Skip to main content

Advertisement

SpringerLink
Log in

Perception of Illness and Its Association with Treatment Willingness in Patients with Newly Diagnosed Nonalcoholic Fatty Liver Disease

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments.

Methods

In a cross-sectional study enrolling patients with newly diagnosed NAFLD, the sociodemographic, anthropometric, biochemical, and radiological determinants of enhanced illness perceptions (measured by the BIPQ score) were investigated using univariate and multivariable binary logistic regression analyses. Finally, the association between individual domains of the BIPQ and willingness to participate in comprehensive medical management was explored.

Results

In total, 264 patients (mean age 53 ± 11.9 years, 59.8% males) were enrolled in the final analysis. The mean and median BIPQ scores in the study population were 30.3 ± 12.8 and 31.0 (IQR, 22.0–40.0), respectively. The variables having a significant independent association with heightened perceptions (BIPQ > 31) were family history of liver disease (aOR, 5.93; 95% CI, 1.42–24.74), obesity (aOR, 3.33; 95% CI, 1.57–7.05), diabetes mellitus (aOR, 2.35; 95% CI, 1.01–5.49), and transaminitis (aOR, 2.85; 95% CI, 1.42–5.69). Patients with a higher level of illness perceptions (31.6 ± 12.9 vs 27.8 ± 12.3, p = 0.022) were more likely to express a willingness to participate in the comprehensive management plan, with 3 of the 8 domains (consequence, identity, and treatment control) mainly affecting willingness.

Conclusion

A family history of liver disease, obesity, diabetes, and transaminitis were independently associated with increased illness perceptions. A belief in serious consequences, a strong illness identity, and higher perceived treatment control were significantly associated with the willingness to undergo comprehensive care for NAFLD.

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. Matteoni CA, Younossi ZM, Gramlich T et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–1419.

    CAS  PubMed  Google Scholar 

  2. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99-s112.

    CAS  PubMed  Google Scholar 

  3. Younossi ZM, Koenig AB, Abdelatif D et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.

    PubMed  Google Scholar 

  4. Targher G, Byrne CD, Lonardo A et al. Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016;65:589–600.

    PubMed  Google Scholar 

  5. VanWagner LB, Rinella ME. Extrahepatic manifestations of nonalcoholic fatty liver disease. Curr Hepatol Rep. 2016;15:75–85.

    PubMed  PubMed Central  Google Scholar 

  6. Sanyal AJ, Chalasani N, Kowdley KV et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362:1675–1685.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Armstrong MJ, Gaunt P, Aithal GP et al. Liraglutide safety and efficacy in patients with nonalcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet. 2016;387:679–690.

    CAS  PubMed  Google Scholar 

  8. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–78.e5; quiz e14–5.

  9. Abd El-Kader SM, El-Den Ashmawy EM. Nonalcoholic fatty liver disease: the diagnosis and management. World J Hepatol. 2015;7:846–858.

    PubMed  PubMed Central  Google Scholar 

  10. Broadbent E, Petrie KJ, Main J et al. The brief illness perception questionnaire. J Psychosom Res. 2006;60:631–637.

    PubMed  Google Scholar 

  11. Broadbent E, Wilkes C, Koschwanez H et al. A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychol Health. 2015;30:1361–1385.

    PubMed  Google Scholar 

  12. Dudala S. Updated Kuppuswamy’s socioeconomic scale for 2012. J Dr NTR Univ Health Sci. 2013;2:201–202.

    Google Scholar 

  13. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama. 2001;285:2486–2497.

  14. Misra A, Chowbey P, Makkar BM et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–170.

    CAS  PubMed  Google Scholar 

  15. Nampoothiri RV, Duseja A, Rathi M et al. Renal dysfunction in patients with nonalcoholic fatty liver disease is related to the presence of diabetes mellitus and severity of liver disease. J Clin Exp Hepatol. 2019;9:22–28.

    PubMed  Google Scholar 

  16. Peduzzi P, Concato J, Kemper E et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.

    CAS  PubMed  Google Scholar 

  17. Cholankeril G, Wong RJ, Hu M et al. Liver transplantation for nonalcoholic steatohepatitis in the US: Temporal trends and outcomes. Dig Dis Sci. 2017;62:2915–2922. https://doi.org/10.1007/s10620-017-4684-x

    Article  PubMed  Google Scholar 

  18. David K, Kowdley KV, Unalp A et al. Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology. 2009;49:1904–1912.

    PubMed  Google Scholar 

  19. Dan AA, Kallman JB, Wheeler A et al. Health-related quality of life in patients with nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;26:815–820.

