what is locus of the study in research

Locus of Control Theory In Psychology: Definition & Examples

Gabriel Lopez-Garrido

Undergraduate at Harvard University

Political Science and Psychology

Gabriel Lopez-Garrido is currently in his final year at Harvard University. He is pursuing a Bachelor's degree with a primary focus on Political Science (Government) and a minor in Psychology.

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Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Take-home Messages

• The term ‘Locus of control’ refers to how much control a person feels they have in their own behavior. A person can either have an internal or external locus of control (Rotter, 1954).
• People with a high internal locus of control perceive themselves as having much personal control over their behavior and are, therefore, more likely to take responsibility for their behavior. For example, I did well on the exams because I revised extremely hard.
• In contrast, a person with a high external locus of control perceives their behaviors as a result of external influences or luck – e.g., I did well on the test because it was easy.
• Research has shown that people with an internal locus of control tend to be less conforming and obedient (i.e., more independent). Rotter proposes that people with an internal locus of control are better at resisting social pressure to conform or obey, perhaps because they feel responsible for their actions.
• Locus of control is an important term to know in almost every branch of the psychology community. This is mainly because it can be applied in many aspects of daily life; whether the locus is external or internal, it will – by definition – affect your mind, body, and even actions.
• Fields like educational psychology, clinical psychology, and even health psychology have all made strides in researching the phenomenon to understand more about how one can control or improve one’s locus of control.
• Experts in the field of psychology often disagree with each other regarding whether differences should be attributed based on cultural differences or whether a more worldwide measure of locus of control will be more helpful when it comes to practical application.

Internal vs. External Locus of Control

Locus of control is how much individuals perceive that they themselves have control over their own actions as opposed to events in life occurring instead because of external forces. It is measured along a dimension of “high internal” to “high external”.

The concept was created by Julian B. Rotter in 1954, and it quickly became a central concept in the field of personality psychology.

An individual’s “locus” (plural “loci”) is conceptualized as internal (a conviction that one can handle one’s own life) or external (a conviction that life is constrained by outside factors which the individual can’t impact or that possibility or destiny controls their lives). There is a continuum, with most people lying in between.

A high internal perceive themselves as having a great deal of personal control and therefore are more inclined to take personal responsibility for their behavior, which they see are being a product of their own effect. High external perceive their behavior as being caused more by external forces or luck.

It is also worth mentioning that the term locus of control is not to be confused with attributional style . Locus of control refers to an idea connected with anticipations about the future, while attributional style is a concept that is instead concerned with finding explanations for past outcomes.

People with an internal locus of control accept occasions in their day-to-day existence as controllable. To be more specific, this means that they can recognize instances where destiny is controllable: for instance, an individual is taking a test for a driver’s license.

A person with an internal locus of control will attribute whether they pass or fail the exam due to their own capabilities. This individual would praise their own abilities if they passed the test and would also recognize the need to improve their own driving if they had instead failed the exam.

An individual with an external locus of control would perceive the same event differently. This individual would be more likely to blame other factors such as the weather, their current condition, or even the exam itself as an excuse rather than accept that the exam went the way it did because of personal decisions.

Rather than accept that part of the blame rests on them, the event is instead attributed to occur because of uncontrollable forces (destiny/fate/etc.).

Locus of control is one of the four elements of center self-assessments – one’s principal examination of oneself – alongside neuroticism , self-viability, and self-esteem.

The idea of center self-assessments was first inspected by Judge, Locke, and Durham (1997), and since has demonstrated to foresee a few work results, explicitly, work fulfillment and occupation performance.

In a subsequent report, Judge et al. (2002) contended that locus of control, neuroticism, self-viability, and confidence elements might all influence each other.

How it Works

The first recorded trace of the term Locus of Control comes from Julian B. Rotter’s work (1954) based on the social learning theory of personality. It is a great example of a generalized expectancy related to problem-solving, a strategy that applies to a wide variety of situations.

In 1966 Rotter distributed an article in Psychological Monographs that summed up around a decade of extensive research (by Rotter and his understudies), with most of this work actually never being published beforehand.

It is speculated that Locus of Control may have come beforehand as a term coined by a psychologist by the name of Alfred Adler . The evidence for this is lacking, however, so the main bulk of the credit for the concept lies in Rotter and his understudies” early works.

One of these understudies was William H. James. This psychologist would later go on to produce his own work in the field, but while he was under the tutelage of Rotter, he wanted to study what he denoted as “expectancy shifts.”

These “expectancy shifts” can be classified as follows:

Typical Expectancy Shifts

Typical expectancy shifts derive from the belief that success (or failure) will be the determining notion for whatever activity/action is preceded next (that is to say, if one succeeds at something, then the expectancy is that they will succeed again).

Let’s say – for example – that during a basketball game, a player shoots a basketball and scores a point. After attempting this three times and scoring all three, the player might come to believe that (due to the fact the player has been continuously successful) if they continue to shoot, they will continue to score.

Atypical Expectancy Shifts

Atypical expectancy shifts, which derive from the belief that success (or a failure) will not have any determining notion for whichever activity/action that follows it (that is to say, if one succeeds at an activity, then the expectancy for the subsequent one is independent of this result; one could fail or succeed).

To give an example of this, picture someone who is at a casino. This individual places a bet on the ball, landing on a red number in the roulette wheel.

After three spins of the wheel, the ball has landed once in a red number, once in a black number, and finally once in a green number. The individual will (hopefully) most likely come to the conclusion that the result of the spin is independent of the last result, with each individual spin being a stand-alone event.

Additional research supported the hypothesis that typical expectancy shifts were much more common amongst individuals who had confidence in their own abilities, whilst those who didn’t really believe in their capabilities tended to attribute their expectancies toward fate rather than skill.

In other words, the distinction lies in whether the cause is internal or external; those who have faith in their own abilities will look towards an internal cause and adapt a typical expectancy shift, while those who attribute their results to external causes will most likely exhibit an atypical expectancy shift.

Rotter has made strides in this area of his research, covering this phenomenon in multiple works (1975). He has talked about issues and confusion in others’ utilization of the interior versus outer build, explaining how misconceptions and miscommunication have led people to mistake Locus of Control for other psychological terms.

Measurement

There are multiple ways to measure locus of control, but by far, the most widely used questionnaire is the 13-item (plus six filler items) forced-choice scale of Rotter (1966). This questionnaire first came into the scene in 1966 and is arguably still the best way to determine the locus of control in the present day. This does not mean that this is the only popular questionnaire.

Another example is Bialer’s (1961) 23-item scale for children, which actually even predates Rotter’s work. Other examples would be the Crandall Intellectual Ascription of Responsibility Scale (Crandall, 1965) and the Nowicki-Strickland Scale (Nowicki & Strickland, 1973), though again, most of these are not used in favor of Rotter’s 1966 questionnaire.

One of his understudies (again, William H. James) was actually responsible for developing one of the earliest psychometric scales to assess locus of control for his unpublished doctoral dissertation, supervised by Rotter at Ohio State University. As just mentioned, however, the work remains unpublished yet it is an example of just how much influence Rotter and his students have over the origins of the term.

Many measures of locus of control have appeared since Rotter’s scale. These vary from the original that predate Rotter’s own original designs to the locus of controls designed specifically for groups – like children (such as the Stanford Preschool Internal-External Scale for three- to six-year-olds).

According to the data analyzed by Furnham and Steele (1993), they suggest that the most reliable, valid questionnaire for adults is The Duttweiler (1984) Internal Control Index (ICI), which might be the better scale. Right off the bat, an advantage these scales have is that they address perceived problems with the Rotter scales.

These issues include adjusting the forced-choice format, removing the susceptibility to social desirability and heterogeneity (as indicated by factor analysis), and the natural improvements that come from developing something almost 30 years after the Rotter scales.

One important thing to note is that while other scales existed in 1984 besides the Duttweiler scales to measure locus of control, they all appear to fall victim to the same problems that the Rotter scales never originally addressed.

The primary difference lies in the removal of the forced-choice format used in Rotter’s scale. Previously, individuals had to affirm whether the assertion presented by the scale was true or false.

However, with Duttweiler’s 28-item ICI, which utilizes a Likert-type scale, individuals must specify whether they would behave as described in each of the 28 statements rarely, occasionally, sometimes, frequently, or usually.

This approach makes the scale much more adaptable to human nature’s nuances than the original Rotter scales.

