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The role of personality factors in predicting the reported physical health symptoms of Turkish college students.

Developments in health psychology and epidemiology have raised the question of how personality factors affect physical well-being. Although today's Western society bombards individuals about the importance of having a physically, mentally, and spiritually balanced lifestyle in order to maintain a healthy and longer life, it seems to have an insufficient effect on such factors as stress, substance abuse, poor diet, insufficient exercise, and eating disorders. This discrepancy highlights the importance of recognizing the influence of personality characteristics on health-related behavior and physical well-being.

Several personality factors have been found to be positively related to physical well-being (Adler & Matthews, 1994; Scheier & Carver, 1987; Steptoe, Wardle, Vinck, Tuomisto, Holte, & Wichstrom, 1994; Kobasa, Maddi, & Courington, 1981; Kobasa, 1979; Antonovsky, 1987). Among these factors are optimism, control beliefs, and sense of coherence.

Optimism and Physical Well-being

A growing interest in the power of positive thinking on health has been manifested in the literature. Scheier and Carver (1985, 1987) first used the term "dispositional optimism," defining it as an inclination to anticipate the best possible outcome; they proposed a model that viewed optimism as it relates to generalized expectancies. Their studies that sought to evaluate the relationship between physical health and optimism revealed that dispositional optimism was associated with a higher level of physical well-being. They also pointed out that individual differences in persistent dispositional optimism were linked to the absence of physical symptoms over time. In another study, Scheier et al., (1989) reported that optimistic patients who underwent coronary artery bypass surgery had a faster recovery in the hospital, a more rapid return to normal activities, and a better post-surgical quality of life. Similarly, Nelson, Kar, and Coleman's (1995) study with undergraduate university students revealed that optimism correlated with low physical symptom scores and that females reported significantly more physical symptom than did males. Results of a study by Levy and his colleague added additional evidence to the link between optimism and physical well-being (cited in Peterson & Bossio, 1991). Further, Lyons and Chamberlain's (1994) findings showed a significant relationship between optimism and health. Lai (1997) in a search on the dimensionality of the Life Orientation Test (LOT) found a negative correlation between symptom reporting and optimism for both undergraduate and working adults groups.

Control Beliefs and Physical Well-being

The literature also has suggested that individuals' beliefs about control (i.e., the extent to which one can alter the environment or oneself to render events more pleasant and or less aversive), appears to be another important personality variable that influences health status (Peterson & Stunkard, 1989; Rosalack & Hampson, 1991; Rotter, 1966, 1975, 1990; Wallston, Wallston, Smith, & Dobbing, 1987). Indeed, it seems that the sense of personal control over life events advances the sense of well-being (Thompson, 1981). Specifically, the degree to which they attribute responsibility to themselves appears to help people cope with illness (Taylor, Lichtman, & Wood, 1984).

Early work that investigated the relationship between locus of control and health has revealed a positive relationship between internal locus of control and seeking information about one's illness (Seeman & Evans, 1962) and less symptomatology (Joe, 1971). Later, Wallston, Wallston, and DeVellis (1978) developed the multidimensional health locus of control (MHLC) scale to measure expectancy beliefs related to health. Health locus of control has been studied with an assorted range of behaviors. Results have revealed that individuals who highly valued health and were internal, had more willingness to seek more illness-related information than did those with an external locus of control (cited in Wallston, Wallston, Kaplan, & Maides, 1976).

Studies that focused on preventive health behaviors indicated a positive relationship between having internal locus of control and preventive health behaviors (Dishman, Ickes, & Morgan, 1980). Similarly, Raja, Williams, and McGee (1994) found that internal locus of control was strongly associated with reports of good health. All these studies indicate that individuals with internal control orientations tend to be preventive in their orientations.

Perceived Health Competence and Physical Well-Being

Smith, Wallston, and Smith (1995) recently extended their work to health-related expectancies and health behavior with the introduction of a new concept: "perceived health competence" which was defined as "the perceptions related to exercising control over a particular problem or in a specific situation." The concept reflects an individual's perceived self-efficacy or personal competence in successfully influencing personal health outcomes. Although, at first glance, health locus of control of perceived health competence concepts seems similar, Smith, Wallston, and Smith (1995), in their comprehensive research, found no relationship between internal health locus of control and perceived health competence in an undergraduate sample. This finding indicates that the two are distinct and discrete constructs. Further, Christensen, Wiebe, Benotsch, and Lawton's (1996) research findings suggested that greater perceived health competence was advantageous for those patients with predominant confidence in the actions of their healthcare providers.

