Multidimensional Health Locus Of Control Research Articles

Influence of personality psychology on outcome of total hip arthroplasty: a cross-sectional study on 69 patients.

Patient's satisfaction after total hip arthroplasty is influenced by many surgical and rehabilitation aspects, but is not available in the literature, a study that analyses the correlation between patient's psychology and clinical results of this procedure. The aim of this study was to investigate the relationship between memory of pain, clinical outcome and subjective satisfaction with the Multidimensional Health Locus of Control. We conducted a cross-sectional study on a cohort of 69 patients operated of total hip arthroplasty in our department from November 2008 to August 2011. Pre- and post-operative hip function was assessed by the Harris Hip Score. At the follow-up visit, patient satisfaction was assessed by means of the Patient Satisfaction Questionnaire. The memory of pain was evaluated by a modified questionnaire of pain experience. Multidimensional Health Locus of Control was evaluated in all patients, and results were connected with patient's subjective satisfaction and pain indexes. Patients were divided into two groups about patient satisfaction, those with GPS > 15 and those with GPS ≤ 15. Patients very satisfied showed a significantly higher mean value of IHLC. Regarding pain experience, patients were divided into two categories: those recalling less pain with OvP score ≤11 (Q1 < 3, avg. score Q2-Q4 ≤ 3) and those recalling more pain with OvP score >11. IHLC score resulted significantly higher in patients recalling less pain. Multidimensional Health Locus of Control can be considered a predictor of patient's satisfaction after an invasive surgical procedure as total hip arthroplasty.

Perception of health control and self-efficacy in heart failure.

The issue of self-perceived health control and related sense of self-efficacy has not received any attention in patients with heart failure (HF), although these psychological features have been established to determine the patients' approach towards healthcare professionals and their recommendations, which strongly affects compliance. A total of 758 patients with systolic HF (age: 64 ± 11 years, men: 79%, NYHA class III–IV: 40%, ischaemic aetiology: 61%) were included in a prospective Polish multicentre Caps-Lock-HF study. A Multidimensional Health Locus of Control (MHLC) scale was used to assess subjective perception of health control in three dimensions (internal control, external control by the others, and by chance); the Generalised Self Efficacy scale (GSES) was used to estimate subjective sense of self-efficacy; and the Beck Depression Inventory (BDI) was used to determine depressive symptoms. The majority of patients perceived the external control (by the others) and internal control of their health as high (77% and 63%, respectively) or moderate (22% and 36%, respectively), whereas self-efficacy was perceived as high or moderate (63% and 27%), which was homogenous across the whole spectrum of the HF cohort, being unrelated to HF severity, HF duration, the presence of co-morbidities, and the applied treatment. The stronger the perception of internal health control, the higher the self-efficacy (p < 0.05); both features were related to less pronounced depressive symptoms (p < 0.05). The established pattern of self-perceived control of own health and self-efficacy indicates that patients with HF acknowledge the role of others (i.e. healthcare providers) and themselves in the process of the management of HF, and are convinced about the high efficacy of their undertaken efforts. Such evidence supports implementation of a partnership model of specialists’ care of patients with HF.

Confirmatory factor analysis and invariance testing between Blacks and Whites of the Multidimensional Health Locus of Control scale.

The factor structure of the Multidimensional Health Locus of Control scale remains in question. Additionally, research on health belief differences between Black and White respondents suggests that the Multidimensional Health Locus of Control scale may not be invariant. We reviewed the literature regarding the latent variable structure of the Multidimensional Health Locus of Control scale, used confirmatory factor analysis to confirm the three-factor structure of the Multidimensional Health Locus of Control, and analyzed between-group differences in the Multidimensional Health Locus of Control structure and means across Black and White respondents. Our results indicate differences in means and structure, indicating more research is needed to inform decisions regarding whether and how to deploy the Multidimensional Health Locus of Control appropriately.

