ABSTRACT

MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL MEN AND WOMEN IN WHITE COLLAR AND BLUE COLLAR JOBS WITH AND WITHOUT LOWER BACK PAIN

by

G.M.Subhasree Iyer

Masters in Clinical Psychology

Bangalore

This study examines the differences in gender, occupation and medical condition with regards to Multidimensional health locus of control and examines whether these vary depending on the five factor model of health locus of control and as a function of occupation and gender. Previous research has shown that differences based on gender are situation based. The present study examines multidimensional health locus of control and its relationship to men and women in white-collar and blue-collar jobs with and without lower back pain. The five-factor model of multidimensional health locus of control has been the most pervasive model that has been used to explain personality traits and is used in the present study.

INTRODUCTION

Locus of control is a term in psychology which refers to a person’s beliefs about what causes the good or bad results in his or her life, either in general or in a specific area such as health or academics. Locus of control refers to an individual’s generalized expectations concerning where control over subsequent events resides. In other words, who or what is responsible for what happens.

According to Weiner (1974) the “attribution theory assumes that people try to determine why people do what they do, i.e., attribute causes to behavior.” (Weiner, 1974, 1986, p362). There is a three stage process which underlies an attribution. The person must perceive or possibly observe the behaviour; Try and figure out if the behavior was intentional; and determine if the person was forced to perform that behavior. The latter behaviour occurs after the fact, i.e., behaviors are explanations for events that have already happened. Expectancy, which concerns future events, is a critical aspect of locus of control.

Locus of control is also grounded in expectancy-value theory (Martin Fishbein), which describes human behavior as determined by the perceived likelihood of an event and the value placed on that event or outcome. More specifically, expectancy-value theory states that if (a) someone values a particular outcome and (b) that person believes that taking a particular action will produce that outcome, and then (c) they are more likely to take that particular action. (Palmgreen, 1984)

Locus of control is a personality dimension first described by Julian Rotter (1966, 1975, 1990), a prominent social learning theorist. Locus of control is a generalised expectancy about the degree to which individuals control their outcomes. Rotter’s work was an important bridge between traditional social learning theories and the most modern ideas that have come to be known as the social- cognitive theory (Rotter, Chance, Phares, 1075).

Rotter found that the final choice of behaviour depends both on how strongly individual expect that their performance will have a positive result (positive expectancy) and how much the value their expected reinforcement (reinforcement value). His theory focuses on why an individual performs a behavior and on which behaviour the individual actually performs in a specific environment.

In any environment, individuals have a variety of possibly relevant behaviours in their repertoire. Some of these are more likely to occur in a particular situation than others. A particular behaviour like, laughing loudly, may have a high behaviour potential in some situations (during a hilarious movie) and low behaviour potential in other situations (during a final exam).

There are specific expectancies; that a particular reward follow a behavior in a particular situation; and generalised expectancies that are related to a group of situations. The roles of reinforcements play a very significant role in Rotter’s theory. According to him, the greater the subjective value of reinforcement, the more likely a person is to perform a behaviour associated with that valued reinforcement. The value of reinforcement is associated in relation to the values of other available reinforces.

Rotter rewarded that reinforcement with the highest value is the reinforcement that individuals expect will lead to other things we value (money, prestige, etc,) secondary reinforces are of value because of their association with the satisfaction of important psychological needs.

Rotter defines 6 psychological needs that develop out of biological needs: (a) Recognition – Status (need to achieve, have positive social standing); (b) Dominance (need to control, influence others); (c) Independence (need to make decisions for oneself); (d) Protection – Dependency (need to have others give one security and help one achieve goals); (e) Love and Affection ( need to be liked and cared by others); (f) Physical Comfort ( need to avoid pain, seek pleasure, enjoy physical security and a sense of well being).

Behavioural potential, outcome expectancy, and reinforcement potential all come together to form what Rotter termed: “The Psychological Situation”. The psychological situation represents the individual’s unique combination of potential behaviours and their value. It is the psychological situation that a person’s expectations and values interact with the situational constraints to exert a powerful influence on behaviour.

The best known feature of Rotter’s theory is the concept of internal versus external control of reinforcements. There is either the generalised expectancy that the individual’s actions lead to desired outcomes – an internal locus of control. Or, there is the belief that things outside of the individual, such as chance or powerful others, determine whether desired outcomes occur – an external locus of control.

“Externals” feel that their outcomes largely beyond their control – which they are pawns of fate. “Internals” feel that their successes and failures are determined by their actions and abilities. (Rotter, 1960: Psychological monographs, 80 (whole no.609)

Of course, locus of control is not an either – or proposition. Like any other dimension of personality, it should be thought of as occurring on a continuum. Some people are more external, some are very internal, but most people fall somewhere in between. (Rotter, 1960)

Ormel and Schaufeli (1991) conducted a research and their studies indicate that people with external locus of control develop more symptoms of psychological disorders than people characterised by an internal locus of control. Likewise, Benassi, Sweeney and Dofour (1988) conducted a Meta – analysis of 91 studies which estimated a correlation of .31 between externality and feelings of depression.

Burger (1984) conducted a research on college students that the externality correlates with a number of suicidal thoughts. Similarly, Findley and cooper (1983) conducted a research which indicated that internality is related to higher academic achievement. Youngsters with an internal locus of control get somewhat better grades than youngsters characterised by an external locus of control. Later, Njus, & Brockway, (1999) conducted a study which found out that students with an internal locus of control showed better adjustment to college in terms of academic achievement and social adjustment. Perceptions of competence and locus of control for positive and negative outcomes. (Njus & Brockway (1999) Personality and Individual Differences 26, 531-548.)

Dille, B. & Mezack, M. (1991) conducted another study which found that community college students who succeeded at distance education had high internal locus of control. Identifying predictors of high risk among community college telecourse students. (American Journal of Distance Education 5 (1), 24-35.)Basgall and Snyder (1983) conducted a study which concluded that external locus of control allows people to make excuses readily for poor performance. Externals can protect their self – esteem by blaming lousy grades or failures in areas on bad luck.

