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Fetal Health Locus of Control Scale. Development and Validation

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Abstract

Describes the development of the 18-item Fetal Health Locus of Control (FHLC) scale and demonstrates the scale's utility in predicting maternal health-related behavior during pregnancy using 63 pregnant women (aged 17–37 yrs). Normative data are presented, along with information on its factor structure and internal consistency. Evidence for discriminant validity of the FHLC in contrast to another measure of locus of control is also provided. Reported cigarette and caffeine consumption during pregnancy were related to locus of control expectancies. Ss' intentions to participate in prepared childbirth classes (a means of enhancing self-control over the labor and delivery process) were also related to their locus of control beliefs. (34 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Journal
of
Consulting
and
Clinical
Psychology
1986.
Vol.
54,
No.
6,814-819
Copyright
1986
by the
American
Psychological
Association,
IDC.
002Z-006X/86/S00.75
Fetal Health Locus
of
Control Scale: Development
and
Validation
Sharon
M.
Labs
Oregon Health Sciences University
Sandy
K.
Wurtele
Washington
State University
This
article
describes
the
development
of the
18-item
Fetal
Health
Locus
of
Control
(FHLC)
scale
and
also
demonstrates
the
scale's
utility
in
predicting
maternal
health-related
behavior
during
preg-
nancy.
Normative
data
are
presented,
along
with
information
on its
factor
structure
and
internal
consistency.
Evidence
for
discriminant
validity
of the
FHLC
in
contrast
to
another
measure
of
locus
of
control
is
also
provided.
Reported
cigarette
and
caffeine
consumption
during
pregnancy
were
related
to
locus
of
control
expectancies.
Women's
intentions
to
participate
in
prepared
childbirth
classes
(a
means
of
enhancing
self-control
over
the
labor
and
delivery
process)
were
also
related to
their
locus
of
control
beliefs.
Expectancy
of
control
beliefs
have
been shown
to
predict
health-related behavior
(see
reviews
by
Strickland, 1978;
B. S.
Wallston
& K. A.
Wallston,
1978).
With some
exceptions,
the
bulk
of
this research using generalized
locus
of
control expec-
tancies
has
supported
the
assumption
that
individuals
who
hold
internal
as
opposed
to
external expectancies
are
more
likely
to
engage
in
health-promoting behavior (Strickland,
1978).
How-
ever,
the
amount
of
variance accounted
for by the
internal-ex-
ternal expectancy
has
been quite small
in
most
situations.
In an
effort
to
better predict
health-related
behavior,
K. A.
Wallston,
B. S.
Wallston,
and
DeVellis
(1978) developed
the
Multidimensional Health Locus
of
Control
(MHLC)
scale. This
scale assesses
respondents'
perceptions
of
the
importance
of
fac-
tors governing their
own
health
or
illness. Paralleling
the
work
of
Levenson
(1974),
the
MHLC scale comprises three separate
subscales.
The
IHLC
measures internal health locus
of
control,
whereas
the
other
two
subscales measure
different
dimensions
of
health externality (Chance
and
Powerful
Others).
The
CHLC
measures
the
extent
to
which respondents believe their health
status
is a
function
of
luck,
chance,
or
fate.
People
who
score
high
on the
PHLC
subscale
believe that their health
is
controlla-
ble,
albeit
by
powerful
others (e.g., physicians).
The
Walstons
have
shown that
the
prediction
of
health behavior
is
increased
when
one
uses such
a
health-specific scale rather than
a
general
measure
of
locus
of
control
(B. S.
Wallston,
K. A.
Wallston,
Kaplan,
&
Maides,
1976. Other researchers
have
successfully
used
specific
measures
of
locus
of
control
to
predict expectan-
cies
in
areas such
as
weight control
(Saltzer,
1978)
and
dental
behavior
(Beck,
1980),
suggesting
the
utility
of
highly
specific
locus
of
control measures.
Work
on
this
project
was
supported
in
part
by a
research
grant
awarded
to the
second
author
from
Washington
State
University.
