ABSTRACT
The ‘commonsense’ self-regulatory model suggests that patients’ own key perceptions of their illness are critical in guiding their coping efforts to deal with symptoms, illness and threats to health.38,39 According to this model, patients’ illness beliefs have been shown to be organized around five central themes:
• the patient’s understanding of causal attributions: the cause(s) of the illness
• timeline: whether the illness is cyclical, short-term, longterm
• control: whether the patient feels they can personally influence the course/outcome of the illness
• identity: the symptoms/signs that the patient associates with the illness
• consequences: the impact of the illness on the patient’s life, i.e. employment, relationships
Illness beliefs can be assessed using a validated tool, the Illness Perception Questionnaire (IPQ)43 and two studies have used the IPQ to examine the role of patient illness beliefs following MI. The New Zealand Heart Attack Study followed 143 male patients post MI for six months.44 The baseline measures (taken during hospitalization) of illness perceptions were correlated with 6 month follow-up outcome measures, including time to return to work, physical and social functioning, sexual functioning and attendance at a cardiac rehabilitation course. Attendance at the rehabilitation course was significantly related to the patient holding a stronger belief that they had some degree of personal control over the future course of their illness. Return to work within 6 weeks was predicted by the percep-
and have less grave consequences for the patient. Belief that heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities and social interaction. A strong illness identity (association of many symptoms with the illness) was significantly related to greater sexual dysfunction at both 3 and 6 months. The influence of key illness beliefs was independent of clinical measures of severity of MI. In the second study, carried out in two centers in the UK,45 baseline measures of illness beliefs were obtained during hospitalization for MI or CABG in 152 patients. Patients were followed up at 6 months and the main outcome measure was attendance at cardiac rehabilitation. Those patients who, during initial hospitalization, had made a causal attribution to some aspect of their lifestyle for their heart condition, e.g. smoking, lack of exercise, poor diet, were more likely to have attended a cardiac rehabilitation course as were those who felt they had some degree of personal control over the course of their heart condition (rather than it being all down to ‘fate’ or ‘chance’).