Hannah Levenson (1973) offered an alternative model to that of Rotter’s uni-dimensional model. According to Levenson, there are three independent dimensions: Interbality; Chance; and Powerful Others. This model says that one can endorse each of these dimensions of locus of control independently and at the same time. It can otherwise be called as orthogonal (independent) dimensions. For Example: A person might simultaneously believe that both oneself and powerful others influence outcomes, but that chance does not.

This means that external people not only believe that events are beyond their control, but they do so either in terms of chance or powerful others. Internal locus of control individuals are more likely to be achievement – oriented because they see that their own behaviour can result in positive effects; and they are more likely to be high achievers as well, external locus of control people tend to be less independent and also are more likely to be depressed and stressed.

Further more; Rotter developed a scale of internal – external locus of control, which measures an individual’s have enduring dispositions, despite the important role of situation in determining behaviour. In his original conception, Rotter saw locus of control as a stable independent difference variable with two dimensions (internal and external), influencing a variety of behaviour in a number of different contexts.

After a few decades of research, it’s becoming clear that a person’s locus of control may not be quite generalised as Rotter originally assumed. Some people display internal locus of control regarding events in one domain of life, while displaying an external locus of control regarding events in another domain. In the light of this finding, some researchers are studying locus of control as it relates to specific domains of behaviour.

Multidimensional Health Locus Of Control:

The Multidimensional Health Locus of Control (MHLC) scales are widely used to characterize a person’s beliefs about control over health outcomes. Health locus of control is one of the widely used measures of an individual’s health belief, and is defined as the governing perception an individual has concerning their health. The multi-dimensional health locus of control scale (HLCS) has been designed to determine whether individuals are internalists or externalists.

The purpose of this study was to examine the relationship between health locus of control and helpfulness of prayer as a direct – action coping mechanism in patients before having cardiac surgery.

The Multidimensional health locus of control scales and the investigator – developed helpfulness of prayer scale was issued to 100 subjects 1 day before the cardiac surgery. 96 subjects indicated that prayer was used as a coping mechanism in dealing with stress of the surgery, and 70 of these subjects gave it the highest possible rating on the helpfulness of prayer scale. No relationship was found between locus of control and helpfulness of prayer.

Past research has raised concern about the possible confounding of desires for control with expectancies about control as measured in the MHLC scales. Researchers

examined whether the original MHLC scales were more highly correlated with measures of expectancies about control or desires for control. They then examined whether the psychometric properties of the MHLC scales could be improved by using response options with expectancy anchors rather than agree—disagree anchors.

Later, the Multidimensional Health Locus of Control Scale was administered to 137 chronic haemodialysis outpatients in a survey designed to examine the relationship of these scores to serum phosphorus, a laboratory indicator of dietary compliance in end-stage renal disease. In a multiple regression analysis, scores on the Powerful Others Locus of Control subscale accounted for 8.9% of the variance in serum phosphorus. Discussion includes a tentative explanation of the findings and limitations of the design.

Norman and Bennett argue that a stronger relationship is found when health locus of control is assessed for specific domains than when general measures of locus of control are taken. Lefcourt, (1991) after his study concluded that “Overall, studies using behavior-specific health locus scales have tended to produce more positive results.

Originally the construct of health locus of control was derived from the Social Learning Theory developed by Rotter in 1966. The social learning theory states that an individual learns on the basis of their history of reinforcement. The individual will develop general and specific expectancies. Through a learning process, individuals will develop the belief that certain outcomes are a result of their action (internals) or a result of other forces independent of themselves (externals).

Questioning the idea of locus of control as a unidimensional construct, Dr. Hannah Levenson argued that understanding and prediction could be improved by studying fate and chance expectations separately from external control and powerful others.

According to Levenson, powerful others should not be internal or external and beliefs about people in general should have less predictive power about one’s control. Realizing the utility and supporting evidence of the multidimensionality, The Multidimensional health Locus of Control was developed.

The brief description of the theory explores the fact that: Health Locus Of Control (HLC) is a degree to which individuals believe that their health is controlled by internal or external factors. Whether a person is external or internal is based on a series of statements. The statements are scored and summed to find the above.

Those scoring above the median are labelled “Health – Externals” and those below the median are labelled “Health – Internals”.

Externals refer to belief that one’s outcome is under the control of powerful others (i.e., doctors) or is determined by fate, luck or chance.

Internals refers to the belief the one’s outcome is directly the result of one’s behaviour.

Dr. Hanna Levenson questioned the conceptualisation of the locus of control as a unidimensional construct. She predicted that the construct could be better understood by studying fate and chance expectancies separately from the external control by powerful others.

Levenson developed the 3 item Likert scale termed the IPC Scale which was used to measure generalized locus of control beliefs.

I      -        Internal

P      -        Powerful others

C      -       Chance

Wallston & Wallston combined their unidimensional HLC Scale and Levenson’s IPC Scale and developed The Muilidimensional Health Locus Of Control (MHLC) Scale. The MHLC Scale consists of 3 six – item scales also using the Likert Scale Format.

Internal HLC (IHLC) is the extent to which one believes that internal factors are responsible for health/illness.

Powerful Others HLC (PHLC) is the belief that one’s health is determined by powerful others.

Chance HLC (CHLC) measures the extent to which one believes that health illness is a matter of fate, luck or chance.

Locus of control has been a concept which has certainly generated more research in psychology, in various areas. There will probably continue to be a debate about specific or more global measures of locus of control will prove to be more useful. Careful differences should be made in between locus of control (a concept linked with expectations of the future) and attributional style (a concept linked with explanations of the past outcomes) or between locus of control and concepts like self efficacy. The importance of locus of control as a topic of psychology is likely to remain quite certain for many years.

Low back pain

LBP is defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds, with or without referred leg pain. (www.backpaineurope.org).

The exact cause of pain for the majority of LBP patients remains unknown. It is frequently reported that low back pain symptoms, pathology and radiological findings are poorly correlated (Espeland et al., 2001; Jarvik & Deyo, 2000; Van Tulder et al., 1997). In 80 to 90%of back pain cases there are no evident objective findings, and therefore difficult to establish 22 pathological basis of pain (Deyo, 1988; Pope & Novotny, 1993; Waddell, 2004d). An approach to diagnosis is Waddell’s diagnostic triage (Waddell, 2004b):

• Non-specific (ordinary) backache

• nerve root pain

• Possible serious spinal pathology

- Most back pain is non-specific, defined as mechanical pain of musculoskeletal origin in which symptoms vary with physical activities and includes a variety of different conditions (Waddel, 2004b).

