Validation of the Parent Health Locus of Control Scales in an Italian sample

Health locus of control is defined as the set of beliefs a person has about his or her personal influence on health. This set of beliefs includes: internal locus of control (if the individual believes that personal actions or thoughts can affect their outcomes) and external locus of control (if the outcome is believed to be determined by powerful others, such as God, health professionals, or if chance is believed to control the outcome) [1, 2]. Empirical research suggests that health locus of control plays a significant role in determining people's health-related behaviours [3].

Individuals' health locus of control influences their own health-related behaviours, including health risk behaviour and adherence to recommended health care regimens [4, 5]. For example, adolescents with high internal control are more likely to abstain from risky behaviors such as smoking and drinking [6], and children suffering for asthma who perceive their ability to control their health more positively adhere to their recommended regimen [7]. Perrin and Shapiro [8] studied differences among children with and without a chronic physical illness, and especially among their parents; they found that learning occurs from experiences related to illness, resulting in an increased external orientation in locus of control beliefs. They concluded that health care professionals should be made aware of the tendency for young children, and for children with a chronic illness and their families, to rely heavily on providers, perhaps to the detriment of learning effective skills for independent health-related decision making.

Parents have an important role in the promotion of their children's health especially when their children are very young. It is therefore of interest to assess parental locus of control relative to children's health [9]. Parents are typically the primary agents in promoting their children's health, giving direct care, providing access to health services, modeling attitudes and behaviors that influence their children's well-being, and instilling a lifelong orientation in health behaviors and future morbidity [2, 10, 11]. In consequence, we studied locus of health control in parents of young children.

Taken together, this literature suggests that children's compliance with interventions may need to include components aimed at enhancing health locus of control both in parents and children themselves and that health locus of control can be considered a factor that promotes adherence to recommendations related to preventive medicine. Given the importance of locus of control in health-related situations, we asked how it should best be assessed.

The PHLOC is a major instrument used to evaluate adult and parent health locus of control. The goal of the present study is to verify the replicability and psychometric properties of the factor structure of the Parent Health Locus of Control (PHLOC) [2] in an Italian sample of mothers of newborn to 3-year-old children. Because of the significance of the PHLOC, validation studies in other cultures are requisite to verify the robustness of the instrument. More generally, assessment instruments in health research must be validated by investigators using different samples in different contexts.

Test-retest reliability was assessed in a subgroup (n = 35) after 2 months. Pearson correlation reliability coefficients were: .87 for Child, .98 for Divine, .87 for Fate, .84 for Media, .98 for Parental, and .96 for Professional scales.

Finally, an Age (0–12 months, 13–24 months, 25–39 months) × Gender (boys vs. girls) × Birth order (firstborn vs. laterborn) analysis of variance was carried out for each PHLOC subscale. Analyses of variance yielded no significant effects for any subscale.

This work aimed to verify the psychometric properties and reliability of the factor structure of the Parent Health Locus of Control Scale [2] in an Italian sample of mothers of newborn to 3-year-old children. The results confirmed the original factor structure with the 28 items of the original instrument distributed among six theoretical dimensions as conceptualized by the original authors of the PHLOC (Child, Divine, Fate, Media, Parental, and Professional influences). Confirmatory factor analysis closely approached the standards for adequate fit for models of this type [13]. The internal consistency coefficients of the six scales were good, supporting the multidimensionality of the construct measured and the existence of different factors which parents perceive to influence their children's health.

The factorial similarity to the original U. S. American version of the PHLOC suggests good cross-national correspondence of the scales and supports the validity of the instrument. This consideration is reinforced by a previous study [14] that demonstrated similar results in a Norwegian sample of mothers of 2-year-olds. The present Italian study contributes to the robustness of this instrument across languages and cultures.

We did not find differences in mothers' attitudes about their children's health in relation to their children's age. Other studies have demonstrated that parental attitudes about child influences change with child age [15] in parents whose children attended elementary school. Age differences between the two studies might explain why we did not find child age effects.

Italian mothers attributed the most importance to themselves and to professionals in relation to their children's health. This is an encouraging result because parents' experience of control over their children's health is positively associated with their adopting safety measures [16].

In pediatric patients, the responsibility of parents for health-related behaviors of their children and the caregivers' impact on the development of children's own subjective health concepts have to be considered. Parents monitor their children's health state, decide whether medical care is to be sought, and comply with medical recommendations or not. Knowledge of family health beliefs may help to develop health promotion programmes, and investigating health locus of control can be useful in relation to the promotion of specific health behaviors and to individualize patient treatment based also on locus of control to enhance resilience [1].

Future research on how information derived from the PHLOC predicts parental behaviors regarding health-risk prevention in infants and toddlers is desirable. Finally, the PHLOC might prove useful in health education interventions with families to prevent neglectful childrearing practices.