Health locus of control beliefs and socio-economic differences in self-rated health

Individual characteristics associated with perceptions of control over mortality risk and determinants of health effort

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk.

Association between nutrition self-efficacy, health locus of control and food choice motives in consumers in nine European countries

We investigated associations between food choice motives and psychological determinants of dietary health behaviour change (nutrition self-efficacy, NS-E, and health locus of control, HLoC) among 9381 participants (18-65 years, 49.4% females) from nine European countries. Price was the highest rated food choice motive. Higher importance of all motives was associated with higher NS-E and with higher Internal HLoC. Relationships between food choice motives and External HLoC were also in the expected direction in showing negative associations with Health, Natural Content, Weight Control, Mood and Sensory Appeal. Higher External HLoC was also associated with perceived greater importance of 'external' motives Ethical Concern, Familiarity and Convenience. Relationships between External HLoC and food choice motives were not all in the expected direction. Price was unrelated to External HLoC. Females rated the importance of all motives higher than males. People with less education ascribed greater importance to Price in motivating food choices. Together, these findings imply that self-efficacy and health locus of control should be considered along with motivations for food choice in dietary health promotion.

Health locus of control and self-management behaviours among individuals with ischaemic heart disease: protocol for a scoping review

INTRODUCTION

Ischaemic heart disease is a significant cause of morbidity and mortality worldwide. Self-management is a way to reduce the risk associated with ischaemic heart disease; however, some individuals may not have the ability or willingness to engage in self-management behaviours. One approach to identify an individual's readiness and capacity to engage in self-management behaviours is to assess their health locus of control. Based on the Individual and Family Self-Management Theory, this review's objectives are to describe: (1) how health locus of control affects the process of engaging in self-management behaviours, (2) impacts of health locus of control on outcomes associated with self-management behaviours and (3) potential contextual variations in the relationship between health locus of control and self-management behaviours.

METHODS AND ANALYSIS

The scoping review will be guided by the Joanna Briggs Institute methodological framework. A comprehensive search will encompass seven electronic databases (Ovid Medline, CINAHL, EMBASE, APA PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus) and grey literature sources (ProQuest Dissertations, ClinicalTrials.gov). Collaborative efforts with library experts will inform our search strategies, building on insights from previous reviews centred on self-management and ischaemic heart disease. Two review authors will independently conduct the screening and data extraction processes; discrepancies will be resolved through consensus or discussion with a third review author. The review will include English studies from database inception, focusing on the health locus of control among adults with ischaemic heart disease. Findings will be presented graphically and tabularly, together with a narrative description.

ETHICS AND DISSEMINATION

We will collect data from published and grey literature, meaning ethical approval is not necessary. Findings will be published in peer-reviewed journals and presented at academic conferences.

REGISTRATION DETAILS

Open Science Framework (https://doi.org/10.17605/OSF.IO/B4A6F).

The role of socioeconomic factors as barriers to patient reported outcome measure completion following lumbar spine fusion

BACKGROUND CONTEXT

Although incorporating patient reported outcomes (PROMs) into practice allows healthcare systems to evaluate the value of care provided, research and policy reflecting PROMs can only be valid if they represent all patients. Few studies have evaluated socioeconomic barriers to PROM completion, and none have done so in a spine patient population.

PURPOSE

To identify patient barriers to PROM completion one year following lumbar spine fusion.

STUDY DESIGN/SETTING

Retrospective single-institution cohort study.

PATIENT SAMPLE

A total of 2,984 patients undergoing lumbar fusion between 2014 and 2020 OUTCOME MEASURES: Completion of Mental Component Score (MCS-12) and Physical Component Score (PCS-12) of Short Form-12 questionnaire 1 year postoperatively.

METHODS

A retrospective review was conducted of all patients undergoing 1-3-level lumbar fusion at a single urban tertiary center. PROMs were queried from our prospectively managed electronic outcomes database. Patients were considered to have complete PROMs if 1-year outcomes were available. Community-level characteristics were collected from patients' zip codes using the Economic Innovation Group Distressed Communities Index. Bivariate analyses were performed to assess factors associated with PROM incompletion along with multivariate logistic regression to control for confounders.

RESULTS

A total of 1,968 (66.0%) had incomplete 1-year PROMs. Patients with incomplete PROMs were more likely to be Black (14.5% vs 9.3%, p<.001), Hispanic (2.9% vs 1.6%, p=.027), reside in a distressed community (14.7% vs 8.5%, p<.001), and be active smokers (22.4% vs 15.5%, p<.001). On multivariate regression, Black race (OR: 1.46, p=.014, Hispanic ethnicity (OR: 2.19, p=.027), distressed community status (OR: 1.47, p=.024), workers' compensation status (OR: 2.82, p=.001), and active smoking (OR:1.31, p=.034) all were independently associated with PROM incompletion. Surgical characteristics, including primary surgeon, revision status, approach, and levels fused were not associated with PROM incompletion.

