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Journal Article•DOI•

The Common Sense Model of Self-Regulation: Meta-Analysis and Test of a Process Model

Martin S. Hagger1, Severine Koch1, Nikos L. D. Chatzisarantis1, Sheina Orbell2•
Curtin University1, University of Essex2
14 Aug 2017-Psychological Bulletin (American Psychological Association)-Vol. 143, Iss: 11, pp 1117-1154
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.

Summary (7 min read)

Jump to: [Public Significance Statement 1] – [The Common-Sense Model of Self-Regulation: Origins and Conceptualization 1] – [A Critical Appraisal of Research on the Common-Sense Model of Self-Regulation 13] – [A Process Model of ‘Common-Sense’ Illness Representations 6] – [Included Studies and Characteristics 13] – [Classification of Illness Representations 19] – [Classification of Coping Strategies 22] – [Classification of Illness Outcomes 1] – [Moderator Coding and Analyses 14] – [Testing the Process Model 5] – [Moderator Analyses 23] – [Path Analyses of the Process Model 15] – [Sensitivity Analyses of Model Effects 15] – [Sufficiency of the Model 21] – [The Function of Coping in the Process Model 16] – [Role of Context and Moderators in the Process Model 1] – [Implications for Practice 11] – [Revising the Common-Sense Model 3] and [Strengths, Limitations and Recommendations 14]

Public Significance Statement 1

  • This review indicates that relations between patients’ illness beliefs and important illness-2 related outcomes (reducing disease progression, improving functioning, promoting well-3 being, allaying distress) across studies are accounted for by sets of coping strategies 4 (avoidance, cognitive reappraisal, emotion venting, problem-focused coping, seeking social 5 support).
  • The identification and interpretation of a deviation from the normally-functioning 3 physical and somatic self is fundamental to initiating self-regulatory processes to restore or 4 protect a state of health, or even protect life itself.
  • Specifically, it is necessary to 16 understand the individual’s cognitive and emotional representations of the threat that initiate 17 subsequent coping procedures directed at threat and emotion management.
  • The 21 mediational model may be informative in resolving inconsistent patterns of effects observed 22 in previous studies and may potentially inform practice by identifying viable targets for 23 intervention.

The Common-Sense Model of Self-Regulation: Origins and Conceptualization 1

  • The common-sense model was developed to understand how patients’ lay perceptions 2 of illness threats guide coping strategies to deal with those threats (Leventhal et al., 1980).
  • The 16 progression to professional treatment may sometimes bypass both self-evaluation and self-17 management, when, for example, an acute event provokes immediate hospitalization leading 18 to diagnosis of illness, or when screening procedures identify diseases such as breast cancer 19 without any prior symptomatic information indicating to the individual that they are ill.
  • If such symptoms occurred after visiting a region where malaria is prevalent, 25 they might activate representations of serious infectious disease associated with elevated 1 threat.
  • The parallel arrowed pathways in Figure 1 depict links between the representation 15 dimensions and coping procedures.
  • Consistent with the proposal that illness cognitions are 22 schematic in nature (Henderson, Hagger, & Orbell, 2007; Leventhal & Cleary, 1980; 23 Leventhal et al., 2011), studies have demonstrated that automatic activation of an illness 24 representation is associated with activation of relevant coping procedures (Henderson, Orbell, 25 & Hagger, 2009).

A Critical Appraisal of Research on the Common-Sense Model of Self-Regulation 13

  • Hagger and Orbell (2003) tested the hypothesized relations among common-sense 14 model constructs in a meta-analysis of studies applying the model in chronic illness.
  • The analysis revealed a consistent pattern of relations such that 19 representation dimensions that signal an elevated level of threat, namely, serious 20 consequences, illness identity, and a chronic timeline were positively associated with 21 emotion-focused coping procedures including expressing emotions and denial.
  • Emotion-focused strategies may be more effective in these 12 contexts as they help individuals manage negative emotional reactions caused by the 13 perceived illness threat.
  • The meta-analytic research indicates that these beliefs tend to 21 1Hagger et al.’s (2003) analysis did not include the emotional representation and illness coherence dimensions as few studies at the time had adopted the revised IPQ and there were insufficient studies reporting effect sizes for these studies.
  • This will permit identification of the unique effects of each representation 3 dimension on coping and outcome constructs controlling for the other dimensions (cf. 4 Hagger, Chan, Protogerou, & Chatzisarantis, 2016; Hagger & Chatzisarantis, 2016).

A Process Model of ‘Common-Sense’ Illness Representations 6

  • Central to the common-sense model is the assertion that individuals’ cognitive and 7 emotional representations of an illness threat will motivate a coping response to mitigate the 8 threat and related distress.
  • Taking a 16 generalized perspective, evaluating the extent to which coping mediates relations between 17 representation dimensions and illness outcomes will provide a test of the sufficiency of the 18 model.
  • Some mediation analyses revealed indirect effects 3 that did not conform to this pattern, but are consistent with Leventhal et al.’s proposal that 4 threat representations motivate problem-focused coping procedures and better illness 5 outcomes.
  • 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).
  • Illnesses vary in their symptomatology, impact on the patients’ life, chronicity, 3 and responsiveness to treatment.

