 diabetes. Methods: Seven electronic databases were searched between October 2018 and May 2020. Randomized controlled trials that tested interventions informed by the Common‐Sense Model in adults with Type 2 diabetes, and measured illness perceptions and glycaemic control at pre and post-intervention were included. The Cochrane risk of bias tool was used to assess the risk of bias. Results: A total of 4095 articles were identified, of which nine randomized control trials (2561 participants) across twelve publications were included in this review. Findings showed that all the illness perception domains were modified in at least one trial, with the exception of cyclical timeline perceptions. Coherence, personal control, treatment control, and chronic timeline perceptions were the most frequently modified perceptions. Glycaemic control demonstrated an improvement in the intervention group compared to the control group at 3 and 6 months post-intervention in two trials. Risk of bias assessment showed high risk of bias especially for the blinding of participants and the personnel domain. Conclusions: There is limited evidence that interventions informed by the Common‐Sense Model can improve glycaemic control in individuals with Type 2 diabetes through changing inaccurate illness perceptions. Recommendations for future research are to tailor intervention content based on baseline perceptions, measure the emotional and causal domains, and involve family members in the intervention.
... These technologies now feel antiquated given the ease with which contemporary researchers can access audio and video recordings (Griggs et al., 2020;Peräkylä, 2019). The explosion of video and visual methods (Broadbent et al., 2019;Hansen, 2018;Macdonald et al., 2019;Wolf, 2011) would not have been possible without easy (and affordable) access to new and developing technologies. New frontiers are opening methodologically, including the possibility of using more computerized and machinelearning approaches to research and data analysis (Beaulieu-Jones et al., 2019;Tay, 2020). ...
Article
Qualitative researchers are increasingly making use of multiple media to collect data within a single study. Such approaches may have the potential to generate rich insights; however, there are also potential methodological challenges in simultaneously analyzing data from multiple media. Using three case studies from our work with women who had recurrent breast cancer in South Africa, we explore four challenges of using multiple media to collect data: (a) how to understand the repetition of themes (or lack thereof) across multiple media; (b) whether or not data collected from multiple media over a protracted period should be read as longitudinal data reflecting a dynamic process; (c) what impact using multiple media has on the participant–researcher relationship; and (d) how the medium may shape the data obtained. We propose that the value of using multiple methods lies in the opportunity they provide to understand how participants engage with the different media.
... In a focus group study of Māori, understanding about gout was obtained from many sources, including health care professionals, family and friends, and personal experiences [30]. The research highlights the need for further work on perceptions of gout in Māori patients using both established questionnaires and the use of alternative strategies for assessing illness perceptions, such as drawings [31]. Previous clinical trials in other diseases have demonstrated that changing illness perceptions can have positive effects on health outcomes. ...
Article
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Background: Despite contemporary advances in understanding pathogenesis and effective management of gout, beliefs about the disease continue to be focused on gout as a self-inflicted illness. The illness label itself may contribute to inaccurate perceptions of the disease and its management. In Aotearoa/New Zealand, Māori (Indigenous New Zealanders) have high prevalence of severe gout. The aim of this study was to examine the impact of the illness label 'gout' on perceptions of the disease and its management for Māori. Methods: Māori supermarket shoppers (n = 172) in rural and urban locations were recruited into a study examining the perceptions about arthritis. Participants were randomised 1:1 to complete a questionnaire examining the perceptions of the same illness description labelled as either 'gout' or 'urate crystal arthritis'. Differences between the two illness labels were tested using independent sample t-tests. Results: 'Gout' was most likely to be viewed as caused by diet, whereas 'urate crystal arthritis' was most likely to be viewed as caused by aging. 'Urate crystal arthritis' was seen as having a wider range of factors responsible for the illness, including stress or worry, hereditary factors and chance. 'Gout' was less likely to be viewed as having a chronic timeline, and was perceived as being better understood. Dietary management strategies were seen as more helpful for management of the gout-labelled illness. Conclusions: This study has demonstrated that for Māori, Indigenous New Zealanders who are disproportionately affected by gout, the illness label influences perceptions about gout and beliefs about management.
... Another previous study (Klis et al., 2008) found significant negative correlation between well-being index (WHO-5) and IPM (a version where the illness circle can have three different sizes). The association between the size of the illness and a worse illness perception has been revealed by conventional drawing tests as well (Broadbent, Schoones, Tiemensma, & Kaptein, 2018). ...
Article
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Objective: We developed and validated a drawing test version of the Pictorial Representation of Illness and Self Measure (PRISM), a visual method to assess the perceived burden of illness and illness perception. Our aim was to test whether the drawing version would allow patients more freedom to deliberately vary both the size and position of circles symbolizing illness and individual coping resources, as well as gain more information about illness representations and available resources. Design and Main Outcome Measures: We applied the PRISM-D test to 500 patients with severe somatic diseases under active hospital treatment. We used Spielberger’s State and Trait Anxiety Inventory and Beck’s Depression Inventory to assess convergent validity. Results: The PRISM-D test is applicable for inpatients and it can be used to explore their subjective representations. The modifications did not cause any loss in convergent validity as the Self-Illness Separation and the Illness Perception Measure are significantly correlated with levels of depression and anxiety. Conclusion: The drawing test enables more detailed measurement of suffering caused by illness, illness perception and more complex assessment of important factors in a patient’s life. The test is adequate for clinical use as well as research among a wide range of somatic inpatients.