CONCLUSIONS

Social determinants of health impact completion of PROMs. Patients completing PROMs are overwhelmingly White, non-Hispanic, and reside in wealthier communities. Efforts should be taken to provide better education regarding PROMs and ensure closer follow-up of certain subgroups of patients to avoid furthering disparities in PROM research.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of health services, and mortality (DESVELA cohort): quantitative study protocol for a prospective cohort study in a hybrid analysis

Introduction

The healthcare and well-being of the population depend on multiple factors and should adapt to societal changes. The opposite is also occurring; society has evolved concerning the individuals' approach to their care, which includes participation in decision-making processes. In this scenario, health promotion and prevention become crucial to provide an integrated perspective in the organization and management of the health systems.Health status and well-being depend on many aspects, determinants of health, which in turn may be modulated by individual behavior. Certain models and frameworks try to study the determinants of health and individual human behaviors, separately. However, the interrelation between these two aspects has not been examined in our population.Our main objective is to analyze whether personal aptitudes related to behaviors are independently associated with the incidence of morbidity. A secondary objective will enquire whether these personal aptitudes are independently associated with lower all-cause mortality, enhanced adoption of healthy lifestyles, higher quality of life, and lower utilization of health services during follow-up.

Methods

This protocol addresses the quantitative branch of a multicenter project (10 teams) for the creation of a cohort of at least 3,083 persons aged 35 to 74 years from 9 Autonomous Communities (AACC). The personal variables to evaluate are self-efficacy, activation, health literacy, resilience, locus of control, and personality traits. Socio-demographic covariates and social capital will be recorded. A physical examination, blood analysis, and cognitive evaluation will be carried out.Several sets of six Cox models (one for each independent variable) will analyze the incidence of morbidity (objective 1); all-cause mortality and the rest of the dependent variables (objective 2). The models will be adjusted for the indicated covariates, and random effects will estimate Potential heterogeneity between AACC.

Discussion

The analysis of the association of certain behavioral patterns and determinants of health is essential and will contribute to improving health promotion and prevention strategies. The description of the individual elements and interrelated aspects that modulate the onset and persistence of diseases will allow the evaluation of their role as prognostic factors and contribute to the development of patient-tailored preventive measures and healthcare.Clinical Trial Registration: ClinicalTrials.gov, NCT04386135. Registered on April 30, 2020.

Perceived controllability of a SARS-CoV-2 infection: an investigation of intersectional differences

BACKGROUND

The perceived ability to influence an infection with SARS-CoV-2 has an impact on compliance with protective measures. Factors influencing perceived controllability are not yet fully known. The aim of this study was to identify intersectional differences in perceived controllability. Insights into these intersectional differences could help to develop user-centered strategies to improve the acceptance of protective measures.

METHODS

Data from the seventh wave of the German Ageing Survey (DEAS) was used to investigate differences in the population regarding the perceived controllability. The role of socio-demographic and socio-economic predictors was investigated using multivariable linear regression modeling. Intersectional differences were examined using interaction terms.

RESULTS

Information on 4,823 respondents aged 46 to 100 years were available, of which 50.9% were female. Migration status (yes vs. no: β = -0.27; 95%-CI = -0.48,-0.06), education level (high vs. low: β = 0.31; 95%-CI: 0.08, 0.55) and employment status (retired vs. employed: β = 0.33; 95%-CI: 0.19, 0.48) were found to be significantly influencing perceived controllability. Interaction effects were found with respect to sex and migration status, with migrant women rating their perceived controllability lower than non-migrant women (β = -0.51; 95%-CI = -0.80, -0.21), while no differences were evident between migrant and non-migrant men (β = -0.02; 95%-CI = -0.32, 0.28). Further intersectional differences were not observed.

CONCLUSIONS

The results show that intersectional differences in perceived controllability occur especially between migrant and non-migrant women. Possible causes may lie in language barriers, which in connection with lower health literacy may affect perceived controllability. Dedicated efforts to improve controllability among older adults, those with lower educational attainment and migrant women are warranted.

Parent's Health Locus of Control and Its Association with Parents and Infants Characteristics: An Observational Study

The Parent Health Locus of Control (PHLOC) investigates the individual’s beliefs about the factors that govern their state of health and that of their children. The direct association between PHLOC and preventive health behaviours compliance has already been demonstrated in the literature. However, it is still unclear how socio-demographic variables affect the PHLOC. We investigated the Parent Health Locus of Control of parents of full-term and preterm infants and evaluated whether there were any correlations between PHLOC and socio-demographic characteristics of both parents and infants. A single-centre transverse observational study was conducted in the Neonatology Operating Unit IRCCS Ca ‘Granda Foundation Ospedale Maggiore Policlinico of Milan. A self-administered questionnaire of the PHLOC scale was distributed to a sample of 370 parents of 320 full-term and 52 preterm infants attending the follow-up service. Parents under the age of 36 and with a higher level of education (bachelor’s degree or above) believe less in the influence of the media on their child’s health. Parents of preterm and first-child infants recognize the greater influence of health care workers, while parents of newborns that have experience complications in their clinical course, believe more in the influence of fate (Chance Health Locus of Control) and God. Younger parents with a higher level of education may be more prone to healthy preventative behaviours. Preterm birth is positively associated with an increased trust in health care professionals. The experience of disease can increase a “Chance Health Locus of Control” and risky behaviours. Assessment of PHLOC helps identify categories of parents prone to risky health behaviours and offer targeted health education interventions.