Included Studies and Characteristics 13

  • The literature research identified 333 articles that met inclusion criteria on initial 14 screening .
  • The authors were unable to source the 17 unreported data for 39 articles, and several articles either reported data from multiple samples 18 within a single study or comprised overlapping samples (multiple studies using the same 19 data).
  • Summary characteristics of the 22 included studies including sample sizes, study design, demographic details, illness types 23 encompassed by the studies, moderator coding.
  • Studies were largely focused on older samples (median of the average sample age reported in 5 studies = 52 years) with most studies having approximately equal ratios of females and 6 males.
  • Other 8 than measures of illness representations, coping strategies, and illness outcomes, a number of 9 studies also included concurrent measures of belief-based, social cognitive, and individual 10 difference constructs.

Classification of Illness Representations 19

  • Studies were relatively consistent in the instruments employed to measure illness 20 representations, relying largely on previously-validated and standardized generic 21 questionnaires based on Leventhal et al.’s (1980) illness representation dimensions of cause, 22 control, consequences, identity, and timeline3.
  • Due to the relatively small number of studies employing this subscale, the authors restricted their analysis to the timeline: acute/chronic dimension.
  • In addition, some instruments (e.g., IPQ-R, Moss-Morris et al., 2002; BIPQ, Broadbent, Petrie, Main, & Weinman, 2006) distinguish between personal control and treatment control while others employ a single control dimension (e.g., IPQ, Weinman, Petrie, Moss-Morris, & Horne, 1996).
  • In addition, the IPQ-R was translated, validated and 15 standardized for various populations.

Classification of Coping Strategies 22

  • The present sample of studies used a large number of instruments to measure coping 23 strategies, many of which were based on cognitive-motivational-relational models of stress 24 and coping (e.g., Carver et al., 1989; Lazarus & Folkman, 1984).
  • A sixth coping category, labelled problem-focused specific coping 13 strategies, encompassed active attempts to address the illness by means of specific illness-14 related coping behaviors, such as medication and dietary adherence, illness-related self-care 15 behaviors, and attendance at illness-related medical appointments .
  • Inter-21 rater reliability coefficients indicated good agreement between the raters for each coping 22 dimension category (Fleiss-corrected κ = .91).
  • Differences in classifications were discussed 23 among the raters with respect to the category definition and item content with resolution 24 based on consensus between all three raters.

Classification of Illness Outcomes 1

  • Given the range of measures used to tap illness-related outcomes in the current 2 sample of studies, it was also important to categorize illness outcome measures into distinct 3 categories.
  • Three raters 16 coded the item content of the illness outcome measures from the source instruments with the 17 operational definitions of the construct categories used in the current analysis with strong 18 agreement across raters (Fleiss-corrected κ = . 92).
  • The authors conducted separate meta-analyses of intercorrelations among the 2 illness representation and coping strategy dimensions, and of correlations between the 3 representation, coping and outcome dimensions, resulting in 138 effect sizes4.
  • The I2 is 17 the proportion of the observed variance in the averaged effect size relative to the variance 18 attributable to sampling error alone expressed as a percentage (Borenstein, Higgins, Hedges, 19 & Rothstein, 2017).
  • Finally, the authors 2 evaluated the presence of small-study bias in the sample of effect sizes by computing 3 statistics based on plots of the effect size from each study against study precision (usually the 4 reciprocal of the study sample size).

Moderator Coding and Analyses 14

  • Assuming substantive, non-trivial variability in the effect sizes of the relations in the 15 illness representation, coping, and outcome constructs unattributed to the statistical artifacts 16 the authors corrected for in the model, they aimed to examine the effect of moderators of the model 17 effects.
  • Study design was coded as cross-sectional, longitudinal, or intervention.
  • Studies describing the target illness or condition of the study as having 4 unknown or uncertain etiology, or if the symptoms of the illness or condition are known to 5 have unknown or uncertain causes, were classified as having medically-unexplained 6 symptoms with the remaining illnesses classified as having medically-explained symptoms.
  • Studies meeting 6 quality standards were assigned a score of 1 for each criterion and those not meeting the 7 quality standard or provided insufficient information to evaluate the criterion were assigned a 8 score of zero.
  • 11 Studies were scored on the checklist by a researcher with experience in the use of 12 methodological quality checklists6.

Testing the Process Model 5

  • The authors used the meta-analytically derived corrected correlations to test hypotheses of the 6 proposed process model in which the effects of illness representations on illness outcomes are 7 mediated by coping strategies.
  • This model assumes that the coping 16 constructs are sufficient in accounting for relations between the representation dimensions 17 and illness outcome.
  • Given the 5 dependency of the statistical significance of their parameter estimates in their model tests on 6 sample size, the authors focused on effect size when evaluating the effects in their models.
  • The authors also report the CFI for each model, with absolute values 11 for Model 1 illustrating the level of misspecification in the model when direct effects were 12 fixed to zero.
  • Perceived control and illness coherence were 14 significantly and positively correlated.

