Representations of illness: patient satisfaction, adherence and coping
Chapter I evaluates the self-regulatory model and other theoretical frameworks which have informed the six empirical studies described in this thesis. Chapter 2 reviews the literature on patients' satisfaction with care, adherence to treatment recommendations and coping with chronic illness. It highlights omissions in the literature which are addressed by the current research. Chapter 3 provides a systematic description of people's representations of 37 different illnesses and examines the basis on which these illnesses are categorized. It was found that beliefs about symptoms, typical sufferer, and treatment were particularly important in discriminating between different illnesses. Using data from interviews with patients visiting their GP (pre- and post-consultation), chapter 4 explores the relationship between patients' representations of their illness, and satisfaction and intentions to follow treatment recommendations. It was found that doctor-patient discrepancies about diagnosis and treatment were the sole predictors of satisfaction, but were not related to intentions. In a follow-up study, chapter 5 investigates the predictors of satisfaction and adherence two weeks after the consultation. Several factors were found to predict satisfaction at time 2, but doctorpatient discrepancies were no longer related to ratings of satisfaction. Belief in the benefits of treatment was the principal predictor of adherence. The primary aim of the two studies described in chapter 6 was to produce a shorter version of the 60-item COPE suitable for assessing coping in patients. The 32-item measure demonstrated construct validity with the longer version and acceptable internal reliability. Chapter 7 explores the relationship between the different stages of the self-regulatory model in diabetic and hypertensive patients. It was found that beliefs about the costs and benefits of treatment were the principal predictors of dietary and exercise adherence. As predicted, strong relationships were found between patients' illness representations, coping strategies and appraisal of functioning. The final chapter surnmarises the findings of the research and concludes that the self-regulatory model is a useful too] for understanding people's responses to illness and adaptation to chronic illness. SuggestionsN verem ade regarding ways in which the self-regulatory model might be extended to incorporate other conceptually compatible models. Theoretical, methodological and practical implications are discussed.
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