MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL 1.

Background and References Personal control beliefs, also referred to as locus of control and personal mastery beliefs, reflect individuals beliefs regarding the extent to which they are able to control or influence outcomes. A wide variety of theorists have emphasized the importance of perceptions of personal control and suggested that the desire to control the world around us (i.e., the desire for behavior-event contingency or personal control) is a fundamental characteristic of human beings (Schultz et al, 1994; see also Haidt & Rodin, 1995; Rothbaum, Weisz and Snyder, 1982 for reviews). Reflecting these varied theoretical perspectives (as well as the extensive research interest in the concept of perceived control), the literature exhibits varying conceptualizations of "perceived control". Most well known is the concept of "locus of control" which derived originally from Rotters social learning theory (Rotter, 1966) and which focuses on "beliefs that individuals hold regarding relationships between actions and outcomes" (Lefcourt, 1991). The earliest instrument developed to measure locus of control beliefs, the Rotter I-E Scale, focused largely on the distinction between belief in internal versus external loci of control. Later instruments, elaborated by Rotter, Lefcourt and others, included more specific assessments of beliefs about personal "internal" control contingencies but also control contingencies manifested by "powerful others" and (similar to the original "external" formulation) perceptions of non-contingency (i.e. "chance") (for review see Lefcourt, 1991). Existing literature on control beliefs in relation to both SES and health largely reflects the "internal vs. external" conceptualization with assessment of individuals in terms of the extent to which they see "control" as residing primarily in themselves versus elsewhere (i.e., in others or chance). [Seeman, 1999] The Multidimensional Health Locus of Control was developed by Ken Wallston et al., at Vanderbilt University and consists of three scales (A, B, and C). Forms A & B are the "general" health locus of control scales that have been in use since the mid-late 1970's (and were first described in Wallston, Wallston, & DeVellis, 1978, Health Education Monographs, 6, 160-170.) Each of these two "equivalent" forms contain three 6 item subscales: internality; powerful others externality; and chance externality. In the past 25+ years, forms A/B have been used in over a thousand studies and have been cited in the literature hundreds of times. Form C is designed to be "condition-specific" and can be used in place of Form A/B when studying people with an existing health/medical condition. [The way you make this happen is to replace the word "condition" in each item with whatever condition (e.g., arthritis, diabetes, pain, etc.) your subjects have.] Like Forms A/B, Form C also has 18 items, but, instead of a single 6 item powerful others subscale, Form C has two, independent 3 item subscales: doctors, and other people. Form C is described in Wallston, Stein, & Smith, 1994, Journal of Personality Assessment, 63, 534-553. All three forms of the MHLC are considered to be "in the public domain, which means that they are free to be used in research (and to be altered in any way one chooses) without obtaining explicit permission.

