The Validity of the Multidimensional Health Locus of Control Scales

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.

Use of complementary and alternative medicine in patients with chronic liver diseases in Germany- a multicentric observational study

BACKGROUND

The use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany.

METHODS

This is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the "Big five" model, "Hospital Anxiety and Depression"-, "Multidimensional Health Locus of Control"- score). Uni- and multivariate analyses assessed factors associated to CAM use.

RESULTS

Overall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use.

CONCLUSIONS

CAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur.

Effects of health-related dispositions on citizens' appraisals toward the COVID-19 pandemic and protective behavior

In this study, health risk attitude and health locus of control were included as dispositional factors in the Protection Motivation Theory (PMT) to explain people's protective behavior in the context of COVID-19 pandemic. Empirical data involved two waves of data with a sample of 526 adults with full-time jobs from Beijing, China, and structural equation model results confirmed a partial successful extension of the PMT. Specifically, health risk attitude had a direct effect on citizens' protective behavior, but without an indirect effect mediated by threat appraisal toward the COVID-19 pandemic; health locus of control did not directly associate with citizens' protective behavior, but had an indirect effect on it fully via coping appraisal toward the COVID-19 pandemic. Thus, the PMT has been extended by adding a distal dispositional factor on the impact of coping appraisal on protective behavior. Implications for advancing the government's anti-epidemic strategy are discussed.

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study

OBJECTIVES

To identify the associated factors of self-neglect in older adults from a salutogenic perspective.

METHODS

A cross-sectional correlational study was conducted in two communities in Beijing with 486 older adults recruited from April to December 2022. Data were collected by a set of questionnaires.

RESULTS

Sense of coherence (β=-0.138), socio-demographic generalized resistance resources (GRRs) (smoking: β=0.156), social GRRs (living alone: β=0.093), psychological GRRs (self-esteem: β=-0.126), and motivational GRRs (powerful others locus of control: β=-0.199, chance locus of control: β=0.119) were all associated with self-neglect among older adults (p<0.05).

CONCLUSIONS

Sense of coherence and GRRs are vital to improve self-neglect in older adults. It is suggested to increase the level of self-esteem and the tendency of the health locus of control to largely facilitate self-neglect management in older adults.

The mediating role of health behaviors in the relationship between internal locus of control and life satisfaction in public health students

Well-being is a continuous process requiring decisions and actions to maintain or build health. This study examines the indirect effect of health locus of control on life satisfaction via healthy behaviors based on living systems theory. Participants were 730 students of various majors related to medicine and health, aged between 19 and 30 (M = 22.29, SD = 1.64), including 79.04% women. Self-report measures were used to assess life satisfaction, multidimensional health locus of control, and health behavior. Women scored higher than men on the total health behavior scale, especially in a healthy diet and preventive behavior. Men scored higher than women on internal health locus of control (HLC), while women scored higher than men on the powerful others HLC in making decisions about their health. The study confirmed the mediating effect of healthy behavior on the relationship between the internal HLC and life satisfaction. The present mechanism highlights the crucial role of internal motivation in increasing subjective well-being by maintaining health behaviors among young adults. The role of intervention programs focused on improving internal HLC and health behaviors is discussed.

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.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis

BACKGROUND

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied.

PURPOSE

To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort.

METHODS

We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research.

RESULTS

PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort.

CONCLUSIONS

Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

Psychosocial interventions affecting global perceptions of control in people with Parkinson's disease: a scoping review

PURPOSE

Perceived control is an important construct for the psychological well-being of people affected by chronic conditions, and higher perceived control is associated with better outcomes. Psychosocial interventions have been trialled in these populations to improve both global and specific perceptions of control. However, most interventions involving people with Parkinson's have focused on single-domain forms of control, while those addressing global perceived control are yet to be reviewed. This study aimed to identify and map the types of psychosocial interventions in individuals with Parkinson's which have included forms of global perceived control as an outcome.

MATERIALS AND METHODS

Scoping review based on a search across MEDLINE, PsycINFO, CINAHL, Academic Search Ultimate.

RESULTS

From an initial return of 4388 citations, 12 citations were eventually included. These consisted of 8 quantitative and 4 qualitative studies, and covered 4 overarching categories of psychosocial interventions. Mixed results were found for cognitive, educational, and physical interventions, while a randomised controlled trial on mindfulness-based lifestyle programme showed more preliminary positive evidence.

CONCLUSIONS

Further rigorous research is required on the topic to build on these preliminary findings. In the meantime, clinicians may need to consider programmes which proved effective with populations similar to people with Parkinson's.IMPLICATIONS FOR REHABILITATIONPerceived control is a psychological construct important for people with chronic illnesses, which can be targeted by psychosocial interventions.This article reviewed psychosocial interventions targeting global forms of perceived control in Parkinson's.Mixed results were reported for the cognitive, educational, and physical interventions identified, while a randomised controlled trial on a mindfulness-based lifestyle programme showed more promising evidence.In the meantime, clinicians may need to consider programmes found to be effective with people with similar conditions to Parkinson's.

Perceived control as a predictor of medication adherence in people with Parkinson's: a large-scale cross-sectional study

PURPOSE

Medication adherence is a multi-faceted construct associated with several positive consequences in people with chronic conditions. However, non-adherence currently represents a major issue in Parkinson's, potentially due to low perceptions of control. This study investigated the predictive ability of several aspects of perceived control on adherence in people with Parkinson's, while accounting for previously established predictors such as depression and medication variables.

MATERIALS AND METHODS

An online cross-sectional survey was carried out with 1210 adults with Parkinson's from 15 English-speaking countries. Demographic and clinical questions, as well as measures of depression, aspects of perceived control, and medication adherence were included. Pearson's correlations and a 4-block hierarchical regression analysis were performed to assess the relationship between the variables.

RESULTS

Perceived control explained a slightly higher amount of variance in medication adherence compared to medication variables when entered in the last block. Unexpectedly, depression was not significantly related with adherence. Internal locus of control was an independent negative predictor of adherence, while external dimensions of locus of control emerged as independent positive predictors.

CONCLUSIONS

In people with Parkinson's, perceptions of control may have a larger impact on adherence compared to medication variables. Implications for clinical practice and future research are discussed.Implications for RehabilitationPerceived control and depression are considered important constructs for medication adherence in Parkinson's, which in turn is often problematic for affected individuals.The specific predictive value of different aspects of perceived control on medication adherence in Parkinson's is currently unclear.This large-scale study found that perceptions of control may have a larger impact on adherence compared to medication variables, while depression was unrelated to it.A need for psychologically-informed interventions, person-centred approaches to medication management, and Parkinson-specific measures of adherence are highlighted.

Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure

Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.

Health behaviours of patients with affective disorders: a cross-sectional study

BACKGROUND

Severe mental disorders, including affective disorders (AD), are associated with high rates of physical illnesses that lead to premature patient death. Excess somatic comorbidity may be partially explained by lifestyle factors. This study aimed to investigate the health behaviours (HBs) of patients with AD in comparison to the HBs of patients with type 2 diabetes (T2D) and healthy controls (HCs) and to examine associations among HBs and sociodemographic and clinical factors, subjective quality of life and health status, and health locus of control.

METHODS

The sample consisted of 108 patients with AD, including 60 with bipolar disorder (BP) and 48 with unipolar disorder (UAD). Analyses included comparisons with a subgroup of AD individuals, patients with T2D and HCs matched in age and sex. The Health Behaviour Inventory was used to evaluate the overall levels of HBs and 4 HB categories. To identify independent determinants of health behaviours, a multivariate linear regression analysis was performed with factors identified as significant in bivariate analyses.

RESULTS

Most AD patients had a low level of HBs (40%), followed by moderate (35%) and high levels (25%), and there were no significant differences in HBs between the BP and UAD groups. Compared with the T2D and HC groups, the AD group had a significantly lower level of overall HBs and lower levels of HBs in one of the categories. Independent predictors of overall HBs were quality of life (β = 0.28, p < 0.001), age (β = 0.27, p = 0.002), and depressive symptoms (β = 0.23, p = 0.008). A total of 30% of the variance in HBs was explained.

CONCLUSIONS

These findings emphasise the need for a systematic assessment of single and multiple health behaviours to provide better care for patients with AD and reduce the potential adverse effects of an unhealthy lifestyle.

Intrapersonal predictors of internalized stigma among school going adolescents living with HIV in southwestern Uganda

We assessed the association between internalized HIV stigma, resilience, health locus of control, coping self-efficacy and empowerment among adolescents living with HIV in Uganda. We conducted a cross-sectional study between August and October 2020 among 173 adolescents aged 13-18 years attending Mbarara Regional Referral Hospital's HIV clinic. We used linear regression to determine the association between HIV stigma and intrapersonal factors adjusting for sociodemographic characteristics. The median age of the participants was 16 (IQR 3) years. There was a negative correlation between HIV stigma and resilience (β= -0.03, p < 0.001), internal health locus of control (β= -0.095, p < 0.001) and coping self-efficacy (β= -0.02, p < 0.001), while empowerment was positively correlated (β = 0.07, p < 0.001) with HIV stigma. After adjusting for the intrapersonal factors (resilience, health locus of control, coping self-efficacy and empowerment) and socio-demographic characteristics (education level and boarding school), only internal health locus of control (β=-0.044, p = 0.016) and coping self-efficacy (β=-0.015, p < 0.001) remained significantly correlated with HIV stigma. The findings suggest that interventions focusing on intrapersonal factors such as internal locus of control, empowerment and resilience may contribute towards reduction of HIV stigma among adolescents in boarding schools.

A Survey of Breastfeeding Attitudes and Health Locus of Control in the Nigerian Population

OBJECTIVES

Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample.

METHODS

Men and women (N = 400) (71% female; mean age 34.2 years/ range 18-86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs).

RESULTS MEAN

IIFAS scores (mean = 57.7; sd = 7.8) became less favourable with increasing age (p = 0.02). Men had higher IIFAS scores (mean = 58.6; sd = 7.6) than women (mean = 56.6; sd = 8.0) indicating more favourable attitudes toward breastfeeding (p = 0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p = 0.003) and external powerful others HLoC (EPHLoC) (p = 0.02). Increasing age was associated with higher scores on ECHLoC (p < 0.01) and EPHLoC (p < 0.01). Multiple linear regression analysis was significant (p < 0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p < 0.01) and EPOHLoC (p < 0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p < 0.01). Neither age nor gender were associated with IIFAS scores in the final model.

CONCLUSIONS

This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.

Impact of maternal psychosomatic empowerment during pregnancy on the improvement of mental health and maternal and fetal outcomes: A pilot study

OBJECTIVES

To investigate the effect of maternal psychosomatic empowerment during pregnancy on improving mental health in Mashhad, Iran.

METHODS

In this quasi-experimental pilot study, 90 pregnant women were assigned into two groups. The intervention group was provided training sessions and routine care, while the control group only received routine care. The General Health Questionnaire - 28 (GHQ - 28) and Edinburgh Postnatal Depression Scale (EPDS) were completed by mothers in both groups. The data were analyzed in SPSS software by multivariate analysis of variance for repeated measures.

RESULTS

The mean GHQ scores were reduced from 39.3 ± 14.8 and 43.1 ± 12.84 in the first stage to 15.7 ± 8.66 and 22.72 ± 11.3 in the fourth stage in the intervention and control groups, respectively. The results demonstrated a significant difference among the GHQ scores obtained at four stages (F = 244.057, P < 0.001), regardless of the group factor.

CONCLUSIONS

The mothers subjected to the training sessions had a lower level of depression than their counterparts in the control group.

PRACTICE IMPLICATIONS

The findings encourage healthcare providers to improve mothers' mental health by implementing psychosomatic empowerment training during pregnancy.

University students' sleep during the COVID-19 pandemic in the State of Hawai'i

Objectives: This study assessed undergraduates' sleep in Hawai'i during the COVID-19 pandemic and whether demographic characteristics, health locus of control, substance use and campus features related to sleep outcomes. Implications are considered for programs to support students' sleep and health during pandemic conditions. Participants: About 1,288 undergraduate students from six universities in Hawai'i. Methods: Surveys assessing sleep, emotional wellbeing, ethnicity, body mass index, locus of health control, and substance use. Results: Students' reported increased sleep time but decreased sleep quality during the pandemic. Sleep disruption related to anxiety, depression, ethnicity, substance use, BMI, health locus of control, class rank, and whether students lived at home. All campuses were associated with disrupted sleep, regardless of size, location, religious affiliation, term structure, or method of instruction. Conclusions: In response to public health crises, such as the COVID-19 pandemic, all Hawai'i universities should screen students for sleep disruption, emotional adjustment, social isolation and substance misuse. Programs to promote sleep and behavioral health appear particularly warranted for graduating seniors, Pacific Islanders, students with high BMI, and students who commute to college.

