Fetal Health Locus of Control Scale (FHLC)

Abstract

The Fetal Health Locus of Control Scale (FHLC) is an 18-item psychometric instrument developed by Labs and Wurtele in 1986. Its purpose is to assess the beliefs held by pregnant women regarding the source of control over the health and outcomes of their unborn child. This specialized measure of Locus of Control utilizes a multi-dimensional framework, dividing attributions into three distinct subscales: Internality, Chance, and Powerful Others. The FHLC is instrumental in research aimed at understanding how maternal perceptions of control influence health adherence and participation in Prenatal Care programs, offering valuable insights for clinical interventions.

Keywords

Fetal Health Locus of Control, FHLC, Pregnancy, Maternal Health, Locus of Control, Health Behavior, Internality, Powerful Others, Chance, Prenatal Health.

Authors

Labs, S. M., Wurtele, S. K.

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Purpose

The primary objective of the Fetal Health Locus of Control Scale is to quantify the specific attributions pregnant women make concerning the causality of fetal health outcomes. By segmenting these attributions, the scale enables researchers and clinicians to predict health behaviors and adherence levels during pregnancy.

Understanding whether a woman believes her baby’s health is determined by her own actions (Internality), governed by fate (Chance), or dependent entirely on medical professionals (Powerful Others) is crucial for tailoring effective Prenatal Care strategies and educational programs. High scores on the Chance or Powerful Others subscales may indicate areas where the mother feels a lack of personal agency, potentially leading to poorer self-management behaviors.

Construct

The FHLC is grounded in social learning theory and applies the generalized concept of Locus of Control (LOC) directly to the domain of Fetal Health. It measures three distinct, yet interrelated, dimensions of perceived control:

• Internality (FHLC-I): This factor assesses the belief that the mother’s personal choices, lifestyle, and diligence in self-care are the determining factors for the health status of her unborn child.
• Powerful Others (FHLC-P): This factor reflects the extent to which the mother attributes control over fetal health to external experts, such as doctors, nurses, and other medical personnel.
• Chance (FHLC-C): This factor measures the conviction that outcomes are arbitrary, determined by external, uncontrollable forces like fate, luck, or destiny, independent of human intervention.

This multi-dimensional approach provides a more nuanced psychological profile than traditional unidimensional LOC scales, making it highly specific for research in maternal-fetal medicine.

Validity

The initial development and validation study by Labs and Wurtele (1986) established the scale’s structural integrity through factor analysis, confirming the theoretical separation of the three hypothesized dimensions. The scale has demonstrated strong construct validity, correlating appropriately with measures of health motivation and behavior, such as adherence to medical advice and participation in prenatal education.

Furthermore, the FHLC has shown predictive utility, serving as a reliable instrument to differentiate behavioral patterns in diverse populations, including women with high-risk pregnancies (e.g., those with diabetes) compared to those with low-risk pregnancies. This differentiation highlights the scale’s specialized relevance in predicting engagement with necessary health protocols vital for optimal Fetal Health outcomes.

Reliability

The FHLC exhibits strong and acceptable psychometric properties, supporting its use as a stable and consistent measure. Both internal consistency (measured by Cronbach’s Alpha, ‘a’) and stability over time (measured by Test-retest correlation, ‘r’) were assessed for each subscale:

• Internality (FHLC-I): The factor demonstrated strong internal consistency (a = 0.88) and high stability (r = 0.80).
• Chance (FHLC-C): This factor showed good internal consistency (a = 0.83) and excellent stability (r = 0.86).
• Powerful Others (FHLC-P): This factor maintained acceptable internal consistency (a = 0.76) and stability (r = 0.67).

These reliability coefficients indicate that the items within each subscale are highly correlated and consistently measure the intended construct across repeated administrations.

Factor Analysis

Factor analysis confirmed the instrument’s tripartite structure, resulting in three distinct, theoretically meaningful factors: Internality, Chance, and Powerful Others. The 18 items of the scale load onto these factors as follows, defining the scoring procedure for the FHLC subscales:

• Internality (FHLC-I) Items: 1, 6, 8, 12, 15, and 17.
• Chance (FHLC-C) Items: 2, 4, 9, 11, 14, and 16.
• Powerful Others (FHLC-P) Items: 3, 5, 7, 10, 13, and 18.

