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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 44  |  Issue : 4  |  Page : 157-162

Locus of control among university students with urban and rural background


1 Psychiatry Department, Faculty of Science, Cairo University, Cairo, Egypt
2 Immunology and Biotechnology Department, Faculty of Medicine, Tanta University, Tanta; Center of Excellence in Cancer Research, Tanta University, Tanta, Egypt
3 Immunology Department, Faculty of Science, Cairo University, Cairo, Egypt
4 Oncology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

Date of Submission22-Jun-2016
Date of Acceptance29-Sep-2016
Date of Web Publication8-Mar-2017

Correspondence Address:
Eman M El-Baiomy
Immunology Department, Faculty of Science, Cairo University, Cairo, 3500539
Egypt
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DOI: 10.4103/1110-1415.201721

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  Abstract 

Background Locus of control (LOC), a psychological theory developed by Julian Rotter (1966), refers to the extent to which an individual believes in controlling the events affecting them. The effect of environment and sex on LOC belief differs from country to country.
Aim The aim of the present study was to evaluate LOC belief in a population of university students and the impact of urban versus rural background and sex.
Participants and methods Data were collected from a cross-sectional study among university students in Egypt. Two scales were used to measure LOC belief. The first is the Rotter Internal–External Locus of Control (I–E LOC) to measure belief in LOC according to general life. The second is the Multidimensional Health Locus of Control scale with five dimensions: Internal Health Locus of Control, Doctor Health Locus of Control, Powerful Other Health Locus of Control, Chance Health Locus of Control, and God Health Locus of Control to measure belief in LOC according to health.
Results Urban population had a significantly higher Doctor Health Locus of Control (mean±SD=15.61±1.91) compared with rural population (mean±SD=14.16±3.38). Rural population had a higher I–E LOC score (mean±SD=8.37±3.24) compared with urban population (mean±SD=6.75±4.14). Women had a significantly higher Powerful Other Health Locus of Control (mean±SD=12.8±3.55) compared with men (mean±SD=10.27±2.84). Women had a significantly higher I–E LOC (high external LOC) (mean±SD=9.6±3.09) compared with men (mean±SD=10.6.33±4.42).
Conclusion The findings show that urban population has higher belief in doctor as a controller of health compared with the rural one. Rural population has more external LOC belief in general life compared with the urban population. Women have more external LOC in general life compared with men. Women have higher belief in powerful others as a controller of their life compared with men.

Keywords: locus of control, university students, Urban and rural background


How to cite this article:
Sabry NA, Salem ML, El-Baiomy EM, El-Amir A, El-Mashad N. Locus of control among university students with urban and rural background. Tanta Med J 2016;44:157-62

How to cite this URL:
Sabry NA, Salem ML, El-Baiomy EM, El-Amir A, El-Mashad N. Locus of control among university students with urban and rural background. Tanta Med J [serial online] 2016 [cited 2017 Aug 20];44:157-62. Available from: http://www.tdj.eg.net/text.asp?2016/44/4/157/201721


  Introduction Top


It has been known that people with similar psychological status or disease setting react with different response. Although different mechanisms contribute to this difference, the difference in the type of locus of control (LOC) between people could be one significant mechanism behind this difference. LOC, a psychological theory developed by Julian Rotter (1966), refers to the extent to which an individual believes in controlling the events affecting them. Rotter [1] divided people as follows: internal locus of control (I-LOC) believers, who believe in controlling their life, and external locus of control (E-LOC) believers, who believe in the effect of external factors such as chance or powerful others on their life. In 1978, Ken Wallston developed Rotter Internal–External Locus of Control (I–E LOC) scale to measure Multidimensional Health Locus of Control (MHLC). He categorized people into Internal Health Locus of Control (IHLC) believers who believe in controlling their health, and external health locus of control believers who believe in the effect of external factors such as Chance Health Locus of Control (CHLC), Doctor Health Locus of Control (DHLC), powerful others health locus of control (OHLC), and God Health Locus of Control (GHLC) on their health [2]. As such, these types of LOC are expected to be represented in one population.

Lifestyle and culture differ from country to country. Hence, these differences could affect the impact of urban and rural background and sex on LOC belief. With regard to the impact of environment background, McConnell et al. [3] used the Rotter I–E LOC scale to examine differences in scores between a rural and an urban population in west Tennessee. They found no significant difference in scores between the two populations. Morrow [4] studied LOC in rural and urban high school students in the state of Nebraska and indicated that rural students tend to claim more responsibility for negative events in the academic domain compared with urban students. With regard to the influence of sex, a Middle East-based study, which surveyed 520 people, found that Arab female population reported lower IHLC scores compared with Arab male population, whereas Jewish male population showed higher IHLC scores [5]. Another study on university students in Germany showed that male population had a higher score in IHLC, Powerful other health locus of control (PHLC), and CHLC compared with female population [6].

