Linda D. Cameron

Changing Illness Perceptions After Myocardial Infarction: An Early Intervention Randomized Controlled Trial

Objective This study was designed to examine whether a brief hospital intervention designed to alter patients’ perceptions about their myocardial infarction (MI) would result in a better recovery and reduced disability. Design In a prospective randomized study, 65 consecutive patients with their first MI aged were assigned to receive an intervention designed to alter their perceptions about their MI or usual care from rehabilitation nurses. Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital. Results The intervention caused significant positive changes in patients’ views of their MI. Patients in the intervention group also reported they were better prepared for leaving hospital (p < .05) and subsequently returned to work at a significantly faster rate than the control group (p < .05). At the 3-month follow-up, patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects (14.3 vs. 39.3, p < .03). There was no significant differences in rehabilitation attendance between the two groups. Conclusions An in-hospital intervention designed to change patients’ illness perceptions can result in improved functional outcome after MI.

Values and their Relationship to Environmental Concern and Conservation Behavior

Recent research has examined the relationship between values and attitudes about environmental issues. Findings from these studies have found values of self-transcendence (positively) and self-enhancement (negatively) to predict general concern for environmental problems. Other recent findings have differentiated between environmental attitudes based on concern for self (egoistic), concern for other people (social-altruistic), and concern for plants and animals (biospheric).This article reports the results from a study of the relationship between values and environmental attitudes in six countries: Brazil, Czech Republic, Germany, India, New Zealand, and Russia. Results show strong support for the cross-cultural generalizability of the relationship between values and attitudes and on the structure of environmental concern. In addition, analyses of the relationship between values and environmental behavior show evidence for norm activation only for self-transcendence; results for self-enhancement show a consistently negative relationship.

Behavioral theories and the problem of compliance

Abstract Capsule presentations are given of the 5 major theoretical approaches to compliance research (Biomedical; Behavioral — Operant and Social Learning; Communication; Rational Decision — Health Belief and Reasoned Action; Self-Regulative Systems) and brief summaries made of their respective contributions and deficits. Suggestions are made for integrating the Biomedical, Behavioral and Rational Decision models into the Self-Regulative Systems Model. The advantages for doing so include completeness of understanding and improved interventions; better integration of the natural history of illness with the individuals perception, understanding, and strategies for coping with illness; recognition of the separate contributions of automatic (habitual) and deliberative (reasoned) determinants of compliance; and the possibility of taking into account the uniqueness of individual understanding of illness and individual patterns of coping with illness. It is also suggested that the self-regulative approach helps to organize insights into the differences between compliance to behavioral measures for prevention and compliance to behavioral measures for cure.

Symptom representations and affect as determinants of care seeking in a community-dwelling, adult sample population.

The cognitive and emotional determinants of health-care utilization were assessed for middle-aged and older adults matched on age, gender, and health status. Both members of a pair were interviewed when either initiated a medical visit. Interviews were based on a self-regulatory model that assumed that Ss would use symptoms to create and update representations and coping procedures. Care seekers reported more symptoms than did matched controls but did not report more symptoms than did matched controls with new symptoms. The mere presence of atypical symptoms was insufficient to trigger care seeking. Care seeking is driven by well-developed representations of a serious health threat, perceptions of inability to cope with the threat, advice to seek care, and life stress.

Expression of stressful experiences through writing: effects of a self-regulation manipulation for pessimists and optimists.

This study assessed the effectiveness of a writing task designed to foster self-regulatory coping with stressful experiences to reduce medical clinic visits and to promote adjustment. Students entering college (N = 122) who were classified as optimists or pessimists by using a dispositional optimism measure participated in a self-regulation task (expressing thoughts and feelings about entering college and then formulating coping plans), a disclosure task (expressing thoughts and feelings only), or a control task (writing about trivial topics) for 3 weekly writing sessions. Among optimists, both the self-regulation task and the disclosure task reduced illness-related clinic visits during the following month; among pessimists, only the self-regulation task reduced clinic visits. In general, the self-regulation task beneficially affected mood state and college adjustment whereas the disclosure task increased grade point averages.

Seeking medical care in response to symptoms and life stress.