... Particularly, when participants are prompted to engage in a brief time of personal reflection prior to beginning the study task, drawings hold the potential to illuminate non-literal understandings of what it means to experience a particular chronic health condition (Cross et al., 2006;Guillemin and Drew, 2010;Guillemin and Westall, 2008). More specifically, drawings provide valuable insight into the illness identity and emotions of drawing-makers, as well as potential pre-occupations and perceptions of treatment environments they may hold (Broadbent et al., 2018;Kearney and Hyle, 2004). As an easy, familiar task to most adults, drawing on paper or digitally may circumvent the technical limitations of equipment familiarity that hampers the effectiveness of other visual methods (Woodgate et al., 2014). ...
Article
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Polycystic ovary syndrome is a chronic endocrine disorder associated with persistent physical symptoms and psychological and lifestyle repercussions. Eighty-nine participants (83 females, 6 non-binary) aged 19–43 years described their experiences of polycystic ovary syndrome through drawings and personal accounts. Four descriptive themes were identified: awareness of visible and invisible symptoms, misshapen self and body, limitations and barriers and resignation. Taken together, participants described a condition with all-encompassing effects: much more than symptom management alone. Findings support the use of drawings as an appropriate method with this population and suggest continuing need for supports for individuals with polycystic ovary syndrome.
... The personal and treatment control dimensions have been shown to be positively associated with adaptive, problem-focused coping strategies such as participating in illness management behaviors (e.g., visiting a health professional or taking medication). Illness perception dimensions related to illness threat, such as the perceived consequences, timeline, and emotional representation dimensions, have been shown to be negatively related to problem-focused coping strategies and positively related to emotionfocused coping strategies such as denial, avoidance, and emotion venting (Broadbent et al., 2019;Durazo & Cameron, 2019;Hagger et al., 2017;Hagger & Orbell, 2003). ...
Article
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Rationale: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management. BEHAVIORS: physical activity, healthy eating, and taking cholesterol lowering medication. Objective: The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries. Method: Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total N = 726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors. Results: Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across samples and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across samples and behaviors. Conclusion: Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across samples and behaviors highlights the imperative of identifying sample- and behavior-specific correlates of FH self-management behaviors.
... The personal and treatment control dimensions have been shown to be positively associated with adaptive, problem-focused coping strategies such as participating in illness management behaviors (e.g., visiting a health professional or taking medication). Illness perception dimensions related to illness threat, such as the perceived consequences, timeline, and emotional representation dimensions, have been shown to be negatively related to problem-focused coping strategies and positively related to emotionfocused coping strategies such as denial, avoidance, and emotion venting (Broadbent et al., 2019;Durazo & Cameron, 2019;Hagger et al., 2017;Hagger & Orbell, 2003). ...
Preprint
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Rationale: Familial Hypercholesterolemia (FH) is a genetic condition that predisposes patients to substantially increased risk of early-onset atherosclerotic cardiovascular disease. FH risks can be minimized through regular participation in three self-management behaviors: physical activity, healthy eating, and taking cholesterol lowering medication.Objective: The present study tested the effectiveness of an integrated social cognition model in predicting intention to participate in the self-management behaviors in FH patients from seven countries.Method: Consecutive patients in FH clinics from Australia, Hong Kong, Brazil, Malaysia, Taiwan, China, and UK (total N = 726) completed measures of social cognitive beliefs about illness from the common sense model of self-regulation, beliefs about behaviors from the theory of planned behavior, and past behavior for the three self-management behaviors.Results: Structural equation models indicated that beliefs about behaviors from the theory of planned behavior, namely, attitudes, subjective norms, and perceived behavioral control, were consistent predictors of intention across samples and behaviors. By comparison, effects of beliefs about illness from the common sense model were smaller and trivial in size. Beliefs partially mediated past behavior effects on intention, although indirect effects of past behavior on intention were larger for physical activity relative to taking medication and healthy eating. Model constructs did not fully account for past behavior effects on intentions. Variability in the strength of the beliefs about behaviors was observed across samples and behaviors.Conclusion: Current findings outline the importance of beliefs about behaviors as predictors of FH self-management behaviors. Variability in the relative contribution of the beliefs across samples and behaviors highlights the imperative of identifying sample- and behavior-specific correlates of FH self-management behaviors.
