title: How people present symptoms to health services: a theory-based content analysis.
abstract: BACKGROUND
  How people present symptoms to health services may influence the care they subsequently receive. Leventhal's Commonsense Model of Self-Regulation (CS-SRM) posits that individuals develop cognitive illness representations elaborated around five main components (identity, timeline, cause, consequences, and cure/control), coherence, and emotional representations.
  
  
  OBJECTIVE
  To examine whether initial presentations to health services consist of the components of illness representation proposed by the CS-SRM.
  
  
  METHODS
  A CS-SRM-based content analysis of calls to the Scottish national telephone advice service, NHS 24.
  
  
  METHODS
  A random sample of callers to NHS 24 was identified. A quota sample of 60 consented to participate. Their consultations were transcribed verbatim. Responses to an initial open question regarding the reason for calling were identified and divided into 'meaning units'. A coding schedule was developed using Leventhal's definitions of illness representations. Meaning units were coded independently by two researchers.
  
  
  RESULTS
  Fifty-nine eligible initial presentations contained between 1 and 13 coding units, (mean = 4). A total of 230 coding units were available for coding. Overall, 202 (88%) coding units were coded to at least one component of illness representation. All 59 (100%) participants made reference to identity, 26 (44%) to timeline, nine (15%) to cause, eight (14%) to consequences, 22 (37%) to cure/control, and 11 (19%) to the degree of coherence. Emotional representations were identified in six (10%) participants' presentations.
  
  
  CONCLUSIONS
  Leventhal's CS-SRM accounts for a large proportion of initial presentations to health services. Most people offer identity plus at least one additional component of illness representation. It may be necessary for clinicians to prompt remaining components to obtain a comprehensive understanding of patients' representations of illness.
authors: College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK. b.farquharson@abdn.ac.uk
authors: Barbara
authors: B
authors: Farquharson
authors: Marie
authors: M
authors: Johnston
authors: Carol
authors: C
authors: Bugge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D059026:Diagnostic Self Evaluation; D005260:Female; D015277:Hotlines; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D014218:Triage; D055815:Young Adult