Primary author:Abena Boaten

Self Regulation Theory

The Self Regulation Theory, also known as the Common Sense Model of Illness Representation, was initially defined in the 1960s by Leventhal and colleagues as a model that provides a framework of understanding for how an individual’s symptoms and emotions experienced during a health threat or diagnosis influence their perception of illness and how their own personal beliefs determine how they respond and cope with threats to health (Browning et al, 2009). This model suggests that individuals develop an understanding of their illness or diagnosis by formulating their own ideas of what the illness is, its causes, its consequences, how long it will last, and whether it can be cured or controlled. This understanding is often times not medically validated but based on personal experience with physical symptoms and emotions, social influences, and interactions with healthcare providers. This understanding creates an individual’s “illness representation” that influences the activities or actions used to reduce individual health risk or health behavior changes (Browning et al, 2009).

The two central phenomena of this model are based around the idea that an individual is a problem-solver that deals with their own perceived reality of the health threat and the emotional reactions to this threat. There are three major constructs of this model; representation, coping, and appraisal. Representation refers to how an individual perceives an illness or health threat based on internal and external stimuli and past health and illness experiences (Diefenbach & Leventhal, 1996). Also, different cultural or ethnic groups may collectively have feelings or beliefs of a specific health issue. Coping strategies are based on the individual’s illness representation and a response plan or procedure that is developed (Diefenbach & Leventhal, 1996). Lastly, an appraisal is done by the evaluation of the progress of the coping actions and is compared to expected outcomes. The progression of each of these stages (representation, coping, appraisal) is not unidirectional, the process can occur from the bottom-up or top-down, for example appraisal outcomes and lead to differences in representation which might lead to new and different coping actions (Diefenbach & Leventhal, 1996).

This model has been examined with multiple illnesses and health-related behaviors including coronary artery disease, HIV medication adherence, and diabetes self-management (Browning et al, 2009). Browning and colleagues conducted a study using this theory to find out why people diagnosed with lung cancer continued to smoke and the changes of individual illness representations over time. They found that over time there were significant changes in illness representation, personal identity, and treatment and personal control. Nicotine dependency was cited as the most frequent cause of continued smoking by study participants. Unsuccessful attempts to quit smoking seemed to lead to decrease patient beliefs in the personal and treatment controllability of the disease and a poorer perception of quality of life (Browning et al, 2009). Jayne and colleagues also used this model to further understand how Chinese immigrants with Type 2 diabetes understood their diagnosis and to plan interventions based on their findings. They found that the representation stage of this model was particularly useful in identifying cognitive and emotional experiences that led to individual beliefs of the disease and its consequences. The consequences of the disease were often perceived as fatalistic and many expressed fears that were of greater magnitude than what was realistic. The participant’s beliefs did not correspond with the accepted medical understanding of diabetes mellitus, and therefore the authors concluded that interventions for health behavior change must begin first with assessing these beliefs and providing further patient teaching and education to achieve desired outcomes ( Jayne & Rankin, 2001).

This theory as applied to public health can give insight into what motivates individuals’ actions and behaviors based on personal experience and perception of health and health promotion activities. “Common sense”, as described in this model can be highly personalized in that people act and display behaviors that make sense to them, which can vary greatly from person to person or culture to culture. What makes sense to one person or group may not to another. Illness representations are influenced by the social and cultural context in which we live as much as they are a product of our own somatic and psychological experiences (Diefenbach & Leventhal, 1996). For example, because mental illness in some cultures has a stigma attached to it, individuals may not incorporate psychological symptoms into their illness representations as they do for more acceptable somatic symptoms. This may create a challenge for health providers in identifying these cultural differences in their patients who aren’t able to express mental health issues they are experiencing.

Using this model, public health professionals may be able to predict health outcomes based on the ability of a specific population to “self-regulate” manage, or problem solve threats to health such as disease epidemics, environmental disaster, drought, or food scarcity. Having a deeper understanding of the history, influences, and experiences of an individual or group can aid in creating interventions for behavior modification. Although members of a specific population or culture can have similar ideas and feelings about certain health issues and practices, every individual is unique in their own personal experiences, personality characteristics, and exposure to external influences. As an individual ages, illness representation can change based on years of analyzing appraisal outcomes and using different coping strategies to an illness or health threat. Some health practices may be firmly adhered to because of favorable outcomes in the past and other behaviors may more subject to media, social, or cultural influences.

Browning, K., Wewers, M.E., Ferketich, A., Otterson, G., Reynolds, N. (2009). The self regulation model of illness applied to smoking behavior in lung cancer. Cancer Nursing, 32(4), E15-E25.
Diefenbach, M.A, & Leventhal, H. (1996). The common sense model of illness representation: theoretical and practical considerations. Journal of Social Distress and Homeless, 5(1), 11-38.
Jayne, R.L. & Rankin, S.H. (2001). Application of Leventhal’s self regulation model to Chinese immigrants with type 2 diabetes. Journal of Nursing Scholarship, 33(1), 53-59.

Primary author:Abena Boaten