Several studies investigated LOC in different diseases and confirmed that, in the chronic phase after traumatic brain injury, CHLC orientation has a negative relationship with health-related quality of life [7]. A study on back pain rehabilitation showed that higher IHLC and lower DHLC beliefs predict high lift scores 1 month after treatment [8]. Patients with alcohol dependence have E-LOC orientation [9]. Moreover, several works studied the impact of LOC on cancer patients and confirmed that patients with stronger E-LOC belief trust the observed oncologist more [10]. Women with breast cancer had higher CHLC, DHLC, OHLC, and GHLC, and lower IHLC compared with healthy women [11]. These studies indicate the clinical significance of LOC with the diseases outcomes.

Given the above-reported differences in LOC in different environments in the above studies, the present study was aimed to determine MHLC and Rotter I–E LOC belief among rural and urban university male and female students in a small population of university students.


  Participants and methods Top


A sample of 111 university students was selected through convenience sampling from Cairo University and Tanta University, Egypt. The mean±SD of age was 19.88±1.911 (range: 18–29). Women represented 74.6% (n=94) of the sample. Rural population constituted 58.6% (n=36) of the sample. The students were recruited from different faculties: nursing, 1.8% (n=2); science, 32.4% (n=36); medicine, 18.9% (n=21); engineering, 16.2% (n=18); education, 4.5% (n=5); pharmacy, 7.2% (n=8); dentistry, 4.5% (n=5); technical health, 6.3% (n=7); electronic learning, 0.9% (n=1); art, 5.4% (n=6); agriculture, 0.9% (n=1); and social service, 0.9% (n=1). All students participated in the cross-sectional study after giving informed consent. The research was approved by the Ethical Committee at Cairo University, Egypt.

Rotter Internal–External Locus of Control scale

The scale developed by Julian Rotter, which consists of 23 items, was used [12]. This scale is designed to measure generalized expectance for perceived LOC whether E-LOC or I-LOC according to general events of life. Each item was divided into two parts, one supporting the belief in I-LOC and another supporting the belief in E-LOC [1]. High total score indicates high E-LOC belief, and a low total score indicates high I-LOC belief. Lange and Tiggemann [12] used test–retest format to confirm the reliability of Rotter I–E LOC scale ([Figure 1]).
Figure 1 Types of locus of control (LOC). CHLC, Chance Health Locus of Control; DHLC, Doctor Health Locus of Control; E-LOC, external locus of control; GHLC, God Health Locus of Control; MHLC, Multidimensional Health Locus of Control; IHLC, Internal Health Locus of Control; I-LOC, internal locus of control; I–E LOC, Internal–External Locus of Control; OHLC, Powerful Other Health Locus of Control.

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Multidimensional Health Locus of Control form C

Ken Wallston developed three forms of MHLC: A, B, and C [13]. In this study MHLC form C was used to measure LOC belief according to health. It is a condition-specific LOC scale and consists of four subscales: IHLC, CHLC, OHLC, and DHLC. The IHLC and CHLC subscales have six items each, whereas the OHLC and DHLC subscales have three items each. The IHLC subscale measures the degree to which an individual believes that his or her behaviors control their health status. The CHLC subscale measures the degree to which an individual believes that fate and chance control their health. The OHLC subscale measures the degree to which individuals believe that powerful others such as family and friends control their health status. The DHLC subscale measures the degree to which individuals believe that doctors and nurses control their health status. Each question ranges from 1 (strong disagree) to 6 (strong agree). Total score in subscales IHLC and CHLC ranges from 6 to 36 and total score in subscales OHLC and DHLC range from 6 to 18 ([Figure 1]).

God Health Locus of Control

This scale was developed by Ken Wallston [14]. It consists of six questions, which measures to what extent an individual believes that God controls health. Each question ranged from 1 (strong disagree) to 6 (strong agree). The total score ranges from 6 to 36 ([Figure 1]).

Data processing and analysis

Statistical presentation and analysis of the present study were performed using the one-way analysis of variance and bivariate correlation with SPSS (version 20; SPSS Inc., Chicago, Illinois, USA).


  Results Top


Multidimensional Health Locus of Control, God Health Locus of Control, and Rotter Internal–External Locus of Control in the sample

As shown in [Figure 2], the mean±SD IHLC score of the total population was 26.59±5.65. The mean±SD CHLC score was 18.5±5.19. The mean±SD DHLC score was 14.51±3.17. The mean±SD OHLC score was 10.98±3.66. The mean±SD GHLC score was 32.92±5.82. The median of Rotter I–E LOC scale was 8.
Figure 2 Mean and SD of Multidimensional Health Locus of Control (MHLC) [Internal Health Locus of Control (IHLC), Chance Health Locus of Control (CHLC), Doctor Health Locus of Control (DHLC), and Powerful Other Health Locus of Control (OHLC)] and God Health Locus of Control (GHLC) in the sample.

