There is a paucity of hterature in relation to PC in patients with Multiple
Sclerosis (MS). Wassem (1991) refers to a study by Yabroff (1984) which
examined the relationship between PC and adjustment to the disease in 77
patients with MS and reported that mid range scores on the MHLC were
predictive of adjustment to the disease. Hahigan and Reznikoff (1985)
investigated relationships between PC and a number of variables in 60
patients with MS. They reported a negative correlation between depression
and an internal PC. They concluded from their results that PC was a stable
characteristic. This differs from the findings of work conducted by Smith
(1970) who reported changes in PC following significant events such as the
diagnosis of a disease.
A recent study (Wassem 1991) of 100 patients with MS investigated the
relationship between PC and three variables namely, knowledge of the
disease, the erqployment of self-care practices and the trajectory of MS.
The patients were recruited from a support group in one state in America.
The author hypothesised that those who were internally oriented would have
a greater knowledge and a milder course of the disease than those who were
externally oriented. Furthermore, patients who had had the disease for less
than five years would have a more external PC than those who had had MS
for longer than five years and finally that self-care practices would be
undertaken more frequently by those with an internal PC. Data was
collected using a Health Locus of Control Scale (Wallston et al 1976b), the
Disabihty Status Scale (Kurtzke 1955), and two inventories to measure self-
care practices and knowledge of MS.
Those with internal behefs had a milder form of the disease (p<0.05), a
higher level of knowledge (p=0.018) and practised more self-care activities
(p=0.037) than those with external behefs. There was no significant
difference (P=0.38) in the mean PC scores for those who had had MS for
less than 5 years compared to those who had had the disease for longer.
The trajectory slope for those with external behefs was five times longer
than for those with internal behefs.
Of particular interest was the finding that 25 years after the onset of MS,
patients were still largely able to fiilfil self-care activities. Possible
explanations for this may be that if the disease allows an individual to remain
ambulant, then they may perceive themselves as having greater personal
contol. Alternatively, it may be that it is because some individuals have a
greater belief in personal control that they remain ambulant. However a
disease specific instrument was not en^loyed to measure PC in subjects
with MS. The MHLC devised by Wallston et al (1976b), whilst the items
relate to health and illness, does not actually focus on a particular illness nor
conditions associated with disabilities. A disease specific tool is likely to
make more accurate predictions than a general instrument (Lau and Ware
1981).
Norman and Norman (1991) attenq)ted to e?q)lore the relationship between
PC in adults and progress in rehabilitation . Ninety-three subjects (45%
males and 55% females) admitted to a rehabilitation facility were recruited
and completed the MHLC scale devised by Wallston et al (1976b).
Rehabilitation progress was measured by quantifying health status using a 26
item instrument which included the following fimctions: pain, mobihty,
speech, relationships, hygiene etc. A minimum recovery of 20% was made
by 97.8% of the sanq)le. No significant relationship was reported between
rehabihtation improvement and those who beheved in chance. However of
those who demonstrated an internal PC, 44% made a complete recovery,
40% made a 90% recovery and 60.2% inq)roved by at least 80%. These
findings supported the results of earher studies that those with a behef in
personal control are more likely to be successfiil in terms of progress in
CONCLUSION
Although some discrepancies exist, a consistent theme of the research into
PC and health related behaviour, is one of internals being more likely to
employ measures to promote health, prevent illness and adopt remedial
strategies in the event of disease or disabihty. It is worth enq)hasising that
intemahty should not be seen as positive and extemahty as negative.
Intemal behefs may not always prove to be facihtative. For example, in the
person whose disease is in remission, there may be a behef in control but if a
relapse occurs intemal expectancies may make it difficult for the individual
to adjust. However, Rotter (1966, 1975) from whose social learning theory
PC was derived, emphasised that PC is only one dimension which may
influence behaviour in specific and unusual situations. He stated that an
individual's psychological situation
"plays an important role in determining which values and expectancies wih be operative at any one moment" (Rotter 1954).
Multiple sclerosis is a common demyelinating disease. Clinical symptoms
vary widely and affect many aspects of daily living. This may result in
dismptions in education, en^loyment, sexual and domestic fimctions.
Psychological distress in this group includes depression, anxiety, poor body
image and low self esteem (VanderPlate 1984). How people respond to
various disabihties, often chronic in nature, wih vary. Factors which
influence response may include the type and severity of the disabihties, the
onset and duration of the disease, the psychological state of the person and
the availabihty of a support network and perception of control.
Patients with MS may be particularly vulnerable to periods of hospitahsation
that some will believe events are dependent on external forces i.e. powerful
others, chance or fate and therefore acquire learned helplessness, unlike
others who may beheve events are contingent on their own behaviour
(Hiroto 1974). Learned helplessness has been described as a product of a
perceived lack of personal control which in turn may lead to poor
motivation, in^aired learning and a deleterious effect on the individuars
emotional state. In MS a person's condition may deteriorate even though
they are assuming responsibihty for their health by taking medication,
following exercise programmes and eating healthily.
Clinical experience would appear to suggest that whilst some patients
beheve that they are able to exert influence over their condition, others
experience a feeling of httle or no personal control. It may be that there is a
behef in control over the symptoms i.e. tiredness and stififiiess but not over
the actual disease process. An individual's perception of personal control
may have an inq)act on how they respond to disabihty. Studies have shown
that although adults who generahy have a greater perception of personal
control may initiahy deny their disabihty, later they are more likely to seek
information about their condition and adopt practices that wih have a
positive effect on health outcomes. Recommendations have been made for
the use of a situation specific instrument when investigating particular
conditions. As no such instrument was available for examining the construct
of perceived control in patients with MS it proved necessary to adapt an
existing tool for this purpose. The instrument comprised a five point Likert
type scale using nine statements expressed by patients with MS in relation to
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