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 survey study of adults with chronic conditions: Examining the correlation between patient activation and health locus of control

OBJECTIVES

This study aimed to examine (1) the association between patient activation (PA), health locus of control (HLOC), sociodemographic and clinical factors, and (2) the effect of HLOC dimensions, sociodemographic and clinical factors on PA.

METHODS

Three hundred U.S. adults, with at least one chronic condition (CC) were recruited through Amazon Mechanical Turk and completed an online survey which included sociodemographic questions, the Patient Activation Measure^® - 10, and the Multidimensional Locus of Control (MHLC) - Form B. Statistical analyses, including descriptive, correlation, and multiple linear regression, were conducted using IBM SPSS v25.

RESULTS

Of the 300 participants, more than half were male (66.3%), White (70.7%), with at least a college degree (76.0%), and employed full-time (79.0%). The average PA score was 68.8 ± 14.5. Multiple linear regression indicated that participants who reported they were Black, retired, with a greater number of CCs, and with higher scores in Chance MHLC had higher PA, while participants with higher scores in Internal MHLC, were unemployed and reported to have been affected by COVID-19-related worry or fear to manage their CC, had lower PA.

DISCUSSION

HLOC dimensions should be addressed concurrently with PA for patients with CCs, thus adding to a more patient-centered clinical approach.

A model to understand COVID-19 preventive behaviors in young adults: Health locus of control and pandemic-related fear

This study investigated COVID-19 preventive behaviors in young adults, exploring the predictive roles of health locus of control and pandemic fear. A sample of 188 Italian young adults (Mage = 22.76, SDage = 1.95; 85% girls) completed an anonymous online survey assessing preventive behaviors, health locus of control styles (i.e. internal, chance, powerful others), and two dimensions of pandemic fear. Fear for COVID-19 consequences-but not general fear for contagion-significantly predicted prevention behaviors, and it also moderated the relationships between each health locus of control style and preventive behaviors. Our findings have relevant implications for research and social policies.

Can Nutritional Status in Adults Be Influenced by Health Locus of Control?

The external health locus of control (HLC) is based on an assumption that obtained health results depend on the influences of external factors. As for the internal HLC-that is the effect of our own actions and capabilities. Little is known regarding how the HLC can influence body weight or the occurrence of visceral obesity. The study aimed to assess the relationship between the health locus of control and nutritional status in adults. The study included 744 adults (452 women, 292 men; 2.8% underweight, 43.8% normal weight, 29.7% overweight, and 23.7% obese). In addition to anthropometric measurement and socio-demographic data, the health locus of control, using the Multidimensional Health Locus of Control Scale (MHLC) by Wallston K, Wallston B, and DeVellis R, was assessed. The percentage of subjects with an internal HLC did not differ significantly between obese, overweight, and normal-weight groups. However, the percentage of subjects with an external HLC-dependent on the impact of others-was significantly higher in both men and women with obesity than in corresponding overweight and normal-weight groups (p < 0.01). Yet, the percentage of subjects with an external HLC subject to the impact of chance was significantly higher among overweight and obese women than in those of normal weight (p < 0.05) only. Women with overweight or obesity, with external health locus of control, experienced both the impact of others and of chance more often than women with normal weight. However, men with overweight and with obesity more often had external health locus of control influenced only by others.

Consumer Attitudes and Purchase Intentions in Relation to Animal Welfare-Friendly Products: Evidence from Taiwan

Animal welfare, environmental sustainability, and food safety have become topics of international concern. With the rise of friendly rearing and green consumption consciousness, consumers can use animal welfare certification labels as references to make purchase decisions. This study adopts the theory of planned behavior (TPB) as its core and incorporates variables, such as moral affection, health consciousness, and trust in certification, to discuss the thoughts of Taiwanese consumers on buying animal welfare-friendly products and the factors that affect their purchase decisions. This study will be conducive in clarifying the consumption behavioral pattern of animal welfare-friendly products, which previous literature has mentioned but not tested, thereby filling this literature gap. This study collects 653 valid questionnaires and uses the partial least square-structural equation modeling to analyze the correlations between various variables. The research findings indicate the following. (1) Consumers' attitudes, subjective norms, and perceived behavioral control have significant and positive influences on the behavioral intention of purchasing fresh milk with animal welfare labels. (2) Moral affection positively influences customers' behavioral intention toward fresh milk with an animal welfare label through attitudes, subjective norms, and perceived behavioral control. (3) Trust in certifications will enhance moral cognition and positive attitudes toward fresh milk with animal welfare labels. According to the research findings of this study, we recommend that businesses strengthen the promotion of dairy products in line with friendly rearing, environmental sustainability, and other ethical consumption concepts to generate market segregation elements.

Development of the multidimensional health perceptions questionnaire in English and Spanish

Purpose

To develop the novel multidimensional health perceptions questionnaire (MHPQ), a self-reported assessment of health perceptions inclusive of (1) individuals beliefs about the causes and consequences of health conditions, benefits and barriers to maintaining and improving health, ability to accomplish health-related goals and control health circumstances, and the role of God and/or spirituality in health and healthcare, (2) anticipated discrimination in the healthcare systems, and (3) trust in healthcare providers and medicine, illustrated in our newly proposed Multidimensional Health Perceptions Conceptual Model.

Methods

We developed an initial MHPQ_β item set, corresponding to domains of our conceptual model, using a patient-centered outcomes development approach. This include literature review, expert and end-user feedback, translation and language validation (specifically to Latin American Spanish), and cognitive interviewing.

Results

The initial 104 items of MHPQ_β had excellent content validity, with a Content Validity Index of 98.1%. After expert (n = 13) feedback, translation and language validation, and cognitive interviewing among community-dwelling English-speakers (n = 5) and Spanish-speakers (n = 4), the final MHPQ_β comprised 93 items rated on a five-point agreement scale (1 = Strongly disagree to 5 = Strongly agree), with a reading grade level of 6th grade in English and 8th grade in Spanish.

Conclusion

The MHPQ_β is a promising tool to assess individuals’ health perceptions. It has excellent content validity and good reading accessibility. Future work will establish the factor structure and final item set of the MHPQ.