    CAS  PubMed  Google Scholar 

  20. Younossi ZM, Blissett D, Blissett R et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology. 2016;64:1577–1586.

    Google Scholar 

  21. Estes C, Razavi H, Loomba R et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67:123–133.

    CAS  PubMed  Google Scholar 

  22. Pakhomov SV, Jacobsen SJ, Chute CG et al. Agreement between patient-reported symptoms and their documentation in the medical record. Am J Manag Care. 2008;14:530–539.

    PubMed  PubMed Central  Google Scholar 

  23. Huber Y, Boyle M, Hallsworth K et al. Health-related quality of life in nonalcoholic fatty liver disease associates with hepatic inflammation. Clin Gastroenterol Hepatol. 2019;17:2085–2092.e1.

    Google Scholar 

  24. Alt Y, Grimm A, Schlegel L et al. The impact of liver cell injury on health-related quality of life in patients with chronic liver disease. PLoS ONE. 2016;11:e0151200.

    PubMed  PubMed Central  Google Scholar 

  25. Tiemensma J, Kaptein AA, Pereira AM et al. Negative illness perceptions are associated with impaired quality of life in patients after long-term remission of Cushing’s syndrome. Eur J Endocrinol. 2011;165:527–535.

    CAS  PubMed  Google Scholar 

  26. Wu H, Zhao X, Fritzsche K et al. Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China. Psychol Health Med. 2014;19:273–285.

    PubMed  Google Scholar 

  27. Zelber-Sagi S, Bord S, Dror-Lavi G et al. Role of illness perception and self-efficacy in lifestyle modification among nonalcoholic fatty liver disease patients. World J Gastroenterol. 2017;23:1881–1890.

    PubMed  PubMed Central  Google Scholar 

  28. Hampson SE, Glasgow RE, Toobert DJ. Personal models of diabetes and their relations to self-care activities. Health Psychol. 1990;9:632–646.

    CAS  PubMed  Google Scholar 

  29. Kroll T, Kehn M, Ho P-S et al. The SCI Exercise Self-Efficacy Scale (ESES): development and psychometric properties. Int J Behav Nutr Phys Act. 2007;4:34–34.

    PubMed  PubMed Central  Google Scholar 

  30. Mlynarsky L, Schlesinger D, Lotan R et al. Nonalcoholic fatty liver disease is not associated with a lower health perception. World J Gastroenterol. 2016;22:4362–4372.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Frostholm L, Fink P, Christensen KS et al. The patients’ illness perceptions and the use of primary health care. Psychosom Med. 2005;67:997–1005.

    PubMed  Google Scholar 

  32. Jackson J, Fiddler M, Kapur N et al. Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics. J Psychosom Res. 2006;60:357–363.

    PubMed  Google Scholar 

  33. Scharloo M, Kaptein AA, Weinman J et al. Patients’ illness perceptions and coping as predictors of functional status in psoriasis: a 1-year follow-up. Br J Dermatol. 2000;142:899–907.

    CAS  PubMed  Google Scholar 

  34. Lydeard S, Jones R. Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters. J R Coll Gen Pract. 1989;39:495–498.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Scharloo M, Kaptein AA, Weinman J et al. Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis. J Psychosom Res. 1998;44:573–585.

    CAS  PubMed  Google Scholar 

  36. Petrie KJ, Weinman J, Sharpe N et al. Role of patients’ view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. BMJ. 1996;312:1191–1194.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Lerdal A, Hofoss D, Gay CL et al. Perception of illness among patients with heart failure is related to their general health independently of their mood and functional capacity. J Patient Rep Outcomes. 2019;3:55.

    PubMed  PubMed Central  Google Scholar 

  38. Frith J, Day CP, Robinson L et al. Potential strategies to improve uptake of exercise interventions in nonalcoholic fatty liver disease. J Hepatol. 2010;52:112–116.

    PubMed  Google Scholar 

  39. Centis E, Moscatiello S, Bugianesi E et al. Stage of change and motivation to healthier lifestyle in nonalcoholic fatty liver disease. J Hepatol. 2013;58:771–777.

