Role of illness perception and self-efficacy in shaping health behaviors in women with
Polycystic Ovary Syndrome
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder and a
leading cause of infertility among women of reproductive age. The prevalence of PCOS in India
is close to 10% using Rotterdam’s and Androgen Excess Society (AES) criteria, while it is 5.8%
using the National Institutes of Health (NIH) (Bharali et al., 2022). Women with PCOS are more
likely to be overweight, with 70% being either overweight or obese (Yildiz et al., 2007). As
such, weight management is recommended as first-line therapy for PCOS through health
behaviors such as diet and physical activity (Teede et al., 2011).
Illness perceptions are a person’s beliefs and expectations about illness. According to the
Common-Sense Model of Self-Regulation (CSM), cognitive and emotional representations of
illness shape a person’s illness perceptions (Leventhal et al., 2003). Self-efficacy encompasses
the capacity to manage present health challenges or prevent upcoming health problems, and it
could indicate self-sufficient attitudes that may have been developed through prior experiences
of managing health concerns or from perceived ability to undertake particular tasks (AbuSabha
& Achterberg, 1997; Ruehlman et al., 1998).
Lin et al. (2017) found that women with PCOS felt greater at risk for adverse health
outcomes and believed that a healthy lifestyle was less beneficial in preventing weight gain
compared to women without PCOS. Fossey et al. (2023) studied the relationship between illness
perception and health behavior among women with PCOS and found that illness identity and
perception of longer illness duration were associated with reduced physical activity and
maladaptive dietary practices. Guo et al. (2022) reported that health-promoting behaviours are
minimal among patients with PCOS and found that one of the main factors influencing the
development and maintenance of health-promoting behaviours is self-efficacy.
The specific intersection of illness perception, self-efficacy, and health behaviors in
women with PCOS remain unexplored. There is also a notable gap in research focusing on the
Indian context with respect to these factors. Therefore, this research aims to fill the gap by
exploring these factors among women with PCOS in India.
Objectives
1. To assess the illness perception of women with PCOS.
2. To assess the self-efficacy of women with PCOS.
3. To examine the relationship between illness perception and health behaviors (diet and
physical activity)
4. To examine the relationship between self-efficacy and health behaviors (diet and physical
activity)
5. To examine whether illness perception and self-efficacy influence health behaviors in
women with PCOS
Method
Participants
The study will adopt a correlational design and employ survey method by means of both
online and offline modes of data collection. The sample will be obtained through convenient
sampling. The sample will consist of about 200 participants. The participants will be considered
based on following inclusion and exclusion criteria:
Inclusion criteria:
-
Women diagnosed with PCOS
18 years or older
Exclusion criteria:
-
Women with other gynecological issues
Below 18 years
Instruments
A personal information sheet will be administered to the participants to obtain the sociodemographic details.
The Brief Illness Perception Questionnaire (B-IPQ), developed by Broadbent et al.
(2006), will be used to assess the illness perception of the participants. The B-IPQ has 9 items
developed to provide an assessment of the cognitive and emotional representations of illness.
The Self-Efficacy for Managing Chronic Disease 6-item Scale will be administered to
assess the self-efficacy of the participants. The scale contains items taken from several SE scales
developed for the Chronic Disease Self-Management study (Lorig et al., 1996).
To assess physical activity, The Short Questionnaire to Assess Health-enhancing physical
activity (SQUASH) developed by the Dutch National Institute of Public Health and the
Environment (Wendel-Vos, 2003) will be used. It has a total of 9 items that cover various
domains of physical activity.
To assess diet quality, The Diet Quality Questionnaire (DQQ) adapted to India will be
used. The DQQ is a standardized survey instrument developed by the Global Diet Quality
Project to assess diet quality by capturing dietary intake data across various food groups (Global
Diet Quality Project, n. d.)
Procedure
The study will be conducted after getting the approval from the Institutional Ethics
Committee (IEC) of the University of Hyderabad. Potential participants identified through
sampling will be chosen for the study and informed consent will be obtained. A rapport will be
established followed by which the personal details of the participants will be collected. The
participants will be informed about the purpose of the study, the questions they need to attend to
and the time required for the same. This will be followed by administering of the psychological
instruments.
Data analysis
Quantitative data will be analyzed using descriptive statistics, correlation, and regression
analysis.
Implications
This study will help in providing valuable insights into the psychological facilitators and
barriers to healthy behaviors among women with PCOS in India, given the limited literature on
this topic. The information obtained may also help in developing culturally sensitive
interventions that address these psychological factors.
