Health Psychology

1993, Vol. 12, No. 3,193-199

Copyright 1993 by the American Psychological Association, Inc., and
the Division of Health Psychology/0278-6133/93/$3.00
Role of Health Locus of Control Beliefs in Cancer Screening of Elderly
Hispanic Women
Nancy I. Bundek, Gary Marks, and Jean L. Richardson
This study examined the health locus of control beliefs of elderly Hispanic women and relation
between frequency of breast self-examination (BSE), attention to health-related information, and
recency of Pap smear and physician breast examination. As hypothesized, holding a belief that
health outcomes are controlled by oneself (internal control) was positively related to screening
behaviors over which one has a high degree of personal control, such as frequency of BSE and
attention to health-related information. Belief that medical professionals control health outcomes
was positively related to physician-dependent screening activities, such as recency of Pap smear
and physician breast exam. The findings confirm the specificity of association between health
control beliefs and preventive behaviors and demonstrate the importance of these beliefs in
medical screening by Hispanic women.
Understanding people's beliefs about the factors that con-
trol health outcomes may be critical to understanding people's
health-related behaviors. Early work by B. S. Wallston, Wall-
ston, Kaplan, and Maides (1976) focused on internal and
external dimensions of health locus of control, an outgrowth of
Rotter's (1954,1966) distinction between internal and external
expectancies of reinforcement. The early two-dimensional
scale was later expanded to the Multidimensional Health
Locus of Control (MHLOC) scale (K. A. Wallston, Wallston,
& DeVellis, 1978). Internal control refers to the belief that
health outcomes are determined by one's own actions and
decisions. Control by powerful others refers to the belief that
the actions of doctors and other health professionals deter-
mine health outcomes through the instructions, recommenda-
tions, and medications they provide. Chance control refers to
the belief that health and illness are largely a matter of chance
or fate.
These beliefs generally form early in life as a result of early
childhood experiences with illness in one's family, and may
remain relatively stable across time (Lau, 1982). The three
health control dimensions are relatively independent of one
another. The strongest correlation has been found between
chance control and control by powerful others (rs = .20 to .35;
Marks, Richardson, Graham, & Levine, 1986; K. A. Wallston
et al., 1978), presumably reflecting a common component of
external control.
Initial research focused on the relationship between locus of
control and people's interest in health-related information
Nancy I. Bundek, Gary Marks, and Jean L. Richardson, Institute for
Health Promotion and Disease Prevention Research, Department of
Preventive Medicine, University of Southern California.
This research was supported by National Cancer Institute Grant
CA3566. We gratefully acknowledge John C. Hisserich, Julia M. Solis,
Lourdes Birba, Fernando Torres-Gil, and Linda Collins for their
contributions to this project.
Correspondence concerning this article should be addressed to
Nancy I. Bundek, University of Southern California, Institute for
Prevention Research, 1000 South Fremont, Suite 641, Alhambra,
California 91803-1358.
(see K. A. Wallston & Wallston, 1982). Using the early
two-dimensional scale, K. A. Wallston, Maides, and Wallston
(1976) found that college students who valued health highly
and had an internal orientation requested more pamphlets on
hypertension than did those who were internal with low health
values or those who were external. Among older non-Hispanic
men and women (mean age = 57 years), Toner and Manuck
(1979) found that internals requested more information on
heart disease than did externals. No effects, however, were
found for younger participants (mean age = 25 years). These
results are consistent with those of K. A. Wallston et al. (1976)
if one assumes that the elderly place greater value on health
than do younger people (K. A. Wallston & Wallston, 1982).
A few studies have examined the extent to which health
control beliefs are associated with medical screening practices.
Redeker (1989) administered the MHLOC scale to a sample of
non-Hispanic women and found that those who had never
practiced breast self-examination (BSE) tended to have lower
internal control scores than did those who had performed BSE
three or more times a year. Beliefs about powerful others were
not examined. Hallal (1982) sampled English-speaking women
and found a significant negative correlation between control by
powerful others and ever practicing BSE and a nonsignificant
positive relationship between internal control and ever perform-
ing BSE.
Methodological limitations, however, raise concern about
HallaPs (1982) findings. First, frequency of BSE was measured
dichotomously: those who ever practiced BSE (80%) versus
those who never practiced BSE (20%). Such unbalanced
groups may produce highly unstable results. Moreover, the
former group included women who performed BSE monthly as
well as those who performed it less than once a year. Thus,
Hallal's results may not reflect the precise manner in which
frequency of BSE relates to a particular health control
dimension.
