RELIABILITY AND VALIDITY OF THE MALAY TRANSLATED MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL (MHLC) SCALES

1. RELIABILITY AND VALIDITY OF THE MALAY TRANSLATED MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL (MHLC) SCALES Dr. Noorzilawati Sahak, Asso. Prof. Dr. Siti Raudzah Ghazali Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, University Malaysia Sarawak.

2. INTRODUCTION • Health locus of control (HLC) • the degree to which an individual believes that one health is controlled by own behaviour or by external forces (Wallston & Wallston, 1978) • one of the most widely researched theoretical construct in relation to health behaviour (Norman et al., 1998). • Multidimensional Health Locus of Control (MHLC) scales • measure the extent to which individuals believe their health is • (1) the result of their own actions (i.e. internal HLC), • (2) under the control of powerful others (i.e. powerful others HLC) • and (3) due to fate or chance (i.e. chance HLC) (Wallston, Wallston, & DeVellis, 1978).

3. INTRODUCTION • To authors’ knowledge, • the study on factors related to health-promoting behaviour applying theoretical construct • very scarce in Malaysia • Furthermore, there is no published Malay translated MHLC scales has ever done so far.

4. INTRODUCTION • Multidimensional Health Locus of Control (MHLC) scales • to be useful in measuring health behaviour • should satisfy important properties of a measurement • principally reliability and validity (Garson, 2009)

5. INTRODUCTION • This paper reviews the usefulness of the scales by assessing the reliability and construct validity of the Malay translated MHLC scales in the studied population

6. MATERIALS AND METHODS • Study design and research participants • cross-sectional study • conducted in three government health clinics in Kuching City • Klinik Kesihatan Jalan Masjid, • Klinik Kesihatan Tanah Puteh, and • Klinik Kesihatan Kota Sentosa. • Ethical approval • from the Faculty Medical Ethics Committee of the University Malaysia Sarawak • Permission for conducting research and data collection • from Director of Sarawak State of Health Department • purpose of the study • explained to the participants, • informed consent to participate • strictly voluntary, and patients’ responses were kept confidential • Patients could refuse participation at any time.

7. MATERIALS AND METHODS • Study design and research participants • 10 to 15 subjects per item • needed to undertake factor analysis of an instrument Pett, Lackey and Sullivan (2003) • minimum number of 180 participants (18 items) • Between August and October, 2009 • questionnaire distributed randomly among 347 women attending the clinics • number of participants from each clinic depends on the average number of patients per day at each clinic • participants aged from 20 - 65 years old • Excluded • serious medical problems, psychiatric illness, and had any form of disabilities • eligible participants • fill out the questionnaire • returned it to the first author before they went home • returned questionnaires checked for data completeness

8. MATERIALS AND METHODS • Translation • original English questionnaire -translated by the first author into Malay • checked by two separate individuals • field-tested by face-to-face interview (30 participants) • During the interview sessions, participants encouraged • to scrutinize each individual question to find out • any difficulties in reading and • understanding the questions • final version • was prepared in English and Malay

9. MATERIALS AND METHODS • Instrument • MHLC scales consists of • 18 items on a 6 point Likert-scale • from strongly agree to strongly disagree • For each of the scales, • a sum of item scores as • a scale score • Others: • age, • household monthly income, • ethnic group, • marital status, and • educational level

10. MATERIALS AND METHODS • Data analysis • Statistical Package for Social Sciences (SPSS) version 13.0 • continuous variables (i.e. age and household monthly income) • Test of normality (mean or median) • frequencies and percentages • for categorical variables.

11. MATERIALS AND METHODS • Data analysis • Reliability (Internal Consistency) • For every scale, Pearson’s (inter-item) correlations, item-total correlations, and Cronbach’s αlpha coefficients • examined to determine internal consistency • P value was set at .05 • Kamarul et al. (2005) and Garson (2009) • minimum value of Cronbach’s αlpha = 0.60 acceptable for exploratory study.

12. MATERIALS AND METHODS • Data analysis • Construct validity • Exploratory factor analysis using the principal component analysis • to determine whether the items written to measure each dimension (i.e. internal HLC, chance HLC, and powerful others HLC) • are more strongly correlated with each other than they are with the items written to measure other dimensions of the scale • If there is correspondence, • one factor to represent each dimension • there should be three factors • Oblique rotation for factor rotation was chosen • author believes that the factors are related to each other Pett et al. (2003) and Collen (2005)

13. RESULTS • The sociodemographic characteristics of participants are shown in Table 1.

14. Table 1. Sociodemographic Characteristics of 347 Female Patients Attending the Health Clinics NOTES: SD = standard deviation; IQR = interquartile range. аThe distribution is skewed to the right.

15. RESULTS • Reliability (Internal consistency) • Table 2 • Cronbach’s α coefficients: • acceptable • chance HLC (0.68) and Powerful Other’s HLC (0.61), and • Poor • Internal HLC (0.49) • item-total correlations • three scales were mostly less than .40 (61%), • indicating that most of the scales items had low correlation with the other items comprising the overall scale score.