The resulting factor structure allows for the calculation of three independent scores, enabling detailed research into the specific beliefs driving maternal health decisions.

Instrument

Test Type: Self-report psychological scale (Attitudinal/Beliefs)

Format: 18 items responded to on a 10-point Likert scale, ranging from “0 = Strongly Disagree” to “9 = Strongly Agree.”

Language Available: English (Original research language).

Population Group: Pregnant women; women planning or contemplating pregnancy.

Age Group: Adult reproductive age (Typically 18+).

Population Details: Utilized in clinical psychology, health psychology, and obstetrics research focusing on maternal adherence, risk perception, and health information-seeking behaviors.

Test Methodology: Quantitative survey methodology yielding three primary subscale scores (Internality, Chance, Powerful Others) based on the summation of item scores related to each factor.

Keywords

Self-care, Maternal perceptions, Health psychology, Internal consistency, Psychometrics, Pregnancy outcomes, Obstetric history, Risk perception.

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Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The Fetal Health Locus of Control Scale (FHLC) was first developed and validated in 1986. The instrument is generally available for academic and non-commercial research use, provided proper citation of the original authors (Labs & Wurtele, 1986) is maintained. The scale items and scoring information are documented in widely used measures sourcebooks for clinical practice and research.

Reference’s

• Labs, S. M., & Wurtele, S. K. (1986). Fetal Health Locus of Control scale: Development and validation. Journal of Consulting and Clinical Psychology, 54(6), 814-819. The original article can be accessed via DOI: http://dx.doi.org/10.1037/0022-006X.54.6.814
• Labs and Wurtele. (1986). Fetal Health Locus of Control Scale (FHLC). In Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page (s): 341-343. The instrument details are also available at: https://www.researchgate.net/publication/19367963
• Spirito, A., Ruggiero, L., McGarvey, S. T. & Coustan, D. R. (1990). Maternal and fetal health Locus of Control during pregnancy: A comparison of women with diabetes and nondiabetic women. Journal of Reproductive and Infant Psychology, 8, 195-206.
• Bielawska-Batorowicz, E. (1993). The effect of previous obstetric history of women’s scores on the fetal health Locus of Control scale (FHLC). Journal of Reproductive and Infant Psychology, 11, 103-106.
• Stewart, D. E. & Streiner, D. L. (1995). Cigarette smoking during pregnancy. The Canadian Journal of Psychiatry, 40, 603-607.
• Sheih, C., Broome, M. E., & Stump, T. (2010). Factors associated with health information-seeking in low-income pregnant women. Women & Health, 5, 426-442.

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Items of the Fetal Health Locus of Control Scale (FHLC)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. By attending prenatal classes taught by competent health professionals‚ I can greatly increase the odds of ha‎ving a healthy‚ normal baby.
2. My unborn child’s health can be seriously affected by my dietary intake during pregnancy.
3. If I get sick during pregnancy‚ consulting my doctor is the best thing I can do to protect the health of my unborn child.
4. Learning how to care for myself before I become pregnant helps my child to be born healthy.
5. What I do right up to the time that my baby is born can affect my baby’s health.
6. Before becoming pregnant‚ I would learn what specific things I should do and not do during pregnancy in order to have a healthy‚ normal baby.
7. Even if I take excellent care of myself when I am pregnant‚ fate will determine whether my child will be normal or abnormal.
8. If my baby is unhealthy or abnormal‚ nature intended it to be that way.
9. No matter what I do when I am pregnant‚ the laws of nature determine whether or not my child will be normal.
10. God will determine the health of my child.
11. Fate determines the health of my unborn child.
12. ha‎ving a miscarriage means to me that my baby was not destined to live.
13. My baby will be born healthy only if do everything my doctor tells me to do during pregnancy.
14. The care I receive from health professionals is what is responsible for the health of my unborn baby.
15. Health professionals are responsible for health of my unborn child.
16. Doctors and nurses are the only ones who are competent to give me advice concerning my behavior during pregnancy.
17. My baby’s health is in the hands of health professionals.
18. Only qualified health professionals can tell me what I should and should not do when I am pregnant.