... SOCIAL CONTEXT AND THE COMMON SENSE MODEL 2 The common sense model (CSM: Leventhal, Meyer, & Nerenz, 1980;Leventhal, Phillips, & Burns, 2016) is an influential framework for understanding patient perceptions of, and adaptation to, illness. The papers in this special issue provide excellent critical reviews of current knowledge in four different areas of CSM application: health behaviours among cancer survivors (Durazo & Cameron, 2019), patients' drawings of illness representations as an assessment tool (Broadbent, Schoones, Tiemensma, & Kaptein, 2019), medically unexplained symptoms (McAndrew et al., 2019), and automatic processes in illness representations (Orbell & Phillips, 2019). We focus here on two gaps in the literature reviewed. ...
Article
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Reviews of the literature on the common sense model (CSM) provide strong support for the value of the framework in understanding and predicting illness behavior. It is clear from these reviews, however, that there are gaps in the literature and aspects of the model that have been left relatively unexamined. Here, we focus on two such gaps. First is an inattention to social contextual factors, including relationships with both formal and informal care providers. The second gap discussed is the dearth of longitudinal research testing the model. In particular, we highlight the need for intensive longitudinal designs to facilitate examination of illness representation and behavior as processes that unfold dynamically overtime.
... This review is the first to address the issue of implicit processes in patients' self-regulation, and also the first to include a broad range of health-related behaviours and illnesses. Broadbent, Schoones, Tiemensma, and Kaptein (2019) highlight the importance of developing and implementing varied means for assessing illness representations. The majority of both qualitative and quantitative studies on the CSM used verbal assessments. ...
Article
Purpose Acquired brain injury (ABI) extends beyond the immediate aftermath, and understanding individual experience of ABI is paramount to providing effective support mechanisms. This study examined how people with ABI used mask-making to engage in self-expression. Method Publicly available data from the Unmasking Brain Injury Project website, an advocacy group for people with ABI, were analyzed. A qualitative approach with hybrid inductive/deductive analysis was used to explore how people with ABI use art to express their emotional experiences of ABI. Results In total, 1,049 masks had narratives describing the visual components and meaning in the associated masks. Three major themes emerged: the multiplicity of experiences after ABI, including positive, negative, and mixed outcomes; the expression of emotional pain and living with loss through art; and the importance of positivity, purpose, and faith in the experience with ABI. Multiplicity was the central expression represented in the masks. The most commonly represented emotional experiences were: emotional pain and living with loss and positivity, purpose, and faith . The masks incorporated literal depictions of the ABI, visual metaphors, and intentional use of colors and shapes for self-expression. Conclusions These results support previous findings that emotional experiences after ABI are complex and often interlaced with several emotions. The most prominent feelings include emotional pain and living with loss, and positivity, purpose, and faith. Mask-making may be a particularly appropriate method for people with ABI to process or express emotional experiences, as well as to provide clinicians with visual records of sense of self, coping, or progress.
Article
Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees’ adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers’ knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural–professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.
Article
Background From the time of new diagnosis to treatment, cancer patients experience a variety of health problems that can affect the patient’s health outcomes. Individuals with cancer are being given increasing responsibility for the self-management of their health and illness. The self-regulating common-sense model (CSM) is effective in patients’ disease management. This article briefly introduces the common-sense model intervention, in which patients with cancer are affected by these interventions, what they are about, and what effects they have. Methods The authors systematically review evidence for the common-sense model of self-regulation for cancer using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Based on a comprehensive literature search, we searched the Cochrane Library, PsycINFO, Embase, PubMed, Medline, CINAHL, CNKI, and WanFang databases. The included studies underwent a quality assessment using the Effective Public Health Practice Project (EPHPP). Results Eleven empirical studies illustrated the aspects of common-sense model interventions for cancer patients. It is concluded that common-sense model intervention has an effect on symptoms in cancer treatment, behavior, and quality of life, but more studies are needed to verify the use of common-sense model intervention to explore in patients with different cancers. The systematic review summarized a four-point paradigm about intervention content, including assessing the current situation, setting goals, having a disease education and psychological adjustment, and getting feedback for further response. However, the application of intervention requires specific analysis of patient behavior and outcomes. Conclusion Common-sense model interventions are beneficial for the self-management of cancer patients; however, more intervention studies are needed to specify the cognitive, emotional, and coping styles of people with a particular cancer.
Chapter
Consultation-liaison psychiatry has evolved rapidly in the last decade, with significant expansion of services across the UK. Now in its third edition, Seminars in Consultation-Liaison Psychiatry provides a current, comprehensive, practically orientated guide that covers clinical topics, education, service development, audit and research. New and updated chapter topics cover the presentation, diagnosis, and management of common conditions, and chapters on organisational topics provide insights into developing and managing the context within which practice takes place. Each chapter is informed by the latest research while remaining hands-on in its focus, structured around common clinical scenarios that liaison staff encounter in hospital settings. A practical guide, this book is packed with essential reading for clinicians working at the interface between mental and physical healthcare.
