Law and Justice

Posts Tagged ‘Health’

Although Republican and Democrats under the influence of corporate money did manage to severely weaken health care reform, they didn’t kill it. Reform is moving ahead, and incensed right wingers are looking for salvation from the courts.

Yes, some of the same folks who rail about “activist judges” who “go against Congress and the law” when the rulings don’t please them are now pinning their meager hopes on courts acting beyond their scope.

Luckily, while it’s almost a guarantee that different portions of the eventual reform bill will be challenged in court, the legislation will most likely be just fine, as the constitutional concerns they raise don’t appear valid except to a small minority of legal experts.

Sounds like the conservatives are asking for the Constitution to be interpreted as a living and breathing document, eh?

The Senate already rejected the argument against the constitutionality of health care reform when the body rejected a point of order brought on December 23rd by Senator John Ensign (R-NV) – perhaps Senator Ensign should introduce a “point of order” covering making hush-money payments to your mistress.

MSNBC and the Washington Post are reporting on moves being made by conservative activists to get health care reform into courts.

“In the history of this country, the federal government has never required every American to enter into a contract with a private company,” said Randy Barnett, a professor of constitutional law at Georgetown University Law Center.

The concerns are centered on the individual mandate portion of health care reform, which will require Americans to have health insurance.

While most progressives would agree that to mandate customers to corporate interests is not the best way to go, the provision isn’t likely to be overturned in the courts.

“There are many close constitutional questions. But this is not among them,” Erwin Chemerinsky, dean of the law school at the University of California at Irvine, wrote in a recent online debate on the subject. “Congress clearly has the legal authority to require individuals to have health insurance.”

An easy fix would be to reconcile Senate and House bills to include a strong public option and skip the need for the mandate to apply to private insurance company patrons.

If the conservatives were legitimately concerned about Americans being forced to enter into contracts with a private company, one could hope they would join progressive members of Congress and push a single-payer system to cover all Americans.

The individual mandate to buy health insurance is a key part of the Democrats’ health-care plan. Their package, if they can pass it now, doesn’t work without the mandate. But is it constitutional?

Sen. Patty Murray, a Democrat, who has been working to pass it, said it is, easily. “We have done it before,” she said, noting that Social Security, which is federal, is mandatory insurance.

But when it came to the Supreme Court in 1937, Social Security was approved as a tax and a spending program. A single-payer plan might be approved that way, but not the current plan. This is mandatory private insurance.

Requiring people to buy that, former Sen. Slade Gorton, a Republican, told me, is “clearly and blatantly unconstitutional.” He immediately sanded down that statement, however, by saying the Founders would have thought it so. Today’s Supreme Court would split on it, he said, and “it will probably be Justice Kennedy who decides it.”

The argument against the mandate is that it exceeds the powers of Congress. The Constitution lists these powers in Article 1, Section 8, from declaring war and fighting pirates to imposing taxes, borrowing money and running the Post Office. They describe a small government. It has grown large by stretching one thing on the list, the power “to regulate Commerce … among the several States … ” This has been interpreted to cover all activities that affect commerce, from racial discrimination to growing marijuana to a hundred other things.

As it said “yes” to federal power, one claim at a time, the Supreme Court kept saying there was a limit. There had to be, otherwise the commerce power would swallow up all the others and federal power would be unlimited. But in 75 years the Supreme Court has only twice said a law exceeded that limit: a gun law and a rape law. Both cases were decided 5-4, with the swing vote Justice Anthony Kennedy’s.

Now comes the mandate to buy health insurance. “The question,” said attorney David Rifkin, who spoke to the Federalist Society in Seattle last fall, “is how to shoehorn this into the Constitution.”

For some, it is easy. Stewart Jay, who teaches constitutional law at the University of Washington School of Law, and has written several histories on constitutional law, said: “Congress is allowed to regulate economic activity, and buying insurance is an economic activity.”

Case done.

Rifkin, of Baker & Hostetler, Washington, D.C, said, “there is something really weaselly about that argument.” The commerce power has always been about regulating an activity. And Rifkin said, “Is refusing to purchase insurance an activity?”

Attorney General Rob McKenna is among a group of Republican state attorneys general who may challenge the individual mandate on just that point.

