A qualitative research study on the illness perception of chronic pruritus in older Asian adults based on the Common-Sense Model of self-regulation

Abstract

Background: Chronic pruritus (CP), itch lasting more than 6 weeks, is common in community-dwelling older adults. Understanding their illness perception allows the attending physician to develop a personalised care plan to mitigate CP.

Aim: This study explores the illness perception of CP among older Asian adults in an urban community.

Design: Qualitative research was conducted, framed by the Common-Sense Model of self-regulation (CSM). Through in-depth interviews (IDIs), qualitative data were gathered from Asian patients with CP, and then a thematic analysis was carried out. The emergent themes were grouped according to the five domains of CSM: 'identity', 'cause', 'time', 'controllability' and 'consequence'.

Setting and patients: IDIs were conducted in a Singapore public primary care clinic before the data were saturated.

Results: The CSM domains illustrate the illness perception of CP. CP was identified as a 'problem' rather than a disease and was often described in metaphor. Patients' perception of the cause was diverse due to the lack of provision of a clear explanation by their physicians. They opined that CP continued indefinitely. Without definite time to resolution, patients adapted their help- and health-seeking behaviours to control it. The consequences included therapeutic experimentation, alternative therapy, self-isolation, avoidance behaviours, emotional disturbance and dermatological complications.

Conclusion and patient contribution: Patients provided information on their perception of CP, which aligned with the CSM. A multipronged approach is needed to deliver holistic and personalised care to patients with CP, providing clarity on its natural progression, to set their expectations on its timeline, treatment effectiveness and undertake appropriate behaviour modification to adapt to its chronicity.

Keywords: cause; chronic pruritus; common-sense model; consequence; controllability; identity; illness perception; illness representation; older adults; time.