Article
Background: Illness perceptions are important for patients with insulin-treated type 2 diabetes mellitus (T2DM) and impaired awareness of hypoglycemia (IAH), as they determine health-related behaviors and motivations. Patients with IAH in many countries have poor illness perception, and there is a paucity of research exploring the effectiveness of Common Sense Model (CSM)-based interventions in this population. Objective: To investigate the effects of a CSM-based intervention program on perceptions of illness in patients with insulin-treated T2DM and IAH. Design: Quasi-randomized controlled trialMethods: 78 patients with IAH receiving routine care were included. The intervention group (n = 39) participated in a CSM-based program, whereas the control group (n = 39) did not. Illness perceptions, coping styles, hypoglycemia fear, and awareness of hypoglycemia at baseline, 1 month, and 3 months were analyzed and compared between the two groups. Results: The intervention group exhibited significant improvements in consequences (β = -1.615, P = 0.032); personal control (β = -1.897, P = 0.006); treatment control (β = -1.274, P = 0.046); and positive coping style (β = 4.872, P = 0.002) at the 3-month follow-up, and timeline (β = 2.769, P = 0.004) at the 1-month follow-up. Hypoglycemia fear and awareness were not significantly improved in the intervention group compared with the control group. No intervention-related adverse events were observed. Conclusions: A CSM-based intervention program can modify illness perceptions to an extent and improve the positive coping style in patients with IAH.Impact statement: Nurses should conduct a CSM-based intervention program to help patients with IAH improve illness perceptions.
Article
This study explored the experienced impact of alopecia using patient’s drawings. Forty patients made drawings of their feelings about appearance of their head and hair before and during chemotherapy. Patients also reported illness perceptions (B-IPQ). Twenty-four patients (60%) reported ⩾50% alopecia at enrollment. Most patients (70%) drew a negative change of feelings over time and physical changes. Many experiences related to alopecia emerged from the written texts underneath the drawings and the B-IPQ. Drawings depicted deteriorated feelings of appearance, affecting many activities throughout the day. Healthcare providers are advised to use patient-tailored questioning about alopecia.
Chapter
Discussion of the value of image, metaphor and creative principles to good consulting skill and patient education within the Primary Care setting is important in enhancing improved patient-physician interactions. A broad-based view of the techniques used in undergraduate and postgraduate teaching within Medical Education in the UK and US are canvassed to establish the best practices and efficacy of using drawings and images as communication tools between physicians and patients. A descriptive analysis of the author's use of image and metaphor is analysed to assess how such convey medical information and help in the improvement of consultation and patient understanding.
Article
Child sexual abuse is present in all strata of Israeli society. However, there is scant research on the emotional experiences of non-abusing mothers after disclosure. In particular, no studies have examined the experiences of these mothers from the Jewish Ultra-Orthodox community in Israel. The current study analyzed the drawings and short narratives of 21 Israeli Ultra-Orthodox mothers to explore the effects of the disclosure of their child's sexual abuse. A phenomenological approach was used to analyze the drawings and yielded four different phenomena: (1) squiggles that represented distress, (2) the mother-child relationship, (3) pseudo-sweet houses, and (4) split drawings. The drawings were either colorful, sweet or shallow, or alternatively were in black and white. As confirmed by the narratives, these drawings primarily expressed the negative emotions of shock, sadness, distress, guilt, and failure as mothers. While some mothers reported breaking down and that pain had permeated their daily lives others coped by dissociating the painful experience, putting up a façade of normalcy, or splitting their lives into two parts corresponding to before and after the disclosure.
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The four preceding systematic review articles raised four conceptual and methodological issues pertaining to the common sense model. These issues include the testability of the model as a whole, the overall emphasis of cognitive aspects of illness representations in the literature as driver of behaviors, measurement issues, especially the reliance on the IPQ, and future directions for the common sense model as sketched out by these reviews.
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In view of evidence that illness prognoses and adaptive functioning may be influenced by the accuracy of people’s knowledge about their physical symptoms, the present study extended these findings to the chronic care population. It was hypothesized that individuals hold beliefs and develop theories about their physical symptoms and that the accuracy of these beliefs is predictive of the individuals’ general level of adaptive functioning. A modified version of an instrument designed to measure the accuracy of illness schemata was employed with a sample of 31 chronic respiratory patients. Accuracy rating correlated positively and significantly with ratings of adaptive functioning, whereas no relationship was observed between adaptive functioning and severity of the patients’ medical condition. Well-informed patients functioned at a higher level physically, psychologically, and socially than less-informed patients. These findings point to the importance of patient education for prognosis. Possible mediating factors are discussed. Key words: symptoms, schema, cognition, models, respiratory
Book
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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 contributions cover a wide range of issues including representational beliefs about chronic illness, cultural influences on illness representations, the role of anxiety and defensive denial in health-related experiences and behaviours, the contribution of personality, and the social dynamics underlying gender differences in adaptation to illness. Particular attention is given to the implications for designing effective health interventions and messages. Integrating theoretical and empirical developments, this text provides both researchers and professionals with a comprehensive review of self-regulation and health.
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Research on the Commonsense Self-Regulation Model (CS-SRM) has emphasized reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients’ self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatize coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.
