Health locus of control (HLC) is a psychological construct that is important to study in the context of health-related behaviors (Burker, Phillips, & Giza, 2012). Health locus of control is the extent to which an individual feels their health-related outcomes are related to their personal behaviors or characteristics or whether they are related to an external cause (Wallston, et al, 1976). With this in mind, the purpose of this paper is to provide an overview of the current and relevant literature on HLC and health-related behaviors. Attention is focused on the strengths and limitations of the studies, their possible interpretations and the ways in which the findings relate to the existing theories and models.
Background
Drawing from Rotter’s construct of locus of control (LOC) and applying it to the health domain, the concept of HLC was first developed by Wallston and colleagues in the 1970s (Janowski, Kurpas, Kusz, Mrocsek, & Jedynak, 2013).Consistent with Rotter’s unidimensional stance on locus of control, HLC was also initially conceptualized on a continuum from internal to external poles (Janowski, et al., 2013). Later, the HLC was viewed as a multidimensional construct with fairly independent dimensions. These dimensions focus on the differences in the attributions individuals hold about the responsibility for and the control of their health. These dimensions cover three main categories (Janowski, et al., 2013). To elaborate, individuals with an internal HLC orientation attribute their health to their actions and take responsibility for the consequences of not taking care of their health. Individuals with an external locus of control orientation, on the other hand, attribute their health to other people, typically medical professionals or to uncontrollable factors, for example, luck or fate. The concept of HLC was later operationalized through the Multidimensional Health Locus of Control Scale, which consists of 18 items on the dimensions of internal locus of control (IHLC) , chance locus of control (CHLC) and powerful others locus of control (PHLC) (Taher, et al., 2015).

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Review of Literature
Researchers have operationalized the concept of HLC in a variety of contexts and settings. For example, the purpose of the cross-sectional study by Burker and colleagues (2012), was to examine the factors related with HLC among lung transplant patients. Additionally, the author’s aimed to identify demographic factors related to IHLC, CHLC, and PHLC as well as the relationship between HLC and anxiety, depression and optimism. Data was obtained through participant self-reports using the Multidimensional Health Locus of Control Scale, the State Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Life Orientation Test (LOT). Data were analyzed using SPSS, specifically Pearson’s correlations, t-tests, and hierarchical multiple regression. The results of this study indicated younger patients had lower trait anxiety and depressive symptoms and were more likely to attribute their own behaviors on their health status. Also, among the patients who were younger, less optimism and less education, had a higher level of trait anxiety and attribute their health condition to fate, luck or chance. Lastly, among their sample, patients with less education were more likely to attribute their health status to powerful people, i.e. doctors, family, nurses. Additionally, male gender was related to an IHLC orientation. The significance of this study is that it provides a better understanding of the factors that influence patient’s HLC. The implications are that the ability to follow recommendations for self-care is related to success of patients post-transplant.

In another study Weilenga-Boiten, Heijenbrok-Kal, and Ribbers (2015) used a prospective cohort design to assess the course of HLC orientation over time among patients with moderate to severe traumatic brain injury (TBI) and the relationship to health-related quality of life (HRQoL). The researchers also used the Multidimensional Health Locus of Control model. Independent t tests were conducted to evaluate the difference between HLC outcomes of patients 36 months after TBI and compared with data from health individuals and chronically ill persons. To assess whether HLC and HR-QoL changed over time, the researcher conducted a linear mixed model using repeated measures. The results of the study indicated a decrease in IHLC and CHLC at the 12 and 36 months post TBI; lower IHLC and PHLC ad higher CHLC scores than data from health adults and an inverse relationship between CHLC and HR-QoL.

The purpose of the descriptive study using a convenience sample was to determine if a relationship exists between adherence to treatment regimen and IHLOC among hypertensive participants (Taher, et al., 2015). Interestingly, the results of this study indicated a direct relationship between adherence to a treatment regimen with internal health locos of control in patients with hypertension. In other words, patients with uncontrolled hypertension have CHLOC whereas individuals with internal locos of control had controlled blood pressure. The researchers also used the Multidimensional Health Locus of Control instrument to assess health attributions.

In a similar study regarding adherence to treatment and HLOC, las Cuevas, Penate, and Sanz (2014) examined the relationship between psychological reactance, HLOC and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression. Surprisingly, in this study, only the external dimension of doctor-attributed or PHLOC was positively related with medication adherence. This is inconsistent with the results of the aforementioned study by Taher and colleagues (2015), in which adherence to treatment regimen was related to IHLOC.

Conclusion
As indicated, health locus of control is an important concept to study in nursing. This concept or construct has been examined in many studies using the Multidimensional Health Locus of Control model, which assesses HLOC or an individual’s attributions regarding their health status. Additionally, HLOC has been studied in a variety of contexts and settings with mixed results. Further research on this construct is needed to identify which health locus of control orientation or attributional style results in the best health related outcomes.

    References
  • Burker, E.J., Phillips, KM., & Giza, M. (2012). Factors related to health locus of control among lung transplant candidates. Clinical Transplant, 26(7), 748-754. doi: 10.1111/j.1399-0012.2012.01614.x
  • Janowski, K., Kurpas, D., Kusz, J., Mroczek, B., & Jedynak, T. (2013). Health-related behavior, profile of health locus of control and acceptance of illness in patients suffering from chronic somatic diseases. PLoS ONE 8(5), e63920. doi:10.1371/journal.pone.0063920
  • Las Cuevas, C., Penate, W., & Sanz, E.J. (2014). The relationship of psychological reactance, health locos of control and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression. BMC Psychiatry, 14(324), 1-9.
  • Taher, M., Bayat, Z.S., Zadi, K.N., Ghasemi, E., Abredari, H., Karimy, M., & Abedi, A.R. (2015). Correlation between compliance regimens with health locus of control in patients with hypertension. Medical Journal of Islamic Republic of Iran, 29(194), 2-5. Retrieved from http://mjiri.iums.ac.ir
  • Wallston, K.A., Maides, S.,& Wallston, B.S. (1976). Health-related information seeking
    as a function of health-related locus of control and health value. Journal of Research in Personaltiy 10 (2), 215–222.
  • Wielenga-Boiten, J.E., Majanka H. Heijenbrok-Kal, & Ribbers, G.M. (2015). The relationship of health locus of control and health-related quality of life in the chronic phase after traumatic brain injury. Journal of Head Trauma Rehabilitation, doi: 10.1097/HTR.0000000000000128