PhD in Nursing Science Program

Thomas Lee Christenbery

Dyspnea Mental Representations as Determinants of Coping Interventions and Appraisal for Individuals with COPD


Dissertation under the direction of Professor Nancy Wells


Guided by the Common Sense Model of Illness, this study explored how dyspnea mental representations influence the selection of coping interventions for dyspnea and subsequent appraisal of those interventions for individuals with COPD. Participants (N = 120) completed the Illness Perception Questionnaire (IPQ), Dyspnea Intervention Scale and Dyspnea Intensity/Distress Numeric Rating Scales. Hierarchical cluster analyses distinguished three clusters based on dyspnea mental representations. The clusters differed principally on perceptions of dyspnea demands and on causal attributions of dyspnea. The first cluster (n = 27) reported low dyspnea demand and identified stress as a primary cause of dyspnea. The second cluster (n = 78) reported slightly higher dyspnea demand but identified no particular cause of their dyspnea. The third cluster (n = 15) reported the highest dyspnea demand and identified stress, pollution and germ/virus as significant causes of their dyspnea. The third cluster reported the highest dyspnea severity (p = .07) and also used more coping interventions (p < .05) than either of the other two groups. Participants in each cluster used problem focused strategies to relieve their dyspnea; none of the interventions were found to be particularly effective. Mental representations were essentially unrelated to the selection of coping intervention for each of the clusters. This study provides nurse researchers with a quantitative methodology for examining dyspnea mental representations. In addition, the study serves as an exemplar of beginning work on identifying and comparing dyspnea mental representations among patients, significant others and healthcare providers.