The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management

Worry about prostate cancer and risk perception among middle-aged men: results from the PROBASE trial

Cancer worry and risk perception are relevant psychological factors that influence preventive health behaviors. Therefore, a thorough understanding of the factors that impact their occurrence and manifestation is critical. The objective of this study was to assess prevalence and factors associated with worry about prostate cancer (PCa) and absolute/comparative risk perception in a community-based sample of 45-year-old men. Data were collected within the German PCa screening trial PROBASE. Variables were assessed by self-report questionnaires and a clinical interview. Worry about PCa and absolute/comparative risk perception were assessed each on a 5-point-Likert scale. Multivariable logistic regression was used to identify factors associated with the outcomes of interest. Data were available for 33,476 (72.0%) of 46,495 men at enrollment. 7.3% had sometimes/(very) often worry about PCa. 3.7% and 9.9% perceived their absolute risk and comparative risk as somewhat high/very high and somewhat higher/much higher, respectively. 18.8% reported a positive PCa family history. Important factors of worry about PCa, absolute risk perception, and comparative risk perception were lower urinary tract symptoms (LUTS) (OR 3.00, 95% CI 2.63-3.42; OR 2.09, CI 1.71-2.56; OR 2.41, CI 2.10-2.76) and a positive PCa family history (OR 2.35, CI 2.08-2.65; OR 15.13, CI 12.73-17.97; OR 9.69, CI 8.76-10.72). A positive history of urological (OR 3.85, CI 2.63-5.63) and non-urological cancers (OR 1.97, CI 1.52-2.54) were associated with a higher comparative risk perception. In conclusion, worry about PCa and risk perception are influenced by non-cancer-related symptoms as well as by a positive PCa family history. These findings need to be addressed in risk communication with patients.

Psychological and behavioural considerations for integrating polygenic risk scores for disease into clinical practice

A polygenic risk score (PRS) summarizes in one number an individual's estimated genetic association with a specific trait or disease based on the common DNA variants included in the score. Disease PRSs have the potential to positively affect population health by improving disease risk prediction, thereby also potentially improving disease prevention, early intervention and treatment. However, given the potential psychological, behavioural and other harms, there are also concerns about integrating PRSs into clinical tools and healthcare systems. Here we assess five arguments against implementing PRSs for physical disease in clinical practice that revolve around psychological and behavioural considerations. For each argument, we consider a counterargument, the evidence and underlying theory, any gaps in the evidence base and possible future directions and research priorities. We conclude that, although there may be other barriers to implementation, there is currently little evidence of psychological or behavioural harms from integrating PRSs into practice.

Exploring pain perception and depression in vulvodynia: the role of catastrophizing and pain acceptance

BACKGROUND

In the context of vulvodynia, a gynecological disorder characterized by chronic vulvar pain affecting an estimated 10% of women, with significant impacts on sexual health, mental well-being, and productivity, the Common-Sense Model of Illness Self-Regulation, a well-established framework for understanding the impact of illness perceptions and coping strategies on mental health, has not yet been empirically tested.

AIM

We aimed to explore whether illness perceptions and pain-specific coping strategies-namely, pain catastrophizing and chronic pain acceptance-influence the relationship between vulvar pain severity and depression in women with vulvodynia.

METHODS

A cross-sectional study was conducted on a total of 119 women with reporting diagnosis of vulvodynia.

OUTCOMES

Through an online questionnaire, we assessed demographic and clinical characteristics, vulvar pain severity, illness beliefs, pain catastrophizing, pain acceptance, and depressive symptoms.

RESULTS

The path analysis showed that vulvar pain positively influences directly illness perceptions (β = .56, P < .001) and depressive symptoms (β = .24, P < .001). Negative perceptions of the illness were significantly associated with increased pain catastrophizing (β = .66, P < .001), and decreased pain acceptance (β = -.59, P < .001), resulting in heightened depressive symptoms (β = .33, P < .001, β = -.27, P < .001, respectively).

CLINICAL IMPLICATIONS

Interventions that challenge negative illness perceptions and promote more positive views could reduce maladaptive coping strategies, enhance pain acceptance, and ultimately diminish psychological distress.

STRENGTHS AND LIMITATIONS

This study's strengths lie in its foundation on a theoretical, well-established model and the use of validated measures. However, the cross-sectional design precludes concluding causality between predictor and outcome variables, and the clinical information was self-reported and could not be verified with medical records.

CONCLUSIONS

The findings underscore the importance of targeting illness perceptions and coping strategies in shaping psychological outcomes for women with vulvodynia.

Gender differences in the public's conceptions of acute coronary syndrome-related chest pain

BACKGROUND

Symptoms often propel individuals to seek care. Chest pain is the most common acute coronary syndrome symptom, but an understanding of the public's conceptions about chest pain is lacking.

OBJECTIVES

The objectives were to describe the general public's conceptions of ACS-related chest pain, including the symptom dimensions quality, distress, intensity, and timing, and to compare those conceptions between women and men.

METHODS

A descriptive, cross-sectional study design was used, leveraging on online survey. Data were collected using the Chest Pain Conception Questionnaire, and conceptions were compared between women and men.

RESULTS

The 597 participants were a mean 54.0 (SD 11.5) years of age and lived across the U.S. Based on 5-point Likert scales, specific descriptors of chest pain, such as pressure and tightness, were rated as more likely to represent ACS-related chest pain (M 4.23) than general descriptors, such as discomfort (M 3.28). Though common descriptors of ACS-related chest pain (e.g., pressure, tightness) were selected by > 70 % of the sample, only 13 % selected indigestion. Most participants (n = 503, 84.3 %) associated ACS-related chest pain with the left chest. Participants believed that ACS-related chest pain would be "intense" (MDN 4.0) and distress them "a lot" (MDN 4.0). Few differences were identified between women and men.

CONCLUSIONS

Participants believed that ACS-related chest pain would be sudden, overwhelming, and experienced in the left chest. Given these findings, health care professionals are advised to address misconceptions about chest pain through individual education and public health messaging campaigns.

Perceived factors influencing the success of pain neuroscience education in chronic musculoskeletal pain: a meta-synthesis of qualitative studies

PURPOSE

We aimed to identify the factors influencing the success of Pain Neuroscience Education (PNE) in chronic musculoskeletal (MSK) pain from the perspective of those experiencing PNE first-hand.

MATERIALS AND METHODS

We conducted a meta-synthesis of qualitative studies. Articles were found on MEDLINE via Pubmed, EMBASE, Cochrane Library, CINHAL, and PsycINFO up to April 2023. Eligible qualitative studies focussed on adults (>16 years old) with a diagnosis of chronic primary or secondary MSK pain who performed PNE. Thematic synthesis by Thomas and Harden was followed. The Critical Appraisal Skills Programme (CASP) tool ensured the quality of the studies, while the Confidence in Evidence from the Reviews of Qualitative Research (CERQual) approach facilitated data confidence assessment.

RESULTS

Nine studies were included (188 participants). Three analytical themes were developed: (i) "Efficient Communication of Information", emphasising the importance of accurate content transmission; (ii) "Emotional Support and Well-being", recognising emotional aspects as integral to treatment; and (iii) "Empowerment Promotion", focusing on information retention and personal transformation. The studies showed good quality, with moderate confidence in the evidence.

CONCLUSIONS

The perceived factors influencing the success of PNE are intricately related to the domain of communication, the emotional dimension of personal experience, and the capacity to be empowered.

Acceptability of multimodal and multidisciplinary group-based program for chronic low back pain: a qualitative study

BACKGROUND

The Programa d'Atenció Integral pels Pacients amb Dolor Crònic (PAINDOC) is a multimodal and multidisciplinary group-based program that integrates pain neuroscience education, mindfulness meditation, pain psychotherapy, Empowered Relief, and therapeutic exercise. It serves as a therapeutic option for individuals with chronic low back pain, providing them with comprehensive adaptive strategies for pain management.

OBJECTIVE

This qualitative study explores participants' retrospective acceptability of the PAINDOC Program.

METHODS

To ensure demographic variability and information power, a purposive sampling approach was applied. Twelve participants were interviewed through three focus groups, supplemented with four individual semi-structured interviews. Data was analyzed using reflexive thematic analysis and evaluated based on the Therapeutic Framework of Acceptability.

RESULTS

Participants provide positive feedback regarding active pain coping strategies and improved self-management. While certain aspects of the Program were more emphasized, participants integrated tools from all components. Strategies included pain reconceptualization, positive self-talk, or problem-solving. The Program's ethicality was closely linked to individual values and may also be influenced by time constraints of certain program elements, the immediate effects of specific approaches, participant perceptions, and individual preferences.

