Healthily Psyched at Guy's

King's College London Health Psychology blog

Month: October 2017

From MSc to PhD: question and answer session with Healthily Psyched PhD students

Pippa and Louise blog photoPippa and Louise graduated from the Health Psychology MSc in 2016 and are currently enrolled as PhD students in faculties at King’s College London. Louise is based at the Faculty of Nursing, Midwifery and Palliative Care researching chronic pain in inflammatory bowel disease. Pippa is based at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) investigating infant feeding practices among women who deliver large-for-gestational-age (LGA) infants. Together, we have teamed up to answer some of the frequently asked questions about making the jump from MSc to PhD, how we got here, and offer some friendly (and hopefully, helpful) advice for anyone interested in or about to make the transition.

1. Did you always know you wanted to do a PhD?
Definitely not! During my undergraduate degree (BSc Psychology) my academic supervisor strongly recommended I apply to do a PhD and I just remember thinking “that’s definitely not me”. She must have seen something I couldn’t see at the time, because fast-forward three years and somehow it is me.

I started coming round to the idea of doing a PhD during the MSc – the course offered the opportunity to tailor quite a few of the assignments to fields of research we were interested in, and I had started to explore pregnancy health and breastfeeding. The more I read about the topic, the more interested I became and I found myself wanting to know more. For as long as I can remember I have been fascinated with pregnancy health, but I never considered the idea that I could have a career based on exploring it.

Completing a PhD is not essential to becoming a fully qualified Health Psychologist (more on ‘Routes into Health Psychology’ later), but it provides the opportunity to carry out in-depth, original research into a topic or specialty subject that you find particularly interesting. The MSc allowed me to find a research area I was really interested in and one that I knew I wanted to pursue further, but I didn’t feel like I had enough research experience to start a PhD straightaway. When I graduated I began looking for Research Assistant (RA) posts on projects related to breastfeeding and pregnancy health and was lucky enough to be offered an RA job on a project investigating ways to empower healthcare professionals to provide tailored breastfeeding support. Throughout my role I was able to develop my research skills in the area and simultaneously conceptualise the idea for my PhD to put forward for funding.

Louise: Not at all. Throughout my undergraduate and master’s degree I was really interested in the subject areas but knew in the long term I wanted have a clinical role, working face-to-face with people and amongst a team. During the MSc I took up a number of both paid and volunteering opportunities to gain experience and expand my skillset and network of contacts. These opportunities included being a student representative for the course and a couple of research assistant (RA) positions. The RA positions in particular allowed me to work closely with PhD students and gain a real insight into the day to day life of doing a PhD. It was then that I began to realise some of real advantages and interesting challenges of a PhD. Particularly in a Health Psychology-related subject, a PhD seemed to involve obviously extensive research and project management but also collaborative work with patients and healthcare staff, as well as other academics in decision-making. Although you focus on a specific subject area for a PhD, I realised that throughout the 3 years you take on a variety of tasks, from recruiting and interviewing patients, applying for ethics, going to conferences (sometimes abroad!) and writing up and critiquing papers. I also knew that even though I wanted to end up long-term in a clinical role, a PhD is a great opportunity to challenge yourself and widen your skillset for whatever career you go on to do thereafter.

2. How did you go about trying to find a PhD?
Pippa:  There are a number of options available for finding a PhD project to suit you and your circumstances (Funded vs. Unfunded (Self-funded) / Part-time vs. Full-time / Established project vs. Self-constructed project) and lots of different ways of sourcing such opportunities. When I had settled on the idea that I wanted to complete a PhD in pregnancy-related health and breastfeeding, I initially started looking for projects that had already been funded and were open to applications. I signed up to and and got daily and weekly updates on projects available. There were plenty of great opportunities being advertised and lots I could have applied for, but as time went on I realised none of them really hit the nail on the head in terms of what it was I wanted to investigate. So, I then started looking into applying for funding for my own research project. I had been told this was going to be a little more difficult than signing up to established projects, but I had taken the approach that I wasn’t going to sign up to a project I didn’t want to do 110%. I looked for PhD Studentships/Scholarships through Research Councils (Medical Research Council (MRC), Economic and Social Research Council (ESRC)), The Wellcome Trust, and various other charities focused on pregnancy and neonatal health. I eventually put forward for two pieces of funding from different organisations.