“My opinion,” said McKenna, “is that it isn’t clear where the federal government would derive its authority to force individuals to buy health insurance. These are individuals who have chosen not to participate in commerce.”

I like McKenna’s argument because I like where it goes. I don’t want government to tell me how to spend the money I have left over after paying taxes. The state government may do it — with car insurance, for example — and that’s enough for me.

The Supreme Court could go either way on this. In the end, it comes down not to who’s “right” about the law, but about what people want.

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

Opponents of healthcare reform failed to prevent bills passing in the Senate and the House of Representatives. These Democratic-sponsored bills seek to provide health insurance plans to the millions of uninsured Americans. Republicans, among those opposed to reform, raised the specter of socialized medicine and drew attention to the soaring cost of the legislation. Although they managed to kill the government-run public option in the Senate bill, their protests largely fell on deaf ears.

When it comes to this issue, conservatives are down but not out. President Obama has vowed to sign the combined bill once it reaches his desk, thereby making it into law. At that point, healthcare reform is open to a judicial challenge. Some people are now considering the possibility that parts of the healthcare reform bill, as enacted, may be unconstitutional. Moreover, they are willing to bring the issue to the Supreme Court if need be.

The proposal of involving the court system appears slightly unusual. After all, much of the contingent that has expressed vociferous disapproval for healthcare reform has also railed against what they consider to be “activist judges” who are “legislating from the bench” in the past. Nevertheless, some constitutional questions have been raised.

For example, some conservative legal scholars have said that the individual mandate–which requires all Americans to buy health insurance plans or pay a fine–is unconstitutional. They believe that such a mandate would only be constitutional under a far too loose interpretation of the Commerce Clause, and would allow the federal government to require any kind of purchase from a private company. If that provision was struck down as unconstitutional, it would be a severe blow to both the House and Senate legislation. The insurance mandate is essential for insurers’ cooperation with new regulations and a centerpiece in their reform strategy: bringing healthier, uninsured individuals into the nation’s health insurance pool would supposedly lower costs for all.

If the mandate for individuals to acquire health insurance plans sounds like state laws that force individuals to buy auto insurance, it is because the two are very similar. The latter has been found to be legal, even though it mandates the purchase of a particular project. On the other hand, unlike people who don’t own a car in order so they don’t have to pay for auto insurance, there is no way to forgo the human body in order to avoid paying for one of the many health insurance plans available. Opposition to the mandate on legal grounds is largely based on the opinion that the fines that would be imposed for noncompliance are not included in the right of Congress to levy and collect taxes. Moreover, the inactivity of individuals who fail to buy health insurance plans would not qualify as interstate commerce, and as a result cannot be regulated by the federal government.

Regardless, the issue is probably moot. As an important, high priority piece of legislation, the healthcare reform bill has most likely gone through stringent vetting to ensure the legality of all its provisions. Supporters would not want to see their efforts fall short due to a constitutional law mishap anywhere in the 2,000-plus page legislation. Senator Max Baucus and other Democrats have made this very point, while accusing Republicans of grasping at straws to stop the nation’s reform of health insurance plans. Nevada Republican John Ensign recently proposed that the Senate vote on a point of order acknowledging that the healthcare reform bill was unconstitutional due to the individual mandate. Unsurprisingly, it failed strictly along party lines; the entire Democratic caucus voted against it, while all Republicans were in favor.

Most mainstream legal scholars reject these arguments against the healthcare reform bills. They point to the fact that past Supreme Court rulings have allowed Congress to regulate activities that, even if they are not interstate commerce in and of themselves, “substantially affect” such commerce. By that definition, there is no doubt that whether or not people buy health insurance plans qualifies. Therefore, the case is unlikely to reach the Supreme Court. If healthcare reform legislation actually made it past the lower courts and reached them, how would the Court rule? Most likely, the ruling would be split among ideological lines. With liberal Justice Sonia Sotomayor replacing fellow left-leaning Justice David Souter, the balance between conservative and liberal justices has been maintained. Justice Anthony Kennedy tends to be the swing voter; on business issues, he has tended to lean conservative and take positions in favor of free markets. Still, the Court must judge based on precedent, and would probably uphold the legality of the individual health insurance mandate.