Patient self-efficacy and health locus of control: relationships with health status and arthritis-related expenditure.

OBJECTIVE To explore the relationship between measures of self-efficacy, health locus of control, health status and direct medical expenditure among community-dwelling subjects with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS This analysis is part of a larger ongoing study of the costs and outcomes of arthritis and its treatments. Community-dwelling RA and OA respondents completed questionnaires concerning arthritis-related expenditure, health status, arthritis related self-efficacy and health locus of control. RESULTS Data were obtained from 70 RA respondents and 223 OA respondents. The majority of respondents were female with a mean age of 63 yr for RA respondents and 68 yr for OA respondents. Among the RA respondents, those with higher self-efficacy reported better health status and lower overall costs. Health locus of control was not consistently correlated with health status. OA respondents with higher self-efficacy reported better health status and lower costs. Health locus of control had more influence. OA respondents with higher external locus of control reported worse pain and function. A higher belief in chance as a determinant of health was correlated with more visits to general practitioners and a higher cost to both the respondent and the health system. CONCLUSION Higher self-efficacy, which is amenable to change through education programmes, was associated with better health status and lower costs to the respondent and the health system in this cross-sectional study. Locus of control had less of an influence; however, the tendency was for those with higher external locus of control to have higher costs and worse health status. As the measurement of these constructs is simple and the outcome potentially affects health status, these results have implications for future intervention studies to improve quality of life and reduce the financial impact of arthritis on both the health-care system and patients.

[1]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[2]  M. Cross,et al.  Living with osteoarthritis: patient expenditures, health status, and social impact. , 2001, Arthritis and rheumatism.

[3]  K. Waller,et al.  Health Locus of Control and Self-Efficacy Beliefs in a Healthy Elderly Sample , 1992, American journal of health promotion : AJHP.

[4]  J. Ware.  SF-36 health survey: Manual and interpretation guide , 2003 .

[5]  J. Rotter.  Generalized expectancies for internal versus external control of reinforcement. , 1966, Psychological monographs.

[6]  T. Cronan,et al.  The effects of coping style and self-efficacy on health status and health care costs , 1998 .

[7]  F. Keefe,et al.  The relationship of locus of control to pain coping strategies and psychological distress in chronic pain patients , 1988, Pain.

[8]  Kenneth A. Wallston,et al.  Hocus-pocus, the focus isn't strictly on locus: Rotter's social learning theory modified for health , 1992, Cognitive Therapy and Research.

[9]  Kenneth A. Wallston,et al.  Development of the Multidimensional Health Locus of Control (MHLC) Scales , 1978, Health education monographs.

[10]  M. Cross,et al.  Living with rheumatoid arthritis: expenditures, health status, and social impact on patients , 2002, Annals of the rheumatic diseases.

[11]  H. Holman,et al.  Measurement of patient outcome in arthritis. , 1980, Arthritis and rheumatism.

[12]  Cynthia A. Flynn.  The relationship of locus of control to career development in college engineering students , 1986 .

[13]  K. Lorig,et al.  Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. , 1989, Arthritis and rheumatism.

[14]  M. Gustafsson,et al.  Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis. , 1996, Patient education and counseling.