PP.LB03.27

Objective: Hypertension is a major health problem leading to high rates of mortality, morbidity and impaired quality of life. Due to high costs of hypertension and low adherence to treatment and lifestyles changes, the tasks of developing maximally beneficial treatment programs for individuals with this health problem have received growing emphasis in recent years. Patients with hypertension need appropriate information in order to take meaningful choices about their future, but information should be focused on patient's peculiar needs to be really effective. Research has highlighted the importance of the identification of information needs and their psychological correlates, in order to create tailored health communication interventions aimed at enhancing the effectiveness of the information provided. A promising construct in this field is Locus of Control (LOC), that refers to the extent to which individuals believe they can control and have power over events affecting their life. In the health context, LOC describes the belief that one's health is dependent upon internal (e.g. behavior) versus external factors (e.g. chance). This study was designed to investigate possible relationships between need for information and health LOC in patients with essential hypertension. Design and method: One hundred seventy-five patients (48.8% women; mean age = 63.68, SD = 10.90, range 26–86) completed an assessment questionnaire evaluating Multidimensional Health Locus of Control (MHLC) and the need for further information on topics related to disease management. Correlation analysis were conducted to explore the relationship between variables. Results: Positive and significant correlations were found between “Internal”, “Doctors”, “Other People” locus of control and need for information, while negative, but not significant, relationships were found between need for information and “Chance” locus of control. Conclusions: Taking into account patients’ types of locus of control could enhance the quality of health communication interventions, leading health-care system to move toward a patient-tailored care.

Su1443 Gastric Neuromuscular Pathology and Therapeutic Outcome of Gastric Electric Stimulation in Patients With Refractory Gastroparesis

Treatment of gastroparesis (GP) often requires long-term adherence to dietary modifications and medications. Patient beliefs on internal (self) and external (others) control of their health and patient empowerment (self activation) have been shown in other chronic diseases to impact disease presentation and outcome. AIMS: 1) Compare health locus of control and patient activation in patients with diabetic (DG) and idiopathic (IG) gastroparesis; and 2) Compare health locus of control and patient activation measure in patients with delayed gastric emptying to patients with similar symptoms but normal gastric emptying.METHODS: This prospective study evaluated patients from June 2014 to October 2014 referred for refractory symptoms of gastroparesis. Patients completed Patient Assessment of Upper GI Symptoms (PAGI-SYM), Multidimensional Health Locus of Control (MHLOC), and Patient Activation Measure (PAM-13). MHLOC measures three localizations of health control: internality (belief that health status depends only on personal decision and behaviors); chance externality (belief that health status is determined by chance, fate or luck), and externality (conviction that health depends on powerful people such as doctors, family members or close friends). RESULTS: 40 patients with refractory gastroparesis symptoms were evaluated. Of the 31 patients with delayed GES, 8 were diabetic and 19 idiopathic. Patient activation scores were similar between normal GES vs delayed GES (61.1±14.9 [SD] vs 57.9±12.1) and DG vs IG (58.6±12.7 vs 58.4±12) (Table 1). These activation scores translate to patient's beginning to take action to self-manage their own disease (Level 3). Abdominal pain was negatively correlated to PAM scores in patients with delayed gastric emptying (r=-0.30; p=0.09). When evaluating localization of health control, externality was higher in patients with delayed GES compared to normal emptying (3.4±0.9 vs 2.9±0.7; p=0.16) and DG compared to IG (3.9±0.9 vs 3.2±0.9; p= 0.11) (Table 2). The other localizations such as internality and chance externality were similar when comparing patients with normal GES to delayed GES and DG to IG. DISCUSSION: This study investigates the role of internal and external control and patient activation in patients with gastroparesis. Our study suggests higher abdominal pain severity scores were related to lower activation levels. Furthermore, patients with delayed gastric emptying tend to have higher scores for externality compared to patients with normal gastric emptying. Within the subset of GP, patients with DG had higher scores for externality. These results suggest a reliance of patients with gastroparesis, especially diabetic patients and those with abdominal pain, on others (including physicians), rather than themselves. Table 1. Patient Activation Measure in patients with normal GES vs delayed GES and diabetic GP vs idiopathic GP

