Page 203 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

178 Chapter 7. Concordance

of time; those finding it difficult to get the garment on and off
might stop wearing it all together. Self-efficacy therefore has
important implications for concordance in cases where self-
care is required. Low levels of self-efficacy have been also
been implicated in patients with leg ulcers who do not engage
in physical exercise (Heinen et al. 2007 ), poor concordance
with compression bandaging (Finlayson et al. 2010 ), and poor
foot-care in people with diabetic neuropathic foot complica-
tions (Vileikyte et al. 2004 ).
Patient beliefs are also central to the self-regulatory theory
or ‘common sense’ model of illness, put forward by Leventhal
and colleagues (Leventhal and Cameron 1987 ; Leventhal
et al. 1997 , 2003 ). According to this model, ‘common- sense’
beliefs about illness and their remedies shape our response
to threats to our health. Thus we expect aspirin to cure a
headache, antibiotics to clear infection, ointment to soothe
an itchy rash and so on (Leventhal et al. 2003 ). When our
expectations are fulfilled (e.g. the ointment soothes the itch),
behaviours are reinforced and we are more likely to repeat
them in the future. However, if our expectations are thwarted
then we will reassess the situation, questioning the relevance
of the remedy (perhaps this rash is more serious than first
imagined) or its efficacy. Concordance behaviours are there-
fore heavily influenced by these common- sense beliefs, and
the patient’s ‘illness perceptions’, that is their representations
of their illness. Illness perceptions differ from person to per-
son (Cameron and Leventhal 2003) and even patients with
the same medical condition can hold very disparate views of
their illness. The way that patients think about their illness is
structured around five cognitive dimensions:
1. illness identity – the label an individual gives to their ill-
ness and the symptoms that they believe are associated
with the condition;
2. t imeline – how long the patient expects the condition to
last;
3. causes of the illness;
4. consequences of their health problem;
5. control over disease progress (can treatment effect a cure)