Attitudes and views on healthy lifestyle interventions for the prevention of dementia and cardiovascular disease among older people with low socioeconomic status: a qualitative study in the Netherlands

OBJECTIVES

Individuals with a low socioeconomic status (SES) have an increased risk of cardiovascular disease (CVD) and dementia, partly due to the high prevalence of unhealthy behaviours in this population. Interventions targeting lifestyle-related risk factors can potentially delay or prevent CVD and dementia onset. In this study, we explore the attitudes, experiences and views of low SES older adults on healthy lifestyles for the prevention of CVD and dementia. We also aim to study the potential role for coach-supported mobile health (mHealth) use, facilitating the development of the Prevention of Dementia using Mobile Phone Applications intervention.

DESIGN

We performed semi-structured interviews and used thematic analysis to analyse the data.

SETTING

Recruitment through multiple general practices in the Netherlands.

PARTICIPANTS

Dutch non-demented adults aged ≥55, at increased risk of dementia, who possess a smartphone. Participants were purposively sampled on age, sex and history of CVD and diabetes.

RESULTS

Between May 2018 and June 2019, we performed 19 interviews. Five main themes were: (1) participants perceived little influence on their future health, (2) the sacrifices of healthy lifestyles outweighed the potential benefits, (3) physical complaints or disease could prompt behaviour change, (4) participants perceived they had limited self-efficacy to change their behaviour and (5) the social network had an important role in behaviour change. Needs regarding mHealth support were an easy-to-use smartphone application with trustworthy health information, which is provided in a non-obligatory way.

CONCLUSIONS

Low SES older adults may benefit from lifestyle interventions that aim to improve self-efficacy levels by (remote) human support. Appropriateness and attractiveness of such interventions may increase when taking into account the participant's own autonomy, and when emphasising the direct gains of lifestyle changes for daily life. Moreover, involving the social network may be a valuable approach when developing lifestyle interventions for low SES older adults.

TRIAL REGISTRATION NUMBER

PRODEMOS trial, ISRCTN15986016; Pre-results.

Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS)

BACKGROUND

Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake.

METHODS

Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics.

RESULTS

The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05).

CONCLUSIONS

The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.

The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study

Background

Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association.

Objective

The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth.

Methods

A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence).

Results

The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%.

Conclusions

This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption.

Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study

BACKGROUND

Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island's environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island.

OBJECTIVE

This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology.

METHODS

Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use.

RESULTS

Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%).

CONCLUSIONS

Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes).

Longitudinal Associations Between Perceived Control and Health for American and Japanese Aging Adults

BACKGROUND AND OBJECTIVES

Research suggests longitudinal and reciprocal relationships between perceived control over life circumstances and health for Western populations; yet, such associations have not been fully understood for non-Western populations. The present study addresses cultural differences in these associations for American and Japanese aging adults.

RESEARCH DESIGN AND METHODS

For respondents aged 40 and older at 2 waves (Time 1 [T1] and Time 2 [T2]) of Midlife in the United States (N = 4,455) and Midlife in Japan (N = 827), cross-lagged path models were analyzed for T1 perceived control predicting change in each health measure (i.e., self-rated health, number of chronic health conditions, and functional limitations) from T1 to T2; and the matched T1 health measure predicting change in perceived control from T1 and T2. In these analyses, the effects of T1 age, T1 perceived control, and each T1 health measure were compared cross-nationally.

RESULTS

A cross-national difference emerged in that T1 perceived control predicted change in chronic health conditions only for Americans. Similar tendencies were found between the 2 nationalities for T1 perceived control predicting changes in self-rated health and functional limitations. Reciprocal relationships between perceived control and health measures were found for Americans, but neither age nor any of the T1 health measures predicted change in perceived control for the Japanese respondents.

DISCUSSION AND IMPLICATIONS

The findings suggest cultural differences and similarities between the 2 nationalities, which have implications for potential health benefits of enhancing perceived control among American and Japanese aging adults. Building on these findings, the present study also indicates future directions of research.

