Psychological Well Being Among People Attending the Better Health Self Management Course'

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Psychological Well Being Among People Attending
the Better Health Self Management Course.

• Georgina Bancroft

Interdisciplinary Research Centre in Health
Health Intervention Team School of Health
Social Sciences Coventry University
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Interdisciplinary Research Centre in Health

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Self-management projects

• Arthritis self-management programme for
  self-referred arthritis patients
• Chronic Disease Course (LILL Project)
• Chronic Disease Course for Bengali speaking
  participants
• Non-attendance on the CDSMC
• Exercise on the CDSMC
• Chronic Disease Course for heart attack patients
• Chronic Disease Course for MS patients
• Tutors self management
• Arthritis self-management for GP referred OA
  patients

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Study rationale

• Studies have not compared outcomes across illness
  groups
• UK government initiative
• Group processes

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Vicious Cycle
Disease Fatigue

Vicious cycle
Tense muscles
Difficult emotions
Stress/anxiety
Depression
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Phase I

• A comparison of five
• chronic illness groups

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Aim

• To compare the five chronic illness groups (CFS,
  DM, ENDO, OP and PPS) in terms of illness
  symptoms, psychological well-being and
  self-efficacy.

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Study design
CDC Assessment ?
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Study Measures

• Visual Analogue Scale (Pain)
• Visual Analogue Scale (Fatigue)
• Self-efficacy for Disease
• Hospital Anxiety/Depression Scale
• Health Distress

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Sample (n162)

• Mean
• Age 53
• Disease duration (years) 16
• Gender Female 81
• Ethnic origin White/Eur. 97
• Comorbidity yes 67

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Main chronic condition
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Fatigue
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Pain
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Anxiety
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Depression
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Self-efficacy disease
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Self-efficacy symptoms
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Phase II
A qualitative study
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Aim

• To gain a greater insight into the group
  processes among participants attending the CDSMP,
  focusing on social comparisons.

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Design, sample analysis

• The study employed a cross-sectional design,
  exploratory in nature. Data for Phase II was
  collected at one point in time following course
  attendance (four-months post-baseline).
• A total of 15 respondents (13 women and 2 men)
  who had enrolled on a CDSMP were purposively
  selected. Interviewees had the following
  illnesses CFS (n3), DM (n3), ENDO (n3), OP
  (n3) and PPS (n3).
• Qualitative data were analysed using content
  analysis (CA) and drew on some of the principles
  of Interpretative Phenomenological Analysis (IPA).

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Social comparison theory

• Our quest to know ourselves, about the search
  for self-relevant information and how people gain
  self-knowledge and discover reality about
  themselves (Mettee and Smith 1977)
• People wish to perceive themselves as superior
  to others and they will in fact construct
  perceptions of themselves and social reality that
  support this wish to the maximum degree that
  physical and social reality permit (Goethals et
  al. 1991)

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Social comparison theory Health research

• 69 of women with breast cancer thought their
  prognosis was better than that of other women
  (Stanton et al. 1999)
• 73 thought they were better adjusted than other
  women (Stanton et al. 1999)
• 80 thought they were better adjusted than other
  women (Wood et al. 1985)

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Social comparison theoryDownward comparison

• Downward comparisons are overwhelmingly more
  frequent than upward comparisons among chronic
  disease populations and are related to positive
  affect and self-esteem
• Downward comparisons may also serve to increase
  anxiety as they serve to highlight potential
  future worse deterioration

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Social comparison theoryUpward comparison

• Upward comparisons are a preferred source of
  information about effective coping and a source
  of inspiration and hope
• Upward comparisons may also be de-motivating
  serving as a reminder that one is not coping as
  well one could or should

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Themes that emerged from interview analysis

• Comparing and learning
• Self-evaluation
• Self-enhancement
• Personality and social comparison

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Comparing and learning (I)

• You know I realised how important it is to keep
  it Diabetes under control because I was the
  only one that didnt have complications. I mean I
  was just on one tablet, I mean some of them were
  on all sorts of tablets and a lot of them didnt
  have it under control and theyd got so many
  different complications. I felt, gosh, I felt so
  different when I came out I thought well, good
  grief, you know. I mean there was one lady who
  just forgot to take her tablets and you know I
  mean stupid things like that. But I mean others
  struggling with diets. So yes, it was ah, if I
  dont look after myself, this is where youre
  going to end up you know. I dont know if Ive
  been the lucky one and theyve been the unlucky
  ones, I dont know. I dont know but they all
  seem to have a lot more problems then I had and,
  I just thought, that does stick in my mind. P4,
  DM