- Nerve root pain, also called sciatica, can arise from a disk prolapse or spinal stenosis. It is a sharp, well-localized pain down the leg that at least approximates to a dermatome pattern. It radiates below the knee and often into the foot or toes. There is a lack of epidemiological studies examining the prevalence of lumbar radiculopathy, but it is assumed that less than 5%true nerve root pain (Waddell, 2004b).

-Serious spinal pathology is often referred to as “red flags” and includes diseases such astumor and infection, and inflammatory disease such as ankylosing spondylitis. About1% of people seen with LBP in primary care have a neoplasm (Deyo, 1992), and 4% have fractures (Deyo, 1992).Spinal infections are rare (www.backpaineurope.org).Less than 1% is due to inflammatory disease that needs rheumatologic investigation and treatment (Waddell, 2004b).

Many factors influence the development of disability due to LBP. Frank et al. (1996) described three stages in the development of chronic disability:

• In the acute stage (< 4 weeks), the prognosis is good and 90% settle within 6 weeks, atleast sufficient to return to work.

• The sub acute stage (4-12 weeks) is the critical stage for intervention. Psychosocial issues become more important.

• In the chronic stage (> 12 weeks), psychosocial issues are important with major impact one very aspect of the individual’s life, family, and work. The prognosis is poor. Likelihood of return to work diminishes with time. Medical treatment, rehabilitation, and vocational rehabilitation are difficult and success rate is low.

In all stages diagnostic concerns related to possible serious spinal pathology as well as psychosocial influences has to be taken into consideration. Psychosocial concerns, expectations, and behavior are different at the acute, sub acute and chronic stages. Social, employment, and economic status changes from the acute to the chronic stage. The outcome of any intervention may be quite different in each phase, so the timing of health care or rehabilitation interventions is critical. To avoid development of chronic LBP, early intervention might be crucial, and active interventions to control pain and improve activity levels might reduce disability.

Prevalence of low back pain / economic consequences

A large number of international studies show that 12-33% of people report back complaints on the day of the interview; 22-65% report back pain in the previous 12 months, and 11-84%report back pain at some timing their life. (backpaineurope.org)

Norwegian studies have found one month prevalence of 22% (Hagen et al., 1997) and 40% (Ihlebæk et al., 2002), and one year prevalence of 53% (Natvig et al., 1995). Studies of adult populations have tended to show an increase in the prevalence of low back pain until mid to late forties, with rates stabilizing after that age until the mid sixties (Walsh et al., 1992; Skovron et al., 1994).

Despite the high prevalence of LBP in the general population, it has been estimated that in a12-month period, fewer than 10% of those episodes will lead to a consultation with a healthcare practitioner (Papa Georgiou et al., 1995). The proportion of the population with work loss due to low back pain is estimated to about 2-5% per year (Mason, 1994; Nachemson et al., 2000; Waddell, 2004d). Most acute LBP episodes resolve within a few weeks regardless of treatment (Deyo, 1998), but residual symptoms and recurrences are common, occurring in 40-80% of patients (Battie & Bigos, 1991; Von Korff et al., 1993), which may influence health and quality of life of the individuals. A minority (6%) develops chronic disabling back pain (Croft et al., 1997), and this minority is responsible for the largest part of the costs due to LBP (Frymoyer & Cats-Baril, 1991; Goossens, 2002; Brage et al., 1998). Interventions directed to reduce development of chronic disability due to LBP might be cost-effective.

REVIEW OF LITERATURE

The purpose of the study was to determine whether there exists a difference in the health locus of control scores of men and women among white collar and blue collar jibs with and without lower back pain. Much has been done in terms of research on lower back pain using the questionnaire Multidimensional Health Locus of Control. A few of the studies are been noted down here below. The literature comprises articles on Health locus of control, gender, different medical ailments.

“Perceptions of health locus of control in people with acute lower back pain”

by Roberts. et. al.(2002) -  tested how people with acute low back pain respond to this common symptom and whether they perceive themselves able to influence their back pain episode. Low back pain was common among Brazilians, especially affecting those who are working. Psychosocial factors, such as the health locus of control, are associated with low back pain prognoses. (Physiotherapy, 88, (9), 543-548). (Doi:10.1016/S0031-9406(05)60137-X). Their basis of such an assumption explained that “With respect to the relationships between sex differences, with men perceiving greater influence of powerful others and chance factors in their acute back pain than women participants.” It is true that perceptions of control over their back pain changed over time and were not synonymous with their perceptions about general health. The results concluded that when people develop back pain, their psychological make-up influences how they respond. Locus of control may be a factor affecting this response and is likely to form part of a broader issue of ‘perceived control over health’.

