The common-sense model of self-regulation of health and illness: how can we use it to understand and respond to our patients' needs?

As Hill et al. point out in their powerful paper [1], there is often a difference between objective clinical and radiographic evidence of musculoskeletal disease activity or severity and the experience of pain, other symptoms and functional ability reported by the patient. For the patient, the greatest impact of the disease lies in the effect it has on their ability to continue with a ‘normal’ daily life and this will necessarily be their focus of interest. It is, however, increasingly important for us as researchers and healthcare professionals to understand how the perceptions, experience and impact of having a musculoskeletal condition might influence a patient’s interpretation and response to it, so that we, in turn, can respond more appropriately. The model used by Hill et al. in their paper [1] to investigate these issues is varyingly known as the Illness Perceptions Model, the Illness Representations Model, the Self-Regulatory Model, the Parallel Process Model, the Common-Sense Model of selfregulation or simply as Leventhal’s model, after Howard Leventhal and colleagues [2–7] who championed research in this field. For ease, we will refer to it as the Common-Sense Model (CSM). Leventhal started his research in the late 1960s and early 1970s looking at how fear messages in relatively acute situations might lead to people taking health-promoting actions such as wearing seat belts or giving up smoking [3]. He and his colleagues found that different types of information were needed to influence both attitudes and actions to a perceived threat to health and wellbeing, and these only lasted for short periods of time. In extending their initial model, Leventhal and colleagues wanted to know what adaptations and coping efforts might need to be made and maintained in those experiencing chronic illness. They proposed a hierarchically organized model of an adaptive system featuring the three main constructs of (i) ‘representation’ of the illness experience that might guide (ii) action planning or ‘coping’ responses and performance of these, followed by (iii) ‘appraisal,’ or monitoring of the success or failure of coping efforts [7]. The model has many similarities with other theories of problemsolving behaviour, such as the transactional model of stress and coping [8], wherein illness can be conceptualized as a stressful experience. A novel feature of Leventhal’s proposition was to delineate the active parallel cognitive processing of how people regulate their responses both to ‘illness danger’ (‘What is this health threat, what can I objectively do about it?’) and to the person’s regulation of ‘emotional control’ (‘How do I feel about it, what can I do to make myself feel better about it?’). The key construct within the CSM is the idea of illness representations or ‘lay’ beliefs about illness. These representations integrate with existing schemata (the normative guidelines that people hold), enabling them to make sense of their symptoms and guide any coping actions. Leventhal and colleagues [2] describe five components of these illness representations:

[1]  P. Croft,et al.  The illness perceptions associated with health and behavioural outcomes in people with musculoskeletal hand problems: findings from the North Staffordshire Osteoarthritis Project (NorStOP). , 2007, Rheumatology.

[2]  C. Wright,et al.  A 12-month follow-up study of self-management training for people with chronic disease: are changes maintained over time? , 2005, British journal of health psychology.

[3]  S. Morrissey,et al.  The Application of Cognitive-behaviour Therapy in Altering Illness Representations of Systemic Lupus Erythematosus , 2005 .

[4]  S. Morrissey,et al.  Illness Representations of Systemic Lupus Erythematosus , 2005, Qualitative health research.

[5]  E. Miller,et al.  The illness representations of multiple sclerosis and their relations to outcome. , 2003, British journal of health psychology.

[6]  M. Koutantji,et al.  Illness perceptions, mood and coping in predicting attendance at cardiac rehabilitation. , 2003, British journal of health psychology.

[7]  Martin S. Hagger,et al.  A Meta-Analytic Review of the Common-Sense Model of Illness Representations , 2003 .

[8]  F. Brown Inside every chronic patient is an acute patient wondering what happened. , 2002, Journal of clinical psychology.

[9]  F. Kraaimaat,et al.  Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial , 2002, Pain.

[10]  Keith J Petrie,et al.  Changing Illness Perceptions After Myocardial Infarction: An Early Intervention Randomized Controlled Trial , 2002, Psychosomatic medicine.

[11]  Keith Petrie,et al.  The Revised Illness Perception Questionnaire (IPQ-R) , 2002 .

[12]  C. Wright,et al.  A randomized controlled study of the Arthritis Self-Management Programme in the UK. , 2000, Health education research.

[13]  C. Main,et al.  Pathological worrying, illness perceptions and disease severity in patients with psoriasis , 2000 .

[14]  J. Hazes,et al.  Predicting functional status in patients with rheumatoid arthritis. , 1999, The Journal of rheumatology.

[15]  M. Heijmans The role of patients' illness representations in coping and functioning with Addison's disease , 1999 .

[16]  K. Petrie,et al.  Functioning in chronic fatigue syndrome: Do illness perceptions play a regulatory role? , 1996 .

[17]  H. Leventhal,et al.  Sex differences in attitude and behavior change under conditions of fear and specific instructions , 1966 .

[18]  Howard Leventhal,et al.  The common-sense model of self-regulation of health and illness. , 2003 .

[19]  Howard Leventhal,et al.  The self-regulation of health and illness behaviour. , 2003 .

[20]  Yael Benyamini,et al.  Illness representations: Theoretical foundations. , 1997 .

[21]  K. Petrie,et al.  The illness perception questionnaire: A new method for assessing the cognitive representation of illness , 1996 .

[22]  H. Leventhal,et al.  Common-sense models of illness: the example of hypertension. , 1985, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[23]  L. Bradley,et al.  Coping with chronic disease : research and applications , 1983 .

[24]  S. Rachman Contributions to medical psychology , 1980 .