Reliability and Validity of the Multidimensional Health Locus of Control Scale in Japan: Relationship with Demographic Factors and Health-Related Behavior

Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations

BACKGROUND

Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual's likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions.

OBJECTIVE

This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC.

METHODS

We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared.

RESULTS

Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed.

CONCLUSIONS

We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts.

Perception of COVID-19 threat, low self-efficacy, and external locus of control lead to psychological distress during the COVID-19 pandemic

While it is well documented that the COVID-19 pandemic has had critical consequences for individuals' mental health, few studies to date have investigated the influence of psychological factors on psychological distress in the context of COVID-19. This study explores the influences of self-efficacy, health locus of control, and COVID-19 threat perception on psychological distress (DASS-21). 180 adults completed an online set of standardised questionnaires. Results indicated that self-efficacy had a significant relationship with all three subscales of psychological distress. However, COVID-19 threat perception was significantly associated with stress. External health locus of control was significantly associated with depression by the chance externality subscale, and stress by the powerful others externality subscale. Additionally, external health locus of control was found to moderate the relationship between COVID-19 threat perception and depression.

Role of health locus of control in preventing occupational decompression sickness among deep-sea fisherman divers

Background

Indigenous fisherman divers frequently experience decompression sickness (DCS). This study aimed to evaluate the associations between the level of knowledge of safe diving, beliefs in the health locus of control (HLC), and regular diving practices with DCS among the indigenous fisherman divers on Lipe island. The correlations among the level of beliefs in HLC, knowledge of safe diving and regular diving practices were evaluated also.

Method

We enrolled the fisherman divers on Lipe island and collected their demographics, health indices, levels of knowledge of safe diving, beliefs in external and internal HLC (EHLC and IHLC), and regular diving practices to evaluate the associations with the occurrence of DCS by logistic regression analysis. Pearson's correlation was used to test the correlations among the level of beliefs in IHLC and EHLC, knowledge of safe diving, and regular diving practices.

Results

Fifty-eight male fisherman divers whose mean age was 40.39 (±10.61) (range 21-57) years were enrolled. Twenty-six (44.8%) participants had experienced DCS. Body mass index (BMI), alcohol consumption, diving depth, duration of time in the sea/dive, level of beliefs in HLC and regular diving practices were significantly associated with DCS (p < 0.05). Level of belief in IHLC had a significantly strong reverse correlation with that in EHLC and a moderate correlation with level of knowledge of safe diving and regular diving practices. By contrast, level of belief in EHLC had a significantly moderate reverse correlation with level of knowledge of safe diving and regular diving practices (p < 0.001).

Conclusions

Encouraging the fisherman divers' belief in IHLC could be beneficial for their occupational safety.

A fuzzy Bayesian network DEMATEL model for predicting safety behavior

Objectives. Safety behavior significantly affects safety performance in the workplace. This study aimed to develop a Bayesian network (BN) model for managing and improving safety behavior. Methods. This study was carried out in the chemical industries in Iran. The data were gathered by a questionnaire consisting of 13 variables including organization safety priority, systems design, safety communication, safety education, work strategy, human-system interaction, mental workload, environmental distractions, work pressure, fatigue, sleepiness, safety knowledge and locus of control. The BN structure was created using the fuzzy decision-making trial, evaluation laboratory method and expert opinions. Belief updating was used to determine variables with the strongest effect on safety behavior. Results. Locus of control, organization safety priority and safety knowledge were the best predictors of safety behavior. Moreover, it was found that improving organization safety priority and safety knowledge is the best intervention strategy to improve safety behavior significantly. Conclusions. BN is a powerful tool that can model causal relationships among variables. Improving organization safety priority and safety knowledge can lead to the maximum possible level of safety behavior.

Knowledge of risk and protective factors for dementia in older German adults A population-based survey on risk and protective factors for dementia and internet-based brain health interventions

Background

Evidence on potentially modifiable risk factors for dementia is accumulating rapidly, including e.g. physical inactivity, hypertension, or diabetes. It is unclear to what extent these risk factors are known among the general population in Germany. We investigated knowledge on risk and protective factors for dementia and openness to eHealth interventions for brain health in the older general population in Germany.

Methods

A population-based telephone survey among randomly selected community-dwelling adults aged ≥ 60 years was conducted. We assessed sociodemographic factors, knowledge on risk and protective factors for dementia, openness towards eHealth and psychosocial outcomes (health literacy, resilience). Factors associated with interest in information on brain health and openness towards eHealth interventions were assessed using multivariable logistic regression.

