Skip to main content
SpringerLink
Log in

Psychometric properties of the Taiwanese version of the Illness Concept Scale: relation of health beliefs to psychopathology and medication compliance

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

This paper describes the development of a Taiwanese version of the Illness Concept Scale (ICS) and assesses the psychometric properties of this instrument. The ICS is one of the few tools available to measure a global level of illness concepts or health beliefs and has been widely used in a range of clinical and research settings. The ICS has already been translated into several languages, but there is no validated Taiwanese version.

Methods

The English version of the ICS was translated into Taiwanese (ICS-T) and applied in this study. A total of 192 participants with and without psychoses completed the ICS-T and additional evaluations to assess psychopathology and medication compliance. Psychometric properties (factor structures and various types of reliability and validity) were assessed for this translated questionnaire.

Results

Overall, the ICS-T showed good reliability and stability over time. Its scale is comprised of a seven-factor solution, as in the original ICS. Following the validation of the internal structure of this scale, we obtained the total ICS-T score, representing the measurement of an individual’s illness concepts by subtracting the scores of the guilt, idiosyncratic assumption, and negative expectation subscales from those of the trust in medication, trust in physician, susceptibility, and chance control subscales. In comparison analyses, the differences in mean total scores between individuals with and without psychoses were not significant. No significant association was found between the ICS and psychopathology. However, both the total and six out of seven subscales of the ICS-T showed a significant connection with compliance.

Conclusions

In light of these findings, we believe that the ICS-T is a valid and reliable instrument for the assessment of illness concepts in research and clinical settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jormfeldt H (2010) Attitudes towards health among patients and staff in mental health services: a comparison of ratings of importance of different items of health. Soc Psychiatry Psychiatr Epidemiol 45:225–231

    Article  PubMed  Google Scholar 

  2. World Health Organization (1991) Implications for the field of mental health of the European targets for attaining health for all. WHO, Copenhagen

    Google Scholar 

  3. Lindsey E (1996) Health within illness: experiences of chronically ill/disabled people. J Adv Nurs 2:465–472

    Article  Google Scholar 

  4. Simmons SJ (1989) Health: a concept analysis. Int J Nurs Stud 26:155–161

    Article  PubMed  CAS  Google Scholar 

  5. Magyari D (2002) Positive mental health: a turn of the century perspective. Issues Ment Health Nurs 23:331–349

    Article  Google Scholar 

  6. McMullen O’Brien S (1998) Health promotion and schizophrenia: the year 2000 and beyond. Holist Nurs Pract 12:38–43

    Google Scholar 

  7. Hedelin B, Strandmark M (2001) The meaning of mental health from elderly woman’s perspective: a basis for health promotion. Perspect Psychiatr Care 37:7–14

    Article  PubMed  CAS  Google Scholar 

  8. Pavis S, Secker J, Cunningham-Burley S, Masters H (1998) Mental health: what do we know, how did we find it out and what does it mean for nurses? J Psychiatr Ment Health Nurs 5:1–10

    Article  PubMed  CAS  Google Scholar 

  9. Mechanic D (1986) The concept of illness behavior: culture, situation and personal predisposition. Psychol Med 16:1–7

    Article  PubMed  CAS  Google Scholar 

  10. Mechanic D (1983) Adolescent health and illness behavior: hypotheses for the study of distress in youth. J Human Stress 9:4–13

    Article  PubMed  CAS  Google Scholar 

  11. Mechanic D (1978) Medical sociology, 2nd edn. Free Press, New York

    Google Scholar 

  12. Beck MH, Maiman LA (1975) Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care 13:10–24

    Article  CAS  Google Scholar 

  13. Becker MH (1979) Understanding patient compliance: the contribution of attitudes and other psychosocial factors. In: Cohen SJ (ed) New directions in patient compliance. Health, Lexington Toronto, pp 1–31

  14. Ludwig W, Huber D, Schmidt S, Bender W, Greil W (1990) Assessment of compliance-related attitudes in psychiatry. Soc Psychiatry Psychiatr Epidemiol 25:298–303

