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Locus of control and subjective well-being - A cross-cultural study

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These analyses explore the differences in locus of control and subjective well-being in China and Southern Africa, including how these variables relate to each other in each region and how demographic variables relate to both subjective well-being and locus of control. One hundred and eleven professionals were studied across Southern Africa and China and the hypothesis that the different regions would yield different locus of control and subjective well-being profiles was supported, with different demographic variables affecting each region differently. Furthermore, locus of control and subjective well-being were differently correlated to one another, with China showing significant negative correlation between subjective well-being and locus of control and Southern Africa showing no significant correlation. Findings also indicate that gender has a significant relationship with locus of control in Southern Africa but not in China; whereas China has a strong link between subjective well-being and gender.
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Problems and Perspectives in Management, Volume 10, Issue 1, 2012
17
Alexandra Stocks(South Africa), Kurt A. April(South Africa), Nandani Lynton(China)
Locus of control and subjective well-being – a cross-cultural study
Abstract
These analyses explore the differences in locus of control and subjective well-being in China and Southern Africa,
including how these variables relate to each other in each region and how demographic variables relate to both subjec-
tive well-being and locus of control. One hundred and eleven professionals were studied across Southern Africa and
China and the hypothesis that the different regions would yield different locus of control and subjective well-being
profiles was supported, with different demographic variables affecting each region differently. Furthermore, locus of
control and subjective well-being were differently correlated to one another, with China showing significant negative
correlation between subjective well-being and locus of control and Southern Africa showing no significant correlation.
Findings also indicate that gender has a significant relationship with locus of control in Southern Africa but not in
China; whereas China has a strong link between subjective well-being and gender.
Keywords: locus of control, subjective well-being, China, Southern Africa, gender, age.
JEL Classification: M10, M14, N30.
Introduction ©
Many authors have noted that the days of ‘one size
fits all’ management theories are over (e.g., Spector
et al., 2002; Theimann, April & Blass, 2006; Peng,
Peterson, & Shyi, 1991; Trompenaars & Hampden-
Turner, 1998). Given ever-increasing globalization,
the need for cross-cultural and cross-national man-
agement research is more important than ever, as we
can no longer assume that American-developed con-
cepts and theory are globally applicable (Specter et
al., 2002; April & April, 2007).
Two main perspectives exist regarding how globali-
zation affects cultural values. The convergence
perspective suggests that economic ideology will
drive cultural values and thus a company exposed to
Western thinking will start to behave in a Western,
manner (Ralston, Gustafson, Cheung & Terpstra
1993). This means that common values with regard
to economic activity and work-related behavior will
develop amongst developed nations (Theimann,
April & Blass, 2006).
The second perspective is known as divergence,
which indicates that culture is the primary driver of
values in any society and thus not economic ideolo-
gy (Theimann, April & Blass, 2006).
Hofstede (2007, p. 413) defines culture as “the collec-
tive programming of the mind, which distinguishes the
member of one human group from another.” Thus, is it
not surprising that significant differences exist between
Eastern thinking and Western thinking.
Chinese people tend to use holistic thought when
problem-solving, whereas Westerners tend towards
analytic thought (Nisbett, Peng, Choi & Noren-
zayan, 2001). It has been shown that Westerners
tend to pay attention to an object, whereas Chinese
pay more attention to the whole or field (Masuda &
© Alexandra Stocks, Kurt A. April, Nandani Lynton, 2012.
Nisbett 2001; Park, Nisbett & Hedden, 1999). In
other words, Westerners focus on items separate from
the contexts in which they occur, whereas Chinese
focus on the situation-meaning of the object (Yama,
Nishioka, Horishita, Kawasaki & Taniguchi, 2007).
The result of this thinking is that Westerners attribute
causality to an object, and Chinese attribute causality
to a situation (Yama, Nishioka, Horishita, Kawasaki
& Taniguchi, 2007).
Both locus of control and subjective well-being have
been well-studied in Western contexts, but not in
Eastern contexts (Spector et al, 2002; White, 2007);
nevertheless, there is evidence to suggest that the
different nature of China (Far Eastern) and Southern
Africa (South Western) should produce different
profiles and relationships between these variables.