Su1442 Patient Related Factors (Patient Activation and Health Locus of Control) in Patients With Refractory Symptoms of Gastroparesis

Treatment of gastroparesis (GP) often requires long-term adherence to dietary modifications and medications. Patient beliefs on internal (self) and external (others) control of their health and patient empowerment (self activation) have been shown in other chronic diseases to impact disease presentation and outcome. AIMS: 1) Compare health locus of control and patient activation in patients with diabetic (DG) and idiopathic (IG) gastroparesis; and 2) Compare health locus of control and patient activation measure in patients with delayed gastric emptying to patients with similar symptoms but normal gastric emptying.METHODS: This prospective study evaluated patients from June 2014 to October 2014 referred for refractory symptoms of gastroparesis. Patients completed Patient Assessment of Upper GI Symptoms (PAGI-SYM), Multidimensional Health Locus of Control (MHLOC), and Patient Activation Measure (PAM-13). MHLOC measures three localizations of health control: internality (belief that health status depends only on personal decision and behaviors); chance externality (belief that health status is determined by chance, fate or luck), and externality (conviction that health depends on powerful people such as doctors, family members or close friends). RESULTS: 40 patients with refractory gastroparesis symptoms were evaluated. Of the 31 patients with delayed GES, 8 were diabetic and 19 idiopathic. Patient activation scores were similar between normal GES vs delayed GES (61.1±14.9 [SD] vs 57.9±12.1) and DG vs IG (58.6±12.7 vs 58.4±12) (Table 1). These activation scores translate to patient's beginning to take action to self-manage their own disease (Level 3). Abdominal pain was negatively correlated to PAM scores in patients with delayed gastric emptying (r=-0.30; p=0.09). When evaluating localization of health control, externality was higher in patients with delayed GES compared to normal emptying (3.4±0.9 vs 2.9±0.7; p=0.16) and DG compared to IG (3.9±0.9 vs 3.2±0.9; p= 0.11) (Table 2). The other localizations such as internality and chance externality were similar when comparing patients with normal GES to delayed GES and DG to IG. DISCUSSION: This study investigates the role of internal and external control and patient activation in patients with gastroparesis. Our study suggests higher abdominal pain severity scores were related to lower activation levels. Furthermore, patients with delayed gastric emptying tend to have higher scores for externality compared to patients with normal gastric emptying. Within the subset of GP, patients with DG had higher scores for externality. These results suggest a reliance of patients with gastroparesis, especially diabetic patients and those with abdominal pain, on others (including physicians), rather than themselves. Table 1. Patient Activation Measure in patients with normal GES vs delayed GES and diabetic GP vs idiopathic GP

Development and validation of a scale measuring the locus of control orientation in relation to socio-dental effects.

To develop a socio-dental impact locus of control scale (SILOC) and to study its relationship with oral health status as well as dental attendance. Observational cross-sectional study design. A seven-item SILOC scale based on locus of control and the WHO international classification of diseases' criteria for "Disability" in relation to oral health was developed. In the pilot study, 100 adolescent school children returned completed forms containing the multidimensional health locus of control (MHLC) and the (SILOC) scale. After confirmation of reliability and validity, 509 adolescent school children returned completed SILOC questionnaires and were examined for caries, plaque and gingivitis. A history of postponement of needed dental treatment was also elicited. The SILOC scores were highly correlated with the MHLC scores. Factor analysis revealed a two-factor solution accounting for 59 % of the variance. A Cronbach's alpha of 0.75 showed its internal consistency. Those with higher SILOC scores had greater levels of caries, plaque, gingivitis, and a history of postponing needed dental visits. Multiple logistic regression analysis after adjusting for potential confounders showed that those with high SILOC scores were more likely to have caries (OR = 3.32, p < 0.001), plaque (OR = 1.83, p = 0.026), gingivitis (OR = 1.80, p = 0.012) and a history of 'Postponement of needed dental treatment' (OR = 4.5, p < 0.001) as compared with the others. The SILOC scale showed satisfactory reliability and validity in measuring locus of control orientation in an Indian adolescent population.