Individuals' Use of Religion in Response to the COVID-19 Pandemic as Complementary to Their Use of Medically Recommended Responses

Many individuals have engaged in behaviors to cope with and mitigate the COVID-19 pandemic, including mask wearing and physical distancing. This study considers the extent to which individuals have also engaged in religious behaviors in response to the pandemic and how those responses are associated with behaviors like mask wearing. Using data from a probability survey of U.S. adults, our analysis finds that over half of the respondents have engaged in pandemic-related prayer and about one-fifth have taken other religious steps in response to the pandemic, such as reading religious texts or carrying religious items for protection. All else being equal, Republicans are significantly less likely to have undertaken religious steps in response to the pandemic relative to Democrats, suggesting that the politicized nature of the pandemic influences religious responses as well. The analysis also finds that religious responses to the pandemic-especially prayer-are positively associated with mask wearing and physical distancing. These findings suggest that religious responses to the pandemic are not inherently opposed to undertaking responses recommended by scientific and medical authorities.

Health locus of control in a pandemic situation: cross-cultural differences between European and Asian respondents

Background

The present cross-cultural study examined the health locus of control construct during the COVID-19 pandemic. The scien-tific purpose of the study was to determine whether, during the pandemic situation, cultural and sex differences influence the health locus of control construct and change the internal health locus of control (IHLC), powerful others health locus of control (PHLC), and chance health locus of control (CHLC).

Participants and procedure

A total of 2617 recipients aged 18-70 years from Asia (China, India, and Indonesia), and Europe (Bulgaria, Germany, and Hungary) completed a questionnaire about their health. The participants completed an online version of the Multidimen-sional Health Locus of Control Scale – Form A.

Results

The survey shows that in a pandemic life-threatening situation, most individuals strive to rely on IHLC and/or PHLC, and fewer of them tend to rely on CHLC. However, there are differences (p < .001) between the two cultural samples: the rep-resentatives of Asian collectivistic culture are more dominated by PHLC, compared to the representatives of the European individualistic culture. When the comparison is between individuals from different cultures, sex differentiation affects the health locus of control, and as a result, significant differences in relation to IHLC, PHLC, and CHLC levels (р < .05) appear.

Conclusions

In conclusion, the study indicates that cultural differences influence both the IHLC and PHLC levels, and that Asian partici-pants are dominated by PHLC more than European respondents. Asian females are more likely to seek support from pow-erful others (PHLC) compared to European women, who perceive themselves as more independent. Asian male partici-pants are prepared to rely on powerful others (doctors or medical institutions), while European male respondents are prone to rely on themselves mainly (IHLC). The results show that sex differences do not significantly affect the health locus of control within the same cultural group.

Health locus of control in a pandemic situation: cross-cultural differences between European and Asian respondents

BACKGROUND

The present cross-cultural study examined the health locus of control construct during the COVID-19 pandemic. The scientific purpose of the study was to determine whether, during the pandemic situation, cultural and sex differences influence the health locus of control construct and change the internal health locus of control (IHLC), powerful others health locus of control (PHLC), and chance health locus of control (CHLC).

PARTICIPANTS AND PROCEDURE

A total of 2617 recipients aged 18-70 years from Asia (China, India, and Indonesia), and Europe (Bulgaria, Germany, and Hungary) completed a questionnaire about their health. The participants completed an online version of the Multidimensional Health Locus of Control Scale - Form A.

RESULTS

The survey shows that in a pandemic life-threatening situation, most individuals strive to rely on IHLC and/or PHLC, and fewer of them tend to rely on CHLC. However, there are differences (p < .001) between the two cultural samples: the representatives of Asian collectivistic culture are more dominated by PHLC, compared to the representatives of the European individualistic culture. When the comparison is between individuals from different cultures, sex differentiation affects the health locus of control, and as a result, significant differences in relation to IHLC, PHLC, and CHLC levels (p < .05) appear.

CONCLUSIONS

In conclusion, the study indicates that cultural differences influence both the IHLC and PHLC levels, and that Asian participants are dominated by PHLC more than European respondents. Asian females are more likely to seek support from powerful others (PHLC) compared to European women, who perceive themselves as more independent. Asian male participants are prepared to rely on powerful others (doctors or medical institutions), while European male respondents are prone to rely on themselves mainly (IHLC). The results show that sex differences do not significantly affect the health locus of control within the same cultural group.

Health Locus of Control and Neurocognitive Function in Latinx and Non-Latinx White People Living With HIV: A Cross-sectional Study

ABSTRACT

Research suggests that health locus of control (HLOC) is related to important health and neurocognitive outcomes in people living with HIV. However, the role of ethnicity in these relationships remains poorly understood. This study explored the role of HLOC on neurocognition in a diverse sample of 134 people living with HIV (Latinx: n = 96; non-Latinx White: n = 38) who completed comprehensive neurocognitive evaluations and the Multidimensional HLOC Scale-Form C. Results indicate no ethnocultural differences in HLOC beliefs (ps > .05). External HLOC (i.e., chance and powerful others) related to worse neurocognition in the Latinx group and contributed to significant variance in global neurocognition and learning, memory, and verbal fluency, underscoring the role of external HLOC beliefs on neurocognition, particularly for Latinx individuals. Additional research is needed to better characterize the mechanistic relationship between HLOC beliefs and neurocognitive function and to further explore this relationship among other underrepresented populations also disproportionately affected by HIV.

Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning

BACKGROUND

The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors.

PURPOSE

To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics.

METHODS

In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2).

RESULTS

We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design.

CONCLUSIONS

By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.

A phone and text message intervention to improve physical activity in midlife: initial feasibility testing

Background

Physical activity during midlife (ages 45-64) plays a major role in the prevention of chronic and serious medical conditions. Unfortunately, many midlife adults struggle to be physically active in the setting of low levels of psychological well-being and the management of multiple confluent sources of stress. Effective, scalable, midlife-specific interventions are needed to promote physical activity and prevent the development of chronic medical conditions.

Objectives

In an initial proof-of-concept trial, we assessed the feasibility and acceptability of a new, midlife-adapted, phone- and text message-based intervention using positive psychology (PP) skill-building and motivational interviewing (MI) techniques. We secondarily analyzed post-intervention changes in accelerometer-measured physical activity and self-reported outcomes.

