In a study by Moss-Morris et al (1996) that tested the model, it was found that ‘identity’, ‘consequences’, and ‘internal control/cure’ factors all correlated positively with various adaptive coping strategies. Infact Brewer et al (2002) found that the belief that an illness had serious consequences lead to increased adherence to medication, and even more impressively Partridge and Johnston (1989) found that an individual’s belief regarding their control over a stroke actually predicted recovery. This seems to offer support for Leventhal’s model and outlines the important role of positive illness cognitions in forming productive coping strategies, which in turn should aid recovery.

The Health Beliefs Model (Rosenstock, 1966) is another early attempt to explain the interplay between cognitions and behavioural intention and to outline the specific aspects that make up a health belief. These aspects are described as being: susceptibility, severity, costs, benefits, cues to action, health motivation and perceived control. Criticisms of the model have pointed out that it does not account for emotion, social context or past experiences. These could each affect a patient’s cognitions and behaviour; for example a patient might be motivated by fear to follow the doctor’s advice. The influence of those close to the patient can have a large impact on their behaviour as parents and spouses might advise certain behaviour, or exaggerate/down-play the seriousness of the condition. Even showing a sufferer sympathy can lead to them taking on an ‘ill person’ role which depending on the situation could actually hamper recover. A patient’s previous experience of illness meanwhile (for example knowing someone who has recovered from the condition or even having experienced it themselves), can cause them to assume events will play out in a predictable fashion perhaps leading them to ignore individual differences or differences in severity. Clearly then, emotion, social context and past experiences all play a role in illness perceptions. The more in-depth ‘Protection Motivation Theory’ (Rogers, 1975) addresses one of these issues by adding fear as a motivational aspect.

Another model meanwhile, ‘The Theory of Reasoned Action’ (Bandura, 1977) focuses heavily on the social aspect of illness perception and the role of ‘important others’ in forming opinions and is a social cognition model. The Theory of Reasoned Action once again neglects a role for emotion however. A similar alternative is ‘The Theory of Planned Behaviour’ (Ajzen, 1985), which includes: beliefs about outcomes, evaluations of these outcomes and attitudes towards behaviour; beliefs about attitudes of important others, motivation to comply with others and the subjective norm; internal control factors, external control factors and behavioural control. This model includes social factors but again at the expense of emotion.

None of these models manages to completely explain the myriad factors that form health beliefs and behavioural intentions or the interplay between them, and they all paint a rather simplistic picture of patients’ behaviours which also include unconscious elements and beliefs about one’s self efficacy. Additionally they portray health beliefs as being static whereas in reality they are constantly changing and evolving throughout the course of the illness (Schwazer, 1992). Sutton (1998) found that studies testing the models’ ability to predict behavioural intentions showed them to be successful only 40-50% of the time. Furthermore he argued that much of the time these behavioural intentions failed to then predict actual behaviour – with the models only predicting 19-38% of behaviour. The models do however outline the importance and complex nature of the phenomenon as well as describe some of the variables involved.

Mack LeMouse

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