Theofilou and Saborit, J Psychol Psychother 2012, S:3
http://dx.doi.org/10.4172/2161-0487.S3-e002
Psychology & Psychotherapy
Research
Editorial Article
Health Locus of Control and Diabetes Adherence
Paraskevi Theofilou1,2,*, and Aymara Reyes Saborit3
1
Panteion University, Department of Psychology, Athens, Greece
2
General Hospital “Sotiria”, Athens, Greece
3
University of Oriente, Department of Psychology, Santiago, Cuba
Adherence has been defined as the degree to which a patient’s
voluntary behaviour corresponds with the clinical recommendations
of health care providers [1] and suggests that patients are self-sufficient
individuals who assume an active and voluntary role in defining and
achieving goals for their medical treatment [1-5].
Adherence is a multi-dimensional element of well-being affected by
health-related quality of life (HRQoL) and specifically by the physical,
mental, emotional and social status of patients [6-8]. Adherence
as well as HRQoL issues is emerging as an important outcome in
chronic disease studies, like chronic heart failure [9], end-stage renal
disease and maintenance dialysis [10-22], kidney transplantation
[23], Alzheimer [24], multiple sclerosis [25], Parkinson’s disease [26],
rheumatoid arthritis [27], systemic lupus erythematosus [28], chronic
obstructive pulmonary disease [29], breast cancer [30], pancreatic
cancer [31], obesity [32] or hypertension [33]. This growing interest on
the part of the scholars towards adherence issues has also characterized
the scientific community dealing with the assessment of adherence in
patients with diabetes.
The diabetes regimen is extremely complex [34] and it is generally
accepted that a patient with a more complex regimen is less likely
to be adherent than a patient with a less demanding regimen [35].
It is crucial that individuals with diabetes follow a strict treatment
regimen in order to maintain control over their blood sugar. This
regimen includes maintaining a proper diet, engaging in regular
physical activity or exercise, blood glucose monitoring, and taking
any prescribed medications [36]. The high incidence of complications
in individuals with diabetes indicates that adherence to the diabetes
regimen is an eminent problem. According to Glasgow and Anderson
[37], many studies have documented that diabetes adherence is not
a unitary construct and in fact varies across different components of
the regimen. Therefore, relationships between adherence and other
variables may not be observed when using a unitary measure of self -
management behaviours [38].
Health Psychology offers a number of models that seek to help
us understand the factors that influence an individual’s adherence to
a medical regime. One such model is Leventhal and colleagues’ self-
regulatory model (SRM), which suggests that health locus of control
factors influence a range of illness coping behaviors and outcomes
among people experiencing illness or disease. This related concept
of patient self -management involves patients in the assessment,
care planning collaborative problem solving and decision making to
manage kidney disease and treatment, including medications [16]. An
individual with internal locus of control may be more willing to follow
treatment recommendations as he or she believes the path of disease
progression may be controlled via personal ability and action; action
in this sense referring to adherence [16]. The positive reinforcement
maintaining behaviour is derived from the belief that hard work and
ability leads to desired positive outcomes [16]. In contrast, individuals
who believe that their fate is determined largely by chance or by other
persons and not by their own actions may less likely to adhere to
J Psychol Psychother Adherence to Chronic Disease
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therapy, because they feel that their actions may not appreciably affect
outcomes [16]. These individuals would attribute advances or declines
in health to natural remission or progression of disease.
The health locus of control theory is used to assess adherence to
diabetes regimen in some studies. According to Rodin [39], an individual
with high perceived control may have better health because he or she is
more likely to take health-enhancing actions. This would suggest that
enhancement of an individual perceived control over his or her health
may lead to improved personal health. In particular, individuals with
diabetes may adhere more closely to their regimen if they experience
an increase in perceived or internal locus of control. Indeed, research
that has examined the relationship between perceptions of control and
adherence to the diabetes regimen has found supporting evidence for
the relationship between these two variables. In a study, Macrodimitris
et al. [40] examined the relationship between perceived control and
HbA1c levels in 115 individuals with type 2 diabetes. Results indicated
that perceived control was negatively related to HbA1c levels. Therefore,
high-perceived control has a beneficial effect on individuals with type
2 diabetes, as demonstrated by lower HbA1c levels. It was concluded
that one’s perception of control over his or her condition is a good
indicator of whether or not that individual will actually exhibit control
over his or her condition. A study conducted by Surgenor et al. [41]
investigated the relationship between sense of control and metabolic
control in 96 females with diabetes. Results were similar to those from
Macrodimitris et al. [40]. Those participants that had optimal HbA1c
levels had significantly higher levels of sense of control in all three
domains than those with poor HbA1c levels.
Theofilou [16] has indicated that in a sample of patients undergoing
haemodialysis or peritoneal dialysis treatment, internal health beliefs
may help the patients to face their problems related to end-stage renal
disease and evaluate in a positive way their HRQoL as well as the status
of general health, showing better psychological health and less somatic
symptoms [16]. On the other hand, focusing on important others’
control and responsibility over one’s condition seems to indicate
depressive mood [16].
The above studies demonstrate the importance of understanding
health locus of control in patients with chronic diseases as well as the
contribution to adherence and HRQoL. This suggests potential for
investigating whether individually based or group based interventions
*Corresponding author: Paraskevi Theofilou, Panteion University, Department of
Psychology, Athens, Greece, E-mail: theofi@otenet.gr
Received January 16, 2012; Accepted January 20, 2012; Published January 23,
2012
Citation: Theofilou P, Saborit AR (2012) Health Locus of Control and Diabetes
Adherence. J Psychol Psychother S3:e002. doi:10.4172/2161-0487.S3-e002
Copyright: © 2012 Theofilou P, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
ISSN: 2161-0487 JPPT, an open access journal
Citation: Theofilou P, Saborit AR (2012) Health Locus of Control and Diabetes Adherence. J Psychol Psychother S3:e002. doi:10.4172/2161-0487.
S3-e002

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