|Year : 2018 | Volume
| Issue : 1 | Page : 44-48
Effect of professionalization on health locus of control among dental students
Department of Public Health Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
|Date of Web Publication||22-Mar-2018|
Dr. Shikha Verma
Department of Public Health Dentistry, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Context: Dental students go through the process of professionalization and imbibe attitude, knowledge, and working skills essential to practice dentistry.
Aim: To assess the effect of different stages of professionalization on health locus of control among undergraduate students of dental colleges in Bengaluru city.
Settings and Design: A cross-sectional study was conducted among 511 undergraduate students of the selected four dental colleges in Bengaluru, India.
Materials and Methods: Nonprobabilistic sampling was adopted and the students who were present on the day of the study were included in the study. The 18-item Multidimensional Health Locus of Control (MHLC) scale consisting of three 6-item subscales (Internal, Chance, and Powerful Others) was administered to the respondents.
Statistical Analysis: Analysis of variance was used to find the overall variance and post hoc to determine the intergroup variance. P value of <0.05 was accepted to be statistically significant.
Results: A comparison of the mean scores for the three subscales from first Bachelor of Dental Surgery (BDS), final BDS, and interns showed that the mean internal score increased in the order of first BDS (25.9), final BDS (26.3), and interns (27.19); the scores varied significantly between first BDS and interns (P = 0.023). The overall variance was also found to be statistically significant (P = 0.04).
Conclusion: Internal health locus of controls was very strong in the study population, and the mean internal scores increased from first BDS till internship.
Keywords: Dental students, health locus of control, professionalization
|How to cite this article:|
Verma S. Effect of professionalization on health locus of control among dental students. J NTR Univ Health Sci 2018;7:44-8
| Introduction|| |
An individual's perception of health involves a variety of behavior patterns, actions, and habits that bear relevance to health maintenance, restoration, or improvement. Health care professionals and policy makers have made persistent efforts to influence an individual's behavior to minimize risky and maximize preventive and protective health-related behavior. Various factors have been reported to be associated with the likelihood of both preventive and risky health-related behavior including socioeconomic status, personality, emotional, and cognitive factors.,,, Among cognitive factors, generalized beliefs related to health controllability and manageability, usually conceptualized as health locus of control (HLC), have been identified as a crucial determinant of health-related behavior.
The concept of HLC was developed by Wallston et al. in 1978,,,, who applied the previously proposed Rotter's construct of locus of control (LOC) to the domain of health and proposed that HLC should be viewed as a multidimensional construct, with relatively independent dimensions.,, These dimensions reflected differences in attributions people can hold about the responsibility for and control of their health. These are (1) internal HLC (IHLC), i.e., the responsibility for one's health is attributed to oneself and to the action one takes with consequences for health; (2) powerful others HLC (PHLC), i.e., the responsibility for one's health is assigned to other people, predominantly medical professionals, who are perceived as those in control of one's health condition; (3) chance HLC (CHLC), i.e., the responsibility for one's health is believed to depend on uncontrollable factors, such as good/bad luck or fate. These beliefs are formed in the process of social adaptation and personal experience, and could predict corresponding health behavior and health values.,, Students of dental sciences can align themselves to health promoting behavior through their professional education program., Professionalization is the process by which an individual becomes a member of a professional body. Dental students go through this process of professionalization and imbibe attitude, knowledge, and working skills essential to practice dentistry. The Multidimensional Health Locus of Control (MHLC) scale provides a mechanism for researchers to study these effect of professionalization on health attitudes and behavior in dental students. Literature search reveals that a very few studies have been conducted discussing the relationship between MHLC and professionalization. Hence, this study was conducted with an aim to assess the effect of different stages of professionalization on the HLC among undergraduate students of dental colleges in Bengaluru city.
| Materials and Methods|| |
A cross-sectional study was conducted among dental undergraduate students from May to October 2012. Prior permission was obtained from the Principals of the selected dental colleges for conducting this study. The purpose of the study was explained to all the participants, and the participation was voluntary.
The study population comprised students from first Bachelor of Dental Surgery (BDS), final BDS, and interns of the selected four dental colleges in Bengaluru, India. The 18-item MHLC was administered to the respondents. Out of 600 students, 538 were present on the day of the visit and participated in the study, with a response rate of 90%. Out of these, 511 students returned completed forms, 11 students refused to participate in the study (nonresponse), and 16 gave incomplete forms (incomplete response), hence, these 27 students were rejected and were not included in further analysis. Additional information that was collected from the students included age, gender, year of study in the dental college, and country of origin.
Stratified random sampling method was employed. All 16 dental colleges in Bengaluru were stratified into four different zones and one college was selected from each strata by simple random sampling method. Nonprobabilistic sampling was adopted and the students who were present on the day of the visit were included in the study. A pilot study was not conducted because the instrument used was a tested one.
All first BDS, final BDS, and interns present on the day of the visit and those who provided consent were included in the study.
The students who did not give consent were excluded from the study.
Instruments and variables
The 18-item MHLC scale was developed by Wallston et al. (1978) and consisted of 3, 6-item scales using a Likert format. The three subscales used were IHLC, PHLC, and CHLC subscales. Respondents were asked to rate each item on the MHLC using the 6-point Likert scale, where 1 = “strongly disagree,” 2 = “moderately disagree,” 3 = “slightly disagree,” 4 = “slightly agree,” 5 = “moderately agree,” and 6 = “strongly agree.” Thus, each subscale of 6 questions had a scoring range of 6–36.
