565826 research-article2015

HPQ0010.1177/1359105314565826Journal of Health PsychologyNowicka-Sauer et al.

Article

Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire

Journal of Health Psychology 1­–11 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105314565826 hpq.sagepub.com

Katarzyna Nowicka-Sauer1, Dorota Banaszkiewicz2, Izabela Staśkiewicz1, Piotr Kopczyński2, Adam Hajduk1, Zenobia Czuszyńska1, Mariola Ejdys3,4, Małgorzata Szostakiewicz5, Agnieszka Sablińska1, Anna Kałużna6, Magda Tomaszewska7 and Janusz Siebert1

Abstract The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with chronic conditions (58.7% women) completed the Brief Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. The internal consistency of the Polish Brief Illness Perception Questionnaire measured with Cronbach’s alpha was satisfactory (α = 0.74). Structural validity was demonstrated by significant inter-correlations between the Brief Illness Perception Questionnaire components. Discriminant validity was supported by the fact that the Brief Illness Perception Questionnaire enables patients with various conditions to be differentiated. Significant correlations were found between Brief Illness Perception Questionnaire and depression and anxiety levels. The Polish Brief Illness Perception Questionnaire thus evaluated is a reliable and valid tool.

Keywords Brief Illness Perception Questionnaire, chronic illness, health psychology, illness perception, methodology, quantitative methods, validation

1Medical

University of Gdańsk, Poland 2Gdańsk University, Gdańsk, Poland 3University of Warmia and Mazury in Olsztyn, Poland 4Municipal Hospital in Olsztyn, Poland 5University of Social Sciences and Humanities, Poland 6Independent Public Specialist Health Care Centre in Lebork, Poland

7Wojewódzki

Szpital Specjalistyczny im. Janusza Korczaka,

Słupsk, Poland Corresponding author: Katarzyna Nowicka-Sauer, Department of Family Medicine, Medical University of Gdańsk, Ul. Dębinki 2, 80-211 Gdańsk, Poland. Email: [email protected]

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Introduction Illness perception is a psychological concept that has evolved as a basic construct of Leventhal’s common sense model (Diefenbach and Leventhal, 1996). According to this model, each patient facing illness creates an individual cognitive and emotional representation of their illness. The cognitive representation has five dimensions: identity (the symptoms believed to be part of the illness), timeline (how long the condition is expected to last), cure/control (the perceived controllability of the illness and the effectiveness of the treatment) and causation (factors believed to be the cause of the condition) (Hagger and Orbell, 2003). Studies of illness perception have revealed that this has affected patients’ involvement in care, compliance and health behaviours, their emotional response to illness, their coping behaviours and the strategies adopted while dealing with illness (Hagger and Orbell, 2003; Van Esch et al., 2014; Woith and Rappleyea, 2014). It is of even greater importance that illness perception is modifiable, and the ensuing changes may enable patients to cope better and produce more satisfactory illness outcomes (Bonsaksen et al., 2013; Hagger and Orbell, 2003; Juergens et al., 2010; Petrie et al., 2002; Rees et al., 2013; Wiborg and Lowe, 2013). In recent years, there has been a significant increase in research concerning illness perception, especially since questionnaires assessing illness perception have become available. These have included the Illness Perception Questionnaire (IPQ) (Weinman et al., 1996), the revised version of the IPQ, known as the IPQ-R (Moss-Morris et al., 2002) and the Brief Illness Perception Questionnaire (B-IPQ) designed by Elizabeth Broadbent (Broadbent et al., 2006). Research has demonstrated that the original English version of the B-IPQ is acceptably reliable and has good concurrent, discriminant and predictive validity (Broadbent et al., 2006). However, the psychometric properties of other language versions of the questionnaire have as yet only been established in a few studies (Bazzazian and Besharat, 2010; Paheco-Huergo et al., 2012; Pain et al., 2006;

Radat et al., 2008; Yaraghchi et al., 2012). New adaptations for other languages and modified versions for particular diseases are encouraged (Broadbent et al., 2006; Hvidberg et al., 2014; Moss-Morris et al., 2002). No validation study has so far been published of the B-IPQ performed in the Polish population. This study aims to rectify this by evaluating the psychometric properties of a Polish translation of the B-IPQ.

Method Measures The B-IPQ consists of eight items scored on an 11-point Likert scale (range: 0–10). Each item reflects one of the following dimensions: consequences, timeline, personal control, treatment control, identity, concern, coherence/understanding and emotional response. The ninth question is open-ended and concerns patients’ beliefs about the causes of their illness (Broadbent et al., 2006). Quantitative analysis provides eight subscores, one for each B-IPQ item, which reflect aspects of illness perception, and a total score generated by summing up the scores for the B-IPQ items with a reverse scoring of items 3, 4 and 7. A higher total score reflects perception of an illness as being more threatening. The openended question asks the patients to list the three most important causes of their diseases. Categorical analysis of the answers received is carried out by grouping these into specific categories, such as hereditary factors, life-style, environment and stress. Analysis of the causal factors was not carried out for this study. The Hospital Anxiety and Depression Scale (HADS) was used to assess levels of depression and anxiety (Zigmond and Snaith, 1983). Evaluation of distress forms an important component of studies among patients with a variety of medical conditions and also in the context of illness perception and its assessment and measurement (Bazzazian and Besharat, 2010; De Raaij et al., 2012). The scale consists of 14 items with responses on a 4-point Likert scale. Seven of the items measure depressive symptoms and the remaining 7 items anxiety symptoms. The