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According to the common-sense model of self-regulation, individuals form lay representations of illnesses that guide coping procedures to manage illness threat. We meta-analyzed studies adopting the model to (a) examine the intercorrelations among illness representation dimensions, coping strategies, and illness outcomes; (b) test the sufficiency of a process model in which relations between illness representations and outcomes were mediated by coping strategies; and (c) test effects of moderators on model relations. Studies adopting the common-sense model in chronic illness (k = 254) were subjected to random-effects meta-analysis. The pattern of zero-order corrected correlations among illness representation dimensions (identity, consequences, timeline, perceived control, illness coherence, emotional representations), coping strategies (avoidance, cognitive reappraisal, emotion venting, problem-focused generic, problem-focused specific, seeking social support), and illness outcomes (disease state, distress, well-being, physical, role, and social functioning) was consistent with previous analyses. Meta-analytic path analyses supported a process model that included direct effects of illness representations on outcomes and indirect effects mediated by coping. Emotional representations and perceived control were consistently related to illness-related and functional outcomes via, respectively, lower and greater employment of coping strategies to deal with symptoms or manage treatment. Representations signaling threat (consequences, identity) had specific positive and negative indirect effects on outcomes through problem- and emotion-focused coping strategies. There was little evidence of moderation of model effects by study design, illness type and context, and study quality. A revised process model is proposed to guide future research which includes effects of moderators, individual differences, and beliefs about coping and treatment. (PsycINFO Database Record
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Purpose: Childhood cancer disrupts children's daily life experiences. Eliciting children's perspectives regarding their life experiences during cancer treatment can be challenging. The purpose of this study was to characterize elementary school-age children's "good days" and "sick days" through their drawings. Methods: This study used draw-and-tell interviews, a developmentally sensitive arts-based technique that supports children's recall and communication of information, facilitating a deeper understanding of children's personal interpretation and meaning of a given phenomenon of interest. Children were asked to draw pictures representing both a "good day" and a "sick day." Following completion of each drawing, research team members used a semi-structured interview guide to elicit children's explanations of their pictures. Content analysis techniques were used to descriptively characterize children's drawings followed by thematic analysis to identify commonalities. Results: Participants were 27 children 6.33-12.83 years of age (mean 9.16 years; SD = 1.9) receiving treatment for cancer. "Good day" and "sick day" pictures were similar with regards to the presence of the child, the inclusion of other individuals, and the type of art medium used. Children's pictures characterized "good days" as being happy, outside in sunny weather, and engaged in activities. In contrast, "sick days" were characterized as feeling sad, lying down or reclining, and experiencing illness-related symptoms. Conclusions: Children's drawings illustrate their capacity to provide rich personal data related to their "good days" and "sick days." Incorporating arts-based strategies in the clinical setting may provide a child-centric strategy to understand the child's perspective and direct interventions.
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Background: Osteoporosis is a degenerative bone disorder that disproportionately affects older women worldwide. Raising awareness regarding osteoporosis within this demographic is significant for health promotion. Initial evidence suggests that visualisations of illness and treatment can improve illness perceptions, increase treatment motivations and even promote health behaviours. We are yet to understand whether different visualisation mediums vary in their impact on perceptions and motivations. Purpose: We investigated whether physical models or virtual animations had a greater impact on changing perceptions of osteoporosis and treatment motivation in an at-risk population of older women. Methods: A total of 128 women aged 50 and over were randomly assigned to view a brief presentation about osteoporosis using either 3-D printed bone models or electronic tablet animations. Illness perceptions, medication beliefs and motivations were measured at baseline and post-presentation. Mixed ANOVAs were used to identify significant changes over time between groups. Results: There were no significant interaction effects, revealing that neither medium had a greater impact on beliefs over time. Significant main effects of time revealed that from baseline to post-presentation, both mediums increased consequence beliefs, personal and treatment control, understanding of osteoporosis, motivations to take treatment if needed and medication necessity beliefs. Timeline beliefs and medication concerns decreased over time for both groups. Conclusions: Both 3-D models and animations of osteoporosis are equally effective in changing beliefs and treatment motivation in an at-risk population. Visualisation devices are brief, cost-effective, have high acceptability and have considerable clinical applicability to promote awareness and prevention.
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Background An emerging approach for investigating patient perspectives of their illness is the use of drawings. Objective This scoping review consolidates findings from current literature regarding the use of drawings to explore patients’ perceptions and experiences of their illness and treatment. Methods Electronic databases (Medline, PubMed, Embase, PsychINFO, Cinahl, Art Index and Scopus) and reference lists were searched to identify published English language studies using participant-generated drawings to explore adults’ perceptions and experiences of their illness and treatment. Using the scoping methodological framework, data were analyzed with respect to each study’s design, key findings and implications. Results Thirty-two studies were identified and these reflected diversities in both health conditions and methods of data collection and analysis. Participants’ drawings revealed new, insightful knowledge about patients’ perceptions, beliefs and experiences of their condition and were associated with clinical and psychological markers of health. Drawing was a powerful adjunct to traditional data collection approaches, and demonstrated potential benefits for participants. This review provides detailed insights and guidance on the use of drawings in research and clinical practice. Conclusion Drawing is a novel and potentially valuable technique for exploring patients’ perceptions and experiences about their illness and treatment. Advancing the methodology and applicability of drawings in this area will assist in the future development of this technique, with benefits for the patient, researcher and health care professional alike.