Notably, the differences between individualism and
collectivism have been shown to have an effect on
both locus of control (Spector et al., 2002) and sub-
jective well-being (Diener, Diener & Diener, 1995).
1. Individualist and collectivist cultures
The difference between individualist and collectivist
cultures is a hypothetical concept, proposed to explain
the observation that people from the Eastern hemis-
phere (notable Confucian Asians1) are more likely to
prefer sociability and interdependence, require strong-
er discrimination between in-group and out-group, and
have stronger encouragement to infer another’s needs
than their Western counterparts (Yama, Nishioka,
Horishita, Kawasaki & Taniguchi, 2007).
Markus and Kitayama (1991) also connected this dis-
tinction, postulating that Westerners have an indepen-
dent self, whereas Easterners have an interdependent
self – the fundamental difference being in how people
view themselves. They further state that Westerners
are more likely to view themselves as individuals –
1 Such as those living in China, Japan, Korea and Taiwan.
Problems and Perspectives in Management, Volume 10, Issue 1, 2012
18
egocentric and separate from society in general, whe-
reas Easterners tend to view themselves as part of a
collective, as socio-centric, and as related to others or
society (Markus & Kitayama, 1991).
Triandis (1995) defines individualism as a social pattern
that consists of loosely-linked individuals that consider
themselves independent of collectives. They are moti-
vated by their own preferences, needs, rights, and the
contracts they have established with others, giving
priority to their own goals over the goals of others, and
they emphasize rational analysis of the advantages and
disadvantages of associating with others.
By contrast, collectivism is a social pattern that con-
sists of closely-linked individuals that consider
themselves part of one or more collectives, and who
are motivated by the norms and duties of those col-
lectives (Triandis, 1995). Collectivists often give
priority to the goals of these collectives over their
own personal goals, and they emphasize their con-
nectedness to other members of these groups (Yama,
Nishioka, Horishita, Kawasaki & Taniguchi, 2007);
and Kagitgibasi (1994) notes that collectivism ex-
presses the need for relatedness, whereas individual-
ism expresses the need for self-sufficiency.
2. Culture and locus of control
Perceived control1 is expressed differently in collec-
tivist cultures compared to individualist cultures,
showing either primary or secondary control. Prima-
ry control refers to when an individual attempts to
control his or her environment through direct inter-
vention, whereas secondary control occurs when an
individual experiences feelings of control through
alignment with a more powerful individual or party,
or through mediation of his or her emotional re-
sponse (Weisz, Rothbaum & Blackburn, 1984).
Primary control is likened to internal locus of con-
trol and secondary control is likened to external
locus of control (Spector et al., 2002).
Spector et al. (2002) note that collectivists develop
secondary control because they have been socialized
to subordinate personal control, rather than the pri-
mary control exhibited by individualist cultures.
Moreover, collectivists do not find this secondary
control distressing, given their expectation that their
direct personal control will be limited.
It is further observed that behavior driven by stable
dispositions has its roots in individualism, whereas
collectivist societal behavior tends to be more con-
text-specific and driven by the environment (Markus
& Kitayama, 1998).
1 The capacity an individual has to influence and predict some aspect of
the environment (Perry, 1991; Perry et al., 2005, as cited in Stupnisky,
Renaud, Perry, Ruthig, Haynes & Clifton, 2007).
Diener, Diener and Diener (1995) have found that
wealthier countries that emphasize individualism and
have a greater focus on freedoms and human rights
tend to have citizens with higher subjective well-being.
However, Diener and Suh (1999) note that these coun-
tries also have very high rates of divorce and suicide.
Diener, Suh and Oishi (1997) suggest that indivi-
dualist cultures are able to pursue their desires and
thus gaining self-fulfilment, but that they may also
lack the cohesive social support structures present in
collectivist cultures, thus amplifying the effects of
troubled times. They suggest that the safety of the
social structure in collectivist cultures may mean
that the extremes of subjective well-being and hap-
piness (or unhappiness) that is seen in individualist
cultures are mitigated.