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inpatients with neurological diseases (N = 24); internal medicine inpatients (N = 21) and young adult outpatients with minor chronic conditions (N = 50). Details of the study sample and characteristics of the patients are presented in Table 1.

maximum HADS score for each subscale is 21 points; scores below 8 indicate a normal result, 9–10 points demonstrate moderate anxiety or depression, while a score of 11 or more reflects severe depressive/anxiety symptoms. In this study, we used a Polish version of HADS. A validation study of the test revealed it to be of satisfactory reliability (Majkowicz, 2000). Sociodemographic data were collected using a structured interview. All the patients were informed of the purpose of the study and agreed to participate in it. The research fulfilled the ethical requirements for each of the participating centres and received their approval.

Examination procedure

Translation procedure

Statistical analysis

Research was conducted between 2006 and 2013. In the early stages, the Polish version of B-IPQ was unavailable. Once translation rights had been obtained, the first author of this article, a psychologist experienced in the field who is also a Polish native speaker fluent in English, translated the questionnaire into Polish. Next, an English speaker who did not know the original English version of the B-IPQ performed a back-translation into English. The latter was checked and approved by a second Polish native speaker fluent in English and then compared with the original by the whole translation team. The final version (see Appendix 1) was tested in a pilot study involving 30 patients with systemic lupus erythematosus (SLE). The aim was to obtain their opinions on the simplicity and comprehensibility of the test. The patients easily understood the questionnaire and filled it in without difficulty.

Descriptive statistics were used to show the characteristics of the study sample. Mean values were used with standard deviation (SD) in the case of quantitative variables and proportions in the case of categorical variables. The reliability of the B-IPQ was tested by examining the internal consistency using Cronbach’s alpha (α) coefficient. In order to assess the test’s structural validity, inter-correlations between the B-IPQ dimensions were calculated using Spearman’s correlation coefficient. Discriminant validity was assessed by using a series of one-way analysis of variance (ANOVA) with post hoc Scheffe tests to determine the differences between the groups of patients studied. Spearman’s correlation coefficient was used to assess concurrent validity by examining the correlations between levels of depression and anxiety measured by the HADS and B-IPQ dimensions and by the total B-IPQ score.

Participants

Results

The study group consisted of 276 patients with medically confirmed diagnoses of various chronic conditions as follows: patients with myocardial infarction (MI) (N = 58) consecutively recruited from a cardiac rehabilitation setting; consecutive outpatients with rheumatoid arthritis (RA) (N = 50), SLE (N = 54) and mixed connective tissue disease (MCTD) (N = 19) recruited from rheumatology outpatient clinics;

Internal consistency

Prior to the study, each researcher (psychologists and a nurse) participated in a lecture on Leventhal’s theory and was given detailed instructions concerning the B-IPQ. Patients were each given oral instruction during face-toface interviews.

The internal consistency of the Polish version of B-IPQ evaluated was very good. Cronbach’s alpha coefficient for the total score was 0.74. The values of Cronbach’s alpha coefficient for the B-IPQ dimensions were in an acceptable range between 0.67 for consequences and identity and 0.74 for personal control and treatment control.

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Table 1.  Characteristics of the study sample (N = 276).

Myocardial infarction Rheumatoid arthritis Systemic lupus erythematosus Mixed connective tissue disease Neurology inpatients Internal medicine inpatients Young adult outpatients with minor chronic conditions

N

Sex (% female)

Mean age (SD)

Mean duration of the disease (SD)

58 50 54 19 24 21 50

19.0 76.0 94.4 84.2 25.0 42.9 62

60.2 (7.6) 52.0 (13.5) 46.5 (11.9) 47.7 (11.3) 59.7 (12.9) 52.05 (13.5) 22.9 (1.5)

5.1 (7.2) 13.8 (12.4) 12.1 (7.6) 6.3 (5.0) 4.7 (6.3) 13.9 (7.6) 7.95 (8.4)

SD: standard deviation.

Table 2.  Correlations between B-IPQ illness perception dimensions. 1. 1. Consequences 2. Timeline 3. Personal control 4. Treatment control 5. Identity 6. Concern 7. Understanding 8. Emotional response

.28* .10 .10 .06* .51* .16* .58*

2.

3.

4.

5.

6.

7.

8.

.28*

.10 .21*

.10 .08 .33*

.63* .32* .22* .08

.51* .23* .07 .04 .51*

.16* .22* .32* .17* .26* .26*

.58* .24* .04 .09 .52* .54* .14*  

.21* .08 .32* .23* .22* .24*

.33* .22* .07 .32* .04

.08 .04 .17* .09

.51* .26* .52*

.26* .54*

.14*

B-IPQ: Brief Illness Perception Questionnaire. *Statistically significant correlations; p 

Illness perception in Polish patients with chronic diseases: Psychometric properties of the Brief Illness Perception Questionnaire.

The study evaluates the psychometric properties of a Polish translation of the Brief Illness Perception Questionnaire. A total of 276 patients with ch...
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