B Stawarz¹,D, M Lewicka 2,A, M Sulima 2,B, I Brukwicka¹,E, H Wiktor 2,F

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1 JOURNAL JOURNAL OF OF PUBLIC OF PUBLIC HEALTH, HEALTH, NURSING NURSING AND AND AND MEDICAL MEDICAL RESCUE RESCUE RECUE No.1/2013 No.1/2013 (1) (20-24) 20 Health locus of as perceived by students in Podkarpacie province (Umiejscowienie kontroli zdrowia w ocenie studentów województwa podkarpackiego) B Stawarz¹,D, M Lewicka 2,A, M Sulima 2,B, I Brukwicka¹,E, H Wiktor 2,F Abstract Introduction. The development of civilisation and rapid urban, technological and information-related changes are connected to the changes of people s lifestyle in well-developed societies. Young people are often insufficiently interested in their health and make no attempts to protect it. Finding out what students think about health is important because of the role their opinion plays as far as their health-related behaviour is concerned. The purpose of the paper was to estimate the health locus of among the students residing in the Podkarpacie province. Materials and methods. The study involved 690 students from the Podkarpacie province. The interviews were conducted using an original questionnaire and a standardized research tool the Multidimensional Health Control scale (MHLC) was used. The results obtained were statistically analysed. Results. The general analysis of the MHLC in the studied group of students has shown that the mean value of internal health locus of was 2,0 points and exceeded the mean powerful (18,28 points) and chance scores (18,21 points) in the studied group of students. Conclusions. The majority of students indicate an internal health locus of. Age and sex have no influence of the health locus of in any of the three dimensions. The university and major are significant as far as students health locus of is concerned, especially in the cases of powerful and chance loci. Internal health locus of and the awareness of the effectiveness of one s actions are relevant influences on assuming health-oriented attitudes by students. Therefore it is important to popularize the knowledge on health promotion and preventive care, for instance as elective courses at all kinds of universities. Key words - health, health locus of, student. Streszczenie Wstęp. Rozwój cywilizacji, dynamika zmian urbanizacyjnych, technologicznych i informacyjnych wiąże się ze zmianami w sposobie i stylu życia ludzi w społeczeństwach rozwiniętych. Ludzie młodzi okazują zbyt małe zainteresowanie zdrowiem, jego ochroną i wzmacnianiem. Poznanie poglądów studentów na temat zdrowia jest istotne ze względu na rolę, jaką odgrywają one w kształtowaniu zachowań związanych ze zdrowiem. Celem pacy było określenie poziomu umiejscowienia kontroli zdrowia wśród studentów województwa podkarpackiego. Materiał i metody. Badaniami objęto 690 studentów z województwa podkarpackiego. Badania przeprowadzono z zastosowaniem ankiety własnego autorstwa oraz standaryzowanego narzędzia badawczego - Wielowymiarowej Skali Umiejscowienia Kontroli Zdrowia (MHLC). Uzyskane wyniki badań poddano analizie statystycznej. Wyniki. Analiza ogólna wyników badania umiejscowienia kontroli zdrowia (MHLC) w grupie badanych studentów wykazała, że średnia wartość wewnętrznego umiejscowienia kontroli zdrowia wynosiła 2,0 punktów i była większa aniżeli średnia wartość (18,28 punktów) wpływu innych oraz przypadku (18,21 punktów) w grupie badanych studentów. Wnioski. Studenci przejawiają w większości wewnętrzne umiejscowienie kontroli zdrowia. Płeć i wiek nie warunkują umiejscowienia kontroli zdrowa w żadnym z trzech wymiarów. Uczelnia i kierunek studiów mają istotny wpływ poziom umiejscowienia kontroli zdrowia wśród studentów, zwłaszcza w zakresie wpływu innych lub przypadku. Wewnętrzne umiejscowienie kontroli zdrowia, poczucie własnej skuteczności, pozostają nie bez znaczenia na podejmowanie zachowań prozdrowotnych przez studentów. Dlatego istotne jest popularyzowanie wiedzy z zakresu promocji zdrowia i profilaktyki na przykład w ramach zajęć fakultatywnych we wszystkich typach uczelni. Słowa kluczowe - zdrowie, kontrola zdrowia, student. Author Affiliations: 1. The Bronisław Markiewicz State School of Higher Technical and Economical, Jarosław, 2. Department of Obstetrics, Gynecology and Obstetrical- Gynecological Nursing Faculty of Nursing and Health Sciences, Medical University, Lublin. Authors contributions to the article: A. The idea and the planning of the study B. Gathering and listing data C. The data analysis and interpretation D. Writing the article E. Critical review of the article F. Final approval of the article