An interesting difference between individualist and
collectivist cultures is the way in which each deter-
mines their life satisfaction. In a study conducted on
college students, individualists made judgements on
their happiness based on recent emotions, whereas
collectivists based their decisions on both their emo-
tions and the perceived cultural values of satisfaction
(Suh, Diener, Oishi & Triandis, 1998).
White (2007) produced a global map of relative le-
vels of subjective happiness, and which found strong
correlations between health, wealth and access to
education (White, 2007). For the purposes of this
study, the researchers note that China has higher le-
vels of subjective well-being than South Africa.
3. Locus of control and subjective well-being
Internal locus of control has been linked with academ-
ic success (Gifford, Briceño-Perriott & Mianzo, 2006),
higher self-motivation and social maturity (Nelson &
Mathias, 1995), lower incidences of stress and depres-
sion (Garber & Seligman, 1980), and longer life span
(Chipperfield, 1993). Psychological and physical well-
being has also been shown to be moderated by per-
ceived control (Brandstadter & Renner, 1990).
One of the main effects of locus of control on subjec-
tive well-being lies in how it affects coping strategies
(Brandtstadter & Baltes-Gotz, 1990). External locus
of control is correlated with higher levels of stress
(Garber & Seligman, 1980), and Grob (2000) notes
that stress is often caused because an individual
perceives the situation as beyond his or her coping
abilities; with ongoing stress having a negative effect
on subjective well-being. Someone with an internal
locus of control who, who believes that the situation
is within his or her control, may find the same situa-
tion stimulating (Owusu-Ansah, 2008).
Kulshrestha and Sen (2006) have noted significant
negative correlation between locus of control and
subjective well-being, which is to say that individuals
Problems and Perspectives in Management, Volume 10, Issue 1, 2012
19
with an external locus of control are significantly less
happy than their internal counterparts. It is noted that
internals actively manipulate their environments, thus
acting to take control of events and to change dissa-
tisfactory conditions (Kulshresta & Sen, 2006). In
contrast, externals feel powerless to control their
successes or failures (Nielsen, 1987) and, thus, are
unable to remove themselves from dissatisfactory
situations (Kulshresta & Sen, 2006).
4. Hypotheses
As noted previously, individualism and collectivism
affect both locus of control (Spector et al., 2002) and
subjective well-being (Diener, Diener & Diener,
1995); and existing literature predicts that China will
have a different locus of control and subjective well-
being profile to Southern Africa (Jackson, 2002;
Theimann, April & Blass, 2006; White, 2007). Given
these differences, we postulate that demographic
variables will yield different effects in each culture
and thus we formulate our first hypothesis as follows.
Hypothesis 1: Southern Africa and China will yield
different locus of control & subjective well-being
profiles to each other and will be differently affected
by demographic variables.
Pervin (1999) noted that there is reason to expect
that cultural and cross-national heterogeneity will
result in differences in the way locus of control re-
lates to well-being. The differences between the two
countries lead us to our second hypothesis:
Hypothesis 2: Locus of control and subjective well-
being will be correlated differently in Southern Afri-
ca than in China.
5. Method and subjects
Our self-completion questionnaire was administered
electronically to participants at the China European
International Business School (CEIBS) and the
Graduate School of Business at the University of
Cape Town (UCT). One hundred and sixty nine res-
ponses were received for the questionnaire, 97 from
China and 72 from Southern Africa. Fourteen res-
ponses were eliminated from the Southern African
results because not all questions were completed by
the respondents, resulting in incomplete data, and a
further nine were eliminated from this set because the
respondents fell outside the geographical and cultural
area being tested. This resulted in a total of 49 res-
ponses (n = 49) for the Southern African set.
Twenty-nine responses were eliminated from the
Chinese set because of incomplete data resulting
from non-completion of all questions. A further six
responses were eliminated because the respondents
fell outside the geographical and cultural area being
tested, resulting in a total of 62 responses (n = 62)
for the Chinese set.
The Chinese set consisted of staff and students at the
China European Business School, in Shanghai, China.
The Southern African set consisted of varying types of
full-time and part-time students at the Graduate School
of Business, University of Cape Town, South Africa.
These samples are thus not representative of the popu-
lations as wholes, but rather represent a well-educated,
professional sub-population.