    Article  PubMed  CAS  Google Scholar 

  15. Becker MH, Haefner DP, Kasl SV, Kirscht JP, Maiman LA, Rosenstock IM (1977) Selected psychosocial models and correlates of individual health-related behaviors. Med Care 15(suppl):27–46

    Article  PubMed  CAS  Google Scholar 

  16. Becker MH (1985) Patient adherence to prescribed therapies. Med Care 23:539–555

    Article  PubMed  CAS  Google Scholar 

  17. Albus M (1995) Zum Problem der Medikamenten—Compliance bei schizophrenen Patiented. Psychiatr Prax 22:221–222

    PubMed  CAS  Google Scholar 

  18. Marser SR, van Putten T, Mintz J, Mckenzie J, Lebell M, Faltico G et al (1984) Costs and benefits of two doses of fluphenazine. Arch Gen Psychiatry 41:1025–1029

    Article  Google Scholar 

  19. Linden M, Nather J, Wilms U (1988) Definition, Bedeutung und Messung der Krankheitskonzepte von Patienten: Die Krankheitskonzeptskala (KK-Skala) fur schizophrenen Patienten. Fortschritte Neurol Psychiatr 56:35–43

    Article  CAS  Google Scholar 

  20. Saravanan B, Jacob KS, Johnson S, Prince M, Bhugra D, David AS (2007) Beliefs models in first episode schizophrenia in South India. Soc Psychiatry Psychiatr Epidemiol 42:446–451

    Article  PubMed  Google Scholar 

  21. Amador XF, David AS (2004) Insight and psychosis: awareness of illness in schizophrenia and related disorders, 2nd edn. Oxford University Press, Oxford

    Google Scholar 

  22. Kleinman A (1986) Social origins of distress and disease. Yale University Press, New Haven

    Google Scholar 

  23. Kleinman A (1980) Patients and healers in the context of culture. University of California Press, Berkeley

    Google Scholar 

  24. Furnhan A, Bower P (1992) A comparison of academic and lay theories of schizophrenia. Br J Psychiatry 161:201–210

    Article  Google Scholar 

  25. Foulks EF, Persons JB, Merkel RL (1986) The effect of patients’ beliefs about their illnesses and compliance in psychotherapy. Am J Psychiatry 143:340–344

    PubMed  CAS  Google Scholar 

  26. Manoharam E, John KR, Joseph A, Jacob KS (2001) Psychiatric morbility, patient perspectives of illness and factors associated with poor medication compliance among the tuberculosis in Vellore, South India. Int J Tuberculosis 48:77–80

    Google Scholar 

  27. Bhui K, Bhugra D (2002) Explanatory models for mental distress: implications for clinical practice and research. Br J Psychiatry 181:6–7

    Article  PubMed  Google Scholar 

  28. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Press, Washington (DC)

    Google Scholar 

  29. Kleindienst N, Greil W (2004) Are illness concepts a powerful predictor of adherence to prophylactic treatment in bipolar disorder? J Clin Psychiatry 65:966–974

    Article  PubMed  Google Scholar 

  30. Linden M, Godemann F (2007) The differentiation between “Lack of insight” and “Dysfunctional Health Belief” in schizophrenia. Psychopathology 40:236–241

    Article  PubMed  Google Scholar 

  31. Linden M, Godemann F, Gaebel W, Kopke W, Muller P, Muller-Spahn F et al (2001) A prospective study of factors influencing adherence to a continuous neuroleptic treatment program in Schizophrenia patients during 2 years. Schizophr Bull 27(4):585–596

    Article  PubMed  CAS  Google Scholar 

  32. Lee MB, Lee YJ, Yen LL, Lin MH, Lue BH (1990) Reliability and validity of using a brief psychiatric symptom rating scale in clinical practice. J Formos Med Assoc 89(12):1081–1087