`“Locus of Control and Health – A Review of Literature” (Health Education Monographs, 6, 107 – 117) by Wallston, B.S. & Wallston, K.A. (1978).                          This is the original article enclosed by Wallston, B.S. & Wallston, K.A. (1978) on Locus of Control, a construct derived from Rotter’s social learning theory. The review of this paper focuses on measurement of internal – external locus of control and the relation of this individual difference dimension to health – related disorders. This review is primarily concerned with health behavior and sick – role behavior. This study is reviewed on the utility of the locus of control construct in understanding smoking reduction, birth control utilization, weight loss, information seeking, adherence to medical regimes, and other health and sick – role behaviors. This arises from the differing opinions of Kasl and Cobb conceptualized health – related behaviors as behavior related to prevention, termed illness behavior, and behavior following diagnosis, termed sick – role behavior. This study had a convenient sample of 60 (31 female and 29 male) guidance student with an age range of 23 to 33 years. The 60 participants belonged to 2 classes and the questionnaire was given depending on the classes chosen the he forms selected. In regards to smoking, several studies concluded that internals (those who believe that reinforcement is contingent upon the individual’s behavior) are more likely to engage in behaviors that facilitate physical well – being. The study was governed to publish their first valid results using the MHLC questionnaire on various areas like birth control and abortion studies, kidney patients and dialysis, venereal disease in women, tuberculosis, sick–role behavior, adherence, weight loss, information, and smoking. Likewise, results in the birth control and locus of control also produced same outcomes. Macdonald showed that among single female college students, 62% of the internals reported practicing contraception, while only 37 % of the externals did so. Harkley and King, in their analysis showed no difference in locus of control between abortion parents and use of birth control, with both groups scoring slightly more internal than female norms. In an early study, Seeman and Evans found that tuberculosis patients matched for occupational status, education and ward placement, internals knew more about their condition, were more inquisitive with patients and nurses about tuberculosis and their situation, and indicated less satisfaction with the amount of information they were getting from hospital personnel than did externals. Weaver found that kidney patients using dialysis machines, internals are more likely to comply with diet restrictions and keep scheduled appointments more regularly than externals. Darrow (summarized in Strickland) found that internal females with venereal disease were more likely to return to treatment with the appearance of new symptoms than were the external females.  Manno and Marston found, in their study that externally oriented subjects weighed more initially, but lost more weight in the later stages. In another study, O’Bryan found that overweight women to be more externals. Thus, there is an evidence that locus of control construct is relevant to the prediction of health behaviors and sick- role behavior. Internals show behavior that is more positive in each of these areas, but contradictory evidence has been presented which, in some instances, could indicate that it is more functional to hold external beliefs. METHODOLOGY

Objective

To assess the differences in the health locus of control in participants with and without lower back pain. To study the influence of occupation and gender on health locus of control among participants with and without back pain.

Hypothesis

There exists gender difference with regards to Multidimensional health locus of control. Different occupations contribute differently to Multidimensional health locus of control. There exist differences in participants with and without lower back pain.

Variables

The independent variables in the study are gender, age and lower back pain. The dependent variables are health locus of control. The study is based on a corelational research design

Research instruments

For the present research, the investigator took the aid of the research conducted by Ken Wallston et al., at Vanderbilt University (1978). The following instruments were used in the study: Multidimensional Health Locus of Control (MHLC) – Form A (Wallston, Wallston, & DeVellis, 1978, and Form C (Wallston, Stein, & Smith, 1994, Journal of Personality Assessment, 63, 534-553).

Multidimensional Health Locus Of Control Form A (MHLC – A) – The brief form of this questionnaire developed by Wallston, Wallston, & DeVellis, (1978) cited in (Health Education Monographs, 6, 160-170) to measure a client’s health locus of control. It is an 18 item, self-report questionnaire made up of 5 discrete subscales designed to measure health locus of control. The subscales measure expectancies in five general areas: Internal Health Locus of Control, Powerful Others Health Locus of Control, and Chance Health Locus of Control, Other People Health Locus of Control, Doctor’s Health Locus of Control. (MHLC – A) of the items is scored on a 6- point Likert response scale ranging from 1 (Strongly Disagree) to 6 (Strongly Agree). Scale scores on the MHLC – A are calculated by summing respective items for a total scale score (i.e., where 1 = “strongly disagree” and 6 = “strongly agree”). Higher scores reflect stronger endorsement of MHLC scales. There were no items, which needed reversed before summing. All of the subscales are independent of one another. As such, there is no such thing as a “total” MHLC score (Health Education Monographs, 6, 160-170). The internal consistency of the scale was measured through Cronbach’s coefficient ? and it ranges from 0.60 to 0.75 (Wallston 1978).

Multidimensional Health Locus Of Control Form C (MHLC – C) – It was developed by Wallston, Stein, & Smith, (1994) cited in (Journal of Personality Assessment, 63, 534-553). It is an 18 item scale that is designed it measure the five domains namely: Internal Health Locus of Control, Powerful Others Health Locus of Control, and Chance Health Locus of Control, Other People Health Locus of Control, Doctor’s Health Locus of Control. Research shows this scale was designed to be “condition-specific” and can be used in place of Form A when studying people with an existing health/medical condition. Responses were measured on 1 to 6 point Likert response scale. Scale scores on the MHLC – C are calculated by summing respective items for a total scale score (i.e., where 1 = “strongly disagree” and 6 = “strongly agree”). Higher scores reflect stronger endorsement of MHLC scales. There were no items, which needed reversed before summing. All of the subscales are independent of one another. As such, there is no such thing as a “total” MHLC score. This scale was developed for people with an existing health condition and it has been shown to be reliable and structurally valid with all groups of individuals (Journal of Personality Assessment, 63, 534-553).

Validity and Reliability

The test-retest reliability for the Internal, Chance, and Powerful Others using Pearson’s moment correlation were 0.60 (p < 0.001), 0.58 (p < 0.002), and 0.74 (p < 0.0001), respectively. (Wallston 1978). The obtained results indicated significant correlation coefficients between the two scale factors i.e., 0.57 for Internal (P < 0.001), 0.49 for Powerful Others (P < 0.01), and 0.53 for Chance (p < 0.001). For bivariate correlation among the subscales, correlation analysis was calculated. In this regard, there was a positive but weak correlation (0.28) between the Internal HLC and Powerful HLC, no correlation was found between the Chance HLC and Powerful Others HLC (r = -0.31); and a negatively weak correlation coefficient was found between the Internal HLC and the Chance HLC (r = -0.20). Thus the MHLC – A can be used with non-client student populations too, regardless of prior counseling experience.

Scoring

The scoring for the questionnaire consisted of 5 subscales namely Internal Health Locus of Control, Powerful Others Health Locus of Control, and Chance Health Locus of Control, Other People Health Locus of Control, Doctor’s Health Locus of Control. Each of these subscales contains six items with a six-point Likert response scale ranging from ‘Strongly Agree’ to ‘Strongly Disagree’, with the scoring of 1, 2, 3, 4, 5, 6 respectively. Form C has two, independent 3 item subscales:  doctors, and other people, instead of a single 6 item powerful others subscale.

Scales are scored by summing respective items for a total scale score (i.e., where 1 = “strongly disagree” and 6 = “strongly agree”). Higher scores reflect stronger endorsement of MHLC scales.

