In a diverse sample of 452 adult diabetes patients, we investigated: (1) personal model dimensions for diabetes and expanded upon the literature by indexing fatalism, (2) the relationship between contextual factors and patients’ beliefs about the seriousness and controllability of diabetes, and (3) the unique contribution of illness representation combinations to clinical outcomes when controlling for baseline disease severity. Major categories of predictors included patients’ sociocultural characteristics, illness history (e.g., co-morbidities, diabetes complications) and recent physical symptoms. Illness representations were measured using the Personal Models of Diabetes Interview and questions that index fatalistic beliefs. Clinical outcome measures included patients’ glycemic control (HbA1c) and the patient's physical and mental functions as measured by the SF-12. Analyses corroborated the literature by identifying seriousness and treatment effectiveness cognitive model dimensions for diabetes. Physical symptoms and other disease-related factors were strong predictors of patients’ seriousness beliefs for diabetes, whereas sociocultural factors (education, ethnicity) best explained representations related to the controllability of diabetes (i.e., treatment effectiveness, fatalism). Seriousness beliefs were good indicators of actual glucose control, except for cases in which patients were more fatalistic and believed diabetes to be less serious. Although patients had medically consistent views of their diabetes, variations in personal models of diabetes were related to specific contextual factors and independently explained diabetes control.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Adrian, A. K., Scharloo, M., Helder, D. I., Kleijn, W. C., Korlaar, I. M., and Woertman, M. (2003). Representations of chronic illnesses. In Cameron, L. D., and Leventhal, H. (Eds.), The Self-Regulation of Health and Illness Behaviour, Routledge, New York, pp. 97–118.
Aiken, L. S., and West, S. G. (1991). Multiple Regression: Testing and Interpreting Interactions, Sage Publications, Newbury Park, CA.
American Diabetes Association (1999). Test of glycemia in diabetes. Diabetes Care 22: S77–S79.
Antshel, K. M. (2002). Integrating culture as a means of improving treatment adherence in Latino population. Psychol. Health Med. 7: 435–449.
Arsie, M. P., Marchioro, L., Lapollo, A., Giacchetto, G. F., Bordin, M. R., Rizzotti, P., et al. (2000). Evaluation of diagnostic reliability of DCA 2000 for rapid and simple monitoring of HbA1c. Acta Diabetol 37(1): 1–7.
Baumann, L. C. (2003). Culture and illness representation. In Cameron, L. D., and Leventhal, H. (Eds.), The Self-Regulation of Health and Illness Behaviour, Routledge, New York, pp. 242–253.
Brislin, R. W., Lonner, W. J., and Thorndike, E. M. (1973). Cross-Cultural Research Methods, Wiley & Sons, New York.
Brown, S. A., Garcia, A. A., Kouzekanani, K., and Hanis, C. L. (2002). Culturally competent diabetes self-management education for Mexican Americans: The Starr County border health initiative. Diabetes Care 25: 259–268.
Cohen, J., and Cohen, P. (1983). Applied Multiple Regression/Correlation Analyses for the Behavioral Sciences (1st ed.). Lawrence Erlbaum, Hillsdale, NJ.
Darlington, R. B. (1990). Regression and Linear Models, McGraw-Hill, New York.
Diefenbach, M. A., and Leventhal, H. (1996). The common-sense model of illness representation: Theoretical and practical considerations. J. Soc. Distress Homeless 5: 11–38.
Edgar, K. A., and Skinner, T. C. (2003). Illness representations and coping as predictors of emotional well-being in adolescents with Type 1 diabetes. J. Pediatr. Psychol. 28: 485–493.
Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 health survey in nine countries; results from the IQOLA project. J. Clin. Epidemiol. 51: 1171–1178.
Glasgow, R. E., Hampson, S. E., Strycker, L. A., and Ruggiero, L. (1997). Personal-model beliefs and social environmental barriers related to diabetes self-management. Diabetes Care 20: 556–561.
Hampson, S. E. (1997). Illness representations and the self-management of diabetes. In Petrie, K. J., and Weinman, J. A. (Eds.), Perceptions of Health & Illness, Harwood Academic Publishers, The Netherlands, pp. 323–347.
Hampson, S. E., Glasgow, R. E., and Foster, L. S. (1995). Personal models of diabetes among older adults: Relation to self-management and other variables. Diabetes Educ. 21: 300–307.
Hampson, S. E., Glasgow, R. E., and Toobert, D. J. (1990). Personal models of diabetes and their relations to self-care activities. Health Psychol. 9: 632–646.
Hibbard, J. H., Greenlick, M., Jimison, H., Kunkel, L., and Tusler, M. (1999). Prevalence and predictors of the use of self-care resources. Eval. Health Prof. 22: 107–122.
Lange, L. J., and Piette, J. D. (2005). Perceived health status and perceived diabetes control: Psychological indicators and accuracy. J. Psychosom. Res. 58: 129–137.
Lau, R. R. (1997). Cognitive representations of health and illness. In Goshman, D. S. (Ed.), Handbook of Health Behavior Research 1: Personal and Social Determinants, Plenum Press, New York, pp. 51–69.
Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., et al. (1997). Illness representations: Theoretical foundations. In Petrie, K. J., and Weinman, J. A. (Eds.) Perceptions of Health & Illness, Harwood Academic Publishers, The Netherlands, pp. 19– 46.
Leventhal, H., and Diefenback, M. (1991). The active side of illness cognition. In Skelton, J. A., and Croyle, R. T. (Eds.) Mental Representations in Health and Illness, Springer-Verlag, New York, pp. 220–246.
Leventhal, H., Leventhal, E. A., and Cameron, L. (2001). Representations, procedures and affect in illness self-regulation: A perceptual-cognitive model. In Baum, A., Revenson, T. A., and Singer, J. E. (Eds.) Handbook of Health Psychology, Lawrence Erlbaum Associates Publishers, Mahwah, New Jersey, pp. 19–47.
Leventhal, H., Meyer, D., and Nerenz, D. (1980). The common sense representation of illness danger. In Rachmen, S. (Ed.), Contributions to medical psychology, Vol. 2, Pergamon Press, New York, pp. 7–30.
Leventhal, H., and Nerenz, D. (1985). The assessment of illness cognition. In P. Karoly (Ed.), Measurement strategies in health psychology. New York: Wiley, pp. 517--554.
Leventhal, H., Nerenz, D., and Steele, D. J. (1984). Illness representations and coping with health threats. In Baum, A., Taylor, S. E., and Singer, J. E. (Eds.), Handbook of Psychology and Health, Lawrence Erlbaum Associates, Hillsdale, N. J., pp. 219–252.
Meyer, D., Leventhal, H., and Gutmann, M. (1985). Common-sense models of illness: The example of hypertension. Health Psychol. 4: 115–135.
Murphy, E., and Kinmonth, A. L. (1995). No symptoms, no problem? Patients’ understandings of non-insulin dependent diabetes. Fam. Pract. 12: 184–192.
Petrie, K. J., Weinman, J., Sharpe, N., and Buckley, J. (1996). Role of patients’ views of their illness in predicting return to work and functioning after myocardial infarction: Longitudinal study. Br. Med. J. 312: 1191–1194.
Piette, J. D., Schillinger, D., Potter, M. B., and Heisler, M. (2003). Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population. J. Gen. Intern. Med. 18: 624–633.
Piette, J. D., Weinberger, M., McPhee, S. J., Mah, C. A., Kraemer, F. B., and Crapo, L. M. (2000). Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?. Am. J. Med. 108: 20–27.
Quatromoni, P. A., Milbauer, M., Posner, B. M., Carballeira, N. P., Brunt, M., and Chipkin, S. R. (1994). Use of focus groups to explore nutrition practices and health beliefs of urban Caribbean Latinos with diabetes. Diabetes Care 8: 869– 873.
Scharloo, M., and Kaptein, A. (1997). Measurement of illness perceptions in patients with chronic somatic illness: A review. In Skelton, J. A., and Croyle, R. T. (Eds.), Mental Representations in Health and Illness, Springer-Verlag, New York, pp. 103–154.
Schwab, T., Meyer, J., and Merrell, R. (1994). Measuring attitudes and health beliefs among Mexican Americans with diabetes. Diabetes Educ. 20: 221–227.
Skinner, T. C., and Hampson, S. E. (2001). Personal models of diabetes in relation to self-care, well-being, and glycemic control: A prospective study in adolescence. Diabetes Care 24: 828–833.
Skinner, T. C., John, M., and Hampson, S. E. (2000). Social support and personal models of diabetes as predictors of self-care and well-being: A longitudinal study of adolescents with diabetes. J. Pediatr. Psychol. 25: 257– 267.
Ware, J. E., Kosinski, M., and Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales, (2nd ed.), The Health Institute, New England Medical Center, Boston, MA.
Ware, J. E., Kosinski, M., and Keller, S. D. (1996). A 12-Item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med. Care 34(3): 220– 233.
Weitzel, M. H., Hudak, J. L., Becker, H. A., Waller, P. R., and Stuifbergen, A. K. (1994). An exploratory analysis of health-promotion beliefs and behavior among white, Hispanic, and black males. Fam. Community Health 17: 23–34.
Weller, S. C., and Baer, R. D. (2001). Intra-and intercultural variation in the definition of five illnesses: AIDS, diabetes, the common cold, empacho, and mal de ojo. Cross-Cultur. Res. 35: 201–226.
Weller, S. C., Baer, R. D., Pachter, L. M., Trotter, R. T., Glazer, M., Garcia de Alba Garcia, J. E., et al. (1999). Latino beliefs about diabetes. Diabetes Care 22: 722–728.
ACKNOWLEDGMENTS
This study was funded by the Department of Veterans Affairs (VA) and the Agency for Healthcare Research and Quality. Dr. Piette is a VA Research Career Scientist. The views expressed do not necessarily reflect the views of the VA. Thanks to reviewers for their insightful and helpful comments and to the patients who so generously gave of their time to participate in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lange, L.J., Piette, J.D. Personal Models for Diabetes in Context and Patients’ Health Status. J Behav Med 29, 239–253 (2006). https://doi.org/10.1007/s10865-006-9049-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-006-9049-4