CONCLUSIONS

The findings provide valuable insights into the acceptability of the PAINDOC Program, guiding future improvements and the development of similar interventions.

Development of a model of help-seeking for dementia diagnosis by the person experiencing changes and family supporters

OBJECTIVES

This paper aimed to develop a model to describe help-seeking for dementia diagnosis. The practical model is intended to guide public health interventions to increase help-seeking.

METHOD

The model was developed by our multidisciplinary team based on qualitative semi-structured interviews in English (n = 33) and Chinese (n = 8) with older people, people with dementia and carers. The model was also informed by systematic reviews on help-seeking for dementia diagnosis, theories of help-seeking and further iterated based on feedback from a co-design group (n = 10).

RESULTS

The model starts with changes which might be symptoms of dementia being observed by the person or family/friends and ends in dementia assessment. Model steps are (1) The person deciding that the changes represent a health problem; (2) obtaining support or confirmation from family/friends that the changes are a health problem; (3) deciding to seek medical help; and (4) persuading the GP to facilitate dementia assessment. The model applies to English and Chinese-speaking Australians, though there were additional barriers for Chinese speakers. There are personal, family, community and health system barriers at each step.

CONCLUSION

Interventions to improve diagnosis of dementia might target public knowledge of dementia symptoms and benefits of a diagnosis, and general practice.

From Unrealistic to Functional Optimism in Illness Perception: A Psychometric Comparison Across 10 Countries

People's perceptions of illness and its risks influence health behaviors, including risk management and precautionary measures. Illness perception often involves unrealistic optimism, reducing infection risk perception. However, crises disrupt self-regulation and optimism due to uncontrollable situations. This study examines optimism's link to risk and illness perception during the first COVID-19 wave in 10 countries, with 7254 participants (48.1% women, mean age = 40, SD = 14.8). We used Bayesian structural equation modeling for psychometric stability and one-way ANOVAs for country comparisons. Multiple regression analyses examined the impact of optimism and demographic variables on illness perception. Significant cross-country variations emerged in illness perception and optimism. In terms of the relationship between variables, optimism correlated with increased COVID-19 risk perception, especially for negative outcomes, concern, and consistency. During crises, optimism shifted from unrealistic to functional, promoting treatment adherence, personal control, and coherence. These dimensions represent individuals' beliefs in managing illness, highlighting optimism's adaptive role in crises.

Illness Perceptions and Quality of Life in Childhood Cancer Survivors

BACKGROUND

Although illness perception (IP) is a widely recognised factor in the psychosocial adjustment to cancer, little is known about the impact of individual dimensions of IP. This study aims to analyse the relationship between individual dimensions of IP and quality of life (QOL) in childhood cancer survivors.

METHODS

The sample consisted of 163 long-term survivors aged 11 to 25 who were administered the Brief Illness Perceptions Questionnaire and the Minneapolis-Manchester Quality of Life Scale.

RESULTS

In the correlational analysis, all dimensions of IP were associated with individual dimensions of QOL, except for understanding and treatment control. The results of the hierarchical regression analysis controlling for demographic and medical factors showed that IP had predicted individual dimensions of QOL above and beyond these factors, with emotional response, concern, consequences and understanding being the most predictive dimensions. Several age-specific relationships between IP and QOL were also identified.

CONCLUSIONS

Illness perceptions significantly contribute to explaining QOL of childhood cancer survivors above and beyond demographic and medical factors. These results may contribute to more effective targeting of psychosocial interventions promoting QOL of survivors.

Fear of cancer recurrence among adolescent and young adult cancer survivors: a mixed-methods systematic review

PURPOSE

Fear of cancer recurrence (FCR) is common and burdensome in adolescent and young adult (AYA) cancer survivors. This systematic review examines FCR assessment, prevalence, severity, progression, related factors, consequences, and interventions in AYA cancer survivors.

METHODS

Electronic databases including PubMed, CINAHL, PsycINFO, Cochrane, and Embase were searched from their inception to October 2024. Two reviewers identified eligible peer-reviewed empirical studies, including both qualitative and quantitative ones on FCR in AYA survivors. The risk of bias was assessed using the Mixed-Methods Appraisal Tool. Quantitative studies were synthesized narratively, while qualitative studies underwent thematic synthesis.

RESULTS

Among the 5340 studies identified, 34 studies were included finally. 21.4 to 93.3% of AYA cancer survivors experienced FCR. About one-third of survivors with moderate or high FCR improved over time. Female survivors, those with advanced cancer stages, and individuals with negative illness perceptions or higher anxiety reported higher FCR. Persistent FCR was associated with increased psychological problems and lower quality of life. Two studies on behavioral interventions, particularly internet-based cognitive-behavioral therapy (CBT), were acceptable but had limited evidence of efficacy.

CONCLUSION

FCR is prevalent among AYA cancer survivors, particularly in female survivors, those with advanced cancer stages, and those with negative perceptions or higher anxiety. A significant proportion experience persistent, but variability in current evidence limits a comprehensive understanding of its severity, progression, and intervention efficacy. To enhance FCR management, the use of validated assessment tools is essential in both research and clinical contexts. Addressing the physical and psychological aspects of survivorship through comprehensive care is crucial for alleviating FCR and improving overall well-being.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying the key factors of FCR will stimulate the research and the development of targeted interventions for AYA cancer survivors.

The role of changes in metabolic syndrome status on health-related quality of life in Bogor City, West Java, Indonesia: A cross-sectional study

Background

Metabolic syndrome (MetS) is a cluster of chronic conditions, including central obesity, hypertension, impaired glucose metabolism, and dyslipidemia (low HDL, high LDL, and triglycerides). A diagnosis of MetS is made when three or more of these symptoms are present. If left unmanaged, MetS can lead to serious health complications such as cardiovascular disease and type 2 diabetes. Over time, individuals with MetS may experience a decline in their health-related quality of life (HRQoL), especially due to its chronic nature.

Objective

This study aimed to evaluate the effects of changes in MetS status on HRQoL.

Methods

This study employed a cross-sectional design. Secondary data from the cohort study of Non-Communicable Disease (NCD) risk factors, conducted by the Health Research and Development Agency of the Ministry of Health of the Republic of Indonesia in Bogor City, was used. Data from four follow-up periods (2011/2012 to 2017/2018) were analyzed. A total of 874 respondents were selected via total sampling based on inclusion and exclusion criteria. Data were collected in 2021, which included measures of knowledge, health check-ups, and HRQoL using the SF-36 questionnaire. Statistical analyses, including chi-square tests, t-tests, and multiple regression analyses, were conducted to examine the associations between MetS status and HRQoL.

Results

Descriptive analysis revealed that 19% (171 participants) had worsened MetS status, while 80.4% (703 participants) showed improvement. Chi-Square analysis found that respondents with worsening MetS status were 1.6 times more likely to experience poor HRQoL in the physical dimension (95% CI = 1.1-2.3), but no significant effect was found for the mental dimension (PR = 1.1, 95% CI = 0.8-1.6). Multiple logistic regression analysis revealed that comorbidities interacted with worsening MetS status to significantly affect HRQoL in the physical dimension. The adjusted prevalence ratios (PR) were 27.5 (95% CI = 10.3-73.2) for those with comorbidities and 9.2 (95% CI = 5.7-15.0) for those without comorbidities, after controlling for age, mental health, BMI changes, routine health checks, and knowledge.

Conclusion

Changes in MetS status towards worsening have a significant negative effect on HRQoL, particularly in the physical dimension. The presence of comorbidities in individuals with worsening MetS status greatly increases the risk of poor HRQoL. Healthcare professionals and nurses should consider the interaction between MetS and comorbidities in patient management. Nurses are encouraged to monitor HRQoL in patients with MetS, promote education on managing comorbidities, and collaborate across disciplines to enhance patient care and intervention programs aimed at improving HRQoL.

Managing preschool wheeze: a qualitative study of parents' views and experiences

OBJECTIVE

The aim of this study was to explore parents' views and experiences of managing preschool wheeze, including opinions on the use of investigations to inform treatment pathways.

DESIGN

Purposive sampling was used to recruit 16 participants from 14 families across England and Wales. Qualitative data were collected via semi-structured interviews with parents of children aged 1-5 years with preschool wheeze, conducted on Microsoft (MS) Teams. Data were transcribed and analysed using thematic analysis, facilitated by NVivo software package.