Both cultural sets showed similar levels of education,
with 85% and 87% of each sample having at least 16
years of formal education; but an unequal gender
distribution was noted in each sample with males
constituting 63% of the Southern African sample, but
only 39% of the Chinese sample.
The samples also differed with respect to age and
vocation, with the Chinese sample showing much
younger individuals (87% of respondents 29 years
and younger) than the Southern African set (59% of
respondents between 30 and 39 years of age, and
35% under 30 years of age), and also far fewer
managers and senior managers. 55% of the Southern
African sample consisted of managers to senior
managers, whereas only 21% of the Chinese sample
was in management positions. Furthermore, the
Southern African sample showed fewer generally-
or vocationally trained individuals (4%) than the
Chinese sample (29%).
To maximize validity in this study, each demographic
variable was individually tested against Rotter’s
(1966) locus of control scale and Diener et al.’s (1985)
satisfaction with life scale.
In order to have parity between samples, the re-
searchers did not request that race be disclosed on the
questionnaire and rather requested nationality and
nationality of origin (if different from current natio-
nality) as per Hofstede’s (1994) Value Survey Model.
Thus racial demographics for the South African set
were not taken into account in this study.
6. Measures and procedures
Our questionnaire included Rotter’s (1966) original
internal-external locus of control scale, the satisfaction
with life scale (SWLS; Diener, Emmons, Larsen &
Griffin, 1985), and the demographic questions from
the Value Survey Module (Hofstede, 1994).
The locus of control scale used was a 29-item ques-
tionnaire including the six filler questions designed
to disguise the purpose of the test, which were not
scored. Each question gave the participant two op-
tions from which to choose, one representing an
attitude typical of internal locus of control, and the
other representing an attitude typical of external
Problems and
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20
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8.1.
tern
a
age,
gest
i
affe
c
In c
o
loci
regi
o
exp
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the
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10 12
Locusofc
o
o
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e
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c
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uestionnair
e
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ata analysi
s
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e
s were calc
u
e
ach demogr
a
s of locatio
n
e
termine wh
e
e
r locus of
c
d
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c
y
sis was als
o
s
hip existed
,
s
ubjective
w
ll cases, a
9
s
s
t
he signif
i
R
esults
t
of Hypot
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yield differ
e
-
b
eing profi
d
emographic
Locus of c
o
a
l loci of c
o
gender, lev
e
i
ng that the
g
c
t the locus
o
o
ntrast, Sou
t
of control,
d
o
n should
d
e
ctancies (Ja
c
u
lation samp
ic or cultura
h
istograms
s of control.
c
ontrol for So
u
14 16
o
ntrol
selection o
f
e
d answers
f
c
ation.
e
s were com
p
s
l
ocus of con
t
u
lated per res
p
u
lated for e
a
a
phic variabl
e
n
were con
d
e
ther a relat
i
c
ontrol or s
u
c
variable
u
o
conducted
,
if any, be
t
w
ell-being in
9
5% confid
e
i
cance of th
e
h
esis 1. Sou
t
e
nt locus o
f
les and will
factors.
o
ntrol. Chin
a
o
ntrol unrela
t
e
l of educat
i
g
eneral cultu
r
o
f control co
n
t
hern Africa
d
espite liter
a
d
isplay bot
h
c
kson, 2002
)
led is more
h
l backgroun
d
for Chinese
u
thern Africa
n
18 20
2
f
pre-existi
n
f
or variables
p
leted in En
g
t
rol and sub
j
p
ondent, the
r
a
ch sample s
e
within each
d
ucted for e
a
i
onship exis
t
u
bjective we
l
u
nder study.
to determin
e
t
ween locu
s
either cultu
r
e
nce level
w
e
results.
t
hern Afric
a
f
control an
d
be differe
n
a
was found
t
ed to varia
b
i
on, or care
e
r
e and beha
v
n
struct in thi
s
exhibited
v
a
ture indicat
i
h
internal a
n
)
. This sugg
e
h
omogenou
s
d
. Figure 1
a
and South
e
n
sample
2
2More
n
g answers,
such as age
g
lish.
j
ective well-
r
eafter mean
et, and then
sample set.
a
ch variable
t
ed between
l
l-being and
Regression
e
what rela-
s
of control
r
al set.