2 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (1) 21 Correspondence to: Dr Barbara Stawarz The Bronisław Markiewicz State School of Higher Technical and Economical, Jarosław, Ostrów 109, PL-37-0 Radymno, Poland, T I. INTRODUCTION he development of civilisation and rapid urban, technological and information-related changes are connected to the changes of people s lifestyle in well-developed societies. Young people are often insufficiently interested in their health and its protection. An important and yet difficult task before health education is to make young people realize that it is in their power to change their lifestyles and health behaviour [1,2,3]. One of the objectives higher education institutions have to bear in mind is to propagate the benchmarks of health-oriented behaviour of students. Graduates, often finding themselves in leading positions in various aspects of social life, greatly contribute to the shaping of people s attitudes towards health [4]. Finding out what students think about health is important because of the role their opinion plays as far as their healthrelated behaviour is concerned. Health behaviour can change within a lifetime and often within the course of studying as well. As reported in literature, the young people who begin their studies usually have positive ideas about health behaviour, often thanks to their parents, schools and mass media. Yet, in order to fit in an academic environment, students often assume common customs, neglecting health-oriented behaviour in favour of negative habits []. Defining the level of health locus of is an important factor in assessing higher education students health-oriented awareness. What is more, it is helpful in planning the actions aimed at encouraging students to assume the desired model of behaviour. The purpose of the paper was to estimate the health locus of among the students residing in the Podkarpacie province. II. MATERIALS AND METHODS The research involved 690 students from Podkrpacie province, studying at the following schools: 1. The State Higher Vocational School in Krosno (n=223; 32,32%), 2. The Bronisław Markiewicz State Higher School of Technology and Economics in Jarosław (n=117; 16,96%), 3. The East European State Higher School in Przemyśl (n=17; 22,7%) and 4. Rzeszów University of Technology (n=193; 27,97%). The Bioethics Committee of the Medical University of Lublin approved the study. All of the interviewees consented voluntarily to fill in the questionnaire after they were informed that the results would be used for scientific purposes only and their anonymity is guaranteed. The questionnaire was composed of an original survey, prepared in order to be able to characterize the interviewed students as well as standardized research tools - the Multidimensional Health Control scale (MHLC) by Kenneth A. Wallston, Barbara S. Wallston and Robert DeVellis (adapted to Polish by Zygfryd Juczyński) [6]. The Multidimensional Health Control Scale (MHLC) allows to separate the interviewed into groups according to the locus of over health as perceived by each person. MHLC is a self-descriptive tool including 18 statements in three dimensions of the over one s health: internal (I) the over my health is dependent on myself, powerful (O) my health is dependent on the influence of, especially medial staff, chance (C) health is dependent on chance and other external factors. The interviewed express their attitude towards the presented statements by means of a 6-grade scale: from strongly disagree (1 point) to strongly agree (6 points). The results obtained are calculated separately for each of the three scales (they are added up). Therefore, the result range in each of the scales is 6-36 points; the higher the score, the stronger the belief that a given factor influences health. The normalized scores are the basis for comparisons. The reliability of MHLC in the Polish version calculated using Cronbach s alpha is 0,74 for the internal (I), 0,69 for chance (C) and 0,4 for powerful (O). The results obtained were analysed statistically. The significance level of p<0,0 was assumed to indicate statistically significant differences and correlations. The database and statistical analysis were prepared using STATISTICA 9.0 software (StatSoft, Poland). III. RESULTS Table 1 presents the general analysis of the findings of the research on health locus of among the tested students.