A path analysis model suggesting the association between health locus of control and compliance with childhood vaccinations

Despite vaccines benefits, parent's vaccine hesitancy is growing. Health locus of control (HLOC) may affect decision making regarding child vaccinations. The aim of this study was to investigate the relationship between parents' HLOC and compliance with routine childhood immunization programs. A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Internal HLOC, powerful others and chance HLOC (dimensions of external HLOC), reliability of information sources, and attitudes towards vaccines were measured. Path analysis was conducted to explore direct and indirect associations between HLOC and vaccination's compliance. The results show that High powerful others HLOC has a direct association with vaccination compliance (ß = 0.23, p < 0.001). High internal and chance HLOC have indirect associations through parents' attitudes regarding vaccines. Perceived reliability of information sources was associated with not complying with vaccines (ß = -0.07, p < 0.05). For conclusions, Interaction between internal and external HLOC may explain vaccination compliance. Decreasing levels of chance HLOC and increasing powerful others HLOC may increase levels of compliance with childhood vaccinations.

How to effectively design public health interventions: Implications from the interaction effects between socioeconomic status and health locus of control beliefs on healthy dietary behaviours among US adults

This study investigated whether individuals with different socioeconomic status (SES) should be provided differently tailored health messages to promote healthy dietary behaviour (HDB). Prior research has suggested that people with different SESs tend to exhibit different types of beliefs about health, but it remains unclear how SES interacts with these beliefs to influence health outcomes. To better understand the differences in HDB between high- and low-SES populations and propose effective intervention strategies, we examined (i) how SES is associated with HDB, (ii) how internal health locus of control (HLC) and powerful others HLC are associated with HDB, and (iii) how SES interacts with internal and powerful others HLC to influence HDB. Using data from the Annenberg National Health Communication Survey, collected from 2005 to 2012 (N = 6,262) in the United States, hierarchical multiple regression analyses were conducted. Education level was found to be positively associated with HDB, while income level was not. Both internal and powerful others HLC beliefs were positively associated with HDB. The positive relationship between internal HLC and HDB strengthened as the level of education and income increased, whereas the positive relationship between powerful others HLC and HDB weakened as respondents' education level increased. These results suggest that the design and delivery of communication messages should be tailored to populations' specific SES and HLC beliefs for effective public health interventions. For example, messages enhancing internal HLC (e.g. providing specific skills and knowledge about health behaviours) might be more helpful for the richer and more-educated, while messages appealing to one's powerful others HLC beliefs (e.g. advice on health lifestyles given by well-known health professionals) might be more effective for less-educated people.

Psychological origins of the Industrial Revolution

Since the Industrial Revolution, human societies have experienced high and sustained rates of economic growth. Recent explanations of this sudden and massive change in economic history have held that modern growth results from an acceleration of innovation. But it is unclear why the rate of innovation drastically accelerated in England in the eighteenth century. An important factor might be the alteration of individual preferences with regard to innovation resulting from the unprecedented living standards of the English during that period, for two reasons. First, recent developments in economic history challenge the standard Malthusian view according to which living standards were stagnant until the Industrial Revolution. Pre-industrial England enjoyed a level of affluence that was unprecedented in history. Second, behavioral sciences have demonstrated that the human brain is designed to respond adaptively to variations in resources in the local environment. In particular, Life History Theory, a branch of evolutionary biology, suggests that a more favorable environment (high resources, low mortality) should trigger the expression of future-oriented preferences. In this paper, I argue that some of these psychological traits - a lower level of time discounting, a higher level of optimism, decreased materialistic orientation, and a higher level of trust in others - are likely to increase the rate of innovation. I review the evidence regarding the impact of affluence on preferences in contemporary as well as past populations, and conclude that the impact of affluence on neurocognitive systems may partly explain the modern acceleration of technological innovations and the associated economic growth.

Low perceived control over health is associated with lower treatment uptake in a high mortality population of Bolivian forager-farmers

Indigenous people worldwide suffer from higher rates of morbidity and mortality than neighboring populations. In addition to having limited access to public health infrastructure, indigenous people may also have priorities and health perceptions that deter them from seeking adequate modern healthcare. Here we propose that living in a harsh and unpredictable environment reduces motivation to pursue deliberate, costly action to improve health outcomes. We assess whether variation in Health Locus of Control (HLC), a psychological construct designed to capture self-efficacy with respect to health, explains variation in treatment uptake behavior among Tsimane Amerindians (N = 690; age range: 40-89 years; 55.8% female; data collection: 2008-2012), a high mortality and morbidity indigenous population in the Bolivian Amazon, Beni Department. Comparisons with two industrialized populations in Japan (Miyagi prefecture; e0 = 76.6 years) and the United Kingdom (Caerphilly county borough; e0 = 81.2 years) confirm that Tsimane (e0 = 54.1 years) have a more externalized HLC. Multilevel level models were used to investigate whether HLC predicts treatment uptake, and mediates the relationship between modernization and treatment uptake. External HLC scores were predictive of treatment outcomes: Powerful others scores were positively associated with probability of receiving modern treatment (adjusted odds ratio [OR] = 1.33), while Chance scores were negatively associated with probability of receiving modern treatment (adjusted OR = 0.76). We found no effects, however, of Internal HLC or educational capital on treatment uptake. Overall, our findings indicate that health-related decision-making is influenced more by a psychological orientation affecting self-efficacy, shaped in part by perceptions of environmental unpredictability and harshness, than by limited knowledge, education or other indicators of modernization.