The
authors
thank
Bill
Janzen,
Michael
Roberts,
and the
administra-
tors
and
staff
at
OB/GYN
Associates
of
Tuscaloosa
for
their
assistance
and
support
on
this
study,
and
Ruth
Day
for
manuscript
preparation.
Correspondence
concerning
this
article
should
be
addressed
to
Sharon
M.
Labs,
Oregon
Health
Sciences
University,
Department
of
Medical
Psychology,
Portland,
Oregon
97201.
One
limitation
of
these locus
of
control scales
is
that
they
assess
only
the
direct
relation between
a
person's
expectancies
for
personal
control
and his or her
health-related
behaviors.
When
working
with
a
pregnant woman,
however,
it
would
be
useful
to
assess
how she
views
the
health
of her
unborn child.
For
example,
does
she see her
newborn's
health
as a
conse-
quence
of her own
actions
and
thus under
her
control?
Or
does
she
see it as
unrelated
to her own
behavior, such
as by
believing
that God,
fate,
or
chance determines
her
baby's health?
Or
does
she
believe that
her
baby's
health
is a
function
of the
care
she
receives
from
professionals? Because relationships exist
be-
tween
the
attitudes
and
beliefs
a
person holds
and the
various
health behaviors
they
exhibit
(e.g.,
Wurtele, Roberts,
&
Leeper,
1982),
a
mother-to-be
who
lacks strong internal
beliefs
might
jeopardize
the
health
of her
baby.
It is
widely
known that
the
mother's health-related behaviors
during pregnancy
can
have
profound consequences
on the
well-
being
of her
newborn child.
For
example, substantial evidence
now
exists
on the
detrimental
effects
resulting
from
maternal
smoking
(Babson,
Pernoll,
Benda,
&
Simpson, 1980; U.S.
Pub-
lic
Health
Service,
1980), drinking
(Abel,
1980;
Harlap
&
Shlono,
1980), drug
ingestion
(Kalter
&
Warkany,
1983),
and
consumption
of a
nutritionally poor diet
during
the
period
of
prenatal
development
(Winick,
1981).
Investigating pregnant
women's locus
of
control
beliefs
specific
to the
health
of
their
babies would provide valuable information
for
identifying
those
mothers
who may put
their unborn children
at risk by not
com-
plying
with their physician's health-related recommendations.
This
report presents information about
a new
scale designed
to
measure expectancies
for
locus
of
control with respect
to ma-
ternal health behavior. Designated
the
Fetal Health Locus
of
Control (FHLC) scale,
its
purpose
is to
facilitate
the
prediction
of
identifiable
antecedent
factors
contributing
to
compliance
with
health-related recommendations during pregnancy.
Scale
Development
Following
the
work
of K. A.
Wallston
et
al.
(1978)
and
Leven-
son
(1974),
questionnaires containing
85
face-valid
items
were
administered
to
171
undergraduate women enrolled
in an in-
814
FETAL
HEALTH
LOCUS
OF
CONTROL
SCALE
815
troductory
psychology
class.
The
items
reflected
three locus
of
control dimensions
specific
to
fetal
health:
Internality
(FHLC-
I),
Chance
(FHLC-C),
and
Powerful
Others
(FHLC-P).
Subjects
also
completed
the
shortened,
10-item
version
of the
Marlowe-
Crowne
Social Desirability Scale
(Strahan
&
Gerbasi,
1972).
All
items used
a
9-point,
graphic rating scale, with responses
ranging
from strongly disagree
(0) to
strongly agree
(9).
The
questionnaire's introduction contained
an
assurance
of
confi-
dentiality
along
with
detailed instructions
for its
completion.
If
they
were
not
currently pregnant, respondents
were
instructed
to
answer
the
questionnaire
as if
they
were
planning
to
become
pregnant
in the
near
future.
Factor analysis
of the
FHLC
items involved
the
principal axis
method
of
factor extraction.
The
"breaks"
criterion
(Cliff
&
Hamburger,
1967;
Pennell,
1968)
was
used
to
determine
the
number
of
factors
to
extract
and
rotate
by the
varimax
method.