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Relationship between all dimensions of Multidimensional Health Locus of Control with each other and with God Health Locus of Control and Rotter Internal–External Locus of Control

A bivariate correlation was made to test the relations between all dimensions of MHLC with each other and with GHLC and I–E LOC ([Table 1]). There was a statistically significant direct correlation of IHLC with DHLC (r=0.401, P<0.01) and OHLC (r=0.217, P<0.05), indicating that, as IHLC increases, DHLC and OHLC increase. There was a statistically significant direct correlation of CHLC with OHLC (r=0.321, P<0.01) and GHLC (r=0.370, P<0.01), indicating that, as CHLC increases, OHLC and GHLC increase.
Table 1 Relationship between all dimensions of Multidimensional Health Locus of Control with each other, God Health Locus of Control and Rotter Internal–External Locus of Control

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There was no significant correlation between either IHLC and CHLC or IHLC and GHLC or CHLC and DHLC or DHLC and OHLC or DHLC and GHLC or GHLC and OHLC. There was a significant direct correlation between I–E LOC and CHLC (r=0.353, P<0.01), OHLC (r=0.282, P<0.01), and GHLC (r=0.203, P<0.05), indicating that, as I–E LOC score increases, E-LOC, CHLC, OHLC, and GHLC increase. There was no significant correlation between I–E LOC and either IHLC or DHLC.

The impact of environment on Multidimensional Health Locus of Control, God Health Locus of Control, and Internal–External Locus of Control

Urban population had significantly higher DHLC (15.61±1.91) compared with rural population (14.16±3.38) (t-test=5.728, P=0.018). Rural population had a higher I–E LOC score (high E-LOC) (8.37±3.24) compared with urban population (6.75±4.14) (t-test=5.069, P=0.026). There was no significant difference between urban and rural population in either IHLC (rural: 25.81±6.06, urban: 0.91±3.84, t-test=3.616, P=0.060) or CHLC (rural: 18.70±4.64, urban: 17.36±5.96, t-test=1.690, P=0.196), or OHLC (rural: 11.32±3.77, urban: 10.83±3.45, t-test=0.427, P=0.515) or GHLC (rural: 32.98±6.28, urban: 31.77±5.86, t-test=0.939, P=0.335) ([Table 2]).
Table 2 Effect of environment on Multidimensional Health Locus of Control, God Health Locus of Control, and Rotter Internal–External Locus of Control

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The impact of sex on Multidimensional Health Locus of Control and Internal–External Locus of Control

Women had a significantly higher OHLC (12.8±3.55) compared with men (10.27±2.84) (t-test=4.658, P=0.040). Women had a significantly higher I–E LOC (high E-LOC) (9.6±3.09) compared with men (10. 6.33±4.42) (t-test=5.507, P=0.026). There was no significance difference between men and women in either IHLC (male: 27.67±5.59, female: 25.47±6.49, t-test=0.990, P=0.328), or CHLC (male: 17.93±5.27, female: 20.4±5.1, t-test=1.698, P=0.203) or DHLC (male: 14.53±3.44, female: 15.47±2.13, t-test=0.797, P=0.380) or GHLC (male: 33.8±3.8, female: 32.4±8.36, t-test=0.348, P=0.560) ([Table 3]).
Table 3 Effect of sex on Multidimensional Health Locus of Control, God Health Locus of Control, and Rotter Internal–External Locus of Control

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  Discussion Top


The current study used the Rotter I–E LOC scale (1966), GHLC, and MHLC form C to examine the differences in questionnaire scores between rural versus urban background and male versus female in a population of university students. Findings associated with each research question are presented below.

The first question of the study was as follows: ‘Is there a relation between dimensions of health LOC with each other and with GHLC and I–E LOC’. Regardless of the influence of environment (rural and urban) and sex (male and female), the findings revealed that there was a significant positive correlation between I–E LOC scores and CHLC, OHLC, and GHLC. It is important to note that the two scales used in this study are scored differently. The Rotter I–E LOC scale indicates a higher E-LOC as the score increases and higher I-LOC as the score decreases. The MHLC scale indicates a higher CHLC as the score increases in the dimension of CHLC, a higher OHLC as the score increases in the dimension of OHLC, and a higher GHLC when the score increases in the dimension of GHLC. One possible explanation for this homogeneity is that, when Wallston developed the MHLC, he considered the dimensions of GHLC, OHLC, DHLC, and CHLC as E-LOC. However, there was no significant correlation between IHLC and I–E LOC. This is consistent with the findings of Strickland [15], who found that I–E LOC scale has a significant relation with health-related behaviors. The findings revealed that there was a significant direct correlation between either IHLC and DHLC or IHLC and OHLC or CHLC and OHLC, or CHLC and GHLC.