3 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (1) 22 Table 1. Mean values of the MHLC scale in the studied group of students The study has shown that the mean value of internal health locus of was 2,0 points and exceeded the mean value (18,28 points) of powerful and chance (18,21 points) in the studied group of students. On the basis of the results obtained it was observed that the interviewed group perceived the health locus of as predominantly internal. The analysis of the correlation between the health locus of (MHLC) and sex, age and a subjective health estimation of the students under research was presented in Table 2. Table 2. The correlation between the health locus of (MHLC) and sex, age and a subjective health estimation of the students under research Internal 2,01 4,89 Women Men Statistical analysis M SD M SD t P 18,39,3 Chance 18,13,62 2,1 17,9 8 18,4 2, 0,32 0,7,0-0,88 0,38,93 0,60 0, up to 21 y.o. 21 y.o. over 21 Statistical M SD M SD M SD analysis 24,7 2 4,94 24,82,27 F=1,77; p=0,17 18,29,3 18,2 4,37 18,32,71 F=0,01; p=0,99 18,3, 18,24,86 F=0,1; p=0,86 Internal 2,1,01 Chance 18,07,72 very good / good average poor / very poor M SD M SD M SD Internal 2,30 4,83 2,0 6,01 24,60,67 M Min Max SD Internal 2,0 6,00 36,00,071 18,28 6,00 34,00,23 Chance 18,21 6,00 36,00,701 18,39,6 Chance 18,40,7 18,1 17, 8 Statistical analysis F=0,66; p=0,00003,36 18,61,92 F=0,74; p=0,48, 20,20 6,01 F=17,88; p<0, As the analysis of the authors research implies, the mean value of internal health locus of in the studied group of male students was 2,1 and exceeded that of female students, which amounted to 2,01 points. The mean value of powerful was 18,39 points in the studied group of female students, which was more than in the case of men (17,98 points). Meanwhile the mean value of the chance locus of was higher in the case of men (18,42 points) than that of women (18,13 points). In the course of statistical analysis, no statistically significant differences pertaining to the locus of dimensions were found (p>0,0). What is more, the research indicates that the mean value of the internal locus of among the interviewed students of no more than 20 years old was 2,1 points, while it amounted to 24,72 points in the age group of 21 and to 24,82 points above 21 years of age. At the same time, the mean value of powerful locus was 18,29 points in the group of no more than 20 years of age, 18,24 points among the interviewed who were 21 years old and 18,32 points in the age group above 21. Finally, the mean value of the chance locus of was higher in the group of exactly 21 years of age (18,3 points) than in the group below 21 (18,07 points) and over 21 (18,24 points). No statistically significant differences between the dimensions of the health locus of were observed (p>0,0). On the basis of the research conducted it was noted that the mean value of internal locus of among the students under research who rated that their health as very good or good was 2,30 points and was higher than in the case of students who claimed they were of average health (2,06 points) and those who perceived their health as poor or very poor (24,60 points). This difference did achieve the level of statistical significance (p<0,00003). Table 3 presents the correlation between the health locus of (MHLC) and the university and major of the students Rzeszów University of Technology East European State Higher School in Przemyśl The Bronisław Markiewicz State Higher School of Technology and Economics in Jarosław State Higher Vocational School in Krosno M SD M SD M SD M SD Internal 24,76 4,89 24,94,27 2,11 4,83 2,3,22 17,0,43 17,84,0 19,03,11 18,88,74 Chance 18,8,36 17,88 6,00 16,68 4,68 18,69 6,11 technical medical humanities management M SD M SD M SD M SD Internal 2,23,91 2,37,0 2,17 4,92 24,72 4,84 19,61,99 18,9,29 17,74,31 17,88,4 Chance 18,79 6,0 16,48 4,79 18,12,88 19,1,79

