High High BBlood lood PPressure ressure RRepresentations epresentations in in RRelation to elation to PPersonality and ersonality and

AAdherence dherence BBehaviour in ehaviour in HHypertensive ypertensive AAdolescentsdolescents

Urška Žugelj, Urška Žugelj, Maja Zupančič,Maja Zupančič, Rajko KendaRajko Kenda & Luka Komidar & Luka Komidar

University of LjubljanaUniversity of Ljubljana

ProblemProblem

The structure of representations about The structure of representations about high blood pressure in hypertensive high blood pressure in hypertensive adolescentsadolescents

Effect of psychosocial factors on self Effect of psychosocial factors on self reported adherence behaviours: reported adherence behaviours: IIllness llness representations and personalityrepresentations and personality

DefinitionsDefinitions

Essential hypertensionEssential hypertension: A state of chronically : A state of chronically elevated blood pressure, with no recognized elevated blood pressure, with no recognized origin; prevalence 1.2%.origin; prevalence 1.2%.

Illness representationsIllness representations: One’s : One’s conecptualization of own illness encompassing conecptualization of own illness encompassing different themes (symptoms, consequences…)different themes (symptoms, consequences…)

Adherence behaviourAdherence behaviour: Following doctors : Following doctors recomandations; different forms; self-ratedrecomandations; different forms; self-rated

Illness representations in Illness representations in hypertensionhypertension

Little is known about hypertensive adolescents’ illness Little is known about hypertensive adolescents’ illness representationsrepresentations

One’s conceptulaization of illness is predictive of One’s conceptulaization of illness is predictive of adherence behaviour (Leventhal et al., 2004): Adult adherence behaviour (Leventhal et al., 2004): Adult hypertensive patients (Meyer et al., 1985; Carter, 2006) hypertensive patients (Meyer et al., 1985; Carter, 2006) & adolescent patients across illnesses (Skinner et al., & adolescent patients across illnesses (Skinner et al., 2002)2002)

Individuals can construe own illness models differently Individuals can construe own illness models differently from the biomedical model: Possible barrier to from the biomedical model: Possible barrier to adherenceadherence

Personality in hypertensionPersonality in hypertension Most research on personality as a risk factor in dvelopment Most research on personality as a risk factor in dvelopment

of hypertension.of hypertension.

Personality can affect health related behaviours, and is thus Personality can affect health related behaviours, and is thus related to health outcomes (Williams et al., 2002).related to health outcomes (Williams et al., 2002).

Conscientiousness consistently shown to be predictive of Conscientiousness consistently shown to be predictive of health related behaviours (Friedman, 2001; Skinner et al., health related behaviours (Friedman, 2001; Skinner et al., 2002).2002).

Results for other dimensions ambiguous (Friedman, 2001).Results for other dimensions ambiguous (Friedman, 2001).

Mid-level traits not represented in literature on hypertension Mid-level traits not represented in literature on hypertension adherence behaviours. adherence behaviours.

Predicting adherence behaviourPredicting adherence behaviour

Adherence to medical regimen of great importance to Adherence to medical regimen of great importance to effective control of BP; uncontrolled BP can reslut in effective control of BP; uncontrolled BP can reslut in severe health complications; problematic in hypertensive severe health complications; problematic in hypertensive patients; adolescence a possible barrier. patients; adolescence a possible barrier.

Illness representationsIllness representations: Proximal determinant: Proximal determinant PersonalityPersonality: Distal determinant: Distal determinant

Personality Adherence

Illness Representations

MethodMethod Participants:Participants: 95 adolescents with diagnosed essential hypertension for 95 adolescents with diagnosed essential hypertension for

min. 4 months prior to assessment; min. 4 months prior to assessment; 35% 35% ♀;♀;13 – 23 yrs (13 – 23 yrs (MM = = 17.44, 17.44, SD SD = = 2.28)2.28)

Instruments:Instruments: Illness Representaions: Illness Representaions: The Brief Illness Representations QuestionnaireThe Brief Illness Representations Questionnaire

(BIPQ, Broadbent et al., 2006): Consequence, Timeline, Personal Control, (BIPQ, Broadbent et al., 2006): Consequence, Timeline, Personal Control, Treatment Control, Identity, Concern, Comprehension, Emotions, Treatment Control, Identity, Concern, Comprehension, Emotions, ((CauseCause)). .

Personality: Personality: The Inventory of The Inventory of CChild hild IIndividual ndividual DDifferencesifferences (ICID, Halverson et (ICID, Halverson et al., 2003): self report and peer reportal., 2003): self report and peer report

ExtraversionExtraversion: Sociable, Positive Emotion, Activity Level: Sociable, Positive Emotion, Activity Level ConscientiousnessConscientiousness: Achievement, Organized, : Achievement, Organized, ununDistractibleDistractible NeuroticismNeuroticism: Fearful/Insecure, Shy, Negative Affect: Fearful/Insecure, Shy, Negative Affect AgreeablenessAgreeableness: : low low Antagonism, Antagonism, low low Strong WillStrong Will OpennessOpenness: Intelligent, Open to : Intelligent, Open to EExperiencexperience

Adherence: Adherence: Modified MOS Adherence QuestionnaireModified MOS Adherence Questionnaire (DiMateo, 1993): (DiMateo, 1993): General Adherence, Specific Adherence General Adherence, Specific Adherence ((Salt Reduction Adherence, Fat Salt Reduction Adherence, Fat Reduction Diet Adherence, Medication Adherence, Exercise Adherence, Stress Reduction Diet Adherence, Medication Adherence, Exercise Adherence, Stress Reduction AdherenceReduction Adherence))

ProceduresProcedures: Participants individually assessed at the clinic or via mail. : Participants individually assessed at the clinic or via mail.