    PubMed  CAS  Google Scholar 

  33. Thompson K, Kulkarni J, Sergejew AA (2000) Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 42:241–242

    Article  PubMed  CAS  Google Scholar 

  34. Kao YC, Liu YP (2010) Compliance and schizophrenia: the predictive potential of insight into illness, symptomatology, and side effects. Compr Psychiatry 51:557–565

    Article  PubMed  Google Scholar 

  35. Nunnally JC, Bernstien IH (1994) Psychometric theory, 3rd edn. MacGraw-Hill, New York

    Google Scholar 

  36. Cortina JM (1993) What is coefficient alpha? An examination of theory and application. J Appl Psychol 78:98–104

    Article  Google Scholar 

  37. Farrow SC, Charney MC, Lewis PA (1983) People’s knowledge of health and disease. J Pub Health Med 17:129–137

    Google Scholar 

  38. Weissfield JL, Kirscht JP, Brock BM (1990) Health beliefs in a population: The Michigan Blood Pressure Survey. Health Educ Quart 17:141–155

    Article  Google Scholar 

  39. Freudenreich O, Cather C, Evins AE, Henderson DC, Goff DC (2004) Attitudes of schizophrenia outpatients toward psychiatric medications: relationships to clinical variables and insight. J Clin Psychiatry 65:1372–1376

    Article  PubMed  Google Scholar 

  40. Wikman K, Marklund S, Alexanderson K (2005) Illness, disease, and sickness absence: an empirical test of differences between concepts of ill health. J Epidemiol Community Health 59:450–454

    Article  PubMed  Google Scholar 

  41. Marder SR, Mebane A, Chien C, Winslade WJ, Swann E, van Putten T (1983) A comparison of patients who refuse and consent to neuroleptic treatment. Am J Psychiatry 140(4):470–472

    PubMed  CAS  Google Scholar 

  42. McEvoy JP, Howe AC, Hogarty GE (1984) Differences in the nature of relapse and subsequent inpatient course medication—compliant and noncompliant schizophrenic patients. J Nerv Ment Dis 172(7):412–416

    Article  PubMed  CAS  Google Scholar 

  43. Bartko G, Herczeg I, Zador G (1988) Clinical symtomatology and drug compliance in Schizophrenia patients. Acta Psychiatr Scand 77:74–76

    Article  PubMed  CAS  Google Scholar 

  44. Lysaker PH, Carcione A, Dimaggio G, Johannesen JK, Nicolo G, Procacci M, Semerari A (2005) Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight, and quality of life. Acta Psychiatr Scand 112:64–71

    Article  PubMed  CAS  Google Scholar 

  45. Lobban F, Barrowclough C, Jones S (2004) The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychol Med 34:1165–1176

    Article  PubMed  CAS  Google Scholar 

  46. Watson AC, Corrigan P, Larson JE, Sells M (2007) Self-stigma in people with mental illness. Schizophr Bull 33(6):1312–1318

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to express their sincere thanks to Dr. Linden, the original ICS designer, for his permission to translate and administer the ICS in the present study.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Songshan Armed Forces General Hospital, No. 131, Jiankang RD., Songshan District, Taipei, 10581, Taiwan, Republic of China

    Yu-Chen Kao & Ming-Kuen Chou

  2. Department of Physiology and Biophysics, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Taipei, 114, Taiwan, Republic of China

    Yia-Ping Liu

  3. Department of Family Medicine, Songshan Armed Forces General Hospital, Taipei, Taiwan, Republic of China

    Tsung-Hsing Cheng

Authors
  1. Yu-Chen Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yia-Ping Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming-Kuen Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tsung-Hsing Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yia-Ping Liu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kao, YC., Liu, YP., Chou, MK. et al. Psychometric properties of the Taiwanese version of the Illness Concept Scale: relation of health beliefs to psychopathology and medication compliance. Soc Psychiatry Psychiatr Epidemiol 47, 597–606 (2012). https://doi.org/10.1007/s00127-011-0363-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-011-0363-y

Keywords

Search

Navigation