Results

Of n = 500 respondents (mean age: 74.8 years, % female: 62.8), 67.9% believed that dementia risk is modifiable. Participants mostly endorsed physical and cognitive activity as protective factors and social isolation as a risk factor. Knowledge on cardiovascular risk factors was low to moderate. 38.0% were interested in information on dementia risk reduction. Better knowledge of risk factors for dementia and higher age were linked to interest in information on brain health. Being widowed and higher levels of health literacy were associated with lower interest in information. Openness to eHealth interventions was moderate (46.2%). Younger age, better knowledge of risk and protective factors were linked to openness towards eHealth tools, as was knowing someone with dementia and interest in information on brain health.

Conclusion

Belief in preventability of dementia was higher in our sample than previously reported. However, knowledge on cardiovascular risk factors for disease was insufficient and more information and intervention approaches targeted at older adults are needed. Interest in information on dementia risk reduction and eHealth approaches was moderate, and further studies are warranted to assess needs and concerns of older adults regarding dementia prevention.

Cross-Regional Research in Demographic Impact on Safety Consciousness and Safety Citizenship Behavior of Construction Workers: A Comparative Study between Mainland China and Hong Kong

The construction industry has rapidly developed with continuous prosperity in Hong Kong and Mainland China, although accidents still occur with unacceptable frequency and severity. For promoting the safety issue of workers in construction industry, safety citizenship behavior (SCB) and safety consciousness (SC) were considered two influential constructs and further studied with integration of sociodemographic theories by scholars. However, no study has compared the SC and SCB of construction workers in terms of the demographic influence between Mainland China and Hong Kong. To fill this research gap, this study investigated the territorial difference between these two regions by conducting a cross-sectional questionnaire survey with recruitment of 253 Mainland construction workers and 256 Hong Kong construction workers. Significant similarities and differences of SC and SCB performance were revealed in terms of the workers with different genders, education levels, weekly working hours, and ages. This study provides insights into the comparison of demographic influence on SC and SCB of construction workers between Hong Kong and Mainland China, which is unique as it can yield useful managerial knowledge relevant to the personal safety of targeted groups of construction workers with particular demographic characteristics in both regions and contribute the implementation of safety interventions in line with the specific distinction in the territorial aspect.

The Use of E-Cigarettes among High School Students in Poland Is Associated with Health Locus of Control but Not with Health Literacy: A Cross-Sectional Study

Since their introduction, the use of electronic cigarettes has increased considerably in the population and among adolescents. Determinants of smoking conventional cigarettes were thoroughly studied in various social groups. However, we know less about the predictors of the use of e-cigarettes in younger generations. The main aim of this study was the assessment of the factors associated with the use of electronic cigarettes among high school students. Specifically, the roles of health literacy (HL) and health locus of control (HLC) were addressed. The analysis was based on the data from a 'pen-and-pencil' survey performed in a large sample of 2223 high school students from southern Poland. The tools used in the survey encompassed 133 items, including a 47-item European Health Literacy Survey questionnaire, an 18-item Multidimensional Health Locus of Control Scale, and a set of questions asking about the health behaviors, and sociodemographic and economic characteristics of respondents. In the study sample, 47.5% of the respondents had used e-cigarettes in the past, and 18.6% had used them in the last month. HL was not significantly associated with dependent variables reflecting the use of e-cigarettes. Two types of external HLC were associated with using e-cigarettes in the past, and 'Chance' HLC (CHLC) was also associated with their use in the last month. Males, students of schools providing vocational training, and students declaring more Internet use during the week showed a higher likelihood of ever using e-cigarettes or using them in the last month. Students smoking conventional cigarettes were also more prone to use e-cigarettes. To sum up, it was an unexpected result that HL is not associated with the use of e-cigarettes. A greater likelihood of using e-cigarettes was positively associated with higher CHLC scores, as in the case of smoking traditional cigarettes.

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.

Comparing the impact of educational messages based on an extended parallel process model on solid waste separation behaviors in female students: A four-group randomized trial

BACKGROUND

The increase in non-separated solid waste is a threat to environmental health. People may be motivated to reduce the destructive effects of waste accumulation in the environment by receiving educational messages and learning the proper methods of waste separation. This study aimed to determine the effect of educational messages on waste separation in dormitory students based on Extended Parallel Process Model (EPPM).

METHODS

This randomized controlled trial was performed on 320 students categorized into four groups from October to December 2019. After installing waste separation tags on separate containers, three types of messages were presented to encourage and educate waste separation in the following four groups: threat messages; efficacy messages; threat/efficacy messages; and control group. Data were collected prior to and one week after training by a self-reported valid and reliable questionnaire. They were analyzed in SPSS21.

RESULTS

In the efficacy group and threat/efficacy group, not only the mean scores of "perceived threat associated with non-segregation and waste accumulation", "attitude" and "intention" but also the mean score of "efficacy" and "waste separation behavior" were improved (P < 0.05). In both groups, the mean score of "perceived barriers" for waste separation was lower than the other two groups (P < 0.001).

