One questionnaire containing two components was utilised for the quantitative aspect of this project. The first component of the survey design was used to collect statistical data from British-Pakistani women in order to validate and generalise the focus group findings regarding preventative perceptions and behaviours. The main limitation of using qualitative methodology is that data is derived from a small sample of participants so results and findings are hard to generalise (Ogden, 2004). Therefore a 12-item prevention perception scale was produced from the main findings of the qualitative studies to explore British- Pakistani female T2DM perceptions on a larger scale. Participants were asked to score the 12 items in regards to how much they agreed with statements, how they felt about the disease in regards to different situations and common and lay beliefs, lifestyle factors and whether living in Pakistan rather than England affected an individual being diagnosed with T2DM. A Likert scale (1-5) was used to collect participant perceptions allowing for a single- item scale approach to assessing responses on a continuous linear scale. This survey
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provided data highlighting British-Pakistani participants’ perceptions and beliefs regarding T2DM and the effects on themselves and their immediate family. Two variations of this survey were used, one targeted mothers with T2DM and for the non-T2DM and young female groups the survey was modified to ask participants to score the items according to if they were to be diagnosed with T2DM.
The Illness Perception Questionnaire Revised (IPQ-R) (Moss-Morris, et al., 2002) was used as the second component of the survey for this project. This questionnaire uses the five cognitive illness representation dimensions of the CSM: identity, cause, consequences, timeline and control/cure. The IPQ-R builds on from the Illness Perception Questionnaire (IPQ) which provides a quantitative assessment of these five components. In addition to these five components the IPQ-R includes illness coherence and the emotional representation of illness. Illness coherence is useful to assess importance of how illness makes sense to the participant and could also be an important component in longer-term adjustment and the response to symptoms. The survey design measures emotional representations affecting coping behaviours and ultimately illness outcomes exploring connections between constructs and behaviour. The purpose of the questionnaire is to focus on illness perceptions of participants and their influences on coping, recovery and adaptation to illness for a range of conditions (Groarke, Curtis, Coughlan & Gsel, 2005; Scharloo, Kaptein, Weinman, Willems, & Rooijmans, 2000b). The IPQ has also been adapted so it can be used with spouses and carers of people with health problems (Figueiras & Weinman, 2003; Weinman, Petrie, Sharpe, & Walker, 2000). Therefore the IPQ-R is a good quantitative tool to use as it can be adapted to the three participant groups and because it provides a more thorough and psychometrically acceptable assessment of the key components of patients’ perceptions of illness.
The format of the IPQ-R has improved the IPQ survey by separating the causal and identity subscales. Participants are asked to identify symptoms they experience and then to identify which of the symptoms they specifically associate with their illness. The causal scale has
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been extended to include more causal items which can be divided into psychological attributions, risk factors, immune system factors and chance factors. There are positive relationships between the attribution factors and illness identity. Psychological and risk factor attributions are related to an increased sense of personal and treatment control suggesting that people feel more in control of their illness if they endorse behavioural and psychological causal factors such as smoking, diet, alcohol, stress, or overwork. On the other hand, immune attributions suggest a more external locus of control relating to a poor sense of treatment control, a chronic and cyclical timeline and serious consequences. Patients who make more psychological attributions also have a tendency to view their illness as chronic and were more distressed by their illness.
The IPQ-R also improves the assessment of perceived timeline of illness by including a cyclical timeline subscale. This increases the reliability of the original acute/chronic timeline subscale and is particularly useful when working with patients whose illness cannot be captured on a simple acute/chronic dimension. The IPQ-R provides support for Horne’s (1997) argument that the control dimension can be divided into personal and treatment components. The new and revised IPQ-R dimensions appear to show logical inter- relationships. For example, beliefs in treatment and personal control and a sense of illness coherence are related to pessimistic beliefs about the timeline and consequences of an illness as well as to negative emotional representations (Horne, 1997).
There are limited studies focusing on how healthy people view and perceive health and illness, and how their ways of thinking relate to health-related behaviours (Figueiras & Alves, 2007). Weinman et al. (1996) expressed the opinion that adaptations can be made to the IPQ to test the psychometric status of it especially with different illness populations therefore in this study the IPQ-R is used with British-Pakistani mothers with T2DM and an adapted version of the IPQ-R for British-Pakistani mothers. Young people’s illness perceptions are compatible with adults (Paterson et al., 1999, Chi et al., 1982) therefore the adapted IPQ-R was also used with the young British-Pakistani female group which consisted of young adults
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(18 years+). The adapted version asked participants for their perceptions if they had T2DM. Using the IPQ-R across the three groups encouraged consistency and reliability of the study. Figueiras and Alves (2007) developed an adapted version of the IPQ-R to use with healthy people that explained significant variance in attitudes and intentions towards the adoption of preventive behaviours, justifying the appropriateness of using the IPQ-R across all the groups.
3.2 British-Pakistani women population group