Illness perceptions in long-term conditions: examining differences within couples and the role of optimism
PURPOSE: The systematic review aimed to explore whether there were significant differences between patients’ illness perceptions and their spouses’ or partners’ illness perceptions and on what specific illness perception dimensions these differences exist. The empirical study aimed to explore the relationships between threat-related illness perceptions, optimism, problem-focused coping and demographic variables. The particular illness perception dimensions of interest were the illness consequences, illness identity and illness timeline dimensions. Specifically, the empirical study aimed to understand if optimism moderated the relationship between threat-related illness perceptions and problem-focused coping when controlling for age. METHODS: A systematic literature search was conducted across multiple electronic databases in order to identify studies that reported results from quantitative statistical analyses analysing the differences between patients’ and their spouses’ or partners’ illness perceptions. Methodological quality of the included studies was assessed by the application of quality criteria and the results from the studies were discussed in the context of methodological quality. For the empirical study, 93 participants were recruited from an NHS Cardiac Rehabilitation service. They completed self-report measures assessing illness perceptions, optimism, problem-focused coping and demographic variables online or by telephone. Correlational and moderation analyses were used to explore the relationships between variables. RESULTS: Twelve studies met eligibility criteria and were included in the systematic review. There were significant differences between patients and spouses/partners, particularly on the illness control dimension. This finding was supported by the most consistent and methodologically strong evidence. Across the remaining illness perception dimensions, the consistency and methodological quality of the evidence was mixed. The empirical study highlighted from correlational analyses that perceiving more severe illness consequences and greater optimism were both associated with greater problem-focused coping. However, illness timeline and illness identity were not significantly correlated with problem-focused coping. A moderation analysis demonstrated that optimism did not moderate the relationship between illness consequences and problem-focused coping when including age as a covariate. CONCLUSIONS: Both chapters illustrated the important role of illness perceptions in the context of long-term health conditions. The systematic review highlighted that further research is needed to understand impact of different illness perceptions on coping responses, physical and psychological outcomes. The empirical study outlined the importance of routinely assessing for illness perceptions within cardiac rehabilitation as this could inform the development of problem-focused coping. It also illustrated that optimism could be assessed as part of routine clinical practice within cardiac rehabilitation and targeted through intervention strategies that aim to increase optimism.