Coming up with my own idea for the PhD took time because it meant I had to establish a good understanding of the current literature in the area to justify the objectives of my research. When I had a stable idea of what I wanted to do, I started looking for academic supervisors whose area of expertise were aligned with my own interests. I approached people I thought would be interested to discuss my academic ambitions and to ask whether they would be interested in supervising the project going forward. Throughout the process of developing the research project, I also contacted multiple professionals in both academic and clinical settings to discuss the project and ask whether they had any advice or recommendations about the idea. Looking back, this was crucial to ensure that the research I was proposing to funders was justified academically and relevant to current healthcare initiatives. Finding relevant and feasible funding opportunities took time and patience but I’m glad I did it.

Louise: Similarly to Pippa, I also signed up and to receive weekly updates on any PhD roles. But I also approached my supervisors and a couple of lecturers on the course to discuss that I was increasingly interested in doing a PhD. Some of the time, these individuals will know of PhD opportunities in the pipeline, so if you voice your interest (particularly to supervisors who you can see yourself working well with) then it gives them the opportunity to think of you when they come available.

That is how I eventually got my PhD. My MSc thesis supervisor informed me of an opportunity that was going to be available (and shortly advertised on these PhD career websites) for a PhD on chronic pain in inflammatory bowel disease. Applying for the PhD felt very much like any other job opportunity; I applied (by both emailing the supervisors personally and formally online), provided a cover letter and then went for an interview where I had to give a short presentation. I was fortunate enough that I didn’t have to apply for my own funding, as all of the funding and arrangements had already been put in place.

Look out for more on ‘Tips on applying for PhD funding’ in our follow-up blog post next year!

3. Do you have to be passionate about a particular subject to do a PhD on it?
This is a tough one – yes and no. Throughout the year of the MSc there were particular things I was more interested in, so I had a general idea of the sorts of topics I wanted to do a PhD on. There were also some particular long term conditions I was more interested in, and felt more passionately about making a difference in. But at the same time, I also felt quite flexible, and knew that as long as the PhD project involved having an impact on patient care, and/or working with healthcare professionals, I didn’t mind.

I have always thought the ‘go with your initial gut instinct’ is fairly reliable. But when I was informed of the PhD on chronic pain in inflammatory bowel disease (IBD), I had mixed feelings. I had always been really interested in the area of pain and psychological influences on pain, but I had no clinical experience in pain and hardly any knowledge of IBD. But after some research both into the PhD and the specific condition of IBD, it felt like a really interesting project. I am now over a year into the PhD, and find IBD a really fascinating and complex long term condition. I still have lots to learn!

Pippa: I agree with Louise – this is a tricky one. When I was looking for opportunities I was told countless times “Don’t do something you’re not 100% interested in – it will be difficult, so you want something you’re really passionate about”.

Because I have always been naturally interested in pregnancy and neonatal health, I never had a difficult decision of what area to study. But it wasn’t just the topic or research question that was important. There were plenty of projects advertised investigating infant feeding and pregnancy-health that I didn’t want to apply for. Just because I am passionate about the topic, didn’t mean I was willing to investigate anything in the field. I signed up to do the PhD I’m doing because it is in the right location; in an institution that has a strong reputation for empirical research in my academic area of interest (Health Psychology in the context of Midwifery and Women’s Health); means I have two incredibly supportive and expert supervisors; access to academic and clinical collaborations among KCL institutes and allied health partners; and that my project investigates the bigger picture of how to improve perinatal support for women.

While I think it’s helpful to be passionate about a topic, you don’t need to be infatuated with an idea. When you find the right opportunity, you know when you know it’s the right one.

