Research using a variety of different assessment techniques suggests patients cluster their ideas about an illness around five coherent themes or components. These components together make up the patient's perception of their illness. The components provide a framework for patients to make sense of their symptoms, assess health risk, and direct action and coping. Each of these components holds a perception about one aspect of the illness and together they provide the individual's coherent view of an illness.
The major cognitive components identified from research are: Identity - which is comprised of the label of the illness and the symptoms the patient views as being part of the disease; Cause - personal ideas about aetiology which may include simple single causes or more complex multiple causal models; Time-line - how long the patient believes the illness will last. These can be categorised into acute, chronic or episodic; Consequences - expected effects and outcome of the illness; and Cure/control - how one recovers from, or controls, the illness.
These components show logical interrelationships. For example a strong belief that the illness can be cured or controlled is typically associated with short perceived illness duration and relatively minor consequences. In contrast, beliefs that an illness will last a long time and has a number of symptoms tends to be associated with more severe consequences perceptions and lower beliefs about cure or control of the disease.
An important question that we have little information on at present is where do illness beliefs come from? It is likely that people build up knowledge and impressions of illness they develop more elaborate models of particular diseases. It is not necessary to have had direct experience with an illness. The source of people's perceptions of illness is diverse and ranges from first hand experiences with a family member who may suffer from an illness, to information from the relatives and friends as well as the media. These perceptions may lie dormant until they are activated by their own illness or someone close to them.
Patient cognitive models of their illness are, by their nature, private. Patients are often reluctant to discuss their beliefs about their illness in medical consultations because they fear being seen as stupid or misinformed. Until recently, assessment of illness perceptions has been by open-ended interviews designed to encourage patients to elaborate their own ideas of the their illness. However, recently a questionnaire has been developed to measure illness perceptions in a variety of illnesses. This questionnaire assesses perceptions on each of the five dimensions by asking patients for their own beliefs about their condition. Example of the questions used to assess these components is shown below.
||Rating of a number of symptoms that the patient sees as part of the illness.
Examples from the CFS identity scale include; nausea, sore or swollen glands, forgetfulness, dizziness, stiff or sore joints, fatigue after exercise, muscle pain.
||A germ or virus caused my illness.
Pollution of the environment caused my illness.
Stress was a major factor in causing my illness.
||My illness is likely to be permanent rather than temporary.
My illness will last for a long time.
||My illness has major consequences on my life.
My illness is a serious condition.
||There is little that can be done to improve my illness.
My treatment will be effective in curing my illness.
Illness perceptions has a wide variety of uses in the health psychology area. Illness perceptions have been used to explain behaviour following heart attacks, responses to cancer screening, disability in chronic fatigue syndrome, how patients cope with cancer treatment, and a variety of illnesses such as diabetes and rheumatoid arthritis.