16. Table 2. Item-total Correlations and Cronbach’s α Coefficients for the MHLS Scales

17. RESULTS • Construct Validity (Factor Analysis) • Kaiser-Meyer-Olkin measure of sampling adequacy index was .749, and • Bartlett’s test of sphericity was significant, χ2 (153, N = 347) = 1,155.82, p < .0001 • sample and correlation matrix appropriate for such an analysis. • correlation matrix • most of the items had weak correlation to other items in the same scale (i.e. less than .40). • analysis yielded six factors with Eigenvalues ≥1.0 accounted for 58.4% of the variance in MHLC scores

18. RESULTS • Table 3

19. DISCUSSION • One of the ways to estimate internal reliability is by • using Cronbach’s αlpha as the coefficient of reliability (Garson, 2009). • uses the correlation among items within an instrument to estimate reliability (Collen, 2005) • internal consistency of an instrument refers • to how well the items that make up an instrument fit together (Pett, Lackey & Sullivan, 2003) • αlpha coefficient ranges in value from 0 to 1; • the higher the αlpha value the more reliable the generated scale is • due to high levels of interrelatedness among the items (Collen, 2005).

20. DISCUSSION • present study is an attempt • to measure the reliability of MHLC scales in female patients attending the three government health clinics in Kuching City. • in this study, the Cronbach’s α coefficients for • chance HLC (.68) and powerful other’s HLC (.61), were acceptable • Internal HLC was poor (.49).

21. DISCUSSION • Exploratory factor analysis used in this study • to confirm the three dimensions MHLC scales • This study showed • weak relationship between the items and the respective scales of MHLC, and • loaded on six factors • the factor structure of the MHLC was heterogeneous in nature. • One possible reason; • these discrepancies may be due to studied participants from • multiethnic group that comprising different socio-culture.

22. DISCUSSION • Malcarne, Fernandez and Flores (2005), • among ethnically diverse sample of college students failed to validate the construct • using confirmatory factor analysis.

23. CONCLUSION • this study demonstrated that the 3 scales of the Malay translated MHLC were not useful measure for research on the attitude relationship between behavioural responses to health promoting practices in studied population.

24. LIMITATIONS • (1) homogeneity of the studied group (by gender) limits generalizability to the larger population of Sarawak, • (2) selection bias is possible as participants were taken from a particular government health clinics and; was not involving health clinics from rural area and private clinics, and • (3) translation of the original version of MHLC scales into Malay was only by forward translation; • because of time constraint and lack of expert panel majoring in psychology in Sarawak. The second author is the only psychologist available in Sarawak who is expert in psychometric instrument. • Further research is needed for validation of the MHLC scales in more diverse populations of Sarawak and the ‘forward-backward’ procedure should be applied to obtain content validity of the Malay version of MHLC scales.

25. ACKNOWLEDGEMENTS • The authors would like to acknowledge the • Medical Ethics Committee, University Sarawak Malaysia and • Sarawak State of Health Department for reviewing and approving the research project. • The authors express their sincere gratitude to the management and staff of the • Klinik Kesihatan Jalan Masjid, • Klinik Kesihatan Tanah Puteh, and • Klinik Kesihatan Kota Sentosa, • for their cooperation during data collection.

26. REFERENCES • Collen, K. D. I. (2005). Measurement in health behaviour: Methods for research and education. CA: Jossey-Bass. • Garson, G. D. (2009). Reliability analysis: Statnotes from North Carolina University, Public Administration Program. Available from:http://faculty.chass.ncsu.edu/garson/PA765/reliab.htm [Accessed 9 November 2009] • Kamarul, I. M, Ismail, A. A. Naing, L. & Wan Mohamad, W .B. (2005). The assessment of the quality of life questionnaires. Malaysian Journal of Public Health Medicine, 5(1): pp. 51-55. • Malcarne, L., Fernadez, S. & Flores, L. (2005). Factorial validity of the multidimensional health locus of control scales for three American ethnic groups. Journal of Health Psychology, 10(5): pp. 657-667. [abstract]

27. REFERENCES • Norman, P., Bennett, P., Smith, C. & Murphy, S. (1998). Health Locus of Control and Health Behaviour, J Health Psychol , 3(2): 171-180. • Pett, M. A., Lackey, N. R. & Sullivan, J. J. (2003). Making sense of factor analysis: The use of factor analysis in instrument development in health care research. Thousand Oaks, CA: Sage. • Santos, J. R A. (1999). Cronbach’s alpha: a tool for assessing the reliability of scales. J Extension. 37(2). Available from: http://www.joe.org/joe/1999april/tt3.html. [Accessed 9 November, 2009].

28. REFERENCES • Sherif, G. (1998). Health Belief Model, Health Locus of Control, and cervical cancer screening practices of Middle Eastern elderly women in New York. Thesis (PhD). New York University. • Wallston, B.S. & Wallston, K.A. (1978). Locus of Control and Health: A Review of the Literature. Health Educ Behav; 6:107-117. • Wallston, K.A., Wallston, B.S. & Robert DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monograpghs: 6(2):160-170.

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