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Beliefs and perceptions about the personality characteristics of children and adults suffering from a terminal illness.

Due to medical advancements, a growing number of individuals with chronic illness are living longer than they previously would have (Newacheck & Taylor 1992; Rosina, Crisp, & Steinbeck, 2003). An estimated 31% (20 million) of children under 18 years or younger have one or more chronic illness and 71% of these children were reported to have two or more chronic illnesses (Newacheck & Taylor, 1992). The issue pertaining to the psychological health of chronically ill individuals and how they are perceived can no longer be ignored by the psychological community since many studies have shown that children and adolescents with chronic illness and disabilities are at an increased risk of psychological problems (Huurre & Aro, 2002). It should be noted that adolescents with chronic illness had twice as many depressive symptoms than non-chronically ill peers (Key, Brown, Marsh, Spratt & Recjnor, 2001). Given this understanding, it is not surprising that having a chronic illness as a child can have continuing effects on the person's well-being throughout adolescence and into adulthood (Farrant & Watson, 2004). Since there is an increase in the number of people living with a chronic or terminal illness, the ways in which these people are perceived may have overall implications for our health care system.

Thus far, there has been little research on how people perceive those with chronic and terminal illness. Understanding how people perceive those with a terminal illness has implications for our health care system. A better understanding of the perceptions held about terminally ill adults and children could help improve the quality of health care terminally ill individuals receive and improve treatment within the health care system itself. Dijker and Raeijmaekers (1999) found that the seriousness of a person's illness influenced the research respondents' level of sadness and powerlessness. Given this finding, it should be expected that people perceive those with terminal and chronic illness differently than non-terminally ill people. People's perceptions of illness not only affect their ability to recognize their own symptoms, but they also influence how they react to others who are ill (Dijker & Raeijmaekers, 1999). For example, after reading correct information about an illness, participants experienced more negative feelings towards the ill person based on the type of (hypothetical) illness described and whether participants perceived the illness to be acquired through controllable or uncontrollable circumstances (Senior, Weinman & Marteau, 2002).

Understanding how people perceive illness has implications for the quality of health care and how people interact with those that are ill. Croyle and Williams (1991) found that the opinions/judgments made about a disease are partly determined by the beliefs held regarding the people who actually have the disease. This process also affects those who are ill, as they may make conscious (or unconscious) judgments concerning their own illness that could positively or negatively influence their chance for recovery. Joachim and Acorn (2000) found that stress in social relationships may occur as people try to deal with feeling discredited due to their illness. Whether these individuals are feeling discredited due to the ways in which they have been treated or due to another outside force needs to be evaluated.

It is also important to understand how ill patients are treated because of age. It should be expected that the age of ill people affects how others perceive them. Antshel, Brewster and Waisbren (2004) found that across all respondents, age was a mediator of parent responses; younger children are more likely to be perceived as being controlled by external forces and their difficulties are perceived as less stable. If younger children are perceived as relatively blameless for their illnesses, than it follows that they will be perceived as having more positive characteristics than adults who suffer from similar illnesses. Rosina, Crisp, and Steinbeck (2003) found that young people with chronic illness are more likely to experience reduced psychosocial functioning compared to young people who do not have chronic illness. With the increased cost of managed care (Fisher & Wehis, 2002), effective treatment is necessary to ensure efficient and accurate care for people suffering from illness. Anything that negatively affects such care will lead to further increases in cost of overall medical treatment.

To our knowledge, no other studies have been done that examined how individuals perceive the personality characteristics of people who have a chronic or terminal illness. This study focuses on the beliefs and perceptions held by participants about terminally ill and healthy individuals.

There were three hypotheses tested in the current study. Hypothesis one stated: healthy adults will be perceived to have more positive personality characteristics than terminally ill adults. Hypothesis two stated: Healthy children will be perceived to have more positive personality characteristics than unhealthy children. Hypothesis three stated: There will be an interaction between age (adult vs. child) and illness (healthy vs. terminally ill), in that participants will perceive children as having more positive personality characteristics than adults, regardless of illness status.

METHOD

Participants

Participants for the study were 114 college students (M age = 20.34 years; SD = 5.54) who were, on average, in their freshman year of college (M years of education = 13.40; SD = 0.71). These students were voluntarily recruited from a midsized public university in the Midwest. There were 98 (59.8%) women who participated and 66 (40.2%) men. Racial/ethnic demographic information was not collected; however, based on the demographic composition of the university from which the participants were drawn, it is estimated that 74% of the sample was Caucasian, 7.5% was African American, and 19.5% was comprised of other racial/ethnic groups.

Design

A 2 (Health Status: Terminal Illness v. Healthy) by 2 (Target Character: Adult v. Child) between-subjects factorial design was used. Dependent measures were the participants' ratings of the character's overall positive and negative personality characteristics.

