Quality of Life Concepts

Secondary Health Conditions

Multidimensional Health Locus of Control- Internal Scale (MHLC-I)

Description: A measure of an individual’s belief in his/her ability to control health outcomes [1].

Format: 18 items comprise the combined-form MHLC-I. Combining the two forms (A & B) increases the alpha reliability of the scale.  Form C is designed to be "condition-specific" and can be used in place of Form A/B when studying people with an existing health/medical condition.  Like Forms A/B, Form C also has 18 items, but, instead of a single 6 item powerful "others" subs-cale, Form C has two, independent 3 item subscales:  doctors, and other people [2].

Scoring: Respondents are asked to indicate the extent to which they agree with each statement using a 6-point Likert scale.

Administration and Burden: Self-administered.

Psychometrics for SCI: From non-SCI populations, cronbach’s alpha coefficients ranging from .86 to .88 have been reported for the combined form MHLC-I [3]. Convergent and predictive validities have also been reported [1].  No psychometric data available for persons with SCI.

Languages: English.

QoL Concept: The MHLC-I is a measure of Subjective Well-Being (Self-Efficacy), which corresponds to Box E (subjective well-being; self-efficacy) of Dijker’s Model.

Permissions/Where to Obtain: Public Domain; All 3 forms and scoring instructions can be found at the MLHC Scales website at: http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm


  1. Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monographs 1978;6:160-70.

  2. Wallston KA, Stein MJ, Smith KA.  Form C of the MHLC Scales: A condition-specific measure of locus of control. Journal of Personality Assessment 1994; 63: 534-53.

  3. Cooper D, Fraboni M. Toward a more valid and reliable health locus of control scale. J Clin Psychol 1988;44:536-41.


Pain SCI Studies: One cross-sectional survey.

  1. Conant LL. Psychological variables associated with pain perceptions among individuals with chronic spinal cord injury pain. J Clin Psycho Med Settings 1998;5:71-90.

Sensitivity to Impact: Conant (1998) explored the relationships between various psychological variables and pain perceptions in persons with chronic SCI pain (N = 103) using the first two sections of the Multidimension Pain Inventory (MPI), in addition to a non-standardized study-specific questionnaire and the Multidimension Health Locus of Control - Internal Scale (MHLC-I). There was a positive correlation between trait anger and perception of pain. There was also a negative correlation between the measures of internal health locus of control and pain severity. Punishing responses from significant others to pain complaints were related to feelings of guilt and perceived pain, but the relationship was not mediated by guilt.

Suggestions for Use: Given that the MHLC-I has not been widely used in persons with SCI, its psychometric properties and clinical utility need to be determined by further research.

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