4 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (1) 23 On the basis of the research, it was observed that the mean value of internal health locus of among the participants studying at the Rzeszów University of Technology was 24,76 points, for the East European State Higher School in Przemyśl it was 24,94 points, for the students of the Bronisław Markiewicz State Higher School of Technology and Economics in Jarosław it amounted to 2,11 points and finally for those attending the State Higher Vocational School in Krosno it was 2,3 points. These differences were not statistically significant (p>0,0). What is more, the findings of the study indicate that the mean value of the internal locus of in the group of medical students was 2,37 points, which was a higher score that that obtained in the group of technical students (2,23 points), humanities students (2,17 points) and management students (24,72 points). That difference was not statistically significant, either. IV. DISCUSSION Health locus of is basically a belief in the ability or inability of influencing one s health. It has significant impact on one s health behaviour. It is believed that the internal health locus of is advantageous as far as health-oriented behaviour is concerned. People who claim the health locus of is internal usually make health-related decisions independently, more often undertake preventive actions aimed at improving and retaining health and have a greater sense of responsibility for their condition [6]. The results of the original research indicate that the selected group of students (both male and female) was dominated by those who perceive health locus of as internal, which means those people are more aware of their responsibility for their own health. The mean value of the internal health locus of was 2,0 points and was higher than the value of powerful (18,28 points) and chance (18,21 points). The mean values of the Multidimensional Health Control in the research are close to those obtained by Naszydłowska et al. [7,8] and those obtained in Polish studies [6]. On the basis of their research, Naszydłowska et al. [7] observed that students health locus of was exclusively internal (MHLC M=28,61). It is also worth noticing that in their opinion, chance (M=1,6) had something to do with their health less frequently than powerful (18,76). Similar results were obtained by Naszydłowska et al. [8] in the research of 200. The majority of the students interviewed by the authors had internal health locus of (women M=28,3; men M=28,39). Both men and women believed that their health is predominantly dependent on themselves rather than powerful (women M=17,32; men M=19,18) or chance (women M=1,91; men M=16,72). The Polish studies, in which 97 students participated, showed that the health locus of is mostly internal [6]. (M=18,76) and chance (M=1,6) were less significant in numbers. In his study of the correlation between health locus of and age, Juczyński [6], observed that people aged between 18 and 2 were mostly inclined to believe in internal health locus of (MHLC M=28,). Similar results were obtained by Łukasik [9] the mean value of internal health locus of (MHLC) was 22,66 points. In the study of Mojs et al. [10], the the mean value of internal health locus of was 27,67 points. The results obtained by all other authors remain consistent with the findings of the authors of the present paper, in which internal health locus of was dominant in the age group up to twenty (M=2,1), in the 21 age group (M=24,72) and over 21 age group (M=24,82). Czarnecka and Cierpiałkowska [11] observed on the group of 80 students attending different universities in Poznań that people who perceived health locus of as internal got lower scores in relation to external locus of (chance). Similar results were obtained by Penar Zadarko et al. [12]. 