A systematic review and meta-analysis of the Brief Illness Perception Questionnaire
TL;DR: The Brief IPQ has been administered to patients from age 8 to over 80, with a wide range of illnesses, in 26 languages from 36 countries, and has good psychometric properties.
Abstract: Objective: This paper aims to systematically review the use and performance of the Brief Illness Perception Questionnaire (Brief IPQ).Design: Electronic databases were searched for papers administering the Brief IPQ published in peer-reviewed journals. Data were extracted from the results for meta-analysis.Main outcome measures: Use by illness population, country, language and study design. The questionnaire’s concurrent validity, predictive validity, sensitivity to change, discriminant validity and mean scores for different populations were summarised.Results: The review included 188 papers. The Brief IPQ has been administered to patients from age 8 to over 80, with a wide range of illnesses, in 26 languages from 36 countries. Pooled correlations between illness perceptions and depression, anxiety, blood glucose levels and quality of life were consistent with previous research and theory (range .25–.49 for consequences, identity and emotional representations; −.12 to −.27 for personal control). All items...
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TL;DR: Meta-analytic path analyses supported a process model that included direct effects of illness representations on outcomes and indirect effects mediated by coping, which includes effects of moderators, individual differences, and beliefs about coping and treatment.
Abstract: According to the common-sense model of self-regulation, individuals form lay representations of illnesses that guide coping procedures to manage illness threat. We meta-analyzed studies adopting the model to (a) examine the intercorrelations among illness representation dimensions, coping strategies, and illness outcomes; (b) test the sufficiency of a process model in which relations between illness representations and outcomes were mediated by coping strategies; and (c) test effects of moderators on model relations. Studies adopting the common-sense model in chronic illness (k = 254) were subjected to random-effects meta-analysis. The pattern of zero-order corrected correlations among illness representation dimensions (identity, consequences, timeline, perceived control, illness coherence, emotional representations), coping strategies (avoidance, cognitive reappraisal, emotion venting, problem-focused generic, problem-focused specific, seeking social support), and illness outcomes (disease state, distress, well-being, physical, role, and social functioning) was consistent with previous analyses. Meta-analytic path analyses supported a process model that included direct effects of illness representations on outcomes and indirect effects mediated by coping. Emotional representations and perceived control were consistently related to illness-related and functional outcomes via, respectively, lower and greater employment of coping strategies to deal with symptoms or manage treatment. Representations signaling threat (consequences, identity) had specific positive and negative indirect effects on outcomes through problem- and emotion-focused coping strategies. There was little evidence of moderation of model effects by study design, illness type and context, and study quality. A revised process model is proposed to guide future research which includes effects of moderators, individual differences, and beliefs about coping and treatment.
335 citations
Cites background from "A systematic review and meta-analys..."
...…have been subsequently corroborated in meta-4 analyses of subsets of the research literature on the common-sense model (Brandes & Mullan, 5 2014; Broadbent et al., 2015; Dempster, Howell, & McCorry, 2015; French, Cooper, & 6 Weinman, 2006; Hudson, Bundy, Coventry, & Dickens, 2014; Mc Sharry et…...
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...Previous meta-analyses have observed considerable 1 heterogeneity in relations among model constructs (Broadbent et al., 2015; French et al., 2 2006; Hagger & Orbell, 2003)....
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TL;DR: This feasibility study demonstrated high rates of recruitment, retention and acceptability of the intervention, and clinical effect size was moderate to large with high probability of being cost-effective.
Abstract: OBJECTIVE: To determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS). METHODS: A randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months. RESULTS: 60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46-0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087. CONCLUSIONS: This feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed. TRIAL REGISTRATION NUMBER: NCT02275000; Results.
162 citations
TL;DR: It is recommended that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients’ expectations that are applicable across various medical treatments, to generate a more comprehensive understanding of expectation effects in medical treatments.
Abstract: Patients' expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients' expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients' treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients' expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients' expectations of illness and treatment. Considering the importance of patients' expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients' expectations in order to improve health outcomes.
144 citations
Cites background from "A systematic review and meta-analys..."
...Finally, expectations about the temporal course of a disease have been shown to be predictive of several health outcomes across medical conditions (Broadbent et al., 2015)....
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TL;DR: The study shows that certain psychological and social determinants were associated with increased depressive symptoms during the lockdown warranting the development of public health guidelines to mitigate the effects of the epidemic to the mental health of the population.