RESULTS AND DISCUSSION

The study was conducted to assess the differences in the health locus of control in subjects with and without lower back pain. The study was also conducted to check the influence of occupation and gender on health locus of control among subjects with and without lower back pain.

The obtained scores are further calculated. Number of subjects divided by age, gender and medical condition is indicated in Table 1. The results obtained are given in

Table 1, Table 2, Table 3.

The hypothesis of the present study is that

Different occupations contribute differently to Multidimensional health locus of control. There exists gender difference with regards to Multidimensional health locus of control. There exist differences in participants with and without lower back pain. Table 1 indicating the scores of the sub scales among all men and women subjects on whom experiment was conducted

Sub Scales

Analysis

Internal

Chance

Doctors

Other people

Powerful others

Mean1(men)

29.771

19.5

12.778

11.935

23.928

Mean 2(women)

27.8

19.05

12.428

11.7

22.314

S. D. 1

6.252

8.374

3.391

3.8325

6.394

S.D. 2

4.951

6.433

3.745

3.5085

6.791

Z – Ratio

**6.968

1.076

*1.550

1.4245

**3.719

** Significant at 0.01 & 0.05 levels

* Significant at 0.01 level

From the above Table 1, the mean of the sub scales internal for men and women are  29.771 and 27.5, that of powerful others is 23.928 and 22.314 and of doctors is 12.514 and 12.428 respectively. The Z – ratio of the sub scales Internal and Powerful others and doctors are 6.968, 3.719 and 1.550 respectively, which indicates that they are highly significant at 0.01 and 0.05 levels. There exists a corresponding difference in health locus of control among men and women and since the mean of men is relatively more than women, it proves that men perceive greater influence to internal factor than the women participants. Whereas, the mean of men and women are comparatively same in regards to doctors and powerful others factors indicates that both give equal importance to these scales in balancing their health. But with regards to the sub scales chance and other people, the Z – ratio is 1.076 and 1.424 is found to be insignificant. The study conducted by Levenson’s (1974) has proved that men are prone to internal sub scale than women. Hence the hypothesis based on gender has been partially proved at some subscales in the present study.

Table 2 indicating the scores of the sub scales of all the participants belonging to white collar and Blue collar jobs in the experiment.

Sub Scales

Analysis

Internal

Chance

Doctors

Other people

Powerful others

Mean1(men)

28.978

16.6

12.151

11.15

11.364

Mean 2(women)

27.8

19.05

12.428

11.7

22.314

S. D. 1

6.156

6.915

3.254

10.596

6.409

S.D. 2

5.250

7.068

3.870

3.757

6.777

Z – Ratio

0.285

**0.316

0.225

**0.320

0.434

From the above Table 2, the mean of the sub scales chance for white collar jobs versus blue collar jobs are 16.6 and 19.05 and that of other people is 11.15 and 11.7 respectively. The Z – ratio of the sub scales chance and other people are 22.314 and 6.777 respectively, which indicates that they are highly significant at 0.01 and 0.05 levels. Since the mean of chance factor of the participants of the blue collar jobs is more than the white collar jobs, which proves that participants of the blue collar jobs perceive more influence of chance factors than the white collar jobs. Since the mean of other people factor of the participants of white collar jobs is comparatively same as blue collar jobs, it proves that men give almost equal importance to sub scale other people to balance their health factors. But with regards to the sub scales internal, doctors and powerful others, the Z – ratio is 1.351, .791 and 0.905 is found to be insignificant. However no research was found with regards to occupation leading to health locus of control in men and women. The study conducted by Roberts et, al., (2002) suggest that men perceive greater influence of powerful others and chance than women, which is much similar to the present study. Hence the hypothesis based on occupation has been partially proved in some subscales in the present study. Table 3 indicating the scores of the sub scales of all the participants with and without lower back pain in the experiment.

Sub Scales

Analysis

Internal

Chance

Doctors

Other people

Powerful others

Mean1(men)

27.8

18.37

13.421

12.292

—-

Mean 2(women)

29.771

20.071

11.785

11.342

23.121

S. D. 1

6.252

8.408

3.209

3.400

—-

S.D. 2

4.951

6.279

3.735

3.874

6.596

Z – Ratio

**6.968

**5.226

**7.343

**4.167

—-

From the above Table 3, the mean of the sub scales internal, chance, doctors and other people for participants with and without lower back pain 27.8 and 29.77, 18.37 and 20.07, 13.42 and 11.7 and 12.29 and 1.34 respectively. The Z – ratio of the sub scales internal, chance, doctors and other people are 6.968, 5.226, 7.343 and 4.167 respectively, which indicates that they are highly significant at 0.01 and 0.05 levels. Since the mean of the participants with lower back pain is comparatively same as without lower back pain, it proves that participants give almost equal importance to the sub scales chance, doctors and other people to balance their health. Hence the hypothesis based on medical condition has been significantly proved in all the subscales in the present study. SUMMARY

The study on Gender and Occupation leading to Multidimensional Health locus of control was conducted on white collar and blue collar men and women.

The first hypothesis formulated namely – there exists gender differences with regards to multidimensional health locus of control has been partially proved. The second hypothesis formulated namely – different occupations contribute differently to multidimensional health locus of control has been partially proved. The results of the third hypothesis namely – there exists differences in multidimensional health locus of control with regards to participants with and without lower back pain has been partially proved.

RECOMMENDATIONS

·        The study shows that lower back pain is based on gender and occupation. This can be reduced by reducing their work loads. Physical spine exercise/relaxation is a form of lower back pain reduction often used by physiotherapists. Lower back pain is situation specific. This can be viewed from the significance levels seen in occupation standards. Hence, the work place ambience and working style is also a major aspect which causes spine ailment. The most important way people deal with lower back pain is avoid its existence in the first place. If someone faces a terrible pain in the spine, the easiest way to deal with this new ailment is to identify the pain and notice the sitting arrangement and work place. The research is limited in its scope with regards to gender and occupation factor only. Hence, further studies can be conducted taken into consideration variables like countries, family background etc.

REFERENCES

Adams N. Psychosocial factors affecting pain. In: Adams N, ed. The Psychophysiology of Low Back Pain.

