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Personal Growth Initiative and Search for Meaning in Life: Moderate Illness Perception and Chronic Illness Coping.

Marlena M. Kossakowska, Ph.D. Department of Clinical and Health Psychology, SWPS University of Social Sciences and Humanities, Sopot, Poland

Corresponding author: Dr. Marlena M. Kossakowska, Department of Clinical and Health Psychology, SWPS University of Social Sciences and Humanities, Sopot, Poland: marlenakossakowska@gmail.com

The aim of this study was the verification of the theoretical Model of Personal Growth in Chronic Illness (MPGCI). The model was inspired by the two following theoretical approaches: 1) the Leventhal’s Common Sense Model (Leventhal et al., 2003) and 2) Park and Folkman’s Meaning Making Model (1997; Park, 2006, 2010). The first theory assumes that illness perceptions determine the behavior of chronically ill people in coping with their disease. The second one pays attention to the meaning-making process in dealing with chronic disease. MPGCI assumes that all the efforts, which are undertaken by people who suffer from a chronic condition, may lead to positive outcomes, which is referred to as personal growth.

Personal growth, in terms of Carol Ryff’s theoretical approach of well-being, is a sense of continued growth and development as a person (Ryff & Keyes, 1995). In the following research, personal growth includes hedonic and eudaimonic aspects of well-being as the signs of: high self-esteem, meaningful life, positive emotions, and benefit-finding / benefit-reminding from going through a disease.

The Model of Personal Growth in Chronic Illness also contains two moderators: Personal Growth Initiative (PGI) (Robitschek et al., 2012) and search for meaning in life (Steger et al., 2006), which interact with each other. The PGI is defined as the intentional engagement in the process of personal growth. PGI encompasses the cognitive components of self-efficacy, including beliefs, attitudes, and values that support personal growth (Robitschek, 1998). It includes behavioral components that involve implementing these cognitions across growth domains. In other words, the behavioral components put into practice the cognitions related to personal growth. For example, if I want to change something in my life, I initiate the transition process. PGI can be thought of as a metacognitive construct, that is, awareness and control of intentional engagement in growth enhancing cognitions and behaviors in all areas of life. Search for meaning is the drive and orientation toward finding meaning in one’s life (Steger et. al., 2006), and is a very important mechanism in the meaning-making process.

The assumptions of the MPGCI model are that, despite going through a challenging experience such as a chronic disease (in terms of illness perceptions), a human being has relevant psychological predispositions. Illness perceptions are cognitive and emotional representations of the illness and include the subjective appraisal of illness impact on a patient’s life (consequences), severity of the illness (identity), concern, personal and cure control, understanding, emotional response, and the timeline of the (Leventhal, Nerenz, & Steele, 1984). They play a significant role in the MPGCI model as independent variables. These are adapted to search for meaning, personal growth initiative, and coping strategies that allow them to live a good life (as defined by positive psychology) and derive some benefits from it, namely personal growth.

Therefore, the theoretical MPGI results in 1) the subjective role of illness perceptions, 2) the interaction of search for meaning in life, and 3) the personal growth initiative, as well as 4) coping strategies in achieving personal growth in chronic illness (see moderated mediation Model 11 according to Hayes, 2013).

Method

The study participants, 188 adults with multiple sclerosis (MS), filled out several questionnaires to measure their illness perceptions. The first, the Brief Illness Perceptions Questionnaire (B-IPQ; Broadbent et al., 2006) was shown in a prior analysis (Kossakowska, 2018) to be a three-factor tool that consists of subscales: functional and cognitive illness perceptions and timeline. Only functional and cognitive illness perceptions were incorporated in the MPGCI model, as listed above in describing the concept of functional illness perceptions.

The second questionnaire measuring personal growth used the Personal Growth Initiative Scale –version I (PGIS I; Robitschek, 1998). A third measuring searching for meaning (ML-S) used one of the two scales from the Meaning in Life Questionnaire (Steger et al., 2006). A fourth measuring coping strategies used the Coping Orientations to Problems Experienced (COPE; Carver, Scheier, & Weintraub, 1989). The sum of all strategies was the variable tested in the MPGCI model.

In this research, personal growth was understood as 1) self-valued self-esteem, 2) the presence of meaning in life, 3) the intensity of feeling positive emotions in life, and 4) benefit-finding/ benefit reminding. Personal growth was the aggregate indicator of four questionnaires scores: Positive Emotions Scale (PES; Kossakowska, 2018), Rosenberg’s Self-Evaluation Scale (SES; Rosenberg, 1964), Silver Lining Questionnaire (McBride et al., 2008) and one of the scales of  the MLQ: Meaning in Life – Presence (ML-P; Steger et al., 2006). All questionnaires were Polish versions and adaptations of the original measures.

Results

The macro Process for SPSS was used to verify the model of “moderated moderated” mediation model 1 (Hayes, 2013). Two separated models with two different independent variables (functional and cognitive illness perceptions) were tested. Only functional illness perceptions (perceptions of illness severity) were significant for the Model of Personal Growth in Chronic Illness: R²= .20; MSE= .12, F(7, 180)=6.44;  p< .0001 (Figure 1). The three-way interaction of functional illness perceptions, personal growth initiative and search for meaning was confirmed: b7= -.02; t(180) = -2.23, p = .027; 95% Cl [-.029; -.002].