The ICI gives individuals much more choice by assessing variables pertinent to internal locus. These include but are not limited to cognitive processing, resistance to social influence, self-reliance, autonomy, and delay of gratification. Small validation studies have indicated that the scale had good internal consistency reliability (a Cronbach’s alpha of 0.85)

Applications

The field most associated with locus of control is health psychology, mainly because the original scales to measure locus of control originated in the health domain of psychology.

These first scales were originally reviewed and approved by Furnham and Steele in 1993; they have since remained an essential part of health and other branches of psychology.

Out of the reviewed scales, The best-known in the field of health psychology are the Health Locus of Control Scale and the Multidimensional Health Locus of Control Scale, or MHLC (Wallston & Wallston, 2004).

The idea that health psychology and Locus of control go together is based on the concept that health may be attributed to three sources: internal factors (such as self-determination of a healthy lifestyle), powerful external factors (the words of a doctor or a loved one) or luck/destiny/coincidence.

Those that belong to the last group are almost impossible to deal with, given that they have a firm belief that nothing they will do can either change or avert what is going to happen either way.

The scales reviewed by Furnham and Steele (1993) have directly contributed to multiple areas of health psychology. Take, for example, Saltzer’s (1982) Weight Locus of Control Scale or Stotland and Zuroff’s (1990) Dieting Beliefs Scale.

Both these scales tackled the issue of obesity and shed light on how it affects different types of individuals. These scales do not limit themselves only to the physical aspects of individuals; take, for example, Wood and Letak’s (1982) Mental health locus of control scale.

These scales try to measure the stages of health and depression that an individual is currently in; there’s even a scale meant for measuring cancer and cancer-like symptoms (the Cancer Locus of Control Scale of Pruyn et al., 1990).

Perhaps the most important link that locus of control has to health psychology is Claire Bradley’s work, which links locus of control to the management of diabetes mellitus. This empirical data was reviewed by Norman and Bennet (1997) and they note that the data collected on whether certain health-related behaviors are related to internal health locus of control is, at best ambiguous.

For example, they point out that according to certain studies, locus of control was found to be linked with increased exercise, but also note how other studies have mentioned that the impact that exercise has on locus of control is either minimal or non-existent.

Activities such as jogging or running have long since been dismissed as lone factors for influencing any sort of command in one’s locus of control.

This ambiguity goes on in the study, with data on the relationship between internal health locus of control and other health-related behaviors also being suspicious.

These health-related behaviors include breast self-examination, weight control, and preventive-health behavior and in the study, it is said that alcohol consumption has a direct relationship with one’s internal locus of control.

Again with alcoholism as a factor, the same problems occur; the facts from the study begin to contradict themselves. During their analysis of the validity of the study, Norman and Bennett (1998) realized that some of the studies concluded by suggesting that a link existed between alcoholism and having an increased externality for health locus of control.

This goes against what is known right now, which is that – according to multiple other studies – alcoholism is related instead to increased internality in regards to an individual’s locus of control. The perceived notion is that alcoholism is directly related to the strength of the locus, not to what type of locus exists.

That is to say, it does not matter whether an individual has an internal or external locus of control; alcohol consumption is only related to the actual strength of that respective locus of control.

What is internal locus of control?

An internal locus of control refers to the belief that one can control their own life and the outcomes of events. Individuals with a high internal locus of control perceive their actions as directly influencing the results they experience.

What is external locus of control?

An external locus of control refers to the belief that external factors, such as fate, luck, or other people, are responsible for the outcomes of events in one’s life rather than one’s own actions.

Who proposed the locus of control concept?

The concept of locus of control was proposed by psychologist Julian B. Rotter in 1954.

Bennett, P., Norman, P., Murphy, S., Moore, L., & Tudor-Smith, C. (1998). Beliefs about alcohol, health locus of control, value for health and reported consumption in a representative population sample. Health Education Research, 13 (1), 25-32.

Bialer, I. (1961). Conceptualization of success and failure in mentally retarded and normal children. Journal of personality .

CRANDALL, V. C., KATKOVSKY, W., & CRANDALL, V. J. (1965) Children’s beliefs in their own control of reinforcements in intellectual-academic achievement situations. Child Development , 36, 91-109.

Duttweiler, P. C. (1984). The internal control index: A newly developed measure of locus of control. Educational and Psychological Measurement, 44 (2), 209-221.

Furnham, A., & Steele, H. (1993). Measuring locus of control: A critique of general, children’s, health‐and work‐related locus of control questionnaires. British Journal of Psychology, 84 (4), 443-479.

Nowicki, S., & Strickland, B. R. (1973). A locus of control scale for children. Journal of Consulting and Clinical Psychology, 40 (1), 148.

Norman, P., Bennett, P., Smith, C., & Murphy, S. (1997). Health locus of control and leisure-time exercise. Personality and Individual Differences, 23 (5), 769-774.

Norman, P., Bennett, P., Smith, C., & Murphy, S. (1998). Health locus of control and health behavior. Journal of Health Psychology, 3 (2), 171-180.

Rotter, J. B. (1954). Social learning and clinical psychology .

Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological monographs: General and applied, 80 (1), 1.

Rotter, J. B. (1975). Some problems and misconceptions related to the construct of internal versus external control of reinforcement. Journal of Consulting and Clinical Psychology, 43 (1), 56.

Saltzer, E. B. (1982). The weight locus of control (WLOC) scale: a specific measure for obesity research. Journal of Personality Assessment, 46 (6), 620-628.

Stotland, S., & Zuroff, D. C. (1990). A new measure of weight locus of control: The Dieting Beliefs Scale. Journal of personality assessment, 54 (1-2), 191-203.

Wallston, K. A., Strudler Wallston, B., & DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health education monographs, 6 (1), 160-170.

Wallston, K. A., & Wallston, B. S. (2004). Multidimensional health locus of control scale. Encyclopedia of health psychology , 171, 172.

Watson, M., Greer, S., Pruyn, J., & Van Den Borne, B. (1990). Locus of control and adjustment to cancer. Psychological Reports, 66 (1), 39-48.

Wood, W. D., & Letak, J. K. (1982). A mental-health locus of control scale. Personality and Individual Differences, 3 (1), 84-87.

Keep Learning

• Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological monographs: General and applied, 80(1), 1.
• Rotter, J. B. (1990). Internal versus external control of reinforcement: A case history of a variable. American psychologist, 45(4), 489.
• Stotland, S., & Zuroff, D. C. (1990). A new measure of weight locus of control: The Dieting Beliefs Scale. Journal of personality assessment, 54(1-2), 191-203.
• Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior

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Locus of Control

• Reference work entry
• First Online: 01 January 2022
• pp 2948–2952
• Cite this reference work entry

• Stephanie A. Robinson 3 &
• Margie E. Lachman 4  

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Control beliefs ; Learned helplessness ; Perceived constraints ; Perceived control ; Primary and secondary control ; Sense of control ; Sense of mastery

Expectancies about the degree of influence one has on outcomes and events in their life (Rotter 1966 ). The locus of control is operationalized with self-assessments using items or statements that rate the degree one expects to be able to bring about desired outcomes or overcome external constraints in order to reach goals, in general or within specific domains and situations (Lachman et al. 2015 ).

The locus of control was first conceptualized by Julian Rotter ( 1966 ) in his social learning theory, where he described the locus of control as either internal (e.g., abilities, effort) or external (e.g., chance, fate, powerful others). While this line of work was prolific, there were limitations with its initial distinction between internal and external control. Internal and external control were described as two...

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Acknowledgments

This work was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the Center for Healthcare Organization and Implementation Research (CHOIR), and Edith Nourse Rogers Memorial Veterans Hospital.

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Robinson, S.A., Lachman, M.E. (2021). Locus of Control. In: Gu, D., Dupre, M.E. (eds) Encyclopedia of Gerontology and Population Aging. Springer, Cham. https://doi.org/10.1007/978-3-030-22009-9_103

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14.1: What is locus of control? How is it related to student achievement and assessment?

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by Lucyna Russell

Learning Objectives

1. Readers will be able to understand what is locus of control.

2. Readers will know the difference between an internal and external locus of control.

3. Readers will learn how locus of control can affect student achievement.

4. Readers will learn what attribution training can do to help an external locus of control.

What is Locus of Control?

