| HBM |
The HBM predicts health-related behaviors by focusing on the attitudes and beliefs of individuals. This model emerged in the 1950s as an application from the behavioral sciences to health problems and currently persists as the most widely recognized conceptual framework for explaining and predicting health-related behaviors by focusing on the attitudes and beliefs of individuals.66–68 |
| DAI |
The original DAI-10 included 10 questions, each with true/false answers pertaining to various aspects of the patient’s perceptions and experiences of psychiatric treatment.73 DAI-10 scoring ranges from −10 to +10 with a total score >0 indicating a positive attitude toward psychiatric medications (pharmacophilia) and a total score <0 indicating a negative attitude toward psychiatric medications (pharmacophobia). A clinimetric version of the DAI70 led us to include 8 items grouped into two subscales (positive and negative aspects of medications). |
| HLOC |
HLOC reflects patients’ beliefs about who or what is responsible for the management of their psychiatric disorder, influencing their health behaviors and consequently their mental health outcomes.78 If patients believe that their own behaviors affect whether they stay healthy, become sick, or recover from an illness, they are said to have an “internal” HLOC orientation. On the other hand, beliefs attributing causation or control of illness to agents outside of the individual – other relevant people such as doctors or family members, the environment, fate, luck, or chance – are referred to as “external”.79 Traditionally, an internally oriented patient (ie, a patient believing that control of his/her health condition and health-related outcomes is contingent on his/her own behaviors and actions) has been considered more likely to engage in healthy behavior than an externally oriented patient (outside factors such as doctors, other people, or chance determine health outcomes).80
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The MHLC-C77 is an 18-item general purpose, condition-specific locus of control self-report scale that can easily be adapted for use with any medical or health-related condition to assess individuals’ beliefs on what influences their health. It is composed of four sub-scales:
An internal locus of control subscale (internality).
Three external locus of control scales (chance, doctors, and other powerful people).
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| Psychological reactance |
Psychological reactance can be considered the emotional reaction in direct contradiction to rules or regulations that threaten or suppress certain freedoms in behavior.82 Psychological reactance theory is a commonly used framework for understanding health-care service users’ resistance to persuasive health messages such as the need for adherence to prescribed treatment.83 According to psychological reactance theory, freedom of behavior is an important, beneficial, and pervasive aspect of people’s lives; when that freedom is threatened, they become motivated to restore it.84,85 The Hong Psychological Reactance Scale86 is a 14-item self-report questionnaire developed to assess individual differences in reactance proneness, that is, individuals’ trait propensity to experience psychological reactance. Participants indicate the extent to which they endorsed each statement on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). |
