Locus of control, quality and outcomes of care among managed care patients with diabetes in Hawai'i

Locus of control (LOC) is a psychological concept with particular sociological relevance. Theoretical and empirical evidence support LOC as a mechanism mediating social, economic and cultural disparities. Current information on LOC and health is limited by measurement issues and small samples. The objectives of this study were to: (1) assess the factorial structure of a diabetes-specific LOC (DLOC) instrument; (2) describe socioeconomic and racial/ethnic differences in DLOC; and (3) measure the relationship of DLOC to quality of care, self care behaviors and intermediate outcomes.; This study was conducted as part of the Translating Research Into Action (TRIAD) Study, a multi-center study of the quality of care for people with diabetes enrolled in managed care health plans at six sites in the United States. The sample for this dissertation study included 1106 Hawai'i participants who completed the 18 item DLOC instrument. Factor analysis was used to identify domains of DLOC. Scales were developed to measure these domains and subsequently used in multivariate analysis.; Two significant domains of DLOC were identified in this study, internal and chance. Differences among study subgroups defined by age, gender, educational achievement, income and race/ethnicity were identified. The quality of care received was not related to internal DLOC. Patients with a high chance DLOC orientation were more likely to receive some services, possibly resulting from poorer health status. A high internal DLOC was significantly associated with not smoking, daily self-monitoring of blood sugar and spending more time exercising. Individuals with a high chance DLOC orientation were significantly more likely to smoke, spend more time shopping and preparing food and caring for their feet. They were also less likely to monitor blood sugar. Neither internal nor chance DLOC was associated with physiological outcomes of diabetes. Internal DLOC was associated with fewer comorbidities, diabetes symptoms, better mental health and physical functioning summary scores. Chance DLOC was associated with more comorbidities, diabetes symptoms and lower physical functioning.; The association of socioeconomic position and DLOC lends further evidence to support LOC as a social, as well as a psychological phenomenon, and as one mechanism leading to disparities in health.