Aarø LE. Health behaviors and socioeconomic status. A study among the adult population in Norway. Thesis for the degree Dr.Philos, Faculty of Psychology, University of Bergen, Bergen 1986.

Atkinson, Hilgard. (203). Introduction to Psychology. India: Thomson Business Information India Pvt. Ltd.

Backpaineurope (www.backpaineurope.org)

Bandura. A (1994) Self – Efficacy. Encyclopedia of human behavior. (Vol. 4, 71 – 81)

Bandura. A (1986). Social Foundations of thought and action. Asocial Cognitive theory. Upper saddle river, NJ: Prentice hall.

Basem Farid, Madekeine Clark, Roger Williams (1998), Health Locus Of Control in Problem Drinkers With and Without Liver Disease ; Alcohol & Alcoholism Vol. 33, No. 2, pp. 184-187, 1998.

Barker Lewis. (2000). Psychology.  New Jersey: Prentice Hall.

Coon Dennis, Mitterer O. John. (2007). Introduction To Psychology, Gateways to Mind and bahavior. New Delhi. Akash Press.

Deyo RA. Low Back Pain. Sci Am 1998;August: 29-33. And More…

APPENDIX

NAME

AGE

SEX

OCCUPATION

HIGHEST DEGREE OF QUALIFICATION

LOWER BACK PAIN – Yes/ No

Instructions: Each item below is a belief statement about your medical condition with which you may agree or disagree. Beside each statement is a scale which ranges from strongly disagree (1) to strongly agree (6). For each item we would like you to circle the number that represents the extent to which you agree or disagree with that statement. The more you agree with a statement, the higher will be the number you circle. The more you disagree with a statement; the lower will be the number you circle. Please make sure that you answer EVERY ITEM and that you circle ONLY ONE number per item. There is no right or wrong answers. There is no time limit for the responses, which you feel may fit right, the same may be marked. Your responses would be kept highly confidential.

Form A:

1=STRONGLY DISAGREE (SD)
2=MODERATELY DISAGREE (MD)
3=SLIGHTLY DISAGREE (D)

4=SLIGHTLY AGREE (A)
5=MODERATELY AGREE (MA)
6=STRONGLY AGREE (SA)

S.NO

SD

MD

D

A

MA

SA

1.

If I get sick, it is my own behaviour which determines how soon I get well again.

1

2

3

4

5

6

2.

No matter what I do, if I am going to get sick, I will get sick.

1

2

3

4

5

6

3.

Having regular contact with my physician is the best way for me to avoid illness.

1

2

3

4

5

6

4.

Most things that affect my health happen to me by accident.

1

2

3

4

5

6

5.

Whenever I don’t feel well, I should consult a medically trained professional.

1

2

3

4

5

6

6.

I am in control of my health.

1

2

3

4

5

6

7.

My family has a lot to do with my becoming sick or staying healthy.

1

2

3

4

5

6

8.

When I get sick, I am to blame.

1

2

3

4

5

6

9.

Luck plays a big part in determining how soon I will recover from an illness.

1

2

3

4

5

6

10.

Health professionals control my health.

1

2

3

4

5

6

11.

My good health is largely a matter of good fortune.

1

2

3

4

5

6

12.

The main thing which affects my health is what I myself do.

1

2

3

4

5

6

13.

If I take care of myself, I can avoid illness.

1

2

3

4

5

6

14.

Whenever I recover from an illness, it’s usually because other people (for example, doctors, nurses, family, and friends) have been taking good care of me.

1

2

3

4

5

6

15.

No matter what I do, I ‘m likely to get sick.

1

2

3

4

5

6

16.

If it’s meant to be, I will stay healthy.

1

2

3

4

5

6

17.

If I take the right actions, I can stay healthy.

1

2

3

4

5

6

18.

Regarding my health, I can only do what my doctor tells me to do.

1

2

3

4

5

6

Form C:

1=STRONGLY DISAGREE (SD)
2=MODERATELY DISAGREE (MD)
3=SLIGHTLY DISAGREE (D)

4=SLIGHTLY AGREE (A)
5=MODERATELY AGREE (MA)
6=STRONGLY AGREE (SA)

S.NO

SD

MD

D

A

MA

SA

1.

If my condition worsens, it is my own behaviour which determines how soon I will feel better again.

1

2

3

4

5

6

2.

As to my condition, what will be will be.

1

2

3

4

5

6

3.

If I see doctor regularly, I am less likely to have problems with my condition.

1

2

3

4

5

6

4.

Most things that affect my condition happen to me by chance.

1

2

3

4

5

6

5.

Whenever my condition worsens, I should consult a medically trained professional.

1

2

3

4

5

6

6.

I am directly responsible for my condition getting better or worse.

1

2

3

4

5

6

7.

Other people play a big role in whether my condition improves, stays the same, or gets worse.

1

2

3

4

5

6

8.

Whatever goes wrong with my condition is my own fault.

1

2

3

4

5

6

9.

Luck plays a big part in determining how my condition improves.

1

2

3

4

5

6

10.

In order for my condition to improve, it is up to other people to see that the right things happen.

1

2

3

4

5

6

11.

Whatever improvement occurs with my condition is largely a matter of good fortune.

1

2

3

4

5

6

12.

The main thing which affects my condition is what I myself do.

1

2

3

4

5

6

13.

I deserve the credit when my condition improves and the blame when it gets worse.

1

2

3

4

5

6

14.

Following doctor’s orders to the letter is the best way to keep my condition from getting any worse.

1

2

3

4

5

6

15.

If my condition worsens, it’s a matter of fate.

1

2

3

4

5

6

16.

If I am lucky, my condition will get better.

1

2

3

4

5

6

17.

If my condition takes a turn for the worse, it is because I have not been taking proper care of myself.

1

2

3

4

5

6

18.

The type of help I receive from other people determines how soon my condition improves.

1

2

3

4

5

6

Weight loss does not happen in a vacuum. There are conditions that impelled it. Without weight gain, there will not be a discussion about weight loss. A good starting point in the desire to loose weight is to first figure out where we went wrong. Is it in our diet? Is it in not moving enough? How much of a roll does genetics play in our weight loss? The individual desiring to loose weight must of necessity ask oneself some of these questions and honestly seek to find proven and tested answers. 

