February is American Heart Month, so we’re going to look at an aspect of behavioural science that can have an impact on outcomes in coronary heart disease (CHD).
People act in line with their thoughts and feelings: the Common Sense Model
If you have a conversation with anyone about symptoms they’re experiencing or a condition they’ve been diagnosed with, you’ll notice that they probably have ideas about what they’ve got, what caused it, how long it will last for, how well they can control it through medication or other tactics, and how much sense it makes to them (“illness perceptions”). The actions they take to manage their condition, such as taking medication or engaging in physical activity, follow on logically from their ideas about it.
The “Common Sense Model” hypothesises exactly that, that illness perceptions and emotional responses to illness have an impact on coping behaviour and consequently health outcomes. The model has been around for 30 years and has been shown to predict behaviour and health outcomes in multiple conditions including CHD.1,2,3
People’s illness perceptions may not be grounded in medical reality
A person’s illness perceptions may not correspond to a medical professional’s understanding of their illness. So, it’s no surprise that people don’t always follow their clinician’s recommendations. For example, in hypertension (a major risk factor for CHD), people who perceived they had less personal ability to control their condition were less likely to take their medication as prescribed.4
Indeed, a person’s perceptions may be a better predictor of their recovery than clinical markers. For example, people in hospital following a heart attack were asked to draw a picture of what they thought their heart looked like before and after their heart attack. The amount of damage shown in people’s drawings had a stronger relationship to the time it took to return to work than a clinical marker (peak troponin-T level).5
Unhelpful illness perceptions can be modified
It follows that intervening to change unhelpful illness perceptions can change coping behaviours and therefore potentially have a positive impact on health outcomes.
The good news is that numerous randomised controlled trials have demonstrated that it is possible to change unhelpful illness beliefs in people with CHD.6 For example, a health psychologist-delivered intervention to change illness perceptions in patients following a heart attack resulted in improved outcomes such as faster return to work and greater participation in physical activity.7,8
Let’s take action!
Since the management of CHD relies a great deal on people’s behaviour (taking medication, taking regular exercise, stopping smoking), understanding people’s illness perceptions is a good starting point for any kind of patient initiative.
In our experience, we have found that interventions to tackle unhelpful perceptions can be successfully incorporated in pharma-sponsored patient support programmes.9 So next time you’re planning an initiative for people with CHD make sure you consider opportunities to address these important behavioural barriers!
If you have CHD, or someone close to you does, check out this downloadable “28 Days Toward a Healthy Heart” resource from the National Heart, Lung and Blood Institute (NHLBI) with suggestions for something you can do each day in February to improve your heart health.
1. Leventhal, H., Phillips, L.A. & Burns, E. (2016). The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. Journal of Behavioural Medicine; 39(6): 935-946.
2. Hagger, M.S., Kock, S., Chatzisarantis, N.L.D. & Orbell, S. (2017). The Common Sense Model of Self-Regulation: Meta-Analysis and Test of a Process Model.
3. Foxwell, R., Morley, C. & Frizelle, D. (2013). Illness perceptions, mood and quality of life: A systematic review of coronary heart disease patients. Journal of Psychosomatic Research; 75(3): 211-222.
4. Ross, S., Walker, A. & MacLeod M.J. (2004) Patient compliance in hypertension: a role of illness perceptions and treatment beliefs. Journal of Human Hypertension, 18:607-613.
5. Broadbent, E., Petrie, K.J., Ellis, C.J., Ying, J. & Gamble, G. (2004). A picture of health – myocardial infarction patients’ drawings of their hearts and subsequent disability: A longitudinal study. Journal of Psychosomatic Research; 57: 583-587.
6. Goulding, L., Furze, G. & Birks, Y. (2010). Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review. Journal of Advanced Nursing; 66(5): 946-961.
7. Petrie, K.J, Cameron, L., Ellis, C.J., Buick, D., & Weinman, J. (2002). Changing illness perceptions after myocardial infarction: An early intervention randomised controlled trial. Psychosomatic Medicine; 64:580-586
8. Broadbent, E., Ellis, C.J., Thomas, J., Gamble, G., & Petrie, K.J. (2009). Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial. Journal of Psychosomatic Research;67:17-23.
9. Ashworth, L., Jackson, C., & Moloney, C. (2016). Impact of a personalized support programme for patients with ACS: beliefs, persistence, and lifestyle change. European Health Psychologist, 18(S), 1021.