There was no significant correlation between either IHLC and CHLC or IHLC and GHLC or CHLC and DHLC or DHLC and OHLC, or DHLC and GHLC. These findings are consistent with the findings of Zampieri and de Souza [16], who found a significant direct correlation between CHLC and OHLC, and consistent with the findings of Naus et al. [17], who found a significant direct correlation between DHLC and IHLC.

The second question of research was s follows: ‘Does the environment affect MHLC or GHLC or I–E LOC’. We used one-way analysis of variance to answer this question. The data revealed that rural population had a significantly higher score in I–E LOC (high E-LOC) compared with urban population. This was different from Witt [18], who conducted a study on 136 undergraduates completing the Rotter I–E LOC scale and found that rural population had a higher I-LOC orientation.

The data revealed that there was no significant difference between rural and urban population in IHLC, CHLC, OHLC, and GHLC, but urban population had a significantly higher DHLC compared with rural population. These data are consistent with a study by Duelberg [19], who showed that rural population depends more on primary preventive behaviors. However, in the study by McConnell et al. [20], there was no significant difference between rural and urban population in the MHLC on people in rural and urban Pennsylvania. One possible explanation for this difference could be that the healthcare is more accessible to the people in the urban areas, but if people do not trust the doctors, they are less likely to use the services [21].

The third question in this research was as follows: ‘Does sex have an effect on MHLC or GHLC or I–E LOC’. The findings of these data showed that women had a significantly higher score in I–E LOC (more E-LOC) compared with men. The data were not consistent with a review by Archer and Waterman [22], who concluded that there was not enough evidence to show that there is sex difference in LOC.

The findings of these data showed that there was no significant difference between men and women in MHLC except OHLC, as women had a statistically significantly higher OHLC compared with men. These data were not consistent with the findings of Paxton and Sculthorpe [23], who examined MHLC beliefs. The study showed that women perceived health to be more internally controlled compared with men. These findings are consistent with findings of Eagan et al. [24], who found in a study that included 2166 American-Indian women and 1433 American-Indian men that there was no difference between men and women with respect to I-LOC scores. This occurrence could be attributed to the difference in culture between populations, as men take on an increased sense of control over various aspects of their family’s life, but this sense decreases in women. Sometimes, it is common to see a growing percentage of single parent homes in which the mother is the sole provider. In this case, the sense of control increases in women. The one limitation of this study was that this study was a cross-sectional study, in which there was a temporary association between sex and environment. Therefore, longitudinal studies are required to prove the relationship.

The study findings cannot be generalized to the entire university students in Egypt as it was based on specific faculties. Moreover, comparison between the study findings and other Arab studies is limited owing to the lack of previous studies investigating HLC and I–E LOC among university students.


  Conclusion Top


The rural and urban areas have different culture, education, annual income, and healthcare. This difference may affect I–E LOC and MHLC belief between rural and urban population. Difference was observed between men and women in terms of a lot of factors such as men have the responsibility over his family’s life. This difference may affect I–E LOC and MHLC between male and female populations. The findings show that urban population has higher belief in doctor as a controller of health compared with rural one. Rural population has more E-LOC belief in general life compared with urban population. Women have more E-LOC in general life compared with male population. Women have higher belief in powerful others as a controller of their life compared with male population.

Implications for further research

Future studies can expand on this study by investigating additional predictors − for example, religious dominations, single or double parent households, criminal history, level of education, annual income, spirituality, age, and marital status. Further exploration would also be beneficial in studying the relation between LOC and mental illness, physiological status, and immune status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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McConnell TR, Larson SL, Santamore WP, Homko CJ, Trevino KM, Kashem A et al. Rural versus urban residence mitigates the effects of telemedicine on exercise capacity. J Exec Physiol Online 2010; 13:1–13.  Back to cited text no. 3
    
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Helmer SM, Kramer A, Mikolajczyk RT. Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany. BMC Res Notes 2012; 5:703.  Back to cited text no. 6
    
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[PUBMED]  [Full text]  
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14.
Wallston KA, Malcarne VL, Flores L, Hansdottir I, Smith CA, Stein MJ et al. Does God determine your health? The God Locus of Control scale. Cognit Ther Res 1999; 23:131–142.  Back to cited text no. 14
    
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