Multidimensional Health Locus of Control Scale

Abstract

The Multidimensional Health Locus of Control Scales (MHLC) is a psychological assessment tool designed to measure an individual’s beliefs regarding the primary determinants of their health status. Developed from Rotter’s Locus of Control theory, the MHLC specifically focuses on the health domain, providing insight into personal factors that influence health behaviors and outcomes.

The scale, typically consisting of 18 items, is structured around three distinct control orientation subscales. These dimensions quantify the degree to which health outcomes are attributed to personal effort (Internal orientation), the actions of external influences such as powerful others (e.g., physicians or medical staff), or random occurrences (Chance orientation).

Keywords

Health Locus of Control, Locus of Control, MHLC, Health Psychology, Health Beliefs, Personal factors, Questionnaire, Wallston.

Authors

Wallston KA, Wallston BS, DeVellis R (1978); Wallston KA, et al. (1994).

Purpose

The primary purpose of the MHLC scale is to inventory and quantify personal factors related to an individual’s perception of control over their health. By assessing these control beliefs, researchers and clinicians can better understand motivational factors underlying health maintenance and illness management behaviors.

Understanding an individual’s health locus of control is crucial for tailoring health interventions. For instance, individuals with a high Internal orientation may respond well to programs focused on self-management and personal responsibility, while those with a high Powerful Others orientation might benefit from strong patient-physician relationships and clear medical guidance.

Construct

The MHLC measures the psychological construct of Health Locus of Control, which is the degree to which individuals generally perceive reinforcements (rewards or consequences) in the health domain as contingent upon their own behavior (internal control) or upon forces beyond their personal control (external control).

The scale specifically delineates three dimensions of control beliefs:

• Internal (I): Belief that one’s own behavior, effort, and discipline determine health outcomes.
• Powerful Others (P): Belief that influential people, such as physicians, nurses, or family members, control one’s health. The original source referred to “arts-oriëntatie” (physician orientation), which falls under this broader construct.
• Chance (C): Belief that health outcomes are determined by fate, luck, or random occurrences, regardless of personal effort or medical intervention.

Validity

The validity of the MHLC has been extensively studied across diverse populations and health conditions. Numerous studies support its construct validity, demonstrating expected correlations between the subscales and various health behaviors, personality traits, and psychological states.

For example, high scores on the Internal subscale typically correlate positively with proactive health behaviors (e.g., exercise, diet adherence), whereas high scores on the Chance subscale often correlate with lower levels of health engagement and higher levels of perceived stress. Discriminant validity is also established by showing that the MHLC measures unique variance compared to general measures of locus of control.

Reliability

The scale demonstrates acceptable levels of internal reliability, particularly for a multidimensional measure of this nature. Internal consistency, measured using Cronbach’s Alpha, typically ranges from 0.60 to 0.75 across the three subscales (I, P, and C) in most published research studies.

Test-retest reliability is generally strong, indicating that the scales provide stable measures of control orientation over time, particularly when administered within a few weeks. This temporal stability supports its utility in longitudinal studies tracking changes in health beliefs following significant life events or medical diagnoses.

Factor Analysis

The underlying structure of the Multidimensional Health Locus of Control Scale has been consistently validated through factor analysis. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) generally support the hypothesized three-factor model (Internal, Powerful Others, Chance).

The 18 items load distinctly onto their respective factors, confirming that the scale successfully differentiates between self-determination, reliance on external experts, and fatalistic beliefs regarding health. This robust factorial structure is critical for maintaining the scale’s utility in research settings.

Instrument

Test Type: Psychological Questionnaire

Format: Self-report scale, typically using a Likert-type response format (e.g., 6-point scale ranging from “Strongly Disagree” to “Strongly Agree”).

Language Available: Originally English; translated into numerous languages globally (e.g., Dutch, Spanish, Chinese).

Population Group: Clinical and Non-clinical populations.

Age Group: Adults (Volwassenen).

Population Details: Suitable for general adult populations, as well as specific patient groups dealing with chronic illness or undergoing health interventions.

Test Methodology: The scale requires participants to rate their agreement with 18 statements, with scores calculated separately for the three subscales. Higher scores on a subscale indicate a stronger belief in that specific source of control.

Keywords

Health beliefs, Internal control, Powerful others, Chance orientation, Health psychology, Psychological assessment, Wallston KA, Chronic illness.

Authors

Author ORCID Identifier: Information not provided in the source.

Affiliation Email addresses: Information not provided in the source.

Correspondence Address: Information not provided in the source.

Permissions & Fee and Test Year

The scale was initially published in 1978 (Form A) and revised in 1994 (Form B). Users should consult the original authors or publishing entities regarding current usage permissions and associated fees.

The original PDF explanation form can be downloaded here: Toelichtingsformulier.

The original PDF measurement instrument can be downloaded here: Meetinstrument.

Reference’s

The primary references for the development and validation of the MHLC scale include:

• 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. (1994). Assessment of Health Locus of Control. In R. F. DeVellis & B. S. Wallston (Eds.), Measurement of Health Behavior (pp. 189–203). John Wiley & Sons.

Items of the Multidimensional Health Locus of Control Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. (Note: The source content provided the structure but not the 18 specific item texts.)

The MHLC consists of 18 questions (items) which are divided across three distinct control orientation scales, as indicated by the original source content:

1. interne oriëntatie
2. arts-oriëntatie
3. kans-oriëntatie

Each of the three subscales (Internal, Powerful Others, Chance) is typically measured using 6 items, totaling 18 items for the complete scale (Form A and B).