Analyses tested the following contrasting hypotheses:a) The occurrence of a new symptom in the presence of ongoing life stress increases the attribution of symptoms to illness and increases the use of health care; b) new symptoms occurring in the presence of ongoing life stress are attributed to stressors if they are ambiguous indicators of illness, and they are unlikely to motivate care-seeking if the stressor, i.e., the perceived cause, is of recent onset. The 43-to-92-year old subjects in this longitudinal study were less likely to seek care for the ambiguous symptoms they experienced during the previous week if there was a concurrent life stressor that began during the previous 3 weeks; these symptoms were attributed to stress rather than to illness, and subjects tolerated the emotional distress caused by the combination of a stressor and an ambiguous symptom. Subjects were less willing to tolerate the combined distress of an ambiguous symptom and a concurrent life stressor if the stressor onset was not recent; under such conditions, subjects were more likely to seek health care. Current life stressors did not affect care-seeking for symptoms that were clear signs of disease; these symptoms were readily identified as health threats in need of medical attention. The findings contribute to a better theoretical understanding of how individuals perceive their physical states and how they cope with stress. Practical implications of these findings for increasing efficient use of health care services are also discussed.

Illness representations and matching labels with symptoms.

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subjects daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.

A CROSS-CULTURAL STUDY OF ENVIRONMENTAL MOTIVE CONCERNS AND THEIR IMPLICATIONS FOR PROENVIRONMENTAL BEHAVIOR

Environmental concern can be driven by biospheric, egoistic or altruistic motives. Few studies, however, have compared these three environmental motive concerns across cultural groups. This study investigated differences between European New Zealanders and Asian New Zealanders in environmental motive concerns and their implications for proenvironmental behaviors. The results demonstrated that the tripartite model of environmental concerns provided good fit in both samples. They also indicated that Asian New Zealanders were significantly higher than European New Zealanders on egoistic concern, whereas European New Zealanders were significantly higher on biospheric concern. For European New Zealanders, biospheric concern predicted proenvironmental behavior positively, whereas egoistic concern predicted it negatively. For Asian New Zealanders, in contrast, both biospheric and altruistic concerns predicted proenvironmental behavior positively. The implications of these findings for environmental education campaigns are discussed.

TRAIT ANXIETY, SYMPTOM PERCEPTIONS, AND ILLNESS-RELATED RESPONSES AMONG WOMEN WITH BREAST CANCER IN REMISSION DURING A TAMOXIFEN CLINICAL TRIAL

Postmenopausal women with breast cancer in remission (N = 140) who were participating in a randomized clinical trial of tamoxifen chemoprevention therapy completed measures of trait anxiety, symptoms, cancer worry, and breast self-examinations (BSEs) during the first 6 months of the trial. Trait anxiety was associated with heightened sensitivity to tamoxifen-induced symptoms (but not with tendencies to report increases in symptoms unrelated to tamoxifen use), greater tendencies to attribute symptoms to tamoxifen use, and greater cancer worry. Tamoxifen use increased BSE rates among high-anxiety participants. For low-anxiety participants, tamoxifen use increased cancer worry but not BSE rates. Trait anxiety appears to be associated with vigilant activation of illness-related representations that trigger attentiveness to sensations, worry, and protective coping in response to somatic cues.

Responses to Information about Psychosocial Consequences of Genetic Testing for Breast Cancer Susceptibility: Influences of Cancer Worry and Risk Perceptions

We assessed the impact of information about psychosocial consequences of genetic testing for breast cancer susceptibility on interest in and beliefs about genetic testing, and whether these effects vary by levels of either cancer worry or perceived cancer risk. Women (N = 180) in an experimental study were randomly assigned to read one of four messages consisting of standard information along with information about either psychosocial advantages, potential disadvantages, both advantages and disadvantages, or no additional information. Women receiving only standard information reported higher interest in obtaining genetic testing than did women who received additional information about advantages, disadvantages, or both advantages and disadvantages. Cancer worry (but not perceived risk) predicted greater interest and more favorable beliefs about the benefits of testing. Beliefs that testing causes emotional distress were positively associated with worry and negatively associated with risk perceptions.