RESULTS

Analysis generated four themes: (1) pathway to diagnosis, (2) medication management, (3) living with preschool wheeze and (4) improving preschool wheeze healthcare. Findings suggest a negative impact of preschool wheeze on families' lives, including high levels of worry and limiting capacity for work and travel. Barriers to effective management of preschool wheeze included inconsistent terminologies and diagnostic uncertainty alongside limited education and management support. Other barriers included parental concerns about medications, delayed investigations and challenges with accessing specialist care. Parents were in favour of performing investigations to guide treatment pathways.

CONCLUSION

Parents' views highlight the problem of diagnosing and treating preschool wheeze at multiple system levels. To improve management and ensure that services for children with preschool wheeze are effective, there is an urgent need for consistent terminology, a unified approach to guide investigations and treatments and for upskilling healthcare professionals in primary and secondary care.

Enhancing self-care management among women with type 2 diabetes mellitus

Effective self-care management is essential for optimizing blood glucose control and preventing complications in patients with Type 2 Diabetes Mellitus (T2DM). This study explores the mediating roles of self-efficacy and illness perception in the relationship between social support and health literacy, with self-care management among women with T2DM. A cross-sectional study was conducted among 330 female patients recruited through multistage sampling from nine health clinics in Malaysia. Structural equation modeling (SEM) was used to analyze the relationships between these factors. The results showed that self-efficacy and illness perception significantly enhanced the influence of social support and health literacy on diabetes self-care management. During analysis, SEM model demonstrated a good fit (c2/df = 3.447, CFI = 0.932, TLI = 0.913, RMSEA = 0.086). Illness perception had the strongest direct effect on self-care management (standardized regression value = 0.69), followed by self-efficacy (standardized regression value = 0.31). These findings emphasize the need for targeted interventions in diabetes self-management programs, such as cognitive and behavioral strategies to improve self-efficacy; and patient-centered education to reshape illness perceptions. Integrating psychosocial support into diabetes care policies can also enhance self-care behaviors and improve health outcomes for women with T2DM, emphasizing the importance of a holistic approach in diabetes management.

Perception of risk of frailty among older adults with colorectal cancer: A descriptive phenomenological study

This study, conducted from November 2023 to March 2024 in Harbin, China, explored frailty risk perceptions among 25 elderly colorectal cancer (CRC) patients using qualitative interviews and Colaizzi's method for analysis. Findings reveal that these perceptions change dynamically across different treatment stages, often deviating from medical definitions. Initially optimistic, patients later experienced increased anxiety and confusion about preventive measures. The study highlights the necessity for stage-specific educational interventions to correct misconceptions, enhance program participation, and improve health outcomes.

Help-seeking in A&E for Functional Neurological Disorder (FND): a mixed methods study of patient experiences of a war on two fronts

OBJECTIVE

This mixed-method study aimed to i) describe characteristics of those who attend A&E frequently (FAs) with and without Functional Neurological Disorder (FND); ii) to explore patients' with FND's experiences of help-seeking in A&E.

METHODS AND MEASURES

First, a database of NHS FAs (10+ times in a year; n = 99) from one hospital was analysed. Next, FAs with FND (n = 6) were interviewed about their help-seeking.

RESULTS

From stage 1, 61% of all FAs were female, had visited A&E a mean of 16 times in the past 12 months and had been referred to a wide range of clinics. No significant differences were found between FND (n = 11) and non FND patients (n = 88). In Stage 2, thematic analysis described four main themes: i) 'symptom experience'; ii) 'feelings of isolation'; iii) 'Healthcare Professional (HCP) barriers to care'; iv) 'HCP perseverance'. Transcending these themes was a transition from uncertainty to judgement as patients eventually obtained a diagnosis of FND. Overarching all themes was the sense of FND as a war on two fronts as patients battled both their symptoms and the health care system.

CONCLUSION

Help seeking for FND involves a battle which may be improved by educating HCPs and offering a specialised clinic.

Patient compliance as a mediator between illness perceptions and quality of life among geriatric Chinese patients with type 2 diabetes mellitus: A cross-sectional study

OBJECTIVE

To explore the mediated role of patient compliance between illness perception and quality of life in geriatric Chinese patients with type 2 diabetes mellitus.

METHODS

It was a cross-sectional study and included 302 geriatric patients with type 2 diabetes mellitus. The mediated effect model was employed to investigate the link between illness perception, patient compliance, and quality of life.

RESULTS

A strong positive link between illness perception and quality of life (r = 0.784, P < 0.001), but a significantly negative correlation with patient compliance (r = -0.618, P < 0.001). There was a substantial negative association found between patient compliance and quality of life (r = -0.678, P < 0.001). Patient compliance mediated the influence of illness perception on quality of life, accounting for 22.62% of the overall effect.

CONCLUSION

Improving patient compliance in geriatric patients with type 2 diabetes mellitus should become a priority target.

Illness perceptions as predictive factors for anxiety and depressive symptoms among patients with coronary heart disease

Background

Individuals diagnosed with Coronary Heart Disease (CHD) form specific perceptions about their condition. These illness perceptions (IP) influence several clinical and mental aspects of patients' health outcomes.

Objective

To describe IP in Jordanian patients with CHD and to examine the role of IP domains in predicting anxiety and depressive symptoms in Jordanian patients with CHD.

Methods

In a cross-sectional study, a convenience sample of 193 patients with CHD, who visited the cardiac clinic for routine follow-up, completed the brief illness perception questionnaire and the Hospital Anxiety and Depression Scale.

Results

Participants perceived CHD as a chronic condition with moderate negative consequences and they were highly concerned about their illness. Illness perceptions domains were significantly associated with anxiety and depressive symptoms. Personal control, treatment control, and disease identity were significant predictors of depressive symptoms, while personal control and emotional representation were significant predictors of anxiety symptoms.

Conclusion

Findings indicate that negative illness perceptions are strongly associated with anxiety and depressive symptoms. Study findings suggest that interventions targeting personal control, treatment control, identity, and emotional representation could improve CHD patients' mental well-being.

Perceived injustice and its relation to chronic pain outcome in complex regional pain syndrome and chronic musculoskeletal pain

Objectives

Clinical observations indicate that patients with complex regional pain syndrome (CRPS) tend to ruminate about their illness. Perceived injustice is a negative cognitive-emotional appraisal regarding the severity of loss associated with blame, unfairness, and pain. We investigated injustice beliefs in CRPS compared with chronic musculoskeletal pain (CMP), where previous evidence indicates clinical relevance for pain-related outcome in this patients' group. The role of perceived injustice in relation to pain intensity and disability was tested through a mediation model including catastrophizing thoughts of pain.

Methods

Patients with CRPS (mean age M = 50.9, SD = 13.8) and CMP (mean age M = 53.9, SD = 8.0 years) were enrolled at two independent specialized outpatient clinics. All patients completed questionnaires on pain intensity, pain disability, and perceived injustice, levels of depression and pain catastrophizing.

Results

CRPS patients displayed higher levels of perceived injustice than the CPM patients. Higher pain intensity in both cohorts was indirectly associated with more feelings and beliefs of injustice through a higher tendency to catastrophize about pain and pain-related information. In contrast, only in the CMP group higher pain-related disability was related to higher catastrophizing, which mediated the effect of perceived injustice.

Conclusions

Perceived injustice influences especially pain intensity through pain catastrophizing. This interaction appears to be common for both pain syndromes.

The role and impact of voice physiotherapy: A qualitative study of service user perspectives

BACKGROUND

Physiotherapy has the potential to benefit people with voice and throat problems in conjunction with existing services.

PURPOSE

This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services.

METHODS

An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practice. Transcripts were analyzed with a general inductive approach suitable for qualitative evaluation data. Data were analyzed from six interviews and four main themes emerged, with each theme further characterized by categories.

RESULTS

Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; facilitates individualized specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; Valuable service. Each theme is further illustrated by categories.

CONCLUSION

This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem and facilitating specific management. There is great potential for physiotherapy to benefit voice users. Future research should further evaluate the potential to include physiotherapy in the voice care team and consider how best to capture the broad impacts illustrated.

The relationship between depressive symptoms and coping style on asthma outcomes in older adults

OBJECTIVE

To examine the impact of coping styles in older adults with asthma on the prospective relationship between depressive symptoms and asthma outcomes, and how their perceptions of social support influenced their coping styles.

METHODS

Adults 60 and over with asthma were recruited and interviewed about their experiences of asthma, depression, and other psychosocial factors over three time points (Baseline, 6-month, and 12-month visits). Structural equation models examined the mediating roles of coping styles in the relationship between depressive symptoms (assessed by BDI-II) and asthma outcomes (i.e., asthma control, asthma quality of life, asthma-related distress, asthma-related hospitalizations, and oral corticosteroid use) and the mediating role of perceived social support in the relationship between depressive symptoms and coping style.

