Impact of health locus of control (HLoC) on diabetes self-management : a systematic review

Background: Health Locus of Control (HLoC), and health beliefs in general, have been found to play a role in the way in which people manage their healthcare needs. Increasingly, patients are being encouraged to self-manage a variety of health conditions, including chronic physical health conditions, such as diabetes, and mental health conditions, such as depression and anxiety. However, evidence regarding which factors might be related to response to self-management is limited. HLoC may help to explain why some take well to the self-management of health conditions, or respond to recommended remote therapies, whereas others struggle to implement advised changes. Similarly, attitudes towards eHealth (AteH) may play a role in engagement with specific remote therapies. Aims & Objectives: The current thesis project aims to consolidate the existing research into the relationship between HLoC and diabetes self-management by conducting a systematic review of the literature (chapter 1), before exploring the concept of HLoC and AteH as potential predictors of response to computerised Cognitive Behavioural Therapy (cCBT), as defined by uptake (starting treatment), adherence (extent to which treatment is completed), and clinical outcome (magnitude of symptom reductions) in chapter 2. Methodology: In chapter 1, a systematic review of the literature was conducted across three electronic databases (PsychINFO, Ovid MEDLINE, and Embase) to examine and critically appraise the literature regarding the relationship between HLoC and adherence to diabetes self management. Studies included research investigating diabetes self-management in relation to HLoC. In chapter 2, a longitudinal study with three major time-points was conducted across N=2130 patients accessing cCBT services in Scotland to individually explore predictors of uptake, adherence and clinical outcomes. Results: N=17 studies were identified and critically reviewed using the AXIS tool in chapter 1. Most were deemed to be of good methodological quality, with a small number of exceptions. The review revealed that the majority of studies found evidence to suggest that stronger internal HLoC beliefs were associated with better adherence to diabetes self-management regimens, however inconsistencies were found across certain HLoC domains, and the heterogeneity of predictor and outcome measures posed a challenge to inter-study comparisons. In chapter 2, neither of the healthcare belief-related factors were found to significantly predict uptake in cCBT services, however both HLoC and AteH predicted higher adherence to cCBT, and various HLoC domains predicted magnitude of clinical changes across treatment. Other significant sociodemographic and clinical predictors of adherence and reductions were found and discussed. Conclusions & Clinical Implications: Chapter 1 concluded that stronger internal HLoC beliefs are positively related with adherence to diabetes self-management regimens, which may improve health outcomes for those self-managing diabetes. However, further research is needed to apply causality to this model. Chapter 2 demonstrated interesting insights into the theoretical factors predicting response to cCBT, which may help inform clinicians in making referrals to the service.