How people present symptoms to health services: a theory-based content analysis

Abstract

BackgroundHow people present symptoms to health services may influence the care they subsequently receive. Leventhal's Commonsense Model of Self-Regulation (CS-SRM) posits that individuals develop cognitive illness representations elaborated around five main components (identity, timeline, cause, consequences, and cure/control), coherence, and emotional representations. AimTo examine whether initial presentations to health services consist of the components of illness representation proposed by the CS-SRM. Design and settingA CS-SRM-based content analysis of calls to the Scottish national telephone advice service, NHS 24. MethodA random sample of callers to NHS 24 was identified. A quota sample of 60 consented to participate. Their consultations were transcribed verbatim. Responses to an initial open question regarding the reason for calling were identified and divided into 'meaning units'. A coding schedule was developed using Leventhal's definitions of illness representations. Meaning units were coded independently by two researchers. ResultsFifty-nine eligible initial presentations contained between 1 and 13 coding units, (mean = 4). A total of 230 coding units were available for coding. Overall, 202 (88%) coding units were coded to at least one component of illness representation. All 59 (100%) participants made reference to identity, 26 (44%) to timeline, nine (15%) to cause, eight (14%) to consequences, 22 (37%) to cure /control, and 11 (19%) to the degree of coherence. Emotional representations were identified in six (10%) participants' presentations. ConclusionLeventhal's CS-SRM accounts for a large proportion of initial presentations to health services. Most people offer identity plus at least one additional component of illness representation. It may be necessary for clinicians to prompt remaining components to obtain a comprehensive understanding of patients' representations of illness.

Relation between illness representation and self-reported degree-of-worry in patients calling out-of-hours services: a mixed-methods study in Copenhagen, Denmark

“…For the purpose of simplicity, the results were then subgrouped into: low DOW (DOW 1–4), moderate DOW (DOW 5 and 6) and high DOW (DOW 7–10). Furthermore, the results were compared with two previous studies: Farquharson et al 21 and Lau et al . 27 …”

“…17 The patients’ understanding of their illness representation influences how they present their health issue to a healthcare provider and this may in turn influence the care they receive. 20 In previous studies, it has been shown that the five components of the CSM framework account for a large proportion of the presentations patients make when contacting OOH services 21 and serve as an appropriate framework for understanding the worry experiences of primary healthcare patients. 22 …”

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