4. What’s the jump like from MSc to PhD academically?
I think we’ve been quite lucky in that the MSc programme we completed was able to provide us with fundamental academic skills needed to undertake a PhD. A lot of the training we completed as part of the MSc has been crucial to the tasks I have completed in the first 6-months of my studies: Protocol writing, conducting a systematic review, critical appraisal of evidence, synthesizing and summarising existing literature, submitting ethics applications. I think it becomes slightly more challenging in the jump from MSc to PhD research when you’re transferring research fields, moving across disciplines, or having to move country to pursue your studies. Knowing what kind of support the University offers has been helpful to know where to go for support and information i.e. Library services, academic skills training courses, seminars and induction sessions.

One of the biggest adjustments I’ve come to terms with is that time is very much your own. Unlike a taught postgraduate programme, there isn’t a stream of (seemingly) endless short-term deadlines that organise when to prioritise your work for you – you have to create the deadlines and priorities yourself. This also means that instead of work being sequential (e.g. do the essay due first and hand it in before starting on the next one) you have to juggle multiple pieces of work all at once and divide your time in your day/week/month accordingly. This might come easy to some, but I’ve found it quite difficult to be continuously switching between pieces of work throughout the day/week. Breaking my ‘To Do’ lists down into the smallest possible components has really helped with staying on top of things on a week-to-week basis!

Louise: I agree with Pippa, it has been a huge advantage for me coming straight from the MSc. A lot of my PhD colleagues in my office in the Nursing and Midwifery department have either had quite a few years out of academia or their previous degrees where in a completely different subject. A lot of the assignments that you do for the MSc are the same for a PhD, such as a systematic review, study planning and recruitment, and writing up a research paper and working on feedback. Moreover, the fact that you do both quantitative and qualitative courses in the MSc really sets you up for your PhD; you go in with some level of confidence about analysing and presenting research data (again, a lot of my colleagues felt quite worried about this).

The main jump for me however, is that the quality of your writing and how you are presenting your research data has to be at a higher standard. Ultimately, you are generating new and interesting findings that your supervisors will want you to share with the academic world! Whether this is in poster presentations for conferences or submitting papers for publications to highly cited academic journals. This is a little bit daunting, because you need to be thorough and professional with your research conduct and presentation of findings. However, if you have a good set of supervisors who support you and give you good feedback with your writing, then this jump is manageable.

5. What are the biggest challenges moving from MSc to PhD?
Pippa: Your PhD will be a marathon, not a sprint. Having long-term goals to work towards (e.g. Write thesis) can easily become overwhelming, and you can sometimes feel like you’ve not achieved very much over time. I’ve found having specific, individual aims and objectives for the week/month that I can tick off as I go along really encouraging – especially on an ‘off’ day when I look back and can see a list of things I’ve already done!

A PhD is a form of academic training; it’s very individual and can involve a lot of lone working. Because you don’t always have someone there to get answers from (like a programme leader or module supervisor in an MSc), you have to learn to be confident in decision making about your work. What do I work on now? Are my search terms okay? What measures should I use? Is this questionnaire helpful? Your supervisors will be there to guide you in the right direction on your decisions and offer expert advice, but a lot of the time there’s not a ‘right’ or ‘wrong’ answer so it’s ultimately your decision. Having such a high degree of autonomy over your work is great – it just takes a little time to get used to!

Louise: I also agree with Pippa. A PhD involves a lot of planning and decision-making, and ultimately you will be the one who has to decide. For example, when you are critiquing models or deciding on suitable questionnaires, you have to develop your own way of thinking and be confident in your decisions. In the world of academia you are surrounded by influential people with strong opinions, and it’s important to learn how to reach a decision with your supervisors. Sometimes I felt like the more reading and research I did the more confused I got when making decisions, because I would read more and more stances on a particular viewpoint and lose track. In this process, it’s fundamental that you can back up your decisions with evidence – what does the research on the whole tell you? If someone challenged you on your decision, how would you back yourself up? Think ahead to those pesky examiners in your Viva and how you would justify yourself.

