‘The impact of pulmonary hypertension on self-image: A systematic review and thematic synthesis of qualitative and mixed-methods studies’ and ‘Using photo-elicitation to explore self-image in adults with pulmonary hypertension: A template analysis’

Pendrey, Jacob 2025. ‘The impact of pulmonary hypertension on self-image: A systematic review and thematic synthesis of qualitative and mixed-methods studies’ and ‘Using photo-elicitation to explore self-image in adults with pulmonary hypertension: A template analysis’. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Pulmonary hypertension (PH) is a rare but serious condition where the blood pressure in the lungs becomes dangerously high. This places strain on the heart, which over time can lead to heart failure. Although new medications and treatments have improved survival, PH remains a life-limiting condition, with symptoms such as breathlessness, fatigue, and chest pain affecting people’s daily lives. Understandably, much of the research focus has been on prolonging life, managing physical symptoms, and Health-Related Quality of Life. However, less attention has been given to how PH changes a person’s sense of self: how they see themselves, their role in society, and their place in the world. This thesis explores these psychosocial aspects of PH, and how that impacts their self-image. Self-image refers to how people think and feel about themselves: their identity, their roles, their body, and their worth. For people with PH, everyday life is not only altered by physical limitations but also by social and emotional changes. Understanding these changes is important, as they can affect mental health, quality of life, and even how well people manage their condition. The first part of the thesis is a systematic review of qualitative and mixed-method studies that may give insight as to how PH affects self-image. After searching four major medical and psychological databases, twenty-three relevant studies were included. These studies came from across the world and captured the voices of people living with PH in a variety of cultural and social settings. A technique called thematic synthesis was used to identify any relevant information into ‘codes’, which are then grouped into descriptive and broader analytical themes, that highlight common patterns across the studies. These themes show which ways and how PH disrupts self-image by undermining people’s confidence, restricting their sense of capability, as well as internalisation of external perceptions. As no study in the synthesis directly investigated self-image, the second part of the thesis uses a qualitative method called template analysis, which allows the development and refinement themes based on both prior knowledge and new insights gained from interviews. Thirteen participants PH in the Western-Europe were interviewed about their experiences of self-image. The interviews used a creative methodology known as photovoice, where they provided photographs that represented their experiences of PH and its impact on self-image. This approach gave participants more control over how their stories were told and allowed deeper exploration of issues that might not surface in traditional interviews. Analysis of the interviews revealed several key themes. Participants described a profound loss of past identity, with PH forcing them to give up valued social roles, often leaving them feeling isolated or less valued, particularly in the eyes of others. The theme of loss extended to their independence and autonomy, with people feeling like PH was making choices for them and leaving them feeling like a failure for becoming dependent on others and not fulfilling their previously held roles. Participants also described the PH becoming a central component to their identity, with a complex dichotomy of being both visibly and invisibly ill making it a difficult experience. Additionally, feelings of fragility, mortality, and vulnerability reflected how the life-limiting nature of PH forced participants to confront their own limitations and uncertain futures. Despite these challenges, many participants also demonstrated resilience. Some found ways to live well with PH, such as reframing roles, finding new sources of meaning, or accepting support. A strong determination to resist being defined by illness, which one participant conceptualised as “two fingers up to PH”, provided insight into strategies for maintaining a positive self-image in the face of adversity. Taken together, the findings from both the systematic review and the empirical study provide a comprehensive picture of how PH impacts self-image. They show that PH is not only a physical condition but also a profound psychological and social challenge. Theoretically, this work highlights the importance of viewing PH through the lens of identity and self-image, not just through measures of physical function or health-related quality of life. It contributes to theories of self-discrepancy, biographical disruption, and social identity, showing how these frameworks can be applied to PH. Clinically, the findings underline the need for more holistic and person-centred care in PH services. This includes sensitive communication about identity-related issues such as family planning, recognition of the psychosocial burden of role loss and stigma, and provision of targeted psychological and peer support. By addressing not only the body but also the self, healthcare can better support people with PH to adjust, adapt, and live meaningful lives alongside their condition.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	8 January 2026
Last Modified:	08 Jan 2026 16:44
URI:	https://orca.cardiff.ac.uk/id/eprint/183713

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