References
AbuSabha, R., & Achterberg, C. (1997). Review of self-efficacy and locus of control for
nutrition- and health-related behavior. Journal of the American Dietetic
Association, 97(10), 1122–1132. https://doi.org/10.1016/S0002-8223(97)00273-3
Bharali, M. D., Rajendran, R., Goswami, J., Singal, K., & Rajendran, V. (2022). Prevalence of
Polycystic Ovarian Syndrome in India: A Systematic Review and MetaAnalysis. Cureus, 14(12), e32351. https://doi.org/10.7759/cureus.32351
Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The Brief Illness Perception
Questionnaire. Journal of Psychosomatic Research, 60(6), 631–637.
https://doi.org/10.1016/j.jpsychores.2005.10.020
Fossey, B., McCaffery, K. J., Cvejic, E., Jansen, J., & Copp, T. (2023). Understanding the
Relationship between Illness Perceptions and Health Behaviour among Women with
Polycystic Ovary Syndrome. International Journal of Environmental Research and
Public Health, 20(11), 5998. https://doi.org/10.3390/ijerph20115998
Global Diet Quality Project. (n.d.). https://www.dietquality.org/tools
Guo, Y., Liu, Y., Yan, X., Ding, R., Tan, H., & Wang, L. (2022). Factors affecting the adoption
of health-promoting behaviours in patients with polycystic ovary syndrome: a crosssectional study. BMJ Open, 12(3), e056478. https://doi.org/10.1136/bmjopen-2021056478
Leventhal, H., Brisette, L., & Leventhal, E. (2003). The Common-Sense Model of
SelfRegulation of Health and Illness. In L. Cameron & H. Leventhal (Eds.), The
SelfRegulation of Health and Illness Behavior (pp. 42-65). New York: Routledge
Lin, A. W., Dollahite, J. S., Sobal, J., & Lujan, M. E. (2017). Health-related knowledge, beliefs
and self-efficacy in women with polycystic ovary syndrome. Human Reproduction,
33(1), 91–100. https://doi.org/10.1093/humrep/dex351
Lorig, K., Stewart, A., Ritter, P., González, V., Laurent, D., & Lynch, J. (1996). Outcome
measures for health education and other health care interventions.
https://doi.org/10.4135/9781452232966
Ruehlman, L., Lanyon, R., Karoly, P. (1998) Multidimensional Health Profile Professional
Manual. Lutz, FL: Psychological Assessment Resources, Inc.
Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A.,
Norman, R. J., & Costello, M. F. (2011). Assessment and management of polycystic
ovary syndrome: summary of an evidence‐based guideline. The Medical Journal of
Australia, 195(S6). https://doi.org/10.5694/mja11.10915
Wendel-Vos, G. (2003). Reproducibility and relative validity of the short questionnaire to assess
health-enhancing physical activity. Journal of Clinical Epidemiology, 56(12), 1163–1169.
https://doi.org/10.1016/s0895-4356(03)00220-8
Yildiz, B. O., Knochenhauer, E. S., & Azziz, R. (2007). Impact of obesity on the risk for
polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 93(1),
162–168. https://doi.org/10.1210/jc.2007-1834
Informed consent
You are invited to participate in a research study being conducted by Lalhluzuali, a post-graduate
student at the Centre for Health Psychology, University of Hyderabad under the guidance of Dr.
G. Padmaja, Professor, Centre for Health Psychology, University of Hyderabad.
Title of the study: Role of illness perception and self-efficacy in shaping health behaviors in
women with Polycystic Ovary Syndrome
Purpose: The purpose of this study is to understand how illness perception and self-efficacy play
roles in the health behaviors of women with Polycystic Ovary Syndrome (PCOS)
Eligibility: To be eligible to participate, you need to be:
i. Diagnosed with PCOS
ii. 18 years or older
Procedure: If you agree to participate in this study, you will be asked to complete questionnaires
related to your illness perceptions, self-efficacy, and health behaviors. If you agree to participate
in the study, the investigator will provide the questionnaires and the entire process will be
completed in 15 to 20 minutes.
Risk and Benefits: There are minimal risks associated with this study. Some questions may
make you feel uncomfortable or emotional. You may skip any questions you do not wish to
answer. There are no direct benefits to you for participating in this study, but the information
gathered may help improve support and interventions for women with PCOS.
Confidentiality: Your privacy is very important. All information collected in this study will be
kept confidential and will only be used for the purposes of this research. Data will be stored
securely, and only the principal investigator and research team will have access to it. Your
identity will not be disclosed in any reports or publications resulting from this study.
Voluntary Participation: Participation in this study is entirely voluntary. You may choose to
withdraw from the study at any time without penalty.
Contact information: If you have any questions about this study or your rights as a participant,
you may contact:
Name of the investigator: Lalhluzuali
Email: 20ipmh09@uohyd.ac.in.
Demographic Sheet
1. Name (optional)
2. Age (in years)
3. Marital status
A. Single
B. Married
C. Separated/ divorced
D. Widowed
4. Education
A. 10th grade
B. Higher secondary (until 12th grade)
C. Bachelor’s degree or diploma
D. Master’s degree or higher
5. Height
6. Weight
7. Occupation
A. Employed
B. Unemployed
C. Student
D. Other
8. Received any education about PCOS?
A. Yes
B. No
9. Current symptoms
A. Polycystic ovaries on ultrasound
B. Weight gain
C. Irregular or absent menstrual cycles
D. Excess male pattern hair growth
E. Acne
F. Difficulty becoming pregnant
G. Hair loss or male pattern balding
H. Other
Brief Illness Perception Questionnaire (B-IPQ)