Health beliefs and carer burden in first episode psychosis.

BackgroundCarer burden is high during First Episode Psychosis (FEP) and evidence suggests that this is a predictor of poor long-term outcome. However our understanding of factors associated with higher burden is poor. We propose that carers’ cultural backgrounds and health belief models will influence their perceived burden of care, over and above that explained by severity of illness.MethodsPatients with FEP and their primary Carers were recruited from the Early Intervention Service. Patients and Carers completed a range of validated measures, self-report ethnicity and demographic information together with the Multidimensional Health Locus of Control and Caregiver Burden Inventory.ResultsSignificant correlations were found between carer burden and health beliefs, which differed by ethnicity and gender. High physical burden was experienced by Black carers with an external locus of control; time restrictions and emotional burden correlated with an external locus of control in Asian carers. For White carers, external locus of control correlated with time dependence burden. In all ethnic groups female carers experienced more time dependency, physical and developmental burden. No significant correlations were found between patient measures of severity or duration of illness and carer burden.ConclusionsThe type of burden experienced by carers differed between gender and ethnicity and was related to their health belief models. Thus the explanation and understanding of illness appears to be more salient than simply a patient’s severity of illness when considering the development of carer burden. Interventions to tackle high carer burden, and thus expressed emotion to improve outcome in patients, may need increasing focus here.

An examination and appreciation of the dimensions of locus of control in psychosis: issues and relationships between constructs and measurement.

Internal locus of control is associated with better psychological outcomes in comparison with external locus of control. Individuals experiencing a psychotic episode have a more external orientation, an externalizing bias for negative events and associations between paranoid delusions and external locus of control. The concept of multidimensional locus of control as measured by the Multidimensional Health Locus of Control (MHLC) scale may provide important information about the nature and course of psychotic symptoms. This narrative review explored the relationship between the orientation of locus of control and psychosis. Few studies have used the scale in samples with people experiencing psychotic symptoms and so there is limited evidence about the psychometric properties of the MHLC scale within this client group, although the findings from studies that have explored the properties of this tool in other groups suggest it could be a valuable instrument for use in psychosis. Further research is required to determine both the relationship between locus of control and psychosis in terms of therapeutic factors and outcome, and also the veracity of the MHLC scale as an instrument of choice in this group.

Influence of health locus of control on recovery of function in recently hospitalized frail older adults

To investigate the influence of health locus of control on physical function, quality of life, depression and satisfaction with care transition in a sample of older adults after a hospital admission. A total of 230 older adults referred for transition care after a hospital admission (mean length of stay 25.7 days, SD 17.2) were recruited into a randomized controlled intervention trial investigating the effect of specialized coaching compared with usual care. Older adults completed the multidimensional health locus of control (MHLC) survey at baseline. Self-rated quality of life, depression and physical function were assessed at baseline and 12 months using the EuroQol five-dimension, Geriatric Depression Scale (GDS) and Modified Barthel Index (MBI), respectively. Results from hierarchical multiple regression analysis in 136 participants (70 usual care and 66 specialized care) with complete data showed that higher scores on the MHLC internal subscale were related to better quality of life, and better physical function in the usual care group at 12 months, but not depression or transition process satisfaction at 3 months. No relationships between MHLC subscales and outcome measures were observed in the specialized care group, where the coaching intervention might have precluded any relationship observed. A stronger sense of personal control over health was associated with better maintenance of quality of life and physical function at 12 months in older adults undergoing usual care transition after acute hospitalization. Modification of control beliefs has the potential to promote resilience and impact on health outcomes in older adults during care transitions.

