Multidimensional Health Locus of Control

Abstract

The Multidimensional Health Locus of Control (MHLC) scale is a widely utilized psychometrics instrument designed to assess an individual’s beliefs regarding the primary sources responsible for controlling their health outcomes. Developed by Wallston, Wallston, and DeVellis, the scale operationalizes the concept of Locus of control within the health domain, proposing that these beliefs are not unitary but rather distributed across three distinct dimensions: Internal, Powerful Others, and Chance. The scale is available in multiple forms (A, B, and the condition-specific Form C) to facilitate both general health research and targeted clinical applications.

Keywords

Health Psychology, Locus of control, Health Beliefs, Internal Health Locus of Control, Powerful Others Health Locus of Control, Chance Health Locus of Control, MHLC, Psychological Assessment.

Authors

Kenneth A. Wallston, Barbara Strudler Wallston, Robert F. DeVellis

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Purpose

The primary purpose of the MHLC is to measure individual differences in the extent to which people believe their health status is determined by their own actions, the influence of powerful external agents (such as medical professionals), or by random fate or luck. Understanding these beliefs is crucial for predicting health behaviors, adherence to medical regimens, and coping mechanisms, particularly in clinical and preventative health settings.

The scale exists in several forms (A, B, and C). Forms A and B are designed to assess general health beliefs concerning overall health and wellness. Form C is an adaptation that measures beliefs concerning a specific, existing medical condition (e.g., diabetes, cancer), allowing for highly tailored assessment in chronic disease management research and intervention planning.

Construct

The scale measures the psychological construct of health Locus of control (HLC), an adaptation of Rotter’s generalized Locus of control theory. The MHLC is specifically structured around three independent dimensions, reflecting the multidimensional nature of health beliefs:

• Internal Health Locus of Control (IHLC): The belief that one’s health status is a direct result of one’s own behavior, effort, and choices (e.g., diet, exercise, self-care). Individuals scoring high on this dimension feel personally responsible for their wellness.
• Powerful Others Health Locus of Control (PHLC): The belief that health outcomes are determined by influential external figures, such as physicians, nurses, family members, or other health professionals.
• Chance Health Locus of Control (CHLC): The belief that health outcomes are governed by luck, fate, chance, or uncontrollable environmental factors, suggesting that personal efforts or professional help are largely ineffective against random events.

Validity

The validity of the MHLC scale has been extensively documented since its introduction in 1978. Evidence for construct validity is supported by numerous studies demonstrating that the three subscales are statistically independent of one another, confirming the multidimensional theoretical framework. This independence allows researchers to measure distinct sources of perceived control simultaneously.

Criterion validity has been established by showing that the subscales correlate meaningfully with relevant behavioral outcomes. For instance, high IHLC scores typically correlate positively with proactive health behaviors (e.g., preventative care, seeking information), while high PHLC scores often correlate with better compliance with prescribed medical advice. The condition-specific Form C often exhibits stronger predictive validity regarding adherence to specific treatment protocols compared to the general forms when used with patients managing chronic illnesses.

Reliability

The MHLC demonstrates generally acceptable levels of Internal consistency across its three subscales when administered to diverse populations. Internal consistency, typically measured using Cronbach’s alpha, usually falls within the range of 0.70 to 0.85 for the IHLC and PHLC subscales, indicating good homogeneity among the items within these dimensions. The CHLC subscale, while sometimes showing slightly lower alpha values, generally remains within an acceptable range for research instruments.

Test-retest reliability has consistently been confirmed across various studies, suggesting that health Locus of control beliefs, particularly Internal and Powerful Others dimensions, are relatively stable psychological traits over moderate periods. This stability makes the scale suitable for longitudinal research measuring the impact of health interventions.

Factor Analysis

The original development of the MHLC utilized principal components analysis, and subsequent confirmatory Factor analysis (CFA) has consistently supported the hypothesized three-factor structure across diverse clinical and non-clinical populations, as well as various cultural contexts. This analysis confirms that the 18 items load cleanly onto the three distinct constructs: Internal, Powerful Others, and Chance, generally demonstrating strong factor loadings and minimal cross-loading.

The robust factor structure validates the argument that health beliefs are not simply bipolar (internal vs. external, as suggested by earlier scales) but require a multidimensional approach to accurately capture the complexity and nuance of perceived control over health outcomes.

Instrument

Test Type: Self-report questionnaire / Psychometrics scale

Format: 18 items, 6-point Likert scale. Responses range from 1 (Strongly Disagree) to 6 (Strongly Agree). Each of the three subscales (IHLC, PHLC, CHLC) consists of 6 items.

Language Available: English (Original), widely translated into numerous languages including Spanish, German, Chinese, and others, often requiring re-evaluation of psychometric properties in new cultural settings.

Population Group: General adult population and clinical populations (patients managing acute or chronic diseases).

Age Group: Typically utilized with adolescents and adults (16 years and older).

Population Details: Applicable for use in health research, preventative medicine, behavioral intervention studies, and chronic illness management where understanding patient beliefs about control is critical.

Test Methodology: Respondents indicate their level of agreement with belief statements pertaining to the control of their health. Scores are calculated by summing the responses for the six items corresponding to each of the three subscales. Higher scores indicate a stronger belief in that specific locus of control dimension.

Keywords

Health Behavior, Patient Compliance, Chronic Illness, Internal Health, Powerful Others, Chance, Health Locus of control.

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Authors

Author ORCID Identifier: Information not provided in source material.

Affiliation Email addresses: [email protected]

Correspondence Address: Kenneth A. Wallston, Ph.D., Vanderbilt University School of Nursing, Nashville, TN, USA.

Permissions & Fee and Test Year

The MHLC scales (Forms A, B, and C) are generally made available for non-commercial academic and clinical research use without charge, provided proper citation is given to the original publication. Users seeking to integrate the scale into commercial products or large-scale institutional assessments should consult the primary author, Kenneth A. Wallston, for formal permissions. The scale was originally developed and published in 1978.

Test Year: 1978 (Original Publication).

Reference’s

• Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monographs, 6(2), 160-170.
• Wallston, K. A. (2005). The Multidimensional Health Locus of Control (MHLC) Scales. Current psychometric information is available at: http://www.nursing.vanderbilt.edu/faculty/kwallston/mhlcscales.htm

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Items of the Multidimensional Health Locus of Control

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

The original source for Form A is available here: http://www.vanderbilt.edu/nursing/kwallston/mhlcforma.htm

The original source for Form B is available here: http://www.vanderbilt.edu/nursing/kwallston/mhlcforma.htm

Further information regarding the scales can be found here: http://www.nursing.vanderbilt.edu/faculty/kwallston/mhlcscales.htm