Deconstructing Illness Threat Perception as a Predictor of Resilience in Adults with Sickle Cell Disease
Danielle OngondoAbstract
Background
Sickle Cell Disease (SCD) is a chronic, inherited condition characterized by severe pain crises, significant physical morbidity, and systemic healthcare disparities. Nurses play a critical role in chronic disease management for this population across community, primary, and acute care settings. However, individuals with SCD often feel stigmatized by nursing staff, affecting trust, engagement in care, and mental well-being. The primary objective of this analysis was to examine how cognitive illness threat perception impacts resilience among adults with SCD, and to evaluate how frontline provider communication and pain episode frequency shape this perception.
Methods
A secondary data analysis was performed utilizing a cross-sectional study design with data derived from the NIH INSIGHTS study. The analysis sample comprised 266 adults diagnosed with SCD. Resilience was assessed using the Brief Resilience Scale (BRS), while illness perception was evaluated via the Brief Illness Perception Questionnaire (B-IPQ). For analytical purposes, illness perception was examined both as a continuous variable and as a dichotomous categorical variable, distinguishing between High Illness Threat Perception and Low/Moderate Illness Threat Perception. Additional variables included self-reported frequency of pain episodes over the preceding year, classified as 0, 1, 2, 3, or 4+ crises, along with the quality of communication with the doctor or nurse, with “Always” indicating consistent positive communication and “Other” indicating inconsistent quality of provider communication. Data analysis was conducted using SPSS and included linear regression, independent-samples t-tests, Chi-square tests for independence, one-way ANOVA, and binary logistic regression.
Results
Among the 266 participants with gender data, 147 were women (55.3%), and 119 were men (44.7%). An independent samples t-test revealed no significant difference in continuous illness perception scores between women (M = 44.95) and men (M = 45.03), p = .954. Furthermore, a Chi-square test of independence confirmed no significant association between gender and high illness threat perception (p = .652), indicating that illness threat perception is experienced similarly across genders in this population. Linear regression indicated that illness perception is a significant negative predictor of resilience (p < .001). Illness perception accounted for 14.6% of the variance in resilience scores (R2 = .146). As illness perception scores increased, resilience significantly decreased (B = -.025, p < .001). A one-way ANOVA demonstrated a significant impact of pain frequency on illness perception scores (p < .001). Post hoc analyses indicated that individuals who endured four or more pain crises in the previous year (M = 48.72) exhibited markedly higher illness perception scores than those with no crises (M = 39.70) or a single crisis (M = 39.08). A logistic regression analysis (p < .001) found that experiencing four or more crises increased the likelihood of possessing a High Illness Threat Perception by 3.86 times (p = .009). Conversely, individuals who consistently reported effective communication with the doctor or nurse had approximately 68% lower odds of exhibiting High Illness Threat Perception than those with inconsistent communication with the doctor or nurse (p = .001).
Conclusions
The findings demonstrate that the perception of illness threat is a critical and modifiable barrier to resilience among adults with SCD, irrespective of gender. Recurrent pain crises significantly intensify the perception of the disease as an uncontrollable threat. However, consistent and high-quality communication from healthcare providers functions as an essential protective factor, markedly reducing high threat perception. These findings bear substantial implications for the treatment and management of the SCD population. Clinical nursing practice must shift from reactive, episodic pain management to proactive, resilience-focused interventions that address the daily management of physical limitations and coping strategies. Furthermore, incorporating the Communication Theory of Resilience (CTR) into nursing education can profoundly enhance patient assessments. By training nurses to utilize communication strategies that affirm identity anchors and reframe illness narratives, nurses can directly lower a patient’s perceived illness threat, acknowledge systemic inequities, and foster long-term resilience.