|Year : 2015 | Volume
| Issue : 3 | Page : 259-263
The association between dental health locus of control and sociodemographic factors among urban and rural people in Davangere, India
Pranati Eswar1, CG Devaraj2
1 Department of Public Health Dentistry, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
2 Department of Periodontology and Implantology, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||14-Sep-2015|
Department of Public Health Dentistry, Mahatma Gandhi Dental College and Hospital, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur - 302 022, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction:Oral diseases have underlying socio-behavioral determinants. Oral health promotion programs aimed at behavior modification will be effective if the factors that motivate health behaviors are known. One of the constructs widely used to predict and analyze health behaviors is the health locus of control scale (HLOC). Aim: To determine the association between sociodemographic factors and dental HLOC among a selected sample of urban and rural people in Davangere district, Karnataka state, India. Materials and Methods: The study sample consisted of 300 people, 150 each from urban and rural area, aged 18 years and above. Sociodemographic data was collected by a self-administered questionnaire. Dental HLOC was assessed by a questionnaire prepared by the author in local language. The association between sociodemographic variables and dental HLOC was analyzed using Chi-square test. Results: Significantly more number of people in urban area had internal LOC when compared to rural people (P = 0.00). There was significant association between gender in rural areas (P < 0.001), education level (P < 0.001) and socioeconomic status (P < 0.001) with dental HLOC. There was no significant association between age, gender in urban areas and marital status with dental HLOC. Conclusions: Gender, education level and socioeconomic status were associated with dental HLOC beliefs. The findings can be useful in planning effective oral health promotion programs aimed at positive oral health behavior modification for people from varying sociodemographic backgrounds by modifying their health control beliefs.
Keywords: Dental health locus of control, India, rural population, sociodemographic factors, urban population
|How to cite this article:|
Eswar P, Devaraj C G. The association between dental health locus of control and sociodemographic factors among urban and rural people in Davangere, India. J Indian Assoc Public Health Dent 2015;13:259-63
|How to cite this URL:|
Eswar P, Devaraj C G. The association between dental health locus of control and sociodemographic factors among urban and rural people in Davangere, India. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 18];13:259-63. Available from: http://www.jiaphd.org/text.asp?2015/13/3/259/165253
| Introduction|| |
Oral diseases like dental caries, periodontitis and oral cancer are global health problems in developed as well as developing countries.  Management of these oral problems depends not only on the traditional treatment based approach of the oral health care system but also on the oral health promotion and disease prevention aspects. To be effective, community based oral health promotion programs must focus not only on the technical aspects of prevention but also on the underlying socio-behavioral determinants of oral diseases. Preventive interventions are likely to be more effective if the factors that motivate health behaviors are known. Beliefs about perceived control over health are now considered to be an important motivational factor for understanding an individual's likelihood of adopting health promoting behaviors. Several studies that have examined these beliefs and health related behaviors suggest that they may be used for planning health promoting programs and to frame health messages in the educational component of health programs. 
One of the constructs which has attracted a lot of attention in the area of predicting and analyzing health behavior is the locus of control (LOC). , Health LOC (HLOC) scales have been widely used to characterize a person's belief about his or her control over health outcomes.  It has its origins in the LOC construct, originally developed within the framework of Rotter's social learning theory. 
LOC is the degree to which the individuals perceive the events that happen to them as being contingent on their own effort and ability or as a result of external factors such as luck, chance or fate or the influence of other powerful persons.  HLOC is the degree to which the individuals believe their health is influenced by their own behavior or by external causes. Those who believe that one's health condition is the direct result of one's own behavior are termed "internals" and those who believe that one's health condition is under the control of powerful others or is determined by fate or luck are termed "externals."  Applying this theory to health settings, those who feel that they have control over their own health and place a high value on health are more likely to pursue health promoting behavior than those who feel that their health is contingent upon external factors. 
In oral care, Rotter's LOC scale and health specific LOC scales have been used in planning individual preventive programs and in examining the relationships between these beliefs and oral health outcomes such as dental care requirements, the patient's oral hygiene performance and compliance with dental health education.  Dental studies have shown some relation between LOC and oral health status and tooth brushing behavior. 
The influence of LOC beliefs on health in general and oral health in particular makes it crucial to understand their origin in the background of other variables. In this direction, understanding the relationship between sociodemographic factors and HLOC can help dental professionals become more aware of the circumstances that might lead to the adoption of particular LOC beliefs and tailor the preventive programs accordingly. This information could also be useful in planning effective oral health promotion programs aimed at changing oral health behavior by modifying the individual's health control beliefs.
Hence, research trying to understand the association between dental LOC beliefs and sociodemographic factors has it's own significance. Literature search revealed a relative scarcity of Indian studies in this perspective. Hence, the study was conducted to determine the association between dental HLOC and sociodemographic factors among urban and rural people in Davangere district, Karnataka state, India.
| Materials and methods|| |
The study employed a descriptive cross-sectional study design. The study was carried out from January 2014 to April 2014. Ethical clearance was obtained from the Institutional Review Board for the study. Voluntary written informed consent was obtained from the participants before the start of the study. Prior to the commencement of the main study, a pilot study was conducted on 50 people to assess the feasibility of the study, sample size estimation and the reliability of the scale. Internal consistency of the scale was quantified by Cronbach's alpha. It demonstrated satisfactory internal consistency (Cronbach's alpha value = 0.70).
Sample size was estimated using the formula:
Where Zα =1.96 ≈ 2; P = prevalence; Q = 1 − P; L = allowable error = 5%
A total of 300 people, aged 18 years and above from the urban and rural area were included in the study. In the urban area, a multistage random sampling method was employed to select 150 people aged 18 years and above. In the rural area, house to house survey was carried out until 150 people aged 18 years and above were selected.
