Illness experience and illness representation among older adults with hypertension

Elise A.G. Duwe, Breanna M. Holloway, Jessie Chin, Daniel G Morrow

Research output: Contribution to journalArticlepeer-review


Objective: This study investigated how older adults’ representations of hypertension relate to their illness experience (years of illness), health literacy and self-rated health. Design: Correlational study. Setting: Community-based older adults diagnosed with hypertension. Method: We measured health literacy (Short Test of Functional Health Literacy in Adults [S-TOFHLA]), hypertension knowledge (Hypertension Knowledge Questionnaire), self-rated health and illness representation (IR by Brief Illness Perception Questionnaire [BIPQ]). Results: Confirmatory factor analysis divided IR into cognitive (chronicity, understanding and control) and emotional (more concern, higher impact of illness on affect) dimensions. Ordinary least-squares regression analyses demonstrated that more years of education, more hypertension knowledge, longer duration of hypertension and natural cause beliefs predicted cognitive IR, while fewer years of education, less hypertension knowledge and behavioural cause beliefs (e.g. diet and exercise) predicted emotional IR. More years of education, emotional IR and belief in natural versus psychosocial causes of hypertension were associated with better self-rated health. Conclusion: More years of illness provides older adults with the opportunity to develop an understanding of their condition. More years of education is associated with a lower emotional impact of illness, perhaps through the development of coping strategies. Emotional IR is more important than cognitive IR in predicting self-rated health. Intervening to promote better health outcomes and self-care should take place not only through health education but also through social support and health care access.

Original languageEnglish (US)
Pages (from-to)412-429
Number of pages18
JournalHealth Education Journal
Issue number4
StatePublished - Jun 1 2018


  • Cognition
  • emotion
  • health literacy
  • hypertension
  • illness representation
  • self-care

ASJC Scopus subject areas

  • Health(social science)
  • Education


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