RESULTS

455 participants were included in this study. Overall, 33.9% of the study population self-identified as Black and 32.8% as Hispanic. Depressive symptoms at baseline predicted less spiritual coping at 6 months (β =  - 0.15, p = 0.03), more negative coping at 6 months (β = 0.44, p < .0001), and worse asthma outcomes at 12 months (β = 0.31, p < .0001). None of the coping styles significantly mediated the relationship between depressive symptoms and asthma outcomes. Perceived social support mediated the relationship between depressive symptoms and positive coping, such that more depressive symptoms predicted less perceived social support, which in turn resulted in less positive coping engagement (β =  - 0.06, p = 0.03).

CONCLUSIONS

This study demonstrates that in older adults with asthma depressive symptoms impact perceived social support, coping strategy selection (including spiritual coping), and subsequent asthma outcomes.

Coping With a Dead End by Relying on Your Own Compass: A Qualitative Study on Illness and Treatment Models in the Context of Fibromyalgia

Fibromyalgia lacks a coherent illness and treatment model, which includes a set of conceptual ideas shaping individuals' perceptions and understandings of pain, its causing and maintaining factors, and management strategies. Developing personalized illness models that can guide treatment plans and alleviate feelings of uncertainty is of crucial importance. This study investigates how individuals with fibromyalgia develop a personal illness and treatment model while navigating the current healthcare system and explore their experiences during this process. Semi-structured interviews were conducted with 15 cis women with fibromyalgia, which were analyzed using reflexive thematic analysis. The analysis produced two themes, each including two subthemes. The first theme encompassed the difficulty of developing a comprehensive illness model due to the biomedical perspective of the healthcare system; the second theme described the importance of participants (re)gaining ownership and agency over their pain management, by constructing their own illness and treatment model. Most women in this study got stuck in the biomedical healthcare web not being provided with a clear illness and treatment model. Consequently, most women gained ownership of this process by developing their personal illness and treatment model (self-empowerment). Conversely, a few women felt powerless and paralyzed. This study underscores the importance of promoting patient empowerment in chronic pain management. Agency is undervalued in the treatment of fibromyalgia and warrants more thorough examination. Increasing knowledge about agency could enhance treatment effectiveness.

Perceived Importance of Counseling Among Patients Receiving Methadone Treatment

We examined the perceived importance of counseling and its correlates among patients receiving methadone treatment (MT). Participants were 345 patients attending MT who completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate agreement with perceived importance of counseling, opioid use disorder (OUD) illness models, and OUD treatment beliefs. We examined predictors of perceived importance of counseling using hierarchical linear regression; steps 1, 2, and 3 were demographics, OUD illness models, and OUD treatment beliefs, respectively. Most (76%) agreed counseling was important (Mean = 5.6, SD = 1.7). Demographics did not contribute significantly to the regression model, F(4, 340) = 0.88, p > .05). R2 was significant for Step 2 (F = 2.89, p < .05) but individual OUD illness model variables did not make a significant contribution (F(3, 337) = 1.76, p > .05). The addition of OUD treatment beliefs on Step 3 (positive overall treatment expectation, importance of daily methadone, life-saving benefit of methadone medication, and importance of mutual aid) explained an additional 51% of the variation in perceived importance of counseling and this change in R2 was significant, F(4, 333) = 31.17, p < .001. We conclude that most participants perceived counseling to be important and OUD treatment beliefs independently predicted perceived importance of counseling.

Understanding patients' perceptions of uncomplicated low back pain: a theory-informed qualitative study using the Common-Sense Self-Regulation Model

BACKGROUND

Uncomplicated low-back pain (LBP), referring to LBP without symptoms that suggest an underlying medical or surgical cause, is a common and challenging problem for patients and primary healthcare providers. Multiple guidelines discourage the use of diagnostic imaging for uncomplicated LBP due to cost and lack of benefit; despite this, diagnostic imaging remains overused in this condition. Study of primary healthcare providers suggests that patient expectations contribute to imaging for uncomplicated LBP. Dedicated study of patient understanding and experiences of uncomplicated LBP is necessary to design interventions to reduce unnecessary diagnostic imaging.

METHODS

In this theory-guided qualitative study, people with uncomplicated LBP were recruited for a semi-structured interview. The Common Sense - Self-Regulation Model (CS-SRM), a framework that explores the relationship between a patient's perceptions, beliefs, and behaviors around their illness and the outcome of their illness, was selected to direct development of the interview guide and analysis. Higher-level themes were created to list patient-related drivers of unnecessary diagnostic imaging for uncomplicated LBP.

RESULTS

Thirteen participants (7 female) had experienced uncomplicated LBP for a median of 5 years (IQR 2-20 years; range 1 to 30 years). Framework analysis based on the CS-SRM suggested that most participants understood their uncomplicated LBP as a permanent part of their lives, though some felt that the pain could be controlled or prevented. Participants shared a range of coping mechanisms, including social support, medication, and exercises. For most participants, uncomplicated LBP negatively affected their lives emotional wellbeing characterized by a sense of loss from missing life events due to pain. Nearly all participants had visited their primary care physician (n = 11) and most underwent diagnostic imaging (n = 8); however, participants generally reported that they had not requested diagnostic imaging (n = 8). Several participants reported that they wanted validation and symptom-management advice from their physician rather than diagnostic tests.

CONCLUSIONS

In contrast to other studies, we report that most patients with uncomplicated LBP in our setting did not request diagnostic imaging. Patient-facing interventions to address unnecessary diagnostic imaging for uncomplicated LBP may be more effective if they address illness conceptions identified in this study; for example, interventions should convey empathy by acknowledging patient worries, validating suffering, describing potential causes or triggers, addressing self-management strategies, and describing the natural history of uncomplicated LBP.

Self-management behaviors in patients undergoing radical prostatectomy: A structural equation model

PURPOSE

To investigate factors influencing self-management behaviors in post-radical prostate cancer patients' behaviors grounded on the Integrated Theory of Health Behaviour Change and to clarify the interactions among these factors.

METHODS

In a cross-sectional study, 281 patients were recruited at The First Hospital of Wenzhou Medical University in China between December 2023 and April 2024. Illness perception, social support, self-regulation and self-management were assessed through Chinese versions of the Brief Illness Perception Questionnaire (BIPQ), Medical Outcome Study Social Support Survey-Chinese (MOS-SSS-C), Treatment Self-regulation Questionnaire (TSRQ) and The Cancer Patient Self-management Assessment Scale. Structural equations were used to explore the relationship between the four variables.

RESULTS

The final structural model using the Integrated Theory of Health Behaviour Change showed a suitable fit (RMSEA = 0.073, CMIN/DF = 2.482). Illness perception directly affected self-management (β = -0.416, P < 0.05) and indirectly affected self-management through self-regulation (β = 0.269, P < 0.05). Self-regulation directly affected self-management (β = 0.453, P < 0.05). Social support indirectly affected self-management (β = 0.225, P < 0.05). These variables contributed to 62.9 % of the variability in self-management behaviors among patients after radical prostate cancer treatment.

CONCLUSIONS

The present study suggested a model can be useful in better understanding self-management in post-radical prostate cancer patients. Besides, these patients experience bad self-management. Illness perception and social support can affect post-radical prostate cancer patients' self-management directly and indirectly through self-regulation.

Patients' experiences of living with Long Covid and their beliefs about the role of psychology in their condition

Some patients with chronic conditions are unreceptive to a psychological approach. This study aimed to explore the experience of Long Covid (LC) with an emphasis on patients' beliefs about the role of psychology. UK participants (n = 14) with either self-reported or diagnosed LC took part in semi-structured interviews. Thematic analysis described three main themes: 'Living in uncertainty', 'Why should I trust you if you don't believe me?' and 'Once I know the cause people will believe me'. Transcending these themes was a tension between professional experts and experts by lived experience and a dichotomy between psychological and medical explanations. Overarching all themes was a sense that synthesising the biological and psychological components of LC could help to resolve this tension. In summary. living with LC is characterised by feeling disbelieved which can drive the rejection of psychology. Helping patients feel listened to may encourage a more positive approach to psychological support.

