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Self-perceived multidimensional health control locus among central Indian dental students: The impact of professionalization

1 Associate Professor, Department Of Dentistry, GMC, Ambikapur, Chhattisgarh, India
2 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, People's University, Bhopal, Madhya Pradesh, India
3 Assistant Professor, Department Of Dentistry, GMC, Ambikapur, Chhattisgarh, India
4 Department of Public health dentistry, GDC, Indore, Madhya Pradesh, India
5 Reader, Dept of Pedodontics, Mansarovar Dental College, Bhopal, Madhya Pradesh, India
6 Public health Dentist, Rotorua, New Zealand

Date of Submission25-Jun-2020
Date of Decision29-Jun-2020
Date of Acceptance20-Jul-2020

Correspondence Address:
Aishwarya Singh,
Department Of Dentistry, GMC, Ambikapur, Chhattisgarh-497001, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_182_19


Background: Assessment of multidimensional locus of control (MLOC) will reveal the effect of professionalization among dental students. The aim of this study was to know the possible factors with effect health locus of control (HLC) of Indian dental students. Methodology: The study population comprised 230 dental students. MLOC was recorded using Form type C with 18 questions. The significance level was set at P ≤ 0.05. Results: Comparison of the mean scores for the three-multidimensional health locus of control subscales (Internal, Chance, and Powerful Others) from the first year to the final year showed that the mean score for the Internal subscale was consistently higher, followed by the mean scores for powerful others and chance in all the years of study. The Internal subscale mean increased from the first year to the second year of study and then decreased from the third year to the final year of study (P = 0.004). Conclusion: Internal HLCs dominated the study population, and the mean internal scores increased from the first BDS to the final year.

Keywords: Dental students, health behavior, health psychology, locus of control

How to cite this URL:
Singh A, Bhambal A, Harish A, Tiwari V, Tiwari U, Santha B. Self-perceived multidimensional health control locus among central Indian dental students: The impact of professionalization. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=321286

  Introduction Top

Locus of control (LOC) in social psychology refers to the extent to which individuals believe that they can control events that affect them. Health locus of control (HLC) is a construct that refers to how individuals perceive the sources regulating their health. HLC is based on the assumption that health-related LOC scale would provide more sensitive predictions of relationship between internality and heath behaviors.[1]

Rotter in 1966[2] explains that LOC can be internal or external. An internal health locus of control (IHLC) is the belief that individuals themselves are responsible for their conditions, while an external HLC is the belief that the responsibility for a given condition can be attributed to factors that do not depend on the individual, i.e., it depends on others. Wallston et al. in 1978[3] originally developed two forms of the multidimensional health locus of control (MHLC) scale, namely Forms A and B. Form A was used for healthy individuals, while Form B was used for individuals with chronic conditions. The third version of MHLC was developed to cater the need to evaluate HLC in specific health conditions. Referred to as Form C, it allows health professionals to adapt the instrument to the clinical condition of interest. This form of the MHLC derived from the authors' belief that an individual could potentially experience different mechanisms of LOC in different situations or conditions. The original theoretical models supporting the use of the general scales (MHLC-A and MHLC-B) and the model for specific conditions (MHLC-C) are similar and are all supported by three subscales: Internal Locus, Chance, and Powerful Others.[4]

Psychosocial factors play an important role in shaping attitudes and behaviors including those of dental professionals. Like any other group of people, their health attitudes and behaviors are equally affected by their life experiences, including personal histories, and professional training. Dentists' own health beliefs and attitudes may influence their patients' ability to comply with oral health instructions.[5]

Dental students go through this process of professionalization and imbibe attitude, knowledge, and working skills essential to practice dentistry. The MHLC scale provides a mechanism for researchers to study these effect of professionalization on health attitudes and behavior in dental students.[6] Although, as an independent variable, there is no theoretical reason to expect LOC to predict health behavior, the aim of the present study was to examine dental student's perceived control over their own health. Dental students are the indicators of skill of future dental workforce, their beliefs on what determines their own health is not the indicative of as what they think their patients believe nor is it the same as what their patients actually believe. However, understanding the beliefs of this group of budding health-care providers is important in strategizing educational and training programs.

  Methodology Top


A questionnaire study was conducted for a period of 7 days to assess the multidimensional HLC of among dental students of a dental college in Bhopal city, Central India.