Do you believe that you are responsible for your fate or that fate is something that is determined. Depending on your answer can tell you what type of locus of control you may have. Locus of control is a psychological term that was developed by Julian B. Rotter in the 1950's (Neill,2006). Locus of control refers to an individuals beliefs about what determines their rewards or outcomes in life. Individuals locus of control can be classified along a specteum from internal to external (Mearns, 2006).

"Julian B. Rotter has been cited as one of the 100 most eminent psychologist of the 20th centrury. Rotter was 18th in frequency of citations in journal articles and 64th in overall eminence." (Haggbloom, 2002)

What are the Differences Between Internal and External Locus of Control?

A person who has an internal locus of control believes that their rewards in life are guided by their own decisions and efforts (Neill,2006). If they do not succeed at something, they believe it is due to their own lack of effort. For example, a student with an internal locus of control doesn't receive a good grade on his exam. He, therefore, concludes that he did not study enough for the exam. He realizes his efforts are what caused the grade and will have to try harder next time (Grantz, 2006).

A person who has an external locus of control believes that rewards or outcomes in life are determined by "luck, chance, or powerful others" (Mearns, 2008). If they do not succeed at something they believe that their lack of success is due to forces beyond their control. For example, a student with an external locus of control doesn't receive a good grade on his exam. He concludes that the test was written poorly and the teacher was incompetent. He blames the grade on external factors that were out of his control and doesn't see the need to try harder (Grantz, 2006).

• "Males tend to be more internal than females"
• "As people get older they tend to become more internal"
• "People higher up in organizational structures tend to be more internal"

(Neill, 2006)

How does Locus of Control Affect Student Achievement?

There have been a number of studies that conclude that there is a correlation between locus of control and academic achievement. These studies concluded that students with an internal locus of control had higher academic achievement than students with an external locus of control (Uget, 2007). The reason for the internals performing better academically comes from their belief that if they work hard and study, they will receive good grades. Therefore, they tend to study longer and spend more time on their homework (Grantz, 2006). On the other hand, externals believe they have no control over what grade they get. This belief may have been caused by many attempted school assignments that they failed, leading them to have low expectations of studying and school (Grantz, 2006). Any success that they might experience will be rationalized as luck or that the task was too easy. They have come to expect low success and whatever goals they do set are unrealistic (Uget, 2007).

Can an External Locus of Contol be Changed?

When there is a student in the classroom that seems to be having a hard time with his grades and shows no motivation for improvement that student may have an external locus of control. (Grantz, 2006). What can be done to help this student? Is there a way to motivate him? "Attribution training which concentrates on strenghthening the student's internal locus of control, may be helpful in increasing motivation" (Grantz, 2006). Part of attribution training is having say positive things about themselves. Some examples are, "I can do this" or "This can be done with hard work". Students train themselves into believing that they do have the control to change things (Grantz, 2006). Students should be encouraged to associate their academic hardships with the cause of their difficulties as they are being guided to see the effect of their actions (Uget, Habibah, Jegak 2007).

It seems that a persons locus of control can greatly affect their academic achievemnet. The way they perceive themselves and the world around them affects how well they will do in school. It only makes sense that if you work hard and study, then you will do well. However, students with an external locus of control do not feel that way and feel there is no need to try. This, of course, will greatly affect their academic achievement. Although there are ways of trying to change their thinking process, it may not be successful every time. It is important that we encourage our children at an early age and show them that hard work and diligence does make a difference.

Exercise \(\PageIndex{1}\)

1. A student that believes he will get good grades if he works hard and studies has an/a

a. internal locus of conrol

b. external locus of control

c. locus of control

d. strong self esteem

2. A student that fails a test and says it was the teachers fault is said to have an/a

a. internal locus of control

d. low self esteem

3. Caleb is a third grade student who constantly says he cannot do the work, that it is too hard, and refuses to complete his tests would most likely have an/a. locus of control

a. locus of control

b. internal locus of control

c. low self esteem

d. external locus of control

4. Andrea is a fifth grade student who just failed a test. Andrea says to herself that she has to study more next time and try harder. Andrea has an/a. locus of control

c. internal locus of control

d. high self esteem

Grantz, Mandy. (2006). Do you have the power to succeed? Locus of control and its impact on education. Retrieved March 21, 2009, from http://www.units.muohio.edu/psybersite/control/education.shtml .

Haggbloom, S.J. et al. (2002). The 100 most eminent psychologists of the 20th century. Review of General Psychology,6,139-152.

Mearns, Jack. (2008). Social learning theory of Julian B. Rotter. Retrieved March 21, 2009, from http://psych.fullerton.edu/jmearns/rotter.htm .

Neill. James. (2006). What is locus of control? Retrieved March 21, 2009, from wilderdom.com/psychology/loc/LocusOfControlWhatIs.html.

Uget, A, Habibah, B., & Jegak, U. (2007). The influence of causal elements of control on academic achievement satisfaction. Journal of Instructional Psychology, 34(2), 120-8 Retrieved March 21, 2009, from education Full Text database.

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7 Foundations of Locus of Control: Looking Back over a Half-Century of Research in Locus of Control of Reinforcement

• Published: September 2016
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Since its introduction by Julian Rotter in 1966, the construct of locus of control of reinforcement (LOC-R) appears to have evolved from a fairly clear and measurable variable into a complex system of varying definitions, measures, and applications. In this chapter, the authors review and evaluate this evolution. They first revisit the origins of LOC, then examine the adequacy and implications of the proliferation of terms like “perceived control” and others akin to it. The authors offer several examples of research paths that, in retrospect, they believe to have been salutary. Finally, based on their 45 year involvement in the study of LOC, they critically examine what they believe are the strengths and weaknesses in the literature on LOC and offer suggestions for future empirical and theoretical directions.

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Locus of Control

Reviewed by Psychology Today Staff

When something goes wrong, it’s natural to cast blame on the perceived cause of the misfortune. Where an individual casts that blame can be related, in many cases, to a psychological construct known as “locus of control.”

• What Is Locus of Control?
• Self-Efficacy and Locus of Control

Locus of control refers to the degree to which an individual feels a sense of agency in regard to his or her life. Someone with an internal locus of control will believe that the things that happen to them are greatly influenced by their own abilities, actions, or mistakes. A person with an external locus of control will tend to feel that other forces—such as random chance, environmental factors, or the actions of others—are more responsible for the events that occur in the individual's life.

Like other constructs in personality psychology, locus of control falls on a spectrum. Genetic factors may influence one’s locus of control, as well as an individual’s childhood experiences—particularly the behaviors and attitudes modeled by their early caregivers.

Researchers have identified several areas in which one’s sense of control appears to affect outcomes, including education , health, and civic engagement. Overall, such research has generally suggested that those with a more internal locus of control are more successful, healthier, and happier than those with a more external locus.

Most people have either an internal or external locus of control. Those with an internal locus of control believe that their actions matter, and they are the authors of their own destiny. Those with an external locus of control attribute outcomes to circumstances or chance.

Many people believe that locus of control is something that you’re born with—an innate part of your personality. However, evidence suggests that parents can play a major role in how their child develops a locus of control. Encouraging a child’s independence and teaching them to associate actions with consequences can result in a better-developed internal locus of control.

Julian B. Rotter developed the locus of control concept in 1954, and it continues to play an important role in personality studies. In 1966, Rotter created a 13-item forced-choice scale in order to measure locus of control, though it is neither the only nor the most popular scale in use today.

Notice when you are self-victimizing or blaming other people for your hardships or negative feelings. Even if it’s true, try not to wallow in self-pity. Focus on the parts of the problem that are within your control—and let go of the rest, including the reactions of other people.

Another psychological concept related to locus of control is that of self-efficacy. Self-efficacy, as described by psychologist Albert Bandura, refers to one’s belief that they are able (or not able) to accomplish tasks and achieve their goals .

Though people with high self-efficacy also typically have a more internal locus of control, the two measures are not perfectly correlated. Someone, for example, may feel like they have the power to influence their own health while simultaneously feeling like they lack certain skills—such as cooking healthy meals—that would improve their health (high internal locus of control, but low self-efficacy).

Some research has suggested that one’s self-efficacy can be improved with practice, while locus of control is less easily influenced. There is some evidence, however, that one's locus of control may naturally change with age.

People with high self-efficacy also tend to have high self-sufficiency, an essential aspect of well-being. They are high in self-esteem, feel secure and content with themselves, and aren’t overly concerned with other people’s opinions of them. People with strong self-efficacy are more resilient and less likely to be destabilized by negative life events. Their locus of control is more likely to be internal than external.  