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The Mexican artist Frida Kahlo (1907–1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities Diego Rivera and Leon Trotsky, less known is the fact that she had lifelong chronic pain. Frida Kahlo developed poliomyelitis at age 6 years, was in a horrific trolley car accident in her teens, and would eventually endure numerous failed spinal surgeries and, ultimately, limb amputation. She endured several physical, emotional, and psychological traumas in her lifetime, yet through her art, she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This article uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this article is to discuss Frida Kahlo's medical history and her art from a modern pain sciences perspective, and perhaps to increase our understanding of the pain experience from the patient's perspective.
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Objective The purpose of this descriptive pilot study was to assess the ability of youth to create a meaningful drawing related to living with type 1 diabetes and explore the benefits of expressing emotion through drawing in future interventional work. Methods Youth aged 4 to 19 years (N = 242) with type I diabetes attending routine follow-up appointments within a pediatric specialty clinic were asked to draw: “If diabetes had a face what would it look like?” Results Drawings reflected many emotions and ranged from simple to complex in detail. Drawings reflected multiple experiences of living with diabetes including emotions, tools used for management, and effects of self-care. Conclusions Youth were able to create drawings reflecting their experience of living with diabetes. Youth conveyed a variety of emotions, attitudes, and experiences in drawing the “face” of diabetes. Drawing during clinic visits provides opportunity to explore the unspoken experiences of living with a chronic health condition, which may not be obtained during routine clinical information gathering. Deeper understanding of patient’s lived experience may assist providers in therapeutic management.
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Context: Sickle cell disease (SCD) and thalassemia are rare but chronic blood disorders. Recent literature showed impaired quality of life (QOL) in people with these blood disorders. Assessing one of the determinants of QOL (i.e. illness perceptions) therefore, is an important next research area. Objective: We aimed to explore illness perceptions of people with a blood disorder with drawings in addition to the Brief Illness Perception Questionnaire (Brief IPQ). Drawings are a novel method to assess illness perceptions and the free-range answers drawings offer can add additional insight into how people perceive their illness. Method: We conducted a cross-sectional study including 17 participants with a blood disorder. Participants' illness perceptions were assessed by the Brief IPQ and drawings. Brief IPQ scores were compared with reference groups from the literature (i.e. people with asthma or lupus erythematosus). Results: Participants with SCD or thalassemia perceived their blood disorder as being more chronic and reported more severe symptoms than people with either asthma or lupus erythematosus. In the drawings of these participants with a blood disorder, a greater number of blood cells drawn was negatively correlated with perceived personal control (P<0.05), indicating that a greater quantity in the drawing is associated with more negative or distressing beliefs. Conclusion: Participants with a blood disorder perceive their disease as fairly threatening compared with people with other chronic illnesses. Drawings can add additional insight into how people perceive their illness by offering free-range answers.
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AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions. METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test. RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study. CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.
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Objective: Acromegaly is frequently associated with altered facial appearance at the time of diagnosis. Furthermore, acromegaly is also associated with adverse psychological outcomes. We conducted a single-centre, cross-sectional study comparing patients with growth hormone vs non-functioning pituitary adenomas (NFA) to assess the association between morphometric changes and psychological outcomes and illness perception of patients with acromegaly. Methods: A seven-step scale was developed to grade morphometric changes based on facial photographs. In addition, all patients were asked to draw an image of their own body and an image of what they considered to be an average healthy body and complete seven psychological questionnaires. We recruited 55 consecutive patients in each of the two groups who had undergone surgery with or without radiation therapy (RT). Results: Our data showed that the clinician-rated morphometric scale was highly reliable in assessing facial changes, with 93/99 (Intraclass correlation coefficient (ICC)=0.95 (0.93-0.97)) graded as similar by independent raters. The mean (s.d.) grading for Acro and NFA patients on the clinician-rated morphometric scale were 3.5 (1.3) and 0.41 (0.35) respectively (P<0.0001). A higher clinician-rated morphometric score was also predictive of a poorer score on the drawing test. Conclusions: Our study demonstrates a correlation between physical changes associated with acromegaly and poor psychological outcomes, whereas no such correlation existed with modes of therapy, disease control status, RT, malignancy, initial or recent GH/IGF1 or secondary hormonal deficiency. Our data support the utility of the morphometric scale as a clinical tool for grading facial changes.
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Research investigating the effects of coccidioidomycosis (valley fever) on children and the psychosocial implications of this disease in general is lacking. This study reviews what is known about pediatric coccidioidomycosis patients. It documents the psychological functioning, quality of life, and illness perceptions of a sample of coccidioidomycosis patient families. Primary caregivers of pediatric patients and patients from a major hospital in the San Joaquin Valley of California were interviewed regarding their perceptions of disease detection, access to care and the patient/family experience.