Increased affluence, life history theory, and the decline of shamanism

I applaud Singh's proposition to use evolutionary psychology to explain the recurrence of shamanistic beliefs. Here, I suggest that evolutionary mechanisms (i.e., life history theory) also can explain the variability of the distribution of shamanism. When resources are abundant, individuals become more patient and more open minded to the point that science becomes cognitively attractive and may replace magic.

The pain, depression, disability pathway in those with low back pain: a moderation analysis of health locus of control

Low back pain (LBP) is common, impacts on the individual and society, and is a major health concern. Psychological consequences of LBP, such as depression, are significant barriers to recovery, but mechanisms for the development of depression are less well understood. One potential mechanism is the individual’s health locus of control (HLoC), that is, perception of the level of control an individual has over their health. The objective of this study is to investigate the moderation effect of HLoC on the pain–depression–disability pathway in those with LBP. The design is a nested cross-sectional analysis of two existing cohorts of patients (n=637) who had previously consulted their primary care physician about LBP. Measures were taken of HLoC, pain intensity and interference, depression, disability, and bothersomeness. Structural Equation Modeling analysis was applied to two path models that examined the pain to depression to disability pathway moderated by the HLoC constructs of Internality and Externality, respectively. Critical ratio (CR) difference tests were applied to the coefficients using pairwise comparisons. The results show that both models had an acceptable model fit and pathways were significant. CR tests indicated a significant moderation effect, with stronger pathway coefficients for depression for those who report low Internality (β 0.48), compared to those with high Internality (β 0.28). No moderation effects were found within the Externality model. HLoC Internality significantly moderates the pain–depression pathway in those with LBP, meaning that those who have a low perception of control report greater levels of depression. HLoC may signify depression among people with LBP, and could potentially be a target for intervention.

Health locus of control as manifested in individuals attending a state-run medical dispensary in northern India

OBJECTIVE

To investigate the health locus of control (HLOC) beliefs of patients and visitors at a free, state-run medical clinic in Faridabad, India, in order to establish a norm for this population and to explore potential associations between the different categories of causal health beliefs.

DESIGN

Participants (110 men, 96 women) were interviewed in Hindi and asked a shortened version of the Multidimensional Health Locus of Control Scale assessing both internal HLOC and three aspects of external HLOC (chance, powerful others, and God). Additional variables of interest included a Traditional Values Scale, a measure of spirituality, an assessment of health status, and demographic information including gender, age, employment status, and religion.

RESULTS

Participants rated the external-God factor as a stronger determinant of their health than the internal or other external HLOC factors. Internal HLOC was positively correlated with external HLOC in terms of chance and the role of powerful others and these associations were strongest for the most interdependent participants (i.e. women and the unemployed).

CONCLUSIONS

For patients and visitors at the Faridabad clinic, religion played a significant role in their causal health beliefs. In addition, internal HLOC was positively associated with aspects of external locus of control, suggesting that causal health beliefs were viewed in a holistic, integrated fashion. Interventions based on these findings are suggested.

The behavioural constellation of deprivation: Causes and consequences

Socioeconomic differences in behaviour are pervasive and well documented, but their causes are not yet well understood. Here, we make the case that a cluster of behaviours is associated with lower socioeconomic status (SES), which we call “the behavioural constellation of deprivation.” We propose that the relatively limited control associated with lower SES curtails the extent to which people can expect to realise deferred rewards, leading to more present-oriented behaviour in a range of domains. We illustrate this idea using the specific factor of extrinsic mortality risk, an important factor in evolutionary theoretical models. We emphasise the idea that the present-oriented behaviours of the constellation are a contextually appropriate response to structural and ecological factors rather than a pathology or a failure of willpower. We highlight some principles from evolutionary theoretical models that can deepen our understanding of how socioeconomic inequalities can become amplified and embedded. These principles are that (1) small initial disparities can lead to larger eventual inequalities, (2) feedback loops can embed early-life circumstances, (3) constraints can breed further constraints, and (4) feedback loops can operate over generations. We discuss some of the mechanisms by which SES may influence behaviour. We then review how the contextually appropriate response perspective that we have outlined fits with other findings about control and temporal discounting. Finally, we discuss the implications of this interpretation for research and policy.

How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services

Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.

Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women

OBJECTIVE

To determine the relations between household material hardships and having a low internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women.

METHODS

We performed a cross-sectional analysis of baseline data collected during a third trimester prenatal visit from women participating in the Starting Early Study, a randomized controlled trial to test the efficacy of a primary care-based family-centered early child obesity prevention intervention. Using multiple logistic regression analyses, we determined whether 4 domains of material hardship (food insecurity, difficulty paying bills, housing disrepair, neighborhood stress), considered individually and also cumulatively, were associated with having a low internal locus of control over the prevention of child obesity.