There’s a powerful link between perceived control and health . The more that someone believes their actions determine their future, the more likely they are to engage in healthy behaviors, like eating well and exercising regularly. If, on the other hand, they feel like they have no control, such as when dealing with a terminal illness, they may experience negative symptoms, like stress and depression .   

People with high self-efficacy and an internal locus of control tend to cope better with stress, because they feel like their actions make a difference. Meanwhile, those with an external locus of control or lower levels of self-efficacy are prone to feelings of helplessness, resulting in the excess release of the stress hormone cortisol. This, in turn, can lead to a sense of hopelessness and depression.

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IResearchNet

What is Locus Of Control?

Locus of control (LOC) is a term used to refer to individual perceptions regarding personal control, particularly with regard to control over important outcomes. For example, have you ever tried to convince someone to vote, emphasizing the impact his or her vote could have in an election? Have you ever known someone who did not apply for a job promotion, deciding instead that his or her hard work did not matter as much as “who you know”? These examples illustrate how our motivation for performing a particular task may be influenced by how much we feel our actions  influence  certain  outcomes  or,  conversely, the extent to which we feel end results will be due to forces outside of our control.

What Is Locus Of Control?

Julian Rotter first proposed the concept of LOC in 1966 while attempting to develop a more accurate model of social learning theory (SLT), a theoretical model that predicts the likelihood that a person will exhibit a particular behavior. Much of the work calculating human behavior up until that point adhered to a strict behavioral model. That is, it examined the execution of behavior as being contingent primarily on how rewarding the end result would be for an individual.  Rotter  was  one  of  the  first  to  incorporate a cognitive component to this model, stating that behavior is not simply contingent on the value of the reinforcer, or end goal. Rotter theorized that the extent to which a person believed that his or her behavior could affect the outcome of an event would also contribute to whether the behavior was executed. SLT has since been expanded on, but this expectancy component  is  still  considered  to  be  an  important factor in predicting behavior. It is this expectancy belief regarding an outcome that is referred to as LOC.

A person’s LOC can be either internal or external. Internal LOC is the belief that a person’s actions or involvement in a given situation can directly affect the attainment of a particular reinforcer. For example, if Tom thinks that studying will better prepare a person for an exam, and that this preparedness will increase the likelihood of getting an “A,” then Tom likely possesses an internal LOC and will probably study diligently for his exam. Conversely, external LOC is the belief that the attainment of a goal has little to do with one’s involvement or actions, but is instead due to outside forces such as luck, chance, or the control of powerful others. Relating this to the previous example, Ty may believe that a person cannot predict the exam’s content, thereby leaving his or her performance up to chance. Ty would be less likely to study for the exam because he presumes that individuals’ actions have little influence over the outcome of the test.

As LOC theories gained popularity, many other theories were proposed examining constructs incorporated into a person’s perceived control of a situation. One of those components, self-efficacy, is often confused with LOC, and for that reason, a distinction should be made. LOC is a person’s belief regarding the degree to which external events are a product of individual effort or of forces outside of individual control, in general. Self-efficacy, on the other hand, is a person’s perceptions of his or her own specific ability to perform the behavior necessary to achieve a particular outcome. It is more orientated toward a person’s opinion of his or her own personal competencies in pursuing a goal.

Problems Defining Locus Of Control

When the concept of LOC was first introduced, a wealth of literature was published exploring the concept. One of the major criticisms of many of these earlier studies was that it examined the concept in isolation,  neglecting  other  facets  of  Rotter’s  SLT. The exclusion of other components (such as the value of the reinforcer to the individual) was misleading because it examined LOC out of context and affected its capacity to predict behavior. Most of the current literature attempts to place LOC within an SLT framework.  For  instance,  when  assessing  the  extent  to which Lisa will attempt to quit smoking, we examine more than simply the degree to which Lisa believes quitting smoking will improve her health (LOC). We must also take into account how much Lisa appreciates her health (reinforcer value) and how capable she sees herself of being able to quit (self-efficacy).

A second criticism of early research is that it frequently mislabeled LOC as a trait characteristic (i.e., a personality characteristic that is fixed throughout the life span). Although this issue is still debated, the majority consensus is that LOC evolves as a person develops and encounters new experiences. Additionally, research also suggests that LOC can change depending on specific situations. Although it is possible to assess a person’s general LOC beliefs, a more accurate account measures their beliefs as they relate to the situation being examined. For instance, a measure of a person’s political LOC would be more predictive of their voting behavior than their general LOC. Thus, unlike some early perceptions of LOC as a fixed and invariant construct, more recent conceptualizations suggest that LOC is responsive to an individual’s experiences, circumstances, and level of development.

A third criticism of the LOC literature is that an internal LOC is frequently misperceived as being intrinsically beneficial. This stems from the increased motivation often associated with an internal LOC. Although an internal LOC is sometimes beneficial, this is not always the case. People who view themselves as the operative force in attaining a desired result may also place unnecessary blame on themselves when they do not achieve their goal. They may think they have more power to influence a situation than they actually do. This inflated sense of effectiveness may also affect the person’s adaptability, including the person’s ability to take direction or work as part of a team.

Assessment Of Locus Of Control

LOC is measured using self-report assessments typically created for specific age groups. These assessments are available for populations spanning from preschool age to the elderly, as well as for people of various races and ethnicities. In general, LOC assessments do not simply identify someone as internal or external, but place individuals on a continuum spanning the two. Along this continuum, people may be identified as being “more internal” or “more external.” Some common LOC measures include the Internal-External Locus of Control Scale , the Adult Nowicki-Strickland Internal-External Control Scale , the Nowicki-Strickland Internal-External Control Scale for Children , Crandall’s Intellectual Achievement Responsibility Scale , and the Multidimensional Health Locus of Control Scale . Validity for LOC scales typically relies on the scale’s ability to predict behavior, the degree to which a measure correlates with other established LOC measures, and the extent to which it discriminates between conceptually different LOCs.

Consistent   with   modern   conceptualizations, LOC assessments can be structured towards a person’s general LOC beliefs or LOC beliefs with regard to a specific situation, event, or condition. Some of the more popular situation-specific LOC scales target areas  such  as  health,  school,  and  work  and  have helped predict variables such as adherence to medical regimens, academic achievement, and vocational success. In general, these specific LOC measures have demonstrated superior predictive validity when compared with the more general LOC measures. The knowledge gained from LOC scales can help guide interventions striving toward helping people achieve maximum benefit in their respective circumstances.

Locus Of Control And Development

Developmental trends in LOC are best examined using general LOC measures (as opposed to situation-specific measures). This is because many of the situation-specific measures target experiences that occur only within certain developmental stages. When examining age trends among more general measures, it is important to consider the role of a person’s cognitive development in how that person views his or her environment. Historical and cultural contexts are also important to take into account because societal values may influence a person’s perception of control.

LOC beliefs have been shown to change across development, in that children’s LOC beliefs tend to become more internal with increasing age. However, this is not a strictly linear trend. Research has shown a large increase in internal LOC at about sixth grade and a small decrease just before high school. This overall increase in internal LOC across childhood makes sense within the context of development: as children become more independent and self-sufficient (i.e., less reliant on parents), they tend to view their actions as being more instrumental in the attainment of goals. These internal LOC beliefs have been shown to stabilize in adulthood. Research has suggested that LOC beliefs later become more external as a person enters old age. This may be related to an increased dependence on others for personal needs such as health and finance.

LOC refers to a person’s beliefs regarding how instrumental individual effort is in achieving a desired result. A person who believes goal attainment is dependent on his or her personal efforts in a given situation is said to have a more internal LOC. On the other hand, a person who believes outcomes are the result of outside forces, such as luck or powerful others, is said to have a more external LOC. In general, LOC becomes more internal as a person develops through childhood and adolescence, remains consistent during adulthood, and becomes more external as one  progresses  through  old  age. Although  general LOC measures are available, the most accurate predictor of a person’s behavior in a particular circumstance is a LOC measure specific to that situation.

