The role of illness beliefs in understanding adjustment after stroke
Publication Date
July 14, 2017
Creator
Abstract
Stroke is a highly prevalent condition. It is a principal cause of adult disability and a leading cause of death in the United Kingdom (UK). The lifetime risk of stroke recurrence is also high, particularly for those with specific risk factors (e.g., hypertension). The long-term management of stroke is multi-faceted and complex. Stroke survivors are often responsible for self-managing their secondary preventive treatment (e.g., oral medication(s)) alongside rehabilitation, which is most beneficial in the first six-months. However, patients undergo a period of psychological adjustment after stroke. This is particularly evident in the early days where mood problems, such as depression, are highly common and affect how well people engage with, and adhere to, their rehabilitation and treatment. The present PhD research was interested in further understanding adjustment after stroke, and in particular, by utilising key evidence from the field of Health Psychology (more specifically, the Common Sense Model (CSM)), examining whether survivors’ perceptions (or beliefs) about their stroke are influential in determining how well people recover.
The overall aims of this work were to:
• Examine and synthesise the current evidence, through a systematic review and meta-analysis on the CSM in relation to physical illnesses to determine whether individual illness belief domains were important predictors of adherence to self-management in adults with acute or chronic conditions;
• Elicit views regarding an assessment method (the Stroke Illness Perception Questionnaire-Revised (Stroke IPQ-R)) that would be suitable and acceptable to a stroke population for accurately measuring peoples’ beliefs in the acute phase (≤three-months post-stroke);
• Apply the CSM (utilising the Stroke IPQ-R) to a population within the acute phase of stroke, to determine whether the model provides a useful framework for understanding survivors’ recovery after stroke (e.g., Health-Related Quality of Life (HRQL), disability, and mood).
This research incorporated three standalone though inter-related studies, the first of which was a systematic review and meta-analysis. The key findings from this meta-analysis indicated that the majority of illness belief domains outlined by the CSM significantly predicted (albeit weakly) adherence to a range of self-management behaviours (e.g., attendance; medication adherence; diet; physical activity; and other disease-specific behaviours (e.g., blood glucose self-monitoring)). Pooled effect sizes ranged from 0.04 and 0.13. None of the relationships varied according to acute and chronic illnesses; the type of self-management behaviour; or the duration of follow-up.
A qualitative study was subsequently undertaken. A variety of approaches were employed (including, expert consultation and Think-Aloud interviews) to develop a stroke-specific version of the IPQ-R. Interview findings showed very few problems with completion of the instrument. Where there were problems, these related to the wording of items, specifically abstract, complex and negative wording; the response format for the identity sub-scale; and questions on the timeline-cyclical and treatment control sub-scales. The revised scale was used in the third and final study.
The final study examined the relationship of illness beliefs, assessed by the Stroke IPQ-R developed in study 2, and measures of post-stroke recovery, including HRQL, disability and mood. This was a longitudinal observational study involving 50 survivors (average age=66.9 years, standard deviation =14.5 years) within three-months of their stroke. The primary outcome for this study, HRQL, was measured using the EQ-5D-5L instrument. The secondary outcomes were: disability, which was assessed using the Barthel Index, Modified Rankin Scale, and Nottingham Extended Activities of Daily Living Scale; and mood, measured using the Patient Health Questionnaire-9. Various statistical approaches were employed in the analyses of these data, the results of which are as follows.
Spearman’s correlations indicated that participants who perceived their stroke to have fluctuating effects and considerable distress at baseline (
Item Type
ethesis
Thesis Type
PhD
Supervisors
Subjects (LC)
Associated Schools / Departments
School of Medicine
eprints ID
39201
UoN Repository URI
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