DISCUSSION

Use of efficacy-based massages alone or in combination with the threat component was proposed to promote waste separation. No specific study has documented the effectiveness of messages based on EPPM on solid waste separation behaviors. The current study highlighted the effectiveness of using EPPM to promote waste-separation behavior in practice, not in theory.

Development and psychometric evaluation of waste separation beliefs and behaviors scale among female students of medical sciences university based on the extended parallel process model

Background

The increasing production of un-recycled waste is a great threat to public health. Therefore, assessment and measurement of people’s beliefs and perceptions with regard to these threats can contribute to the development of suitable educational messages promoting waste separation behaviors. This study aimed to carry out the scale development and psychometric evaluation of behaviors and beliefs associated with waste separation among female students.

Method

This methodological research was performed in 2019. The primary questionnaire was developed based on the assessment of waste separation beliefs and behaviors based on the extended parallel process model. Afterwards, to confirm the content and face validity of the research tool, the opinions of 14 faculty members and certain students were asked for, respectively. In order to assess the construct validity of the questionnaire, exploratory factor analysis was performed based on the data collected from 386 female students in Isfahan University of Medical Sciences, Iran. The internal and external reliability of the tool was determined through estimating Cronbach’s alpha and test-retest based on intraclass correlation (ICC) index, respectively.

Results

The mean age and academic semester of the students were 22 ± 1.9 years and 5.58 ± 2.6, respectively. The primary version of the questionnaire was designed with 65 items; one item was omitted during the content validity process. Construct validity with factor analysis technique yielded nine dimensions including 64 items with a factor loading above 0.3. The overall reliability of the research tool was confirmed at Cronbach’s alpha of 0.87. Furthermore, the ICC of the entire questionnaire was 0.89.

Conclusion

According to the results of the study, the final 64-item questionnaire could be used by various researchers to assess waste separation beliefs and behaviors considering suitable psychometric features.

Turkish validity and reliability of Multidimensional Health Locus of Control Scale Form A

AIM

The aim of this study was to assess the validity and reliability of the Turkish version of Multidimensional Health Locus of Control Scale Form A.

METHODS

The research is a methodological instrument validation study, and the study sample consisted of 275 participants. The data collection phase of the study was completed between 15 July and 15 September 2016. The study used data collection tools including a Personal Information Form, the Multidimensional Health Locus of Control Scale Form A, and the Internal-External Locus of Control Scale. Data on sociodemographic variables are presented as percentages and means. Confirmatory factor analysis and correlation analyses were used.

RESULTS

The Cronbach α values of the subdimensions of the Multidimensional Health Locus of Control Scale Form A were determined as acceptable for the internal control, the chance, and powerful other subscales. The confirmatory factor analysis showed acceptable values and acceptable fit for the model fit statistics.

CONCLUSION

The Turkish version of Multidimensional Health Locus of Control Scale Form A was accepted as valid and reliable.

Relationship of Health Locus of Control with Breast Cancer Screening Belief of Iranian Women

Promoting breast cancer screening (BCS) behavior of women can lead to a reduction in mortality. The health locus of control affects cancer screening behavior of women; however, there is not sufficient evidence regaring this issue in Iran. The overall goal of our study is to determine the relationship of the health locus of control with the breast cancer screening belief of Iranian Women. This is a cross-sectional study carried out on 325 women in Tehran. The Multidimensional Health Locus of Control (MHLC), Breast Cancer Screening Belief Questionnaire (BCSBQ), and Demographic questionnaire were used for collecting data. Statistical analyze was performed by the SPSS version 17 software. The Pearson correlation and regression model were used for data analyze. In this study, 325 women, age 18 to 75 years, participated in this study. The mean±SD of BCSBQ and MHLC score was 40.72±10.41 and 67.78±17.67 respectively. The regression analysis showed that for the one-unit increase in the Internal Health Locus of Control (IHLC), Powerful others Health Locus of Control (PHLC), and Chance Health Locus of Control (CHLC) score (dimensions of Health Locus of Control), the total BCSBQ scores increased 0.54, 0.31, and 0.57 respectively. For each unit increase in age and education, the knowledge and perceptions of the BC score increased 0.05 and 0.23 units respectively. For the one-unit increase in the IHLC, PHLC, age, and education dimensions, the attitudes towards the general health check-up score increased 0.17, 0.1, 0.05, and 0.188 respectively. The current study provided new insights about the BCSB of Iranian women with MHLC. In the study, all the dimensions of the health locus of control were useful in predicting the breast cancer screening belief of the participants.

Factors associated with physical activity in African Americans with hypertension

BACKGROUND

Pharmacological management only controls 58% of those with hypertension. Combining pharmacological therapy with physical activity is important in controlling hypertension.

AIM

To examine factors associated with physical activity (PA) adherence in African Americans (AAs) with hypertension and antihypertensive medication adherence.

