Oral Health Locus of Control Scale

Abstract

The Oral Health Locus of Control Scale (LOCOH) is a specialized psychological scale developed to assess how individuals perceive the degree of control they have over their oral health status and outcomes. Based on Rotter’s Locus of Control theory, the instrument is structured around three primary dimensions: Internality (the belief that outcomes are due to one’s own behavior), Chance (the belief that outcomes are due to luck or fate), and Powerful Others (the belief that outcomes are controlled by dental professionals or family members). The scale was developed as part of a Doctor of Philosophy dissertation in 2006 to explore the relationship between control beliefs, general health orientation, and the value placed on dental well-being.

Keywords

Oral Health Locus of Control, LOCOH, Rotter, Internality, Chance, Powerful Others, Dental Health, Health Psychology, Locus of Control, Oral Health Value.

Authors

Rosita Brown Long

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Purpose

The primary purpose of the LOCOH scale is to provide a reliable and valid measure of control beliefs specifically within the domain of oral health. Prior to its development, most research relied on general health locus of control measures, which may not accurately capture domain-specific beliefs that influence dental behavior and adherence to treatment. This instrument aims to differentiate between individuals who believe their dental outcomes are self-determined, those who attribute them to external factors like luck, and those who rely heavily on dental professionals.

Furthermore, the scale was designed to investigate the relationship between these specific control orientations and other key psychological variables, including the value placed on oral health (measured by the supplementary Oral Health Value Scale) and actual oral health care experiences, thereby offering deeper insights for health promotion and patient education strategies in dentistry.

Construct

The LOCOH scale operationalizes the Locus of Control (LOC) construct as applied to dental outcomes. LOC is a psychological concept referring to how strongly people believe they have control over the experiences that affect their lives. The LOCOH scale measures three distinct dimensions:

• Internality: Reflects the belief that good oral health results from personal behaviors, diligence, and self-care efforts (e.g., brushing, flossing, healthy choices).
• Chance: Reflects the belief that dental outcomes are determined by fate, luck, or uncontrollable factors like heredity or unavoidable aging processes.
• Powerful Others: Reflects the belief that dental outcomes are primarily controlled by external authorities, specifically dental professionals (dentists, hygienists) or, to a lesser extent, family members.

The scale assumes that these orientations are relatively stable personality characteristics that predict health behaviors and adherence to prescribed dental regimens.

Validity

While the full, detailed psychometric data is contained within the originating Doctor of Philosophy dissertation, the development process included rigorous steps to ensure validity. Content validity was established through expert review and alignment with established LOC theory. The scale’s construction utilized items derived from extensive literature review concerning dental beliefs and behaviors.

Construct validity was tested through factor analysis, confirming the theoretical three-factor structure (Internality, Chance, Powerful Others). Furthermore, criterion validity was implied by examining the relationship between LOCOH scores and self-reported oral health behaviors and dental care utilization, suggesting that individuals with a higher Internal Locus of Control were more likely to engage in preventative dental behaviors.

Reliability

The reliability of the LOCOH scale was assessed during its initial development phase in 2006. Internal consistency was measured using Cronbach’s Alpha for the three subscales. High reliability coefficients were sought to ensure that the items within each subscale consistently measure the intended dimension (Internality, Chance, or Powerful Others).

The dissertation reported that the final item sets for the LOCOH subscales—Internality (10 items), Chance (11 items), and Powerful Others (10 items)—demonstrated acceptable to good internal reliability, suggesting that the instrument provides stable and consistent measurements of the specific oral health control beliefs.

Factor Analysis

The development of the LOCOH scale was grounded in an exploratory and confirmatory factor analysis (EFA/CFA) process performed on the initial pool of potential items. This analysis was crucial in refining the instrument and ensuring that the final items loaded correctly onto the hypothesized factors, thereby supporting the underlying theoretical model.

The factor analysis confirmed the hypothesized three-factor structure, distinguishing clearly between the beliefs related to personal responsibility (Internality), external fate (Chance), and reliance on experts (Powerful Others). This rigorous statistical validation demonstrated the scale’s ability to isolate distinct components of the oral health control construct.

Instrument

Test Type: Psychological scale; Self-report inventory

Format: 6-point Likert scale (1=Strongly Agree to 6=Strongly Disagree) for the LOCOH and Oral Health Value items, supplemented by behavioral checklists and frequency questions regarding dental symptoms and care utilization.

Language Available: English (Original development language)

Population Group: General adult population; initially tested on undergraduate students and community adults.