Moderator Analyses 23

  • The authors examined the effect of moderators on correlations among the illness 24 representation, coping strategies, and illness outcome constructs across studies by conducting 25 their meta-analysis at each level of the candidate moderators: study design, illness type, 1 medically-explained and medically-unexplained symptoms, illness stage, and methodological 2 quality.
  • In all cases, the authors found little evidence for moderator effects.
  • In addition, the analyses did little to resolve the heterogeneity in the 8 effect sizes with moderate-to-high heterogeneity according to I2 values and significant values 9 for Q observed for effects within each moderator group.
  • Of the correlations that did exhibit 10 statistically significant differences, many included moderator groups with low numbers of 11 studies (k < 10); in such cases the confidence intervals, t-tests, and heterogeneity tests may 12 not be reliable.
  • Overall, there was little indication of systematic variation in effect sizes 13 attributable to the candidate moderators in the current analyses.

Path Analyses of the Process Model 15

  • The authors therefore rejected 18 10Correcting for methodological artifacts is known to increase the magnitude of effect sizes, perhaps more than is appropriate, which may lead to over- or under-estimation of the true effect sizes (see Johnson & Eagly, 2014; Köhler, Cortina, Kurtessis, & Gölz, 2015).
  • Examination of the total indirect effects to establish the extent to 8 which the effects of illness representation dimensions on illness outcomes were mediated by 9 the coping strategies was warranted (Leventhal et al., 1980).
  • 23 Based on this evidence, it is possible that both positive and negative specific indirect effects 24 would be present, and that these effects would amount to null or relatively small total indirect 25 effects.
  • This was corroborated by the specific indirect 20 effects, which indicated significant positive effects of perceived control on these outcomes 21 mediated by generic and specific forms of problem-focused coping.

Sensitivity Analyses of Model Effects 15

  • The authors conducted 17 sensitivity analyses to test whether the pattern of effects among constructs in their proposed 18 process model was dependent on levels of the study design, illness type, medically-explained 19 vs. medically-unexplained symptoms, and methodological quality moderators13,14.
  • Goodness-of-fit estimates for the single 8 sample and multi-group path analyses of both models for each outcome variable and at all 9 levels of each moderator are presented in Tables 17 to 20 .
  • This suggested that the proposed pattern of effects among the illness 21 representation, coping, and outcome constructs in Model 2 provided a robust representation 22 of observed relations among these constructs in the meta-analyzed data.
  • Consistent with the 23 15Some of the effects in the moderator groups were tested by fewer than two studies so an averaged corrected effect size could not be computed .
  • It also has potential implications beyond the model as relations between beliefs about 17 threat, emotional distress and coping are key tenets of other theories of stress and coping 18 (e.g., Lazarus & Folkman, 1984).

Sufficiency of the Model 21

  • The present research is the first to produce a full meta-analytic inter-correlation 22 matrix among the representation, coping, and outcome variables across studies adopting the 23 common-sense model.
  • Illness-specific coping 16 strategies were expected to have closer correspondence with the representation and outcome 17 measures.
  • Few studies in the current sample included such measures and the 18 measures inevitably captured only one specific coping strategy when a range of specific 19 strategies may have been relevant.
  • Other coping strategies or unmeasured 25 extraneous variables may have served to mediate the direct effects of representations on 1 outcomes.
  • Such patterns are likely to be adopted by patients 6 who are high on certain traits, such as perfectionism, and prone to distress (c.f., Limburg, 7 Watson, Hagger, & Egan, 2016).

The Function of Coping in the Process Model 16

  • The total indirect effects of the cognitive and emotional representation dimensions on 17 illness outcomes were consistent with the general expected pattern of effects in many cases.
  • Furthermore, 1 examination of the specific indirect effects revealed patterns of effect for illness 2 representation dimensions on outcomes that could not be ascertained from the total indirect 3 effects alone.
  • These 16 findings suggest a pattern of effects among constructs in the common-sense model that is 17 more complex than that found in previous research syntheses.
  • Previous research has also found 17 negative mediated effects of consequences on disease state and distress through problem-18 focused coping and self-nurturing coping procedures (Benyamini et al., 2004; Brewer et al., 19 2002).
  • Current findings indicate that representation dimensions relate to multiple coping 20 strategies which have both positive and negative effects on outcomes related to illness 21 recovery.

Role of Context and Moderators in the Process Model 1

  • High levels of heterogeneity were observed in the majority of the effect sizes in the 2 current analysis.
  • A search for moderators was, therefore, warranted.
  • The authors contended, consistent with theory and previous research on the common-sense 13 model (Horne & Weinman, 2002; Leventhal et al., 1980; Moss-Morris et al., 2011), that 14 contextual factors will moderate effects within the common-sense model.
  • More primary research is needed that systematically tests the proposed 8 mediation effects in the process model in the presence and absence of the moderators.
  • Resolving the unique moderating effects of these characteristics may require systematic 10 comparisons of the direct and indirect effects of illness representation dimensions on 11 outcomes through coping at different levels of the moderator.