Scree-break curves indicated that
four
factors
should
be
rotated
(eigenvalues
2:
3.2).
An
item
was
defined
as
salient
when
it
loaded unambiguously
on
only
one
factor
(Kaiser,
1958; Thur-
stone,
1947)
and
when
the
factor
loading value
was .30 or
greater.
Factor
4,
which
accounted
for
12%
of the
variance,
was
composed entirely
of the
items
on the
Marlowe-Crowne
Social
Desirability
Scale.
Ten
items
with
the
highest
factor
loadings
on
each
of the
remaining three
factors
were
selected. Factor
1 was
composed
of
internally
worded items
and
accounted
for 39% of
the
variance. Factor
2 was
composed
of
chance/luck/fate
items
and
accounted
for
25%
of the
variance. Factor
3 was
composed
of
items tapping
the
powerful
others dimension
and
accounted
for
24% of the
variance.
From
this pool
of 30
items,
the
following
criteria
were
used
to
select
the
items that constituted
the new
scales:
(a)
significant
item-to-scale correlation;
(b)
item mean close
to
4.5,
the
mid-
point;
(c)
wide
distribution
of
response alternatives;
and (d) low
correlation with
the
Marlowe-Crowne
Social Desirability Scale.
Using
these criteria,
six
items
were
chosen
for
each
of the
three
new
scales.
The
readability
of the
scale
is at the
9th-10th
grade
level
(Dale
&
Chall,
1948).
Table
1
presents
the
items chosen
for
each
of the
three scales
along
with
their
factor
loadings
and
item-scale
correlations.
Each
six-item
subscale
has a
potential
range
of
from
0 to 54.
For
the
original sample, mean responses (standard deviations)
were
FHLC-I:
47.01
(7.64);
FHLC-C: 27.08
(11.10);
and
FHLC-P:
27.12
(9.32). Cronbach's
(1951)
alpha
coefficients
for
each
subscale
were
.88, .83,
and .76 for
FHLC-I, FHLC-C,
and
FHLC-P,
respectively.1
Test-retest
reliabilities
for the
FHLC-I,
FHLC-C,
and
FHLC-P
subscales
over
a
2-week
interval
were
.80,
.86,
and
.67.
Method
Subjects
Sixty-three pregnant women attending
an
obstetric/gynecology
clinic
in
a
southeastern
city
(population
=
140,000)
served
as
subjects (mean
age
=
26.5
years, range
=
17-37).
Ninety-four
percent
of
them were
married;
86%
were
white,
13%
were
black,
and 1%
were
of
Hispanic
origin.
The
sample
was
predominantly middle class,
with
44%
reporting
a
gross
family
income
of
$
15,000-25,000,
and 39%
reporting
an
income
of
$25,000-35,000.
For
38%
of the
women
this
was
their
first
pregnancy,
for
37%
their second,
for
21%
their third,
for 3%
their fourth,
and for
1%
their
fifth.
With respect
to
length
of
pregnancy,
the
women
were
evenly
distributed,
with
27% in the first
trimester,
35% in the
second,
and
37%
in
the
thirt.
Procedure
A box
containing
the
questionnaires
was
placed
in the
clinic's
waiting
room.
A
sign asking
for
pregnant women
to
complete
the
questionnaire
was
attached
to the
box.
Respondents completed
the
questionnaire
while
waiting
for
their
appointments
and
placed
the
completed
forms
back
in the
box.
The
questionnaire's introduction contained
an
assur-
ance
of
confidentiality
along with detailed instructions
for its
comple-
tion.
The
questionnaires requested demographic
information
and
con-
tained
the
FHLC,
the
MHLC
(Forms
A and B), and a
Health
Value
(HV)
scale. This latter scale
is a
modification
of
Rokeach's
(1973)
Value
Survey
used
by
K.
A.
Wallston,
Maides,
and B. S.
Wallston
(1976).
Health
(defined
as
"physical
and
mental well-being")
is
rank-ordered
in
importance
by the
individual against other potentially desirable
out-
comes (e.g., "freedom,"
"pleasure,"
"a
sense
of
accomplishment").
