Health  Vol.5 No.4 A , April 2013
Illness beliefs about hypertension among non-patients and healthy relatives of patients

Objectives: Personal beliefs about illnesses have received increasing interest because these cognitions help to explain and predict preventive and therapeutic coping efforts, adjustment to a disease and health outcomes. We sought to explore and compare non-specialised illness representations of hypertension among adults never suffering from hypertension who had and had not lived with hypertensive patients. Design: Hypertension representations were explored in a community-based, convenient sample of normotensive Spanish adults of both genders from different educational backgrounds and with different family experience with this illness. Method: An adapted Illness Perception Questionnaire-R was used to assess such perceptions among healthy people in nine dimensions: Identity, Time-line, Consequences, Personal Control, Treatment Control, Illness Coherence, Evolution, Emotional Representations and Causes. Results: The participants’ beliefs mixed accurate and folk knowledge, while gender, age and education level had little impact, family experience (having or not having a relative with hypertension) strongly determined the content of hypertension representations. Participants with family experience held significantly stronger beliefs of controllability of the disease, both by patients and treatments, considered the disease as less stable and reported a lower emotional impact when thinking on suffering from hypertension. Family experience was the only significant predictor of illness cognitions. Conclusions: This study allowed us to know the perceptions of hypertension among non-patients and healthy relatives of patients. Our findings are useful in designing interventions aimed at hypertension prevention, particularly considering family experience with the disease.

Cite this paper: Castillo, A. , Godoy-Izquierdo, D. , Vázquez, M. and Godoy, J. (2013) Illness beliefs about hypertension among non-patients and healthy relatives of patients. Health, 5, 47-58. doi: 10.4236/health.2013.54A007.

[1]   Hajjar, I., Morley Kotchen, J. and Kotchen, T.A. (2006) Hypertension: Trends in prevalence, incidence, and control. Annual Review of Public Health, 27, 465-490. doi:10.1146/annurev.publhealth.27.021405.102132

[2]   Kearney, P.M., Whelton, M., Reynolds, K., Muntner, P. and Whelton, P.K. (2005) Global burden of hypertension: Analysis of worldwide data. Lancet, 365, 217-222.

[3]   Wolf-Maier, K., Cooper, R.S., Banegas, J.R., Giampaoli, S., Hense, H.W., Joffres, M., Kastarinen, M., Poulter, N., Primatesta, P., Rodriguez Artalejo, F., Stegmayer, B., Tuomilehto, J., Vanuzzo, D. and Vescio, F. (2003) Hypertension prevalence and blood pressure levels in 6 European countries, Canada and the United States. JAMA, 289, 2363-2369. doi:10.1001/jama.289.18.2363

[4]   Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (2005) Guía española de hipertensión arterial. Hipertensión, 22, S2.

[5]   Diefenbach, M.A. and Leventhal, H. (1996) The common-sense model of illness representations: Theoretical and practical considerations. Journal of Social Distress and the Homeless, 5, 11-38. doi:10.1007/BF02090456

[6]   Leventhal, H. and Diefenbach, M. (1991) The active side of illness cognition. In: Skelton, R.T. and Croyle, M., Eds., Mental Representation in Health and Illness, Springer Verlag, New York, 247-272. doi:10.1007/978-1-4613-9074-9_11

[7]   Leventhal, H., Meyer, D. and Nerenz, D. (1980) The common sense model of illness danger. In: Rachman, S., Ed., Medical Psychology, Vol. 2, Pergamon, New York, 7-30.

[8]   Leventhal, H., Nerenz, D.R. and Steele, D.F. (1984) Illness representations and coping with health threats. In: Baum, A., Taylor, S.E. and Singer, J.E., Eds., A Handbook of Psychology and Health: Sociopsychological Aspects of Health, Erlbaum, Hillsdale, 219-252.

[9]   Leventhal, H., Diefenbach, M. and Leventhal, E.A. (1992) Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 116, 143-163. doi:10.1007/BF01173486

[10]   Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E.A., Patrick-Miller, L. and Robitaille, C. (1997) Illness representations: Theoretical foundations. In: Petrie, K.J. and Weinman, J., Eds., Perceptions of Health and Illness, Harwood Academic, London, 19-47.