Abstract: Objective. The COVID-19 epidemic has shown a more benign course in Greece possibly due to the early lockdown measures. Mental health consequences of the lockdown however are unknown. In addition, illness perceptions and relevant strategies to cope with the stress of the epidemic may have played a role in complying with the restrictions. We conducted a survey of the Greek population with the aim to investigate the prevalence of anxiety and depression during the lockdown, the emotional impact of the epidemic, and the effect of coping strategies and illness perceptions in mental health. Methods. Adult persons were invited during the peak of the lockdown period through social media. Depressive and anxiety symptoms were assessed with the PHQ-9 and GAD-2 scales, respectively. Coping strategies were assessed with selected items of the Brief COPE questionnaire, while illness beliefs were assessed with items from the revised Illness Perception Questionnaire (IPQ-R). Results. A total of 3379 individuals took part. A strong emotional impact of the epidemic was more often in women and in those with severe financial difficulties. Levels of depressive and anxiety symptoms were high but similar to past assessments. Participants showed high levels of personal control and used more often positive strategies to cope with the stress of the epidemic. Depressive symptoms were higher in the younger, in students, in those with a stronger emotional impact, in those isolated due to symptoms, and those overexposed to media for COVID-19-related news. Lower levels of depression were seen in those using positive coping strategies and showing high levels of personal and treatment control. Conclusions. The study shows that certain psychological and social determinants were associated with increased depressive symptoms during the lockdown warranting the development of public health guidelines to mitigate the effects of the epidemic to the mental health of the population.
88 citations
Cites methods from "A systematic review and meta-analys..."
...IPQ-R has been widely used and validated in a range of chronic diseases as well as in healthy participants for hypothetical disease scenarios or genetic predispositions [36, 37]....
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TL;DR: A brief animated intervention delivered at the patients’ bedside on perceptions and recovery in acute coronary syndrome patients may be clinically effective for acute coronary Syndrome patients.
Abstract: Recovery from myocardial infarction has been associated with patients’ perceptions of damage to their heart. New technologies offer a way to show patients animations that may foster more accurate perceptions and encourage medication adherence, increased exercise and faster return to activities. The purpose of this study was to investigate the effects of a brief animated intervention delivered at the patients’ bedside on perceptions and recovery in acute coronary syndrome patients. Seventy acute coronary syndrome patients were randomly assigned to the intervention or standard care alone. Illness perceptions, medication beliefs and recovery outcomes were measured. Post-intervention, the intervention group had significantly increased treatment control perceptions and decreased medication harm beliefs and concerns. Seven weeks later, intervention participants had significantly increased treatment control and timeline beliefs, decreased symptoms, lower cardiac avoidance, greater exercise and faster return to normal activities compared to control patients. A brief animated intervention may be clinically effective for acute coronary syndrome patients (Trial-ID: ACTRN12614000440628).
75 citations
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TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
Abstract: David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
62,157 citations
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TL;DR: A convenient, although not comprehensive, presentation of required sample sizes is providedHere the sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests.
Abstract: One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
38,291 citations
Additional excerpts
...As hypothesised, higher consequences, emotional representation and identity, were moderately to strongly associated with higher depression and anxiety, higher HbA1c (worse control) and lower quality-of-life dimensions according to Cohen’s criteria (Cohen, 1992)....
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TL;DR: A meta-analysis of single-item measures ofOverall job satisfaction found an average uncorrected correlation of .63 (SD = .09) with scale measures of overall job satisfaction, which is slightly lower than the overall mean correlation.
Abstract: A meta-analysis of single-item measures of overall job satisfaction (28 correlations from 17 studies with 7,682 people) found an average uncorrected correlation of .63 (SD = .09) with scale measures of overall job satisfaction. The overall mean correlation (corrected only for reliability) is .67 (SD = .08), and it is moderated by the type of measurement scale used. The mean corrected correlation for the best group of scale measures (8 correlations, 1,735 people) is .72 (SD = .05). The correction for attenuation formula was used to estimate the minimum level of reliability for a single-item measure. These estimates range from .45 to .69, depending on the assumptions made.
2,986 citations
TL;DR: A revised version of the Illness Perception Questionnaire (IPQ-R) is presented in this paper to assess cyclical timeline perceptions, illness coherence, and emotional representations.
Abstract: This paper presents a revised version of the Illness Perception Questionnaire (IPQ-R), a recently developed and widely used quantitative measure of the five components of illness representations in Leventhal's self-regulatory model. The revised version stemmed from a need to deal with minor psychometric problems with two subscales, and to include additional subscales, assessing cyclical timeline perceptions, illness coherence, and emotional representations. Item selection was determined by principal components analyses which verified the factorial structure of the questionnaire in a sample of 711 patients from 8 different illness groups. Further analysis provided good evidence for both the internal reliability of the subscales and the short (3 week) and longer term (6 month) retest reliability. The IPQ-R also demonstrated sound discriminant, known group and predictive validity. While it is possible that the new subscales will vary in their applicability in different patient groups, the IPQ-R provides a more comprehensive and psychometrically acceptable assessment of the key components of patients' perceptions of illness.
2,682 citations
"A systematic review and meta-analys..." refers methods in this paper
...Illness coherence was not one of the original dimensions of illness perceptions described in early research, and was added by the authors of the IPQ-R as a metacognition to assess the extent to which patients’ illness perceptions provided a coherent understanding of the illness....
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...One criticism of the original Brief IPQ was that it developed from the items of the IPQ-R rather than from patient interviews (van Oort, Schroder, & French, 2011)....
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...The Illness Perception Questionnaire-Revised (IPQ-R) (Moss-Morris et al., 2002) added 48 more items and new subscales to assess illness coherence, emotional response, cyclical timeline perceptions, and divided the control/ cure dimension into personal control and treatment control....
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