If my cholesterol is…then I foresee…: patient accounts of uncertainty

The author examines the talk of patients with high cholesterol as they discuss their experiences of adding a statin to their treatment regimen. The primary objective was to understand patients’ expectations of statins, and their beliefs and feelings as they continued or discontinued use, and to better understand why adherence to a statin regimen is particularly low. While numerous studies report reasons for nonadherence, few apply theory to provide plausible explanations. Analysis of the focus group data revealed three major themes. First, patients do not view high cholesterol as serious in light of other major health problems like diabetes and cancer within the household. Second, patients believe statins are effective in lowering cholesterol but risky. Third, many patients do not understand how high levels of cholesterol are produced in the body and how statins interrupt that process. Problematic integration theory is used to explain the uncertainty patients experience when given a diagnosis of high cholesterol, the use of statins to control it, and the quality of information received about both cholesterol and statins.

Families and Uncertainty: Using Problematic Integration Theory in Transition Services

Families of young adults with intellectual disabilities face a number of uncertainties when they leave secondary settings and begin the transition to adult life. Services may be inconsistent, resources unavailable, and options for independent living and employment severely limited. Research indicates that many families experience fear, frustration, and disappointment as part of this process, and many also believe helping professionals are unequipped to assist them. Drawing from the field of interpersonal communication, Austin Babrow's Problematic Integration Theory posits that both information and the ability to process feelings and fears can be helpful to families facing uncertain futures with their children. This article suggests rehabilitation counselors may be better able to assist families if they encourage open discussion of their fears and uncertainties as part of transition and adult service planning.

Reaching Acceptance

Health-care decisions at the latter end of the lifespan are meaningful communicative experiences that can have important consequences for the health and well being of older adults. Using problematic integration theory as a guiding framework, I examined patterns of communication involved with the personal health-care decisions of older adults. I conducted interviews with sixty-two older adults in the process of considering a major health-care decision. Thematic analysis revealed that as older adults attempted to integrate and make sense of incongruent information related to their health-care decisions, interactions with physicians, adult children, spouses, and friends were influential. Additionally, overcoming avoidance, managing uncertainty, and reaching acceptance emerged in the health-care decision experiences of older adults in ways meaningful for problematic integration.