Results: Structure of IRResults: Structure of IR

OverallOverall

InfluenceInfluence

Low Low ControlControl

TimelineTimeline

ConsequenceConsequence .82.82 -.33-.33

IdentityIdentity .65.65 -.42-.42 .43.43

ConcernConcern .83.83

EmotionEmotion .72.72 -.29-.29

Pers. ControlPers. Control .42.42 -.81-.81

Treat. ControlTreat. Control .51.51 -.70-.70

ComprehensionComprehension -.84-.84 .34.34

TimelineTimeline .25.25 .88.88

Results: Multiple Regression (Stepwise method)Results: Multiple Regression (Stepwise method)

Adherence Bahaviour:General and Specific(Salt diet, Fat diet,

Medications, Exercise, Stress)

Illness Representations:8 dimensions (Consequence, Timeline, Personal Control, Treatment Control,

Identity, Concern, Comprehension, Emotions)

Personality:1) Self rated (SR) Big Five personality

dimensions 2) SR 15 mid-level personality

traits3) Peer rated (PR) Big Five personality

dimensions4) PR 15 mid-level personality

traits

Results: Predicting adherence (SR)Results: Predicting adherence (SR)

Adherence Behaviour Predictors Adj R2 General B5 Treatment Control, Conscientiousness, Agreeableness .31 ML Treatment Control, Strong Willed (A), Organized (C) .31 Specific B5 Treatment Control .19 ML Treatment Control, Activity level (E), Shy (N) .34 Salt diet B5 Treatment Control .06 ML Treatment Control .06 Fat diet B5 Concern .11 ML Concern, Activity Level (E), unSociable (E) .23 Medication taking B5 Treatment Control, low Emotion, Concern .47 ML Treatment Control, low Emotion, Concern .47 Exercise B5 Extraversion .13 ML Activity level (E), low Positive emotions (E) .43 Stress reduction B5 Treatment control, low Concern .31 ML Treatment control, low Concern .31 Note. Illness Representations; Personality.

Results: Predicting adherence (PR)Results: Predicting adherence (PR)

Adherence Behaviour Predictors Adj R2

General B5 Treatment Control, Extraversion .26 ML Treatment Control, Activity Level (E) .31 Specific B5 Treatment Control .19 ML Treatment Control, Activity Level (E), Timeline, low Emotion .36 Salt Reduction Diet B5 Timeline .07 ML Timeline, Treatment Control, low Emotion .19 Fat Reduction Diet B5 Treatment Control .16 ML Treatment Control .17 Mediaction Taking B5 Treatment Control, Concern, low Emotion .48 ML Treatment Control, Concern, low Emotion .40 Exercise B5 Extraversion .14 ML Activity Level (E) .34 Stress Reduction B5 Treatment Control, low Concern .34 ML Treatment Control, low Concern .38 Note. Illness Representations; Personality.

ConclusionsConclusions: : Illness Illness representationsrepresentations

EH a disease with not toEH a disease with not tooo many perceived many perceived consequences in everyday life of adolescents, nor in consequences in everyday life of adolescents, nor in sense of symptoms nor in sense of emotional burdensense of symptoms nor in sense of emotional burden

Participants feel quite in control over their illnessesParticipants feel quite in control over their illnesses

Only a few participants found EH to be a life lasting Only a few participants found EH to be a life lasting diseasedisease

Conclusions: Predicting adherence Conclusions: Predicting adherence behaviour behaviour

IR & personality important predictors of A; lowest in diet IR & personality important predictors of A; lowest in diet behaviour: adolescents hold little influence over their behaviour: adolescents hold little influence over their nutritionnutrition

Predicting adherence complex: Different types of A have Predicting adherence complex: Different types of A have different pathwaysdifferent pathways

Illness representationsIllness representations TC: connected to nearly all adherence behaviours; TC TC: connected to nearly all adherence behaviours; TC

indicator of medical regimen representations; TC indicator of medical regimen representations; TC related to external locus of control (Broadbent et al., related to external locus of control (Broadbent et al., 2006)2006)

Other aspects of IR also of interest: Concern, Other aspects of IR also of interest: Concern, Emotion, TimelineEmotion, Timeline

Conclusions: Predicting adherence Conclusions: Predicting adherence behaviourbehaviour

Presonality: Presonality: Multiple informants (personality): Different patterns of Multiple informants (personality): Different patterns of

connections emerge connections emerge B5: Conscientiousness (Organized), Extraversion B5: Conscientiousness (Organized), Extraversion

(Activity Level, Positive Emotions, unSociable), (Activity Level, Positive Emotions, unSociable), Agreeability (Strong Willed), Neuroticism (Shy) Agreeability (Strong Willed), Neuroticism (Shy)

ML: Mid-level trait scores important in more specific ML: Mid-level trait scores important in more specific behavioursbehaviours

Exercise behaviour: across informants E (AL, Positive Exercise behaviour: across informants E (AL, Positive emotions) seems to be the only predictoremotions) seems to be the only predictor

ConclusionsConclusions

AdvantageAdvantage

Hypertensive adolescent Hypertensive adolescent population (not represented in population (not represented in the literature on this topic) the literature on this topic)

Different forms of adherenceDifferent forms of adherence Different informants on Different informants on

personalitypersonality

Future prospectsFuture prospects

Follow-upFollow-up To increase N: comparison of To increase N: comparison of

subgrous subgrous Inclusion of different measures Inclusion of different measures

of adherenceof adherence Medical regimen Medical regimen

representationsrepresentations Comparisson with different Comparisson with different

illness groups and between illness groups and between different hypertensive groupsdifferent hypertensive groups

Structural modelStructural model