Effects of illness identity and perceived controllability on the health outcomes of patients with type 1 diabetes

A patient’s illness identity is the degree to which a patient’s diagnosis is integrated into their sense of self. As a frequent point of discussion for providers, physicians often discuss how providers should not call their patients “diabetic patients;” instead, they should use the phrase “patients with type 1 diabetes.” The reminder to providers merely points to the prevalence of how an dillness can become a part of a person’s identity, with a patient’s illness identity impacting a patient’s life in a variety of way, both positive and negative. Although research has begun to show the positive and negative effects of illness identity on health outcomes in a variety of conditions, there is a lack of understanding as to why illness identity has the impact on outcomes that it does. Although attribution theory as a whole is not often studied explicitly in healthcare settings, health locus of control has gained significant attention. Other elements of attribution theory, particularly controllability, can be found in recent research on patient illness representations, or a patient’s common-sense understanding of a health threat. In this paper, I review the state of the current literature on illness identity, attribution theory, and illness representation with a particular focus on controllability in medical patient populations. I end this review with a proposal for a study of pediatric and adolescent patients with type 1 diabetes that has as its goal investigating a possible mediation model. I hypothesize that the effects of illness identity on health outcomes are mediated by a patient’s perception of the controllability of their illness. In my conclusion, I discuss possible applications and further investigations of this mediation model both within and outside of pediatric and adolescent patients with type 1 diabetes.