It is noteworthy that, while internal locus of control has been found to be positively associated with the maintenance of physical health, there is little information about the influence of perceptions as they relate to exercising control over a health problem (Simoni, Adelman, & Nelson, 1991). Thus, it seems crucial to include this new concept in the present study in order to investigate the role of both the outcome and efficacy expectations--in other words, perceived health competence.

Cultural and Gender Differences in Terms of Control Beliefs and Life Orientations

Research has also suggested that cultural and gender differences have an effect on beliefs about internal locus of control (Dag, 1991; Massari & Rosenblum, 1972; Shaw & Uhl, 1971), health locus of control (DeHass & VanReken, 1979; Nice, 1980; Eminson, Benjamin, Shortall, & Woods, 1996; Furnham & Kirkcaldy, 1997; Lai, 1997; Ruback, Padney, & Begum 1997) and optimism (Chang, 1996). However, a number of studies in Turkey failed to find gender differences in locus of control (Korkut, 1986; Yesilyaprak, 1988) and optimism (Aydin & Tezer, 1991) but reported cultural differences in locus of control orientation (Mocan-Aydin, 2000).

Optimism and control beliefs have been widely studied in western samples, however, these concepts still remain to be investigated with diverse cultures. In Turkey, a number of studies are investigating locus of control beliefs and their relationship to several variables (Aydin, 1993; Yesilyaprak, 1988). However, health-specific locus of control has not yet been studied with Turkish samples. Perceived health competence, on the other hand, is a new concept in the world's health literature and needs to be investigated in both the Western and other cultures.

In sum, studies generally show that positive beliefs such as optimism, hope, sense of coherence and control are related to physical well-being (Strickland, 1989). In particular, optimism has a direct positive effect on maintaining good health (Aspinwall & Taylor, 1992). Aydin and Tezer (1991) reported confirming results, which showed that there was a negative relationship between optimism and frequency of reports of health problems. Therefore it is reasonable to expect that optimism plays a role in predicting the reported physical symptoms of the Turkish students. However, the other variables included in the study appear to be more subject to cultural variation, which limits the possibility of generating such predictions.

Our study aims to investigate the role of optimism, health control beliefs, and perceived health competence in predicting frequency of reported physical illness symptoms of Turkish college students. In addition, the study addresses gender differences and attempts to understand the magnitude of the effects of optimism, health control beliefs, perceived health competence, and medical help seeking on both genders.

METHOD

Participants

A total of 345 volunteer undergraduate students (207 males and 138 females) from 37 different departments of five different colleges (i.e., Education, Humanities, Engineering, Art and Science, and Administration) of Middle East Technical University (METU) participated in the study. Of the total sample, 202 students had not consulted the medical center for the past 4 weeks for any physical or mental problems while 143 students were presently consulting the medical center for non-life-threatening illnesses such as influenza, dental problems, headache, allergy, and coughs.

Measures

Optimism. The life orientation test (LOT; Scheier & Carver, 1985) measures the extent to which individuals have positive expectancies toward life events. The LOT was originally developed by Scheier and Carver (1985) and is comprised of 4 positively worded, 4 negatively worded, and 4 filler items. Items are arranged on a 5-point Likert scale with alternatives ranging from 0 (strongly disagree) to 4 (strongly agree).

Aydin and Tezer (1991) reported that, with a sample of 50 METU and Hacettepe University students, the LOT scores correlated significantly (r = .56; p < .001) with the Beck Depression Inventory scores. The internal reliability of the scale estimated by Cronbach alpha was 0.72 and test-retest reliability was 0.77 over a 4-week interval. In addition, a separate study was carried out for the present study to obtain further evidence about the construct validity of the inventory. For this purpose, the inventory was administered to 351 Middle East Technical University students, and principal component analysis with varimax rotation was employed for the LOT scores of the subjects. Results yielded two meaningful factors with eigenvalues of 3.046 for the positively worded items and 1.347 for the negatively worded items. The two factors accounted for the 55% of the variance. The factor loadings ranged between .838 and .475. These results indicated that the factor structure of the inventory was quite similar to that of the original scale developed by Scheier and Carver (1985).

