Exploring and Changing Cognitive Representations, Coping and Quality Of Life Outcomes in Chronic Spontaneous Urticaria

Chronic Spontaneous Urticaria (CU) is a pruritic skin disorder that affects 0.8% of the population. As its aetiology is not fully understood the aim is to control symptoms through medicines to improve quality of life (QoL). Demographic and clinical factors have been inconsistent and poorly predict QoL but one modifiable factor that has gained credence is ones illness representations. The Common-Sense Model (Leventhal, Meyer and Nerenz, 1980) postulates that these guide coping procedures that impact outcomes. The aim of the thesis was to examine whether CU representations (mediated by coping) predicted QoL and whether both representations and QoL in CU were amenable to change via intervention. Preliminary studies undertaken validated CSM measures in CU and confirmed key reference values for CU-related QoL and its measurement. CU was seen as uncontrollable, emotionally arousing, chronic, cyclical, caused by stress and immunity with serious consequences and has a moderate impact on QoL (n=78). The necessity to take CU medicines equalled concerns about side effects. Cognitive representations were the strongest predictors of QoL explaining 35.0-60.6% of the variance independent of coping. Qualitative analyses presented CU as unsightly, uncontrollable and difficult to comprehend and self-regulate. Fifteen participants undertook psych-education and action plans to change CU representations. Multivariate analyses found a strong within-group main effect on QoL outcomes (p<.001) and for aspects of outcome over time (all p<.001). Correlation based change analysis further inferred that targeting CU cognitions resulted in changing QoL outcomes over time. In summary the thesis supported that: poor QoL is prevalent in individuals experiencing CU. Not only do CU representations predict QoL outcomes, they are amenable to change via intervention as are QoL outcomes. Such findings have implications for CU-related QoL research and how health psychology-dermatology collaborations maybe instrumental to improving outcome through psycho-education interventions in routine care to facilitate better CU self-management

Health-Related Quality of Life Experience of Young Adults Living With Psoriatic Arthritis

Psoriatic arthritis (PsA) is an inflammatory autoimmune disease that includes symptoms of arthritis, inflammation of tendons/ligaments, swelling of toes/fingers, and possible involvement of spinal joints. The disease activity of PsA causes structural damage to the joints impacting activities involved with an individual\u27s quality of life (QOL). Existing PsA research on health-related quality of life (HRQOL) mainly shows results concerning children and adult/older adult populations there is a gap in the research on the young adult population living with PsA and their HRQOL. This qualitative study was conducted to gather the experiences of the HRQOL of young adults (18–25 years old) living with PsA. A generic qualitative approach as used to explore these experiences and better understand this population living with PsA. Interviews were conducted with each participant lasting 60–90 minutes. Questions for the interview drew from Wilson and Cleary\u27s HRQOL conceptual framework. Common themes in the interviews were identified. Results revealed one overarching theme of hope and four subthemes, being diagnosed with PsA and participant’s understanding of the diagnosis, the symptoms experienced living with PsA and the affects they have on their quality of life, how participants created their treatment plans for PsA and what their quality of life was like before and after medication, and the role of participant’s doctors. This study may contribute to positive social change goal by shedding light on this population and offering a better understanding of members’ HRQOL. This may help professionals in the psychological and medical fields approach treatment differently to tailor treatment plans to individuals’ needs