Association between area under the curve of oral glucose tolerance test and the risk of preterm birth among women with gestational diabetes mellitus: a mediation effect of gestational weight gain

BACKGROUND

The risk of preterm birth (PTB) is associated with maternal hyperglycemia but differs by combinations of abnormal oral glucose tolerance test (OGTT) values. However, the potential pathway by which maternal hyperglycemia affects PTB is unclear. This study aimed to investigate the association between OGTT-related measures and PTB and evaluate the mediation effect of gestational weight gain (GWG) on the association between maternal hyperglycemia and the risk of PTB in women with gestational diabetes mellitus (GDM).

METHODS

This retrospective cohort study included women with GDM from a women's and children's hospital in Chengdu, China, from December 2021 to December 2023. The associations between OGTT-related measures, GWG, and PTB were evaluated by logistic regression analyses. Two-step clustering was used to classify participants by area under the curve (AUC) of the OGTT. SPSS Process Macro was utilized to explore the mediation effect of GWG on the relationship between AUC and PTB.

RESULTS

This study included 1860 women with GDM, of whom 694 (37.3%) women had higher AUC (≥ 17 mmol/L·h), 935 (50.3%) women had insufficient GWG, and 132 (7.1%) women had PTB. Multivariable logistic regression analyses showed that only higher AUC was associated with increased odds of PTB (OR:1.47, 95% CI:1.03 to 2.10; P = 0.036), and no significant associations between other OGTT-related measures and PTB were observed. Besides, GDM women with higher AUC had a higher risk of insufficient GWG (OR:1.23, 95% CI:1.02 to 1.49; P = 0.033), which was associated with increased odds of PTB (OR:2.15, 95% CI:1.47 to 3.14; P < 0.001). Mediation analyses revealed that the effect of AUC on PTB was mainly mediated through GWG (indirect effect: 0.15, bootstrapped 95% CI: 0.08 to 0.24).

CONCLUSIONS

This study found that AUC of the OGTT was positively associated with the occurrence of PTB, and GWG mainly mediated this positive association. Effective intervention strategies for GDM should pay close attention to avoiding insufficient GWG when managing their blood glucose, especially for those with higher AUC levels, to reduce the impact of maternal hyperglycemia on the risk of PTB.

Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients' and GPs' views and experiences

BACKGROUND

Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care.

AIM

To explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS.

DESIGN AND SETTING

Qualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063).

METHOD

Semi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes.

RESULTS

We found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms.

CONCLUSION

Patients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep.

Prehospital treatment-seeking for acute coronary syndrome in culturally and linguistically diverse immigrant populations: a scoping review

AIMS

Studies consistently report longer prehospital delays in culturally and linguistically diverse (CALD) patients experiencing acute coronary syndrome (ACS). A scoping review was conducted to describe terms and methods used to define and identify CALD populations and summarize available evidence on factors related to prehospital delays in ACS studies involving CALD populations.

METHODS AND RESULTS

We searched six electronic databases for published studies and Google Scholar for grey literature to identify studies on prehospital treatment-seeking in CALD immigrants experiencing ACS. We followed the Joanna Briggs Institute methodological framework for scoping review. Twenty-three studies met our eligibility criteria (quantitative n = 17; qualitative n = 6; mixed n = 1). Terms like ethnicity, migrant, or expatriate defined CALD populations. Most studies used a single indicator (e.g. country of birth) to identify CALD cohorts, and only two studies used a theoretical model related to treatment-seeking delays to guide data collection. Most factors affecting prehospital delays in CALD populations were similar to those reported in general populations. A unique finding was a difference in the language used to describe symptoms, which, when translated, changes their meaning and resulted in misinterpretation by healthcare providers [e.g. asfixiarse (translates as asphyxiate/suffocate) used for dyspnoea/shortness of breath in Hispanics].

CONCLUSION

Terms and methods used for defining and identifying CALD populations are inconsistent. Studies on factors affecting prehospital treatment-seeking in CALD ACS patients are limited. Future studies should use theoretical models related to treatment-seeking delays to comprehensively explore factors affecting prehospital delays. Additionally, researchers should consider self-reported or multiple indicators to determine CALD status.

Cardiovascular Health Behavior Prediction Model in Patients With Type 2 Diabetes

BACKGROUND

To prevent cardiovascular disease in adults with type 2 diabetes, it is necessary to identify the factors that affect cardiovascular health behavior.

OBJECTIVE

The aim of this study was to verify the causal relationship between illness perception and diabetes knowledge as cognitive representations, depression as emotional representations, self-efficacy as cognitive coping, and oral health and cardiovascular health behaviors as behavioral coping strategies. A hypothetical model was established based on a literature review and the self-regulation model.

METHODS

In this study, a cross-sectional survey design was used, and the participants were adults 30 years or older who had been given a diagnosis of type 2 diabetes for more than 6 months and were recruited from South Korea. Data from 272 participants were collected through face-to-face interviews or Google surveys in 2021, and analyzed using SPSS 25.0 and AMOS 22.0.

RESULTS

Oral health behavior (β = 0.26, P < .001) and self-efficacy (β = 0.16, P = .048) had a direct effect on cardiovascular health behavior, and illness perception (β = 0.24, P = .018) and depression (β = -0.25, P < .001) had an indirect effect through self-efficacy (β = 0.24, P = .016), with a total explanatory power of 19.1%. Oral health behavior was directly affected by illness perception and self-efficacy, and self-efficacy was directly affected by illness perception, diabetes knowledge, and depression ( P < .05).

CONCLUSION

To practice cardiovascular health behaviors in adults with diabetes, self-efficacy for diabetes management should be enhanced. To this end, it is necessary to increase illness perception and knowledge, and reduce depression through cardiovascular disease prevention education for them, and the importance of oral health behaviors should also be emphasized.

Intuitive knowing for student nurses

ABSTRACT

"Intuitive knowing" is the ability to understand a clinical case instinctively without the need for conscious reasoning. This article examines the critical role of intuitive knowing in clinical decision-making among nurses, particularly in the context of increasingly complex patient care. Furthermore, the article offers recommendations for nursing educators to cultivate this essential skill in nursing students, ensuring they are equipped to effectively navigate the challenges of modern healthcare environments.

Describing acute coronary syndrome symptom information on social media platforms

BACKGROUND

Social media is a common source of health-related information. However, more clarity regarding ACS symptom information posted on social media is needed.

OBJECTIVES

The objective was to describe ACS symptom information on social media platforms, including Twitter (now named X), Instagram, and TikTok.

METHODS

A cross-sectional, qualitative descriptive design was used. The three social media platforms were searched in 2022 for posts containing ACS symptom information. A random sample of posts meeting inclusion was drawn. Posts were analyzed using a qualitative coding process, and network analysis was used to triangulate data.

RESULTS

Posts (N = 342) included in the final analysis were most often published by healthcare organizations (46.2 %), lay persons (20.8 %), or healthcare professionals (13.7 %). Five key themes were identified: 1) a focus on gendered symptom experiences, 2) diverse types of symptom messages (educational, emphasis on getting help, personal testimony, advertising, diagnostic help, research findings), 3) variety of specific symptoms mentioned, 4) different dimensions of symptoms included, and 5) varying levels of information quality and accuracy. Chest pain was the most common ACS symptom highlighted in posts, and symptom differences between men and women were often emphasized.

CONCLUSIONS

Of particular concern was incorrect or misleading ACS symptom information on social media that could create misconceptions and contribute to delays in seeking care for ACS. The findings from this study provide more insight into the ACS symptom information shared on social media platforms and provide preliminary information that can influence practice and future research.

Early diagnosis of rheumatoid arthritis: associations between patients' perceptions of initial symptoms and the timing of seeking help from the general practitioner

OBJECTIVES

Early diagnosis is essential to the prognosis of rheumatoid arthritis (RA), but little is known about patients' perceptions of the first symptoms. Illness representations shape patients' help-seeking behaviour. The Illness Perception Questionnaire - Revised (IPQ-R) can measure these, allowing us to understand the patients' role in diagnostic delays. The aim of this study was to explore the connection between RA patients' perceptions of initial symptoms and the time taken to seek help from a general practitioner (GP).

METHOD

1163 recently diagnosed individuals with RA, identified from the Danish Rheumatology Database, DANBIO, filled out a questionnaire. We used adjusted multivariable linear regression to calculate the median ratio (MR) for those with the highest scores within each IPQ-R subscale compared to the lowest scores.

RESULTS

Altogether, 404 patients answered the questionnaire. The overall median patient delay was 63 [interquartile range (IQR) 17-214] days. Younger patients experienced longer delays than older [84 (IQR 30-361) vs 54 (14-162) days]. High expectations of treatment control led to 54% lower median time to first GP contact compared to low expectations [adjusted median ratio (MR) 0.54, 95% confidence interval (CI) 0.29-0.99]. High perceptions of symptom variability at disease onset led to a higher median time to first GP contact (adjusted MR 1.61, 95% CI 0.93-2.78).

