3.9.2 Illness representations and maintenance of positive health behaviour: A comparison of adults with different levels of attendance at a cardiac rehabilitation programme (424)

Elizabeth Tolmie, Clinical Research Nurse, School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom Co authors: G M Lindsay, H E Watson & Elaine Duncan



Maintaining health behaviour change over the longer term is difficult. Efforts to facilitate recommended change are unlikely to be successful. Unless factors that impede the process are identified and addressed. Leventhal et al (1980, 1992) proposed that if we ‘tap’ into the layperson’s own theories about their illness, practical and effective interventions can be developed.


The aims of this study were to:

  • Compare and contrast differences and similarities in illness representations across three groups of cardiac patients with different levels of attendance at a cardiac rehabilitation programme
  • Identify the factors that promoted or inhibited maintenance of positive health behaviour.

Design & methods:

This was a mixed-methods design. Seventy three adults (mean age 52.4 ± 8.3) with different attendance at a cardiac rehabilitation programme completed three self-report questionnaires to assess illness representations, quality of life and anxiety and depression. A sub-sample (n = 28) participated in an individual face to face interview or Focus Group, underwent a brief clinical assessment, and completed a brief task.

Data analysis:

Data were analysed using StatScan statistical software and Framework analysis.


A significant difference between groups was detected in the type of symptoms experienced (p = 0.039, Fisher-Freeman-Halton exact) but not in those attributed to the heart problem. There was wide variation in illness representation scores and in case by case comparison of patient narratives but not between groups. Regardless of attendance level, efforts to preserve both physical and emotional health were made but were often impeded.


Health behaviour change occurs at the individual level but can be impeded at the individual level and by factors beyond individual control. These issues need to be addressed.

Recommended reading list:

  • Leventhal, H., Meyer, D., Nerenz, D. (1980). The common sense representation of illness danger. In Rachman, S. (Ed), Medical psychology, Vol II, 7-30
  • Leventhal, H., Diefenbach, M,. Levanthal, E., A. (1992). Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 2, 143-163

Source of Funding: N/A

Level of funding: N/A


Elizabeth Tolmie trained as a Registered Nurse in 1989. She gained her BA Nursing Studies from Strathclyde University in 1996 and MSc from the University of Glasgow in 2000. Since qualifying, Elizabeth has held a variety of research positions within clinical, academic, and commercial settings. Over recent years her research interests have focused on the patients’ experiences and perspectives of health and health related issues.