Another obvious answer to this question, but it’s important to say it anyway, is time management. Although you have a main task to carry out for your PhD, throughout your PhD you will also be exposed to a wide number of opportunities, whether it’s teaching, collaborative work or service development. A PhD is great at allowing you to build up your CV but it’s important to remember to distribute your time effectively, so that you are getting your work done effectively whilst taking up opportunities.

6. What does your day-to-day look like?
Louise: As the tasks throughout your PhD vary so much, your day-to-day can vary considerably depending on what stage you are at. For example, in the depths of recruitment, you may not see your desk for a few days at a time, if you are going into hospital sites or arranging meetings with the clinical team. However for the majority of the time, I am working at my desk in a big postgraduate office. I treat my PhD very much like a working job, working Monday-Friday unless the volume of work means I need to do the odd weekend here and there. I seldom work at home, and really enjoy sitting amongst other PhD students who will frequently be able to answer your questions if you are struggling with an ethics query for example.

Once a week I will attend an MDT meeting at the hospital near my office, as this allows me to keep a relationship with the clinical team and listen to discussion of interesting patients cases on complex medication regimes. During recruitment periods, this meeting also gives you the opportunity to locate any suitable participants. I also do a bit of teaching when I can during my PhD. I teach as a TA on a statistics course which I do weekly in the autumn term, and occasionally do blocks of weekly teaching throughout the year in a secondary school (as part of a charity scheme), where I teach my research to high-achieving students in deprived schools.

Doing a PhD forces you to be organised, so I find it helpful writing a list at the beginning of the week and keep a physical diary to have everything down that I am doing. Although no one is keeping tabs on you to clock out at the end of the day, being able to tick off your lists of tasks gives you a structured way to carry out our day and ensures you don’t fall behind on anything.

Pippa: I come into the office every day Monday – Friday because I find it almost impossible to work from home. I also work more efficiently later in the day, so tend to come in and leave a little later than the rush hours.  Usually I have three or four tasks for the day that I aim to tick off and start with the one that will take the most time, leaving smaller tasks or ones that require less brainpower (like collecting search results from systematic review searches) for the afternoon. I save tasks that need the most brainpower until my optimal ‘thinking’ hours and if I’m in flow I tend to run with it until my brain/body tell me it’s time to lock up and go home! At the moment I’m working on two systematic reviews, a protocol for a cohort study and writing a background chapter justifying why I’ve included the measures I have included. I am also part of a parent support group and a local neonatal unit which I attend one lunch time a week, and attend monthly family support MDT meetings there. In the lead up to setting up my cohort study I have also had the opportunity to attend an antenatal clinic specifically for women with diabetes. Observing clinicians in the clinic has given me insight into the feasibility of recruiting women for the study and (hopefully) means I will be prepared for any challenges that lie ahead.

Our ‘Ten Top Tips’:
1. Network– when getting a PhD idea together, starting on a project, or putting a study together, use all the resources available to you to discuss your ideas and ambitions and get feedback from professionals in the area.  Ask them what they think, if they have any recommendations, and if they’d like to be involved moving forward.

2. Your supervisor(s) are key – Making sure you have good mutual expectations and a clear and open dialogue will mean you are able to get the support you need academically.

3. Treat it like a ‘9-5’ – Although you might still be referred to as a ‘Student’, for all intents and purposes your PhD is your full-time job so make sure to treat it like one. Find your optimal working hours, if you’re an early bird or night owl, and try to set your work around that but still be available during normal work hours.

4. Don’t compare yourself! – Every PhD is unique and every student has a different style of working, so comparing yourself to other PhD students around you isn’t going to be helpful a lot of the time. There isn’t a set structure or timeframe of tasks to adhere to so as long as you’re meeting the targets you have set, you’re doing okay!

