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The Influence of Social Comparison on the Perception of Quality of Life Amongst People Living with Epilepsy in Iran and the United Kingdom

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The Influence of Social Comparison on the Perception of Quality of Life Amongst People Living with Epilepsy in Iran and the United Kingdom THE INFLUENCE OF SOCIAL COMPARISON ON THE PERCEPTION OF QUALITY OF LIFE AMONGST PEOPLE LIVING WITH EPILEPSY IN IRAN AND THE UNITED KINGDOM A thesis submitted for the degree of Doctor of Philosophy By Aisan Ghaemian Oskouei Department of Psychology, Brunel University London February 2016 I, Aisan Ghaemian Oskouei, declare that the entire work in this thesis is mine and is written by myself. All the data demonstrated in this thesis is grounded in this original work. This research was carried out independently, and has not been submitted for any other degree. i Abstract Epileptic seizures are usually stressful episodes for individuals, not least as they are often experienced in public. Most research into epilepsy has been conducted in Western cultures, and we know little about the experiences of people with epilepsy and living in Middle Eastern countries. This study aims to examine the influence of social comparison on the perception of quality of life for people with epilepsy in Iran and in the United Kingdom. Three studies were completed. Two studies were qualitative; exploring individuals’ experiences of living with epilepsy and investigating coping strategies, respectively, (UK = 10, Iran = 10), for each study. Thematic analysis was used for data analysis. The third quantitative study was examined to determine whether social comparison dimensions, (upward negative, upward positive, downward negative, downward positive), predict quality of life in both countries, (N = 100 for each country), and a hierarchical multiple regression was used to analyse data. The first study indicated people compare themselves to others and the unpredictable nature of a seizure causes individuals to perceive negative feelings and experience anxiety, furthermore urinary incontinence attached to seizures appeared to leave people feeling ashamed and anxious. Study two revealed that whilst Iranian people used emotion-focused coping strategies, individuals from the United Kingdom applied problem-focused coping strategies. In Iran religious coping strategies were used to cope with incontinency; however positive social comparison (downward) was used as a coping strategy for incontinency in the United Kingdom. Study three found that self-esteem was the main predictor for quality of life in Iran and the United Kingdom. Whilst a seizure’s severity negatively predicts quality of life in the United Kingdom, positive social comparison (upward) accounted for quality of life in Iran. This study suggests that providing positive role models can help Iranians have a better perception for their quality of life, whereas British people potentially maximise their quality of life through seizure management. ii Contents Abstract .................................................................................................................................... ii List of Tables .......................................................................................................................... iii Acknowledgment ................................................................................................................ ix CHAPTER 1: INTRODUCTION ............................................................................................ 1 1.0 Introduction .................................................................................................................... 1 1.1 Epilepsy........................................................................................................................ 5 1.1.1 Classification of Epileptic Seizures ........................................................................... 6 1.1.2 Incidence ..................................................................................................................... 7 1.1.3 Etiology ..................................................................................................................... 8 1.2 Comorbidity of Epilepsy .............................................................................................. 9 1.2.1 Urinary Incontinence .............................................................................................. 9 1.2.1.1 Psychosocial Impact of Urinary Incontinence ................................................. 10 1.3 Psychosocial Impact of Epilepsy ............................................................................... 12 1.4 What Can Provoke an Epileptic Seizure? ................................................................. 16 1.5 Treatment of Epilepsy ............................................................................................... 17 1.5.1 Medication Side-effects ......................................................................................... 18 1.6 Conclusion ................................................................................................................. 19 CHAPTER 2: QUALITY OF LIFE ....................................................................................... 20 2.1 Introduction .................................................................................................................. 20 2.2 Definition ..................................................................................................................... 20 2.3 Theoretical Aspects of Quality of Life ..................................................................... 23 2.3.1 A Patient-Based Health-Related Quality of Life Model in Epilepsy ................... 24 2.3.2 The Biopsychosocial Model ............................................................................. 25 2.4 Impact of Epilepsy on Quality of Life ......................................................................... 27 2.5 Other Factors Related to Predict Quality of Life in People with Epilepsy ............. 30 2.5.1 Demographic Characteristics ............................................................................ 30 2.5.2 Physical Variable ................................................................................................ 33 2.5.3 Psychological Variables ....................................................................................... 35 2.6 Quality of Life and Adjustment ................................................................................ 38 2.7 Coping .......................................................................................................................... 39 iii 2.7.1 Coping and Psychosocial Adaptation to Epilepsy .............................................. 40 2.8 Conclusion ................................................................................................................ 43 CHAPTER 3: THEORY OF SOCIAL COMPARISON ....................................................... 45 3.1 Introduction .............................................................................................................. 45 3.2 The Theory of Social Comparison ............................................................................ 45 3.3 The Role of Social comparison in Chronic Illness.................................................... 54 3.4 Social Comparison and Adjustment to Chronic Illness ........................................... 58 3.5 Mediating or Moderating Factors that may Affect Social Comparison Processes . 61 3.5.1 Anxiety ................................................................................................................ 61 3.5.2 Self-esteem ........................................................................................................ 62 3.6 Conclusion .............................................................................................................. 63 CHAPER 4: METHODOLOGY ............................................................................................ 65 4.1 Introduction ............................................................................................................... 65 4.2 Summary of the Literature Review .......................................................................... 65 4.3 Overview of the Research Design ............................................................................ 66 4.4 The Mixed-Methods Rationale ............................................................................. 68 4.5 Rationale for the Qualitative Research .................................................................. 71 4.5.1 Philosophical Underpinning ................................................................................. 72 4.5.2 Rationale for Data Collection ................................................................................... 72 4.5.3 Method of Analysis .................................................................................................... 73 4.6 Rationale for Quantitative Research ........................................................................ 77 4.7 Reflexivity................................................................................................................. 77 4.5 Conclusion ................................................................................................................. 79 CHAPTER 5: THE QUALITATIVE ANALYSIS OF THE UK SAMPLE .......................... 81 5.1 Introduction .............................................................................................................. 81 5.1 Study One ................................................................................................................. 81 5.1.1 Aim of the Study ................................................................................................
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