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Comparing and learning (II)

• I mean before I came back to England I didnt
  even know what post-polio syndrome was. I
  wouldnt necessarily have realized that such and
  such could be down to a post-polio thing and I
  would put it down to something else. Certainly
  being on the course, you know kind of highlighted
  that for me. P15, PPS
• I hadnt realised that the symptoms I had was
  part of the ENDO. P8, ENDO

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Self-evaluation (I)

• When you want to go out but you cant and you
  say oh my god I get that, I didnt realise it
  was because of the endometriosis. Because there
  are so many different aspects of the disease you
  start to worry if its the endometriosis thats
  making me feel this way. And then when you have
  12 people that are all saying, yes, I feel that
  then you feel better already, and you know youre
  not the only one. So I think the sharing yeah,
  thats a great benefit. The sharing and the
  understanding that we all have these certain
  things. P9, ENDO
• I didnt feel as if I was mad anymore because
  every doctor Id ever been to made me feel as if
  it was all in my head. But I was in a room full
  of women who had exactly the same problems as
  me. P8ENDO

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Self-evaluation (II)

• I think there are a lot of people that were on
  the course who got a lot out of it because they
  realised that they werent the only ones with
  similar types of problems. I think collectively
  you get something out of it dont you, whereas
  individually you perhaps dont gain so much. You
  sort of say oh yeah, thats a good idea. P13,
  PPS
• Well, yes, in so much as they've doctors been
  asking me to change my insulin for quite a while
  and it was only speaking to other people on the
  CDSMP and realising that the insulin I was using
  was getting a bit out of date and I needed
  updating with it. It was only by speaking to
  other people and saying well yes, I'm alright
  even though any change you are rather feared a
  bit. Going into the unknown, changing from one
  machine to another but yes, I did do it and I
  think it was through gaining confidence on the
  course that gave me the well you must do it.
  P5, DM

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Self-enhancement (I)? Comparison

• Well again I felt incredibly lucky because I
  could actually use incredibly simple things to
  manage the pain, whereas a lot of them seemed to
  be totally intolerant to just about everything,
  which is disastrous. I mean I dont know what
  Id do if I was still waking up and feeling like
  someone was stabbing me in the legs. So its
  like a dreadful nightmarelt made me feel sort
  of better, you know, what are you complaining
  about, all these people, in wheelchairs or
  whatever. P2, CFS
• Well some were wheelchair bound, you know, so
  obviously Im better then that. I felt I was at
  the very top because of all the things, that Ive
  kept up. P12, OP
• Id always been recommended to go on an exercise
  course, which is what I do. I have a relatively
  good amount of movement, which is good. A lot of
  other people actually werent doing anything, so
  they didnt have very much movement, and they
  looked to me, I mean in the six-weeks that we had
  the course, it looked to me they hadnt fully
  maintained their upright stature, you know. I
  know, I know, I try to sort of relate it just to
  myself, and sort of say but for the grace of God
  I could be like that, Im jolly well going to
  make sure I exercise all the time and not give in
  to it and I want to sort of maintain as much of a
  healthy lifestyle as is possible, you know.
  P10, OP

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Self-enhancement (II)? Comparison

• I mean there was a couple of people there you
  know, whod got HIV from being given infected
  blood and how somebody like that can stay so
  positive and optimistic and forward looking and
  you know not be bitter. You know somebody like
  that can be happy and positive, for goodness sake
  so can I. P3CFS

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Self-enhancement (III) Not all comparisons are
beneficial!