References:

• Fournier, G., & Jeanrie, C. (2003). Locus of control: Back to basics. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures (pp. 139–154). Washington, DC: American Psychological
• Lefcourt, M. (1991). Locus of control. In J. P. Robinson, P. R. Shaver, & L. S. Wrightsman (Eds.), Measures of personality and social psychological attitudes (pp. 413–499). San Diego, CA: Academic Press Unlimited.
• Mirowsky, , & Ross, C. E. (1999). Well-being across the life course. In A. V. Horowitz & T. L. Scheid (Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (pp. 328–347). New York: Cambridge University Press.
• Skinner, A. (1996). A guide to constructs of control . Journal of Personality and Social Psychology, 71 , 549–570.
• Steitz, A. (1982). Locus of control as a life-span developmental process: Revision of the construct . International Journal of Behavioral Development, 5 , 299–316.
• Strickland, B. R. (1989). Internal-external control expectancies: From contingency to creativity. American Psychologist, 44 , 1–12.
• Wallston, A. (1992). Hocus-pocus, the focus isn’t strictly on locus: Rotter’s social learning theory modified for health. Cognitive Therapy and Research, 16, 183–199.

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Locus of Control and Your Life

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Dr. Sabrina Romanoff, PsyD, is a licensed clinical psychologist and a professor at Yeshiva University’s clinical psychology doctoral program.

Karen Cilli is a fact-checker for Verywell Mind. She has an extensive background in research, with 33 years of experience as a reference librarian and educator.

Verywell / Theresa Chiechi

• Internal vs. External
• Determine Your Locus of Control

When you are dealing with a challenge in your life, do you feel that you have control over the outcome, or do you believe that you are at the mercy of outside forces? Your answer to this question refers to your locus of control.

Our locus of control influences our response to events in our lives and our motivation to take action. If you believe that you hold the keys to your fate, you are more likely to change your situation when needed. Conversely, if you think that the outcome is out of your hands, you may be less likely to work toward change.

What Is Locus of Control?

Locus of control is the extent to which you feel you have control over events that impact your life. Put another way, it is "a belief about whether the outcomes of our actions are contingent on what we do (internal control orientation) or on events outside our personal control (external control orientation)," explains psychologist Philip Zimbardo .

In 1954, psychologist Julian Rotter suggested that our behavior was controlled by rewards and punishments . The consequences of our actions helped determine our beliefs about the likely results of future behaviors.

Our anticipation of certain results influences our behaviors and attitudes . In other words, an individual is more likely to pursue a goal if they have been rewarded for similar efforts in the past and believe that they can influence their chances of future success.

In 1966, Rotter published a scale designed to measure and assess external and internal locus of control. The scale utilizes a forced choice between two alternatives, requiring respondents to choose just one of two possibilities for each item.

While the scale has been widely used, it has also been the subject of considerable criticism from those who believe that locus of control cannot be fully understood or measured by such a simplistic scale.

Internal vs. External Locus of Control

If you believe that you have control over what happens, you have what psychologists refer to as an internal locus of control. If you believe that you have no control over what happens and that external variables are to blame, you have what is known as an external locus of control.

It is important to note that locus of control is a continuum. No one has a 100% external or internal locus of control. Instead, most people lie somewhere on the continuum between the two extremes.

These are characteristics of people with a dominant internal or external locus of control.

Are more likely to take responsibility for their actions

Tend to be less influenced by the opinions of other people

Often do better at tasks when they are allowed to work at their own pace

Usually, have a strong sense of  self-efficacy

Tend to work hard to achieve the things they want

Feel confident in the face of challenges

Tend to be physically healthier

Report being happier and more independent

Often achieve greater success in the workplace

Blame outside forces for their circumstances

Often credit luck or chance for any successes

Don't believe that they can change their situation through their own efforts

Frequently feel hopeless or powerless in the face of difficult situations

Are more prone to experiencing  learned helplessness

What Role Does Your Locus of Control Play in Your Life?

Internal locus of control is often used synonymously with " self-determination " and "personal agency." Some research suggests that men tend to have a higher internal locus of control than women while others suggest the opposite: that women have greater internal locus of control in comparison. Other research reports a shift towards more internal locus of control as people grow older.

Experts have found that, in general, people with an internal locus of control tend to be better off. However, it is also important to remember that internal locus of control does not always equal "good" and external locus of control does not always equal "bad." 

In some contexts, having an external locus of control can be a good thing—particularly when a situation poses a threat to self-esteem or is genuinely outside of a person's control.

For example, a person who loses a sports game may feel depressed or anxious if they have a strong internal locus of control. If this person thinks, "I'm bad at sports and I don't try hard enough," they might allow the loss to affect their self-image and feel stressed in future games.

However, if this person takes an external focus during such situations ("We were unlucky to get matched with such a strong team," or "The sun was in my eyes!"), they will probably feel more relaxed and less stressed.

Do You Have an External or Internal Locus of Control?

Where does your locus of control fall on the continuum? Read through the statements below and select the set that best describes your outlook on life.

• I often feel that I have little control over my life and what happens to me.
• People rarely get what they deserve.
• It isn't worth setting goals or making plans because too many things can happen that are outside of my control.
• Life is a game of chance.
• Individuals have little influence over the events of the world.

If the statements above best reflect your view on life, then you probably tend to have an external locus of control.

• If you work hard and commit yourself to a goal, you can achieve anything.
• There is no such thing as fate or destiny.
• If you study hard and are well-prepared, you can do well on exams.
•  Luck has little to do with success; it's mostly a matter of dedication and effort.
• In the long run, people tend to get what they deserve in life.

If the statements above best reflect your outlook on life, then you most likely have an internal locus of control.

A Word From Verywell

Your locus of control can have a major impact on your life, from how you cope with stress to your motivation to take charge of your life.

In many cases, having an internal locus of control can be a good thing. It means that you believe that your own actions have an impact.

If you tend to have more of an external locus of control, you might find it helpful to start actively trying to change how you view situations and events.

Rather than viewing yourself as simply a passive bystander who is caught up in the flow of life, think about actions you can take that will have an impact on the outcome.

Zimbardo PG. Psychology and Life .

Rotter JB. General principles for a social learning framework of personality study . In: J. B. Rotter, ed., Social Learning and Clinical Psychology . Prentice-Hall, Inc.; 1954: 82-104. doi:10.1037/10788-004

Rotter JB. Generalized expectancies for internal versus external control of reinforcement . Psychol Monogr. 1966;80(1):1-28. doi:10.1037/h0092976

Kourmousi N, Xythali V, Koutras V. Reliability and validity of the Multidimensional Locus of Control IPC Scale in a sample of 3668 Greek educators .  Social Sciences . 2015;4(4):1067-1078. doi:10.3390/socsci4041067

Carton JS, Ries M, Nowicki S Jr. Parental antecedents of locus of control of reinforcement: A qualitative review .  Front Psychol . 2021;12:565883. doi:10.3389/fpsyg.2021.565883

Lopez SJ (ed). The Encyclopedia of Positive Psychology . New York: John Wiley & Sons; 2011.

Awaworyi Churchill S, Munyanyi ME, Prakash K, Smyth R. Locus of control and the gender gap in mental health . J Econ Behav Organ . 2020;178:740-58. doi:10.1016/j.jebo.2020.08.013

McPherson A, Martin CR. Are there gender differences in locus of control specific to alcohol dependence ?  J Clin Nurs . 2017;26(1-2):258-265. doi:10.1111/jocn.13391

Hovenkamp-Hermelink JHM, Jeronimus BF, van der Veen DC, et al. Differential associations of locus of control with anxiety, depression and life-events: A five-wave, nine-year study to test stability and change . J Affect Disord . 2019;253:26-34. doi:10.1016/j.jad.2019.04.005

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• The Scientist University

How to Present a Research Study’s Limitations

All studies have imperfections, but how to present them without diminishing the value of the work can be tricky..

Nathan Ni holds a PhD from Queens University. He is a science editor for The Scientist’s Creative Services Team who strives to better understand and communicate the relationships between health and disease.

View full profile.

Learn about our editorial policies.

Scientists work with many different limitations. First and foremost, they navigate informational limitations, work around knowledge gaps when designing studies, formulating hypotheses, and analyzing data. They also handle technical limitations, making the most of what their hands, equipment, and instruments can achieve. Finally, researchers must also manage logistical limitations. Scientists will often experience sample scarcity, financial issues, or simply be unable to access the technology or materials that they want.

All scientific studies have limitations, and no study is perfect. Researchers should not run from this reality, but engage it directly. It is better to directly address the specific limitations of the work in question, and doing so is actually a way to demonstrate an author’s proficiency and aptitude.

Do: Be Transparent

From a practical perspective, being transparent is the main key to directly addressing the specific limitations of a study. Was there an experiment that the researchers wanted to perform but could not, or a sample that existed that the scientists could not obtain? Was there a piece of knowledge that would explain a question raised by the data presented within the current study? If the answer is yes, the authors should mention this and elaborate upon it within the discussion section.