Implications for Practice 11

  • The identification of specific indirect effects in the current analysis has implications 12 for the application of the common sense model in practice.
  • In some cases, targeting change in a given representation dimension 17 would be an appropriate strategy if the dimension was consistently related to adaptive 18 outcomes through the model pathways.
  • Providing messages that highlight the serious 24 consequences of an illness to patients may lead to adaptive outcomes by prompting adoption 25 of problem-focused coping strategies, but may, in turn, lead to maladaptive outcomes like 1 distress and disease progression through avoidance.
  • A solution might be to adopt strategies 2 that link the representation with the desired coping strategy.
  • So while current findings may provide guidance for interventions, it is 22 important to consider such suggestions in light of the heterogeneity of the effects identified 23 and the likely context-dependency of the indirect effects.

Revising the Common-Sense Model 3

  • The authors meta-analytic test of the process model has been instrumental in identifying the 4 prominence of particular illness representation dimensions in predicting illness outcomes 5 directly and indirectly through coping strategies.
  • The basic mediation effects of the 6 process model tested in the current meta-analysis are depicted in the central section of Figure 7 3.
  • In the revised model, medication beliefs are 6 expected to explain unique variance in specific coping behaviors (i.e., medication adherence) 7 alongside illness representations and beliefs about other coping behaviors (Figure 3).
  • Problem-focused coping 21 procedures are depicted as a response to illness beliefs, consistent with the original model.
  • Formation of action plans has been shown to be pivotal 21 for illness management by assisting individuals in the efficient enactment of an appropriate, 22 effective coping response to a threat representation (Leventhal et al., 2016).

Strengths, Limitations and Recommendations 14

  • Fixed effects vs. random effects meta-analysis 16 models: Implications for cumulative research knowledge in psychology.
  • A prospective examination of 5 illness beliefs and coping in patients with type 2 diabetes.
  • Illness perceptions account for 11 variation in positive outlook as well as psychological distress in Rheumatoid Arthritis.
  • The illness perception 7 questionnaire: A new method for assessing the cognitive representation of illness.