Where did I go wrong?

Much of America as we know today is overweight. Some reports say a whooping 2/3 of the population is either just obese or morbidly obese. They also show that our food and diet are the main culprits for this epidemic. There is a saying that says, “You are what you eat”. It is therefore self evident that we have not eaten the right things in the right amounts. We have been lax with our diet. Knowing this, it would appear that loosing weight would be as simple as doing the opposite of what we have done so far. And for many, weight loss would simply mean just that- eating the right things in the right amount and being patient to give the body time to work itself out. And over time, the weight will drop off.

But we live in a complex world and things are not always as simple as they seem. There are old habits to break, and emotions to deal with. There is the issue of time, and availability of the right foods at the right place and time. There are genetic dispositions that sometimes work against our best efforts in weight loss. There is also the noise in the diet and weight loss industry generated by the dizzying number of weight loss products and the claims and counter claims made by the beneficiaries of these weight loss products and programs. The individual desiring to loose weight is therefore faced not only with the weight that he or she needs to loose, but how to approach his or her weight loss goal within such a confusing environment?

The trick is to get back to the basics of weight loss by:

1.  Doing all things in moderation. I believe that nothing eaten in moderation will in and of itself become a problem. It is when we over indulge and make a hobby of some foods that we open ourselves for weight problems.

2. Making wise food choices. Instead of loading up on over processed foods laden with sugar, fat and carbohydrates, we can instead load up on foods with high fiber contents as these give a sense of fullness with minimal intake.

3. Drinking sugar free liquids in-between bite as this helps to give us that sense of fullness, without necessarily consuming much.

4. Not being a mindless eater. Mindless eating can be avoided by being aware of what you are eating and how much. Make it a habit to use smaller plates for your servings. Chew your food completely and quit at the first sign of fullness.

5. Ridding your environment of the temptation of mindless eating. According to a recent survey by a popular media house, just by merely moving the candy jar a few feet away from its location, reduced the amount of candy the participants consumed.

6. Only stocking foods that are nutritionally healthy and balanced.

7. Getting enough sleep and

8. Keeping on moving. Be active! Exercise! Activities as simple as just working are very beneficial. Walk to the neighborhood store. Park a little away from the office and walk the rest of the way.

For the morbidly obese, who need to loose more weight, additional help may be necessary. Getting a health or colon cleanse would be a good place to start. The colon, it has been established plays a significant role in maintaining a healthy digestive system and body functions. A toxic and diseased colon creates an imbalance in the body, leading to increased fat deposits, especially around the organs. A health or colon cleanse helps to remove toxins from the body and restores the normal functions of the digestive track and colon, leading to better absorption and removal of fat deposits, especially around the organs.

Weight loss surgery may also be considered where everything else fails. Because of the risk associated with surgeries generally, bariatrics or weight loss surgery should be considered with extreme care. A complete risk benefit analysis must be carried out before a final decision is made. Choose the procedure with the list risk and the most benefits.

Of all the articles and ads about weight loss and weight loss products, you will notice that many of them seem to be saying that weight loss without exercise is what they have to offer. They will tell you about some diet pill, or perhaps a diet, which is going to take the weight off without you lifting a finger…other than to unscrew the cap.

So here’s the question: Can somone really lose weight simply by adjusting their diet? So many people feel that they do not have the time to exercise, or feel they lack the energy to exercise, or just plain don’t want to. It would be great if all they had to do was take some pill or eat some specific diet and the weight would go away, right?

Now, my problem is that when I think of, or advise someone on, weight loss, I automatically throw in adjectives like “healthy” and “permanent”. I’m not really in touch with the concept of using a diet to lose a few pounds to get back into last year’s clothes or to look good at the high school reunion. I tend to think of losing weight as a step to the point where you achieve your weight loss goal and enter the realm of weight management. At this point, you are living a healthy lifestyle of combined physical activity and proper nutrition and are able to enjoy life to the max…for a good many years to come!

“Yeah, Don, that’s great, but I’m one of the first group of people you talked about. I just want to lose weight and don’t want to mess with exercise. Heck, man, I’m so overweight and pooped all the time that just thinking about exercise scares me. Just tell me what diet pill to take or diet to follow so that I can get my weight down, look good, feel good about myself, and enjoy life like you say!”

Well, there are people who want to be rich but who don’t want to “mess with” saving, or making wise purchasing decisions, or working hard, either. Whatever we really want in life usually has some sort of price tag attached, and, as the saying goes, we usually, “get what we paid for”.

To throw in another old saying, anything worth doing is worth doing well.

To get back to the weight loss without exercise issue, let’s look at a couple of facts.

1. Diets do not work as far as permanent or healthy weight loss is concerned.

2. Permanent, healthy weight loss is commonly achieved through a combination of exercise and proper nutrition.

3. While there are diet products and supplements which can enhance the effects of any weight loss program, they very seldom do the trick by themselves for most people.

Let’s start with that last one.

Start by reading the labels or advertising literature of most diet pills and other weight loss supplements. Somewhere you will usually find a statement that will say something like “when used with regular exercise and a sensible nutrition program”. In other words, taking that diet pill or supplement “might” help you lose weight IF it is taken as part of some other weight loss program.

Even the manufacturers of the Alli fat loss pill, which at the moment is the only federally approved weight loss pill, will let you know that you really need to be doing other things as well as taking their pill to experience effective weight loss. Testing of that pill, one of the most effective available, show that weight loss with the pill alone will be minimal unless it is used with a program of regular exercise and proper nutrition.

Let’s face it. If there WAS one diet pill that you could take and then sit around watching TV, eating ice cream, and drinking beer…AND still lose weight and be healthy, there would not be so many different diet pills claiming to do the trick!

Okay, I started with the last fact, so let’s jump around and deal with the first fact next.

Diets per se do not work for permanent, healthy weight loss.

When you suddenly decrease the calories you regularly have been feeding your body, it senses a starvation situation (built in survival trait) and lowers its basic metabolic rate. In other words, it adjusts itself to function with fewer calories. This might not be too bad, but, if you go back to your old eating habits, the same amount of calories will now produce more fat to be stored on your body.

