Health locus of control in Malawi: A failure to support the cross-cultural validity of the HLOCQ

The validity of the Health Locus of Control Questionnaire (HLOCQ; Lau and Ware 1981) was considered in the context of a study of health belief and behaviour in 415 undergraduate students of the University of Malawi on the occasion of their enrolment health check-up. Internal consistency of the four originally defined sub-scales of the HLOCQ (Chance Health Outcomes, Provided Control over Health, General Health Threat and Efficacy of Self-Care) were, with the Malawi sample, poor (0.50, 0.51, 0.12 and 0.37 respectively). Factor analysis suggests a three factor structure as a more suitable explanatory structure for the responses of the current sample population. The two largest factors were labelled 'Influence over Health' (IOH) and 'Limits of Medical Care' (LMC) respectively, while the third factor involved a heterogeneous grouping of items (defining a sub-scale of very low internal consistency). Scores on the factors IOH and LMC significantly correlated with certain responses regarding the controllability of the health risks malaria, bilharzia and AIDS indicated on a Perceptions of Illness Questionnaire. While this encourages the further exploration of these variables in understanding belief and behaviour regarding tropical health risks in tropical settings, the psychometric weakness of these factors derived from the original HLOCQ item pool is noted.