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Multidimensional Health Locus of Control (MHLC)
Please note that this section is an archive (last updated in June 2006). [disclaimer]
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Overview |
Instrument Reviews |
Construct Overviews |
Book Compendium Reviews |
Internet Site Reviews
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Practical Information
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Instrument Name:
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Multidimensional Health Locus of Control (MHLC)
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Instrument Description:
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This instrument is used to help predict health behavior based on health beliefs; specifically about the control over one’s health status. A subject is determined to be, to varying degrees, a health-external, in which one’s health is believed to depend on luck, fate or chance, or health-internal, in which one believes health status is determined by one’s own behavior. (Ref: 1)
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Price:
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Free (public domain)
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Administration Time:
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10-15 minutes
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Publication Year:
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1978 (Forms A & B); 1994 (Form C)
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Item Readability:
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Flesch-Kincaid grade of 5.2; Dale-Chall grade level of 5-6. (Ref: 1) Items are written in first person and utilize simple sentences that are less than 20 words each.
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Scale Format:
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Five subscales with 6 or 3 items each among 3 forms; 6-point Likert-type response per item
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Administration Technique:
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No specific training requirements were reported.
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Scoring and Interpretation:
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Range is 6-36 on each subscale (3 to 18 for Doctors and for Others subscales on Form C. Items are summed based on the associated values (i.e. Strongly Disagree=1, Strongly Agree=6); high scores on the subscales indicate belief in those constructs (see Constructs/Factor Structure below)
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Forms:
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Form C can be made disease-specific by substituting the disease for "condition." (Ref: 3)
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Research Contacts
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Instrument Developers:
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Kenneth A. Wallston, PhD, Barbara Strudler Wallston, PhD, and Robert DeVellis, PhD
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Instrument Development Location:
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Vanderbilt University School of Nursing
Godchaux Hall
21st Avenue South
Nashville, TN 37240
George Peabody College for Teachers
Vanderbilt University
21st Avenue South
Nashville, TN 37240
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Instrument Developer Email:
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ken.wallston@mcmail.vanderbilt.edu
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Instrument Developer Website:
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www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm
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Annotated Bibliography
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1. Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr. 1978 Spring;6(2):160-70. [PMID: 689890]
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Purpose: The authors developed a multidimensional measure based on the unidimensional Health Locus of Control (HLC) that can be used to reveal an individual’s health beliefs. |
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Sample: 115 (354 approached, 282 participated, 125 returned surveys) completed surveys were analyzed from people over age 16 who took part in the development stage. Mean age of the useable sample was 42 years, 49% were male, and 74% had some college education. |
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Methods: Booklets were distributed at a metropolitan airport. Items were analyzed separately by subscales and selected by six criteria (see reference). Descriptive statistics, reliability, predictive validity and intercorrelation matrices were performed on the data. |
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Implications: The authors contend that since the internal and external were no longer combined, as in the HLC, the internal consistency has increased. They also mention that these scales may be useful for understanding and predicting health behaviors. |
2. Wallston, K.A. & Wallston, B.S. 1981. Health locus of control scales. In H. Lefcourt (Ed.) Research with the locus of control construct (Volume 1). New York: Academic Press. Pp189-243.
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Purpose: This chapter, written by the developers of the MHLC, reviews studies that have used various health locus of control scales, including the MHLC. |
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Sample: Several studies are cited within this review. |
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Methods: Several studies are cited within this review. |
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Implications: The authors contend that the MHLC is reliable given the alpha scores, but admit that reliability is difficult to determine since human behavior is “complex and multidetermined.” |
3. Russell SF, Ludenia K. The psychometric properties of the Multidimensional Health Locus of Control Scales in an alcoholic population. J Clin Psychol. 1983 May;39(3):453-9. [PMID: 6874981]
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Purpose: The MHLC was used on a sample of Veterans under inpatient alcohol treatment to determine its psychometric stability among patient populations. |
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Sample: The study group consisted of 100 male inpatient Veterans from an Alcohol Dependency Treatment Unit at a VA Hospital. Sample mean age was 45.5 years; at least 61.9% reported having attended some high school, and about a fourth completed high school or attained a GED. |
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Methods: A unit psychologist initially evaluated the patients. Patients underwent a psychological assessment that included the MMPI Form R and the Health Locus of Control Scales. |
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Implications: It was found that the MHLC was both reliable and valid in this population.
