Loss of control, self-blame, and depression: an investigation of spouse caregivers of Alzheimer's disease patients

What is a health expectation? Developing a pragmatic conceptual model from psychological theory

INTRODUCTION

Examination of the existing literature in respect of health expectations revealed both ambiguity in relation to terminology, and relatively little work in respect of how abstract theories of expectancy in the psychological literature might be used in empirical research into the influence of expectations on attitudes and behaviours in the real world. This paper presents a conceptual model for the development of health expectations with specific reference to Alzheimer's disease.

METHOD

Literature review, synthesis and conceptual model development, illustrated by the case of a person with newly diagnosed, early-stage Alzheimer's disease, and her caregiver.

OUTCOME

Our model envisages the development of a health expectation as incorporating several longitudinal phases (precipitating phenomenon, prior understanding, cognitive processing, expectation formulation, outcome, post-outcome cognitive processing).

CONCLUSION

Expectations are a highly important but still relatively poorly understood phenomenon in relation to the experience of health and health care. We suggest a pragmatic conceptual model designed to clarify the process of expectation development, in order to inform future research into the measurement of health expectations and to enhance our understanding of the influence of expectations on health behaviours and attitudes.

The relative importance of dispositional optimism and control appraisals in quality of life after coronary artery bypass surgery

Similar mechanisms have been proposed to explain the stress-buffering effects of both dispositional optimism and perceived control. Yet dispositional optimism as a personal resource should function independently of situational control appraisals. To evaluate the unique and additive contributions to adaptation of control appraisals and optimism, we followed 49 individuals scheduled for coronary artery bypass surgery. One month before surgery dispositional optimism was associated with neither health locus of control nor specific expectancies about the outcomes of surgery. Dispositional optimism, however, was associated with perceived control over the course of the illness and with quality of life appraisals. Although presurgery optimism predicted life quality 8 months after surgery, this was not the case when general and specific control appraisals and specific expectancies were included in the prediction. These findings are discussed as they relate to current conceptions of trait optimism.