Methods

The PP-MI intervention included six weekly phone sessions with a study trainer, with completion of PP activities and physical activity goals between calls, and in the subsequent six weeks briefer phone check-ins were conducted. Text messages over the 12-week intervention period were utilized to support participants and identify barriers to goal completion. Feasibility (session completion rates) and acceptability (participant ratings of intervention ease and utility) were assessed via descriptive statistics, and pre-post improvements in psychological, functional, and physical activity outcomes at 12 weeks were examined via mixed effects regression models.

Results

Twelve midlife adults with low baseline physical activity enrolled in the single-arm trial. Overall, 76.8% of all possible sessions were completed by participants, and mean ratings of weekly phone sessions were 8.9/10 (SD 1.6), exceeding our a priori thresholds for feasibility and acceptability. Participants demonstrated generally medium to large effect size magnitude improvements in accelerometer-measured physical activity, psychological outcomes, and function.

Conclusions

A novel, midlife-specific phone- and text-based PP-MI intervention was feasible and had promising effects on physical activity and other clinically relevant outcomes, supporting next-step testing of this program via a randomized controlled trial.

Patient beliefs about who and what influences their hip and knee osteoarthritis symptoms and progression

BACKGROUND

Osteoarthritis management aims to reduce pain and improve function. Many factors affect whether patients follow recommended strategies. Locus of control refers to individual beliefs around who and what influences health. Locus of control is related to the treatment strategies patients prefer. Currently, no studies explore locus of control in non-surgical management of osteoarthritis.

OBJECTIVES

To explore patients' beliefs about the influences on their osteoarthritis symptoms and disease progression.

METHODS

Semi-structured interviews were conducted with individuals experiencing self-reported hip and/or knee osteoarthritis who had at least one joint that had not undergone replacement surgery. We used a qualitative description approach and the Braun and Clarke method for thematic analysis. Participants' locus of control classifications-internal, chance, doctors, or other people-were based on the Multidimensional Health Locus of Control (MHLC) Scales Form C score.

RESULTS

Locus of control was discussed in relation to aetiology, progression, and symptoms. Participants' opinions varied on whether their osteoarthritis progression could be influenced. 46% of participants attributed control to other people. Most participants believed that a previous injury had caused their osteoarthritis and that both themselves and others had some influence over their osteoarthritis symptoms, regardless of their locus of control classification.

CONCLUSION

This research highlights the need for education about: the aetiology of osteoarthritis, the link between management and progression, and patient management of osteoarthritis. Further research is required to discern why expected patterns were not observed between participants' beliefs and locus of control classifications.

Trust in God and/or Science? Sociodemographic Differences in the Effects of Beliefs in an Engaged God and Mistrust of the COVID-19 Vaccine

At present, COVID-19 vaccines are widely available in the USA, but large proportions of the American populace remain unvaccinated. One possible source of COVID-19 vaccine hesitancy is a lack of trust in science. In this study, drawing from the large literature at the intersection of science and religion, we ask whether beliefs in an engaged God (the belief that God is involved in daily human affairs) predict mistrust of the COVID-19 vaccine and whether any observed association differs across race, gender, and education. Using nationally representative data from Wave 6 of the Baylor Religion Survey (2021), our results suggest that beliefs in an engaged God were associated with greater mistrust in the COVID-19 vaccine. This association was amplified for Hispanic and lower educated Americans. We argue that beliefs in an engaged God may promote a distrust of science, reduce motivation to get vaccinated, and derive comfort and strength by placing control over one's life in the hands of a loving, involved deity. We also situate our findings within an emerging body of work on the "dark side" of religion and reflect on their implications for understanding the broader religion/health connection.

Health locus of control in cancer patient and oncologist decision-making: An exploratory qualitative study

Objective

To investigate how cancer patients’ and family members’ perspective and health locus of control are presented in clinical encounter decision-making.

Methods

Semi-structured in-depth interviews were carried out with 16 cancer patients and 6 family members living in Israel (n = 22). Interviews were transcribed verbatim, and data were analyzed using thematic analysis.

Results

Following the health locus of control model, the findings were divided into an external and internal locus of control themes, and we added a theme regarding shared decision-making. Internal locus of control sub-themes included asking for a second opinion, negotiating with the doctor, asking questions, looking for information, and fighting for their rights. External locus of control sub-themes included powerful others, oncologists, and fate. The dominant approach of most of the interviewees was an external locus of control. Women demonstrated more external locus of control than men. On the direct question of who should decide on treatment—the doctor, the patient, or both jointly—the answers ranged from only the doctor (n = 8) to together (n = 7) to only the patient (n = 8).

Conclusions

This study provides insights into different aspects of locus of control in the clinical encounter involving cancer patients. The findings reflect the need to devote comprehensive attention to cancer patients’ perceptions and experiences in the clinical encounter. A patient-centered care approach and a personalized framework for decision-making in cancer care are essential to achieving better treatment outcomes. Further research can engage in the development and validation of an up-to-date health locus of control questionnaire for cancer patients based on the findings of this study.

Women's health behaviour change after receiving breast cancer risk estimates with tailored screening and prevention recommendations

Background

The Predicting Risk of Cancer at Screening (PROCAS) study provided women who were eligible for breast cancer screening in Greater Manchester (United Kingdom) with their 10-year risk of breast cancer, i.e., low (≤1.5%), average (1.5–4.99%), moderate (5.-7.99%) or high (≥8%). The aim of this study is to explore which factors were associated with women’s uptake of screening and prevention recommendations. Additionally, we evaluated women’s organisational preferences regarding tailored screening.

Methods

A total of 325 women with a self-reported low (n = 60), average (n = 125), moderate (n = 80), or high (n = 60) risk completed a two-part web-based survey. The first part contained questions about personal characteristics. For the second part women were asked about uptake of early detection and preventive behaviours after breast cancer risk communication. Additional questions were posed to explore preferences regarding the organisation of risk-stratified screening and prevention. We performed exploratory univariable and multivariable regression analyses to assess which factors were associated with uptake of primary and secondary breast cancer preventive behaviours, stratified by breast cancer risk. Organisational preferences are presented using descriptive statistics.

Results

Self-reported breast cancer risk predicted uptake of (a) supplemental screening and breast self-examination, (b) risk-reducing medication and (c) preventive lifestyle behaviours. Further predictors were (a) having a first degree relative with breast cancer, (b) higher age, and (c) higher body mass index (BMI). Women’s organisational preferences for tailored screening emphasised a desire for more intensive screening for women at increased risk by further shortening the screening interval and moving the starting age forward.