Asking and addressing these questions demonstrates that the authors have knowledge, understanding, and expertise of the subject area beyond what the study directly investigated. It further demonstrates a solid grasp of the existing literature—which means a solid grasp of what others are doing, what techniques they are using, and what limitations impede their own studies. This information helps the authors contextualize where their study fits within what others have discovered, thereby mitigating the perceived effect of a given limitation on the study’s legitimacy. In essence, this strategy turns limitations, often considered weaknesses, into strengths.

For example, in their 2021 Cell Reports study on macrophage polarization mechanisms, dermatologist Alexander Marneros and colleagues wrote the following. 1

A limitation of studying macrophage polarization in vitro is that this approach only partially captures the tissue microenvironment context in which many different factors affect macrophage polarization. However, it is likely that the identified signaling mechanisms that promote polarization in vitro are also critical for polarization mechanisms that occur in vivo. This is supported by our observation that trametinib and panobinostat inhibited M2-type macrophage polarization not only in vitro but also in skin wounds and laser-induced CNV lesions.

This is a very effective structure. In the first sentence ( yellow ), the authors outlined the limitation. In the next sentence ( green ), they offered a rationalization that mitigates the effect of the limitation. Finally, they provided the evidence ( blue ) for this rationalization, using not just information from the literature, but also data that they obtained in their study specifically for this purpose. 

Don't: Be Defensive

It can feel natural to avoid talking about a study’s limitations. Scientists may believe that mentioning the drawbacks still present in their study will jeopardize their chances of publication. As such, researchers will sometimes skirt around the issue. They will present “boilerplate faults”—generalized concerns about sample size/diversity and time limitations that all researchers face—rather than honestly discussing their own study. Alternatively, they will describe their limitations in a defensive manner, positioning their problems as something that “could not be helped”—as something beyond what science can currently achieve.

However, their audience can see through this, because they are largely peers who understand and have experienced how modern research works. They can tell the difference between global challenges faced by every scientific study and limitations that are specific to a single study. Avoiding these specific limitations can therefore betray a lack of confidence that the study is good enough to withstand problems stemming from legitimate limitations. As such, researchers should actively engage with the greater scientific implications of the limitations that they face. Indeed, doing this is actually a way to demonstrate an author’s proficiency and aptitude.

In an example, neurogeneticist Nancy Bonini and colleagues, in their publication in Nature , discussed a question raised by their data that they have elected not to directly investigate in this study, writing “ Among the intriguing questions raised by these data is how senescent glia promote LDs in other glia. ” To show both the legitimacy of the question and how seriously they have considered it, the authors provided a comprehensive summary of the literature in the following seven sentences, offering two hypotheses backed by a combined eight different sources. 2 Rather than shying away from a limitation, they attacked it as something to be curious about and to discuss. This is not just a very effective way of demonstrating their expertise, but it frames the limitation as something that, when overcome, will build upon the present study rather than something that negatively affects the legitimacy of their current findings.

Striking the Right Balance

Scientists have to navigate the fine line between acknowledging the limitations of their study while also not diminishing the effect and value of their own work. To be aware of legitimate limitations and properly assess and dissect them shows a profound understanding of a field, where the study fits within that field, and what the rest of the scientific community are doing and what challenges they face.

All studies are parts of a greater whole. Pretending otherwise is a disservice to the scientific community.

Looking for more information on scientific writing? Check out  The Scientist’ s  TS SciComm  section. Looking for some help putting together a manuscript, a figure, a poster, or anything else?  The Scientist ’s  Scientific Services  may have the professional help that you need.

• He L, et al. Global characterization of macrophage polarization mechanisms and identification of M2-type polarization inhibitors . Cell Rep . 2021;37(5):109955.
• Byrns CN, et al. Senescent glia link mitochondrial dysfunction and lipid accumulation . Nature . 2024.

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Study investigates the role of allies in advancing social movements

by Hebrew University of Jerusalem

A new study sheds light on the crucial role of allies in social movements, showing how their participation can sway public opinion on protests. By positively influencing public perceptions and encouraging participation from both advantaged and disadvantaged groups, allies can play a significant role in addressing structural inequality. This research offers valuable insights for activists and policymakers aiming to foster positive change in society.

A new study led by Dr. Devorah Manekin from Hebrew University's Department of International Relations highlights how allies from advantaged groups can support social movements of disadvantaged groups. This research, focused on the 2020 Black Lives Matter protests, shows how White allies positively influenced public opinion among both Black and White audiences. The work is published in the journal Proceedings of the National Academy of Sciences .

Dr. Manekin and her team used surveys and social media analysis to understand the impact of allies. They discovered that among White respondents, allies increased public attention and support for the protests. Among Black audiences, allies were supported for their perceived strategic benefits, such as attracting attention to the movement and reducing the likelihood of heavy policing.

The study also found that, while protests led by ethnic minorities are often perceived as more violent and requiring more police, the presence of allies reduced these negative perceptions, making the protests feel safer for everyone.

Dr. Manekin said, "Our research shows how important allies can be in shaping public opinion and increasing support for social movements. While there are valid concerns about allies becoming overly prominent in the movement, our findings show that thoughtful allyship is perceived positively by the public and can thus be a powerful means of combating inequality."

These insights are valuable for activists, policymakers, and researchers, helping them understand and support social movements better.

Journal information: Proceedings of the National Academy of Sciences

Provided by Hebrew University of Jerusalem

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Most Black Americans Believe U.S. Institutions Were Designed To Hold Black People Back

Table of contents.

• In their own words: Quotes from our 2023 focus groups of Black Americans
• Most Black adults say they experience racial discrimination
• Black adults feel angry or undermined in the face of discrimination 
• Black adults say they must work more than everyone else to get ahead 
• Black Americans believe the criminal justice system was designed to hold them back
• Black adults and mistrust about policing and prisons 
• Many Black Americans believe the U.S. political system was designed to hold them back
• Black Americans, Black political leaders and mistrust of the U.S. political system
• Black Americans believe the economic system was designed to hold them back
• Mistrust of big businesses
• About half of Black Americans believe U.S. news media was designed to hold them back 
• Most Black adults say they encounter inaccurate news about Black people
• Some Black Americans believe the health care system was designed to hold them back
• Mistrust about medical research
• Mistrust of family-related government policy  
• Mistrust of government reproductive health policy
• Acknowledgments
• The American Trends Panel survey methodology
• Focus group methodology

Editorial note to readers

A version of this study was originally published on June 10. We previously used the term “ racial conspiracy theories ” as an editorial shorthand to describe a complex and mixed set of findings. By using these words, our reporting distorted rather than clarified the point of the study. Changes to this version include: an updated headline, new “explainer” paragraphs, some additional context and direct quotes from focus group participants.

Claudia Deane, Mark Hugo Lopez and Neha Sahgal contributed to the revision of this report.

Pew Research Center conducted this study to explore how Black Americans think about the factors that contribute to or hinder their success in the United States. An early 2024 report explored the success factors, and this current report focuses on the hindrances. Based on their real personal and collective historical experiences with racial discrimination, Black Americans might be suspicious of the actions of U.S. institutions.

These suspicions often circulate in Black spaces as ideas about the intentional or negligent harm that hinders Black people from thriving. For this report, Black adults were asked in a survey how familiar they are with these ideas. Then, regardless of their familiarity , they were asked if they thought these things were restricted to the past or could also be happening today. Detailed examples of these ideas and corresponding survey results are discussed at length in Chapters 2-7.

We surveyed 4,736 U.S. adults who identify as Black and non-Hispanic, multiracial Black and non-Hispanic, or Black and Hispanic. The survey was conducted from Sept. 12 to 24, 2023, and includes 1,755 Black adults on the Center’s American Trends Panel (ATP) and 2,981 Black adults on Ipsos’ KnowledgePanel.

Respondents on both panels are recruited through national, random sampling of residential addresses. Recruiting panelists by mail ensures that nearly all U.S. Black adults have a chance of selection. This gives us confidence that any sample can represent the whole population (see our Methods 101 explainer on random sampling). For more information on this survey, refer to its methodology and topline questionnaire .

This study also included seven focus groups with Black adults of various ages, income levels, political affiliations, and geographic locations. Conducted online from May 23 to June 1, 2023, these groups gave Black adults the opportunity to describe how they defined success and accounted for hindrances to their success. For more information, read the focus group methodology .

