been made previously in response to descriptions of ‘your most recent illness’. They
reported that the subjects’ piles of categories reflected the dimensions of identity
(diagnosis/symptoms), consequences (the possible effects), time line (how long it
will last), cause (what caused the illness) and cure/control (how and whether it can be
treated).
A series of experimental studies by Bishop and colleagues also provided support for
these dimensions. For example, Bishop and Converse (1986) presented subjects with
brief descriptions of patients who were experiencing six different symptoms. Subjects
were randomly allocated to one of two sets of descriptions: high prototype in which all
six symptoms had been previously rated as associated with the same disease, or low
prototype in which only two of the six symptoms had been previously rated as associated
with the same disease. The results showed that subjects in the high prototype condition
labelled the disease more easily and accurately than subjects in the low prototype con-
dition. The authors argued that this provides support for the role of the identity dimension
(diagnosis and symptoms) of illness representations and also suggested that there is some
consistency in people’s concept of the identity of illnesses. In addition, subjects were
asked to describe in their own words ‘what else do you think may be associated with this
person’s situation?’. They reported that 91 per cent of the given associations fell into
the dimensions of illness representations as described by Leventhal and his colleagues.
However, they also reported that the dimensions consequences (the possible effects) and
time line (how long it will last) were the least frequently mentioned.
There is also some evidence for a similar structure of illness representations in other
cultures. Weller (1984) examined models of illness in English-speaking Americans and
Spanish-speaking Guatemalans. The results indicated that illness was predominantly
conceptualized in terms of contagion and severity. Lau (1995) argued that contagion is
a version of the cause dimension (i.e. the illness is caused by a virus) and severity is a
combination of the magnitude of the perceived consequences and beliefs about time line
(i.e. how will the illness effect my life and how long will it last) – dimensions which
support those described by Leventhal and his colleagues. Hagger and Orbell (2003)
carried out a meta analysis of 45 empirical studies which used Leventhal’s model of
illness cognitions. They concluded from their analysis that there was consistent support
for the different illness cognition dimensions and that the different cognitions showed a
logical pattern across different illness types.
Measuring illness cognitions
Leventhal and colleagues originally used qualitative methods to assess people’s illness
cognitions. Since this time other forms of measurement have been used. These will be
described in terms of questionnaires that have been developed and methodological issues
surrounding measurement.
The use of questionnaires
Although it has been argued that the preferred method to access illness cognitions
is through interview, interviews are time consuming and can only involve a limited
ILLNESS COGNITIONS 51