[11]   Leventhal, H., Leventhal, E. and Contrada, R.J. (1998) Self-regulation, health and behavior. A perceptual cognitive approach. Psychology & Health, 13, 717-734. doi:10.1080/08870449808407425

[12]   Leventhal, H., Leventhal, E.A. and Cameron, L. (2001) Representations, procedures, and affect in illness self- regulation: A perceptual-cognitive model. In: Baum, A., Revenson, T.A. and Singer, J.E., Eds., Handbook of Health Psychology, Lawrence Erlbaum, Mahwah, 19-48.

[13]   Leventhal, H., Brissette, I. and Leventhal, E.A. (2003) The common-sense model of regulation of health and illness. In: Cameron, L.D. and Leventhal, H., Eds., The Self-Regulation of Health and Illness Behaviour, Routledge, London, 42-65.

[14]   Anagnostopoulos, F. and Spanea, E. (2005) Assessing illness representations of breast cancer: Comparison of patients with healthy and benign controls. Journal of Psychosomatic Research, 58, 327-334. doi:10.1016/j.jpsychores.2004.09.011

[15]   Heijmans, M., de Ridder, D. and Bensing, J. (1999) Dissimilarity in patients’ and spouses’ representations of chronic illness: Exploration of relations to patient adaptation. Psychology & Health, 14, 451-466. doi:10.1080/08870449908407340

[16]   Lau-Walker, M. (2004) Relationship between illness representation and self-efficacy. Journal of Advanced Nursing, 48, 216-225. doi:10.1111/j.1365-2648.2004.03190.x

[17]   Heijmans, M. and de Ridder, D. (1998) Structure and determinants of illness representations in chronic disease: A comparison of Addison’s disease and chronic fatigue syndrome. Journal of Health Psychology, 3, 523-537. doi:10.1177/135910539800300406

[18]   Lehto, R.H. (2007) Causal attributions in individuals with suspected lung cancer: Relationships to illness coherence and emotional responses. Journal of the American Psychiatric Nurses Association, 13, 109-115. doi:10.1177/1078390307303112

[19]   Sterba, K.R. and DeVellis, R.F. (2009) Developing a spouse version of the illness perception questionnaire- revised (IPQ-R) for husbands of women with rheumatoid arthritis. Psychology & Health, 24, 473-487. doi:10.1080/08870440701867788

[20]   Buick, D. and Petrie, K.J. (2002) “I know just how you feel”: The validity of healthy women’s perceptions of breast cancer patients receiving treatment. Journal of Applied Social Psychology, 32, 110-123. doi:10.1111/j.1559-1816.2002.tb01422.x

[21]   Del Castillo, A., Godoy-Izquierdo, D., Vazquez, M.L. and Godoy, J.F. (2011) Illness beliefs about cancer among healthy adults who have and have not lived with cancer patients. International Journal of Behavioral Medicine, 18, 342-351. doi:10.1007/s12529-010-9141-6

[22]   Figueiras, M. and Weinman, J. (2003) Do similar patient and spouse perceptions of myocardial infarction predict recovery? Psychology and Health, 18, 201-216. doi:10.1080/0887044021000057266

[23]   Godoy-Izquierdo, D., López-Chicheri, I., López-Torrecillas, F., Vélez, M. and Godoy, J.F. (2007) Contents of lay illness models dimensions for physical and mental diseases and implications for health professionals. Patient Education and Counselling, 67, 196-213. doi:10.1016/j.pec.2007.03.016

[24]   Lykins, E.L., Graue, L.O., Brechting, E.H., Roach, A.R., Gochett, C.G. and Andrykowski, M.A. (2008) Beliefs about cancer causation and prevention as a function of personal and family history of cancer: A national, population-based study. Psycho-Oncology, 17, 967-974. doi:10.1002/pon.1306

[25]   Moss-Morris, R. and Chalder, T. (2003) Illness perceptions and levels of disability in patients with chronic fatigue syndrome and rheumatoid arthritis. Journal of Psychosomatic Research, 55, 305-308. doi:10.1016/S0022-3999(03)00013-8

[26]   Sullivan, H.W., Finney Rutten, L.J., Hesse, B.W., Moder, R.P., Rothman, A.J. and McCaul, K.D. (2010) Lay representations of cancer prevention and early detection: Associations with prevention behaviours. Preventing Chronic Disease, 7, 1-11.