METHODS

A cross-sectional descriptive correlational design was used to examine if systolic BP, co-morbidities, serum creatinine and potassium, education, depression, locus of control, and social support explained PA adherence in a convenience sample of AAs (N = 77) aged 55 to 84. All completed: demographic data, PA visual analog scale (VAS-PA); Multidimensional Health Locus of Control Scale; Patient Health Question-9 Depression Instrument. Physiological data and co-morbidities were also collected.

RESULTS

A third (n = 26) had systolic BP over 140 mm/Hg. The model explained 26% variance in adherence to PA (F = 3.378 [8, 68]; p = .003) with creatinine (p < .05), depression (p < .01), and social support (p < .05) as significant. Differences in VAS-PA scores between levels of depression were significant (F = 4.707 [269], p = .012; Eta² = 0.12). Those with no depression had significantly higher PA adherence (M = 88.26, SD = 18.97) compared to mildly depressed (M = 70.24, SD 27.71) and moderately depressed (M = 66.83, SD = 23.31).

CONCLUSIONS

Clinicians should promote PA as an adjunct to medications for effective control of hypertension in AAs. Screening and intervening for depression are important when examining adherence to PA in AAs with hypertension.

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.

Effect of educational intervention based on locus of control structure of attribution theory on self-care behavior of patients with type II diabetes

Background: Different factors, such as personality and psychological characteristics, are effective in the self-care and control of diabetes. This study aimed at determining the effect of educational intervention based on locus of control structure of attribution theory on the self-care behavior of patients with type II diabetes. Methods: This was a quasi-experimental controlled study performed on 180 patients in Babol Diabetes Association. The sampling method was simple random sampling. Data collection tool was form C of standard questionnaire in multidimensional health locus of control (MHLC) and summary of diabetes self-care activities (SDSCA). Based on the results obtained from the initial completion of the questionnaires, educational intervention was designed as three 60-minute educational sessions using short lectures, question and answer, group discussions, and consultation methods, as well as educational materials, such as films, posters, and pamphlets. Intervention was only performed for the test group. The questionnaires were filled out again 2 and 3 months after the intervention. Results: Before the intervention, there was no significant difference in the mean scores of self-care, internal, chance, and external locus of control between the 2 groups. However, 2 to 3 months after the intervention, the mean scores of self-care (p<0.001) and locus of control (p<0.001) increased in the test group. Moreover, the mean score of chance (p<0.001) and external (p<0.001) locus of control decreased significantly. Conclusion: Educational intervention decreases the mean scores of chance and external locus of control and increases the mean score of internal locus of control; as a result, it improves self-care in patients with diabetes.

Examining the relationship between health locus of control and God Locus of Health Control: Is God an internal or external source?

For many people, the influence of believing in a higher power can elicit powerful effects. This study examined the relationship between God control, health locus of control, and frequency of religious attendance within 838 college students through online surveys. Regression analysis showed that chance and external locus of control and frequency of religious attendance were significant and positive predictors of God Locus of Health Control. The association of powerful others external locus of control and God Locus of Health Control differed by race (stronger in non-Whites than Whites) and somewhat by gender (stronger in women than men). For some people, the role of a supreme being, or God, should be considered when designing programs for improving health behaviors.

Examining Depressive Symptoms and Their Predictors in Malaysia: Stress, Locus of Control, and Occupation

The 2015 National Health and Morbidity Survey estimated that over 29% of the adult population of Malaysia suffers from mental distress, a nearly 3-fold increase from the 10.7% estimated by the NHMS in 1996 pointing to the potential beginnings of a public health crisis. This study aimed to better understand this trend by assessing depressive symptoms and their correlates in a cross-section of Malaysians. Specifically, it assesses stress, perceived locus of control, and various socio-demographic variables as possible predictors of depressive symptoms in the Malaysian context. A total of 728 adults from three Malaysian states (Selangor, Penang, Terengganu) completed Beck’s depression inventory as well as several other measures: 10% of respondents reported experiencing severe levels of depressive symptoms, 11% reported moderate and 15% reported mild depressive symptoms indicating that Malaysians are experiencing high levels of emotional distress. When controlling for the influence of other variables, depressive symptoms were predictably related to higher levels of stress and lower levels of internal locus of control. Ethnic Chinese Malaysians, housewives and those engaged in professional-type occupations reported less depressive symptoms. Business owners reported more depressive symptoms. Further research should look more into Malaysians’ subjective experience of stress and depression as well as explore environmental factors that may be contributing to mental health issues. It is argued that future policies can be designed to better balance individual mental health needs with economic growth.