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Running head: COMMON-SENSE MODEL OF SELF-REGULATION 1
The Common Sense Model of Self-Regulation: Meta-Analysis and Test of a Process Model
Martin S. Hagger
Curtin University and University of Jyväskylä
Severine Koch and Nikos L. D. Chatzisarantis
Curtin University
Sheina Orbell
University of Essex
©2017, American Psychological Association. This paper is not the copy of record and may
not exactly replicate the final, authoritative version of the article. Please do not copy or cite
without authors permission. The final article will be available, upon publication, via its DOI:
10.1037/bul0000118
Full citation: Hagger, M. S., Koch, S., Chatzisarantis, N. L. D., & Orbell, S. (2017). The
common-sense model of self-regulation: Meta-analysis and test of a process model.
Psychological Bulletin. http://dx.doi.org/10.1037/bul0000118
Author Note
Martin S. Hagger, Health Psychology and Behavioral Medicine Research Group and
Laboratory of Self-Regulation, School of Psychology and Speech Pathology, Perth and
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä;
Severine Koch, and Nikos L. D. Chatzisarantis, Health Psychology and Behavioral Medicine
Research Group and Laboratory of Self-Regulation, School of Psychology and Speech
Pathology, Perth; Sheina Orbell, Department of Psychology, University of Essex, Colchester.
Running head: COMMON-SENSE MODEL OF SELF-REGULATION 2
Martin S. Hagger’s contribution was supported by a Finland Distinguished Professor
(FiDiPro) award from TEKES, the Finnish funding agency for innovation.
We thank Associate Editor Blair T. Johnson for his helpful comments on earlier drafts
of this manuscript. We are grateful to Angela Carroll for her help with the literature search.
We also thank the following authors who provided additional data for the current meta-
analysis: Abdolaziz Aflakseir, Seher Arat, Vera Araújo-Soares, Yael Benyamini, Becky Bih-
O Lee, Felicity Bishop, Tore Bonsaksen, Noel T. Brewer, Elizabeth Broadbent, Trudie
Chalder, Joseph Chilcot, Jimmy Chong, Arden Corter, Erin Costanzo, Francis Creed, Nicola
Dalbeth, Martin Dempster, Aleid de Rooij, Alex Federman, Maarten Fischer, Nadine Foster,
Lana Fu, Milena Gandy, Rinie Geenen, David Gillanders, Prosenjit Giri, Lesley Glover,
Christopher Graham, Konstadina Griva, AnnMarie Groarke, Brooks Gump, Jorine Hartman,
John Harvey, Ankie Heerema-Poelman, Susan Hill, Alex Holmes, Joanna Hudson, Thomas
Hyphantis, Egil Jonsbu, Rebecca Knibb, Deirdre Lane, Margaret Lau-Walker, Valerie
Lawson, Yvonne Leung, Carrie Llewellyn, Sean Lynch, Julie MacInnes, Pamela McCabe,
Elaine McColl, Aušra Mickevičienė, Gerry Molloy, Kevin Morgan, Rona Moss-Morris,
Stanton Newman, Arie Nouwen, Ronan O'Carroll, Agnieszka Olchowska-Kotala, Catherine
O'Leary, Patrícia Pinto, Heather Powell, Yolanda Quiles, Gwyneth Rees, Orna Reges, Jillian
Riley, Tina Rochelle, Michael Rose, Reza Sadjadi, Gregory Sawicki, Margreet Scharloo,
Stefanie Schroeder, Louise Sharpe, Timothy Skinner, Debbie Snell, Lesley Stafford, Susan
Stott, Ilse Stuive, Elaine Thomas, Barbara Tomenson, Amy Turriff, Maureen Twiddy, Mike
van der Have, Tina van der Velde, Firdous Var, Manja Vollmann, Ken Watkins, Robert
Whittaker, Wendy Woith, and Urška Žugelj.
Correspondence concerning this article should be addressed to Martin S. Hagger,
Health Psychology and Behavioral Medicine Research Group and Laboratory of Self-
Regulation, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin
Running head: COMMON-SENSE MODEL OF SELF-REGULATION 3
University, GPO Box U1987, Perth, WA 6845, Australia, email:
martin.hagger@curtin.edu.au
Running head: COMMON-SENSE MODEL OF SELF-REGULATION 4
Abstract
1
According to the common-sense model of self-regulation, individuals form lay
2
representations of illnesses that guide coping procedures to manage illness threat. We meta-
3
analyzed studies adopting the model to (a) examine the intercorrelations among illness
4
representation dimensions, coping strategies, and illness outcomes; (b) test the sufficiency of
5
a process model in which relations between illness representations and outcomes were
6
mediated by coping strategies; and (c) test effects of moderators on model relations. Studies
7
adopting the common-sense model in chronic illness (k = 254) were subjected to random-
8
effects meta-analysis. The pattern of zero-order corrected correlations among illness
9
representation dimensions (identity, consequences, timeline, perceived control, illness
10
coherence, emotional representations), coping strategies (avoidance, cognitive reappraisal,
11
emotion venting, problem-focused generic, problem-focused specific, seeking social support),
12
and illness outcomes (disease state, distress, well-being, physical, role, and social
13
functioning) was consistent with previous analyses. Meta-analytic path analyses supported a
14
process model that included direct effects of illness representations on outcomes and indirect
15
effects mediated by coping. Emotional representations and perceived control were
16
consistently related to illness-related and functional outcomes via, respectively, lower and
17
greater employment of coping strategies to deal with symptoms or manage treatment.
18
Representations signaling threat (consequences, identity) had specific positive and negative
19
indirect effects on outcomes through problem- and emotion-focused coping strategies. There
20
was little evidence of moderation of model effects by study design, illness type and context,
21
and study quality. A revised process model is proposed to guide future research which
22
includes effects of moderators, individual differences, and beliefs about coping and treatment.
23
Keywords: Illness perceptions; illness cognition; coping procedures; parallel-processing
24
model; chronic illness
25
Running head: COMMON-SENSE MODEL OF SELF-REGULATION 5
Public Significance Statement
1
This review indicates that relations between patients’ illness beliefs and important illness-
2
related outcomes (reducing disease progression, improving functioning, promoting well-
3
being, allaying distress) across studies are accounted for by sets of coping strategies
4
(avoidance, cognitive reappraisal, emotion venting, problem-focused coping, seeking social
5
support). Behavioral interventions aimed at changing illness outcomes should not only target
6
change in the beliefs linked to adaptive outcomes, but also the coping strategies related to the
7
beliefs.
8
9
10
Citations
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A meta-analysis of the health action process approach.

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Chun-Qing Zhang, Ru Zhang1, Ralf Schwarzer, Martin S. Hagger•
Hong Kong Baptist University1
11 Apr 2019-Health Psychology
TL;DR: Findings highlight the importance of self-efficacy in predicting health behavior in motivational and volitional action phases and are expected to catalyze future research including experimental studies targeting change in individual HAPA constructs, and longitudinal research to examine change and reciprocal effects among constructs in the model.
Abstract: Objective The health action process approach (HAPA) is a social-cognitive model specifying motivational and volitional determinants of health behavior. A meta-analysis of studies applying the HAPA in health behavior contexts was conducted to estimate the size and variability of correlations among model constructs, test model predictions, and test effects of past behavior and moderators (behavior type, sample type, measurement lag, study quality) on model relations. Method A literature search identified 95 studies meeting inclusion criteria with 108 independent samples. Averaged corrected correlations among HAPA constructs and multivariate tests of model predictions were computed using conventional meta-analysis and meta-analytic structural equation modeling, with separate models estimated in each moderator group. Results Action and maintenance self-efficacy and outcome expectancies had small-to-medium sized effects on health behavior, with effects of outcome expectancies and action self-efficacy mediated by intentions, and action and coping planning. Effects of risk perceptions and recovery self-efficacy were small by comparison. Past behavior attenuated the intention-behavior relationship. Few variations in model effects were observed across moderator groups. Effects of action self-efficacy on intentions and behavior were larger in studies on physical activity compared with studies on dietary behaviors, whereas effects of volitional self-efficacy on behavior were larger in studies on dietary behaviors. Conclusions Findings highlight the importance of self-efficacy in predicting health behavior in motivational and volitional action phases. The analysis is expected to catalyze future research including experimental studies targeting change in individual HAPA constructs, and longitudinal research to examine change and reciprocal effects among constructs in the model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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Stefan M. Gold1, Ole Köhler-Forsberg2, Rona Moss-Morris3, Anja Mehnert4, J. Jaime Miranda5, Monika Bullinger, Andrew Steptoe6, Mary A. Whooley7, Christian Otte1 •
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TL;DR: The epidemiology, mechanisms, diagnosis and treatment of comorbid depression in patients with medical diseases, including major depressive disorder, are discussed.
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Gerjo Kok1, Gjalt-Jorn Peters2, Loes T. E. Kessels1, Gill A. ten Hoor1, Robert A. C. Ruiter1 •
Maastricht University1, Open University2
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Cites background from "The Common Sense Model of Self-Regu..."