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Few studies have explored the factors associated with long-term maintenance of exercise following cardiac rehabilitation. The present study used auto-photography and interviews to explore the factors that influence motivation and continued participation in physical activity among post cardiac rehabilitation patients. Twenty-three semi-structured interviews were conducted alongside participant-selected photographs or drawings with participants that had continued participation in physical activity for at least two years following the cardiac rehabilitation programme. Participants were recruited from circuit training classes in East Sussex in the UK. Thematic content analysis revealed seven main themes: fear of death and ill health avoidance, critical incidents, overcoming aging, social influences, being able to enjoy life, provision of routine and structure, enjoyment and psychological well-being. Fear of death, illness avoidance, overcoming aging, and being able to enjoy life were powerful motives for continued participation in exercise. The social nature of the exercise class was also identified as a key facilitator of continued participation. Group-based exercise suited those that continued exercise participation post cardiac rehabilitation and fostered adherence.
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The rheumatology field is moving towards identifying individuals with an increased risk for rheumatoid arthritis (RA) at a stage when arthritis is still absent but persons having clinically suspect arthralgia (CSA). Incorporating patients' views in rheumatologic care is pivotal; however, the views of persons with CSA on their condition are unknown. We aimed to help fill this gap by exploring illness perceptions of persons with CSA and their views on hypothetical prognoses for developing RA. Persons with CSA were invited to participate in a semi-structured focus group discussion. Illness perceptions according to the Common Sense Model (CSM) and four a priori formulated themes were explored in detail during the group discussion. The discussion was audio-taped and transcribed verbatim. Transcripts were analysed in an interpretative phenomenological approach manner, on the basis of the dimensions of the CSM by three researchers independently. The views of four participants with CSA were explored during one focus group discussion. Four dimensions of the CSM were mainly observed: Identity, Consequences, Personal Control and Concern. None of the patients identified themselves as being a patient. They did experience pain and impairments in daily functioning and were concerned that their symptoms would progress. In the absence of physician-initiated treatment, some patients changed lifestyle in order to reduce pain and to promote health. Patients unanimously said that they could not interpret prognostic information on RA development expressed in hypothetical chances. Persons with CSA do not consider themselves patients. Prognostic information related to the development of RA based on risk percentages was considered as not useful by persons with CSA. Understanding of the illness perceptions of persons with CSA by health care professionals might improve medical management and facilitate shared decision-making.
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This paper aims to systematically review the use and performance of the Brief Illness Perception Questionnaire (Brief IPQ). Electronic databases were searched for papers administering the Brief IPQ published in peer-reviewed journals. Data was extracted from the results for meta-analysis. Use by illness population, country, language, and study design. The questionnaire's concurrent validity, predictive validity, sensitivity to change, discriminant validity and mean scores for different populations were summarised. The review included 188 papers. The Brief IPQ has been administered to patients from age 8 to over 80, with a wide range of illnesses, in 26 languages from 36 countries. Pooled correlations between illness perceptions and depression, anxiety, blood glucose levels, and quality of life, were consistent with previous research and theory (range .25 to .49 for consequences, identity and emotional representations; -.12 to -.27 for personal control). All items were able to predict some outcomes up to one-year follow-up. Each subscale demonstrated sensitivity to change after intervention in randomised controlled trials with the personal control and causal items showing most frequent change. The Brief IPQ is widely used and has good psychometric properties. More studies should include and analyse the causal item.
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The aim of this study was to examine whether heart drawings of patients with acute myocardial infarction reflect acute distress symptoms and negative illness beliefs and predict posttraumatic stress symptoms 3 months post-myocardial infarction. In total, 84 patients aged over 18 years drew pictures of their heart. The larger the area drawn as damaged, the greater were the levels of acute distress (r = 0.36; p < 0.05), negative illness perceptions (r = 0.42, p < 0.05), and posttraumatic stress symptoms (r = 0.54, p < 0.01). Pain drawings may offer a tool to identify maladaptive cognitions and thus patients at risk of posttraumatic stress disorder.
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The aim of this study was to explore the role of body image, posttraumatic growth, and emotional state in recovery after transplantation. A total of 53 kidney transplant patients were assessed using our Self-Test and Organ Drawing Test, the Spielberger Anxiety Inventory, the Beck Depression Inventory, and the Posttraumatic Growth Inventory in a 3-year follow-up. Logistic regression analysis showed that lower levels of integrity of the body image and posttraumatic growth, and higher pre-discharge serum creatinine levels were significant predictors of graft rejection. Our results suggest that the integrity of the body image and posttraumatic growth might contribute to better health outcomes in organ transplantation.
