Asthma expectations predict symptoms over time: a longitudinal cohort study

Background: Illness expectations are cognitive schemas, both explicit and implicit, describing how symptoms are expected to be in the future. They can be particularly relevant to disease in a mind/body framework. Asthma is a condition in which the psychological aspects can highly influence the body, but no study has directly explored these specific expectations, and no dedicated assessment tools are available. Methods: We developed a questionnaire to assess the illness expectations, together with an ad hoc version of the Implicit Association Test (IAT). We tested its factorial structure, and the internal and test–retest validity, recruiting a sample of 183 asthmatic people. We also explored the convergent validity and the correlations with objective and subjective clinical assessments. Results: Data suggested a three-factorial structure of the questionnaire into expectations about future symptoms, change in current health status, and rigidity of these expectations. The questionnaire showed good psychometric properties and strong associations with the other considered outcomes, including implicit expectations. The implicit evaluation, however, lacked test–retest reliability. Conclusion: The questionnaire is a valid tool to assess illness expectations in people with asthma. The two expectation scales are highly related, and the implicit expectations are moderately associated with the explicit ones. The lack of stability related to IAT results may reflect a lack of stability of the implicit expectations. The implications for the mind/body framework still need to be fully explored.