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4. Wall RE, Hinrichsen GA, Pollack S. Psychometric characteristics of the multidimensional health locus of control scales among psychiatric patients. J Clin Psychol. 1989 Jan;45(1):94-8. [PMID: 2494225]
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Purpose: The authors evaluated the psychometric properties of the MHLC among a group of psychiatric patients. |
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Sample: The group consisted of 60 psychiatric patients who were on self-supervised lithium and were being discharged from a large suburban teaching hospital. 73.3% were bipolar I, 16.7% had schizoaffective disorder, and 10.0% had major depressive disorder. Mean age was 35±11.59 years; 78.3% were White, 58.3% werefemale, and 88% completed high school. |
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Methods: Forms A and B of the MHLC was administered to this group. The authors performed factor analysis and intercorrelations were also calculated. |
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Implications: The results support the use of the MHLC in this population. |
5. Marshall GN, Collins BE, Crooks VC. A comparison of two multidimensional health locus of control instruments. J Pers Assess. 1990 Spring;54(1-2):181-90. [PMID: 2313540]
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Purpose: The study compared the psychometric properties of two multidimensional HLC scales developed by different groups. |
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Sample: The sample consisted of 181 male Veterans from large mailings to an outpatient population (the response rate was 36%.) There was no evidence of sample bias. The mean age was 62 years; 65% reported being high school graduates or equivalent; 54% were White, 33% were Black, 5% Hispanic, 3% Asian and 5% did not specify. Also, 54% were married, 24% divorced or separated, and 11% were never married. Patients in this sample reported having received treatment for multiple health problems, which were commonly heart and vascular in nature. |
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Methods: Patients were asked to complete the Wallston MHLC scale (Form A; 18 items) and the Lau-Ware HLC scale (20 items), which were all arranged on one form in a random order. |
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Implications: The authors reported that construct validity was modest among the subscales and identical constructs were significantly correlated, though they were weak. They also reported that factor analysis revealed that the factor structure may vary greatly among populations for the Lau-Ware scale. |
6. Wallston KA, Stein MJ, Smith CA. Form C of the MHLC scales: a condition-specific measure of locus of control. J Pers Assess 1994 Dec;63(3):534-53. [PMID: 7844739]
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Purpose: The authors evaluated Form C of the MHLC, an 18-item, disease-specific, adaptable scale. |
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Sample: A total of 588 patients drawn from different disease groups were used. The groups were arthritis (N=273; 75% female; 95% White; 80% married; 78% minimum of high school education; mean age was 55 years), chronic pain (N=111; 61% female; 70% White; 49% married; mean education was 12.2 years; mean age was 40.7 years), Type I and II diabetes (N=111; no demographic data found), and two cancer groups (N=42; mean age was 54.7 years; age range was 24-80 years; mean education was 14 years; 61% female; 67% married and N=51; mean age was 53.4 years; age range was 18-78 years; mean education was 12.6; 61% female). |
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Methods: A 24-item MHLC Form C was administered to all samples. The arthritis group also completed Form B of the MHLC and Levinson’s I, P, and C scales also. Patients in the chronic pain and arthritis groups also answered pain-related, depression and helplessness items. The subjects were combined and split into two random groups before analysis was performed. |
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Implications: Form C was eventually reduced to 18 items. It was found to be valid and reliable. |
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Factors and Norms
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Factor Analysis Work:
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There are five subscales distributed among three forms: Internal (Form A, B, C; Items 1, 6, 8, 12, 13, 17), Chance (Form A, B, C; Items 2, 4, 9, 11, 15, 16), Powerful Others (Form A, B; Items 3, 5, 7, 10, 14, 18), Doctors (Form C; Items 3, 5, 14), and Other People (Form C; Items 7, 10, 18.) Forms A & B assess general health and Form C can be made disease-specific by substituting the disease in place of the word "condition." (Ref: 1, 2)
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Normative Information Availability:
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Mean score data exist for a variety of population subgroups, including college students (n=749), healthy adults (n=1287), chronically ill persons (n=609), and persons engaged in preventive health behaviors (n=720). (Ref: 2)
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Reliability Evidence
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Test-retest:
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The authors reported test-retest reliability only for Form C of the MHLC. Data was collected on a sample of patients with either Arthritis or Chronic Pain. Stability coefficients (r) were calculated for two test administrations in the Arthritis group (time interval was 1 year) and three administrations in the Chronic Pain group (pretreatment: T1, post treatment: T2=6 weeks, and follow-up: T3=1 month after T2; r1 was between T1 and T2; r2 was between T2 and T3). The following data were reported: Arthritis [Internal (r=0.66); Chance (r=0.61); Doctors (r=0.66); Other People (r=0.54)] and Chronic Pain [Internal (r1=0.64, r2=0.80); Chance (r1=0.39, r2=0.72); Doctors (r1=0.45, r2=0.58); Other People (r1=0.35, r2=0.40)]. As an intervention was given between the first two assessments of the pain study, it was expected that correlations would be lower between time 1 and 2 as compared to times 2 and 3. (Ref: 3)
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Inter-rater:
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The scales are self-report; therefore, inter-rater reliability is not applicable.