Health locus of control. The multidimensional health locus of control scale (MHLC-Form A; Wallston, Walston, & DeVellis, 1978) assesses the orientation of subjects' health locus of control beliefs. The MHLC is an 18-item, 6-point Likert-type scale which has three sub-scales, each having six items: Internality of Health Locus of Control (IHLC), Powerful Others Health Locus of Control (PHLC), and Chance Health Locus of Control Scale (CHLC).

Initially, adaptation studies of the Turkish version of the MHLC (Form A) were conducted with a different college sample of 176 (114 males and 62 females) randomly drawn from the four different colleges of METU. Factor analytic studies for the Turkish version of the scale revealed a four-factor model with eigenvalues higher than one, with factor loadings ranging between .791 and .406. These four factors accounted for 47.4% of the total variance. Results revealed an additional dimension labelled "Fate Health Locus of Control" for the Turkish version of MHLC. The emergence of this new factor in the Turkish version appeared to reflect a traditional pattern of attributing the responsibility of the person's own health to fate. The Cronbach's alpha coefficient of the Turkish version was .63 and test-retest reliability, assessed over four weeks, was r = 0.70. The Cronbach's alpha coefficients of the subscales ranged from 0.68 to 0.39 (for IHLC, 0.68; for CHLC, 0.59; for PHLC, 0.66; for FHLC, 0.39), and test-retest reliability coefficients ranged from 0.70 to 0.56 (for IHLC, 0.70; for CHLC, 0.70; for PHLC, 0.65; for FHLC, 0.56).

Perceived health competence. The Perceived Health Competence Scale (PHCS; Smith, 1995) measures the degree to which an individual feels capable of effectively managing his or her health outcomes. The instrument consists of eight items that combine both outcome and behavioral expectancies. The response alternatives are arranged on a 6-point Likert scale with alternatives ranging from 6 (strongly agree) to 0 (strong disagree).

A similar procedure that was pursued in examining the reliability and validity of MHLC was followed to obtain evidence for the validity and reliability of the Turkish version of the PHCS. The principal component analysis with varimax rotation revealed one meaningful factor with an eigenvalue above one, with factor loadings ranging between .816 and .408. This factor accounted for 44.7% of the variance. The Cronbach's alpha coefficient of the Turkish version of PHCS was 0.75 (p < .05), and test-retest reliability, assessed over four weeks, was .71 (p < .05).

Measure of physical symptoms. The number of physical symptoms the subjects experienced was measured by the Physical Symptom Checklist (PSC) borrowed from Scheier and Carver (1985) and adapted to Turkish by Aydin and Tezer (1991). Most of the symptoms on the checklist were relatively mild and included those that students might be expected to experience, such as fatigue, coughs, headaches, muscle soreness, and dizziness. The subjects were asked to indicate, on a scale of 1 (never) to 5 (very often), how frequently, if at all, they experienced the symptoms over a four-week period. The checklist contains 38 items with possible scores ranging from 38 to 190, a high score indicating frequent occurrence of the indicated symptoms. Translation studies of the PSC were carried out by Aydin and Tezer (1991) in four consecutive steps by using several judges for translating and back translating the scale which provided evidence for the face validity of the Physical Symptom Checklist.

Procedure

The data were collected in two different settings; 202 volunteer students of the sample were tested during their English classes and the remaining 143 students, seeking medical help from dermatology, dentist, surgery, biopsy, ultrasound, internal disease, and ear-nose-throat departments, were tested at the medical center of the university. The students seeking medical help were recruited as volunteers for our research project during the time they were registering for medical services. The general purpose of the study was explained to all students, with information as provided which stated that the researchers would be interested in the group results as opposed to individual results. Moreover it was explained that there were no right or wrong answers. Confidentiality and anonymity were guaranteed by using nicknames. Students were also informed as to how they could receive the research results.

RESULTS

Three separate stepwise multiple regression analyses were carried out to investigate the role of the independent variables (optimism, health control beliefs, perceived health competence, and medical help seeking) in predicting the physical symptom reporting of the male, female, and total group of students. The reason for carrying out separate analyses for males and females was to determine any differences in the pattern of the predicting variables across gender. The results of the intercorrelation matrix analyses revealed no extreme multicollinearity among the variables in all three groups. Table 1 shows the results of the multiple regression analysis employed in the PSCS of the total, male, and female group of subjects, respectively.