Measures

Participants completed a nine-item questionnaire that evaluated the personality of the character in the vignette. Each item was anchored with a positive anchor at one end and a negative anchor at the other (i.e., happy to sad; calm to angry; secure to insecure; anxious to relaxed; organized to disorganized; irritable to easygoing; spontaneous to thoughtful; extroverted to introverted; motivated to apathetic). Participants rated the actor in the vignette on each item on a scale from 1 to 10. The items were counterbalanced so that positive characteristics were sometimes rated 1 and sometimes rated 10. The questionnaire was in the same presentation format as the vignettes and participants were asked in single questions to rate the perceived quality of life of the character in the vignette and the probability of the character living longer than five years.

Participants were randomly assigned to read one of four vignettes, which were presented to them in print format. The vignettes varied along health status (healthy vs. terminally ill) and age (child vs. adult). These vignettes described, respectively, a healthy adult, a terminally ill adult, a healthy child and a terminally ill child. In the vignettes a gender neutral name (Jamie) was used to avoid gender bias. Samples of the vignettes used to describe a terminally ill and a healthy adult follow:
   Jamie is an average adult who was recently diagnosed with a
   terminal illness. Jamie has a good home life. Jamie has a
   successful career and has missed few days of work. Jamie is of
   average intelligence and has little trouble completing assignments
   for work. Jamie has healthy relationships with co-workers and
   friends. Jamie maintains a healthy diet and is physically active.

   Jamie is an average adult who has a good home life. Jamie has a
   successful career and has missed few days of work. Jamie is of
   average intelligence and has little trouble completing assignments
   for work. Jamie has healthy relationships with co-workers and
   friends. Jamie maintains a healthy diet and is physically active.


Procedures

Participants were recruited through their introductory level psychology courses. The participants enrolled in the study, and chose a time they desired, through the psychology department's online recruitment system. Upon arriving for the study, participants read and signed an informed consent document. The participants were informed that the purpose of the study was to study how participants perceive terminally ill individuals. After giving their consent, participants read a randomly assigned vignette and completed the nine-item rating of the character in the vignette. The participants were asked not to put their name on the response form and their responses were kept anonymous. The participants were given 30 minutes to complete the questionnaires. Once the participants had finished they were debriefed, thanked for their time, and released.

RESULTS

Responses from the nine-item rating of the characters in the vignettes were summed create a total score. In order to do this, items were recorded such that higher ratings indicated more positive ratings. Cronbach's alpha for this scale was .72. Means and standard deviations are shown in Table 1.

To evaluate hypotheses one and two, the scores from the rating scale were analyzed using a One Way Analysis of Variance (ANOVA). Follow-up Bonferroni tests were used to determine if there were any differences among the perceptions of the different characters (i.e., healthy adult, terminally ill adult, healthy child, terminally ill child). The overall F was significant for this analysis, F(3, 109) = 4.92, p = .003. Follow-up tests indicated that healthy children were perceived as having a higher level of positive characteristics than healthy adults (p = .03) and terminally ill adults (p = .008), but not higher than terminally ill children (p = 1.00). There were no differences in the ratings among terminally ill children, terminally ill adults, and healthy adults. Hypothesis three was evaluated via an independent samples t-test. Results indicated that children (M = 59.6, SD = 7.7) were perceived to be healthier than adults (M = 66.4, SD = 10.2), t(111) -3.59, p < .001.

DISCUSSION

The purpose of this study was to examine people's perceptions of those with terminal illness. There were three hypotheses tested in the current study: Healthy adults will be perceived to have more positive personality characteristics than terminally ill adults, healthy children will be perceived to have more positive personality characteristics than unhealthy children, and we expected to find an interaction between age (adult vs. child) and illness (healthy vs. terminally ill), in that participants will perceive children as having more positive personality characteristics than adults, regardless of illness status.

Hypothesis one was not supported. There were no differences in perceptions of healthy and terminally ill adults. Huurre and Aro (2002) found that when chronic illness was associated with perceived limitations in daily living, the person experienced more problems in their psychological well being. Since individuals who are suffering from a chronic condition do experience more problems in their psychological well-being, it should be noted that the participants in the current study perceived neither healthy nor terminally ill individuals as having more negative personality characteristics. The inconsistency between the actuality of terminally ill individuals experiencing more psychological problems and the perception that healthy and terminally ill individuals are psychologically similar is an area for further study.

Hypothesis two was not supported. Healthy children were rated similarly to unhealthy children. Rosina, Crisp, and Steinbeck (2003) found that there is a difference between the emotional and behavioral functioning of young people with and without chronic illness. Since the participants in the current study perceived healthy children to be similar to unhealthy children, this demonstrates that our participants inaccurately perceived the psychological functioning of unhealthy children. This inconsistency should be an area of further research.