Conclusions

Breast cancer risk communication predicts the uptake of key tailored primary and secondary preventive behaviours. Effective communication of breast cancer risk information is essential to optimise the population-wide impact of tailored screening.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09174-3.

Demographics, health literacy and health locus of control beliefs of Australian women who take complementary medicine products during pregnancy and breastfeeding: A cross-sectional, online, national survey

Background

Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian sample.

Aim

The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used.

Methods

A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted.

Results

A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the sample, followed by Internal HLOC beliefs mean scores. Almost all (n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total sample (57.3%, n = 464), but significantly higher (p < .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents).

Conclusions

Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.

Influences on Public Perceptions of the Importance of, and Responsibility for, Supportive Care Following Cancer Diagnosis

Comprehensive cancer services aim to provide support in all domains of care that impact distress: physical, emotional, family, practical and spiritual. The extent of provision, referral and utilisation of these services varies dramatically, suggesting a need to improve understanding of the importance of these services. The aim of this study was to assess Australian community views on the importance of supportive cancer care, the influence of individual difference variables and who is responsible for supportive care provision. An online survey of 369 members of the Australian general public measured demographic variables, experience of cancer, awareness of supportive care, attitude to psychological help seeking, health locus of control and self-efficacy for health. Supportive care importance in physical, emotional, family, practical and spiritual domains was measured on scales from 0 to 100. These were compared to perceived importance of treatment improvements. Perceptions of responsibility for the provision of care were also rated from 0 to 100. Only attitude to psychological help seeking reliably predicted perceived importance, which was uniformly lower for supportive care than treatment improvements. Survivors and their families were viewed as having a high level of responsibility for support, although those who attributed control of health to powerful others ascribed more responsibility to those within the healthcare system. Education of the general public is needed concerning what supportive care is, how it may be provided to patients and the benefits of these services.

Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study

Background

Personalized treatment of atrial fibrillation (AF) risk factors using mHealth and telehealth may improve patient outcomes.

Objective

The purpose of this study was to assess the feasibility of the Atrial Fibrillation Helping Address Care with Remote Technology (AF-HEART) intervention on the following patient outcomes: (1) heart rhythm tracking; (2) weight, alcohol, blood pressure (BP), and sleep apnea reduction; (3) AF symptom reduction; and (4) quality-of-life (QOL) improvement.

Methods

A total of 20 patients with AF undergoing antiarrhythmic therapy, cardioversion, and/or catheter ablation were enrolled and followed for 6 months. The AF-HEART intervention included remote heart rhythm, weight, and BP tracking; televisits with a dietician focusing on AF risk factors; and referrals for sleep apnea and hypertension treatment.

Results

Patients transmitted a median of 181 rhythm recordings during the 6-month follow-up period. Patients lost an average of 3.5 kilograms at 6 months (P = .005). Patients had improved SF-12 scores (P = .01), AFSS score (P = .01), EQ-5D score (P = .006), and AFEQT Global Score (P = .03). There was significant correlation between weight loss and decrease in symptom severity (r = -0.45, P = .05), and between % weight loss and decrease in symptom severity (r = -0.49, P = .03).

Conclusion

This study described the feasibility of the AF-HEART intervention for (1) consistent remote tracking of heart rhythm, weight, and BP; (2) achievement of weight loss; (3) reduction of symptoms; and (4) improvement in QOL. Expansion to a larger randomized study is planned.

The landscape of COVID-19 vaccination among healthcare workers at the first round of COVID-19 vaccination in China: willingness, acceptance and self-reported adverse effects

The COVID-19 vaccines have been developed in a wide range of countries. This study aimed to examine factors that related to vaccination rates and willingness to be vaccinated against COVID-19 among Chinese healthcare workers (HCWs). From 3rd February to 18th February, 2021, an online cross-sectional survey was conducted among HCWs to investigate factors associated with the acceptance and willingness of COVID-19 vaccination. Sociodemographic characteristics and the acceptance of COVID-19 vaccination among Chinese HCWs were evaluated. A total of 2156 HCWs from 21 provinces in China responded to this survey (effective rate: 98.99%)), among whom 1433 (66.5%) were vaccinated with at least one dose. Higher vaccination rates were associated with older age, working as a clinician, having no personal religion, working in a fever clinic or higher hospital grade, and having received vaccine education, family history for influenza vaccination and strong familiarity with the vaccine. Willingness for vaccination was related to working in midwestern China, considerable knowledge of the vaccine, received vaccine education, and strong confidence in the vaccine. Results of this study can provide evidence for the government to improve vaccine coverage by addressing vaccine hesitancy in the COVID-19 pandemic and future public health emergencies.

Ideal Cardiovascular Health in Racially and Ethnically Diverse People with Serious Mental Illness

Cardiovascular disease is a primary contributor to premature death among people with serious mental illness (SMI). This study used baseline data (N=314) from an effectiveness trial testing a healthy lifestyle intervention for racial/ethnically diverse participants with overweight/obesity and SMI living in supportive housing. We examined the prevalence and correlates of a modified version of the American Heart Association (AHA) metric of ideal cardiovascular health (ICVH). Five AHA ICVH metrics (smoking, body mass index, diet, physical activity, and blood pressure) were used to create a composite ICVH score. The mean ICVH score was 3.15 (range 0-8). Multivariate analysis indicated that higher ICVH scores were associated with lifetime cancer diagnosis and better cardiorespiratory fitness. Lower scores were associated with female gender, racial/ethnic minority status, and antipsychotic use, suggesting that these subgroups of people with SMI may benefit from targeted screening and interventions to improve their cardiovascular health.

Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study

BACKGROUND

Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide.

OBJECTIVE

This protocol describes the study "Management of my Bipolarity" (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform.

METHODS

The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0).

RESULTS

A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors.

CONCLUSIONS

Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25168.

