Fetal Health Locus of Control Scale [FHLC-18]

Scale Description

The Fetal Health Locus of Control Scale (FHLC-18) is a psychological assessment instrument designed to evaluate pregnant women’s beliefs regarding their perceived control over fetal health outcomes. The scale examines how expectant mothers understand the relationship between their own behaviors, decisions, and lifestyle choices and the health, development, and well-being of their unborn child.

The FHLC-18 is based on the theoretical framework of health locus of control, originally introduced by Rotter (1966) and further developed through the Multidimensional Health Locus of Control model proposed by Wallston, Wallston, and DeVellis (1978). According to this theory, individuals differ in the extent to which they perceive health outcomes as being determined by their own actions (internal control) or by external forces such as chance, fate, medical professionals, or environmental factors (external control).

The scale consists of 18 items assessing maternal beliefs and perceptions related to fetal health responsibility and influence. It explores whether pregnant women believe that:

  • Their own behaviors, such as nutrition, prenatal care attendance, stress management, and health-related decisions, can positively influence fetal development.
  • External factors, such as genetics, medical conditions, healthcare providers, or uncontrollable events, play a dominant role in determining fetal health outcomes.

Participants respond to each statement using a 5-point Likert-type scale, indicating the extent to which they agree with each item. Higher scores indicate stronger beliefs regarding perceived control over fetal health, either through internal responsibility or external influences, depending on the scoring structure of the instrument.

The FHLC-18 provides valuable information regarding maternal beliefs, health-related decision-making, and psychological factors that may influence prenatal behaviors. Understanding these perceptions can assist healthcare professionals in designing targeted educational and supportive interventions during pregnancy.

Data Analysis and Applications

Data obtained from the Fetal Health Locus of Control Scale (FHLC-18) can be analyzed using quantitative statistical methods to examine maternal beliefs and their relationship with pregnancy-related behaviors and outcomes.

Descriptive Statistical Analysis

The initial analysis includes descriptive statistics such as:

  • Mean scores
  • Standard deviations
  • Frequency distributions
  • Item response patterns

These analyses provide an overview of pregnant women’s perceptions regarding their ability to influence fetal health and identify common patterns of maternal beliefs.

Scoring and Data Processing

Each FHLC-18 item is scored according to the Likert response scale:

1 = Strongly Disagree
5 = Strongly Agree

Item scores are combined to produce overall scores and, where applicable, separate dimension scores reflecting different types of health locus of control.

Possible dimensions include:

  • Internal Fetal Health Control: The belief that personal actions and maternal behaviors influence fetal health.
  • External Fetal Health Control: The belief that fetal health is primarily determined by external factors, medical professionals, genetics, or chance.

Higher internal control scores generally indicate stronger maternal responsibility and perceived influence over fetal well-being, whereas higher external control scores may indicate greater reliance on external determinants.

Reliability Analysis

The psychometric reliability of the FHLC-18 is evaluated through measures of internal consistency, primarily:

  • Cronbach’s alpha coefficient (α)

Reliability analysis determines whether the items consistently measure maternal perceptions of control over fetal health.

Separate reliability coefficients may be calculated for different subscales if the instrument demonstrates a multidimensional structure.

Correlation and Predictive Analysis

The FHLC-18 can be used to investigate relationships between maternal control beliefs and various pregnancy-related factors, including:

  • Prenatal health behaviors
  • Adherence to medical recommendations
  • Maternal anxiety and stress
  • Pregnancy-related knowledge
  • Health literacy
  • Maternal self-efficacy
  • Smoking, nutrition, and lifestyle behaviors
  • Birth outcomes

Regression analyses may be used to examine whether fetal health locus of control predicts maternal engagement in protective health behaviors during pregnancy.

Factor Analysis

The construct validity of the FHLC-18 can be examined using:

  • Exploratory Factor Analysis (EFA) to identify underlying dimensions of maternal control beliefs.
  • Confirmatory Factor Analysis (CFA) to evaluate whether the proposed factor structure adequately represents the theoretical model.

Factor analysis helps determine whether the scale appropriately distinguishes between internal and external perceptions of fetal health control.

Purpose of the Scale

The primary purpose of the Fetal Health Locus of Control Scale (FHLC-18) is to assess how pregnant women perceive their ability to influence the health and development of their fetus.

Understanding maternal control beliefs can help healthcare professionals identify:

  • Women who demonstrate strong personal responsibility for prenatal health.
  • Women who may feel powerless or overly dependent on external factors.
  • Individuals who may benefit from additional education, reassurance, or psychological support.

The FHLC-18 contributes to the understanding of how maternal beliefs influence pregnancy-related decision-making and health behaviors. By identifying differences in perceived control, professionals can develop interventions that encourage effective prenatal care practices and promote positive maternal–fetal health outcomes.

Psychometric Evaluation and Calibration

The calibration of the Fetal Health Locus of Control Scale (FHLC-18) involves systematic psychometric procedures to establish reliability, validity, and interpretive accuracy.

Content Validity

Content validity evaluates whether the items adequately represent the psychological construct of maternal perceived control over fetal health.

Expert evaluation is typically used to determine whether the scale appropriately covers important aspects of pregnancy-related control beliefs, including personal responsibility, external influences, and perceived uncertainty.

Reliability Assessment

Reliability is assessed through:

  • Cronbach’s alpha (α) for internal consistency.
  • Test–retest reliability for evaluating stability of responses over time.

High reliability values indicate that the FHLC-18 provides consistent measurement of maternal fetal health control beliefs.

Construct Validity

Construct validity examines whether the scale accurately reflects theoretical concepts associated with health locus of control.

Validation procedures may include:

  • Factor analysis
  • Correlations with related psychological constructs
  • Comparison with established health locus of control measures

Criterion-Related Validity

Criterion validity can be assessed by examining associations between FHLC-18 scores and relevant maternal behaviors or outcomes, including:

  • Prenatal care utilization
  • Healthy pregnancy behaviors
  • Maternal coping strategies
  • Psychological adjustment during pregnancy

Normative Data

FHLC-18 scores may be compared with normative data from larger samples of pregnant women. These comparisons help contextualize individual scores and identify patterns of maternal beliefs relative to similar populations.

Applications

The Fetal Health Locus of Control Scale can be applied in multiple research and healthcare contexts, including:

  • Maternal and perinatal psychology, for studying beliefs and emotions during pregnancy.
  • Obstetric and prenatal care settings, for identifying educational and support needs.
  • Health behavior research, for examining factors influencing prenatal lifestyle choices.
  • Public health programs, for developing interventions promoting maternal and fetal health.
  • Clinical counseling, for supporting women experiencing anxiety, uncertainty, or reduced confidence during pregnancy.

The FHLC-18 provides a valuable framework for understanding the psychological factors that shape maternal health behaviors and contribute to positive fetal health outcomes.

Bibliography

Lau, R. R., & Ware, J. E. (1981). Refinement in the measurement of health-specific locus of control beliefs. Medical Care, 19(11), 1147–1158.

Rubin, R. (1984). Maternal Identity and the Maternal Experience. New York: Springer Publishing Company.

Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Education Monographs, 6(2), 160–170.