Re-
spondents were also asked whether
they
intended
to
attend prepared
childbirth classes during their current pregnancy.
In
addition, respon-
dents
were
asked
to
describe both their current health-related behaviors
and
their behaviors during
the
year
before
they became pregnant.
Spe-
cifically,
they
were
asked about their smoking (number
of
cigarettes
per
day),
drinking (number
of
drinks
per
week),
and
daily
caffeine
intake
(calculated
using
the
guidelines provided
in
Cohen,
1981).
Inquiry
re-
garding
dietary habits proved
to be
imprecise because
of
difficulties
in
retrospective recall
and in
estimating servings
of
various
food
groups;
thus,
these questions
are not
discussed
further.
The
presentation order
of
the
FHLC, MHLC,
HV, and the two
health behavior questionnaires
(prepregnancy
and
current)
was
randomized.
Results
Scale
Characteristics
Means
and
standard deviations
for the
FHLC, MHLC,
and
HV
scales obtained
from
the 63
pregnant women
are
included
in
Table
2. For
comparison, descriptive data
on the
MHLC
from
K. A.
Wallston
et
al.
(1978)
are
also included.
As can be
Validation Study
This study's purpose
was to
test
the
propositions that women
who
intended
to
attend prepared childbirth classes
would
score
higher
on the
internal subscale than those
who did not and
that
women
with
high internal locus
of
control
beliefs
would exhibit
healthier
behaviors during their pregnancy (i.e.,
lower
con-
sumption
of
alcohol,
caffeine,
and
cigarettes).
'
Intercorrelations
between
the
FHLC subscales
and the
Marlowe-
Crowne
Social Desirability Scale
were
all of
small
magnitude
(rs
=
.25,
.19,
and
.01
for
FHLC-I,
FHLC-C,
and
FHLC-P,
respectively). Al-
though
statistically
significant,
the
correlations
with
the
FHLC-1
and
FHLC-C subscales accounted
for
only
6% and 4% of the
variance,
re-
spectively.
Furthermore,
the
internal reliability
of the
10-item
version
of
the
Marlowe-Crowne
scale
was
considerably
lower
in our
sample
(al-
pha =
.40)
than
had
been previously
reported by
Strahan
and
Gerbasi
(1972),
which
calls into question
the
substantive significance
of
these
findings.
816
SHARON
M.
LABS
AND
SANDY
K.
WURTELE
Table
1
Rotated
Factor
Loadings
and
Item-Scale
Correlations
for
Internal,
Chance,
and
Powerful
Others
Subscales
FHLC Factor
Item-scale
item loading Internal
subscale
correlation
1
.76 By
attending
prenatal
classes
taught
by .77
competent
health professionals,
I
can
greatly increase
the
odds
of
having
a
healthy, normal baby.
6
.77 My
unborn
child's
health
can be .75
seriously
affected
by my
dietary
intake during pregnancy.
8 .75
If
I
get
sick during pregnancy,
.74
consulting
my
doctor
is the
best
thing
I can do to
protect
the
health
of my
unborn
child.
12
.73
Learning
how to
care
for
myself
before
.73
I
become pregnant
helps
my
child
to
be
born
healthy.
15
.75
What
I
do right
up
to
the
time
that
my .73
baby
is
bora
can
affect
my
baby's
health.
17
.64
Before
becoming pregnant,
I
would
.64
learn what
specific
things
I
should
do and not do
during pregnancy
in
order
to
have
a
healthy, normal
baby.
Chance subscale
2
.69
Even
if
I
take excellent
care
of
myself
.72
when
I am
pregnant,
fate
will
determine whether
my
child
will
be
normal
or
abnormal.
4 .67
If
my
baby
is
unhealthy
or
abnormal,
.70
nature
intended
it to be
that
way.
9 .66 No
matter what
I do
when
I am .69
pregnant,
the
laws
of
nature
determine whether
or not my
child
will
be
normal.
11
.73
God
will
determine
the
health
of
my .67
child.