w
as used to
a
and China
d
subjective
n
tly affected
to have ex-
b
les such as
r type, sug-
v
ioral norms
s
region.
v
ery internal
i
ng that this
n
d external
e
sts that the
s
in terms of
a
nd 2 shows
e
rn African
Southern
A
b
etween v
a
control, n
o
tus. Wom
e
trol than
m
more inte
r
parts, and
m
than non-
m
Table 1 sh
culture an
d
with each
v
Table
Sample mean
l
Sample stand
a
Locus of contr
o
Locus of contr
o
Locus of contr
o
Locus of contr
o
Locus of contr
o
Locus of contr
o
Locus of contr
o
Locus of contr
o
8.2. Subje
tive well-b
e
global ma
p
ca showe
d
being scor
e
b
eing hig
h
being, w
h
Southern
A
shows a c
o
Southern
A
Fi
g
A
frica also
a
rious demo
g
o
tably gend
e
e
n were fou
n
m
en, people
r
nal control
m
anagers w
e
m
anagers.
ows the me
a
d
their corr
e
v
ariable.
1. Summar
y
l
ocus of control
a
rd deviation
o
l & culture (p-valu
e
o
l & gender (p-valu
o
l & age (p-values)
o
l & level of educat
o
l & post graduate s
t
o
l & general career
o
l & management
s
o
l & subjective well
ctive well-
b
e
ing were su
r
p
of subjecti
d
a much h
i
e
than expe
c
h
er than t
h
h
ich White’
s
A
frica’s su
bj
o
mparative
h
A
frican scor
e
g
. 2. Histogra
m
showed str
o
g
raphic vari
a
e
r, age, and
n
d to have
m
over 30 we
than their
y
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re found to
a
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lation coe
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of locus o
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ion (p-values)
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(p-values)
type
(p-values)
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tatus
(p-values)
-being
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eing. The r
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gher mean
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map sho
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h
istogram o
e
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m
showing dist
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m
ore external
re found to
y
ounger co
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be more in
t
y scores for
ff
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control dat
a
Southern
Africa
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7.3
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0
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sults for s
u
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n White’s (
2
s. Southern
subjective
e
map, as w
e
subjective
w
s as exce
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l
-being. Fig
u
f Chinese v
Proble
ribution of lo
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ships
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the
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us of control
f
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ographic v
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ly happier t
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ficients are
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le 2. Summ
a
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ple mean subjecti
v
m
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ective well-being
&
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ective well-being
&
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ective well-being
&
j
ective well-being
&
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ective well-being &
j
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ective well-being
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t of Hypot
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result was
f
p
opulation (
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or Chinese sa
m
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riables we
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women w
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detailed in
T
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a
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post graduate studi
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general career typ
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ective well-being (
h
esis 2. Loc
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will
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culture.
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and locus o
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A
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ound to hav
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p
= 0.35).
e
ment, Volume
1
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ple
r
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(p-values) 0
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s (p
-
values) 0
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e
(p-values)
0
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s (p-values) 0
.
p-values)
0
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s of control
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rently corr
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t
ionship bet
w
f
control in
t
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ective wel
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A
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p
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no signifi
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1
0, Issue 1, 201
2
21
h
ave no im
-
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xception o
f
o
be signifi
-
.
05); wome
n
r
n Africa al
-
ariables wa
s
d
correlatio
n
e
ing findings
u
thern
f
rica China
2
8.3
22
4
.2
5.8
1.2 x 10-9
.
053
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323
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0
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and subjec
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lated to on
e
w
een subjec
-
t
he Souther
n
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-being wa
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p
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c
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t
2
-
f
-
n
-
s
n
-
e
-
n
n
s
r
t
Problems and Perspectives in Management, Volume 10, Issue 1, 2012
22
Fig. 3. Scatter diagram showing relationship between locus of control and subjective well-being in the
Southern African population
Fig. 4. Scatter diagram showing relationship between locus of control and subjective well-being in the
Chinese population
Figure 4 above represents the relationship between
subjective well-being and locus of control in the
Chinese population.
A weak negative correlation, -0.272, between locus of
control and subjective well-being was discovered in
the Chinese sample. This was found to be significant
in the Chinese population (p = 0.032).
