The Brief Illness Perception Questionnaire

1 The Brief Illness Perception QuestionnaireElizabeth Broadbenta,4, Keith J. Petriea, Jodie Maina, John WeinmanbaDepartment of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New ZealandbHealth Psychology Section, Department of Psychology (at Guy s), Institute of Psychiatry, 5th floor Thomas Guy House, London Bridge, London SE1 9RT,UKReceived 12 June 2005; received in revised form 3 October 2005; accepted 18 October 2005 AbstractObjective:This study evaluates the Brief Illness PerceptionQuestionnaire ( Brief IPQ), a nine-item scale designed to rapidlyassess the cognitive and emotional representations of :We assessed the test retest reliability of the scale in132 renal outpatients.

2 We assessed concurrent validity bycomparing the Brief IPQ with the Illness Perception Question-naire Revised (IPQ-R) and other relevant measures in 309 asthma,132 renal, and 119 diabetes outpatients. Predictive validity wasestablished by examining the relationship of Brief IPQ scores tooutcomes in a sample of 103 myocardial infarction (MI) validity was examined by comparing scores on theBrief IPQ between five different Illness :TheBrief IPQ showed good test retest reliability and concurrentvalidity with relevant measures. The scale also demonstratedgood predictive validity in patients recovering from MI withindividual items being related to mental and physical functioningat 3 months follow-up, cardiac rehabilitation class attendance,and speed of return to work.

3 The discriminant validity of theBrief IPQ was supported by its ability to distinguish betweendifferent :The Brief IPQ provides a rapidassessment of Illness perceptions , which could be particularlyhelpful in ill populations, large-scale studies, and in repeatedmeasures research Elsevier Inc. All rights : Illness perceptions ; Questionnaire ; Reliability; Validity; Brief IPQ; Chronic illnessIntroductionThe study of individuals perceptions of Illness stemmedfrom research into the communication of health threats in the1960s. Leventhal et al.[1]developed the self-regulatorymodel to describe the process by which individuals respondto a perceived health threat.

4 The model proposes thatsituational stimuli (such as symptoms) generate bothcognitive and emotional representations of the Illness orhealth threat. These representations are processed in parallelthrough three stages. The individual first forms the repre-sentation of the Illness or health threat, next, they adoptbehaviours to cope with this, and, lastly, they appraise theefficacy of these behaviours. The model incorporates a con-tinuous feedback loop in which the results of the appraisalprocess are fed back into the formation of the Illness /threatrepresentation and the adoption of coping research identified five dimensions within thecognitive representation of Illness :identity the label theperson uses to describe the Illness and the symptoms theyview as being part of the disease;consequences theexpected effects and outcome of the Illness ;cause personal ideas about the cause of the Illness ;timeline how long the patient believes the Illness will last.

5 Andcureor control the extent to which the patient believes thatthey can recover from or control the Illness [1,2]. Theemotional representation incorporates negative reactionssuch as fear, anger, and distress. Ongoing research overthe past 30 years has demonstrated the importance of illnessrepresentations to patient behaviour[3]. Changing patients Illness perceptions has been shown to improve recoveryfollowing myocardial infarction (MI)[4], and other self-regulatory interventions in illnesses as diverse as diabetesand AIDS have also improved patient outcomes[5].Early research investigating the content of illnessrepresentations largely involved open-ended interviews.

6 Asknowledge has grown and Leventhal s self-regulatory model0022-3999/06/$ see front matterD2006 Elsevier Inc. All rights author. Tel.: +64 9 3737599x84511; fax: +64 9 (E. Broadbent).Journal of Psychosomatic Research 60 (2006) 631 637has become more widely used, more objective measureshave been developed. The Illness Perception Questionnaire (IPQ)[6]is a widely used multifactorial pencil-and-paperquestionnaire which assesses the five cognitive illnessrepresentations on a five-point Likert scale. A revisedversion of this scale, the Illness Perception Questionnaire Revised (IPQ-R), extended the original scale by addingmore items, splitting the control dimension into personalcontrol and treatment control, and incorporating a cyclicaltimeline dimension, an overall comprehension of illnessfactor, and an emotional representation[7].

7 The IPQ-R has over 80 items, and in some situationssuch a long Questionnaire is prohibitive. This is particularlythe case when patients are very ill or when there is limitedtime available for assessment. A shorter questionnairewould be more suitable for patients who are very ill orelderly because it would be less taxing and much quicker tocomplete. It may also be more acceptable to those who arelimited in their reading and writing ability. The shorterquestionnaire offers the potential for Illness perceptions tobe investigated in a wider range of patient groups[8]andwould be especially useful when Illness perceptions aremeasured as only one part of a larger set of psychologicalconstructs, in large population-based studies, and whenrepeated measures are taken on a frequent research aimed not only to construct a very shortand simple measure of Illness perceptions , but also toconstruct a measure with an alternative format to themultifactorial Likert scale approach used in the IPQ andIPQ-R.

8 The Brief Illness Perception Questionnaire (BriefIPQ) uses a single-item scale approach to assess perceptionson a continuous linear scale. This paper assesses thepsychometric properties of the Brief IPQ using samplesfrom several Illness groups and investigates the value of abrief scale to assess Illness developmentThe Brief IPQ has nine items and is shown in AppendixA. The items were developed by forming one question thatbest summarised the items contained in each subscale of theIPQ-R. The Brief IPQ therefore has eight new items pluspart of the causal scale previously used in the IPQ-R.

9 All ofthe items except the causal question are rated using a 0-to-10 response scale. Five of the items assess cognitive illnessrepresentations: consequences (Item 1), timeline (Item 2),personal control (Item 3), treatment control (Item 4), andidentity (Item 5). Two of the items assess emotionalrepresentations: concern (Item 6) and emotions (Item 8).One item assesses Illness comprehensibility (Item 7).Assessment of the causal representation is by an open-ended response item adapted from the IPQ-R, which askspatients to list the three most important causal factors intheir Illness (Item 9).

10 Responses to the causal item can begrouped into categories such as stress, lifestyle, hereditary,etc., determined by the particular Illness studied, andcategorical analysis can then be the IPQ and IPQ-R, the most general version of theBrief IPQ uses the worddillnessT, but it is possible to replacethis with the name of a particular Illness such as diabetes orasthma. Similarly, the treatment control item uses the worddtreatmentT, but this can be replaced by a particulartreatment such asdsurgeryTordinhalerTif researchers areinterested in a particular were collected from six Illness groups to evaluatethe psychometric properties of the scale: MI (N=103), renaldisease (N=132), type 2 diabetes (N=119), asthma(N=309), minor illnesses (allergies, colds, headaches)(N=166), and a group with chest pain undergoing stress-exercise testing prior to diagnosis (N=62).