Hypothesis three was supported. Healthy children were perceived to have more positive characteristics than either healthy adults or terminally ill adults. This is consistent with Antshel, Brewster and Waisbren (2004), whose findings suggest that young children are viewed as being more controlled by external forces. Since children are perceived to be controlled by external forces more so than adults, the current finding, that healthy children were perceived to have more positive personality characteristics than both healthy and terminally ill adults, suggests that the personality characteristics of adults are perceived to be controlled by internal forces, whereas the personality characteristics of children are perceived to be controlled by external forces. These participants may have believed children to have less control over their personality characteristics and were therefore less inclined to prescribe negative personality characteristics.

There were limitations for the study. The measures used in the present study were designed specifically for this study, so the strengths and weakness are therefore unknown. Since ethnic data and data regarding socioeconomic status were not collected from the sample, it may not accurately represent the entire population. Further, the sample was composed entirely of young college students. These findings may not generalize to older people or the general public or to those who are in constant contact with terminally ill individuals (such as health care or hospice workers). Since a gender neutral name was used it may have caused males to identify the character as being male and females to identify the character as female. Finally, the term "terminal illness" was not clearly defined and therefore could have been interpreted by participants in several ways.

Even though this is a preliminary study, main effects were found for perceived personality characteristics and a person's health status, which are relatively unrelated in the context of developing a terminal illness. Since this study showed that people perceive individuals differently if they have a terminal illness, the effect the illness has on the individual might go beyond what one would expect. Terminally ill individuals may experience other hardships because of their medical illness, since people perceive and treat them differently than if they were healthy.

REFERENCES

Antshel, A. M., Brewster, S., & Waisbren, S. E. (2004). Child and parent attributions in chronic pediatric conditions: phenylketonuria (PKU) as an exemplar. Journal of Child Psychology and Psychiatry, 45, 622-630.

Croyle, R. T., & Williams, K. D. (1991). Reactions to medical diagnosis: The role of illness stereotypes. Basic and Applied Social Psychology, 12, 227-241.

Dijker, A. J., & Raeijmaekers, F. (1999). The influences of seriousness and contagiousness of disease on emotional reactions to ill persons. Psychology and Health, 14, 131-141.

Farrant, B., & Watson, P. D. (2004). Health care delivery: Perspectives of young people with chronic illness and their parents. Journal of Pediatric Child Health, 40, 175-179.

Fisher, L., & Wehis, K. L. (2000). Can addressing family relationships improve outcome in chronic disease? The Journal of Family Practice, 49, 561-566.

French, D. P., Marteau, T. M., Senior, V., & Weinman, J. (2005). How valid are the measures of beliefs about the causes of illness? The example of myocardial infarction. Psychology and Health, 20, 615-635.

Huurre, T. M., & Aro, H. M. (2002). Long-term psychological effects of persistent chronic illness: A follow-up study of Finnish adolescents aged 16 to 32 years. European Child & Adolescent Psychiatry, 11, 85-91.

Key, J. D., Brown, R. T., Marsh, L. D., Spratt, E. G., & Recknor, J. C. (2001). Depressive symptoms in adolescents with a chronic illness. Children's Health Care, 30, 283-292.

Newacheck, P. W., & Taylor, W. R. (1992). Childhood chronic illness: Prevalence, severity, and impact. American Journal of Public Health, 82(3), 364-371.

Rosina, R., Crisp, J., & Steinbeck, K. (2003). Treatment adherence of youth and young adults with and without a chronic illness. Nursing and Health Sciences, 5, 139-147.

Senior, V., Weinman, J., & Marteau, T. M. (2002). The influence of perceived control over causes and responses to health threats: A vignette study. British Journal of Health Psychology, 7, 203-211.

Natalie Truba, Frederick G. Grieve

Western Kentucky University

Author info: Correspondence should be sent to: Dr. Frederick G. Grieve, Department of Psychology, Western Kentucky University, 1906 College Heights Blvd, #21030, Bowling Green, KY 42101-1030 rick.grieve@wku.edu
TABLE 1 Means and Standard Deviations for The Personality Ratings
for Characters in Each of the Vignettes.

                       Mean    Standard Deviation

Healthy Adult          59.94          7.79
Terminally Ill Adult   59.45          7.81
Healthy Child          67.72         10.28
Terminally Ill Child   64.73          9.96
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Author:Truba, Natalie; Grieve, Frederick G.
Publication:North American Journal of Psychology
Article Type:Clinical report
Geographic Code:1USA
Date:Mar 1, 2010
Words:2643
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