Characterizing explanatory models of illness in healthcare: development and validation of the CONNECT instrument.

OBJECTIVE: A growing body of qualitative and quantitative research suggests that individual patients and physicians often have differing perspectives, or 'explanatory models,' regarding the patient's health condition or illness. Discordance between explanatory models may lead to difficulties in communication and poor disease outcomes. However, due to a lack of tools to systematically measure concordance in patient and physician explanatory models, a large-scale study of explanatory models of illness has not been previously possible. The objective of this project was to develop and pilot-test a survey-based tool (the CONNECT Instrument) that measures salient aspects of explanatory models of illness. METHODS: We conducted a multi-method survey development project that included qualitative and quantitative item development, refinement, pilot testing, and psychometric evaluation. We evaluated the instrument in two unique, consecutive cohorts of primary care patients in a variety of private and public settings in Houston, TX. We also used the instrument to examine concordance between patient and physician explanatory models in the second cohort. RESULTS: The final version of the CONNECT Instrument contains nineteen items that focus on six dimensions of explanatory models. Cronbach alphas ranged from 0.65 to 0.89 for the six CONNECT dimensions. The instrument demonstrated evidence of criterion-related validity when individual CONNECT dimension scores were compared with scores from previously published instruments, and demonstrated expected differences between patients 'and physicians' explanatory models of illness. CONCLUSION: The CONNECT instrument is a tool with good psychometric properties that enables researchers to measure important aspects of patients 'and physicians' explanatory models of illness. Our continuing work will focus on gathering additional validity evidence and evaluating associations between explanatory model concordance and health outcomes. PRACTICE IMPLICATIONS: The CONNECT instrument can be used to improve quality in clinical practice and medical education by measuring an important intermediate outcome in the chain of factors leading to patient trust, satisfaction, and adherence.

Associations between the impact of terrorism and health perceptions of patients.

OBJECTIVE: Previous studies have demonstrated the effects of the September 11th 2001 terrorist attacks on anxiety and anxiety-related conditions in Americans. However, data regarding associations between the attacks and patients' health perceptions are lacking. The objective of this study was to explore associations between the personal impact of the September 11th attacks and patients' perceptions of health and illness. METHOD: We performed a cross-sectional survey of 303 adult African-American, Caucasian, and Hispanic patients at primary care clinics in Houston, Texas. Data were collected between October 15, 2001 and March 1, 2002. We developed items to measure the impact of the September 11th attacks and patients' quality of life. Previously validated scales were used to measure health status, health locus of control, preferences regarding the patient-physician relationship, and patients' explanatory models of illness. RESULTS: Twenty-two percent of patients reported no impact from the attacks, 41% reported mildly negative impact, 22% reported moderately negative impact, and 15% reported extremely negative impact in their lives. In multivariate analysis, demographic characteristics were not associated with impact from the attacks. However, patients who perceived a more external locus of control with respect to health and patients who reported greater meaning of illness in their lives also reported more negative impact from the September 11th attacks. CONCLUSIONS: The September 11th terrorist attacks had at least a somewhat negative impact for a majority of patients far from the site of the nearest attack, and regardless of their demographic backgrounds. The amount of negative impact that patients perceived as a result of the terrorist attacks correlates with certain illness perceptions, including an external health locus of control and a perception of greater meaning of illness in one's life. Such correlations may indicate an effect of terrorism on patients' illness behaviors. Further research is needed to better understand effects of the threat of terrorism on the general health and illness behaviors of patients.