One purpose of the present study was to test the idea that a
specific MHLOC belief promotes a specific health practice. In
other words, we tested the specificity of association between
beliefs and behaviors (Fishbein & Ajzen, 1975). We were
193
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194
N. BUNDEK, G. MARKS, AND J. RICHARDSON
especially interested in the manner in which beliefs relate to
frequency of performing BSE, recency of gynecological screen-
ing, and attentiveness to health-related information.
We would expect people high in internal control to perform
screening behaviors that have a strong personal control compo-
nent, such as BSE and paying attention to information about
health issues (Redeker, 1989; Toner & Manuck, 1979; K. A.
Wallston et al., 1976). Although gynecological screening in-
volves some degree of personal control in setting up an
appointment, this type of screening behavior strongly empha-
sizes the role of a doctor as the controller of health outcomes.
Thus, it should be related more strongly to belief in control by
powerful others than to belief in internal control. Accordingly,
we tested the following three hypotheses: (1) The frequency of
performing BSE correlates directly with internal control be-
liefs. (2) Attentiveness to health-related information corre-
lates directly with internal control beliefs. (3) Recency of
gynecological screening correlates directly with belief in con-
trol by powerful others.
A second purpose of the study was to examine these
hypotheses with a sample of Hispanic women. Previous studies
of health control beliefs have been performed almost exclu-
sively with non-Hispanic samples. In fact, K. A. Wallston et al.
(1978) identified and validated the multidimensional nature of
these beliefs with a predominantly White sample. Thus, it is
reasonable to ask whether MHLOC beliefs are relevant to
medical screening behaviors in other cultural groups.
Hispanic women in the United States represent one such
important group. They are diagnosed with breast and cervical
cancers at a more advanced stage of disease than are non-
Hispanic White women (Richardson et al., 1992; Samet, Hunt,
Lerchen, & Goodwin, 1988; Westbrook, Brown, & McBride,
1975). This has prompted concern about the cancer screening
practices of Hispanic women. Indeed, compared with other
groups, they are screened irregularly, thus contributing to
later-stage diagnosis and reduced chances of survival (Ander-
son, Lewis, Giachello, Aday, & Chiu, 1981). Most of the past
research on screening practices of Hispanic women (and men)
has focused on the roles of acculturation (Chavez, Cornelius,
& Jones, 1985; Chesney, Chavira, Hall, & Gary, 1982; Deyo,
Diehl, Hazuda, & Stern, 1985; Marks et al., 1987; Wells,
Hough, Golding, Burnam, & Karno, 1987) and access to care
(Anderson et al., 1981; Richardson et al., 1987; Solis, Marks,
Garcia, & Shelton, 1990). Our focus was on the role that
psychological variables play in preventive health behaviors.
Method
Sample
Our data were part of "Proyecto a Su Salud" (Project to Your
Health), a longitudinal study of cancer symptom knowledge and
screening practices of elderly Hispanic women. Participants lived in 17
publicly subsidized housing projects in Los Angeles. These projects
were selected because they had a very high percentage of Hispanic
residents. All women 55 years of age or older received a mailed
solicitation to participate and then were contacted in person by a study
representative. Hispanic ethnicity (i.e., family origin from a Latin
American country, including Cuba and Puerto Rico) was confirmed by
the interviewer. Of the 890 Hispanic women contacted, 603 (67.8%)
agreed to be in the study.
The study involved an intake assessment of health knowledge and
screening behaviors. Following the intake, housing projects were
randomly assigned to one of three conditions (comprehensive health
education program, minimal-information control group, or no-
information control group). The comprehensive program consisted of
four 2-hr group educational programs pertaining to breast, cervical,
colorectal, and oral cancers. The minimal-information control pro-
gram consisted of a 45-min presentation about warning signs of cancer,
risk factors, screening recommendations, and the importance of early
detection. A follow-up questionnaire was administered to all subjects
approximately 1 year after the intervention.
The present data involve women in either of the two control
conditions ( = 429). These groups were combined because the two
conditions did not produce any main or interaction effects on any
outcome measure. We omitted women who received the comprehen-
sive education program (n = 174) because it was designed to improve
medical screening practices.