Colon cancer surveillance in inflammatory bowel disease: unclear gain but no psychological pain?

Surveillance for colorectal neoplasia in inflammatory bowel disease (IBD) is widely practised despite a lack of convincing mortality reduction. The psychological impact of this approach is largely unexplored. To examine psychological well-being among IBD subjects undergoing colonoscopic surveillance for colorectal cancer (CRC). A cross-sectional study was performed by interrogating an IBD database for subjects currently enrolled in colonoscopic surveillance programmes. Identified surveillance subjects were age- and gender-matched with IBD control subjects not meeting surveillance criteria. Subjects were mailed a questionnaire including demographic details, the Short Form 36 (SF-36) survey to assess quality of life, the Spielberger State-Trait Personality Inventory, the Multidimensional Health Locus of Control, and a Risk Perception Questionnaire. One hundred and thirty-nine of 286 (49%) subjects responded, 53% male, 46% Crohn disease. Fifty-six per cent respondents were in the surveillance group. Surveillance subjects were older (55.4 vs 51.1 years; P = .048) with longer disease duration, but otherwise had comparable demographics with controls. Overall, quality of life was not significantly different between cohorts (mean SF-36 63.82 vs 65.48; P = 0.70). Groups did not differ on any locus of control classification (P = 0.52), nor was there any difference between mean scores on 'state' subscales of the Spielberger State-Trait Personality Inventory: anxiety (P = 0.91), curiosity (P = 0.12), anger (P = 0.81) or depression (P = 0.70). Both groups grossly overestimated their perceived lifetime risk of CRC at 50%, with no difference between surveillance and control subjects (P = 1.0). Enrolment in colonoscopic colon cancer surveillance does not appear to impair psychological well-being in individuals with IBD despite longer disease duration. IBD patients overestimate their risk of CRC.

Health Locus of Control, Health Related Behaviors and Demographic Factors: A Study in a Turkish Population

Aims : The purpose of this study was to examine the association between sociodemographic variables and the health locus of control (HLC) as well as health locus of control and health-related behaviors. Study Design: Cross-sectional, descriptive. Place and Duration of Study: This study was conducted in 2012 in the fourth largest city of Turkey. Data collection lasted about six months. Methodology: Participation in this study was voluntary and data collection was conducted anonymously. Convenience sampling was used. People on the streets, in parks, in shopping centers, metro stations, and students at the university campus were informed about the study and asked to participate. A total of 1125 people were asked and 885 gave their verbal consent. The participation ratio was 78.7%. The study participants (437 women and 448 men aged 18-84 years) filled out the Multidimensional Health Locus of Control (MHLC) scale, together with a questionnaire about their social, demographic and economic characteristics and a questionnaire regarding their health

Health Locus of Control and Compliance in Diabetic Patients

For treatment of Diabetes to be successful patient compliance with therapeutic regimens is very essential. This descriptive study was conducted to examine the relationship between the health locus of control (HLC) orientation and Self-reported compliance with diabetic treatment regimens. The convenience sample of 100 diabetic patients was obtained from a diabetic clinic in Maharashtra. A Demographic Questionnaire, the Multidimensional Health Locus of Control (MHLC) Scale, and self-reported Compliance questionnaire were used to collect the data. The average overall rate of self-reported compliance with therapeutic regimen was 39%. Examining the compliance measures it was found that patients were most compliant in following dietary advice, taking medications and follow-up. A significant correlations between the three subscales of the multidimensional health locus of control (MHLC) and overall compliance measures were found in this study (p < 0.01). The study suggests that the locus of control has a positive relationship with the compliance practices of diabetic patients. Implications of findings for nursing practice, nursing education, community practice and research are discussed.

