Name: Francisco Borja Ponce Date: 16th February 2010

Course: Psychology of Health and Illness Teacher: Dr. Jörg Huber

HEA020N222Y

Roehampton University

Biosciences School

Coursework Assessments

Case Study: Leventhal¶s theory of illness representations and the self-regulatory model.

The self-regulatory model gives an idea about what the patient (Mrs Begum) thinks about her
disease, in this case, her µmild¶ diabetes. Due to her illness, she will have an expectation that
will make her have an emotional-based perspective or behaviour against this condition.
(Diefenbach A. Michael, Mount Sinai School of Medicine)

This theory proposed by Leventhal (Leventhal, 1970; Leventhal, Meyer & Nerenz, 1980)
explains that patients¶ beliefs may directly influence their illness experiences and thus they
will have an emotional response towards that illness. (Cameron, Linda and Moss-Morris,
Rona; 2010) The patients usually try to assume the control of the disease after their emotion-
based perspectives can be affected by many factors, in our case: such as the lack of
communication between the health professionals and their patients, the fact she doesn¶t speak
English and that her medical±terms translator is her 14 years old teenage daughter (Maes,
Spielberger, Defares, Sarason, 1988).

Mrs Begum may actually think that, if she doesn¶t feel any symptoms, it¶s because she
stopped suffering from that disease or that she can manage the situation by herself (Sarafino,
2008) and have emotional consequences in the belief that its condition is not very bad or that
it is something that will pass soon. This could explain the patient¶s cognitive processes in the
evolution of its disease and how it can affect the communication with their health
professionals. (Maes, Spielberger, Defares, Sarason, 1988)

In this special case, we have a non-English speaker that thinks she has µmild¶ diabetes but
doesn¶t know why she¶s in the clinic, because she doesn¶t feel bad. She has brought her 14
years old daughter to try to translate medical terms. It¶s not a direct relation between the
doctor and the patient so this may have emotional, communication and affective consequences
that will affect the illness perspective of not only the patient but her teenage daughter
(Coolican, Hugh 2007). She doesn¶t know what diabetes is or if she does know, she will only
have the negative view of the disease: knowing that her mother suffers from diabetes she will
try to assume, as her mother say she feels good, that what the doctor says is wrong. She may
think her mother doesn¶t need any medication and because her medical English might not be
good or very limited, she will not give her mother a clear perspective of her condition. She
may unconsciously try to protect her mother from any shocking news from the progression of

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her disease and exclude doctor¶s information from the consultation as she also translated it.
Petrie and Moss-Morris (1997) said that all the doctors involved with patients with any
chronic illness, such as diabetes, must be aware that there is an elevated risk of those patients
and their families from suffer from depression distresses because of the difficulties this type
of illnesses cause them. This may lead Mrs Belgium child to try to protect her mother. As a
consequence of this type of µfamily protection¶, her mother will not have a clear overview of
what is truly happening with her health and assume that it is alright. (Diefenbach A. Michael,
Mount Sinai School of Medicine).

Mrs Begum feels frustrated and confused, she may think she doesn¶t need the medication the
doctor prescribed because she feels her health is fine and she will imply that her daughter
gave her a good explanation of what the doctor said or that the doctor wasn¶t clear enough.
She might not follow the treatment for her cholesterol condition.