9. Discussion
9.1. Locus of control. According to Jackson (2002),
Southern Africa exhibits both internal and external
locus of control as well as both individualistic and
collectivist aspects. However, the results yielded from
the questionnaire indicate a far more internal locus of
control for this population than would be expected
given these facts. Mean locus of control for this group
falls within the 95% confidence interval of 6.2 to 8.5,
suggesting that the sub-population represented in this
study is far more internal and thus individualistic than
the population as a whole.
The data shows that China exhibits a much more
external locus of control than Southern Africa. As
China is a collectivist nation (Hamid, 1994; Hui,
1982) and thus expected to exhibit more external
locality, this result is not surprising. The 95% confi-
dence interval for Chinese mean locus of control is
Problems and Perspectives in Management, Volume 10, Issue 1, 2012
23
from 12.4 to 14.3 on the original Rotter scale
(1966), a finding that is in line with previous re-
searchers’ discoveries (Spector et al., 2002; Smith,
Trompenaars & Dugan, 1995).
9.2. Locus of control & gender. Given the more
external control exhibited by Southern African fe-
males, we posit that historical gender roles have
resulted in more secondary control in this popula-
tion, whereby a woman expresses her control
through alignment with powerful others or through
emotional response mediation (Weisz, Rothbaum &
Blackburn, 1984). This, in turn, suggests that wom-
en are more collectivist in nature than men.
Within China, we conclude that the lack of relation-
ship between locus of control and gender can be
attributed to the general collectivist nature of the
state, arising from the communist beliefs of an
equal, classless society.
9.3. Locus of control & age. Given the relationship
between locus of control and age in Southern Africa
with older individuals exhibiting more internal con-
trol, we consider it likely that life experience rein-
forces the idea that outcomes are based on what a
person puts in rather than on external factors. We
further suggest that younger individuals are less
likely to have been in positions of power or control
than older individuals, and thus their expectancy
that they are under the control of powerful others is
reinforced. Once an individual reaches a stage
where he or she has more control over his or her
environment, his or her internal expectancies are
reinforced, resulting in more internal control.
China’s lack of relationship between locus of con-
trol and age suggests that culture is a more pertinent
actor upon locus of control expectancy, however,
the young mean age of the sample prevents solid
conclusions from being drawn at this stage.
9.4. Locus of control & management status. The
relationship between Southern Africa and manage-
ment status showed that managers had more internal
control than non-managers. As with age, we suggest
that occupying a position of control reinforces inter-
nal expectancy and that experiencing limited control
as a non-manager reinforces external expectancy. It
is also possible that individuals with more internal
locus of control more often apply for and receive
management positions because they are comfortable
taking charge of situations and making decisions.
This relationship does not hold true in the Chinese
population, again suggesting that the collectivist
cultural norms override individual expectancy rein-
forcement.
9.5. Locus of control & education. No relationship
was found between locus of control and level of
education in either population, leading us to con-
clude that education does not fundamentally rein-
force either internal or external expectancy.
9.6. Subjective well-being. The results for subjec-
tive well-being were surprising given White’s
(2007) global map of subjective happiness. Southern
Africa showed a much higher subjective well-being
than expected from the map, as well as being higher
than Chinese subjective well-being, which the maps
shows as exceeding Southern Africa’s.
The fact that the educated, professional Southern Afri-
can population researched is happier than the popula-
tion of the country as a whole (White’s 2007 global
map of subjective happiness) is likely explained by the
better financial well-being, health, and/or levels of
opportunity available to this subpopulation.
This Southern African population is also happier
than the equivalent Chinese population, although in
this case it is unlikely that White’s (2007) main
correlates of subjective well-being – health, wealth,
and access to education – are causes of the discre-
pancy, as the populations tested are reasonably ho-
mogenous with respect to those factors.
A possible reason for Southern Africa’s higher le-
vels of subjective well-being could be related to its
more internal locus of control. The literature has
noted the negative correlation between locus of con-
trol and subjective well-being with externals being
less happy than their internal counterparts.