Posttraumatic stress disorder following asthma attack: the role of agency beliefs in mediating psychiatric morbidity

BACKGROUND

The link between serious illness and subsequent posttraumatic stress disorder (PTSD) and psychiatric comorbidity has been established. In populations with asthma, however, few studies have investigated this link, or what psychological mechanisms mediate it. Healthcare guidance for chronic conditions, and PTSD literature, highlight "agency beliefs" as a direction for investigation.

AIMS

To determine the prevalence of PTSD following asthma attack, and investigate whether agency beliefs mediate PTSD and comorbid psychiatric symptoms in this population.

METHOD

We recruited 110 adults with asthma from online peer support forums. Participants completed the Asthma Symptom Checklist, PTSD Checklist, GHQ-28, General Self-Efficacy scale, and Multidimensional Health Locus of Control scale.

RESULTS

20% of our sample met criteria for PTSD. Regression results indicated that higher asthma severity significantly predicted PTSD and psychiatric co-morbidity. Lower self-efficacy significantly predicted PTSD symptoms while controlling for asthma severity, however Locus of Control (LoC) did not improve the model further. Self-efficacy, but not LoC, significantly partially mediated the effect of asthma severity on PTSD severity and psychiatric co-morbidity.

CONCLUSIONS

PTSD and other psychiatric symptoms in asthma populations are mediated in part by self-efficacy. Safeguarding and improving self-efficacy in this population is an important area for future research and 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.

Why do Dutch people use dietary supplements? Exploring the role of socio-cognitive and psychosocial determinants

BACKGROUND

In the Netherlands, the prevalence of dietary supplement use has doubled (from 17 to 40 per cent) since the 1980s. Yet, limited data is available on which socio-cognitive factors are associated with dietary supplement use. Therefore, the purpose of the study is to explain dietary supplement use with determinants deriving from the Integrated Change Model (ICM) and from formative research.

METHOD/DESIGN

Socio-cognitive and psychosocial factors were measured among users and non-users of dietary supplements in a longitudinal survey study, with measurements at baseline (N = 1448) and at one-month follow-up (N = 1161). Negative binomial regression analysis was applied to de data.

RESULTS

Intention emerged as the main predictor of dietary supplement use (OR = 1.99). Further predictors of dietary supplement use with smaller effect-sizes were: health regulatory focus (promotion, OR = 1.46), social modelling (OR = 1.44), attitude (pros, OR = 1.37), attitude (cons, OR = 0.87), health locus of control (OR = 0.77), and risk perception (chance of getting ill, OR = 1.22).

CONCLUSIONS

Individuals tend to use dietary supplements if they are promotion oriented, notice dietary supplement users in their social environment, estimate their chances of getting ill higher, and have positive attitudes towards dietary supplements. In contrast, non-users believe that external factors affect their health, and hold negative attitudes towards dietary supplements.

PRACTICAL IMPLICATIONS

Mapping out individuals' socio-cognitive profile may contribute to the development of online health communication. Based on socio-cognitive and demographical factors, personalised advice can be given about dietary supplement use.

Two systems for empathy in obsessive-compulsive disorder: mentalizing and experience sharing

Objective:

To investigate empathic abilities in patients with obsessive-compulsive disorder (OCD) compared to control subjects. OCD is characterized by persistent obsessions and compulsions. Previous studies have proposed specific emotion recognition deficits in patients with OCD. The ability to recognize emotion is part of the broad construct of empathy that incorporates mentalizing and experience-sharing dimensions.

Methods:

Twenty-four subjects with a diagnosis of OCD and 23 control subjects underwent empathic measures.

Results:

Patients with OCD compared to control subjects showed deficits in all mentalizing measures. They were incapable of understanding the mental and emotional states of other people. On the other hand, in the sharing experience measures, the OCD group was able to empathize with the emotional experience of other people when they expressed emotions with positive valence, but were not able to do when the emotional valence was negative.

Conclusion:

Our results suggest that patients with OCD show a difficulty in mentalizing ability, whereas the deficit in sharing ability is specific for the negative emotional valence.

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.

Relationship of locus of control with plaque and gingival status before and after oral health education in a group of college students - an experimental study

OBJECTIVES

In health psychology, several models are being constructed to understand human behaviour. Multidimensional health locus of control (MHLC) is one among them. We sought to know the relationship of MHLC with dental plaque and gingival status before and after oral health education programme among 286 college students, aged 18-21 years in Davangere city.

METHODS

Multidimensional health locus of control questionnaire consisting of questions measuring internal health locus of control (IHLC), powerful others health locus of control (PHLC) and chance health locus of control (CHLC) was administered to students. Dental plaque and gingival health status were recorded using Plaque Index (PLI) and Gingival Index (GI), 1967. Oral health education was provided using power point presentation after the baseline oral examination. After 10 weeks of intervention, the students were given the same proforma followed by the assessment of plaque and gingival status.