5. Don’t be afraid to ask for help – Colleagues, Post-docs, former PhD students, academic support staff, PhD students ahead of you, supervisors, Institutional support (e.g. Library services, counselling services). They all want to see you succeed and are happy to help at every step along the way. Better to reach out earlier than wait until it’s all on top of you.

6. Break down your to-do lists – Having smaller achievable goals for your day or week will really help to organise your work and keep you moving forward. Being able to look back at last month and seeing all the things you achieved will also help keep up your motivation!

7. Support network – Having a good support network both personally and academically is crucial. There will be highs and lows so making sure you have people to celebrate with and pick you up is important.

8. Make the most of your time – Spend some time seek out other opportunities relevant to your work that can help you build up helpful skills. This could include teaching opportunities, volunteering positions in clinics or even getting involved in student representative boards at King’s.

9. Be confident with your decision making! Being surrounded by so many academics and other PhD students – it’s hard to know which is the correct way of doing things. As long as you have done your research and have a good argument to back up your decision-making, go with it and be confident with your supervisors. They won’t want you to rely on them.

10. Enjoy the ride! Sometimes it can feel a bit daunting having such a large amount to accomplish when you are mindful that you have limited time. But enjoy each stage and the new skills you are learning.


This post was written by Louise Sweeney and Pippa Davie who are PhD students at King’s College London. You can find out more about their research here. We hope you’ve enjoyed this article and that we’ve left you healthily psyched for more.

Modifying measures: How to get the most out of your questionnaires for your PhD. An example using the Revised Illness Perception Questionnaire (IPQ-R).

A key stage to writing your PhD proposal, after coming up with your main research questions and hypotheses, is deciding how exactly you’re going to measure these factors. It may seem like the obvious choice is to pick the most widely used, validated questionnaire, but it’s important to spend some time considering whether that questionnaire will be relevant to your population, able to capture the unique experiences of your patient-group, and whether it fits in with the wider theory. Using a pre-validated generic questionnaire can save time but may lead to important idiosyncratic experiences of your target population being missed.

In this article, we briefly describe how we modified the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002) in two different patient populations: 1) patients with atrial fibrillation (AF), an irregular heart rhythm predisposing patients to a five-fold increased risk of stroke (Taylor, O’Neill, Hughes & Moss-Morris, 2017) and breast-cancer survivors (BCS; Moon, Moss-Morris, Hunter & Hughes, 2017), who have completed active treatment for breast cancer but who may require continued therapy and monitoring.

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A brief background of the questionnaire

The IPQ-R measures patients’ cognitive representations of illness (illness representations) which are developed based on abstract (disease labels) and concrete (symptom-based) information sources. Illness representations consist of a number of different components including: identity (symptoms association with the illness), causes, consequences, timeline (acute, chronic or cyclic), controllability (treatment control/cure and personal control of illness) and illness coherence (whether the illness makes sense) (Moss-Morris et al., 2002). Emotional representations about illness (e.g. fear) are processed alongside these cognitive representations (Moss-Morris et al., 2002). Cognitive and emotional representations of illness can be understood within the context of the Common Sense Model (CSM; Leventhal, Meyer & Nerenz, 1980) which proposes that patients’ cognitive and emotional representations of illness guide coping behaviours, quality of life (QoL) and clinical outcomes, as supported by a wide range of research (Hagger, Koch, Chatzisarantis & Orbell, 2017). Whilst the scale was developed as a generic measure to assess illness representations across conditions, the authors recommend that it is modified to suit the specific needs of each illness population (Moss-Morris et al., 2002).

Step 1: Qualitative interviews

To understand the target population, we carried out interviews with our patient groups. Questions specifically related to components of the IPQ-R, outlined above. For instance, the following question related to the personal control component; ‘Is there anything you can do to control/prevent the risk of recurrence?’. Transcripts were analysed using deductive thematic analysis and key themes were identified which informed the modification of the IPQ-R.