  • ...Hall et al. (2016) developed a Reactance to Health Warnings Scale studying the potentially negative effects of defensive reactions to cigarette pack warnings. They indeed showed that reactance may weaken the effects of warnings, confirming the existence of defensive reactions. Hall et al. (2016) also state that ‘it would be unwise to conclude that pictorial warnings are counterproductive simply because they produce reactance’; they suggest that reactance merely reduces the positive effect of the warnings despite that assumption’s inconsistency with the relevant theories....

    [...]

  • ...Hall et al. (2016) developed a Reactance to Health Warnings Scale studying the potentially negative effects of defensive reactions to cigarette pack warnings. They indeed showed that reactance may weaken the effects of warnings, confirming the existence of defensive reactions. Hall et al. (2016) also state that ‘it would be unwise to conclude that pictorial warnings are counterproductive simply because they produce reactance’; they suggest that reactance merely reduces the positive effect of the warnings despite that assumption’s inconsistency with the relevant theories. However, as they did not measure actual behaviour and did not study the effect of self-efficacy, their work does not provide evidence for that statement. Thrasher et al. (2014) studied the effect of cigarette package inserts with cessation-related tips and messages, which supplement the exterior pictorial health warnings. They showed that smokers who read the inserts a few times or more in the past month had a higher intention to quit and were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. Trasher et al. (2014) conclude that cigarette package inserts ‘may enhance the efficacy of pictorial warning labels’....

    [...]

  • ...Hall et al. (2016) developed a Reactance to Health Warnings Scale studying the potentially negative effects of defensive reactions to cigarette pack warnings. They indeed showed that reactance may weaken the effects of warnings, confirming the existence of defensive reactions. Hall et al. (2016) also state that ‘it would be unwise to conclude that pictorial warnings are counterproductive simply because they produce reactance’; they suggest that reactance merely reduces the positive effect of the warnings despite that assumption’s inconsistency with the relevant theories. However, as they did not measure actual behaviour and did not study the effect of self-efficacy, their work does not provide evidence for that statement. Thrasher et al. (2014) studied the effect of cigarette package inserts with cessation-related tips and messages, which supplement the exterior pictorial health warnings. They showed that smokers who read the inserts a few times or more in the past month had a higher intention to quit and were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. Trasher et al. (2014) conclude that cigarette package inserts ‘may enhance the efficacy of pictorial warning labels’. However, as pictorial warning labels were not manipulated in this study, the only conclusion can be that cigarette package inserts with cessation-related tips and messages (the only manipulated variable) have a positive effect on smoking cessation. This is exactly as would have been predicted from the earlier description of the theory and evidence: an approach based on self-efficacy in combination with risk perception. (Note, however, that the design chosen by Trasher et al. (2014) could only yield a dataset that is also consistent with the inserts being less effective as a consequence of their combination with pictorial warning labels....

    [...]

  • ...Hall et al. (2016) developed a Reactance to Health Warnings Scale studying the potentially negative effects of defensive reactions to cigarette pack warnings. They indeed showed that reactance may weaken the effects of warnings, confirming the existence of defensive reactions. Hall et al. (2016) also state that ‘it would be unwise to conclude that pictorial warnings are counterproductive simply because they produce reactance’; they suggest that reactance merely reduces the positive effect of the warnings despite that assumption’s inconsistency with the relevant theories. However, as they did not measure actual behaviour and did not study the effect of self-efficacy, their work does not provide evidence for that statement. Thrasher et al. (2014) studied the effect of cigarette package inserts with cessation-related tips and messages, which supplement the exterior pictorial health warnings....

    [...]

  • ...Hall et al. (2016) developed a Reactance to Health Warnings Scale studying the potentially negative effects of defensive reactions to cigarette pack warnings....

    [...]

Book Chapter•DOI•
Changing Behavior Using the Model of Action Phases

[...]