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This study examines patients' pictorial representations of their chronic pain, alongside their accounts of those images, in order to help our understanding of their lived experience of the condition. The sample comprises 7 women in middle adulthood from southern England. They began by drawing what their pain felt like and were then interviewed about their portrayals. The interviews were analyzed with interpretative phenomenological analysis. The participants produce strong, vivid, abstract pictures. In many of the pictures, the pain is objectified as punitive and sinister. This is enhanced through the use of stark colors of red and black. Paintings also often have a temporal element, showing either the movement from self before pain to self since the pain had started, or pointing to aspirations for the possible relief of pain in the future. The analysis of the images is grounded in the participants' accounts of them. The images and accounts provide a powerful insight into the internal world of the pain sufferer and the subjective experience of chronic pain. We link this work to other attempts to represent patients' pain and point to the particular contribution our work makes. We make some suggestions for subsequent research following on from what is presented here and we also argue that the methodology outlined in the article offers considerable potential for research on other health conditions. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Context and objective: Patients with acromegaly have persistent complaints despite long-term biochemical control. Drawings can be used to assess patients' perceptions about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions and quality of life (QoL) in patients after long-term remission of acromegaly. Design: A cross-sectional study was conducted to evaluate the utility of the drawing test. Methods: A total of 50 patients after long-term remission (mean±s.e.m., 16±1.2 years) of acromegaly were included in this study. Patients completed the drawing test (two retrospective drawings of their body perception before acromegaly and during the active phase of acromegaly, and one drawing on the current condition after long-term remission), Illness Perception Questionnaire-Revised, Physical Symptom Checklist, EuroQoL-5D, and AcroQoL. Results: Patients perceived a dramatic change in body size during the active state of the disease compared with the healthy state before the awareness of acromegaly. Patients reported that their body did not completely return to the original proportions after long-term remission. In addition, larger drawings indicated more negative consequences (P<0.05), a higher score on emotional representations (P<0.05), and more perceived symptoms that were attributed to acromegaly (P<0.01). Larger drawings also indicated more impaired QoL, especially disease-specific QoL (all P<0.05). Conclusion: There are strong correlations among the drawing test, illness perceptions, and QoL. The drawing test appears to be a novel and relatively easy tool to assess the perception of patients after long-term remission of acromegaly. The assessment of drawings may enable health care providers to appreciate the perceptions of patients with long-term remission of acromegaly, and enable discussion of symptoms and remission.
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Objective: This pilot study investigated the use of patient drawings to explore patient experiences of symptoms of melanoma prior to health care use. Design: Patients (n = 63) with melanoma were interviewed within 10 weeks of diagnosis. Participants were asked to draw what their melanoma had looked like when they first noticed it, and to make additional drawings to depict changes as it developed. Main outcome measure: The size and features of the drawings were compared between participants and with clinical data (thickness of the melanoma; histological diameter; clinical photographs). Results: Eighty-four percent of participants were able to produce at least one drawing. This facilitated discussion of their lesion and recall of events on the pathway to diagnosis. Common features of the drawings related to the view, presence of shading, inclusion of sections and the shape and border of the lesion. There was potential for disparity between the details in awareness resources and the perceptions of patients. The drawings resembled the clinical photographs and the size of the drawings was positively associated with the histological diameter, but did not differ according to tumour thickness. Conclusion: Asking patients to make drawings of their melanoma appears to be an acceptable, inclusive, feasible and insightful methodological tool.
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Abstract Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at three months (p=0.03) and decreased viral load (p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART.
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Background Chagas disease is a tropical parasitic disease affecting about 10 million people, mostly in the Americas, and transmitted mainly by triatomine bugs. Insect vector control with indoor residual insecticides and the promotion of housing improvement is the main control intervention. The success of such interventions relies on their acceptance and appropriation by communities, which depends on their knowledge and perceptions of both the disease and the vector. In this study, we investigated school-aged children's knowledge and perception on triatomine vectors and Chagas disease to further understand how communities view this vector and the disease in Yucatan, Mexico. Methodology/Principal findings We performed an analysis of children's drawings on the theme of triatomines and their house in several rural villages, to explore in an open-ended manner their views, understanding and misconceptions. A total of 261 drawings were collected from children ages 6–12 from four villages. We found that children are very familiar with triatomine vectors, and know very well many aspects of their biology and ecology, and in particular their blood-feeding habits. On the other hand, their drawings suggest that the role of triatomines as vectors of a chronic and severe cardiac disease is less understood, and the main perceived health threat appears limited to the bite itself, as previously observed in adults. Conclusions/Significance These results have important implications for the specific design of future education materials and campaigns, and for the promotion of the inclusion of children in raising Chagas disease awareness in these endemic communities.
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Over the past few years, perceptions about disability – at least at the theoretical level – have been shifted toward a more progressive approach, which stresses the social aspects of the construction of disability (social model) rather than personal limitations, as supported by the traditional disability approach (medical–individual model). Drawing upon the sociosemiotic approach as developed by Kress and van Leeuwen, the present study examines from a comparative perspective the representations about disability and people with disabilities, as emerging from the drawings produced by 4th grade Greek primary scho