1. How much does your illness affect your life?
No affect at all
0
1
2
3
4
5
6
7
8
9
10
Severely affects my life
2. How long do you think your illness will continue?
A very short time 0
1
2
3
4
5
6
7
8
9
10
Forever
3. How much control do you feel you have over your illness?
Absolutely no control 0
1
2
3
4
5
6
7
8
9
10
Extreme amount of
control
4. How much do you think your treatment can help your illness?
Not at all
0
1
2
3
4
5
6
7
8
9
10 Extremely helpful
5. How much do you experience symptoms from your illness?
No symptoms at all 0
1
2
3
4
5
6
7
8
9
10
Many severe symptoms
5
6
7
8
9
10
Extremely concerned
6. How concerned are you about your illness?
Not at all concerned 0
1
2
3
4
7. How well do you feel you understand your illness?
Don’t understand at all 0
1
2
3
4
5
6
7
8
9
10
Understand very
clearly
8. How much does your illness affect you emotionally? (e.g. does it make you angry, scared,
upset or depressed?)
Not at all affected emotionally 0
emotionally
1
2
3
4
5
6
7
8
9
10
Extremely affected
PLEASE LIST IN RANK-ORDER THE THREE MOST IMPORTANT FACTORS THAT YOU
BELIEVE CAUSED YOUR ILLNESS.
The most important causes for me:
1.
2.
3.
Self-Efficacy for Managing Chronic Disease 6-item Scale
1. How confident do you feel that you can keep the fatigue caused by your disease from
interfering with the things you want to do?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
2. How confident do you feel that you can keep the physical discomfort or pain of your disease
from interfering with the things you want to do?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
3. How confident do you feel that you can keep the emotional distress caused by your disease
from interfering with the things you want to do?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
4. How confident do you feel that you can keep any other symptoms or health problems you have
from interfering with the things you want to do?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
5. How confident do you feel that you can the different tasks and activities needed to manage
your health condition so as to reduce your need to see a doctor?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
6. How confident do you feel that you can do things other than just taking medication to reduce
how much your illness affects your everyday life?
Not at all confident 0
1
2
3
4
5
6
7
8
9
10
Totally confident
The Short Questionnaire to Assess Health-enhancing physical activity (SQUASH)
Diet Quality Questionnaire (DQQ)
1.
2.1
2.2.
3.
4.
5.
6.1
7.1
7.2
7.3
8.
9.
10.1
10.2
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Yesterday, did you eat any of the following foods:
Rice, idli, dosa, poha, naan, kulcha, paratha, or upma?
Chapati, roti, dalia, or roasted maize?
Pearl millet or finger millet?
Potato, sweet potato, turnip, arum root, tapioca, or raw banana?
Daal, sambar, chickpeas, kidney beans, soya, or khichdi?
Yesterday, did you eat any of the following vegetables:
Carrots, or pumpkin that is orange inside?
Mustard leaves, spinach, radish leaves, cassava leaves, taro leaves,
drumstick leaves, amaranth leaves, or wild greens/other greens?
Tomatoes, eggplant, okra/lady finger, French beans, cauliflower, cabbage,
or beetroot?
Bitter gourd, bottle gourd, pointed gourd, ivy gourd, apple gourd, ridged
gourd, or snake gourd?
Cucumber, radish, capsicum, German turnip, or drumstick?
Yesterday, did you eat any of the following fruits:
Papaya, mango, orange musk melon, or apricots?
Orange, tangerine, or grapefruit?
Ripe banana, apple, pear, watermelon, guava, custard apple, pomegranate,
or pineapple?
Grapes, kiwi, peaches, jackfruit, chickoo, jamun, palmyra palm fruit, or
other wild fruits?
Yesterday, did you eat any of the following sweets:
Cakes, cream biscuits, biscuits, suji halwa / kesari bath, jalebi, or ladoo?
Other mithai, rice pudding, kulfi, ice cream, milkshake, toffees, or
chocolates?
Yesterday, did you eat any of the following foods of animal origin:
Eggs?
Paneer or cheese?
Curd, lassi, buttermilk, or raita?
Sausages or salami?
Mutton, beef, lamb, or liver?
Pork or wild meat?
Chicken, duck, or turkey?
Fish, prawn, crab, or seafood?
Yesterday, did you eat any of the following other foods:
Peanuts, cashews, almonds, pistachios, walnuts, pumpkin seeds, or
sunflower seeds?
Potato chips, namkeen or mixture?
Instant noodles such as Maggi noodles or Wai Wai?
Samosa, pakora, puri, vada, mathri, kachori, murukku, or bonda?
Yesterday, did you have any of the following beverages:
Milk, flavoured milk, chai with milk, or coffee with milk?
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
YES or NO
26.
27.
28.
29.
Tea with sugar, coffee with sugar, milk with sugar, flavoured milk,
Bournevita, Horlicks, or Boost?
Fruit juice, packet juice such as Rasna or Frooti, sugarcane juice, or
nannari sarbath?
Soft drinks such as Sprite, Pepsi, Mirinda, or energy drinks?
Yesterday, did you get food from any place like...
McDonald's, KFC, Pizza Hut, Domino's, Burger King, or other places that
serve pizza or burgers?
YES or NO
YES or NO
YES or NO
YES or NO