Health LOC

Power, Pessimism & Prevention:
The impact of locus of control on physical health

There is extensive interest in understanding the relationship between locus of control beliefs and a variety of different health attitudes, behaviors, and situations. Health Locus of Control (HLC), first popularized in the 1970s by Wallston, Wallston, Kaplan and Maides, examines the degree to which individuals believe that their health is controlled by internal or external factors. External beliefs are premised on the notion that one’s health outcome is under the control of powerful others (i.e. medical professionals) or is determined by fate, luck, or chance. Internal beliefs characterize one’s health condition as being the direct result of one’s own actions.

In recent decades, a great deal of research has linked internal locus of control to positive health beliefs and behaviors. While not all attempts to correlate the two have been successful, it is widely accepted that health-related locus of control is significantly associated with a variety of health behaviors and outcomes. Internal locus of control has been associated with knowledge about disease (Seeman & Evans, 1962), ability to stop smoking (Coan, 1973), ability to lose weight (Balch & Ross, 1975), adherence to a medical regimen (Lewis, Morisky, & Flynn, 1978), effective use of birth control (MacDonald, 1970), getting preventive inoculations (Dabbs & Kirscht, 1971), wearing seat belts (Williams, 1972a), and getting regular dental checkups (Williams, 1972b). The importance of locus of control beliefs on health makes crucial our need to understand their origin. If their development is understood, then parents, school officials, and medical professionals can become more aware of the circumstances that might lead to the adoption of particular locus of control beliefs.
(Graphic courtesy of NHTSA.)

Rotter (1975) suggests that general locus of control beliefs come from specific experiences and past reinforcement history. Reinforcement theory (Skinner, 1938) argues that what controls behavior are reinforcers. A reinforcer is a consequence that immediately follows a response and either removes a negative stimulus or adds a positive stimulus, thereby increasing the probability that the behavior will be repeated. Thus, individuals who have a history of successful attempts at health control are more likely to be internal than are those who have been unsuccessful in their attempts.

A possible determinant of these beliefs is practice in taking care of oneself. Lau (1982) divides practiced health habits along two separate dimensions. Certain behaviors involve self-care, such as brushing one’s teeth, getting exercise, getting sufficient sleep, and eating a good diet. Other health habits involve utilizing the services of medical professionals, like maintaining regular checkups at a doctor or dentist, or receiving preventive vaccines. It has been identified that practicing a variety of different health habits as a child is associated with optimistic beliefs in the controllability of health, both for beliefs in the efficacy of self-care and of doctors. Peterson, Seligman, and Vaillant (1988) found that the tendency to adopt a pessimistic explanation of personal misfortune in young adulthood was associated with poor physical health in later life.
(Clipart found at this public domain site.)

Research has also suggested that internal locus of control is associated with nurturing and accepting parents who display consistent discipline (Rotter, 1975). Reinforcement theory easily explains why this might be the case. Nurturing parents are likely to be attentive to their children’s behavior and prepared to respond to the child’s actions with reinforcers to encourage the practice of good health habits and discourage poor ones. Yet, it is not only parents that must be aware of their influence on the establishment of children’s health beliefs. In a study of the health beliefs of elementary school children and their mothers, Mechanic (1964) found that the mother’s health beliefs were at best only slightly related to those of her children. He implies that peers, teachers, and mass media are other important factors that influence health beliefs.

Socioeconomic status is another variable that has been shown to correlate with locus of control. Perhaps the greater availability of reinforcements for middle-class children explains the consistent findings that they are more internally oriented than are lower-class children (review by Phares, 1976). Data suggests that early health habits are more prevalent in higher SES families, where regular visits to medical professionals for checkups and vaccinations are most likely only minor financial considerations. Lau concludes that it is particularly important for health professionals in contact with lower SES families to stress the wide-ranging importance of practicing good health habits. These habits are not only important in and of themselves, but they also provide the basis for beliefs that influence life-long health behaviors. Nevertheless, this recommendation may be overly simplistic in its assumption that lower SES families are able to come in contact with health professionals.

Prior experiences with sickness and health contribute to health locus of control beliefs as well. In a study conducted by Tolar (1978), it was found that women who had many childhood experiences with illness and accidents were more external in their beliefs about the controllability of health. DeVellis, DeVellis, Wallston, and Wallston (1980) encountered a similar relationship between personal health history and locus of control beliefs in a study involving a group of epileptics. It was found that greater predictability and controllability of seizures were associated with greater internal HLC beliefs, whereas earlier onset and increased years of seizures were associated with increased external HLC beliefs. There is always a degree of uncontrollability or chance in health. Individuals who have had many experiences with unpredictable sickness have presumably been conditioned to be more aware of this than those who have not experienced as many such events. This conditioning would account for a feeling of inefficacy in one’s health, or belief toward external HLC.

(Clipart found at this public domain site.)

Lau (1982) found that encounters with sickness in one’s family also have strong effects on controllability of health beliefs. Experiences with ill loved ones often lead to beliefs that health is not controllable and that self-care and doctors are relatively ineffective. However, one’s own recent personal experiences with sickness have been shown not to affect HLC beliefs. Wallston and Wallston (1980) indicate that common, fairly minor ailments and illnesses do not affect HLC beliefs. It is likely that the individuals in Lau’s study experienced relatively minor afflictions as compared to the examples that could be drawn upon from experiences with numerous relatives.

What lies behind the attributions you make about health across the lifespan?

The most dramatic effect of experience with illness is its negative relation to beliefs in self-control over health (Nisbett & Borgida, 1978.). A few vivid examples of individuals who seemed to practice perfect health behaviors, but still experienced severe health impairments can be enough to effect one’s perception of the controllability of health. Since good health is the “normal” state, people may not often see the links between their behavior and their good health, or the many instances of positive health practices being manifested in the good health of others. However, illnesses, which good health habits are supposed to prevent, are particularly salient. As research on selective recall, the effects of expectancy on perception, and the imperfection of human memory have demonstrated, we are particularly prone to making exaggerated causal attributions for salient events.

It has been proposed that the reverse effect, where positive exceptions are viewed as more causal than actually possible, might be true for a much older and less healthy population. Such people might be more likely to see the links between their behavior and their good health (Lau, 1982). Further research in this area could help us to better understand the impact of positive thinking on actual physical health. Marshall (1991) found that age is associated with perceived personal competence but not with self-blame for health outcomes. Although a decreased internal locus of control may accompany physical illness in older adults, that decline is counteracted by greater knowledge of personal resources and capabilities.

(Photos courtesy of Careguide.)

Also important is the study of how the effect of experience on locus of control beliefs can be weakened. Episodes of health ailments do not have to lead to adoption of negative beliefs in the realm of self-care; rather, they can be used to reinforce positive beliefs. In congruence with classic reinforcement theory, doctors and parents could stress how the negative episode would not have occurred had certain self-care behaviors been performed. Or, ways in which the illness would have been more serious or occurred earlier if negative behaviors had been performed could be recognized (Lau, 1982). “Since it is true that internals appear more likely to engage in positive health and sick-role behaviors, it is apparent that health locus of control emphasizes the importance of the health educator’s need to involve themselves in training patients to hold more internal beliefs” (Brown, 1999).

It is imperative to realize that the attributions people make after getting sick are critical in determining what effects that illness episode will have on related health beliefs and health behaviors (Lau, 1982). Also crucial, is that health locus of control beliefs are primarily formed in childhood and remain relatively stable throughout the life span. We empower ourselves when we recognize the benefits that internal HLC beliefs can have on the health behaviors we practice and encourage in others.

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