Development and Validation of a Socio-Dental Impact Locus of Control (SILOC) Scale

Purpose: To develop a Socio-Dental Impact Locus of Control Scale (SILOC) and to study its relationship with oral health status as well as dental attendance. Materials and methods: In the pilot study, 100 students returned completed forms containing the Multi Dimensional Health Locus of Control (MHLC) and the (SILOC) scale. In the main study, 509 adolescent school children from three schools returned completed forms containing the SILOC scale and were examined for oral health status and dental attendance. Results: The SILOC scores highly correlated with the MHLC scores. A Cronbach’s alpha of 0.75 showed its internal consistency. Those with higher SILOC scores had greater levels of caries, plaque, gingivitis, and a history of postponing needed dental visits. Multiple logistic regression analysis after adjusting for potential confounders showed that those with high SILOC scores were more likely to be having caries (OR=3.32, p<0.001), plaque (OR=1.83, p=0.026), gingivitis (OR=1.80, p=0.012) and a history of ‘Postponement of needed dental treatment’ (OR=4.5, p<0.001) as compared to the others. Conclusion: The SILOC scale showed satisfactory reliability and validity in measuring Locus of Control orientation in relation to socio-dental impacts in an Indian adolescent population.

The Relationship between Religion/Spirituality and Mental Health in Patients on Maintenance Dialysis

The religious beliefs and spirituality of patients on dialysis therapy have not been studied extensively. This study aimed to investigate the relation of religion/spirituality to mental health and health representations among haemodialysis and peritoneal dialysis patients. A sample of 144 patients was recruited from three general hospitals in the broader area of Athens, consisting of 84 patients undergoing in-centre Haemodialysis (HD) and 60 patients in Continuous Ambulatory Peritoneal Dialysis (CAPD/PD). Measurements were conducted with the following instruments: the World Health Organization Quality of Life instrument (WHOQOL-BREF), the General Health Questionnaire (GHQ-28), the State-Trait Anxiety Inνentory (STAI 1/STAI 2), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Multidimensional Health Locus of Control (MHLC). Religion/spirituality was associated negatively with all the subscales of GHQ-28 (somatic symptoms, anxiety/insomnia, social dysfunction, severe depression) and the GHQ-28 total score. It was also related negatively to depression, measured by CES-D scale, as well as state and trait anxiety and positively to internal health locus of control. The present study demonstrates the importance of religion/spirituality in understanding health representations of patients with Chronic Kidney Disease (CKD) and the contribution of religious beliefs to mental health.

Stress management and sexual health of young adults: a pilot randomised controlled trial.

Young people often experience excessive stress that definitely undermines their sexual life and leads them to adopt risky sexual behaviours. As such, the design and application of a stress management programme in this particular age group is, undoubtedly, a crucial matter. In this parallel randomised controlled trial, 60 psychology students of the Panteion University of Athens, aged 18–20, were randomly assigned to undergo either an 8-week stress management programme (n = 30; diaphragmatic breathing–progressive muscle relaxation and guided imagery, twice a day) or not (n = 30). Self-reported validated measures were used to evaluate stress, stressful life events, health locus of control, general health status, sexual behaviours, sexual desire, satisfaction from sexual life and interpersonal relationships. Between-group analyses revealed statistically significant differences in internal health locus of control and general health evaluation. Within the intervention group analyses showed reductions in BMI, stress, the ‘chance’ subscale of multidimensional health locus of control (MHLC) and greater satisfaction from sexual life. No other significant change was reported. We deem that our results should encourage relevant future studies.