Age Group: Adults (typically 18+)

Population Details: The initial sample included participants whose demographics were analyzed to ensure the instrument was broadly applicable, although specific demographic characteristics would influence oral health care experience.

Test Methodology: Paper-and-pencil questionnaire format. Scoring involves summing item responses within each of the three subscales (Internality, Chance, Powerful Others) to produce three distinct scores reflecting the strength of each control orientation.

Keywords

Dental beliefs, Health behavior, Psychometrics, Internal consistency, Rotter’s LOC, Oral hygiene, Preventative dentistry, Health promotion.

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Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: Rosita Brown Long, Oklahoma State University (Affiliation at time of publication of the Doctor of Philosophy dissertation)

Permissions & Fee and Test Year

The scale was developed as part of a doctoral dissertation in 2006. Permissions for use may be required from the author, Rosita Brown Long, or the degree-granting institution, Oklahoma State University. As a doctoral instrument, it is generally available for academic research, but specific commercial or clinical applications should verify copyright status. The original dissertation is publicly available online.

Reference’s

Long, R. B. (2006). Development of an Instrument Measuring Oral Health Locus of Control: Relationship to General Health Locus of Control, Oral Health Care Experience, and Oral Health Value. Unpublished Doctor of Philosophy Dissertation, Oklahoma State University, Stillwater, OK.

The original PDF can be downloaded here: http://digital.library.okstate.edu/etd/umi-okstate-2149.pdf

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Items of the Oral Health Locus of Control Scale

Locus of Control for Oral Health (LOCOH) Internality Scale (Final)

1= Strongly Agree‚ 2= Moderately Agree‚ 3= Agree‚ 4= Disagree‚ 5= Moderately Disagree‚ 6= Strongly Disagree

1. If I take care of myself I can avoid problems with my teeth and gums.
2. If I have a dental problem(s)‚ other than an injury‚ it will be because of something I’ve done or not done.
3. Dental problems happen because of personal neglect.
4. I am directly responsible for keeping my teeth and gums healthy.
5. I control the condition of my teeth and gums.
6. My dental health can only be good if I take the right actions myself.
7. I take oral health and disease seriously enough to act on my own knowledge.
8. I learned growing up how to take care of my teeth and mouth for good oral health.
9. My oral health depends solely on the way I take care of myself.
10. I make the decision whether to have good oral health or not.

Locus of Control for Oral Health (LOCOH) Chance Scale (Final)

1= Strongly Agree‚ 2= Moderately Agree‚ 3= Agree‚ 4= Disagree‚ 5= Moderately Disagree‚ 6= Strongly Disagree

1. No matter what I do‚ I’m likely to have dental problems.
2. If you have bad dental health when you are young‚ there is little more you can do.
3. I think just about everybody looses teeth as they get older.
4. Luck probably plays a big part in how soon I recover from my dental problems.
5. Most things that affect my dental health happen because of luck.
6. There is little I can do to avoid dental problems.
7. A lot of things that affect my dental health are out of my control.
8. Poor dental health is unavoidable.
9. Dental health happens mostly because of luck.
10. When I think of oral health problems‚ I’m just lucky things are not worse.
11. Dental problems happen in spite of everything I try to do to avoid them.

Locus of Control for Oral Health (LOCOH) Powerful Others Scale (Final)

1= Strongly Agree‚ 2= Moderately Agree‚ 3= Agree‚ 4= Disagree‚ 5= Moderately Disagree‚ 6= Strongly Disagree

1. Regarding my dental health‚ I do only what the dental professionals tell me to do.
2. Ha‎ving regular contact with my dental professionals is the best way for me to avoid dental problems.
3. My family plays a big part in my dental health recovery.
4. Dental professionals are responsible for keeping my teeth and gums healthy.
5. The care I receive from dental professionals is the main reason for how well I recover from dental problems.
6. There is a direct connection between going to the dentist and good dental health.
7. Ha‎ving good dental health can only happen by listening to dental professionals.
8. If I don’t visit my oral health provider regularly‚ then my oral health will probably get worse.
9. Without the work of dental professionals to care for my teeth and gums‚ I couldn’t have good oral health.
10. Most dental problems can be helped by making visits to the dental office.

Oral Health Value Scale (OHV) – Final

1= Strongly Agree‚ 2= Moderately Agree‚ 3= Agree‚ 4= Disagree‚ 5= Moderately Disagree‚ 6= Strongly Disagree

1. There are many things I care about more than my dental health.
2. Good dental health is only of minor importance in a happy life.
3. My dental health is highly important compared to other things in my life.