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Title: Dissimilarity in couples' beliefs in long-term illness, and its relation to coping strategies and health outcomes
Author: Box, Caitlyn
ISNI:       0000 0004 8500 4747
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2018
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The diagnosis of a health condition can present an individual and their significant others with complex and ongoing challenges. The role of psychological factors in adjusting to illness has been increasingly recognised, including that of the person's subjective beliefs about the illness. Much of the research thus far regarding these personal beliefs has utilised Leventhal and colleagues' (e.g. Leventhal, Meyer & Nerenz, 1980) self-regulatory, or "Common Sense Model" (CSM), of illness. The CSM posits that individuals utilise parallel cognitive and emotional processing to produce these lay beliefs, termed "illness representations". It is theorised that these representations then lead to the use of particular coping strategies, which are subsequently evaluated and revised if needed. Research originally showed that these illness representations could be coherently ordered into five cognitive dimensions (Leventhal & Cameron, 1987); Identity, Cause, Consequences, Timeline, and Curability/controllability. Timeline and Curability/controllability were later subdivided into Timeline Acute/chronic and Timeline Cyclical, and Personal and Treatment Control respectively (Moss-Morris et al., 2002). Two additional illness representation dimensions, Illness coherence and Emotional representations, were also added (Moss-Morris et al., 2002). The CSM has been applied to a range of health conditions with demonstrated discriminant validity, including cancer, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, psoriasis, and rheumatoid arthritis, amongst others (Hagger & Orbell, 2003). The predictive validity of illness representations for health outcomes has been demonstrated across conditions, for both psychological and physical health outcomes (Hagger & Orbell, 2003). Illness representation dimensions have also been associated with particular coping strategies, which can act as a mediator between representations and health outcomes (Hagger, Koch, Chatzisarantis & Orbell, 2017). However, models of health beliefs, including the CSM, have been accused of neglecting the wider social context of adjusting to a long-term health condition. These models have traditionally focused on the unwell individual, with the role of the partner predominantly as provider of information and/or practical or emotional support. Yet, there is now a substantial body of research showing that illness can also impact detrimentally upon the relationship and on their partner, including on their quality of life, physical health, mood, and social isolation. This includes the condition of Fibromyalgia (FM), of which the detrimental impact upon the partner relationship has been well-chronicled (e.g. Arnold et al., 2008). This shift in thinking has been echoed in the evolution of models of dyadic coping in illness, which propose reciprocal interaction throughout adjustment to the health condition. These models include the Developmental-Contextual Model (DCM) (Berg & Upchurch, 2007), the Systemic Transactional Model (STM) (Bodenmann, 1995, 2005), and the Cognitive-Transactional Model (CTM) (Badr & Acitelli, 2017). The DCM (Berg & Upchurch, 2007) and the CTM (Badr & Acitelli, 2017) both utilise the illness representation dimensions from the CSM in their construct of illness appraisals, which are proposed to then influence coping and outcomes. However, to understand dyadic coping, research is first needed to identify the processes by which couples develop shared appraisals of the illness. Most research using the CSM in couples has focused upon the extent of similarity, or "congruence", in the couple's illness representations. However, there appear to be conflicting findings. Some have found that dissimilarities on illness representation dimensions were related to poorer health outcomes, whilst others have related dissimilarity to improved health outcomes for the participant or their partner. Furthermore, this can seem dependent on whether one member of the dyad holds more "positive" illness representations. Some have suggested that partners' representations in fact act as a mediator or a moderator. In FM, studies have found varying agreement within the couple about its symptoms. However, no study as yet had used the CSM to examine dissimilarity in couples' beliefs in FM. Therefore, the aims of this thesis were: i) to synthesise and analyse the existing evidence regarding dissimilarity of illness representations, coping strategies, and health outcomes from studies using the CSM in the systematic review, and ii) to examine these associations in a FM population in the empirical study. Communication was additionally included as a variable in the empirical study, due to its established impact upon health outcomes and inclusion in a recent model of dyadic coping (CTM; Badr & Acitelli, 2017).
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available