All variables used in the analysis, except measures of demographics
and acculturation, were taken from the follow-up questionnaire. Of
the 429 women in the two control conditions, 270 provided complete
data on the study variables and constituted our analytic sample. To
check for possible attrition bias, we compared women who dropped
out of the study (n = 159) with our analytic sample on several variables
measured at intake: demographics, date of last physical examination,
frequency with which they did BSE, nervousness about BSE, physician
breast exam and Pap smear, and recency of these screening proce-
dures. Dropouts differed from participants (p < .05) only in the
frequency with which they had performed BSE. The primary differ-
ence was that 27.4% of the participants reported that they never
practiced BSE, compared with 41.2% of those who dropped out. Thus,
generalizations from our study may be more applicable to women who
practice BSE with at least some regularity.
Questionnaire Design and Administration
The questionnaire was written in English, translated into Spanish,
and then back-translated to identify ambiguity of meaning. Both
versions were pilot-tested with a small sample of Hispanic women from
the housing projects. In the main study, the questionnaire was
administered at each participant's home by Spanish-speaking women
trained in interviewing techniques. The interview was conducted in the
language of the participant's choice (75.9% chose Spanish).
Independent Variables
Demographics and acculturation. We measured several demo-
graphic factors, including age, education, marital status, monthly
income, and health insurance coverage. Acculturation was measured
with 18 items from the Acculturation Rating Scale for Mexican
Americans (Cuellar, Harris, & Jasso, 1980), focusing primarily on
language preference and usage, country of birth, and years residing in
the United States. Internal reliability was very high (Cronbach's
alpha = .95). Responses were standardized to a mean of zero and a
variance of one and then averaged to form one overall acculturation
score for each subject. Standardizing the raw scores gave equal weight
to each item in the scale.
Health locus of control. Health locus of control was measured with
nine items from the MHLOC scale (K. A. Wallston et al., 1978). The
original scale used six items to measure each dimension of control. To
keep our questionnaire at a manageable length, we used the three
items that most strongly defined each subdimension in terms of the
highest item-subscale correlations (Marks et al., 1986; C. H. Wolk,
personal communication, 1982). These items and the response format
are presented in the Appendix.
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HISPANIC CANCER SCREENING 195
The internal reliability for each dimension was quite high. Cron-
bach's alpha was .82 for the three internal control items, .82 for the
powerful others items, and .72 for the three chance control items.
Responses to the items within each dimension were standardized and
averaged to form three subscale scores for each participant.
Dependent Variables
Frequency of BSE. It is generally accepted that once per month is
the optimal frequency for performing BSE (Alagna, Morokoff, Bevett,
& Reddy, 1987). This frequency enables women to develop the most
sensitivity to detect breast lumps and changes in their breasts.
Performing BSE more frequently may diminish one's ability to detect
subtle changes. This recommendation governed our decision about
how we coded our BSE frequency data.
Each woman was asked whether she had performed BSE and how
often she did it. Seventeen percent reported doing BSE on a monthly
basis; for purposes of analysis, they were assigned a code of 4.
Thirty-seven percent reported that they performed BSE more fre-
quently than once a month; they were assigned a code of 3. Those who
reported performing BSE less than once a month (21,0%) were coded
2, and those who reported never doing BSE (25.0%) were coded 1.
Empirical support for this coding scheme is provided by the
women's demonstration of their ability to detect lumps in a foam
breast model. During questionnaire administration, they were pre-
sented with a life-size foam model of a breast that contained five lumps
of varying sizes. They were asked to examine it as they would their own
breasts and to report the number of lumps found. For the 72% who
agreed to examine the model (n = 195), women who performed BSE
monthly found significantly more lumps than did those who performed
BSE more than once a month (Ms = 2.57 vs. 1.48, p < .05, Duncan
test). Those who performed BSE less than once a month or who never
performed BSE were far less accurate (Ms = 0.83 and 0.44, respective-
iy).
We repeated our substantive analyses using a slightly different
coding scheme for BSE frequency that combined subjects who per-
formed BSE on a monthly basis with those who performed the
screening procedure more than once a month. The other two catego-
ries remained the same. The findings obtained were essentially the
same as the results reported later.
Recency of gynecological screening. Each woman was asked (a) how
long it had been since she had her breasts examined by a doctor and
(b) how long it had been since she had a Pap smear. For each item,
subjects responded on a 5-point scale (within the last year [5], 12 to 23
months [4], 24 to 60 months [3], over 5years [2], or never [I]). Responses
to the two screening items had an alpha reliability of .75. Scores were
standardized and averaged to obtain a single index of recency of
gynecological screening.