Life orientation, medical help seeking, chance health locus of control, and internal health locus of control variances emerged as significant predictors, explaining approximately 17.5% of the variance of the PSCS in the total sample. The first variable entered into the equation was optimism (LOT) which accounted significantly for a relatively large proportion of the variance (12.9%) of the physical symptom checklist scores (PSCS) (F (1,342) = 50.43, p < .001). The results also yielded a negative relationship between optimism and symptom reporting in the total group. The second variable entered into the equation was medical help seeking which accounted significantly for an additional 2.30% of the variance of the PSCS (F (1,341) = 9.25, p < .01). This expected result suggested that as the student group received medical help for their health problems, they reported more physical health symptoms. It appears that experiencing a health problem and consulting with a physician may have led the students to perceive themselves as being ill, which may have been reflected in their symptom reporting regardless of the severity of their health problem. The third variable entered into the equation was chance health locus of control (CHLC) scores which accounted significantly for an additional 1.30% of the variance of the PSCS (F (1,340) = 5.40 p < .05). Finally, the fourth variable entered into the equation was internal health locus of control (IHLC) scores which accounted significantly for an additional 1% of the variance of the PSCS (F (1,339) = 4.07, p < .05). The negative relationship between internal locus of control orientation and symptom reporting indicated that the more an individual believed in internal control, the fewer the reported symptoms.

As predicted, results of the stepwise multiple regression analyses revealed different patterns for males and females. Table 1 presents the results of the multiple regression analysis for the male group.

Optimism (LOT) and internal health locus of control scores appeared to be significant predictors, explaining approximately 9% of the total variance of the PSCS of the male students. Similarly, optimism scores entered into the equation as the first variable accounted significantly for 7% of the variance (F (1,205) = 15.87,p < .001). The second variable entered into the equation was the internal health locus of control (IHLC) score; its unique explanation of the total variance produced on the reported physical symptom scores was also significant (F (1,204) = 4.74, p < .05) and accounted for an additional 2% of the variance.

On the other hand, for the female group, optimism and external health locus of control scores emerged as significant predictors, explaining approximately 24% of the total variance of the PSCS of the female students. The first variable entered into the equation was the life orientation score which accounted significantly for the 18% of the variance of the PSCS of the females (F (1,135) = 28.58, p < .001). Further, the second variable entered into the equation was the chance health locus of control (CHLC) score which accounted significantly for an additional 6% of the variance of the PSCS of the female students (F (1,134) = 11.023, p < .001).

DISCUSSION AND CONCLUSION

Taken collectively, results of this study indicated that life orientation, medical help seeking, chance health locus of control, and internal health locus of control predicted the physical symptom scores of the total sample. However, variables that entered into the equation changed as a function of gender. While life orientation and internal health locus of control were the predicting variables for the symptom reports of males, life orientation and chance health locus of control emerged as the predictors of the females' symptom reporting.

The findings obtained were generally in the predicted direction. The results revealed that dispositional optimism appeared to be the most significant predictor of physical well-being of both males and females and the whole group. The negative relationship between optimism and physical symptom scores suggests that the more the students displayed dispositional optimism, the less physical health symptoms were reported. This finding was consistent with those of previous studies (Aydin & Tezer, 1991; Hamid, 1990; Scheier & Carver, 1985; Smith, Pope, Rhodewalt, & Poulton, 1989).

The results also indicated that experiencing health problems and being treated by a doctor appeared to encourage students to report more physical health symptoms. This expected result may suggest that experiencing a health problem and consulting by a physician may lead the students to perceive themselves as being ill, which may be reflected in their symptom reporting even though their health problems were not severe. Finally, internal health locus of control appeared to be a predicting factor for the physical symptom reporting of the total group. This result was also in the predicted direction and consistent with research that found a relationship between internal locus of control and physical well-being and taking preventive health steps that enhance the quality of health status (Duffy, 1987; Raja, Williams, & McGee, 1994; Wallston, Walston, & DeVellis, 1978; Vandervoort, Luis, & Hamilton, 1997).

The present study also reveals that having internal health locus of control appeared to contribute to the well-being of the males but not to the females. These results indicated that females seemed to perceive their health problems as occurring by chance, while this did not appear to be a significant predictor of the reported physical symptoms of the males. These results indirectly support the findings that males display more internal orientations than do females in their health-related behaviors (Buckelew, Shutty, Hewett, Londan, Morrow, & Frank, 1990; Furnham & Kirkcaldy, 1997; Herman & Lester, 1994; Steptoe, Wardle, Vinck, Tuomisto, Holte, & Wichstrom, 1994).