The terms Black Americans , Black adults and Black people are used interchangeably throughout this report to refer to U.S. adults who self-identify as Black, either alone or in combination with other races or Hispanic identity.

Throughout this report, Black non-Hispanic respondents are those who identify as single-race Black and say they have no Hispanic background. Black Hispanic respondents are those who identify as Black and say they have a Hispanic background. We use the terms Black Hispanic and Hispanic Black interchangeably. Multiracial respondents are those who indicate two or more racial backgrounds (one of which is Black) and say they are not Hispanic.

In this report, immigrant refers to persons born outside of the 50 U.S. states or the District of Columbia, Puerto Rico or other U.S. territories.

To create the upper-, middle- and lower-income tiers, respondents’ 2021 family incomes were adjusted for differences in purchasing power by geographic region and household size. Respondents were then placed into income tiers: Middle income is defined as two-thirds to double the median annual income for the entire survey sample. Lower income falls below that range, and upper income lies above it.

Throughout this report, Black adults with upper incomes are those who have family incomes in the upper-income tier. Black adults with middle incomes and Black adults with lower incomes have family incomes in the middle- and lower-income tier, respectively. For more information about how the income tiers were created, read the methodology .

Throughout this report,  Democrats  are respondents who identify politically with the Democratic Party or those who are independent or identify with some other party but lean toward the Democratic Party. Similarly,  Republicans  are those who identify politically with the Republican Party and those who are independent or identify with some other party but lean toward the Republican Party.

While many Black Americans view themselves as at least somewhat successful and are optimistic about their financial future , previous work by Pew Research Center also finds most believe U.S. institutions fall short when it comes to treating Black people fairly.

A new analysis suggests that many Black Americans believe the racial bias in U.S. institutions is not merely a matter of passive negligence; it is the result of intentional design. Specifically, large majorities describe the prison (74%), political (67%) and economic (65%) systems in the U.S., among others, as having been designed to hold Black people back, either a great deal or a fair amount.

Black Americans’ mistrust of U.S. institutions is informed by history, from slavery to the implementation of Jim Crow laws in the South, to the rise of mass incarceration and more.

Several studies show that racial disparities in income , wealth , education , imprisonment and health outcomes persist to this day.

The goal of the current study is to explore how Black Americans think about U.S. institutions and the impact they have on their success.

Specifically, we examine the extent to which Black Americans believe U.S. institutions intentionally or negligently harm Black people and how personal experiences of racial discrimination factor into these beliefs.

The beliefs and narratives that Black Americans have about institutional harm have long been studied by scholars in the health and social sciences and the humanities . Narratives about how institutions were designed to hold Black people back also surfaced in several of the online focus groups Pew Research Center conducted with this study last year. (Selected quotes from our focus group discussions can be found in an accompanying text box .)

To measure the prevalence of these narratives of mistrust, we conducted a survey of 4,736 Black adults in the U.S. from Sept. 12 to 24, 2023.

First, respondents were asked if they had ever heard a series of statements about how U.S. institutions might intentionally or negligently harm Black people. Respondents were then asked if they thought these harms were also happening to Black people today. Here are some key findings about Black Americans’ beliefs in institutional mistrust.

• 76% of Black adults say Black public officials today are singled out to be discredited in a way that doesn’t happen to White public officials.
• 76% say police today do very little to stop guns and drugs from flooding Black communities.
• 74% say Black people are more likely than White people to be incarcerated because prisons want to make money on the backs of Black people today.
• 67% of Black Americans say businesses today target marketing of luxury products to Black people in order to put them into debt.
• 55% of Black adults say secret and nonconsensual medical experiments (like the Tuskegee study) are happening to Black people today.
• 55% of Black adults say the government today encourages single motherhood and the elimination of Black men from Black families. 
• 51% of Black adults say the government promotes birth control and abortion to reduce the size of the Black population, and this is happening today.

The report also finds that Black Americans who have experienced racial discrimination are more likely to believe U.S. institutions intentionally or negligently harm Black people.

There are also modest differences among Black Americans by gender, education, family income and political affiliation. Still, majorities across many Black demographic subgroups are familiar with these statements about the intentions of many U.S. institutions and say these things are happening to Black people today.

To understand how Black Americans view success and setbacks in the U.S., in May and June 2023, we conducted seven online focus groups nationally among Black people of varying income, age and ideological backgrounds. For details on how groups were defined and recruited, refer to the focus group methodology .

One theme that emerged: Some participants felt they are up against a system deliberately designed to hold them back. The following are some illustrative quotes:

“I believe there are … strategic works, behind the scenes, that are being done to sabotage a Black person’s effort. … You could be on the road to success with nothing stopping you. But then, all it takes is one incident that was planned and plotted against you to destroy your life.” – Woman, low-income group, early 50s

“As Black people we are always fighting some type of fight. … We always get to some type of height of success. And then there’s always something that takes us down. …There is always something in the way.” – Woman, young adult group, late 20s

“Well, there’s institutionalized stuff that is invisible. …There are institutionalized things that are in place that one has always suspected, but because they are seemingly benign, you can’t really call them out on it. …There are things like that which I think are purposely built into society or industries or whatever to keep certain numbers down because of access to financial gain.” – Man, high-income group, late 30s

“I trust the government to an extent, but when it comes to certain things, I don’t. For example, take the pandemic. They had all this help out there for people, but there were certain people that applied for help that just couldn’t get it and they were literally just struggling to just get by. … I feel like us Black people are helped the least because we’ve always had the short end of the stick.” – Woman, Republican group, late 20s

“This is a capitalistic society. And I feel as though Black men just have to be the ones at the bottom in order for this system to succeed. … I think that a few hands may be part of this. I don’t want to speculate, but it just still seems to be a system set in place where Black people, especially Black men, have not been successful for a while. We can even go back to Black Wall Street where we were starting to have a little bit of success, and then that was taken down by the powers to be. So whatever system it is, it’s a pretty good system that doesn’t reveal itself so easily.” – Man, Republican group, late 30s

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Six distinct types of depression identified in Stanford Medicine-led study

Brain imaging, known as functional MRI, combined with machine learning can predict a treatment response based on one’s depression “biotype.”

June 17, 2024 - By Rachel Tompa

Researchers have identified six subtypes of depression, paving the way toward personalized treatment. Damerfie -   stock.adobe.com

In the not-too-distant future, a screening assessment for depression could include a quick brain scan to identify the best treatment.

Brain imaging combined with machine learning can reveal subtypes of depression and anxiety, according to a new study led by researchers at Stanford Medicine. The study , published June 17 in the journal Nature Medicine , sorts depression into six biological subtypes, or “biotypes,” and identifies treatments that are more likely or less likely to work for three of these subtypes.

Better methods for matching patients with treatments are desperately needed, said the study’s senior author,  Leanne Williams , PhD, the Vincent V.C. Woo Professor, a professor of psychiatry and behavioral sciences, and the director of Stanford Medicine’s Center for Precision Mental Health and Wellness . Williams, who lost her partner to depression in 2015, has focused her work on pioneering the field of precision psychiatry .

Around 30% of people with depression have what’s known as treatment-resistant depression , meaning multiple kinds of medication or therapy have failed to improve their symptoms. And for up to two-thirds of people with depression, treatment fails to fully reverse their symptoms to healthy levels.  

That’s in part because there’s no good way to know which antidepressant or type of therapy could help a given patient. Medications are prescribed through a trial-and-error method, so it can take months or years to land on a drug that works — if it ever happens. And spending so long trying treatment after treatment, only to experience no relief, can worsen depression symptoms.

“The goal of our work is figuring out how we can get it right the first time,” Williams said. “It’s very frustrating to be in the field of depression and not have a better alternative to this one-size-fits-all approach.”

Biotypes predict treatment response

To better understand the biology underlying depression and anxiety, Williams and her colleagues assessed 801 study participants who were previously diagnosed with depression or anxiety using the imaging technology known as functional MRI, or fMRI, to measure brain activity. They scanned the volunteers’ brains at rest and when they were engaged in different tasks designed to test their cognitive and emotional functioning. The scientists narrowed in on regions of the brain, and the connections between them, that were already known to play a role in depression.

Using a machine learning approach known as cluster analysis to group the patients’ brain images, they identified six distinct patterns of activity in the brain regions they studied.