RESULTS

The sample included 559 low-income Hispanic pregnant women, with 60% having experienced at least 1 hardship. Food insecurity was independently associated with a low internal locus of control over the prevention of child obesity (adjusted odds ratio, 2.38; 95% confidence interval, 1.50-3.77), controlling for other hardships and confounders. Experiencing a greater number of material hardships was associated in a dose-dependent relationship with an increased odds of having a low internal locus of control.

CONCLUSIONS

Prenatal material hardships, in particular food insecurity, were associated with having a lower prenatal internal locus of control over the prevention of child obesity. Longitudinal follow-up of this cohort is needed to determine how relations between material hardships and having a low internal locus of control will ultimately affect infant feeding practices and child weight trajectories.

Patterns and causes of health inequalities in later life: a Bourdieusian approach

This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self-rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class-related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.

The relationship between age-stereotypes and health locus of control across adult age-groups

OBJECTIVE

This study integrates healthy ageing and health psychology theories to explore the mechanisms underlying the relationship between health control expectancies and age-attitudes on the process of ageing well. Specifically, the aim of this study is to investigate the relationship between age-stereotypes and health locus of control.

DESIGN

A population-based survey of 739 adults aged 20-97 years (mean = 57.3 years, SD = 13.66; 42% female) explored attitudes towards ageing and health attitudes. A path-analytical approach was used to investigate moderating effects of age and gender.

RESULTS

Higher age-stereotype endorsement was associated with higher chance (β = 2.91, p < .001) and powerful other (β = 1.07, p = .012) health expectancies, after controlling for age, gender, education and self-rated health. Significant age and gender interactions were found to influence the relationship between age-stereotypes and internal health locus of control.

CONCLUSION

Our findings suggest that the relationship between age-stereotypes and health locus of control dimensions must be considered within the context of age and gender. The findings point to the importance of targeting health promotion and interventions through addressing negative age-attitudes.

The importance of internal health beliefs for employees' participation in health promotion programs

OBJECTIVE

To investigate associations between employees' health locus of control (HLOC) and self-perceived health, health behaviors, and participation in health promotion programs (HPPs) and the mediating effect of self-perceived health and health behaviors on the relation between HLOC and participation.

METHOD

Between 2010 and 2012, a six-month longitudinal study was conducted among 691 Dutch employees. Using questionnaires, information was collected on health behaviors, self-perceived health, HLOC, and intention to participate at baseline. Actual participation was assessed at follow-up. Logistic regression analyses were used to study associations between HLOC and self-perceived health, health behaviors, and participation, and to examine whether associations between HLOC and participation were mediated by self-perceived health and health behaviors.

RESULTS

Higher internal HLOC was associated with sufficient physical activity (moderate: OR:1.04, 95%CI:1.00-1.08; vigorous: OR:1.05, 95%CI:1.01-1.10) and fruit and vegetable intake (OR:1.05, 95%CI:1.01-1.09), a good self-perceived health (OR:1.20, 95%CI:1.11-1.30), a positive intention towards participation (OR:1.05, 95%CI:1.00-1.09), and actual participation (OR:1.06, 95%CI:1.00-1.13). Self-perceived health or health behaviors did not mediate associations between HLOC and participation.

CONCLUSION

Employees with a higher internal HLOC behaved healthier and were more likely to participate in HPPs, irrespectively of their health. Increasing internal HLOC seems a promising avenue for improving employees' health and participation in HPPs.

Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit) and an unhealthy alternative (chocolate). Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people's health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

Nutritional status and its health-related factors among older adults in rural and urban areas

AIM

To compare health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban counties of Taiwan.

BACKGROUND

The older adult population of Taiwan is increasing. Furthermore, older people living in rural areas have shorter life expectancy and more chronic diseases than their urban counterparts. However, little is known about the health-related characteristics, nutrition-related factors and nutritional status of older adults living in rural and urban areas of Taiwan, limiting nurses' ability to identify and care for older adults at risk of poor nutritional health.

DESIGN

Cross-sectional, comparative.

METHODS

Older adults were randomly selected from names of residents of an adjacent rural and urban area of northern Taiwan and having completing the 2009 health evaluation. From March-July 2010, older adult participants (N = 366) provided data on demographic and health-related information, nutritional self-efficacy, health locus of control and nutritional status. Data were analysed by descriptive statistics and compared using chi-square and t-test.

RESULTS

Older rural participants had significantly lower educational level, less adequate income, higher medication use, lower scores on self-rated health status and researcher-rated health status and lower self-rated healthy eating status than their urban counterparts. Moreover, rural participants had significantly lower nutritional self-efficacy, higher chance health locus of control and poorer nutritional status than their urban counterparts.