47 students of higher education institutions based in the Podkarpackie region participated in their research. Internal health locus of was predominant. Age, sex and major were factors conditioning the internal health locus of in the studied group of students. The mean value of the internal health locus of among women was 27 points and was significantly lower (p=0,0007) than the 29 points obtained in relation to men. Meanwhile the mean value of MHLC was 28 points in the age group of 19 to 20 and was significantly higher (p=0,0047) than the 27 points obtained in the group over 20 years of age. The mean value of MHLC in the group of nursing students was 27 points and was significantly lower (p=0,0032) than the mean of 28, points obtained among the students of obstetrics. On the basis of the findings of the present research it was observed that age, sex and major did not modify (p>0,0) internal health locus of. The results of this study are not consistent with the findings of Penar Zadarko at al. [12]. As the research by Kolarczyk et al. [13] indicates, 36,1% of the students under research claimed their health was very good, 0,0% stated in was good, for 13,1% their health was not good and for 0,8% it was poor. In the study of the authors, 26,38% of students claimed to have very good health, 7,83% claimed to have good health, while 13,91% assessed their health as average and 1,8% claimed it was poor. The subjective health assessment of the students who participated in the research was significant as far as the internal locus of is concerned, as it was in the case of those who claimed their health was good or very good than those who assessed their health as poor or very poor. Meanwhile the chance locus of was higher in the case of students who claimed their

5 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RECUE 2013 (1) 24 health was poor or very poor than in the case of those who claimed they were of average health. V. CONCLUSIONS 1. The health locus of as perceived by students is predominantly internal. 2. Age and sex do not impact the health locus of in any of the three dimensions. At the same time, the subjective health self-assessment is significant as far as the level of internal health locus of is concerned; it was higher among students who perceived their health as very good or good than in the group who thought to be of poor and very poor health. 3. The university and major significantly influence students health locus of, especially as powerful or chance dimensions are concerned. 4. Internal health locus of and self-efficacy have an impact on students health-oriented behaviour. Therefore it is important to popularize the knowledge on health promotion and preventive care, for instance as elective courses at all kinds of universities. promujące zdrowie studentów. Annales UMCS 200; LX, suppl. XVI, 349: [9] Łukasik IM. Predykatory zachowań zdrowotnych. Annales UMCS 2003 ; LVIII, suppl. XIII, 14: [10] Mojs E, Wójciak RW, Kleka P. Umiejscowienie kontroli zdrowia a palenie tytoniu u młodych dorosłych. Prz Lek 2006; 63, 10: [11] Czarnecka M, Cierpiałkowska L. Naukowe subiektywne koncepcje zdrowia i choroby wśród studentów i ich determinanty. Now Lek 2007; 76, 2: [12] Penar Zadarko B, Zadarko E, Binkowska Bury M, Januszewicz P. Rozpowszechnienie palenia tytoniu wśród studentów a umiejscowienie kontroli zdrowia. Prz Lek 2009; 66, 10: [13] Kolarczyk E, Łyszczarz J, Jaworska Szyc J. Samoocena stanu zdrowia oraz stanu psychicznego studentów Wydziału Lekarskiego CMUJ w Krakowie. Prz Lek 2003; 60, 6: VI. REFERENCES [1] Kiełbasiewicz Drozdowska I, Pluta B, Wiza A. Prozdrowotny styl życia w samoocenie studentów. Część I. Ocena zachowań prozdrowotnych. Annales UMCS 200; LX, suppl. XVI, 199: [2] Kiełbasiewicz Drozdowska I, Pluta B, Wiza A. Prozdrowotny styl życia w samoocenie studentów. Część II. Rangowanie elementów prozdrowotnego stylu życia. Annales UMCS 200; LX, suppl. XVI, 200: [3] Buławska K, Talaga S, Lubiąska Żądło B. Analiza zachowań zdrowotnych wśród młodzieży studiującej pielęgniarstwo i fizjoterapię. Zdr Publ 200; 11, 3,: [4] Binkowska Bury M, Hejda G, Januszewicz P. Czynniki sytuacyjne a zachowania związane ze zdrowiem wśród studentów. Med Og 2009; 1, 1: [] Jopkiewicz A, Markowska M, Przychodni A. Charakterystyka zachowań zdrowotnych studentów WSP w Kielcach. Mierniki zachowań zdrowotnych. Warszawa; Wyd. IGNIS, [6] Juczyński Z. Narzędzia pomiaru w promocji i psychologii zdrowia. Warszawa; Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego [7] Naszydłowska E, Kozieł D, Trawczyńska M. Ocena zachowań zdrowotnych młodzieży oraz ustalenie kierunków ich modyfikacji. Annales UMCS 2003; LVIII, Supl. XIII, 169: [8] Naszydłowska E, Krawczyńska J, Kozieł D, Czerwiak G, Trawczyńska M. Wartościowanie zdrowia, a zachowania