Lucas Keller, Peter M. Gollwitzer, Paschal Sheeran
23 Jul 2020
TL;DR: Heckhausen and Gollwitzer as mentioned in this paper proposed the Rubicon model of action phases, which describes the course of action as a temporal, linear path starting with a person's wishes or desires and ending with the evaluation of the action outcomes achieved.
Abstract: In the mid-1980s, Heckhausen and Gollwitzer set out to analyze how people control their actions (see Heckhausen, Gollwitzer, & Weinert, 1987). They quickly realized that breaking action control down into different phases greatly benefited its understanding. Heckhausen and Gollwitzer’s analysis was heavily influenced by the work of Kurt Lewin (e.g., Lewin et al., 1944), for whom there was never any doubt that motivational phenomena can only be properly understood and analyzed from an action perspective that distinguishes the processes of goal setting from those of goal striving, an insight that went unheeded for several decades. Accordingly, Heckhausen and Gollwitzer (1987) proposed the “Rubicon”model of action phases, which describes the course of action as a temporal, linear path starting with a person’s wishes or desires and ending with the evaluation of the action outcomes achieved. The model was designed to raise and help answer the following questions: How do people select their goals? How do they plan the execution of goal striving? How do they enact these plans? Moreover, how do they evaluate their accomplishments? According to the Rubicon model, a course of action involves a phase of deliberating the desirability and feasibility of one’s wishes at the outset in order to arrive at a binding decision regarding which of them one wants to pursue as a goal (pre-decisional phase), a phase of planning concrete strategies for achieving this goal Practical Summary

127 citations

Journal Article•DOI•
Redefining fatty liver disease: an international patient perspective.

[...]

Gamal Shiha, Marko Korenjak, Wayne Eskridge, Teresa Casanovas, Patricia Velez-Moller, Sari Högström, Ben Richardson, Christopher Munoz, Sólveig Sigurðardóttir, Alioune Coulibaly, Miskovikj Milan, Fabiana Bautista, Nancy Leung, Vicki Mooney, Solomon Obekpa, Eva Bech, Naveen Polavarapu, Abd Elkhalek Hamed1, Temur Radiani, Edhie Purwanto, Bisi Bright, Mohammad Ali, Cecil Kwaku Dovia, Lone McColaugh, Yiannoula Koulla, Jean-François Dufour2, Reham Soliman, Mohammed Eslam3 •
Military Medical Academy1, University of Bern2, University of Sydney3
01 Jan 2021-The Lancet Gastroenterology & Hepatology
TL;DR: This advocacy group enthusiastically endorses the call to reframe the disease, which they believe will ultimately have a positive effect on patient care and quality of life and, through this effect, will reduce the burden on health-care systems.

121 citations

References
More filters
Journal Article•DOI•
Common method biases in behavioral research: a critical review of the literature and recommended remedies.

[...]

Philip M. Podsakoff1, Scott B. MacKenzie1, Jeong-Yeon Lee1, Nathan P. Podsakoff2•
Indiana University1, University of Florida2
01 Oct 2003-Journal of Applied Psychology
TL;DR: The extent to which method biases influence behavioral research results is examined, potential sources of method biases are identified, the cognitive processes through which method bias influence responses to measures are discussed, the many different procedural and statistical techniques that can be used to control method biases is evaluated, and recommendations for how to select appropriate procedural and Statistical remedies are provided.
Abstract: Interest in the problem of method biases has a long history in the behavioral sciences. Despite this, a comprehensive summary of the potential sources of method biases and how to control for them does not exist. Therefore, the purpose of this article is to examine the extent to which method biases influence behavioral research results, identify potential sources of method biases, discuss the cognitive processes through which method biases influence responses to measures, evaluate the many different procedural and statistical techniques that can be used to control method biases, and provide recommendations for how to select appropriate procedural and statistical remedies for different types of research settings.

52,531 citations

Journal Article•DOI•
Measuring inconsistency in meta-analyses

[...]

Julian P T Higgins1, Simon G. Thompson1, Jonathan J Deeks, Douglas G. Altman•
University of Cambridge1
04 Sep 2003-BMJ
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Abstract: Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …

45,105 citations

Journal Article•DOI•
Self-efficacy: toward a unifying theory of behavioral change.

[...]

Albert Bandura1•
Stanford University1
01 Mar 1977-Psychological Review
TL;DR: An integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment is presented and findings are reported from microanalyses of enactive, vicarious, and emotive mode of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes.
Abstract: The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more dependable the experiential sources, the greater are the changes in perceived selfefficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. Possible directions for further research are discussed.

38,007 citations

"The Common Sense Model of Self-Regu..." refers background in this paper

  • ...…in personal capacity to perform the behavior (self-efficacy), and beliefs in capacity to 3 cope with difficulties or setbacks in managing the illness (coping self-efficacy), as indicated 4 in social cognitive approaches to behavior (e.g., Bandura, 1977; Fishbein & Ajzen, 2009; 5 Schwarzer, 2008)....

    [...]

Journal Article•DOI•
Bias in meta-analysis detected by a simple, graphical test

[...]