CONCLUSIONS

Our results suggest that nurses should assess older adults living in rural areas for nutritional health and nutrition knowledge. Based on this assessment, nurses should develop easy, practical and accessible nutritional programmes for this population.

The Impact of Unemployment on Mental and Physical Health, Access to Health Care and Health Risk Behaviors

The purpose of this study was to examine the impact of employment status and unemployment duration on perceived health, access to health care, and health risk behaviors. Data from Nevada's 2009 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. We compared participants who were unemployed (greater than and less than one year) to those who were employed and those who were voluntarily out of the labor force (OLF). Unemployed participants had significantly worse perceived mental health profiles, were more likely to delay health care services due to cost, and were less likely to have access to health care than employed participants and OLF participants. OLF participants were not significantly different from employed participants. Contrary to previous findings, unemployed participants in this study were not more likely to binge drink, smoke, or be physically inactive. Findings from this study suggest that the impetus for unemployment, be it voluntary or involuntary, may significantly impact a person's mental health.

Cohort profile: the Caerphilly health and social needs electronic cohort study (E-CATALyST)

The Caerphilly Health and Social Needs study was established to inform and support collaborative multiagency working on reducing inequalities in health and to investigate neighbourhood influences on mental health. Initially, we collated a robust small-area multiagency dataset of contextual health determinants and outcomes from routine sources and sharing of data between the National Health Service and Caerphilly county borough council. These data were widely used in local joint planning to improve health and reduce health inequalities. Secondly, we carried out a baseline population questionnaire survey, collecting data from 10 892 (60.6%) respondents aged 18-74 years on a wide range of socio-economic, lifestyle, health and housing factors and perceptions of the local neighbourhood, including access to services, social cohesion and neighbourhood quality. We carried out wave 2 of the survey after 7 years with responses from 4558 (50.2%) participants to the same range of questions. We developed the study into an electronic cohort, linking all 17 979 sampled participants aged 18-74 years to mortality and hospital admission records with 10-year follow-up and full recording of migration both within and out of the borough. Readers with an interest in collaborative use of the data should contact Professor David Fone, Principal Investigator.

Sense of control and sociodemographic differences in self-reported health in older adults

PURPOSE

Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health.

METHODS

Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the midlife developmental inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions).

RESULTS

Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals.

CONCLUSIONS

Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health.

Effect of education and health locus of control on safe use of pesticides: a cross sectional random study

Background

In Egypt, many pesticides are used to control pests in agricultural farms. Our study aimed to investigate knowledge and behaviors of farmers related to pesticide use and their relation to educational level and health locus of control. Health locus of control is the degree to which individuals believe that their health is controlled by internal or external factors.

Methods

A cross-sectional randomized approach was used to collect data from 335 farmers in Mahmoudiya region, Egypt using an interview questionnaire. Results were analyzed using Pearson Chi-square test, Fisher's exact test, Student t-test and ANOVA.

Results

The average age of farmers was 34 years and 61% of them didn't receive school education. School education was related to higher levels of knowledge and behaviors. Farmers who received school education had more knowledge about the negative effects of pesticides on health and routes of contamination with pesticides. They also had higher scores on reading labels of pesticides containers and taking precautions after coming in contact with pesticides. Regarding health locus of control, higher internal beliefs were significantly related to higher knowledge and behaviors scores, while there was no significant relation between chance and powerful others beliefs with knowledge or behaviors.

Conclusion

In the present study, higher level of education and lower level of internal beliefs were related to better knowledge and safer use of pesticides among Egyptian farmers. We recommend that strategies for raising internal beliefs must be included in health education programs that aim to ameliorate pesticides use among farmers.

Gender differences in Greek centenarians. A cross-sectional nation-wide study, examining multiple socio-demographic and personality factors and health locus of control

Background

Centenarians are exceptional ageing paradigms, offering valuable information on achieving longevity. Although, there are several studies examining different biomedical factors as determinants of longevity in centenarians, little is known about gender differences with respect to personality traits and health locus of control.

Methods

Nation -wide study carried out in Greece, between 2007 and 2010. Our final sample of analysis consisted of 400 centenarians who reported on sociodemographic, disease-related and personality factors and health locus of control (HLC). Gender differences were investigated by simple nonparametric comparisons. Bivariate correlations between personality factors and internal and external HLC were obtained.

Results

Women centenarians outnumbered men by a ratio of 1.68 to 1. Significant gender sociodemographic differences were noted, with men reporting less often widowhood, more often centenarian 1st degree relatives and smoking. Higher BMI score was measured in males than females. Concerning personality variables, females were more reward-dependent and adaptable than men, while men were more optimistic than women. No differences were found on health locus of control profile between the genders. Positive correlations between self-directness and spirituality with internal locus of control in men and negative correlations between optimism and external locus of control in women emerged as the main gender disparities in the correlation analyses. Self-directness in men and optimism in women were consistently correlated with the two HLC subscales.