For these types of cases we have to understand three factors: the fact she have a chronic
disease, she doesn¶t speak English, and she brought her 14 years old teenage daughter to
translate. Leventhal in his theory (Leventhal, 1970; Leventhal, Meyer & Nerenz, 1980)
postulates a model: the patient is understood that to have a clear bond, or patient-health care
professional communication, that may lead them to change their emotional-behaviour by their
own illness experience. But in this case, Mrs Begum does not share a direct language contact
with the health professional; she is not probably related (confident) to the doctor then, finally,
she¶s going to draw an erroneous conclusion about what is really happening. (Detrick,
Douglas and Detrick, Susan; 1989) If we add her confusion and stress of which originates
from her for being in a place she thinks she¶s not supposed to be in, because she only have
µmild¶ diabetes, no symptoms, and is not familiarized with the staff and clinic. She doesn¶t
understand she needs to check and control her disease and she feels confusion and stress by
the staff she cannot communicate with. (Pitts, Marian and Phillips, Keith; 1998) These types
of hospital staff-patient relationships are really important because this may give the patient an
emotional perspective of the condition inclusively before their medical consultations: patients
will feel confused, stressful and be unfriendly if they have to deal with stressful, unfriendly
and busy staff or because of the lack of understanding among them. (Maes, Spielberger,
Defares, Sarason, 1988)

In diabetes, the high-glucose levels in blood will damage micro-vascular tissue at first that
eventually, without any proper treatment, develop other conditions that may trigger high
concentrations of cholesterol in blood (Axford, John; 1996). The need for an annual and
recurrent medical consultation is essential for a good evolution of this chronic disease
(Axford, John; 1996), but patients that have a limited or none knowledge of the need and
importance of coming to the annual evaluation may experience frustration when coming
inside a crowded clinic with people that µlook¶ sicker than they feel. (Sarafino, 2008)

Also people will try to seek for medical help if they need it, because they feel pain or any
distress with their health, so in this case pain will be a motivation factor for searching a health
care system. (Sarafino, 2008) or may feel confusion for all the exams she thinks are
unnecessary.

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In conclusion to this theory, it has a clear perspective of how the emotions can alter a patient¶s
behaviour towards a certain illness (Diefenbach A. Michael, Mount Sinai School of Medicine)
but in this case there are other factors that make this theory insufficient for explaining the
cognitive process for illness representations in Mrs Begum cases, because she probably
doesn¶t have any new attitude (behaviour) for her disease, as she didn¶t establish a
communication bond with the doctor and the fact that she may feel some support with her
child, including the many other factors explained before. She may not take the pills to treat
her high- cholesterol and the perception for her disease may still be the same, and probably
she will not attend to the annual reviews until clear and painful symptoms start appearing after
her untreated disease generate more health problems (Sarafino, 2008).

References:

Books:

Axford John (1996) V
 (1st Edition): Blackwell, Oxford

Baum, Andrew et Al. (1997) 


 
    
V
  (1st
Edition): University Press, Cambridge

Brannon, Linda and Feist, Jess (1992)    (2nd Edition): Wadsworth, Belmont

Coolican, Hugh (2007) 
  (2nd Edition): Hodder Arnold, London

Detrick, Douglas and Detrick, Susan (1989)    (1st Edition): The Analytic Press,
Hillsdale

Donaldson, Stewart; Berger, Dale; Pezdek, Kathy (2006) 
   








(1st Edition): Lawrence Erlbaum, New Jersey

French, David et Al. (2010)    (2nd Edition): Blackwell, Chichester

Sarafino, Edward P. (2007)          

  (6th Edition):
Wiley, Chicago

Pitts, Marian and Phillips, Keith (1998)        (2nd Edition): Routledge,
London

Journals:

Hale, E.D; Treharne, G.J; Kitas, G.D (2007) The common-scense model of self-regulation of
Health and Illness: how can we use it to understand and respond to our patients¶ needs?
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c904-906c

Leventhal, Howard; Diefenbach, Michael and Leventhal, Elaine (1992) Illness cognition:
Using common sense to understand treatment adherence and affect cognition interactions.
 ! 
 !     u
c143-163

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Radley, A. and Chamberlain, K. (2001) Health Psychology and the study of the case: from
method to analytic concern.    "V
   c
c321-332

Internet Sources:

Michael A. Diefenbachcë  

  Mount Sinai School of Medicine, U.S
National Institutes of Health:

http://cancercontrol.cancer.gov/brp/constructs/illness_representations/index.html

Web source accessed on February 11, 2011 at 4:10 pm

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