The negative relationship between physical symptom reporting and dispositional optimism showed that the more male and female students manifested dispositional optimism, the less physical symptom was reported by both sexes. Similar to that of the total group, this result was consistent with the findings obtained in a previous study carried out with the Turkish university students. Indeed, Aydin and Tezer (1991) found a negative association between reported physical health symptoms and dispositional optimism, but this relationship did not vary as a function of gender. Consistent with this finding, the result of the present study did not imply a gender difference, but suggested that optimism was an important factor in predicting the physical well-being of the students regardless of gender.

This study points out the importance of optimism and health locus of control in understanding the physical well-being of both male and female Turkish college students.

Some limitations of the study should be noted. Specifically, self-reports of symptoms are imperfect measures of underlying physiological events. Moreover, presentations of physical symptoms may well reflect other possible contributing factors--genetic, cognitive, cultural, and environmental.

It appears that the most significant implication of our study is the positive contribution of dispositional optimism in maintaining physical well-being. This finding may indicate that optimism is a significant variable in enhancing health in diverse cultures. Relevant to the counselors' positive asset search technique, this finding also implies that positive orientations associated with good health may need to be supported by health or counseling practitioners. In particular, counselors should serve as role models in this regard.

Further, results of this study add emphasis to the view that an increase in internal health locus of control beliefs may reduce the risk of poor health and identifying particular health beliefs may be valuable in motivating individuals to participate in preventive behaviors. One important strategy in managed health care may be to alter orientations toward internal locus of control. However, the literature does not suggest a specific method for control of beliefs; rather the recommendation is to help individuals identify their thoughts and encourage them to participate actively regarding their health (Buckelew, Shutty, Hewett, Londan, Morrow, & Frank, 1990).

A cultural implication of the findings of our study relates to the factor structure of the Multidimensional Health Locus of Control Scale. The factor analytic study of the Turkish version of the scale revealed a fourth dimension labeled "Fate." This dimension appears to reflect a culture-specific belief about health issues. Further research on diverse cultures would be beneficial in clarifying the cross-cultural differences in the psychometric properties of this instrument.

To conclude, we think that our study, for both researchers and practitioners dealing with health issues, points out the significant role of personality variables in maintaining physical health. We also think that our findings provide further evidence for the need for a holistic approach (Lewis, Sperry, & Carlson, 1993) and suggest the need of a biopsychosocial perspective (Schwartz, 1982, cited in Lewis, Sperry, & Carlson, 1993) in counseling that acknowledges the biological, social, and psychological components of all aspects of well-being.

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Affiliation of authors: Sense-West, Virmingham, United Kingdom, Middle East Technical University, Ankara, Turkey.

Send reprint requests to authors at 10 Bishopton Rd., Smethwick, B 67 5DS West Midlands, Birmingham, UK. Email: meltemub@hotmail.com
Table 1
Stepwise Regression Analysis for Variables Predicting Physical
Symptoms

 [R.sup.2]
Variable [R.sup.2] Change F df1 df2

Total (N = 345)
 LOT .129 .129 50.429 1 342
 MHS .152 .023 9.251 1 341
 CHLC .165 .013 5.399 1 340
 IHLC .175 .010 4.073 1 339
Males (n = 207)
 LOT .072 .072 15.872 1 205
 IHLC .093 .021 4.745 1 204
Females (n =138)
 LOT .175 .175 28.583 1 135
 CHLC .237 .062 11.023 1 134

Variable Sig. F [beta]

Total (N = 345)
 LOT .000 -.308
 MHS .003 .129 *
 CHLC .021 .111
 IHLC .044 -.103 *
Males (n = 207)
 LOT .000 -.246 *
 IHLC .031 -.147 *
Females (n =138)
 LOT .000 -.401 *
 CHLC .001 .251 *

Note. LOT = Life Orientation Test; MHS = Medical Help Seeking;
CHLC = Chance Health Locus of Control; IHLC = Internal Health
Locus of Control.

* p < .05
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Author:Ustundag-Budak, Meltem; Mocan-Aydin, Gul
Publication:Adolescence
Geographic Code:1CANA
Date:Sep 22, 2005
Words:5252
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