    PubMed  Google Scholar 

  40. Petrie KJ, Cameron LD, Ellis CJ et al. Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med. 2002;64:580–586.

    PubMed  Google Scholar 

  41. Petrie KJ, Perry K, Broadbent E et al. A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication. Br J Health Psychol. 2012;17:74–84.

    PubMed  Google Scholar 

  42. Keogh KM, Smith SM, White P et al. Psychological family intervention for poorly controlled type 2 diabetes. Am J Manag Care. 2011;17:105–113.

    PubMed  Google Scholar 

  43. Davies MJ, Heller S, Skinner TC et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336:491–495.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Cunningham MA, Swanson V, O’Carroll RE et al. Randomized clinical trial of a brief psychological intervention to increase walking in patients with intermittent claudication. Br J Surg. 2012;99:49–56.

    CAS  PubMed  Google Scholar 

  45. Sararoudi RB, Motmaen M, Maracy MR et al. Efficacy of illness perception focused intervention on quality of life, anxiety, and depression in patients with myocardial infarction. J Res Med Sci. 2016;21:125.

    PubMed  PubMed Central  Google Scholar 

  46. Williams CD, Stengel J, Asike MI et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140:124–131.

    PubMed  Google Scholar 

  47. Younossi ZM, Gramlich T, Matteoni CA et al. Nonalcoholic fatty liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. 2004;2:262–265.

    PubMed  Google Scholar 

  48. Younossi ZM, Stepanova M, Rafiq N et al. Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality. Hepatology. 2011;53:1874–1882.

    PubMed  Google Scholar 

  49. Younossi ZM, Otgonsuren M, Venkatesan C et al. In patients with nonalcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not. Metabolism. 2013;62:352–360.

    CAS  PubMed  Google Scholar 

  50. Dulai PS, Singh S, Patel J et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–1565.

    CAS  PubMed  Google Scholar 

  51. Angulo P. Long-term mortality in nonalcoholic fatty liver disease: Is liver histology of any prognostic significance? Hepatology. 2010;51:373–375.

    PubMed  Google Scholar 

  52. Angulo P. Diagnosing steatohepatitis and predicting liver-related mortality in patients with NAFLD: two distinct concepts. Hepatology. 2011;53:1792–1794.

    PubMed  Google Scholar 

  53. Taylor R, Brown JS, Weinman J. A comparison of the illness perceptions of North Indian and white British women. J Ment Health. 2013;22:22–32.

    PubMed  Google Scholar 

Download references

Funding

No funding was taken for this work.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, GTBS (C) Hospital, Ludhiana, Punjab, 141002, India

    Harpal S. Dhaliwal & Ripudaman Singh

  2. Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India

    Abin M. Abraham

  3. Department of Internal Medicine, GTBS (C) Hospital, Ludhiana, Punjab, India

    Rajan Sharma

  4. Department of Psychiatry, GTBS (C) Hospital, Ludhiana, Punjab, India

    N. K. Goyal

  5. Department of Psychiatry, Government Medical College, Rajnandgaon, Chhattisgarh, India

    Rajat Soloman

  6. Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Medicine and Science, Eau Claire, WI, 54702, USA

    Pankaj Bansal

  7. Department of Internal Medicine, Marietta Memorial Hospital, Marietta, OH, 45750, USA

    Amandeep Goyal

Authors
  1. Harpal S. Dhaliwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ripudaman Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abin M. Abraham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajan Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. K. Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rajat Soloman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pankaj Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amandeep Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dhaliwal HS designed and performed the research, reviewed the literature and wrote the draft. Singh R and Sharma R collected the data. Goyal NK and Soloman R helped in expert guidance on the psychosomatic aspect while performing the study. Abraham AM contributed to literature review. Bansal P and Goyal A critically reviewed the paper for intellectual content.

Corresponding author

Correspondence to Harpal S. Dhaliwal.

Ethics declarations

Conflict of interest

We, all authors, declare no conflict of interest relevant to this work.

Ethical approval

This study was conducted in accordance with the principles of the Declaration of Helsinki (1975). The institutional review board approval was obtained before starting the enrolment of study patients.

Informed consent

Informed consent was obtained prior to the enrollment from the included patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhaliwal, H.S., Singh, R., Abraham, A.M. et al. Perception of Illness and Its Association with Treatment Willingness in Patients with Newly Diagnosed Nonalcoholic Fatty Liver Disease. Dig Dis Sci 66, 4197–4207 (2021). https://doi.org/10.1007/s10620-020-06794-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-020-06794-2

Keywords

Search

Navigation