CONCLUSION

People with RA symptoms may delay seeing their GP due to low expectations of treatment effectiveness and significant symptom variability. Information campaigns could educate patients on recognizing warning signs and encourage them to seek medical attention.

How perceived risk of recurrence strengthens health management awareness in stroke patients: the chain mediating role of risk fear and health literacy

Background

Prior research has found that perceived risk in stroke patients motivates health behaviors in visitors. However, the role that perceived risk of recurrence in stroke patients plays in reinforcing health management awareness during the motivation phase is unclear.

Objective

This study explores this issue by examining the effects of risk fear and health literacy on health management awareness due to perceived risk of recurrence in stroke patients.

Methods

We validated the effect of perceived risk of recurrence on health management awareness and its internal mechanism by constructing a structural equation model and including 763 stroke patients, extending the relevant literature and application of the Healthy Behavior Procedural Approach (HAPA) model.

Result

The results suggest that perceived risk of recurrence in stroke patients can effectively reinforce and improve health management awareness, with risk fear and health literacy having a chain-mediated role in this group relationship.

Conclusion

This study reveals the differential effects of perceived risk of recurrence, risk fear, and health literacy in stroke patients on health management awareness at the individual level, providing valuable guidance for healthcare practitioners and families to improve patients' health outcomes and health well-being.

Determinants of medication adherence in patients with diabetes, hypertension, and hyperlipidemia

OBJECTIVES

To investigate medication non-adherence and its determinants in diabetes, hypertension, and hyperlipidemia.

METHODS

In a multicenter, cross-sectional, non-interventional study, 518 diabetic, 721 hypertensive, and 463 hyperlipidemic patients were recruited, using consecutive sampling, in Greece during the COVID-19 pandemic. Medication adherence was measured with the Adherence to Refills and Medications Scale (ARMS). Multiple linear regressions with robust standard errors investigated the predictors of the ARMS summary score.

RESULTS

Perfect adherence was estimated at 16%, 12%, and 11%, and low adherence at 38.8%, 61.3%, and 66.7% in diabetes, hypertension, and hyperlipidemia, respectively. The factors that significantly increased the likelihood of non-adherence were the following: (a) lower age, female gender, no public health insurance, high perceived threat of illness, low satisfaction with physician consultations, shorter consultations, bad general health, fewer comorbidities, and type 2 diabetes; (b) male gender, not being married, low education, no public insurance, smoking, frequent drinking, shorter consultations, self-perceived inadequacy of knowledge, negative views of medication, presence of comorbidities, fewer medicines being used, and high blood pressure in hypertension; and (c) lower age, not being employed, smoking, frequent drinking, no public insurance, low satisfaction with consultations, negative views of medication, taking 3-4 medicines, high LDL, and low HDL and triglyceride levels in hyperlipidemia. Different curvilinear associations of adherence with BMI and exercise were also found.

CONCLUSION

Medication non-adherence is very common in diabetes, hypertension, and hyperlipidemia. Strategies to improve adherence should consider the different determinants of non-adherence among patient groups.

How face-to-face and online patient-provider communication associate with cervical cancer screening behaviors: The mediating roles of HPV awareness and cancer worry

Cervical cancer screening is a crucial cancer detection measure that can be facilitated by effective patient-provider communication (PPC). This study examined how face-to-face patient-provider communication (FPPC) and online patient-provider communication (OPPC) were associated with cervical cancer screening behaviors through the mediation of human papillomavirus (HPV) awareness and cancer worry. Using data from 3133 women in the Health Information National Trends Survey (HINTS 6, 2022), we applied structural equation modeling to examine our model. Results suggested that FPPC and OPPC positively correlated with screening behaviors. HPV awareness acted as a mediator in the relationship between OPPC and screening behaviors. Cancer worry mediated the association between FPPC/OPPC and screening behaviors but functioned differently: increased FPPC diminished cancer worry, whereas heightened OPPC augmented it. Only OPPC was linked to screening behaviors via sequential mediation of HPV awareness and cancer worry, underscoring the significance of promoting screening through cognition-affect mechanism in the digital era.

Identifying modifiable factors that influence walking in patients undergoing surgery for neurogenic claudication: a prospective longitudinal study

Neurogenic claudication, caused by lumbar spinal stenosis, is the most common reason for spinal surgery in older adults, aiming to improve pain and walking. However, most people do not increase walking post-operatively. This study aimed to identify modifiable physical and psychosocial factors that could be targeted with rehabilitation. A prospective longitudinal study recruited 97 adults, aged > 50 years, awaiting surgery for neurogenic claudication. Walking measures (six-minute walk test, daily step count, self-rated maximum walking distance) were assessed pre-surgery and 12-weeks post-surgery. Modifiable variables, mapped to a behaviour change model (COM-B; e.g. falls, lower limb performance, fear of movement, illness perceptions), were evaluated using mixed-effects regression models. All walking measures demonstrated statistically significant improvements (p < .001). However, 50% did not achieve minimum clinically important differences. The strongest correlation with post-operative walking was pre-operative walking. Cross-sectionally, lower limb performance (b:.75; 95CI .64, .86 to b:.35; 95%CI .19, .52), pre-surgery history of falls (b:-.29; 95%CI-.44,-.13), fear of falling (b:-.55; 95%CI-.69,-.41 to b:-.32; 95%CI -.48, -.15), fear of movement (b:-.48; 95%CI-.63,-.33 to -.22; 95%CI -.40, -.03), coherence of condition (b:-.23; 95%CI -.41, -.05 to b:-.17; 95%CI-.33,-.01) and perceived personal control (b:.26; 95%CI .09, .43 to b:.14; 95%CI.02,.31), were significantly associated with pre-surgical walking (p < .05). Most pre-surgical variables were not longitudinally associated with change in walking post-surgery. Six-weeks post-surgery fear of falling (b:-.35; 95%CI -.57, -.13 to b:-.18; 95%CI-.33,-.02), fear of movement (b:-.32; 95%CI-.53,-.11 to b:-.19; 95%CI -.33, -.05), and emotional response (b-.24; 95%CI -.38, -.11 to b:-.22; 95%CI -.41, -.03) were significantly associated with less improvement in walking at 12-weeks post-surgery. Prehabilitation and post-operative rehabilitation targeting walking, balance, and psychosocial factors is recommended to optimise post-surgical walking.

Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support

PURPOSE

Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress.

METHODS

The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression.

RESULTS

Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (β =  - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (β =  - .11, p < .05).

CONCLUSION

Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.

Risk of somatic symptom disorder in people with major medical disorders: Cross-sectional results from the population-based Hamburg City Health Study

BACKGROUND

Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, emotions, and behaviors related to physical symptoms irrespective of their etiology. Estimates of SSD frequency assessed via self-report questionnaires range between 6.7% (general population) and 53% (specialized setting). This study aims to examine the frequency of risk of SSD and associated factors in people with Major Medical Disorders (MMD) using cross-sectional data from the population-based Hamburg City Health Study.

METHODS

Risk of SSD was operationalized using the Somatic Symptom Scale-8, the Somatic Symptom Disorder-B Criteria Scale-12, and one item on symptom persistence. People at risk of SSD and not at risk were compared regarding biopsychosocial factors. Factors associated with risk of SSD were identified by hierarchical multiple logistic regression analysis.

RESULTS

N = 1944 people (mean age 64.8 ± 8 years, 43.8% female) reported at least one MMD. Of those, 6.8% [95%, CI 5.6-7.9%] were at risk of SSD and reported greater healthcare utilization and lower health-related quality of life. Logistic regression identified higher age (p=.032), lower education (p=.002), number of somatic comorbidities (p<.001), and elevated neuroticism (p<.001) and depression (p<.001) scores as factors associated with risk of SSD, with an explained variance of Nagelkerke R2=0.45.

CONCLUSION

The observed frequency of risk of SSD in people with MMD does not point towards an excessive symptom burden in this sample. However, those at risk experience significant psychosocial burdens and increased healthcare utilization, highlighting a vulnerable subgroup prone to SSD.

How symptom distress mediates the relationship between individual differences and perceived controllability among women with gynecologic cancer

PURPOSE

This study aims to investigate the individual differences in perceived controllability among women with gynecologic cancer who are undergoing chemotherapy. We also examined the mediating effect of symptom distress on the relationship between individual differences and perceived controllability.