Matthias Egger1, George Davey Smith, Martin Schneider, Christoph E. Minder•
University of Bristol1
13 Sep 1997-BMJ
TL;DR: Funnel plots, plots of the trials' effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials.
Abstract: Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews . Main outcome measure: Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. Results: In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. Conclusions: A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution. Key messages Systematic reviews of randomised trials are the best strategy for appraising evidence; however, the findings of some meta-analyses were later contradicted by large trials Funnel plots, plots of the trials9 effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials Funnel plot asymmetry was found in 38% of meta-analyses published in leading general medicine journals and in 13% of reviews from the Cochrane Database of Systematic Reviews Critical examination of systematic reviews for publication and related biases should be considered a routine procedure

37,989 citations

Journal Article•DOI•
The Hospital Anxiety and Depression Scale.

[...]

A. S. Zigmond, R. P. Snaith
01 Jun 1983-Acta Psychiatrica Scandinavica
TL;DR: It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

35,518 citations

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The Brief Illness Perception Questionnaire

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Elizabeth Broadbent, Keith J. Petrie, Jodie Main, John Weinman 
A Meta-Analytic Review of the Common-Sense Model of Illness Representations

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Martin S. Hagger, Sheina Orbell
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[...]

01 Apr 1992-Cognitive Therapy and Research
Howard Leventhal, Michael A. Diefenbach, Elaine A. Leventhal
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[...]

01 Jan 1996-Psychology & Health
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Frequently Asked Questions (16)
Q1. What are the contributions in this paper?

The authors meta3 analyzed studies adopting the model to ( a ) examine the intercorrelations among illness 4 representation dimensions, coping strategies, and illness outcomes ; ( b ) test the sufficiency of 5 a process model in which relations between illness representations and outcomes were 6 mediated by coping strategies ; and ( c ) test effects of moderators on model relations. 

A stronger evaluation of the process model needs to include 14 multiple illness representation, coping strategy, and outcome measures simultaneously across 15 conditions and samples, and adopt appropriate multivariate confirmatory analyses (e.g., path 16 analysis, structural equation modeling). 

In these analyses, paths among the illness 14 representation, coping, and outcome variables were set to be invariant across the models 15 estimated at each level of the moderator by imposing a set of equality constraints. 

The meta-analyses 10 were conducted using the MetaQuick (Stauffer, 1996) and Comprehensive Meta-Analysis 11 Version 2 (Borenstein, 2011) statistical software. 

Contextual factors such as 13 illness familiarity and coherence may determine whether threat perceptions lead to problem- 14 or emotion-focused coping. 

Control has been identified as having a pivotal role in driving the adoption of 16 problem-focused coping strategies, so the effects on outcomes were expected to be mediated 17 by the generic and specific forms of problem-focused coping. 

Not only do the authors expect that quantifying the overall effects of illness 17 representations on outcomes mediated by coping to be of interest, the authors also expect to identify 18 specific indirect effects that will indicate the extent to which illness representations are 19 positively associated with outcomes related to recovery and effective management, or 20 undermine recovery such as poorer functioning and well-being, and elevated distress. 

The 15 consequences and identity dimensions emerged as consistent positive predictors of 16 maladaptive outcomes, that is, outcomes related to increased illness progression, greater 17 distress, and poorer well-being, and perceived control as a positive predictor of adaptive 18 outcomes such as better functioning and well-being, and reduced distress and disease 19 progression. 

In addition, the synthesis enables us to assess the influence of moderator 24 variables that may explain variability in relations among model constructs across studies. 

21The present sample of studies used a large number of instruments to measure coping 23 strategies, many of which were based on cognitive-motivational-relational models of stress 24 and coping (e.g., Carver et al., 1989; Lazarus & Folkman, 1984). 

A further strength of the current analysis is their systematic classification and 2 coding of measures of illness representation, coping, and outcome across research adopting 3 the common-sense model in chronic illness. 

In the event that a particular category of their 12 key variables was represented by more than one construct in a specific study (e.g., the 13 positive reintegration and acceptance scales from the COPE inventory were both classified 14 into the cognitive reappraisal coping category), the average of the correlation coefficients was 15 taken to provide a single test of the expressed relationship for use in the meta-analysis 16 consistent with Hunter and Schmidt’s (2004) methods. 

The typical pattern of relations between representations, coping, and outcomes 8 derived from previous research neglects to account for the moderating influence of contextual 9factors. 

Studies describing the target illness or condition of the study as having 4 unknown or uncertain etiology, or if the symptoms of the illness or condition are known to 5 have unknown or uncertain causes, were classified as having medically-unexplained 6 symptoms with the remaining illnesses classified as having medically-explained symptoms. 

Horne et al. (1999) contend 25that medication adherence (e.g., taking anti-hypertension tablets to manage blood pressure) is 1 a function of specific beliefs about the effectiveness (e.g., taking tablets reduces blood 2 pressure at the next test) and drawbacks (e.g., debilitating side-effects of taking the tablets) of 3 medication. 

There were also 7 statistically significant non-trivial positive direct effects of identity on avoidance, cognitive 8 reappraisal, and emotion venting. 

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