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Internal Consistency:
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Using the six items separately from either A or B resulted in Cronbach’s alpha values in the range of 0.673 to 0.767. Alpha’s ranged from 0.830 to 0.859 for the combined forms (A+B) (Ref: 1). Internal consistency for Form C was estimated using two samples. Cronbach alpha reliabilities for each of the subscales (Sample 1/Sample 2) were: Internal was 0.87/0.85; Chance was 0.82/0.79; Doctors was 0.71/0.71; Other People was 0.71/0.70. Values for the latter two subscales were lower because they only consisted of three items each (Ref: 3) Wall et al found that the Chance scale was correlated significantly and negatively with the Internal scale (-0.27, p<0.05) in a sample of 60 psychiatric patients recently discharged from inpatient or day hospital psychiatric facilities. (Ref: 6)
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Alternate Forms:
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Alternate form reliabilities of 0.834, 0.761, & 0.734 were reported for Internality, Powerful Others, and Chance by the original authors (Ref. 1). Another study using alcoholic patients reported 0.68, 0.76, and 0.65 for the same scales (Ref. 5). Correlations between Form C and Form B were 0.59 for Internal, 0.65 for chance, 0.55 between Powerful Others (Form B) and Doctors (Form C), and 0.38 between Powerful Others (Form B) and Other People (Form C) (Ref. 3).
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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Construct validity for Form C using the Arthritis and Pain groups was evaluated. For the former group no significant changes were expected or observed for the Internality subscale. Externality subscale scores, however, decreased over time (1 year): Chance [t(233)=1.94, p=0.053]; Doctors [t(233)=2.17, p<0.04]; Other People [t(233)=2.96, p<0.01]. In the Pain sample, all four subscales were expected to change due to intervention and in fact, they significantly decreased between Time 1 and Time 2 (6 weeks). Internal [t(104)=-5.10, p<0.001]; Chance [t(104)=2.11, p<0.04]; Doctors [t(104)=2.63, p<0.01]; Other People [t(104)=4.10, p<0.001] (Ref 3). Additional construct validity is available. (Ref: 4)
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Criterion-related/ Concurrent/ Predictive:
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Correlations for predictive validity, between health status and MHLC scores, were reported. The authors found a positive correlation with the Internal subscale (r=0.403, p<0.001); a negative correlation with the Chance subscale (r=-0.275, p<0.1); and no correlation with the Powerful Others subscale (r=-0.055). (Ref: 1); Chance with C: 0.50 or with P: 0.38; Other People with C: 0.30 or with P: 0.41. Doctors did not correlate with any of Levenson’s scales. The authors presented further validity evidence including differences among diagnostic groups, correlations with related constructs, and differential utility of Forms B and C. (Ref: 3)
The MHLC has not been found to be associated with preventive health behaviors such as annual checkups, immunizations, seat belt use, diet and exercise, weight reduction, oral hygiene behaviors, or contraceptive use (Ref. 2). The MHLC has been found to be associated with smoking reduction. (Ref. 2). Equivocal results have been found between MHLC scores and adherence behavior. (Ref. 2)
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Content:
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No information found.
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Responsiveness Evidence:
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Several studies are reported where the MHLC was used to monitor changes in beliefs resulting from interventions (Ref. 2 ).
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Scale Application in VA Populations:
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Yes. 181 Veteran outpatients. (Ref: 4) Sample of 100 Veterans from an Alcohol Dependence Treatment Clinic. (Ref: 5)
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Scale Application in non-VA Populations:
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Yes. Multiple populations and studies. (Ref: 1-3)
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Comments
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The MHLC represents a relatively well-developed set of measures for Health locus of control. The scales are self-report, easy to administer, and brief. There is modest evidence of reliability, at least for research purposes. Validity evidence has been limited mainly to factor analyses, correlations with Levenson’s scales, and sensitivity to intervention. Evidence is less compelling with respect to appropriate uses of the scale beyond narrowly focused interventions, theoretical tests, or predicting health behaviors. The authors report that their own work in the latter area has not been fruitful. Thus more work needs to be done in order to determine if this construct is a viable one in Health research in general. One advantage is its use in VA populations. Results of these studies show that the structure and reliability are similar in this population to others reported in the literature.
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