METHODS

This cross-sectional study employs purposive sampling; data were collected via self-reported questionnaires. In total, 170 women completed the survey. Structural equation modeling was used to examine the proposed hypotheses of the mediating effect of symptom distress.

RESULTS

Results revealed that individual differences in age (r = -0.20, p < .05), education (t = -2.24, p < .05), employment (t = -2.05, p < .05), cancer stage (t = 2.35, p < .05), and number of chemotherapy sessions in the past three months (r = -0.16, p < .05) were significantly associated with perceived treatment control. Physical, but not psychological, symptom distress fully mediated the relationship between individual differences and perceived controllability. Participants who perceived financial distress (β = 0.179, p < .05) and those who had undergone a higher number of chemotherapy sessions within the past three months (β = 0.216, p < .05) experienced greater physical symptom distress. Additionally, those who experienced greater physical symptom distress perceived lower personal control (β = -0.199, p < .05) and treatment control (β = -0.217, p < .05).

CONCLUSIONS

Understanding the mediating effects of symptom distress on the relationship between individual differences and perceived controllability can enhance our knowledge of the mechanisms of illness acceptance, which significantly contributes to illness adaptation among women with gynecologic cancer.

Coping in the Danish general population: psychometric properties of the Danish version of the Brief Approach/Avoidance Coping Questionnaire

OBJECTIVE

To enable measurement of coping in the general Danish population the aims of this study are to 1) describe the translation and cultural adaption of the Danish Brief Approach/Avoidance Coping Questionnaire (BACQ) and 2) investigate the psychometric properties of the Danish BACQ.

DESIGN

The BACQ was translated and adapted into Danish, and the psychometric properties tested in two samples of adult Danish citizens: Sample A = 167, used for exploratory factor analysis (EFA), and Sample B = 330 persons, used for confirmatory factor analysis (CFA). Internal consistency was evaluated by Cronbach's Alpha, item-to-rest correlation, and scale-to-scale Pearson correlation.

RESULTS

The EFA suggested reasonable fits for both a three-factor and four-factor model, confirmed by the CFA with acceptable goodness-of-fit indices for both models. Using the four-factor-model would require a re-evaluation of the scale. The three-factor model had admissible internal consistency with an overall Cronbach's alpha of 0.66. Individuals with low self-rated health, extreme concern about current health and poor physical fitness, respectively, had lower Approach and higher Diversion and Resignation scores.

CONCLUSION

The psychometric properties showed that the Danish BACQ could be used as a three-factor model. With some limitations, the Danish version had acceptable construct validity, internal consistency, and content validity.

Asthma beliefs and overuse of short-acting beta-adrenergic receptor agonists among older adults

OBJECTIVE

Short-acting Beta-adrenergic Receptor Agonists (SABA) carry a risk of worse asthma outcomes when overused. Beliefs about asthma controller medications are associated with medication-taking behaviors in older adults, but the association of medication beliefs with SABA use has not been previously examined. We aimed to investigate the association of asthma and controller medication beliefs with SABA use among older patients with asthma.

METHODS

We performed a cross-sectional analysis of data on adults ≥ 60 years old with moderate to severe asthma in New York City, NY (n = 234). SABA overuse was defined as the average of ≥1 inhalation per day and controller medication adherence as ≥80% of expected inhalations, measured electronically. Illness and medication beliefs were measured using the Brief-Illness Perception Questionnaire and Beliefs about Medications Questionnaire, respectively. The associations of medication-taking behaviors with beliefs were examined in multivariable logistic regression models.

RESULTS

The mean age was 67.6 ± 6.5 years, 84% were female, 26% were Black and 53% were Hispanic. 35% of participants overused SABA and 21% had adequate controller medication adherence. Overuse of SABA was not significantly associated with controller medication beliefs (Necessity: odds ratio [OR] 1.04, 95% confidence interval [CI] [0.97-1.12], p = 0.28, Concerns: OR 0.95 [95% CI 0.88, 1.03], p = 0.23) or asthma beliefs (OR 1.06 [95% CI 0.99, 1.15], p = 0.11). SABA overuse was also not significantly associated with controller medication adherence (OR 2.20 [95% CI 0.88, 5.51], p = 0.09).

CONCLUSIONS

SABA overuse was common among older adults with asthma and was not significantly associated with asthma controller medication or illness beliefs.

Perceiving immunity, predicting somatic symptoms: Validation of the 'Perceived Immunity' scale and its association with daily health

OBJECTIVE

While ample research links health beliefs to physical health in both healthy and clinical populations, the specific health beliefs that drive this effect remain underexplored. Addressing this gap is critical for mechanistic examinations and targeted intervention development. Building on previous work, this study aimed to assess subjective beliefs about immune system efficacy and develop a novel Perceived Immunity scale.

METHODS

Across three studies (total N = 378; Study 1: N = 206 healthy; Study 2: N = 132 healthy and N = 40 with immune-related diseases; and Study 3: subset of N = 87 from Study 2), we examine Perceived Immunity scale's validity, reliability, and association with everyday physical health.

RESULTS

Perceived immunity demonstrated excellent internal consistency (Cronbach alpha = 0.9), strong construct validity (all items were loaded onto one factor) and structural validity, including convergence validity with scales assessing subjective health perceptions, and discriminant validity from scales measuring external health control. These findings were replicated across different cohorts. Furthermore, regression analyses revealed significant correlations with daily physical health measures, specifically somatic symptoms, across cohorts (all β > -0.347, all p < .001) and sick leave days (all β = -0.174, all p < .045). These associations were stronger in individuals with immune-related conditions. Finally, Perceived Immunity exhibited good test-retest reliability (interclass correlation coefficient = 0.74) and prospectively predicted somatic symptoms over time (β = -0.324, p = .002), with significant results observed up to 1 year.

CONCLUSIONS

The Perceived Immunity scale offers a valuable tool for researchers and health care providers, providing insights into the interplay between specific health beliefs and daily health. Furthermore, its validation lays the groundwork for targeted interventions that explore how health perceptions may directly influence actual physical experiences.

Beliefs About the Causes of Alzheimer's Disease Among Latinos in New York City

Latinos face health disparities in Alzheimer's disease (AD), with high disease prevalence relative to non-Latino whites and barriers to healthcare access. Several studies have found misconceptions about AD among Latinos that were linked to reduced preventative or help-seeking behavior. To improve understanding of illness perceptions among Latinos, we examined beliefs about the causes of AD, one of the five dimensions of illness representations from Leventhal's Self-Regulation Theory, among a sample of N = 216 Latinos. We conducted in-depth, semi-structured interviews with participants aged 40 to 64 (average age 53 years) living in northern Manhattan. Seven distinct causes of AD were identified, though participants demonstrated a general understanding of AD as a multifactorial disease. Genetics was found to be the most endorsed cause of AD, followed by unhealthy lifestyle factors. Most Latinos who believed psychosocial factors played a critical role in AD development were first-generation immigrants. No participants attributed AD to a normal process of aging, and few ascribed the disease to brain damage from stroke or head injuries. Several participants expressed the belief that environmental contaminants can cause AD, which has received little mention in prior studies. Though only a small number thought AD could occur by chance, most participants remained uncertain about the exact causes of the disease and used lay knowledge to explain their beliefs. Our findings help identify areas where educational interventions would be beneficial in improving community knowledge and offer perspectives that can foster cultural competency in healthcare.

Relevance of the common-sense model for people living with a genetic predisposition for breast and ovarian cancer

OBJECTIVES

BRCA1/2 pathogenic variants have been associated with an increased risk for breast, ovarian, pancreatic, prostate cancer as well as melanoma. The present research uses the Leventhal's common-sense model of self-regulation (CSM), a theoretical framework highlighting the role of mental representations on responses to a health-threat. We aim at understanding the personal meaning and representation of living with an hereditary breast and ovarian cancer predisposition.

METHOD

Semi-structured interviews of 15 BRCA carriers were analysed using the interpretative phenomenological analysis.

RESULTS

Mental representations develops in childhood and are influenced by childhood emotional responses to the familial experience of the BRCA predisposition. Pre-existing beliefs about BRCA, even erroneous, are deeply anchored and not called into question by medical informations given during the genetic counselling. This is particularly true when medical information is perceived as too complex, inconsistent or in contradiction with familial experience. These beliefs about the consequences of being carriers of the BRCA gene influence emotional and behavioural experiences leading to experience fear, anxiety, lack of hope for future or self-identity change. For participants with a traumatic familial experience of cancer, the lack of treatment for this genetic disease generates a perpetual overestimation of cancers' risk and the feeling of an unending danger associated with early death despite breast and ovarian prophylactic surgery. When strong negative representations of the BRCA predisposition are experienced, dysfunctional health behaviours, such as drugs consumption or overuse of medical consultations, could appear consecutively to emotional disorders.