• In some ways I envied them because they often
  lived with someone and obviously that meant there
  was help. P1, CFS
• People had goals for example of filling the
  freezer up with meals and I said I can have that
  as a goal but I cant cook the meals and I
  havent got any home help and they couldnt
  relate to somebody not even having a family to
  help them. P7, ENDO
• I was one of the worst because I have to walk
  with 2 sort of sticks and there were ladies there
  that were walking not too bad, they were in their
  first stages. They were interested in the fact
  Id had it so long and Id got to the stage I was
  and they wanted to prevent getting like I am.
  P11OP

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Self-enhancement (IV)Finding something to focus
on

• Well I think there were some that were better
  physically but actually having coped not that
  well. I realised how mentally strong I was, but
  then again Ive had it for longer then a lot of
  people now, so Ive adjusted a bit more I think.
  Physically though, I was a bit more conky than a
  lot of them, but mentally I was doing a bit
  better. P9, ENDO

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Social comparison and personality

• I always felt, people will say, that people who
  have had polio are more resilient and have got
  more sort of determination about them and they
  have got that sort of get up and go sort of
  attitude. Not one of the participants with polio
  actually said they had suffered at all from the
  effects of depression. That was an interesting
  talk, but whether that has anything to do with
  the symptoms of disease I am not sure, but
  whether or not we are more optimistic than most
  disabilities I dont know, but its an
  interesting thought. P13, PPS

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Conclusions

• The current results confirm that a
  self-management course can provide a unique
  opportunity for people with chronic illness to
  compare themselves with each other.

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Phase III
12-month follow-up
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Aims

• (i) To compare the change over time across five
  chronic illness groups on illness symptoms,
  psychological well-being and self-efficacy,
  12-months following attendance on the CDSMP.
• (ii) To determine whether there are differences
  in personality traits across five chronic illness
  groups.
• (iii) To explore whether personality is
  associated with change over time on illness
  symptoms, psychological well-being and
  self-efficacy.

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Fatigue (Scale 0-10, ? better)
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Pain(Scale 0-10, ? better)
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Anxious mood (Scale 0-21, ? better)
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Depressed Mood (Scale 0-21, ? better)
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Self-efficacy Disease(Scale 5-35, ? better)
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Self-efficacy Symptoms (Scale 5-35, ? better)
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The Big-Five

• Neuroticism- Characterized by negative
  affectivity, nervousness and often refers to
  maladjustment
• Extraversion- Refers to energy or enthusiasm,
  which is often displayed interpersonally in
  sociability and dominance in high activity level
  and cheerfulness
• Openness- Refers to individuals who are
  imaginative, aesthetically sensitive and
  intellectually curious
• Agreeableness- or altruism is a dimension that
  determines trust, sympathy and cooperation
• Conscientiousness- refers to control and
  encompasses a sense of competence and sense of
  duty, need for achievement, organization,
  planning and self-discipline

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Neuroticism
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Extraversion
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Openness
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Associations personality change over time
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Limitations

• Small sample size
• Floor effects
• Volunteer bias

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Conclusions

• Results showed that 12-months following
  attendance on the CDSMP, there were differences
  both within and across illness groups on illness
  symptoms, psychological well-being and
  self-efficacy. Reassuringly, most groups improved
  in the expected direction. Participants tended to
  report improvements across the study variables
  that were most pertinent to their specific
  illness. For example, participants with CFS
  reported significant improvements in fatigue
  likewise participants with ENDO, for whom pain is
  the greatest symptom, reported significant
  improvements in pain.
• This is the first study to examine the big
  five-factors of personality among participants
  attending the CDSMP. Results showed that there
  were statistically significant differences both
  within and across illness groups on the big
  five-factors of personality. Moreover,
  significant associations were evident with regard
  to illness symptoms, psychological well-being and
  self-efficacy. Of interest was that personality
  was associated with change over time. These
  findings are unique in that they extend the
  current evidence base by comparing CDSMP
  participants from five chronic illness groups by
  focusing on personality.

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Future research suggestions

• Personality and the CDSMP

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Overall conclusions from PhD

• The findings clearly suggest that a generic
  intervention that focuses on common illness
  related problems (such as fatigue and pain) might
  be effective in terms of change over time on
  illness symptoms, psychological well-being and
  self-efficacy among participants from five
  chronic illnesses groups, attending illness
  specific courses.
• Social comparison and personality may mediate
  outcomes following attendance on the CDSMP

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Self-management opportunities _at_Arthritis Victoria

• EMAIL
• georgieb_at_arthritisvic.org.au
• PHONE
• 8531 8015