Effect of health locus of control on physical activity in stable patients with chronic obstructive pulmonary diseases

[Purpose] A strong correlation exists between low physical activity and the prognosis of patients with chronic obstructive pulmonary disease (COPD). The interaction between psychological factors and low physical activity remains unclear in patients with COPD. Here, we investigated the impact of the health locus of control (HLOC) on the response to an education program in patients with COPD. [Participants and Methods] We assessed the physical activities and HLOC in participants with COPD before and after a five-month education program. We assessed physical activity using the Japanese version of the International Physical Activity Questionnaire (IPAQ). We evaluated the HLOC using the Japanese version of the HLOC scales. We provided an identical educational program to all participants after the initial evaluation. [Results] The total activity and walking scores were significantly elevated after the intervention. We observed a significant negative correlation between the IPAQ Total score after the intervention and the supernatural HLOC. We also observed significant negative correlations between the IPAQ Vigorous score after the intervention and Family HLOC and Chance HLOC. [Conclusion] The response of patients with COPD to self-care educational programs was influenced by the HLOC.

Stress, locus of control, hope and depression as determinants of quality of life of pregnant women: Croatian Islands' Birth Cohort Study (CRIBS)

The aims were to investigate determinants of the quality of life (QoL) of pregnant women. Total of 302 healthy women 18 to 28 weeks of gestation participated in prospective study. WHOQOL-bref, Multidimensional Health Locus of Control scales, Edinburgh Postnatal Depression Scale, and the perceived stress appraisals were administered. Various patterns of predictors for four domains of QoL were identified, for psychological (42% variance explained), social relationship (29%), environmental (29%) and physical health (25%). Depression and hope, together with the extent to which one's health is influenced by powerful other or chance should be targeted in health promotion strategies during pregnancy.

Reduction of Risk Factors for ACL Re-injuries using an Innovative Biofeedback Approach: Rationale and Design

Nearly 1 in 60 adolescent athletes will suffer anterior cruciate ligament (ACL) injuries with 90% of these athletes electing to undergo an ACL reconstruction (ACLR) at an estimated annual cost of $3 billion. While ACLR and subsequent rehabilitation allow these athletes to return to sports, they have a 15-fold increased risk of second ACL injuries. The modification of post-operative rehabilitation to improve movement and loading symmetry using visual and tactile biofeedback could decrease the risk factors for sustaining a second ACL injury. Participants included 40 adolescent ACLR patients who were intending to return to full sport participation. This preliminary randomized controlled trial (RCT) examined the changes in knee extension moment symmetry, a known risk factor for second ACL injuries, during landing from a stop-jump task between the following time-points: pre-intervention, immediate post-intervention, and subsequent follow-up 6-weeks post-intervention. Participants met twice per week for six-weeks (12-session). The intervention included bilateral squat biofeedback (visual and tactile); the attention control group attended weekly educational sessions. This RCT enrolled and randomize 40 participants over a two-and-a-half-year period. All participants were greater than 4.5 months post-op from a primary, unilateral ACLR and were released to participate by their treating physician. The findings from this pilot biofeedback RCT will provide critical effect size estimates for use in subsequent larger clinical trials.

Management of inflammatory bowel disease associated colonic dysplasia: factors predictive of patient choice and satisfaction

AIM

In cases of prognostic uncertainty and equipoise as to the best management (prophylactic colectomy vs. surveillance) for dysplasia in inflammatory bowel disease (IBD), individualized discussion with the patient is required. Further understanding of patients' preferences is needed.

METHODS

A nationwide cross-sectional survey was distributed to adult IBD patients who had never been diagnosed with dysplasia (dysplasia-naïve) and those who had (dysplasia-experienced). Risk perceptions and factors that influence management choices were explored.

RESULTS

There were 123 respondents. A substantial proportion (29%) of the dysplasia-experienced respondents did not feel well informed about the associated cancer risk and/or its management by their clinical team. Contributing themes included contradictory advice and lack of personalized information regarding their cancer risk, alternative management options and impact on long-term quality of life. Decisional regret and health-related quality of life amongst those who chose either surveillance or surgery were comparable, but cancer-related worry scores were elevated in the surveillance group. The dysplasia-naïve respondents reported that they would only consider having a prophylactic colectomy if they had on average a 50% or even higher risk of developing cancer. On multivariable logistic regression analyses, predictors of colectomy or surveillance preference included ethnicity, personality traits such as health locus of control (whether health status is influenced by luck) and differences in perception of what a low risk of cancer is.

CONCLUSIONS

This study identifies predictive factors that can influence decision-making and satisfaction with the counselling process when IBD dysplasia is diagnosed. Further qualitative exploration of cultural themes would be informative.

Do psychological factors predict changes in oral health-related quality of life and clinical status after periodontal treatment?

AIMS

To determine psychological factors predicting changes in OHRQoL and clinical status after periodontal treatment.

METHODS

Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment consisting of scaling, root surface debridement and instruction in plaque control. Participants self-completed questionnaires enquiring about sense of coherence, locus of control, self-esteem and task-specific self-efficacy before treatment, and the Oral Health Impact Profile-14 before treatment, at oral hygiene review and end of study. Relationships among OHRQoL, clinical changes, individual factors (demographic and psychological) and environmental characteristics were analysed using latent growth curve modelling guided by the Wilson and Cleary model.

RESULTS

OHRQoL and periodontal status improved after treatment. Being male and having a greater sense of coherence predicted better OHRQoL before treatment. Stronger internal dimension of locus of control predicted a greater rate of improvement in OHRQoL, whereas greater external dimensions predicted a slower rate of improvement. Greater task-specific self-efficacy predicted less gains in probing attachment and reductions in probing depth.

CONCLUSIONS

Knowledge of psychological factors may be helpful in explaining individual differences in OHRQoL and clinical responses to periodontal treatment, and in identifying where health-promoting interventions may strengthen relevant factors to improve these outcomes.

Adolescent Engagement in a Binge-Eating Behavioral Health Intervention: Influence of Perceptions of Physical Appearance and Locus of Control

Traditional weight management approaches focused solely on weight loss as a measure of success may lead youth to internalize negative beliefs about their appearance, and feel they have little control over their health. We examined how perceptions of appearance and health-related locus of control (HRLOC) influenced engagement and outcomes in a behavioral health intervention for binge eating. Thirty adolescents aged 14-18 years completed measures of self-perception, HRLOC, and eating behaviors. Half (n = 15) completed baseline assessments only, while the other half participated in a 10-week intervention targeting dysregulated eating behaviors. Analyses revealed negative perceptions of physical appearance and internal HRLOC were higher at baseline among youth who completed the intervention compared to those who completed baseline assessments only. Among those completing the intervention, however, greater internal HRLOC and more positive perception of physical appearance at baseline was associated with greater reduction in objective binge episodes and emotional eating post-intervention. Findings of the present study suggest that while having a more negative perception of one's appearance may initially motivate youth to participate in weight-related interventions, such perceptions can actually lead to poorer health outcomes, and further supports the extant literature on the benefits of interventions that engender positive body image.

