Original articleThe Brief Illness Perception Questionnaire
Introduction
The study of individuals' perceptions of illness stemmed from research into the communication of health threats in the 1960s. Leventhal et al. [1] developed the self-regulatory model to describe the process by which individuals respond to a perceived health threat. The model proposes that situational stimuli (such as symptoms) generate both cognitive and emotional representations of the illness or health threat. These representations are processed in parallel through three stages. The individual first forms the representation of the illness or health threat, next, they adopt behaviours to cope with this, and, lastly, they appraise the efficacy of these behaviours. The model incorporates a continuous feedback loop in which the results of the appraisal process are fed back into the formation of the illness/threat representation and the adoption of coping responses.
Early research identified five dimensions within the cognitive representation of illness: identity—the label the person uses to describe the illness and the symptoms they view as being part of the disease; consequences—the expected effects and outcome of the illness; cause—personal ideas about the cause of the illness; timeline—how long the patient believes the illness will last; and cure or control—the extent to which the patient believes that they can recover from or control the illness [1], [2]. The emotional representation incorporates negative reactions such as fear, anger, and distress. Ongoing research over the past 30 years has demonstrated the importance of illness representations to patient behaviour [3]. Changing patients' illness perceptions has been shown to improve recovery following myocardial infarction (MI) [4], and other self-regulatory interventions in illnesses as diverse as diabetes and AIDS have also improved patient outcomes [5].
Early research investigating the content of illness representations largely involved open-ended interviews. As knowledge has grown and Leventhal's self-regulatory model has become more widely used, more objective measures have been developed. The Illness Perception Questionnaire (IPQ) [6] is a widely used multifactorial pencil-and-paper questionnaire which assesses the five cognitive illness representations on a five-point Likert scale. A revised version of this scale, the Illness Perception Questionnaire–Revised (IPQ-R), extended the original scale by adding more items, splitting the control dimension into personal control and treatment control, and incorporating a cyclical timeline dimension, an overall comprehension of illness factor, and an emotional representation [7].
The IPQ-R has over 80 items, and in some situations such a long questionnaire is prohibitive. This is particularly the case when patients are very ill or when there is limited time available for assessment. A shorter questionnaire would be more suitable for patients who are very ill or elderly because it would be less taxing and much quicker to complete. It may also be more acceptable to those who are limited in their reading and writing ability. The shorter questionnaire offers the potential for illness perceptions to be investigated in a wider range of patient groups [8] and would be especially useful when illness perceptions are measured as only one part of a larger set of psychological constructs, in large population-based studies, and when repeated measures are taken on a frequent basis.
This research aimed not only to construct a very short and simple measure of illness perceptions, but also to construct a measure with an alternative format to the multifactorial Likert scale approach used in the IPQ and IPQ-R. The Brief Illness Perception Questionnaire (Brief IPQ) uses a single-item scale approach to assess perceptions on a continuous linear scale. This paper assesses the psychometric properties of the Brief IPQ using samples from several illness groups and investigates the value of a brief scale to assess illness perceptions.
Section snippets
Scale development
The Brief IPQ has nine items and is shown in Appendix A. The items were developed by forming one question that best summarised the items contained in each subscale of the IPQ-R. The Brief IPQ therefore has eight new items plus part of the causal scale previously used in the IPQ-R. All of the items except the causal question are rated using a 0-to-10 response scale. Five of the items assess cognitive illness representations: consequences (Item 1), timeline (Item 2), personal control (Item 3),
Reliability
The test–retest reliability of the Brief IPQ was assessed in renal patients attending outpatient clinics. The first questionnaire was filled in at the clinic and then follow-up questionnaires were sent to half of the participants after 3 weeks and to the other half of the participants after 6 weeks. Pearson correlations demonstrate that the items have good test–retest reliability over both time periods (see Table 2).
Illness Perception Questionnaire–Revised
To assess the concurrent validity of the Brief IPQ, we asked patients in the
Discussion
This paper reports the psychometric properties of a new nine-item scale, the Brief IPQ. The scale measures patients' cognitive and emotional representations of their illness including consequences, timeline, personal control, treatment control, identity, coherence, concern, emotional response, and causes. The Brief IPQ allows very simple interpretation of scores: increases in item scores represent linear increases in the dimension measured. Results indicate that the Brief IPQ has good
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