Attentiveness to health-related information. Each women was asked
four questions, such as "How likely would you be to read written
materials or use radio, television, or other forms of media when you
have concerns about your health?" and "If a short commercial on
cancer comes on television, how likely is it that you would pay attention
to it?" Responses were coded so that higher scores on the 4-point scale
reflected more attentiveness to the information. Alpha reliability for
the set of four items was .88. Scores were standardized and averaged to
create an overall index of attentiveness to health-related information.
Results
Demographics and Acculturation
The demographic characteristics of our sample are pre-
sented in Table 1. As seen, most of the participants were over
Table 1
Sample Characteristics
Variable
Age
55-64
65-74
75-84
85+
Education
None
1-8
9-12
Beyond high school
Marital status
Single, never married
Married
Divorced
Widowed
Separated
Monthly income (dollars)
0-300
301-450
451-500
501-600
Over 600
Health insurance (Medicare, Medical, private)
Yes
No
First language spoken
English
Spanish/English simultaneously
Spanish
English comprehension (self-rated)
Very good/good
Not good/none
Years lived in United States
1-20
21-40
41-60
60+
Country of birth
United States
Mexico, other Latin American countries
Country of family origin
Mexico
Cuba
Puerto Rico
Other Latin American countries
17.0
47.8
32.2
3.0
12.6
64.1
19.1
4.2
10.7
13.3
17.8
53.0
5.2
7.9
17.8
53.5
11.4
9.4
93.3
6.7
5.9
8.9
85.2
40.4
59.6
18.3
28.3
13.1
40.3
33.0
67.0
74.0
5.5
4.8
14.7
Note. Country of family origin is presented for descriptive purposes
only and was not part of the overall acculturation index.
65 years of age, had little education, and had low income.
Fifty-three percent were widowed, and 10.7% had never been
married. Among these demographic variables, only age was
correlated with screening activity (as described later). Table 1
also includes responses to a few of the acculturation scale
items. Taken as a whole, the sample appeared to be marginally
acculturated. However, there was a full range of responses to
individual items, indicating that some of our participants were
moderately to highly acculturated.
Means on Study Variables
Prior to standardizing our items, we computed the raw-score
means for each of our critical variables. As seen in Table 2, on
the 4-point scale, our sample scored highest on internal
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196
N. BUNDEK, G. MARKS, AND J. RICHARDSON
Table 2
Means and Standard Deviations of Study Variables
Variable
Belief in internal control
Belief in control by powerful others
Belief in chance control
Frequency of breast self-examination
Recency of gynecological screening
Attention to health-related information
M
3.44
3.27
2.08
2.45
3.90
3.37
SD
0.57
0.59
0.87
1.04
1.27
0.79
Note. Entries are based on raw score means.
control, followed by powerful others. Paired t tests indicated
that the means for internal control and control by powerful
others differed significantly, t(269) = 4.41, p < .01. Both
differed greatly from chance control: powerful others versus
chance, t(269) = 27.0, p < .001, and internal versus chance,
t(269) = 28.55, p < .001. In sum, our subjects had a stronger
tendency to attribute health outcomes to their own actions or
to the efforts of their doctors than to chance.
Correlations Among Variables
Table 3 presents the Pearson correlations among the study
variables. Internal control was related directly to BSE fre-
quency and to paying attention to health-related information,
supporting Hypotheses 1 and 2. A t test of differences between
dependent correlations (Cohen & Cohen, 1975, p. 53) indi-
cated that frequency of BSE correlated with internal control
more strongly than it did with control by powerful others,
f(267) = 2.11, p < .01. Similarly, attention to health-related
information correlated with internal control more strongly
than it did with control by powerful others, t(267) = 4.43, p <
.001.
We performed a Spearman rank-order correlation involving
BSE frequency (monthlyImore than monthly [3], irregularly [2],
or never [1]) with internal control and control by powerful
others. The latter two variables were grouped into four levels.
The pattern of results was highly similar to that obtained with
the Pearson analysis: BSE-internal, p = .33, p < .001, and
BSE-powerful others, p = .16, p < .01. The difference was
significant, f(267) = 2.24,^ < .05.
In support of Hypothesis 3, gynecological screening was
strongly associated with control by powerful others. This
relationship was stronger than that between gynecological
screening and belief in internal control,? (267) = 2.45, p < .05.
Contrary to Hallal's (1982) finding, we found that control by
powerful others was positively, not negatively, correlated with
BSE frequency. Neither age nor acculturation was significantly
related to any of the health control variables. Age, however,
was inversely related to BSE frequency and to attention to
health-related information. Age tended to be inversely corre-
lated with recency of gynecological screening.