[27]   Weinman, J., Petrie, K., Sharpe, N. and Walker, S. (2000) Causal attributions in patients and spouses following first-time myocardiac infarction and subsequent lifestyle changes. British Journal of Health Psychology, 5, 263- 273. doi:10.1348/135910700168900

[28]   Weinman, J., Heijmans, M. and Figueiras, M. (2003) Carer perceptions of chronic illness. In: Cameron, L.D. and Leventhal, H., Eds., The Self-Regulation of Health and Illness Behaviour, Routledge, London, 207-219.

[29]   Hagger, M.S. and Orbell, S. (2003) A meta-analytic review of the common-sense model of illness representations. Psychology & Health, 18, 141-184. doi:10.1080/088704403100081321

[30]   Lobban, F., Barrowclough, C. and Jones, S. (2003) A review of the role of illness models in severe mental illness. Clinical Psychology Review, 23, 171-196. doi:10.1016/S0272-7358(02)00230-1

[31]   Kaptein, A.A., Scharloo, M., Helder, D.I., Kleijn, W.C., van Korlaar, I.M. and Woertman, M. (2003) Representations of chronic illness. In: Cameron, L.D. and Leventhal, H., Eds., The Self-Regulation of Health and Illness Behaviour, Routledge, London, 97-118.

[32]   Petrie, K.J. and Weinman, J. (1997) Perceptions of health and illness. Harwood Academic, London.

[33]   Figueiras, M., Marcelino, D.L., Claudino, A., Cortes, M.A., Maroco, J. and Weinman, J. (2010) Patients’ illness schemata of hypertension: The role of beliefs for the choice of treatment. Psychology & Health, 25, 507-517. doi:10.1080/08870440802578961

[34]   Fongwa, M.N., Evangelista, L.S., Hays, R.D., Martins, D.S., Elashoff, D., Cowan, M.J. and Morisky, D.E. (2008) Adherence treatment factors in hypertensive African American woman. Vascular Health and Risk Management, 4, 157-166. doi:10.2147/vhrm.2008.04.01.157

[35]   Frosch, D.L., Kimmel, S. and Volpp, K. (2008) What role do lay beliefs about hypertension etiology play in perceptions of medication effectiveness? Health Psychology, 27, 320-326. doi:10.1037/0278-6133.27.3.320

[36]   Heckler, E., Lambert, J., Leventhal, E., Leventhal, H., Janh, E. and Contrada, R. (2008) Commonsense illness belief, adherence behaviors and hypertension control among African Americans. Journal of Behavioral Medicine, 31, 391-400. doi:10.1007/s10865-008-9165-4

[37]   Meyer, D., Leventhal, H. and Gutmann, M. (1985) Common sense models of illness: The example of hypertension. Health Psychology, 4, 115-135. doi:10.1037/0278-6133.4.2.115

[38]   Ross, S., Walker, A. and McLeod, M.J. (2004) Patient compliance in hypertension: Role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18, 607-613. doi:10.1038/sj.jhh.1001721

[39]   Schlomann, P. and Schmitke, J. (2007) Lay beliefs about hypertension: An interpretative synthesis of the qualitative research. American Academy of Nurse Practitioners, 19, 358-363. doi:10.1111/j.1745-7599.2007.00238.x

[40]   Theunissen, N.C., de Ridder, D.T., Bensing, J.M. and Rutten, G.E. (2003) Manipulation of patient-provider interaction: Discussing illness representations or actions plans concerning adherence. Patient Education and Counseling, 51, 247-258. doi:10.1016/S0738-3991(02)00224-0

[41]   Wilson, R.P., Freeman, A., Kazda, M.J., Andrews, T.C., Berry, L., Vaeth, P.A. and Victor, R.G. (2002) Lay beliefs about high blood pressure in a low- to middle-income urban African-American community: An opportunity for improving hypertension control. The American Journal of Medicine, 112, 26-30. doi:10.1016/S0002-9343(01)01049-X

[42]   Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L. and Buick, D. (2002) The revised illness perception questionnaire (IPQ-R). Psychology & Health, 17, 1-16. doi:10.1080/08870440290001494

[43]   Weinman, J., Petrie, K., Moss-Morris, R. and Horne, R. (1996) The Illness Perception Questionnaire: A new method for assessing the cognitive representation of illness. Psychology & Health, 11, 431-435. doi:10.1080/08870449608400270

[44]   Beléndez, R., Bermejo, R.M. and García-Ayala, M.D. (2005) Estructura factorial de la versión española del revised illness perception questionnaire en una muestra de hipertensos. Psicothema, 17, 318-324.

