Health-Related Quality of Life among People with Borderline Intellectual Functioning and Obesity

People with borderline intellectual functioning face a plethora of challenges related to their low level of cognitive ability and complex medical conditions (Contena & Taddei, 2017). One common medical condition among them is obesity (Ranjan et al., 2018). Obesity, considered a major challenge to public health in the 21^st century, has been declared a pandemic by the World Health Organization (WHO, 2020). People affected by obesity tend to report lower health-related quality of life compared to the general population (Kochar et al., 2017). The cognitive perceptions and emotional responses of patients suffering from chronic diseases regarding chronic disease have been found to be connected to health-related quality of life (Khowles et al., 2020; Masson et al., 2020; Rivera et al., 2020). However, there has been little research addressing this specific population. This dissertation analyzes these connections, based on the Self-Regulation Model (SRM) (Leventhal et al., 1980), a theoretical framework for assessing an individual’s cognitive perceptions and emotional responses to the threat of illness. This study expands upon the SRM by including self-efficacy, a variable that has been noted as a coping resource affecting health-related quality of life in previous research (Nezami et al., 2016; Parkinson et al., 2017).

The purpose of this study is to use the integrative SRM to examine the connection between cognitive and emotional perceptions of illness and self-efficacy with health-related quality of life (Leventhal et al., 1980) among people with borderline intellectual functioning and obesity. The research sample consisted of 124 individuals: 62 people with borderline intellectual functioning and obesity who reside in a post-hospitalization care facility in Israel, and a control group of 62 people with obesity from the general population in Israel. Questionnaires were distributed in-person to the group with borderline intellectual functioning, and a professional from the relevant field was present to assist participants, as needed, with reading and comprehension of the questionnaire. Among the general population, the questionnaire was distributed via social media and through an online survey using the “snowball” method.

The main findings indicate several connections between the perception of illness and self-efficacy with health-related quality of life among people with obesity and with or without borderline intellectual functioning. The findings indicate that the more that participants reported detection of symptoms, higher anxiety levels, and negative perceptions of illness, the more likely they were to also report lower health-related quality of life. Conversely, reports of higher levels of self-efficacy were associated with a more positive health-related quality of life. The research found significant differences between the two research groups in relation to almost all cognitive and emotional perceptions of illness. No significant differences between the groups were observed regarding self-efficacy, self-control, or health-related quality of life. By using the SRM, we were able to find that participants with high intellectual functioning, symptom detection, emotional perception of illness, and self-efficacy accounted for 36% of the variance in health-related quality of life. That is, residence in a care facility narrowed the gap in health-related quality of life in comparison to the general population, but only to a degree

The theoretical implications of this dissertation provide us with a view into the relationship between cognitive and emotional perceptions of illness and quality of life among people with obesity and borderline intellectual functioning, based on the SRM. By doing so, this work enriches the body of knowledge in this field. The practical implications of this are that it is beneficial to focus the treatment of people with obesity on the detection of the symptoms associated with obesity and on aiding them in the identification and description of negative emotions arising from their physical condition. This recommendation applies irrespective of whether the patient has borderline intellectual functioning. Moreover, intervention centered on strengthening self-efficacy may contribute to a higher perception of health-related quality of life, and even strengthen one’s belief in their own ability to cope with obesity.