Conclusions

Gender differences should be incorporated in future basic research and epidemiological studies of longevity. Informed policies on ageing and wellbeing programs should also take into account gender issues to increase efficacy by targeting health locus of control.

Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome?

STUDY DESIGN

Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above.

OBJECTIVE

To assess the influence of education level on outcomes for treatment of lumbar disc herniation.

SUMMARY OF BACKGROUND DATA

Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.

METHODS

The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disc herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open discectomy versus nonoperative treatment. Outcomes were changes from baseline for 36-Item Short Form Health Survey (SF-36), bodily pain (BP), and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years.

RESULTS

Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For nonoperative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (P = 0.007), PF (P = 0.001), and ODI (P = 0.003). At 4 years a "dose-response" type relationship was shown for BP (high school or less = 25.5, some college = 31, and college graduate or above = 36.3, P = 0.004) and results were similar for PF and ODI. The success of nonoperative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery.

CONCLUSION

Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.

Oral health: locus of control, health behavior, self-rated oral health and socio-demographic factors in Istanbul adults

OBJECTIVES

To determine oral health control beliefs of Istanbul adults using the Multidimensional Oral Health Locus of Control Scale (MOHLCS) after confirming its factorial validity and to examine the relationships between these beliefs, self-rated oral health, oral health behaviors and socio-demographic factors.

MATERIAL AND METHODS

The MOHLCS was administered to a sample of 1200 subjects aged ≥18 years in Istanbul chosen using a quota-sampling method (response 88%). The relationship between the MOHLCS and oral health behaviors, self-rated oral health and socio-demographic factors was assessed after confirming the factorial validity of the MOHLCS.

RESULTS

The MOHLCS demonstrated satisfactory internal reliability. Factor analysis results showed a new four-factor solution, namely Internal, Dentist, Chance, and Socialization agents. Multivariate analysis showed that female gender, younger age, higher socioeconomic status, more frequent daily toothbrushing, and regular dental check-ups were associated with higher Internal beliefs, while older age, lower educational level, lower socioeconomic status, low toothbrushing frequency, and symptom-orientated dental attendance were associated with higher Chance beliefs. Being unmarried and low toothbrushing frequency were associated with lower Dentist beliefs. Males and older subjects had lower Socialization agents beliefs. Internal, Dentist and Chance beliefs were significantly associated with self-rated oral health.

CONCLUSIONS

Compared with the original factor structure, the new factor structure had better goodness of fit for this sample. Self-rated oral health, socio-demographic factors, and oral health behaviors were significantly associated with oral health control beliefs. These beliefs may be useful for planning oral health promotion programs and for formulating advice given by oral health professionals about their patients' oral health behaviors.

Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women

This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.

Relationship of quality of life to dispositional optimism, health locus of control and self-efficacy in older subjects living in different environments

PURPOSE

To describe the relationship of dispositional optimism, health locus of control and self-efficacy to quality of life (QOL) in older subjects differing in level of disability and institutionalisation.

METHODS

The study was conducted in the three groups of subjects aged > or = 65: 110 relatively healthy community-dwelling elderly, 102 independent elders who voluntarily decided to live in veteran home and 112 inhabitants of a long-term care home. Life orientation test-revised (LOT-R), multidimensional health locus of control (MHLC) and generalised self-efficacy scale (GSES) together with a multidimensional assessment were performed with each subject. QOL was assessed using the Euroqol 5D questionnaire, the Nottingham health profile and the satisfaction with life scale (SWLS).

RESULTS

QOL generally decreased with growing level of dependence and institutionalisation. LOT-R, MHLC and GSES were important and independent correlates of QOL in all three environments of older subjects. The relationship of education, smoking habit, physical activity, strength and mobility measures to psychological characteristics was different in the three groups of elders. LOT-R, MHLC Powerful Others, MHLC Chance and GSES were the most important QOL correlates in veteran home group, while MHLC Internal was most significant in long-term care home inhabitants.

CONCLUSIONS

Data of this cross-sectional study suggests that the veteran home elderly, as a group 'in transition' between community and institution, should be the first target of psychological preventive and health-promoting measures aimed at improving QOL in older population.

Examining the association between race, ethnicity, and health status: do assets matter?

The current study employs data from the 2004 Immigration and Intergenerational Mobility in Metropolitan Los Angeles (IIMMLA) study to examine the degree to which observed differences in self-reported health status between African Americans, Asians, Latinos, and non-Hispanic Whites in the United States can be attributed to differences in various indicators of socioeconomic status. Results of the multinomial logistic regression techniques suggest that socioeconomic indicators had varying significant effects in predicting self-reported health status among all racial and ethnic groups. Among African Americans, homeownership, income, and age played a significant role. Among Asian Americans, only income and age significantly predicted health status. Among Latinos, income, having a checking account, and age significantly shaped health status, while education, age, and homeownership significantly predicted health status among non-Hispanic Whites.