Predicting Self-Management Behaviors in Familial Hypercholesterolemia Using an Integrated Theoretical Model: the Impact of Beliefs About Illnesses and Beliefs About Behaviors

  • Martin S. Hagger
  • Sarah J. Hardcastle
  • Catherine Hingley
  • Ella Strickland
  • Jing Pang
  • Gerald F. Watts



Patients with familial hypercholesterolemia (FH) are at markedly increased risk of coronary artery disease. Regular participation in three self-management behaviors, physical activity, healthy eating, and adherence to medication, can significantly reduce this risk in FH patients. We aimed to predict intentions to engage in these self-management behaviors in FH patients using a multi-theory, integrated model that makes the distinction between beliefs about illness and beliefs about self-management behaviors.


Using a cross-sectional, correlational design, patients (N = 110) diagnosed with FH from a clinic in Perth, Western Australia, self-completed a questionnaire that measured constructs from three health behavior theories: the common sense model of illness representations (serious consequences, timeline, personal control, treatment control, illness coherence, emotional representations); theory of planned behavior (attitudes, subjective norms, perceived behavioral control); and social cognitive theory (self-efficacy).


Structural equation models for each self-management behavior revealed consistent and statistically significant effects of attitudes on intentions across the three behaviors. Subjective norms predicted intentions for health eating only and self-efficacy predicted intentions for physical activity only. There were no effects for the perceived behavioral control and common sense model constructs in any model.


Attitudes feature prominently in determining intentions to engage in self-management behaviors in FH patients. The prominence of these attitudinal beliefs about self-management behaviors, as opposed to illness beliefs, suggest that addressing these beliefs may be a priority in the management of FH.


Illness perceptions Hyperlipidemia Theoretical integration Common sense model Theory of planned behavior Social cognitive theory Attitudes 



This research was supported by a grant from the International Atherosclerosis Society and Pfizer (grant #10839501).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.


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© International Society of Behavioral Medicine 2016

Authors and Affiliations

  1. 1.Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health ScienceCurtin UniversityPerthAustralia
  2. 2.The Metabolic Research Centre and Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital and the School of Medicine and PharmacologyThe University of Western AustraliaPerthAustralia
  3. 3.Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
  4. 4.School of Applied Psychology and Menzies Health Institute, QueenslandGriffith UniversityBrisbaneAustralia

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