This is the reason that going on and off diets is very likely to cause weight gain, rather than weight loss! It’s called yo-yo dieting.

Additionally, extreme reductions in nutrition can also mean extreme reductions in the vitamins, minerals, protein, carbohydrates, fats (needed for life), phytonutrients, and other nutritional factors required for health, energy, and long life. You might lose weight but actually endanger your health and lack the energy necessary to live your life with pleasure.

Just to throw in another monkey wrench, once your body has adapted to its new diet and adjusted its basic metaolism, the weight loss will cease. This usually occurs after only a few pounds have been lost. To lose more weight, you will have to cut your nutritional intake even more, or simply decide to take a look at the second fact I listed.

Test after test and study after study has demonstrated beyond a doubt that the most effective weight loss program is one that includes regular, moderate exercise and healthy eating and living habits. The exercise does NOT have to be extreme, although overall results will usually be directly related to the amount of effort expended.

Most of us are NOT going to wind up looking like Arnold Schwarzenegger or Cory Everson unless we exercise and eat like they do!

However; regular, moderate exercise can burn calories and build lean muscle tissue which will continue to use up excess calories and burn fat even when we are not exercising. It will raise energy levels, make daily life easier, help elevate mood and fight depression, and will help protect us against a host of degenerative diseases. It has been shown to delay and mitigate the effects of aging, and has been shown a potent protector against many conditions including heart disease, high blood pressure, diabetes, arthritis, and many forms of cancer.

Healthy eating does not necessarily mean “dieting”. Healthy eating involves such things as proper selection of foods, paying attention to portion sizes, and changing a few eating habits…including that great American pastime…snacking!

I used the term “healthy eating and living” because such things as getting the proper amount of sleep, having fun, and having friends can also contribute to health in general and weight loss in particular.

Is weight loss without exercise possible?

Sure! Millions of people throughout history have gotten very thin before they starved to death!

Millions more have simply combined exercise with healthy eating and living habits to experience permanent, healthy weight loss and have enjoyed a long and happy life as a result.

Your choice?

A study in England of thousands of women and men found that people who went through the good and bad times with the original mate and stayed together were much happier mentally.

It was also found that men who played the field got over the relationships when they ended much quicker then women did.

Women who stay single who once had a great love that did not work out tended to be mentally stable.

The fact that women who live with a man without benefit of marriage are not as happy as the men is because there is no financial protection for them when the relationship ends. Security is everything to women and marriage represents stability and although the relationship can end they will have some rights. This explains why women who are married are more mentally stable then if they simply lived together.

Women have children and need a stable lifestyle and a strong desire to protect themselves and their kids. So marriage is very important financially and also there is the question of respect that everyone needs. If a women has her own career and here own money these thing may be less important.

From a man’s point of view and if he’s over 25 security is not very important. But most men don’t want to be squeezed into a relationship by the women he loves. He want’s it to be his idea. The trick for a woman is to make him believe it is His Idea.

Being married has always been associated with greater mental and physical health. Bachelors don’t live, as long, at least that’s what the myth indicates. In the past studies have shown married men live a longer life with greater psychological happiness.

There was an English study for 10 years ending in the millennium of 10,000 adults. Both men and women were interviewed and asked a series of questions about being depressed or anxious.

Long-lasting relationships that have weathered the storm provided excellent mental health.

People that had failed relationships and were now alone had combinations of grief and anger and were often depressed. Both men and women had poor mental health after this experience. But for those who could move on to new relationships, much of the damage was somewhat reversed. Although women seemed to have a harder time of letting go than men did.

Women’s mental health progressively deteriorated with the more break-ups they experienced.

For men that had several different experiences it seemed the opposite was true. Men who had more then one relationship and moved on seemed to be in excellent mental health. Those men that had only one relationship and not moved on were not as mentally stable.

Women who never married but lived with their mate were in great mental health unlike men in the same situation

Losing weight is easy! How? Just cut off your daily intake of high calorie food and back it up with more and more exercise. These simple steps are the answers of almost all people’s question on how to lose weight without extensive diets. Why is this so? It’s simple.

Our bodies have organisms that seek energizers; calories are the primary example of it. When these organisms cannot find enough energizers from the food we eat, it will instead start to burn the stored fats in our waist and on the other parts of our body. Therefore, the most practical way to lose weight is to follow a simple diet and burn energy by making exercise as a habit.

Though these approaches to lose weight are the most ordinary and healthy, many people failed to follow. This is actually the reason why weight loss pills were formulated, which is easier no exercise and no diet to follow. Among the most common categories of these pills are the so-called fat binders and fat blockers. These pills work by decreasing the amount of fat that our body organism absorbs from foods. Xenical, one of the most common brands of Fat blockers, slows down the lipase enzyme in the intestines which breaks up fat making it prepared for digestion. This will prevent the fats from being absorbed by the organisms so it freely passes our body through the bowel. Fat binders on the other hand work by fastening the fat molecules. Same as fat blockers, it prevents the fats from being absorbed by the intestines. As expected from medicinal diets, fat binders and blockers have very wicked side effects. Examples of these side effects are foul smelling and unmanageable anal discharges. Naturally, taking up diet pills to remove fats is easy and effortless but, it is also expected to be unhealthy.

Moreover, appetite suppressants are another class of weight loss supplements. As it name indicates, these classes of supplements reduces your appetite by making your body organism feel like being full always. Hodia Gordonii, a cactus-like plant found in South Africa is one of the most known herbal appetite suppressants. This natural appetite suppressant was made known by Bushman during his long hunting adventures. Since this suppressant is most likely raw and a pure natural treatment, it does not have nasty side effects unlike those other synthetic appetite suppressors.

This different ways on how to lose weight without extensive diets may be effective to some people. However, it is much more advisable to follow steps that require extensive effort, dedication and discipline. These steps may require you to exert effort and time, yet, they are proven to provide longer lasting effect. Remember, no glory can ever be obtained in just a single snap. What ever it is that you want to achieve, may it be to lose weight or anything else, hard work is the key.