Intention to Vaccinate Against the Novel 2019 Coronavirus Disease: The Role of Health Locus of Control and Religiosity

The urgency to develop a vaccine against the 2019 coronavirus (COVID-19) has waxed stronger in speed, scale, and scope. However, wisdom dictates that we take a vantage position and start to examine the demographic predictors of COVID-19 vaccine hesitancy. The objective of this study was to examine the role of health locus of control (HLOC) in the relationship between religiosity and COVID-19 vaccination intention. In a cross-sectional survey (N = 501), we found a significantly negative association between religiosity and COVID-19 vaccination intention. This relationship was partially mediated by external HLOC. Collaborative efforts with religious institutions may influence COVID-19 vaccine uptake.

Impact of individualized intervention on the psychological status of patients with localized small cell lung cancer complicated with pleural effusion

To explore the intervention effects of individualized measures on the psychological status of patients with localized small cell lung cancer complicated with pleural effusion (LSCLC-PE). A total of 79 LSCLC patients were selected for comparing the source of psychological control and psychological distress between the patients with combined (group LSCLC-PE, n = 38) and non-combined pleural effusion (group LSCLC, n = 41). LSCLC-PE patients were randomly sub-divided into the control group (CON, for conventional intervention) and the observation group (OBS, for individualized intervention) for evaluating the intervention effects between these two subgroups using the SCL-90 scale. The PHLC score, psychological pain score, and sources of psychological pain (proportion of dyspnea, etc.) in group LSCLC-PE were higher than group LSCLC, but the IHLC and CHLC scores were lower; after intervention, the somatization, obsessive-compulsive symptoms, and total average score in subgroup OBS were statistically lower than subgroup CON. LSCLC-PE patients have poor psychological status, and intervention can improve their psychological status.

Investigating Treatment Adherence of British and Greek Patients With Type 2 Diabetes Mellitus

Abstract. Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.

Periodontal treatment, psychological factors and oral health-related quality of life

AIMS

To determine changes in OHRQoL and clinical status after periodontal treatment and the factors predicting these changes.

METHODS

Cohort of 140 patients with chronic periodontitis receiving non-surgical treatment. Participant self-completed questionnaires: Sense of Coherence, Locus of Control, Self-esteem and Task-specific Self-efficacy before treatment, and Oral Health Impact Profile at treatment, oral hygiene review and end of study. Relationships between OHRQoL, clinical data, individual and environmental characteristics were analysed with structural equation modelling guided by the Wilson and Cleary model.

RESULTS

OHRQoL and the periodontal status improved after treatment. Greater sense of coherence and age, better periodontal status, lower DMFT and being male predicted better OHRQoL after treatment. Better task-specific self-efficacy and self-esteem, but worse plaque score predicted better end periodontal status.

CONCLUSIONS

OHRQoL and periodontal status improved after periodontal treatment, and this was predicted by individual demographic and psychological factors. These factors may assist with case selection and as possible points for intervention to improve clinical and subjective outcomes of periodontal treatment.

Health literacy and quality of life among Iranian pregnant women: The mediating role of health locus of control

Background: Main health challenge of the 21st century is improving quality of life (QoL). This study aimed to investigate the mediating role of health locus of control (HLC) between health literacy and QoL among Iranian pregnant women. Methods: In this cross sectional survey, 400 pregnant women referred to the community health centers of Gonabad, Iran, and completed the demographic, health literacy, QoL, and multidimensional HLC questionnaires during 2015-2016. Descriptive statistics and structural equation modeling were conducted using SPSS 22.0 version and AMOS 24.0 software. Results: The findings showed that health literacy has a significant positive effect on the physical (β= 0.54, p< 0.001) and mental (β= 0.57, p< 0.001) health. Also, it has a significant positive effect on internal subscale (β= 0.42, p< 0.001) and a significant negative effect on the chance (β= -0.51, p< 0.001) and powerful others (β= -0.33, p< 0.001) subscale of HLC. From HLC subscales, internal HLC had a significant positive effect on physical (β= 0.26, p< 0.001) and mental (β= 0.12, p= 0.010) health, while the effects of chance and powerful others on QoL dimensions were not significant. The findings indicated that internal HLC is a partial mediator between health literacy and physical dimension of QoL. Conclusion: The results indicate that health literacy can be considered as an effective factor in HLC orientations and can improve QoL. This reflects the need for more attention on health literacy and the recognition of the type of HLC beliefs, especially the internal belief in health promotion programs for pregnant women.

Psychometric properties of the Weight Locus of Control Scale (MWLCS): study with Spanish individuals of different anthropometric nutritional status

INTRODUCTION

The Multidimensional Weight Locus of Control Scale (MWLCS) measures a person's beliefs regarding the locus of control or lack of locus of control over his/her body weight.

PURPOSE

We aim to evaluate the factorial structure and psychometric properties of the MWLCS with Spanish normal weight, overweight and obese samples.

METHODS

The research was carried out in two different studies. The first included a sample of 140 normal weight participants, selected out of a 274 sample recruited with an online survey. Study 2 was carried out in a sample of 633 participants recruited from the PREDIMED-Plus study. Out of them, 558 participants fulfilled the weight criteria and were categorized into: overweight (BMI 25 - < 29.99; N = 170), obese class I (BMI 30 - < 34.99; N = 266), and obese class II (BMI 35 - < 39.99; N = 122). Exploratory (EFA) and confirmatory (CFA) factor analyses were used to evaluate the factor structure of the MWLCS, and reliabilities and Spearman's correlations were estimated. Invariance measurement was tested across the three subgroups of weight in Study 2.

RESULTS

A three-factor structure indicating weight locus of control factors (internal, chance, and powerful others) was supported, both via EFA in the normal weight sample and CFA in the overweight and obese samples. In the normal weight sample, the powerful others dimension was positively related to BMI and the dimensions of the Dutch Eating Behaviors Questionnaire. Additionally, the scale showed evidence of scalar invariance across the groups with different weight conditions.

CONCLUSIONS

This scale seems to be a psychometrically appropriate instrument and its use is highly recommended when designing interventions for overweight or obese individuals.

LEVEL OF EVIDENCE

Level V, descriptive study.