First-year to final-year dental students comprised the study population. Before the start of the survey, ethical clearance (PCDS/IEC/2018–2019/PHD/23) to conduct a study was obtained from the People's College of Dental Sciences and Research Centre. Permission was obtained from the administrators to conduct the questionnaire study. A nonprobability convenient sampling was followed in the present study, where all the dental students present on the day of the survey were included. A total of 230 first-year to final-year dental students who were available at the time of the study participated. Subjects who were absent on the day of examination and who did not co-operate and who were not willing were excluded from the study. A schedule of the survey for data collection was prepared. On an average, students of one professional year were interviewed per day. Students were distributed the questionnaire at the end of their lecture classes in their respective classrooms. All the students who were willing to participate in the survey were requested to remain in the class.


The self-administered questionnaire[3] included age, gender, and year of study as demographic variables. To calculate the MHLC Scale, the score on each subscale is the sum of the values circled for each item on the subscale (i.e., where 1 = “strongly disagree” and 6 = “;strongly agree”). No items need to be reversed before summing. All of the subscales are independent of one another. There is no such thing as a “total” MHLC score. The questions pertaining to Internal LOC are Questions no. 1, 6, 8, 12, 13, 17.

The questions expressing to Chance LOC are Question no. 2, 4, 9, 11, 15, 16.

The questions pertaining to Powerful Others are Question no. 3, 5, 7, 10, 14, 18.

Statistical analysis

The data were transferred to precoded survey form to a computer. A master chart was created for the purpose of data analysis. Statistical analysis was done using the Statistical Package of the Social Sciences (SPSS version 20.0; Chicago Inc., IL, USA). The significance level was fixed at P < 0.05. Nonparametric tests such as Mann–Whitney U-test and Kruskal–Wallis test and one-way analysis of variance test were used to draw inferences.

  Results Top

The study population comprised 204 females and 26 males, with a mean age of 20.36 years. The description of students participating in the study is given in [Table 1]. In addition to the questionnaire, the students were also asked about their self-reported oral status. Maximum students (70.9%) reported not having any dental problems. Among those who reported having problems, dental calculus (12.1%) and tooth decay (8.2%) were the most prevalent.
Table 1: Description of students participating in the study

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[Table 2] presents significant (P < 0.05) differences that were noted across the professional years in questions If I become sick, I have the power to make myself well again, My physical well-being depends on how well I take care of myself, the type of care I receive from other people is what is responsible for how well I recover from an illness, and following doctor's orders to the letter is the best way for me to stay healthy.
Table 2: Distribution of responses for the locus of control and significant difference value according to year of study

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The subscale comparison of multidimensional locus of control depicts a statistically significant difference across the years pertaining to internal LOC (P = 0.004) [Table 3].
Table 3: Comparison of locus of control subscales according to the year of study

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  Discussion Top

The HLC scale is recommended in conjunction with behavioral measures to evaluate the success of health education programs. Since it is true that people with internal beliefs appear more likely to engage in positive health and sick role behaviors, it is apparent that the HLC emphasizes the importance of the health educators need to involve themselves in training patients to hold more internal beliefs. These beliefs may be useful for planning oral health promotion programs and for formulating advice given by oral health professionals about their patients' oral health behaviors. The MHLC Scale was developed to create equivalent forms of the scale, so researchers could repeat the measurements.[7]

The behavioral sciences have become an increasingly important component of dental education and research. Studies on LOC and its determinants among dental students as a specific group have been reported in the literature.[6],[8] Previous studies in the literature have reported an improvement in oral health attitudes and behavior among dental students from their entry years to the final year.[8],[9],[10] The present reported study was part of a larger study done to using psychometric measurements as predictors of health behaviors and health-related factors. Highlighted here is the MHLC among students in a Central Indian dental college, which so far has been overlooked by the research community.

Similar to the present study, the internal LOC aspect of the MHLC showed a dominant role in shaping health attitudes among students in all the years of the dental course in previous studies.[8],[9],[11],[12] The finding of no gender differences between mean scores of the MHLC subscales is in agreement with the studies conducted by Verma[6] and Acharya[8] and in contrast with Kuwahara et al.[13] The major finding of the present study showed that the mean internal score increased from first-year BDS to second-year BDS and then decreased from third-year BDS to final-year BDS, and there were significant differences in the mean scores. This finding is dissimilar from the previous study[6] which reveals that the mean score increased in the order of first BDS, final BDS, and interns, which is similar to the previous literature in which influence of the Internal Locus of Control was high in the students of the first and second years but was lower among the third-year students.[8] This has been explained previously as since the third-year students experience a qualitative shift in their training from an essentially didactic to a clinical one, it can contribute to low ILC since it causes a temporary crisis of confidence resulting in a lower ILC. Increased familiarity with his or her role as a health-care provider brought about by clinical training may again increase the ILC in students when they are in their final year,[8] although this is not observed in the present study.