9.7. Subjective well-being & gender. This study
suggests that women are happier than men in both
populations. This is an exciting finding, not well
noted in the literature, which suggests that some-
thing in the feminine make-up results in women
being happier with, and more accepting of, their
lives than men in similar positions.
9.8. Subjective well-being & other demographic
factors. This study indicated that subjective well-being
is independent of age, level of education, and career
type and that other factors are therefore responsible for
happiness in these populations, or alternately that these
factors in conjunction with other life experiences con-
tribute to a person’s global well-being.
9.9. Hypothesis 2: subjective well-being and locus
of control. As previously noted, there is significant
negative correlation between locus of control and
subjective well-being in the literature, however, this
correlation was not borne out in this study.
Problems and Perspectives in Management, Volume 10, Issue 1, 2012
24
Southern Africa did show a weak negative correlation
between the factors, but this was shown not to be
significant within the population as a whole. This
contrary finding suggests that Southern African pro-
fessionals’ subjective well-being is not dependent on
how internal or external they are, and that they de-
termine their happiness through other means.
The Chinese population under study showed signifi-
cant negative correlation in line with existing litera-
ture, with people becoming less happy as their locus
of control become more external.
This study has shown that Southern Africa and China
do have different correlations between locus of control
and subjective well-being, thus affirming Hypothesis 2.
Conclusion
Southern Africa and China show marked differences
both in locus of control and subjective well-being,
and in factors which affect these constructs. It ap-
pears that culture remains the overriding factor that
differentiates the two, with the other factor differenc-
es providing exciting hints towards better understand-
ing of these differences at a psychological level.
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Objetivo: O objetivo do trabalho foi identificar os fatores associados com a adesão à medicação em pacientes transplantados renais, mostrando os fatores que contribuem para o aumento e a diminuição da adesão. Métodos: Para tanto, foi realizada uma revisão integrativa da literatura, buscando nas bases de dados Medline Complete, Academic Search Premier, Embase e CINAHL. Foi usado o programa Rayyan para gestão dos trabalhos. Resultados: Identificaram-se inicialmente 1.859 trabalhos e foram incluídos 36 artigos. Todos os estudos envolviam pacientes adultos, geralmente com média de idade entre 40 e 50 anos. Os homens foram a maioria dos pacientes em praticamente todos os estudos. A maior parte dos pacientes transplantados possuía mais de um ano de transplante. A adesão foi aferida na maior parte dos estudos por instrumentos validados e amplamente usados, como o caso do The Basel Assessment of Adherence to Immunosuppressive Medication Scale (Baasis) e a Escala de Adesão à Terapia Imunossupressora (ITAS). Outras escalas usadas para outras doenças também foram adotadas, como o instrumento de Morisky, usado nas versões de quatro ou oito questões. Os valores de adesão foram bastante distintos variando de valores muito baixos como 10,8 e 16,9%, até valores muito altos como 90,8 ou 94,5%. Entre os fatores que aumentam a adesão estão: maior índice de satisfação com a vida; melhor percepção dos medicamentos; apoio dos médicos; suporte social; maior tempo de espera em lista de transplante; e melhores resultados de função renal. Entre os fatores que diminuem a adesão à medicação cita-se: possuir vínculo de trabalho; sonolência diurna; enfrentamento tipo paliativo; menor autonomia; problemas financeiros; possuir estresse; mudança de rotina; menor conhecimento e literacidade em saúde; eventos adversos aos imunossupressores; crenças e preocupações com os imunossupressores; menor crença na autoeficácia; e religiosidade intrínseca. Além disso, houve fatores em que existe, na literatura, divergência quanto à influência na adesão como sexo, idade, renda e tempo de transplante. Conclusão: Este estudo demonstrou que diversos fatores modificáveis e não modificáveis contribuem para a adesão à medicação o que demonstra a importância destes achados para o cuidado de pacientes transplantados renais.
... In this sense, this factor was associated with decreased adherence, because the patient does not have autonomy in their own decisions and has no incentive to follow the treatment with the drugs because they think that their attitudes are not useful. 48 Similar to this is self-efficacy, which is the individual's perception of his capabilities in performing a certain activity. This factor was positively associated with increased adherence due to the fact that the patient seeks to overcome the proposed challenges, including those related to their treatment. ...
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