Predictors of Perception of Pregnancy Risk among Nulliparous Women

To determine factors associated with perception of pregnancy risk using a conceptual framework based on a review of the relevant literature and the psychometric model of risk perception. A correlational study. Ambulatory care and antepartum units of two tertiary hospitals and selected obstetricians' offices and prenatal classes in Winnipeg, Canada. A convenience sample of nulliparous women in their third trimester with a singleton pregnancy. Between December 2009 and January 2011, the following questionnaires were completed by 159 nulliparous women: the Perception of Pregnancy Risk Questionnaire, the Pregnancy-related Anxiety scale, Knowledge of Maternal Age-related Risks of Childbearing Questionnaire, the SF-12v2 Health Status Survey, the Multidimensional Health Locus of Control, and the Prenatal Scoring Form. Pearson's r correlations and stepwise multivariable linear regression analyses were conducted to achieve the research objectives. Of the eight proposed factors in the conceptual framework, five factors were significant predictors of perception of pregnancy risk, including pregnancy-related anxiety, maternal age, medical risk, perceived internal control, and gestational age, accounting for 47% to 49% of the variance in risk perception. An interaction between the pregnancy-related anxiety score and maternal age was found. These results contribute to the literature on perception of pregnancy risk by identifying a new predictor (gestational age), supporting the role of previously known factors in the state of pregnancy, and proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. This knowledge may have implications for developing more effective risk communication models.

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared-decision-making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings. To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style. Fifty-nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini-mental state exam (MMSE) assessed patient's level of cognitive impairment. Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency. Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach.

Factors affecting the physician–patient relationship of older veterans with inadequate health literacy: an observational study

In Taiwan, older veterans typically match the characteristics of a high prevalence of inadequate health literacy, which is a major barrier to effective communication in delivering proper health care. A good physician-patient relationship increases patients' trust and willingness to communicate, so an awareness of the factors that influence this relationship could improve it over time and enhance patients' health. To explore factors related to the physician-patient relationship among older veterans with inadequate health literacy in Taiwan. Observational study in veterans' homes. Data were collected using self-report questionnaires in face-to-face interviews. Patients with a Test of Functional Health Literacy in Adults score <60 (defined as inadequate health literacy) were recruited. Demographic characteristics, the Geriatric Depression Scale-Short Form, Multidimensional Health Locus of Control, and Perceived Involvement in Care Scales were used to identify related factors. Multiple regression and bootstrapping were used for data analyses. A total of 256 older individuals were defined as having inadequate health literacy. Patients' perceived involvement in health care partially mediated the relationship between Health Locus of Control and the physician-patient relationship. Perceived Involvement in Care, depression score, and Health Locus of Control were predictors of the physician-patient relationship. Older patients with inadequate health literacy had difficulty becoming actively involved in health care. The GP is in an ideal position to become a key person in helping such patients become involved in health care, and appropriately treating their depression may improve the physician-patient relationship.

Multidimensional health locus of control and depressive symptoms in the multi-ethnic population of the Netherlands

Ethnic inequalities in health in Western societies are well-documented but poorly understood. We examined associations between health locus of control (HLC) and depressive symptoms among native and non-native Dutch people in the Netherlands. We used hierarchical multiple linear regression analyses on a representative sample of the multi-ethnic population of Amsterdam and The Hague (n=10,302). HLC was measured with the multidimensional health locus of control scale. Depressive symptoms were measured with the Kessler Psychological Distress scale. Multivariate analyses showed that HLC contributes to ethnic differences in the prevalence of depressive symptoms. Respondents who scored high on external locus of control (PHLC) were more likely to have depressive symptoms than those with a low score on PHLC (β=0.133, p<0.001). Conversely, respondents scoring high on internal locus of control (IHLC) were less likely to have depressive symptoms compared to those scoring low on IHLC (β=-0.134, p<0.001). The associations were most pronounced among Turkish-Dutch and Moroccan-Dutch respondents. Our findings suggest that HLC contributes to ethnic inequalities in depressive symptoms, especially among Turkish and Moroccan ethnic groups. Professionals (e.g. clinicians and policy makers) need to take HLC into account when assessing and treating depression among ethnic minority groups, particularly in Turkish and Moroccan populations. Future research should look further into the associations within these groups.