[45]   Karademas, E.C., Zarogiannos, A. and Karamvakalis, N. (2010) Cardiac patient-spouse dissimilarities in illness perception: Associations with patient self-rated health and coping strategies. Psychology and Health, 25, 451-463. doi:10.1080/08870440802652089

[46]   Kaptein, A.A., Scharloo, M., Helder, D.I., Snoei, I., van Kempen, G.M., Weinman, J., van Houwelingen, J.C. and Roos, R.A. (2007) Quality of life in couples living with Huntington’s disease: The role of patients’ and partners’ illness perceptions. Quality of Life Research, 16, 793-801. doi:10.1007/s11136-007-9194-4

[47]   Karasz, A., McKee, M.D. and Roybal, K. (2003) Women’s experiences of abnormal cervical cytology: Illness representations, care processes, and outcomes. Annals of Family Medicine, 1, 196-202. doi:10.1370/afm.31

[48]   Rees, G., Fry, A., Cull, A. and Sutton, S. (2004) Illness perceptions and distress in women at increased risk of breast cancer. Psychology and Health, 19, 749-765. doi:10.1080/08870440412331279764

[49]   Kagee, A., Le Roux, M. and Dick, J. (2007) Treatment adherence among primary care patients in a historically disadvantaged community in South Africa. Journal of Health Psychology, 12, 444-460. doi:10.1177/1359105307076232

[50]   Cameron, L.D. (2008) Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk. Psychology & Health, 23, 91-112. doi:10.1080/14768320701342383

[51]   Claassen, L., Henneman, L., Kindt, I., Marteau, T.M. and Timmermans, D. (2010) Perceived risk and representations of cardiovascular disease and preventive behaviour in people diagnosed with familial hypercholesterolemia: A cross-sectional questionnaire study. Journal of Health Psychology, 15, 33-43. doi:10.1177/1359105309345170

[52]   Figueiras, M.J. and Alves, N.C. (2007) Lay perceptions of serious illnesses: An adapted version of the revised illness perception questionnaire (IPQ-R) for healthy people. Psychology & Health, 22, 143-158. doi:10.1080/14768320600774462

[53]   Selem, S.S., Castro, M.A., Galvao, C.L., Lobo, D.M. and Fisberg, R.M. (2012) Validity of self-reported hypertension is inversely associated with the level of education in Brazilian individuals. Arquivos Brasileiros de Cardiologia, 100, 52-59.

[54]   Van Eenwyk, J., Bensley, L., Ossiander, E.M. and Krueger, K. (2012) Comparison of examination-based and self-reported risk factors for cardiovascular disease, Washington State, 2006-2007. Prevention of Chronic Disease, 9, 321-332.

[55]   Lima-Costa, M.F., Peixoto, S.V. and Firmo, J.O. (2004) Validity of self-reported hypertension and its determinants (the Bambuí study). Revista de Saúde Pública, 38, 637-642. doi:10.1590/S0034-89102004000500004

[56]   Estoppey, D., Paccaud, F., Vollenweider, P. and Marques- Vidal, P. (2011) Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health, 11, 114-123. doi:10.1186/1471-2458-11-114

[57]   Kaplan, M., Huguet, N. and Feeney, D.H. (2010) Self- reported hypertension prevalence and income among older adults in Canada and the United States. Social Science and Medicine, 6, 844-849. doi:10.1016/j.socscimed.2009.11.019

[58]   Pereira, M., Carreira, H., Vales, C., Rocha, V., Azevedo, A. and Lunet, N. (2012) Trends in hypertension prevalence (1990-2005) and mean blood pressure (1975-2005) in Portugal: A systematic review. Blood Pressure, 4, 220- 226. doi:10.3109/08037051.2012.666380

[59]   Pitsavos, C., Milias, G.A., Panagiotakos, D.B., Xenaki, D., Panagopoulos, G. and Stefanadis, C. (2006) Prevalence of self-reported hypertension and its relation to dietary habits, in adults; a nutrition & health survey in Greece. BMC Public Health, 6, 206-214. doi:10.1186/1471-2458-6-206

[60]   Valderrama, A.L., Tong, X., Ayala, C. and Keenan, N.L. (2008) Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults health styles. The Journal of Clinical Hypertension, 12, 222-232.