RESULTS

A negative correlation was observed between PHLC and IHLC with PLI and GI and positive correlation of CHLC with PLI and GI at a level of P < 0.01. The difference between 'pre-test' and 'post-test' mean PLI scores, GI scores, PHLC was found to be statistically significant at a level of P < 0.05.

CONCLUSION

Oral health education was found to be effective and this could change the behaviour of individuals.

The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study

BACKGROUND

Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease.

METHODS

In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach.

RESULTS

The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control.

CONCLUSIONS

This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

A comparative study of health locus of control in patients with schizophrenia and their first degree relatives

BACKGROUND AND AIMS

An individual's behaviour may be predicted from their beliefs about their locus of control (attribution). A person's "locus" can be internal or external. The present study aimed at comparing the locus of control as measured by Multidimensional Health Locus of Control Scale (MHLC) in patients with schizophrenia and their healthy first degree relatives. We hypothesized that persons with schizophrenia have different locus of control than their first degree relatives.

METHOD

Multidimensional Health Locus of Control Scale (MHLC) was first translated and validated in Hindi by bilingual students (N = 71). Consecutive patients affected with schizophrenia (SZ) (N = 125) and their siblings/offsprings (N = 119) were recruited. Diagnostic Interview for Genetic Studies and MHLC Scale were administered after written informed consent.

RESULTS

There was moderate intra-class correlation between Hindi and English versions of MHLC Scale. Schizophrenia patients were found to have more of 'chance' locus of control (F 6.625, p = 0.011) whereas their first degree relatives have more of 'internal' locus of control (F 6.760, p = 0.010).

CONCLUSION

Patients with SZ attributed their health to external factors which has been found to be associated with poor or late recovery. These findings may provide a theoretical base for developing intervention strategies to promote behavioural changes in patients.

Health-related behavior, profile of health locus of control and acceptance of illness in patients suffering from chronic somatic diseases

PURPOSE

The purpose of the study was to determine health-related behaviors, profile of health locus of control (HLC), and to assess the relationships between these constructs among patients suffering from chronic somatic diseases.

MATERIAL AND METHODS

Three-hundred adult patients suffering from various chronic diseases participated in the study. The patients' mean age was 54.6 years (SD = 17.57).

RESULTS

No statistically significant differences were found between the different clinical groups in health-related behavior, acceptance of illness, internal HLC or chance HLC. Patients with neurologic conditions showed slightly lower powerful others HLC than did some other clinical groups. Health-related behavior was significantly positively related to all three categories of HLC, with most prominent associations observed with powerful others HLC. Only one type of health-related behavior--preventive behavior--correlated significantly and negatively with acceptance of illness. Differences in the frequency of health-related behavior were also found due to gender (women showing more healthy nutritional habits than men), age (older subjects showing more frequent health-promoting behavior), education (higher education was associated with less frequent health-promoting behavior) and marital status (widowed subjects reporting more frequent health-promoting behavior).

CONCLUSIONS

Health-related behavior in patients with chronic diseases seems to be unrelated to a specific diagnosis; however it shows associations with both internal and external HLC. Sociodemographic factors are also crucial factors determining frequency of health-related behavior in such patients.

The locus of pain control in patients with lower limb ulcerations

AIMS AND OBJECTIVES

(1) To analyse the distribution of pain control profiles of individuals suffering from the lower limb ulcerations. (2) To identify sociodemographic and clinical factors determine the locus of pain control in this group of patients.

BACKGROUND

The locus of pain control can play a critical role in determining the quality of life in patients with lower limb ulcerations, and identification of individuals with an unfavourable pain control profile would enable the opportunity of offering them dedicated psychological counselling.

DESIGN

Quantitative survey.

METHODS

This study included 298 patients with lower limb ulcerations resulting from chronic venous insufficiency (n = 101), lower limb atherosclerosis (n = 98), or having mixed arteriovenous aetiology (n = 99). The study included the completion of the Polish version of the Beliefs about Pain Control Questionnaire.

RESULTS

The most important role in the control of pain was assigned to the powerful others locus. This locus correlated directly with poorer educational level and higher professional activity. Additionally, the intensity of usual pain correlated inversely with the powerful others locus. Respondents' age was the only sociodemographic variable decreasing the level of the internal locus. Moreover, the severity of usual and maximal pain and the area of ulceration correlated inversely with the internal locus of pain control. In contrast, the aetiology of lower limb ulceration did not affect significantly any of the dimensions of pain control.

CONCLUSION

The control of pain in ulceration patients is mostly determined by the support of medical personnel, which generally should be considered a negative finding. Relevance to clinical practice.  Determination of the locus of pain control should be included in the complex medical evaluation of individuals suffering from ulcerations.

Spiritual health locus of control and health behaviors in African Americans

OBJECTIVE

To examine relationships between spiritual health locus of control beliefs and various health behaviors.