Semipartial Correlations
To analyze our hypotheses in greater detail and with greater
statistical control, a semipartial correlation analysis was con-
ducted for each of the three dependent variables. For each
analysis, an identical two-step procedure was used. In Step 1,
five predictor variables (age, acculturation, internal control,
control by powerful others, and chance control) were entered
into the equation simultaneously. Thus, the effect of each
variable was calculated after statistically controlling for the
other predictors. To examine whether a subject's combined
standing on internal control and control by powerful others
accounted for any unique variance in the dependent variable,
in Step 2 we entered an interaction term (Internal x Powerful
Others) into the equation. The specificity of our hypotheses
predicts that this interaction term will be nonsignificant. The
results of these analyses are presented in Table 4.
Frequency of BSE. Internal control was the most powerful
predictor of the frequency with which the women performed
BSE, confirming Hypothesis 1. Strong beliefs that one could
personally control one's health outcomes were associated with
greater frequency of BSE, accounting for 12.7% of the vari-
ance in the screening activity. Control by powerful others was
also positively related to BSE frequency, but accounted for
only 2.0% of the variance. The semipartial correlation of BSE
with internal control was stronger than the semipartial relation
of BSE with control by powerful others, t(267) = 2.11,p < .01.
The Internal x Powerful Others interaction was not signifi-
cant.
Attention to health-related information. Confirming Hypoth-
esis 2, internal control was the only health belief to predict
attentiveness to health-related information, accounting for
17.5% of the variance in the dependent measure. As internal
control increased, so did attention to information about cancer
and other health issues. The semipartial correlation of atten-
tiveness with internal control was significantly stronger than it
was with control by powerful others, t(267) = 4.43, p < .01.
The interaction term did not contribute to the prediction.
Table 3
Pearson Correlations Among Variables
Variable
1. Age
2. Acculturation
3. Internal control
4. Control by powerful others
5. Chance control
6. Frequency of breast self-examination
7. Recency of gynecological screening
8. Attention to health information
-.11
.07
.02
.10
-.17**
-.11
-.12*
-.09
.09
.01
-.02
.12*
-.07

.07
.10
.37***
.14*
.42***

.31***
.18**
.36***
.08

.11
.15* .31***
-.03 .27*** .11
*p < .05. **/> < .01. **> < .001.
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HISPANIC CANCER SCREENING 197
Recency of gynecological screening. Consistent with Hypoth-
esis 3, strong beliefs that health outcomes are controlled by
powerful others were associated with more recent gynecologi-
cal screening, accounting for 10% of the variance. In addition,
internal control was related to this activity, but the effect was
not as strong as that produced by powerful others, accounting
for only 1.5% of the variance. The effect of control by powerful
others was significantly stronger than the effect of internal
control, t(267) = 2.42,p < .05. Again, there was no interaction
effect.
Discussion
The purpose of our study was to examine three hypotheses
regarding the specificity of association between MHLOC
beliefs and medical screening practices, including attentive-
ness to health-related information. We hypothesized that
beliefs in internal control would be related to behaviors that
have a large component of personal control, such as frequency
of BSE and attention to health information, and that beliefs in
control by powerful others would be related to screening
behaviors that are physician dependent, such as recency of Pap
smear and physician breast examination. Each of these hypoth-
eses was supported. Furthermore, internal control did not
interact with control by powerful others in predicting any of
the health behaviors examined in our study. Thus, being high
on both of these dimensions did not account for any unique
variance in health practices over and above the main effects
produced by these dimensions.
Our findings do not replicate the inverse relationship
between control by powerful others and BSE frequency
reported by Hallal (1982). We found that both internal control
and powerful others were positively related to frequency of
BSE, with internal control producing much stronger effects.
The discrepancy between studies may be explained, in part, by
differences in the measures of BSE frequency. Hallal used a
dichotomous measure (ever vs. never) that produced a highly
skewed distribution (80% vs. 20%). Our findings, coupled with
those of Redeker (1989), who also used relatively sensitive
measures of BSE frequency, strongly suggest that the internal
control dimension is the most critical in predicting screening
practices that have a strong component of personal control.