Haidt J, Rodin J. (1995). Control and Efficacy: An Integrative Review. Report to John D. and Catherine T. MacArthur Foundation Program on Mental Health and Human Development. Lefcourt, HM. (1991). Locus of Control. In Robinson JP, Shaver PR, Wrightsman LS (Eds.) Measures of Personality and Social Psychological Attitudes (Vol. 1, pp. 413-499). San Diego, CA: Academic Press, Inc. Rothbaum R, Weisz JR, Snyder SS. (1982) Changing the world and changing the self: a two-process model of perceived control. J Pers & Soc Psych, 42:5-37. Rotter, J.B. (1966). Generalized expectancies for internal versus external control of reinforcement. Journal of Educational Research, 74(3): 185-190. Seeman T. (1999). MacAurthur Research Network on Socioeconomic Status and Health: http://www.macses.ucsf.edu/Research/Psychosocial/notebook/control.html Schultz R, Heckhausen J, O'Brian AT. (1994) Control and the disablement process in the elderly. J Soc Beh and Pers, 9:139-152. Wallston, B. S., Wallston, K. A., Kaplan, G. D., & Maides, S. A. (1976). The development and validation of the health related locus of control (HLC) scale. Journal of Consulting and Clinical Psychology, 44, 580-585. Wallston, K. A., Maides, S. A., & Wallston, B. S. (1976). Health related information seeking as a function of health related locus of control and health value. Journal of Research in Personality, 10, 215-222. Wallston, B. S. & Wallston, K. A. (1978). Locus of control and health: A Review of the literature. Health Education Monographs, 6, 107-117. Wallston, K. A., Wallston, B. S. & DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Education Monographs, 6, 160-170. Wallston, K.A. & Wallston, B.S. (1981). Health locus of control scales. In H. Lefcourt (Ed.) Research with the locus of control construct, Volume 1. New York: Academic Press. Wallston, K.A. & Wallston, B.S. (1982). Who is responsible for your health: The construct of health locus of control. In G. Sanders & J Suls (Eds.) Social Psychology of Health and Illness. Hillsdale, N.J.: Lawrence Erlbaum & Associates, 65-95. Stein, M. & Wallston, K. A. (1983). Biofeedback and locus of control: Some considerations for future re-search. American Journal of Clinical Biofeedback, 6, 40-45. Wallston, K. A., Smith, R. A., King, J. E., Forsberg, P. R., Wallston, B. S., & Nagy, V. T. (1983). Expectancies about control over health: Relationship to desire for control of health care. Personality and Social Psychology Bulletin, 9, 377-385. Stein, M., Smith, M., & Wallston, K. A. (1984). Cross-cultural issues in health locus of control beliefs. Psychological Studies, 29, 112-116. Wallston, K. A., Wallston, B. S., Smith, S., & Dobbins, C. (1987). Perceived control and health. Current Psychological Research and Reviews,6, 5-25.

Wallston, K.A. (1989). Assessment of control in health care settings. Chapter in A. Steptoe & A. Appels (Eds.) Stress, personal control and health. Chicester, England: Wiley. Wallston, K.A. (1991). The importance of placing measures of health locus of control beliefs in a theoretical context. Health Education Research, Theory & Practice, 6, 215-252. Smith, M.S. & Wallston, K.A. (1992). How to measure the value of health. Health Education Research, Theory & Practice, 7, 129-135. Wallston, K.A. (1992). Hocus-pocus, the focus isn't strictly on locus: Rotter's social learing theory modified for health. Cognitive Therapy and Research, 16(2), 183199. Wallston, K.A., Stein, M.J., & Smith, C.A. (1993). Form C of the MHLC Scales: A condition-specific measure of locus of control. Unpublished manuscript. Vanderbilt University, Nashville, TN. 2. Summary Statistics The score on each subscale is the sum of the values circled for each item on the subscale (i.e., where 1 = "strongly disagree" and 6 = "strongly agree"). No items need to be reversed before summing. All of the subscales are independent of one another. There is no such thing as a "total" MHLC score. SUBSCALE Internal Chance Powerful Others Doctors Other People FORM(s) A, B, C A, B, C A, B C C POSSIBLE RANGE 6 - 36 6 - 36 6 - 36 3 - 18 3 - 18 ITEMS 1, 6, 8, 12, 13, 17 2, 4, 9, 11, 15, 16 3, 5, 7, 10, 14, 18 3, 5, 14 7, 10, 18

3. Reliability and Validity Aya Kuwahara, Yoshikazu Nishino, Takayoshi Ohkubo, Ichiro Tsuji, Shigeru Hisamichi and Toru Hosokawa. Reliability and Validity of the Multidimensional Health Locus of Control Scale in Japan: Relationship with Demographic Factors and Health-Related Behavior. Tohoku J. Exp. Med., 2004, 203(1) A study was conducted of 2388 men and 2454 women aged 40-79 years in Japan, who completed a questionnaire regarding socio-demographics, healthrelated behavior, such as smoking and drinking, and the MHLC. The Cronbach alpha of the MHLC scale, was within the range 0.62-0.76. Elderly subjects, women, and subjects with fewer years of education showed more

external belief, which is generally consistent with previous reports from overseas. Subjects with adverse health behavior, such as smoking and excess drinking, also had more external belief. These results indicate that the MHLC scale has sufficient reliability and validity among the Japanese population. Use of the MHLC scale should help to provide a better understanding of health belief among Japanese, and development of health education programs to prevent lifestyle-related disease.