Principales contextos donde se desarrollan los valores

Leventhal’s common sense model (Leventhal,1980) views patients as active problem-solvers. They make sense of threats posed to their health due to disease. This cognitive representation of potential risks also determines their responses to illness. “Illness perceptions” have been denoted as “cognitive representations” or “emotional representations” in earlier descriptions of the commonsense model. In the common sense Model there are three main

constructs (i) ‘representation’ of the illness experience which could be either as cognitive representation or emotional representation, (ii) action planning or ‘coping’ responses which are followed by (iii) ‘appraisal,’ of illness management and emotion regulation thus effecting quality of life, adjustment and other outcomes (Levanthal et al.,2003).

A 3-stage model has been proposed to understand the emotional and behavioral responses of cardiac patients in the context of the common sense model. The most important stage is the process of interpretation followed by coping responses of patients. On the basis of evaluation of outcomes of coping strategies, patients rearrange their illness-related cognitive schemas. The behaviour of patients with cardiac illness has been explained in the context of these three stages. For instance, the chest pain and other symptoms of myocardial infarction are interpreted as threats to the patients’ physical health status, daily functioning and quality of life and as an increase in the risk of mortality due to cardiac arrest. Leventhal (1970) proposed parallel process approach (Fig 1) is adopted by patients and they simultaneously process information at cognitive and emotional level after experiencing health threats. If the threat is high e.g. after the major episode of a heart attack the feelings of fear, anxiety or sadness heightens.

Situational Stimuli

Inner and outer

Representation of Danger Representation of Fear Coping Procedures (Action Plans) Coping Procedures Appraisal Appraisal

Figure 3-1: The Parallel Process Model (Rachman, 1980)

Leventhal (1970) identified five main types of illness cognitions; identity, causation, timeline, consequences and control. The individual’s perception of threats associated with any illness determines their reactions towards illness as well as coping strategies adopted to face the situation. In the case of patients post MI the commonly used label of disease (heart attack) refers to the identity component of illness related cognitions. Stress, obesity and a high-calorie diet have been identified as common causes of this disease and patients respond in accordance with their perceptions of possible causes. Timeline refers to the patient’s expectations about the time for development of the disease and

duration of recovery. The possible consequences of this illness include an inability to carry out daily functions, time off from work, restricted social activities and increased dependence on others for self-care. The last of Leventhal’s typology of cognitions, ‘control’, refers to the patient’s perception of having control over the disease in terms of delaying its progression or their being an early cure. This illness related cognitions have an impact on illness-related behaviors. The possible coping mechanisms adopted by patients are categorized as approach or avoidance coping techniques (Leventhal & Cameron, 1987). There might follow a stage in which cognitive representation of illness and the responses are revised in the light of judgments made by patients about the impact of coping mechanisms implemented.

Health Threat Cognitive representations of illness Emotional representation of illness How illness is managed How emotions are regulated Appraisal Threat Quality of life adjustment Well-being Functioning

Figure 3-2: Commonsense Model (Levanthal et al., 2003)

In the common sense model there are three main constructs (i) ‘representation’ of the illness experience which could be either as cognitive representation or emotional representation, (ii) action planning or ‘coping’ responses which are followed by (iii) ‘appraisal,’ of illness management and emotion regulation thus effecting quality of life, adjustment and other outcomes (Levanthal et al., 2003). The commonsense model has been applied to interpret and understand the health related behaviors of cardiac patients particularly how their responses influence their recovery from illness (Byrne, 1982; Diedricks et al., 1991; Garrity, 1973). Regardless of the severity of MI, the perceptions of patients have been found to play a significant role in determining their levels of functioning and

recovery. Patients who perceive their illness as more disabling and exhibit excessive dependency and passivity are at high risk of having another episode of cardiac arrest (Byrne, 1982; Hagger & Orbell, 2003; Lau-Walker et al., 2009).

Petrie et al. (1996) found that a strong relationship existed between patient’s perception of illness and their behaviors in relation to continuing treatment, recovery and being functional. Similarly, other researchers (Cooper et al., 1999; Seeedat, 1999; Welish, 2006) found that the belief system of patients largely determined their ability to cope with their illness. Those who have a strong belief in their ability to cope with their illness were also active agents in following their treatment plan and regaining previous functional status. Based on this evidence, some interventions have been specifically designed for MI patients. These target cognition and the belief systems of patients, consequently modifying their behaviour (Petrie et al., 2002).Cardiac patients who were exposed to some brief cognitive behaviour intervention, showed better treatment outcomes as compared to patients who had negative perceptions of their illness. The intervention comprised of sharing some information related to the pathophysiology of MI, knowing about patients’ beliefs about the cause to their MI and addressing any misconceptions they have related to their health conditions. Patients who received this brief therapy not only had better treatment outcomes but also responded better than controls on other variables like optimism, quality of life and regaining social and domestic responsibilities (Petrie et al., 2002). The common sense model explains and predicts the health related behaviour of cardiac patients by targeting patient’s cognition, personality, and

prospective thinking (Cooper et al., 1999; Petrie et al., 2002; 1996; Steed et al., 1999; Williams, 2007).

While preventive interventions aim to change behavioral risk factors such as poor eating habits, alcohol use, smoking and sedentary lifestyle, the patients' perceptions about their condition and effectiveness of these measures determine the concordance with risk factor reduction (Lau-Walkder et al., 2009). Lin et al. (2012) investigated the role of social influence in altering the cardiac patients’ perceptions about their illnesses. Their research examined the perceptions of people with other chronic illnesses about coronary heart disease, assuming that the perceptions of these people are likely to reflect societal misconceptions about cardiac illnesses. They found that patients with a non- cardiac chronic illness held similar misconceptions about cardiac diseases as patients with myocardial infarctions. These findings were explained using Leventhal’s self-regulatory model, which states that social factors influence each variable involved in the representations of health threats and coping with illness (Lin et al.,2012).The study findings strongly suggested that patients’ misconceptions and maladaptive beliefs should be taken into account when planning primary or secondary interventions for these patients. In addition, there is a need for education programs targeting patient, family, and overall societal beliefs about cardiac illness (Lin et al., 2012).

The common sense model of health and illness is a very useful model in terms of identifying the role of cognitive representations of illness, which ultimately

have an impact on health and rehabilitative behaviors (Leventhal et al., 2003). However, it does not include the role of personality factors which might influence the cognitive representation (Moutafi et al.,2006).A relationship between personality dimensions and cognition has been supported by previous research studies (Moutafi et al., 2006; Soubelet & Salthouse, 2011). Some research findings indicate negative relations of Neuroticism to cognitive measures (Crowe et al., 2006; Wilson et al., 2007) while other research has indicated that higher levels of openness are associated with better performance on several cognitive tasks (Ackerman & Heggestad, 1997; DeYoung et al., 2005). To address this William (2007) included personality as a mediating variable in her adaptation of the common sense model.