Illness representations and associated coping responses in adults experiencing multimorbidity: A systematic review and narrative synthesis.
Date: 26 May 2020
University of Exeter
Doctorate in Clinical Psychology
LITERATURE REVIEW Abstract Objectives: Research indicates that illness representations are associated with the management of health conditions. They are therefore important to understand when supporting people to best cope with their illnesses. This systematic review aims to summarise and synthesise the literature exploring illness ...
LITERATURE REVIEW Abstract Objectives: Research indicates that illness representations are associated with the management of health conditions. They are therefore important to understand when supporting people to best cope with their illnesses. This systematic review aims to summarise and synthesise the literature exploring illness representations and associated coping responses in people experiencing more than one chronic condition. Methods: A systematic review of literature published prior to November 2018 on MEDLINE, Embase, CINAHL, Web of Science and PsycINFO databases. Search terms included three broad areas; multimorbidity, health and illness representations. Results are synthesised using a narrative approach. Results: Eight papers are included in the review and comprise qualitative and quantitative research designs. Findings indicate that illness representations in those with multimorbidity vary across conditions and individuals, while people hold representations relating to both individual conditions and multimorbidity. These representations have been associated with medication adherence and self-management behaviours. Conclusions: This narrative synthesis highlights that representations have a role in coping. There is a need to consider illness representations in clinical consultations and in the delivery of care to improve condition management. Further research is needed to establish how this may be best achieved and to consider other variables which may influence representations and coping. Developing a theoretical framework which may account for both single and multimorbid representations will be important for such future research. Keywords: Multimorbidity, chronic condition, common-sense model, illness representation, systematic review, narrative synthesis. EMPIRICAL PAPER Abstract Objectives: Research has highlighted an association between illness representations and coping responses, such as self-management, medication taking and treatment-seeking. However, illness representations for common mental health symptoms when experienced alongside multimorbidity are poorly understood. The current study aims to understand how people experiencing multimorbidity represent and respond to their common mental health symptoms. Methods: Semi-structured interviews were conducted with thirteen participants experiencing mild to moderate symptoms of anxiety and/or depression alongside physical multimorbidity. Thematic analysis combined with deviant case analysis was used to analyse the data. Results: The results provide an understanding of illness representations and coping responses for common mental health symptoms in those experiencing multimorbidity. Four key themes were identified; 1) interconnected conditions, 2) methods of responding to mental health difficulties, 3) relationships: the importance of connection and understanding, and 4) narrow treatment options. Conclusions: Illness representations for common mental health symptoms appear to have a role in guiding coping responses, including treatment-seeking. Having an awareness of people’s illness representations will be useful in clinical practice to guide consultations and interventions. By understanding and working with illness representations and increasing primary care accessibility we may begin to improve coping and treatment-seeking within this population. The implications of this research will be useful in allowing health services to meet the needs of the growing multimorbidity population and close the mental health treatment gap. Keywords: Multimorbidity, chronic conditions, mental health, illness representations, coping responses, treatment-seeking, qualitative research.
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