Descriptive methods were employed for data presentation and analysis. Because the response rate was high (90%), distribution was assumed to be normal and parametric tests were employed for the analysis. Multiple intergroup comparisons such as comparison among first BDS, final BDS, and interns for Internal, Powerful Others, and Chance, as well as among the three locus of control (LOC) groups was done. Analysis of variance was used to determine overall variance and post hoc was performed to find out intergroup variance, i.e., to compare the findings among the three years. A P value of <0.05 was accepted to be statistically significant. The statistical analysis was performed using the software Statistical Package for the Social Sciences (SPSS)™ software (version 18) (SPSS Inc., Chicago, IL).
| Results|| |
A total of 511 dental undergraduates completed the MHLC questionnaire. Of these, 369 (68.5%) were females and 142 (26.3%) males. No significant differences were observed between the mean scores of the MHLC subscales when compared according to the gender. The mean age of participants was 20.88 years. The year of study is assumed as a proxy for age.
The comparison of mean scores for the three subscales from first BDS, final BDS, and interns showed that the mean internal score increased in the order of first BDS (25.9 ± 5.35), final BDS (26.3 ± 5.18), and interns (27.19 ± 4.66); the overall variance was not statistically significant (P = 0.073); however. on post hoc analysis, the scores varied significantly between first BDS and interns [Table 1].
The comparison of the mean chance score decreased in the order of first BDS (19.97 ± 5.19), final BDS (19.13 ± 4.94), and interns (19.34 ± 5.22); and the overall variance was statistically significant (P = 0.04). In addition, on post hoc analysis, the scores varied significantly between first BDS and interns [Table 2]. The mean powerful others scores for first BDS, final BDS, and interns were 24.18 ± 5.60, 23.42 ± 5.52, and 23.64 ± 5.40, respectively, and the overall variance was not statistically significant (P = 0.381). In addition, on post hoc analysis, the scores did not vary significantly. Although mean internal, chance, and powerful others scores for females was found to be more than males, no significant differences were observed.
The mean scores for the internal subscale was consistently higher, followed by powerful others and the scores were the least for chance subscale among the dental undergraduate students [Table 3] and [Figure 1].
|Table 3: Comparison of the three multidimensional health locus of control subscales in the four years of study|
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|Figure 1: Comprehensive results of the three Multidimensional Health Locus of Control subscales for males and females|
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| Discussion|| |
The present study assessed the effect of different stages of professionalization on the HLC among undergraduate students and found that professionalization was an important factor in shaping and influencing the health attitudes of dental students. Previous studies in the literature have reported an improvement in oral health attitudes and behavior among dental students from their entry years to the final year.,,,,,
The findings of the present study showed that the mean internal score increased in the order of first BDS, final BDS, and interns with varied significant differences in the mean scores of first BDS and interns. This finding is similar to the previous literature in which the internal LOC aspect of the MHLC showed a dominant role in shaping health attitudes among students in all the years of the dental course.,,,,,,, The finding of no gender differences between mean scores of the MHLC subscales is in agreement with the studies conducted by Acharya, however, contrasting results have been reported by Kuwahara et al.
The influence of the ILC was high in the students of the first and second years, but was lower among the third-year students. Further, it was found to be the highest among the final-year students. These results are in line with the previous literature. The possible reason for the lower IHLC among the third-year students may be due to the qualitative shift in their training from an essentially didactic to a clinical one in the third year. This sudden change from a familiar role of that of an ordinary student to a dentist may cause a temporary crisis of confidence resulting in a lower ILC. Increased familiarity with his or her role as a health care provider brought about by clinical training may again increase the ILC in students when they are in their final year.
The MHLC model suggests that those who score high on the internal dimension, i.e. who regard their health as largely within their own control are likely to engage in health maintaining behaviors., Conversely, those who score high on the external dimension view their health as relatively independent of their behavior and, accordingly, are more likely to engage in health-damaging behaviors than that of those with lower scores. This finding is in accordance with previous literature.,,
In the present study, it was seen that the mean chance score decreased significantly in the order of first BDS, final BDS, and internship. This is in contrast to the study done by Acharya, in which the CHLC increased from the first to second year, decreased in the third year, and again increased in the final year, however, the values were not found to be statistically significant. The findings of decrease in mean powerful others scores from first BDS to internship is in agreement with the previous studies., Thus, it was seen in this study that the IHLC was very strong in the study population.
Despite of this, there was still some scope for modification in the LOC beliefs through further reduction of the PHLC and CHLC beliefs. Behavior modification measures such as counseling by teachers and peer group discussions can be advocated. A number of studies ,,, have sought to modify the LOC beliefs and increase internality by behavioral modification programs, educational programs, or other cognitive techniques.
Limitations of the present study
Only first BDS, final BDS, and interns were included in the present study. Therefore, further studies should be conducted including students from all years and the effect of professionalization should be investigated.
| Conclusion|| |
It is evident from the study that IHLC increases as a student passes from first year in BDS until internship. The dynamic change from a student to a health care professional reverses this increase in LOC. This paradigm shift indicates the fact that major changes need to be inculcated in the present educational system of dental students to prepare them for the challenges they are likely to face as health care professionals. Preventive strategies also need to be applied in the early life of a dental student to empower him/her for the challenges ahead.
We would like to acknowledge all the heads of various institutions and the study participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]