Furthermore, our results support the contention that the
health locus of control construct has strong cross-cultural
relevance. First, health control beliefs were useful in predict-
ing specific medical screening behaviors of elderly Hispanic
women after statistically controlling for level of acculturation
(language preference, years living in the United States, and
nativity). Second, we did not find any significant correlation
between acculturation and the MHLOC dimensions. Concep-
tually, one might expect to find a positive association between
acculturation and belief in internal control, which is empha-
sized in American culture. Our null finding may emanate from
the relatively low level of acculturation that characterized our
sample. Thus, more research with acculturatively diverse
samples is needed.
Other researchers have found an external control orienta-
tion among Hispanic populations (Mirowsky & Ross, 1984;
Sugarek, Deyo, & Holmes, 1988), suggesting that these popula-
Table 4
Semipartial Correlation Analysis: Effects of Age, Acculturation,
and Health Locus of Control
Variable/step Semipartial r Semipartial r
2
Predicting frequency of breast self-examination
Stepl
Age .199***
Acculturation .023
Chance control .042
Control by powerful others .143***
Internal control .357*
Step 2
Internal x Powerful Others .023
.040
.001
.002
.020
.127
.001
Predicting attention to health-related information
Stepl
Age .145** .021
Acculturation .058 .003
Chance control .084 .007
Control by powerful others .083 .007
Internal control .418*** .175
Step 2
Internal x Powerful Others .050 .003
Predicting recency of gynecological screening
Stepl
Age .116* .013
Acculturation .091 .008
Chance control .044 .002
Internal control .124* .015
Control by powerful others .317*** .100
Step 2
Internal x Powerful Others .010 .000
Note. Variables in Step 1 were entered simultaneously. The interac-
tion effect in Step 2 was assessed after controlling for Step 1 variables.
'p < .05. **/ < .01. ***p < .001.
tions would measure higher on the powerful others dimension
than on the internal control dimension. We found just the
opposite. Certain unique characteristics of our sample may
have accounted for our results. For example, many of the
women were quite sophisticated in the use of social services.
They had acquired public housing, and most had health
insurance coverage and had used public health facilities. This
resourcefulness may explain to some extent why they rated
themselves significantly higher on internal control than on the
other two dimensions.
A couple of methodological aspects of our study deserve
comment. First, the sample was restricted to elderly Hispanic
women. The extent to which our results generalize to younger
Hispanic women, to Hispanic men, and to other cultural
groups remains open. However, we have no reason to believe
that the findings are limited to our sample. The belief-
behavior specificity hypothesis ought to apply equally to other
groups. Second, we assessed screening activities by asking
women to report the frequency or recency of a specific
screening. We attempted to validate a portion of these data by
examining the correspondence between the women's reports
of BSE frequency and their ability to detect lumps in a life-size
foam breast model, and we found a significant association in
the expected direction. This finding suggests that the women's
reports of their other screening activities were also relatively
valid. Of course, different types of screening measures may
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198
N. BUNDEK, G. MARKS, AND J. RICHARDSON
elicit different types and magnitudes of response biases.
Validation of a reported physician exam may necessitate
contacting medical providers to verify that visit.
Finally, our results suggest an important direction for future
research in health care settings. An abbreviated health locus of
control measure might be tested as part of the intake proce-
dure in clinical settings. By noting a patient's responses to
MHLOC items, a physician may be able to identify the pattern
of orientation as being related more strongly to belief in
internal control or to control by powerful others. Using this
information as a guideline, the physician could strive to
present advice about screening behaviors that is in line with
patients' existing MHLOC orientations. For example, this
might involve stressing the self-initiated nature of BSE and
appointment setting to patients high in internal control and
advising such patients to follow recommendations about gyne-
cological screening published in health pamphlets. Similarly,
for patients who measure high in control by powerful others,
compliance with physician recommendations regarding BSE
can be stressed as an important component of the physician-
patient relationship. Appropriate modifications may be made
for those patients who measure high in both dimensions. In
these ways, physicians may be able to increase the extent to
which women perform necessary medical screening.
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HISPANIC CANCER SCREENING 199
Appendix
Multidimensional Health Locus of Control Items
The following items were rated on a 4-point scale ranging from strongly disagree (1) to strongly agree (4).
Internal Control Items Chance Control Items
1. The main thing which affects my health is what I myself do. 1. Luck plays a big part in determining how soon I will recover from
2. I am in control of my health. an illness.
3. If I take the right actions, I can stay healthy. 2. Most things that affect my health happen to me by accident.
3. My good health is largely a matter of good fortune.
Powerful Others Control Items
1. Regarding my health, I can only do what my doctor tells me to do.
2. Having regular contact with my physician is the best way for me to
avoid illness.
3. Health professionals control my health.
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