The HLC beliefs can be used to predict health practices and outcomes in the long run that they are amenable to change, and those who report more IHLC are more likely to proactively seek health-promoting information and skills, realize for themselves the link between their lifestyle and health, and purposefully engage in initiatives associated with psychosocial and developmental well-being.[14] On the contrary, those who score high on the external dimension view their health as relatively independent of their behavior and, accordingly, are more likely to engage in health-damaging behaviors than those with lower scores.[15] In the present study, the internal LOC was very strong among the dental students. This may be due to the fact that the study population consisted of future dental health workforce with high personal drive and independence. This finding is in accordance with the previous literature.[6],[8]


In the present study, it was seen that the mean chance score decreased significantly in the order of year of study. This is in contrast to the study done by Acharya[8] and similar to study done by Verma;[6] however, the values were not found to be statistically significant. The findings of decrease in mean powerful other scores across the professional years is in agreement with the previous studies.[6],[8],[10] Thus, it was seen in this study that the IHLC was very strong in the study population.

The use of HLC scales does have their limitations. Validity of studies investigating the relationship between LOC and health-related behaviors has been questioned due to the fact that an individual may have a tendency to be internal in many life areas but have an external belief with regard to the particular health-related behavior in question. Valid LOC measures more specific to the particular behavior, in this case, oral health behavior, need to be developed.[11] Dental educators can play a major role in modifying the HLC to minimize the chance and the powerful other LOC among the dental students and prepare them to be confident and face the competitive cutthroat professional world.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Egan JT, Leonardson G, Best LG, Welty T, Calhoun D, Beals J. Multidimensional health locus of control in American Indians: The strong heart study. Ethn Dis 2009;19:338-44.  Back to cited text no. 1
Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr 1966;80:1-28.  Back to cited text no. 2
Wallston KA, Wallston BS, de Vellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr 1978;6:160-70.  Back to cited text no. 3
Wallston KA, Stein MJ, Smith CA. Form C of the MHLC scales: A condition-specific measure of locus of control. J Pers Assess 1994;63:534-53.  Back to cited text no. 4
Freeman R. The psychology of dental patient care. 5. The determinants of dental health attitudes and behaviours. Br Dent J 1999;187:15-8.  Back to cited text no. 5
Verma S. Effect of professionalization on health locus of control among dental students. J NTR Univ Health Sci 2018;7:44-8.  Back to cited text no. 6
  [Full text]  
Acharya S. Professionalization and its effect on health locus of control among Indian dental students. J Dent Educ 2008;72:110-5.  Back to cited text no. 8
Kawamura M, Honkala E, Widström E, Komabayashi T. Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students. Int Dent J 2000;50:46-50.  Back to cited text no. 9
Rong WS, Wang WJ, Yip HK. Attitudes of dental and medical students in their first and final years of undergraduate study to oral health behaviour. Eur J Dent Educ 2006;10:178-84.  Back to cited text no. 10
Acharya S, Sangam DK. Oral health-related quality of life and its relationship with health locus of control among Indian dental university students. Eur J Dent Educ 2008;12:208-12.  Back to cited text no. 11
Helmer SM, Krämer A, Mikolajczyk RT. Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany. BMC Res Notes 2012;5:703.  Back to cited text no. 12
Kuwahara A, Nishino Y, Ohkubo T, Tsuji I, Hisamichi S, Hosokawa T. Reliability and validity of the Multidimensional Health Locus of Control Scale in Japan: Relationship with demographic factors and health-related behavior. Tohoku J Exp Med 2004;203:37-45.  Back to cited text no. 13
O'Hea EL, Bodenlos JS, Moon S, Grothe KB, Brantley PJ. The multidimensional health locus of control scales: Testing the factorial structure in sample of African American medical patients. Ethn Dis 2009;19:192-8.  Back to cited text no. 14
Wallston BS, Wallston KA, Kaplan GD, Maides SA. Development and validation of the health locus of control (HLC) scale. J Consult Clin Psychol 1976;44:580-5  Back to cited text no. 15


  [Table 1], [Table 2], [Table 3]


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