Illness perceptions, symptom severity and psychosocial outcomes in adults with dysfunctional breathing

BACKGROUND

People with dysfunctional breathing (DB) experience symptoms such as air hunger and breathing pattern irregularities. The condition is often comorbid with other respiratory conditions, as well as anxiety and depression. Illness perceptions, the beliefs an individual has of an illness may explain health and wellbeing outcomes.

METHODS

In this cross-sectional study we examined the illness perceptions of those diagnosed with DB, symptom severity, and psychosocial outcomes of depression, anxiety, and impact on daily living. Data were analyzed using tests of comparison and regression analysis.

RESULTS

82 people diagnosed with DB completed the brief illness perception questionnaire, the Nijmegen symptoms questionnaire, and questionnaires measuring mood and impact on daily living. The illness perceptions of those with DB were overall negative. There was a positive correlation between illness perceptions and mood, indicating that the stronger the beliefs that individuals had that DB is a serious condition, the more negative their mood. Illness perceptions significantly predicted psychosocial outcomes, even when controlling for demographic factors and symptom severity (depression: adj. R2=.352, F(10,51)=4.32, p<.001; anxiety: adj. R2=.40, F(11,47)=4.55, p<.001; impact on daily living: adj. R2= .33, F(8,53)=4.79, p<.001).

CONCLUSIONS

This is the first study to examine illness perceptions held by those diagnosed with DB. Our study found significant relationships between illness perceptions and psychosocial outcomes. It is possible that psychological interventions that target illness perceptions may also improve outcomes.

Analysis of the characteristics and illness comprehension bias among Chinese patients with psycho-cardiovascular disease: a multi-centre cross-sectional survey

Background

Psychological distress, such as depression and anxiety, impacts cardiovascular disease (CVD) prognosis and management. Illness comprehension is essential for effective treatment, but biases can lead to suboptimal outcomes. We explored psycho-cardiovascular disease (PCD) patient characteristics, with a specific focus on comprehension biases and treatment choices from patients' perspectives in China, to improve management strategies.

Methods

We enrolled 864 PCD patients in Chinese hospitals across 11 provinces. Tools included the seven-item General Anxiety Disorder scale, the nine-item Patient Health Questionnaire, and a self-designed PCD illness comprehensibility survey. We used χ2 test, univariate, and multivariate logistic regression to examine patient characteristics.

Results

Of 834 enrolled PCD patients, over 90% experienced mild to moderate anxiety and depression, yet less than 10% received treatment. 52.90% of patients had high illness comprehension. Among the high comprehension group, there were fewer labourers (19.30% vs. 26.40%; P < 0.05), fewer older individuals (39.20% vs. 46.90%; P < 0.05), and those with lower household income (15.60% vs. 30.50%; P < 0.05). A greater proportion of those in the high comprehension group lacked insurance (17.50% vs. 10.00%; P < 0.05), and they were more highly educated (42.90% vs. 32.10% with a college education). Additionally, more patients in the high comprehension group frequently received psychological consultation (24.00% vs. 5.10%; P < 0.05) and therapy (7.70% vs. 2.30%; P < 0.05). These patient groups preferred tertiary hospitals (71.66% vs. 63.33%; P < 0.05) and psycho-cardiovascular clinics (40.14% vs. 25.90%; P < 0.05). In comparison, low comprehension patients prioritised cost (32.65% vs. 46.41%; P < 0.05) and favoured a transition to community hospitals (16.55% vs. 25.38%; P < 0.05).

Conclusions

More than 90% of PCD patients in Chinese CVD departments experience mild to moderate anxiety and depression with low treatment rates. Different illness comprehension levels are associated with variations in treatment willingness, considerations, health care preferences, medication choices, and illness knowledge acquisition methods.

The PainSMART project: Protocol for a research program on effectiveness, mechanisms of effect and patient-practitioner experiences of the PainSMART-strategy as an adjunct to usual primary care physiotherapy management for musculoskeletal pain

BACKGROUND

Musculoskeletal pain (MSKP) disorders entail a significant burden for individuals and healthcare systems. The PainSMART-strategy has been developed aiming to reduce divergences between patients and healthcare practitioners in their understanding of MSKP by providing a shared basis for communication and to facilitate patients' self-management of MSKP. The objective of the PainSMART-project is to evaluate the effects of the PainSMART-strategy as an adjunct to usual physiotherapy management compared to usual physiotherapy management alone.

METHODS

The PainSMART-project is a research program with a collective suite of studies utilising mixed methods, centred around a randomised controlled trial (ClinicalTrials.gov NCT06187428). Subjects: Adults (18 years or older) seeking primary care for MSKP who are triaged and booked for an initial physiotherapy consultation at five primary care physiotherapy departments within the Swedish public healthcare regions of Östergötland and Jönköping. A total of 490 subjects will be randomised to receive one of two possible interventions.

INTERVENTIONS

Both groups will receive usual physiotherapy management for benign MSKP. The intervention group will also receive the PainSMART-strategy consisting of an educational film, reflection and reinforcement of the film's key messages prior to the initial physiotherapy consultation and a patient-practitioner discussion based on the film.

OUTCOME

The primary outcome is 1) between group mean change over time from baseline to 24 hours post initial physiotherapy consultation and baseline to 3 months regarding self-reported average pain intensity and pain self-efficacy. Secondary outcomes include similar measurements for MSKP illness perception, reassurance of benign nature, pain coping, physical activity, analgesic medication use, sick leave, healthcare use and direct healthcare costs. Physiotherapist and patient reported experience measures and qualitative evaluation of the effects of the PainSMART-strategy on communication at the initial physiotherapy consultation will also be explored.

DISCUSSION

This study will investigate potential added effects of PainSMART-strategy upon usual primary care physiotherapy for MSKP.

Patient perceptions of persistent symptoms after mild traumatic brain injury and their influence on mental health treatment-seeking: a grounded theory study

PURPOSE

Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated. According to the Common Sense Model of Self-Regulation, the way patients perceive their health conditions can influence the way they manage them, including if, when, and how they seek treatment. This study explored how individuals perceive persistent symptoms after mTBI, in order to develop a grounded theory about what motivates and demotivates them to seek mental health treatment after their injury.

METHODS

Seventeen adults experiencing persistent symptoms after mTBI participated in semi-structured interviews, which were analyzed using constructivist grounded theory.

RESULTS

An explanatory model of patient perceptions was developed with three interrelated categories: (1) Symptom persistence and uncertainty result in life challenges; (2) Self-advocating for answers through extensive treatment-seeking; preference for biomedical treatment; (3) Mental health problems are caused by symptom persistence, therefore mental health treatment is supplementary.

CONCLUSION

Findings suggest a potential barrier to seeking mental health treatment during complicated mTBI recovery: if patients do not consider mental health as an important cause of their ongoing symptoms, they may feel less motivated to prioritize mental health treatment.

Symptom representations in people with multimorbidity undergoing treatment for cancer: a qualitative descriptive study

PURPOSE

The symptom representations (i.e., beliefs and attitudes) that people with cancer hold about their symptom experience can impact how they self-manage their symptoms. Having two or more chronic conditions (multimorbidity) can complicate illness representations. Little is known about symptom representations in people with cancer and multimorbidity.

METHODS

This qualitative descriptive study was conducted with a sample of adults with a diagnosis of cancer and at least one additional chronic condition. Semi-structured interviews were conducted to understand their symptom representations. Leventhal's Common-Sense Model of Illness Representations (i.e., identity, consequences, cure/control, timeline, and cause) provided the guiding framework. A qualitative thematic analysis was used to identify codes, themes, and subthemes.

RESULTS

The mean age of the participants (n = 17) was 62.1 years and primary cancer sites were gastrointestinal, thoracic, or head/neck. Five themes were identified: (1) perceiving and living with symptoms, (2) being unable to do things, (3) self-management behaviors, (4) domino theory, and (5) a side effect of conditions. These themes aligned with Leventhal's Common-Sense Model dimensions. The interaction among diagnoses and multimorbidity was identified by a minority of participants.

CONCLUSION

People with cancer and multimorbidity described symptom representations primarily in the context of cancer. Consistent with previous research, symptoms negatively impacted their lives, and their representations include an understanding of how symptoms interact. Few participants described their symptoms within the larger context of multimorbidity. Future research is needed to determine how symptom representations impact their communication patterns with providers and coping behaviors.