In the AF study 30 participants were interviewed with a range of demographic characteristics including different treatment types and pre/post treatment status.  Key themes included unpredictability of AF and a struggle to gain control of symptoms. Patients reported engaging in targeted behaviours such as avoidance to try to control symptoms. Patients also believed certain events or behaviours could trigger AF symptoms. Patients expressed different concerns relating to treatment-type. (For separate qualitative study see Taylor, O’Neill, Hughes, Carroll & Moss-Morris, 2017).

In BCS, 18 women prescribed tamoxifen were interviewed about their perceptions of cancer and suvivorship. A key theme was that the majority of patients did not identify as currently having breast cancer. Instead, when asked about control, consequences and causes, patients tended to discuss their risk of recurrence. Patients attributed symptoms to tamoxifen, an adjuvant treatment, rather than to their breast cancer. Specific causes of recurrence and symptoms were also elicited during the interviews.

Step 2: Modification of questionnaire

Interviews led to questionnaire modification through 1) retention of items, 2) minor revisions 3) development of new items.

Examples of minor revisions included wording changes such as replacing ‘my illness’ with ‘my AF/BCS’ and inclusion of population-specific symptoms onto the identity scale. For instance, in AF patients this included items such as heart palpitations and in BCS this included items such as hot flushes and night sweats.

Development of new items in AF patients related to the unpredictability theme. Three new items related to personal control behaviours (slowing down and avoidance): ‘Avoiding certain activities will control my AF’, ‘Resting will prevent me from having symptoms’, ‘By doing less and slowing down I can control whether I have AF symptoms’. In addition, AF patients seldom mentioned the original cause of AF but reported triggering AF symptoms instead. This led to changing the causes scale into a triggers scale to reflect factors which patients believed triggered AF. Due to different treatments, the treatment control component was re-worded to relate to pharmacological (antiarrhythmic and anticoagulant) and procedural (cardioversion, catheter ablation and AV-node ablation) treatments.

The modification of items in BCS focussed mainly on replacing references to ‘my breast cancer’ with ‘risk of recurrence’. For example, treatment control items were modified to assess the extent to which patients felt their treatment could reduce their risk of recurrence. The timeline scales were amended to reflect the fact that patients did not have symptoms which come and go, and instead are at increased risk of a recurrence. The identity scale was modified to identify symptoms attributed to tamoxifen as well as breast cancer.

Step 3: Think-aloud

Think aloud techniques enable the researcher to establish whether items on the questionnaire are interpreted as intended (i.e. face validity). In our studies, a small subset of patients were given the modified questionnaire and asked to read each item aloud during telephone interviews and to verbalise their thought process on how they would answer questions (Ericsson & Simon, 1998).

Changes were made in both studies to improve the clarity of questions. For instance, in BCS items were revised to improve applicability of questions to all participants. Some items were deleted where possible to reduce repetitiveness. In AF patients, some items were expanded upon to provide further context and improve interpretation.

Step 4: Factor analysis

Confirmatory factor analysis (CFA) is used when testing a hypothesised model and to ensure the original factor structure is still relevant for the modified questionnaire. Exploratory factor analysis (EFA) may be used when more significant changes have been made to the questionnaire and when the factor-structure is not pre-specified. Both analyses were used in Moon et al. (2017) and Taylor et al. (2017).

In both studies a CFA was conducted in MPlus (version 7) on the main scale of the IPQ-R (i.e. timeline (chronic/cyclic), consequences, control (personal and treatment), illness coherence, emotional representations). Items were specified to load on these hypothesised components using syntax to test model fit. It is recommended that CFA is run with at least 200 participants (Brown, 2015). While there are various methods of assessing model fit, both studies used Comparative Fit Index (CFI), Tucker Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA), as recommended by Jackson, Gillaspy & Purc-Stephenson (2009). RMSEA values of less than 0.08 indicate reasonable fit and CFI/TLI values of greater than 0.95 suggest acceptable model fit (Hu & Bentler, 1999). For further useful instructions on conducting CFA see Brown (2014).