14
.56
Fate determines
the
health
of
my .61
unborn child.
16
.51
Having
a
miscarriage means
to me .56
that
my
baby
was not
destined
to
live.
Powerful
Others
subscale
3
.64
My
baby
will
be
born healthy
only
if
I .61
do
everything
my
doctor tells
me to
do
during pregnancy.
5
.62 The
care
I
receive
from
health
.60
professionals
is
what
is
responsible
for
the
health
of my
unborn baby.
7
.63
Health
professionals
are
responsible
.60
for
health
of my
unborn child.
10
.57
Doctors
and
nurses
are the
only ones
.60
who
are
competent
to
give
me
advice
concerning
my
behavior
during pregnancy.
13
.51 My
baby's
health
is
in
the
hands
of .58
health
professionals.
18
.50
Only
qualified
health professionals
can .49
tell
me
what
I
should
and
should
not
do
when
I am
pregnant.
Note.N=
171. FHLC
=
Fetal Health Locus
of
Control scale.
seen,
means obtained
on the
MHLC
are
quite comparable
to
those
reported
by
Wallston
et
at.
Contrary
to
results reported
by
Larde
and
Clopton
(1983),
scores
on
Forms
A and B of the
MHLC
were
highly
similar,
supporting
the
equivalency
of the
two
forms.
Thus,
the
more
widely
used version (Form
A) was
subsequently used
in the
remaining analyses.
Table
2
also
presents
the
intercorrelation
matrix
for the
FHLC
and the
MHLC subscales.
The
Bonferroni
procedure
to
control
Type
I
error rate
for
multiple
comparisons
(Myers,
1979),
indicates that
the
FHLC subscales
are
statistically inde-
pendent.
Relation
Between Scale Scores
and
Reported Behavior
Intentions
to
take
childbirth
classes.
Respondents were
di-
vided
into
two
groups: those
who
intended
to
take prepared
childbirth classes
(n = 42) and
those
who did not (n =
21).
A
multivariate
analysis
of
variance
(MANOVA)
was
performed
on
the
demographic variables (age, marital status, income, race,
number
and
trimester
of
current pregnancy).
The
MANOVA
(SAS
Institute Inc., 1982)
was
significant, Wilks's lambda
=
0.73,
F(6,
56) =
3.53,
p <
.01,
with
the
univariate
tests
being
significant
for the
last
two
demographic variables. Those
who
intended
to
attend
were
more
likely
to be
pregnant with their
first or
second child
(M =
1.76) than those
who did not (M =
2.29), F(\,
62) =
4.70,
p <
.05.
On the
average,
nonintenders
were
midway
between their second
and
third trimester
(M -
2.43)
and
were thus
further
along
in
their pregnancy than
the
intenders(M=
1.98),^U,62)
=
4.36,
p<
.05.
Another
MANOVA
was
performed
to
assess
the
differences
be-
tween
intenders
and
nonintenders
on
FHLC
and
MHLC scores.
The
MANOVA
was
significant, Wilks's lambda
=
0.62,
F(6,
54)
=
5.42,
p<
.001,
with
only
the
univariate test
for
FHLC-I
being
significant.
On the
FHLC-I subscale, those
who
intended
to
attend
were
more internal
(M =
49.24) than those
who did
not
(M=
42.80),^!,
60)
=
27.94,
p<.
001.
To
assess
the
joint ability
of the
FHLC
and
MHLC subscale
scores
and the two
demographic variables (number
and
trimes-
ter of
current pregnancy)
to
predict
whether
a
woman
intended
to
attend childbirth classes,
a
stepwise
linear discriminant anal-
ysis
with
Wilks's
criterion
for
entry
was
performed (SAS Insti-
tute Inc., 1982).
A
woman's score
on the
FHLC-I subscale
emerged
as the
only
significant
predictor, accounting
for 32% of
the
variance, F(l,
60) =
27.94,
p <
.001. None
of the
other
subscale scores
met the
significance
level
for
entry
into
the
model. Using
a
cutoff
score
of 44 on the
FHLC-I correctly pre-
dicted intentions
to
attend
such
classes
in 80% of the
cases.2
Smoking.