METHODS

A cross-sectional survey of a national sample of African Americans assessed spiritual beliefs, fruit and vegetable consumption, physical activity, and alcohol consumption.

RESULTS

Active spiritual beliefs were positively associated with fruit consumption and negatively associated with alcohol consumption. Passive spiritual beliefs were associated with lower vegetable and increased alcohol consumption. Among male participants, passive spiritual beliefs were associated with higher alcohol consumption.

CONCLUSIONS

Findings suggest that dimensions of spiritual health locus of control beliefs have complex and varying relationships with health behaviors.

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.

Multiple dimensions of health locus of control in a representative population sample: ordinal factor analysis and cross-validation of an existing three and a new four factor model

BACKGROUND

Based on the general approach of locus of control, health locus of control (HLOC) concerns control-beliefs due to illness, sickness and health. HLOC research results provide an improved understanding of health related behaviour and patients' compliance in medical care. HLOC research distinguishes between beliefs due to Internality, Externality powerful Others (POs) and Externality Chance. However, evidences for differentiating the POs dimension were found. Previous factor analyses used selected and predominantly clinical samples, while non-clinical studies are rare. The present study is the first analysis of the HLOC structure based on a large representative general population sample providing important information for non-clinical research and public health care.

METHODS

The standardised German questionnaire which assesses HLOC was used in a representative adult general population sample for a region in Northern Germany (N = 4,075). Data analyses used ordinal factor analyses in LISREL and Mplus. Alternative theory-driven models with one to four latent variables were compared using confirmatory factor analysis. Fit indices, chi-square difference tests, residuals and factor loadings were considered for model comparison. Exploratory factor analysis was used for further model development. Results were cross-validated splitting the total sample randomly and using the cross-validation index.

RESULTS

A model with four latent variables (Internality, Formal Help, Informal Help and Chance) best represented the HLOC construct (three-dimensional model: normed chi-square = 9.55; RMSEA = 0.066; CFI = 0.931; SRMR = 0.075; four-dimensional model: normed chi-square = 8.65; RMSEA = 0.062; CFI = 0.940; SRMR = 0.071; chi-square difference test: p < 0.001). After excluding one item, the superiority of the four- over the three-dimensional HLOC construct became very obvious (three-dimensional model: normed chi-square = 7.74; RMSEA = 0.059; CFI = 0.950; SRMR = 0.079; four-dimensional model: normed chi-square = 5.75; RMSEA = 0.049; CFI = 0.965; SRMR = 0.065; chi-square difference test: p < 0.001). Results were confirmed by cross-validation. Results based on our large community sample indicated that western general populations separate health-related control-beliefs concerning formal and informal assistance.

CONCLUSIONS

Future non-clinical HLOC studies in western cultures should consider four dimensions of HLOC: Internality, Formal Help, Informal Help and Chance. However, the standardised German instrument needs modification. Therefore, confirmation of our results may be useful. Future research should compare HLOC structure between clinical and non-clinical samples as well as cross-culturally.

Iranian version of Form B of the Multidimensional Health Locus of Control Scales among the youth

AIMS

The purpose of this study was to translate the Form B of Multidimensional Health Locus of Control Scales into Persian and then to measure its psychometric characteristics among the Iranian youth.

BACKGROUND

The Health Locus of Control is regarded as an effective variable in developing health behaviours, clinical capacities and in determining health problems. Many studies have been conducted on Form B in the world, which have led to valuable results in health behaviours, health outcomes and health cares.

DESIGN

Questionnaire survey.

METHODS

Undergraduate students (n=448) participated in this study. The reliability of the scale was calculated through three methods of estimating reliability, namely, test-retest, parallel forms and Cronbach's alpha. To calculate the validity of the scale, we used content, concurrent, construct and predictive methods.

RESULTS

We determined the content validity of the scale by forward and backward-translating each item from English into Persian. The concurrent validity of the questionnaire was estimated as acceptable. To determine the predictive validity, the relationship between Form B and health status was used, an action that showed that health status correlated positively with Internal but negatively with Chance and did not correlate with Powerful others Health Locus of Control. The exploratory factor analysis indicated that the factor structure of the translated scale was quite similar to that of the original one. The internal consistency ranged from 0·69-0·72 and parallel forms reliability indices ranged from 0·70-0·72 for its subscales.

CONCLUSION

The results indicated that psychometric characteristics of the Iranian version of Form B were estimated acceptable among the youth.

RELEVANCE TO CLINICAL PRACTICE

The findings will assist professional health educators and nurses to develop educational interventions that should be designed to support and strengthen students' abilities so that they could recognise, understand and predict health behaviours.

