Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 3  |  Page : 259-263

The association between dental health locus of control and sociodemographic factors among urban and rural people in Davangere, India


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 Publication14-Sep-2015

Correspondence Address:
Pranati Eswar
Department of Public Health Dentistry, Mahatma Gandhi Dental College and Hospital, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur - 302 022, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.165253

Rights and Permissions
  Abstract 

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 2019 Oct 16];13:259-63. Available from: http://www.jiaphd.org/text.asp?2015/13/3/259/165253


  Introduction Top


Oral diseases like dental caries, periodontitis and oral cancer are global health problems in developed as well as developing countries. [1] 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. [2]

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). [3],[4] Health LOC (HLOC) scales have been widely used to characterize a person's belief about his or her control over health outcomes. [5] It has its origins in the LOC construct, originally developed within the framework of Rotter's social learning theory. [6]

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. [3] 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." [7] 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. [4]

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. [2] Dental studies have shown some relation between LOC and oral health status and tooth brushing behavior. [4]

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 Top


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. [8]

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 Top


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 1: Association between area of residence and dental HLOC beliefs


Click here to view
Table 2: Association between age and dental HLOC among urban and rural people


Click here to view
Table 3: Association between gender and dental HLOC among urban and rural people


Click here to view
Table 4: Association between marital status and dental HLOC among urban and rural people


Click here to view


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


Click here to view


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


Click here to view



  Discussion Top


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. [2],[4],[9] 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. [2] 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. [2],[4] One study reported that LOC scores were unrelated to gender. [3]

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. [2],[10] 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. [2]

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. [4],[10],[11],[12],[13],[14]

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. [2],[3]

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 Top


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.

Acknowledgements

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

Nil.

Conflict of interest

There are no conflict of interest.

 
  References Top

1.
Daly B, Watt R, Batchelor P, Treasure E, editors. Overview of behavior change. In: Essential Dental Public Health. New Delhi: Oxford University Press; 2003. p. 155-66.  Back to cited text no. 1
    
2.
Doherty W. Divorce and belief in internal versus external control of one's life. J Divorce Remarriage 1980;3:391-401.  Back to cited text no. 2
    
3.
Kent GG, Matthews RM, White H. Locus of control and oral health. J Am Dent Assoc 1984;109:67-9.  Back to cited text no. 3
    
4.
Kneckt MC, Syrjälä AM, Knuuttila ML. Locus of control beliefs predicting oral and diabetes health behavior and health status. Acta Odontol Scand 1999;57:127-31.  Back to cited text no. 4
    
5.
Kumar N, Shekhar C, Kumar P, Kundu AS. Kuppuswamy's socioeconomic status scale-updating for 2007. Indian J Pediatr 2007;74:1131-2.  Back to cited text no. 5
    
6.
Ludenia K, Donham GW. Dental outpatients: Health locus of control correlates. J Clin Psychol 1983;39:854-8.  Back to cited text no. 6
    
7.
Mangelsdorff AD, Brusch WA. Locus of control as a predictor of dental care requirements. J Prev Dent 1978;5:29-30.  Back to cited text no. 7
    
8.
Peker K, Bermek G. Oral health: Locus of control, health behavior, self-rated oral health and socio-demographic factors in Istanbul adults. Acta Odontol Scand 2011;69:54-64.  Back to cited text no. 8
    
9.
Poortinga W, Dunstan FD, Fone DL. Health locus of control beliefs and socio-economic differences in self-rated health. Prev Med 2008;46:374-80.  Back to cited text no. 9
    
10.
Poudyal S, Rao A, Shenoy R, Priya H. Utilization of dental services in a field practice area in Mangalore, Karnataka. Indian J Community Med 2010;35:424-5.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.
Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr 1966;80:1-28.  Back to cited text no. 11
    
12.
Singh-Manoux A, Marmot M. Role of socialization in explaining social inequalities in health. Soc Sci Med 2005;60:2129-33.  Back to cited text no. 12
    
13.
Steptoe A, Wardle J. Locus of control and health behaviour revisited: A multivariate analysis of young adults from 18 countries. Br J Psychol 2001;92:659-72.  Back to cited text no. 13
    
14.
Wallston BS, Wallston KA, Kaplan GD, Maides SA. Development and validation of the health locus of control (HLC) scale. J Consult Clin Psychol 1976;44:580-5.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and me...
Results
Discussion
Conclusions
References
Article Tables

 Article Access Statistics
    Viewed934    
    Printed10    
    Emailed0    
    PDF Downloaded150    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]