A survey Performa was used to collect data related to sociodemographic factors like age, gender, marital status, education level and socioeconomic status. Socioeconomic status was determined by Kuppuswamy's scale and categorized into five classes from 1 to 5 with 1 being the highest social class and 5 being the lowest. 
Dental HLOC was determined by a self-report questionnaire which was prepared by the author in the local language. The questionnaire consisted of 16 questions, 8 questions each on internality and externality respectively. People were asked to choose between "yes" or "no" alternatives that suggested either internality or externality.
Statistical package for social sciences (SPSS) package 13 (SPSS Inc. 223, South Wacker Drive, 11 th floor, Chicago II, 60606-6412) was used for statistical analysis of data. Association between dental HLOC and sociodemographic variables was analyzed using Chi-square test. P < 0.05 was set for statistical significance.
| Results|| |
Statistical analysis of data showed that significantly more number of people in urban area belonged to internal LOC group when compared to rural people (P = 0.00; HS) [Table 1]. There was no significant association between age and HLOC both in urban (P = 0.10; NS) and rural areas (P = 0.07; NS) [Table 2]. There was no significant association between gender and HLOC in urban area (P = 0.25; NS). In the rural area, highly significant number of women had an external LOC belief compared to men (P < 0.001, HS) [Table 3]. There was no significant association between marital status and HLOC both in urban (P = 0.17; NS) and rural areas (P = 0.43; NS) [Table 4].
|Table 2: Association between age and dental HLOC among urban and rural people |
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|Table 3: Association between gender and dental HLOC among urban and rural people |
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|Table 4: Association between marital status and dental HLOC among urban and rural people |
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There was a highly significant association between education level and HLOC in urban as well as rural people (P < 0.001; HS) [Table 5]. Majority of college educated people both in urban and rural area had internal health locus control beliefs.
|Table 5: Association between education level and dental HLOC among urban and rural people |
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A highly significant association was found between socioeconomic status and HLOC both in urban and rural areas (P < 0.001; HS) [Table 6]. Majority of people in higher social class in urban and rural areas had internal control beliefs whereas majority of people in lower social class had external control beliefs.
|Table 6: Association between socioeconomic class and dental HLOC among urban and rural people |
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| Discussion|| |
A descriptive cross-sectional study was carried out to determine the association between HLOC beliefs and sociodemographic variables among urban and rural people in Davangere district, Karnataka state in India.
Results of the study showed that significantly more number of people in urban area had internal LOC beliefs than rural people. This may be because of better access to information through media, wide social contacts, exposure to body of knowledge and better exchange of ideas among urban people which could make them feel responsible for their health.
Rural people on the other hand may have "inbox thinking" as they are a confined and more homogenous population and have less exposure to information and education than urban people. This could make them feel less in control of their dental health.
Age was not associated with HLOC beliefs in urban as well as rural area. However, few other studies found that younger people had more internal LOC beliefs than older ones. ,, Older people had higher scores on chance LOC beliefs and dentist subscale reflecting the important psychological and social development of aging and an increasing need for prosthetic and restorative treatment in older people.  Since the data on age and HLOC beliefs are conflicting it may be inferred that the relationship between the two is ambiguous.
Significantly more number of women in rural area had external LOC beliefs compared to urban area. This may be because rural women in India have a more dependent way of life and are confined to their houses with very less exposure to the outside world. Living in a patriarchal, male dominant society in rural areas may make these women feel less in control of their life situations which may translate into their health beliefs as well. Some studies found that women had higher internal LOC scores than men. , One study reported that LOC scores were unrelated to gender. 
The study showed that there was no association between dental HLOC beliefs and marital status. This may indicate that dental HLOC beliefs are more individualistic and are less influenced by the spouse. However, some studies have reported that married people had more external control beliefs than unmarried ones. , Due to increasing family responsibility and limited time for oral self-care, married people may be more likely to prefer professional oral care instead of home-based oral hygiene. 
The study showed that majority of those who had college education both in urban and rural area had internal LOC beliefs than others. This may indicate that, with increase in education level, awareness increases, and people feel responsible and in control of their health. This result is in line with findings of other studies. ,,,,,
Majority of people in the higher social class had internal LOC beliefs and majority in lower social class belonged to external LOC. The possible reason for this may be that people from higher social class enjoy financial stability, good social position and better exposure to knowledge than the lower social class people. This may help them feel a sense of control over their health. People living in economically deprived circumstances have less control over their health. ,
The results obtained in the study can have important implications for the development of oral health promotion programs aimed at behavior modification for people from varying sociodemographic backgrounds. Using this information, the oral health professionals can strive to modify the oral health behaviors by modifying the individual's existing control orientations.
Though the study was done on a small scale, the results may provide an initial step in understanding the dental HLOC beliefs in the background of sociodemographic variables. In future studies it will be necessary to extend the analysis to a larger sample of individuals and determine the predictive ability of these factors in determining dental HLOC beliefs through regression analysis. This study had a cross-sectional design and it is thus difficult to establish a causal relationship among sociodemographic factors and dental health LOC beliefs. Longitudinal research studies are needed to determine the direction of associations found in the study.
| Conclusions|| |
Gender, education level and socioeconomic status were associated with dental HLOC beliefs. The findings can be useful in planning effective oral health promotion programs aimed at positive oral health behavior modification for people from varying sociodemographic backgrounds by modifying their health control beliefs.
The authors are grateful to all the people who participated in the study and are thankful to Mr. Sangam D.K, Department of Biostatistics, JJM Medical College and Hospital, Davangere, Karnataka state, India for his help in statistical analysis of data.
Financial support and sponsorship
Conflict of interest
There are no conflict of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]