A lifestyle to prevent or combat the metabolic syndrome among Japanese workers: analyses using the health belief model and the multidimensional health locus of control

We investigated the predictors significantly associated with a lifestyle to prevent or combat the metabolic syndrome among Japanese workers. We conducted an anonymous self-administered questionnaire survey and analyzed the resulting data using multiple linear regression analysis. The dependent variable was a lifestyle to prevent or combat the metabolic syndrome (7-point scale). Independent variables were: subjects' basic attributes (age, gender, blue or white collar worker, with or without a family physician), Multidimensional Health Locus of Control (7-point scale for each item), with or without the metabolic syndrome being pointed out or not by healthcare providers, and 4 items regarding the metabolic syndrome produced with reference to the Health Belief Model (7-point scale for each item). Those independent variables were all included in this model. The analysis shows the older workers, white-collar workers, and workers who had the metabolic syndrome pointed out by healthcare providers had appropriate lifestyles. Those with high scores in Powerful Others Health Locus of Control also had appropriate lifestyles. Those who realized that the metabolic syndrome was a life-threatening disease and who knew practical ways to prevent or combat the metabolic syndrome also had appropriate lifestyles. Our findings can be applied to various types of medical education regarding the metabolic syndrome.

Validity of the Multidimensional Health Locus of Control scales in American Sign Language

Few instruments have been translated and validated for people who use American Sign Language (ASL) as their preferred language. This study examined the reliability and validity of a new ASL version of the widely used Multidimensional Health Locus of Control (MHLC) scales. Deaf individuals (N = 311) were shown the ASL version via videotape, and their responses were recorded. Confirmatory factor analysis supported the four-factor structure of the MHLC. Scale reliabilities (Cronbach's alphas) ranged from 0.60 to 0.93. There were no apparent gender or ethnic differences. These results provide support for the new ASL version of the MHLC scales.

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.

Determinants of return to work in patients with hand disorders and hand injuries

INTRODUCTION

Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries.

METHODS

Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately.

RESULTS

Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group.

CONCLUSION

Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job.

Validation of the Parent Health Locus of Control Scales in an Italian sample

Aim

This study examined the psychometric properties and the replicability of De Vellis's (1993) Parent Health Locus of Control (PHLOC) scales in an Italian sample.

Method

The Italian version of PHLOC was administered to 470 mothers of birth to 3-year-old children.

Results

Varimax rotated confirmatory factor analysis identified the six original subscales, namely Child, Divine, Fate, Media, Parental, and Professional influences over child health. Internal consistency of the subscales was good (α > .70), and test-retest correlations were adequate (r > .80). More highly educated mothers rated media influence as most important. No differences were found considering children's age, gender, and birth order.

Conclusion

The results offer good evidence of the cross-cultural validity of the PHLOC scales, an instrument that can be useful in interventions with families by the health care practitioners to prevent neglectful childrearing practices.

Responsibility for managing musculoskeletal disorders--a cross-sectional postal survey of attitudes

BACKGROUND

Musculoskeletal disorders are a major burden on individuals, health systems and social care systems and rehabilitation efforts in these disorders are considerable. Self-care is often considered a cost effective treatment alternative owing to limited health care resources. But what are the expectations and attitudes in this question in the general population? The purpose of this study was to describe general attitudes to responsibility for the management of musculoskeletal disorders and to explore associations between attitudes and background variables.

METHODS

A cross-sectional, postal questionnaire survey was carried out with a random sample of a general adult Swedish population of 1770 persons. Sixty-one percent (n = 1082) responded to the questionnaire and was included for the description of general attitudes towards responsibility for the management of musculoskeletal disorders. For the further analyses of associations to background variables 683-693 individuals could be included. Attitudes were measured by the "Attitudes regarding Responsibility for Musculoskeletal disorders" (ARM) instrument, where responsibility is attributed on four dimensions; to myself, as being out of my hands, to employers or to (medical) professionals. Multiple logistic regression was used to explore associations between attitudes to musculoskeletal disorders and the background variables age, sex, education, physical activity, presence of musculoskeletal disorders, sick leave and whether the person had visited a care provider.

RESULTS

A majority of participants had internal views, i.e. showed an attitude of taking personal responsibility for musculoskeletal disorders, and did not place responsibility for the management out of their own hands or to employers. However, attributing shared responsibility between self and medical professionals was also found. The main associations found between attitude towards responsibility for musculoskeletal disorders and investigated background variables were that physical inactivity (OR 2.92-9.20), musculoskeletal disorder related sick leave (OR 2.31-3.07) and no education beyond the compulsory level (OR 3.12-4.76) increased the odds of attributing responsibility externally, i.e placing responsibility on someone or something else.

CONCLUSION

Respondents in this study mainly saw themselves as responsible for managing musculoskeletal disorders. The associated background variables refined this finding and one conclusion is that, to optimise outcome when planning the prevention, treatment and management of these disorders, people's attitudes should be taken into account.