A
MANOVA
was
performed
to
compare
the
FHLC
and
MHLC scores
of
those women
who
reported
not
smoking
during pregnancy
(n =
51)
to
those
who did (n
=
9). The
MA-
NOVA
was
significant,
Wilks's lambda
=
0.77,
F(6,
53) =
2.65,
p
<
.05.
Nonsmokers
had
higher FHLC-I scores
(M =
47.73)
than
the 9
smokers
(M =
43.56),
F(l,
59) =
4.82,
p
<
.05.
In
2
Even when
scores
on
Item
1
(referring
to
prenatal classes) were
re-
moved,
the
FHLC-I subscale score
still
emerged
as the
only significant
predictor,
accounting
for 21% of the
variance
F(l,
58) =
15.43,
p <
.001.
A
cutoff
score
of 42 on the
modified FHLC-I subscale correctly
classified
75% of the
women
who
intended
to
participate.
FETAL
HEALTH
LOCUS
OF
CONTROL
SCALE
817
Table
2
Descriptive
Statistics
of
the
FHLC,
MHLC,
and
HV
Scales
and
Intercorrelations
of
the
FHLC
and
MHLC
Subscales
Data
from
K.
A.
Wallston,
B. S.
Wallston,
&
DeVellis
Present
study
Scale
FHLC
FHLC-I
FHLC-C
FHLC-P
MHLC"
IHLC
Form
A
FormB
CHLC
Form
A
Form
B
PHLC
Form
A
Form
B
HV
M
46.84
24.56
26.76
25.59
25.12
15.52
15.68
19.18
20.08
8.97
SD
5.76
10.44
10.24
3.52
3.89
5.19
4.82
4.46
4.44
1.71
(1978)
M
25.10
25.30
15.57
15.46
19.99
20.97
SD
4.89
4.65
5.75
5.20
5.22
5.49
FHLC-I
-.36
.05
.04
-.33
-.13
.14
Intercorrelations
FHLC-C
.20
-.26
.34
.16
.02
FHLC-P
.10
-.05
.43*
.19
Note.
N = 63.
1
Fetal
Health
Locus
of
Control,
scores
range
from
0 to 54.
Subscales:
Intemality
(I),
Chance
(C),
and
Powerful
Others
(P).
"
Multidimensional
Health
Locus
of
Control,
scores
range
from
6 to 36.
Subscales;
Internal
(I),
Chance
(C),
and
Powerful
Others
(P).
'
Health
Value,
scores
range
from
1
to 10.
*p
<.
.003
(or
.05/15);
adjusted
level
of
significance
using
Bonferroni
procedure.
addition, smokers
had
higher CHLC scores than
nonsmokers
(Ms =
18.89vs.
15.08,
respectively),
F(l,59)
=
4.46,p<.05.
Of
the
15
women
who
were smokers prior
to
becoming pregnant,
6
quit
smoking
during pregnancy. Compared
to
those
who
con-
tinued
smoking, quitters
had
higher FHLC-I scores
(Ms =
43.56
vs.
49.83
for
smokers
and
quitters, respectively),
P(\,
13) =
6.34,
p
<
.03,
and
lower
CHLC scores
(Ms =
18.89
vs.
10.33,
respectively),
F(
1,13)
=
21.12,
p <
.001.
On
the
discriminant analysis, scores
on the
FHLC-I,
FHLC-
C, and
CHLC
subscales
emerged
(in
that
order)
as
significant
predictors
of
smoking
status,
accounting
for
19%
of the
vari-
ance,
F(3,
56) =
4.52,
p <
.01.
In
addition
to
smokers
having
lower
FHLC-I scores, they
also
had
lower
FHLC-C scores
(Ms =
21.56
vs.
24.63
for
nonsmokers)
and
higher
CHLC scores
(Ms =
18.89
and
15.08).
Thus, results
using
the two
chance subscales
were
contradictory.
Caffeine
intake.
In
contrast
to
smoking,
in
which
a
clear