EFA was conducted on the causal attribution scale in both studies, as recommended by Moss-Morris et al. (2002) and because substantial changes were made to both this scale in both studies. In AF patients, Taylor et al (2017) conducted the EFA in SPSS (V22) using maximum-likelihood extraction and oblique rotation as factors were expected to correlate. For a useful paper on conducting EFA in SPSS see Yong & Pearce (2013). In BCS, Moon et al. (2017) used SPSS with R-menu for ordinal factor analysis based on polychoric correlations, which has shown some benefits over using SPSS alone (Basto & Pereira, 2012). Preliminary interpretation of the data should examine any ceiling effects, which can be tested by examining/removing item frequencies in which >80% of participants disagreed with any specified items. You should also examine whether there is a patterned relationship amongst variables to see if any items should initially be removed. Kaiser-Meyer-Olkin Measure (KMO) of >0.50 will also indicate that the data is suitable for an EFA. The number of factors to be extracted are indicated by using Kaiser’s criterion (eigenvalues of 1.0 cut-off), visual inspection of scree plots or parallel analysis. Items which do not load onto any factors or cross-load onto multiple factors can be removed. Factors should be labelled based on the items contained. For example, in the EFA for AF patients, a factor was labelled as ‘emotional triggers’ which contained items related to stress, mental attitude and emotional state.

Step 5: Testing the psychometric properties of the modified questionnaire

Internal reliability measures how well a set of items measure a particular concept. High internal reliability suggests that all items are measuring the same concept. Cronbach’s alpha can be examined using SPSS. Acceptable alpha values range from 0.70 to 0.95, with 0.95 indicating excellent reliability, (Tavakol & Dennick, 2011) and values higher than this indicating redundancy across items

Test-retest validity examines whether patients’ responses are consistent over time, and the stability of the questionnaire. Participants were asked to complete the questionnaire at baseline and at two-weeks. Intra-class correlations (ICC) can vary between 0 and 1.0 whereby 1 indicates perfect reliability. To examine any potential outliers, Bland-Altman plots can be used (Bland & Altman, 1986).

Construct validity examines the extent to which a test measures what it claims to be measuring, and can be tested by looking at the relationships between the subscales of the modified questionnaire and other theoretically-related questionnaires. Correlations range from 0 to 1.0, with scores closer to 1.0 indicating high correlation.

In the AF study, the modified IPQ-R was examined with a measure of treatment beliefs; the Beliefs about Medicines Questionnaire (BMQ, Horne, Weinman & Hankin, 1999), and an AF-specific QoL measure (AFEQT; Spertus et al., 2010). The BCS study examined the modified IPQ-R with the BMQ and Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983).


This blog post by Elaina Taylor and Zoe Moon has outlined how we modified and validated the IPQ-R specific to the patient populations we are studying. If you have any questions, please feel free to get in contact with us via the Healthily Psyched blog page. You can also check out the papers that we’ve written on this topic which are linked up to our profiles. In the meantime, we hope we’ve left you healthily psyched for more.



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Brown, T.A. (2014). Confirmatory factor analysis for applied research. New York: Guilford Publications.

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Moon, Z., Moss-Morris, R., Hunter, M.S., & Hughes, L. D. (2017). Measuring illness representations in breast cancer survivors (BCS) prescribed tamoxifen: Modification and validation of the Revised Illness Perceptions Questionnaire (IPQ-BCS). Psychology & Health, 1, 1-20.

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Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds. M. R., …& Burk, C. (2010). Development and validation of the atrial fibrillation effect on quality-of-life (AFEQT) questionnaire in patients with atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 10(5),15-25.

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Taylor, E. C., O’Neill, M., Hughes, L. D., Carroll, S., & Moss-Morris, R. (2017). ‘It’s like a frog leaping about in your chest’: Illness and treatment perceptions of patients with persistent atrial fibrillation. British Journal of Health Psychology, 22, 1-19.

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