Predicting recovery from stroke

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70 HEALTH PSYCHOLOGY
USING THE SELF-REGULATORY MODEL TO
PREDICT OUTCOMES
The self-regulatory model describes a transition from interpretation, through illness cognitions, emotional response and coping to appraisal. This model has primarily been used
in research to ask the questions ‘How do different people make sense of different
illnesses?’ and ‘How do illness cognitions relate to coping?’ Research, however, has
also explored the impact of illness cognitions on psychological and physical health outcomes. Some research has addressed the links between illness cognitions and adherence
to treatment. Other research has examined their impact on recovery from illnesses
including stroke and myocardial infarction (MI; heart attack).
Predicting adherence to treatment
Beliefs about illness in terms of the dimensions described by Leventhal and colleagues
(1980, 1997) have been shown to relate to coping. They have also been associated with
whether or not a person takes their medication and/or adheres to other suggested treatments. For example, Brewer et al. (2002) examined the relationship between illness
cognitions and both adherence to medication and cholesterol control in patients with
hypercholesterolaemia (involving very high cholesterol). The results showed that a
belief that the illness has serious consequences was related to medication adherence. In
addition, actual cholesterol control was related to the belief that the illness was stable,
asymptomatic with serious consequences. Some research has also included a role for
treatment beliefs. For example, Horne and Weinman (2002) explored the links between
beliefs about both illness and treatment and adherence to taking medication for asthma
in 100 community-based patients. The results showed that non-adherers reported more
doubts about the necessity of their medication, greater concerns about the consequences
of the medication and more negative beliefs about the consequences of their illness.
Overall, the analysis indicated that illness and treatment beliefs were better predictors of
adherence than both clinical and demographic factors. In a similar study, Llewellyn et al.
(2003) explored the interrelationships between illness beliefs, treatment beliefs and
adherence to home treatment in patients with severe haemophilia. The results showed
that poor adherence was related to beliefs about the necessity of the treatment, concerns
about the consequences of treatment and beliefs about illness identity.
Predicting recovery from stroke
Research has also explored links between illness cognitions and recovery from stroke. For
example, Partridge and Johnston (1989) used a prospective study and reported that
individuals’ beliefs about their perceived control over their problem predicted recovery
from residual disability in stroke patients at follow-up. The results showed that this
relationship persisted even when baseline levels of disability were taken into account. In
line with this, Johnston et al. (1999a) also explored the relationship between perceived
control and recovery from stroke and followed up 71 stroke patients one and six months
after discharge from hospital. In addition, they examined the possible mediating effects of
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