Leanne Williams

The scientists also randomly assigned 250 of the study participants to receive one of three commonly used antidepressants or behavioral talk therapy. Patients with one subtype, which is characterized by overactivity in cognitive regions of the brain, experienced the best response to the antidepressant venlafaxine (commonly known as Effexor) compared with those who have other biotypes. Those with another subtype, whose brains at rest had higher levels of activity among three regions associated with depression and problem-solving, had better alleviation of symptoms with behavioral talk therapy. And those with a third subtype, who had lower levels of activity at rest in the brain circuit that controls attention, were less likely to see improvement of their symptoms with talk therapy than those with other biotypes.

The biotypes and their response to behavioral therapy make sense based on what they know about these regions of the brain, said Jun Ma, MD, PhD, the Beth and George Vitoux Professor of Medicine at the University of Illinois Chicago and one of the authors of the study. The type of therapy used in their trial teaches patients skills to better address daily problems, so the high levels of activity in these brain regions may allow patients with that biotype to more readily adopt new skills. As for those with lower activity in the region associated with attention and engagement, Ma said it’s possible that pharmaceutical treatment to first address that lower activity could help those patients gain more from talk therapy.

“To our knowledge, this is the first time we’ve been able to demonstrate that depression can be explained by different disruptions to the functioning of the brain,” Williams said. “In essence, it’s a demonstration of a personalized medicine approach for mental health based on objective measures of brain function.”

In another recently published study , Williams and her team showed that using fMRI brain imaging improves their ability to identify individuals likely to respond to antidepressant treatment. In that study, the scientists focused on a subtype they call the cognitive biotype of depression, which affects more than a quarter of those with depression and is less likely to respond to standard antidepressants. By identifying those with the cognitive biotype using fMRI, the researchers accurately predicted the likelihood of remission in 63% of patients, compared with 36% accuracy without using brain imaging. That improved accuracy means that providers may be more likely to get the treatment right the first time. The scientists are now studying novel treatments for this biotype with the hope of finding more options for those who don’t respond to standard antidepressants.

Further explorations of depression

The different biotypes also correlate with differences in symptoms and task performance among the trial participants. Those with overactive cognitive regions of the brain, for example, had higher levels of anhedonia (inability to feel pleasure) than those with other biotypes; they also performed worse on executive function tasks. Those with the subtype that responded best to talk therapy also made errors on executive function tasks but performed well on cognitive tasks.

One of the six biotypes uncovered in the study showed no noticeable brain activity differences in the imaged regions from the activity of people without depression. Williams believes they likely haven’t explored the full range of brain biology underlying this disorder — their study focused on regions known to be involved in depression and anxiety, but there could be other types of dysfunction in this biotype that their imaging didn’t capture.

Williams and her team are expanding the imaging study to include more participants. She also wants to test more kinds of treatments in all six biotypes, including medicines that haven’t traditionally been used for depression.

Her colleague  Laura Hack , MD, PhD, an assistant professor of psychiatry and behavioral sciences, has begun using the imaging technique in her clinical practice at Stanford Medicine through an experimental protocol . The team also wants to establish easy-to-follow standards for the method so that other practicing psychiatrists can begin implementing it.

“To really move the field toward precision psychiatry, we need to identify treatments most likely to be effective for patients and get them on that treatment as soon as possible,” Ma said. “Having information on their brain function, in particular the validated signatures we evaluated in this study, would help inform more precise treatment and prescriptions for individuals.”

Researchers from Columbia University; Yale University School of Medicine; the University of California, Los Angeles; UC San Francisco; the University of Sydney; the University of Texas MD Anderson; and the University of Illinois Chicago also contributed to the study.

Datasets in the study were funded by the National Institutes of Health (grant numbers R01MH101496, UH2HL132368, U01MH109985 and U01MH136062) and by Brain Resource Ltd.

• Rachel Tompa Rachel Tompa is a freelance science writer.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

Hope amid crisis

Psychiatry’s new frontiers

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CRISPR/Cas9 gene editing represents an exciting avenue to study genes of unknown function, and can be combined with genetically-encoded tools such as fluorescent proteins, channelrhodopsins, DREADDs, and various biosensors to more deeply probe the function of these genes in different cell types. However, current strategies to also manipulate or visualize edited cells are challenging due to the large size of Cas9 proteins and the limited packaging capacity of adeno-associated viruses (AAVs). To overcome these constraints, we developed an alternative gene editing strategy using a single AAV vector and mouse lines that express Cre-dependent Cas9 to achieve efficient cell-type specific editing across the nervous system. Expressing Cre-dependent Cas9 from a genomic locus affords space to package guide RNAs for gene editing together with Cre-dependent, genetically encoded tools to manipulate, map, or monitor neurons using a single virus.

We validated this strategy with three common tools in neuroscience: ChRonos, a channelrhodopsin, for studying synaptic transmission using optogenetics; GCaMP8f for recording Ca2+ transients using photometry, and mCherry for tracing axonal projections. We tested these tools in multiple brain regions and cell types, including GABAergic neurons in the nucleus accumbens, glutamatergic neurons projecting from the ventral pallidum to the lateral habenula, dopaminergic neurons in the ventral tegmental area, and proprioceptive neurons in the periphery. This flexible approach could help identify and test the function of novel genes affecting synaptic transmission, circuit activity, or morphology with a single viral injection.

Significance Statement Our CRISPR/Cas9 approach is the first to use a single vector to both knock-down genes of interest and express tools to monitor, map, and manipulate neurons. We demonstrate its utility in the central nervous system and describe the first systemic CRISPR/Cas9 gene editing with co-expressed reporters in the peripheral nervous system. Our approach fills a significant gap in the neuronal gene editing toolkit, allowing high-throughput study of genes of unknown function in the nervous system, and has broad utility for loss-of-function studies in other biological fields. This tool has great translational potential: it can be used to screen risk factor genes identified through genome-wide association studies, or knock-down native gene expression and reintroduce mutant variants identified in clinical settings.

We would like to thank all members of the lab for helpful discussions and feedback. We thank Alexxai Kravitz for his feedback on our photometry experiment design. We thank Alex Legaria for help with photometry analysis. We would also like to thank Dr. Mingjie Li at the Hope Center Viral Vectors Core at Washington University for assistance in establishing viral vector purifications. We thank the Genome Engineering & Stem Cell Center (GESC@MGI, RRID: SCR_023243) at the Washington University in St. Louis for reagent validation services. We would like to thank Vera Thornton for consulting on statistical analyses. AAV PHP.S viruses were purchased from the UNC Neuroscience Center/BRAIN Initiative NeuroTools Core (U24 NS124025 to Kimberly Ritola).

Authors report no conflict of interest.

This work was supported by NIH R01s NS130046 (BAC), DA049924 (MCC), DA058755 (MCC), and internal funds from the McDonnell Center for Systems Neuroscience (BAC).

Animal Use: All procedures were conducted in accordance with National Institutes of Health guidelines and with approval from the Institutional Animal Care and Use Committee at Washington University in St. Louis.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license , which permits unrestricted use, distribution and reproduction in any medium provided that the original work is properly attributed.

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Impact of Locus of Control on Patient–Provider Communication: A Systematic Review

Alva rodriguez.

1 CUNY School of Public Health & Health Policy, New York, NY, USA

CAROLINE DELBOURGO PATTON

2 D. Samuel Gottesman Library, The Albert Einstein College of Medicine, Bronx, New York, USA

CARA STEPHENSON-HUNTER

3 Harold and Muriel Block Institute for Clinical and Translational Research, Department of Family and Social Medicine, The Albert Einstein College of Medicine, Bronx, New York, USA

Associated Data

The data that support the findings of this study are openly available in figshare at https://doi.org/10.6084/m9.figshare.22296934.v1 for the data extraction table and https://doi.org/10.6084/m9.figshare.22296931.v1 for the quality assessment table.

Growing evidence shows there is heterogeneity in patient communication preferences and a need to tailor communication approaches accordingly. However, little is known about the psychosocial factors that influence communication preferences. Among them is locus of control (LOC), a belief about who or what determines outcomes, including health. Although LOC theory was developed over 60 years ago as a personality theory, its relevance in healthcare has increased over the past two decades. There is a paucity of empirical evidence on patient or provider LOC as it influences communication quality and outcomes in healthcare settings. We conducted a systematic review to collate the current state of the literature.

We carried out a comprehensive search of PubMed MEDLINE, Embase, PsycInfo, and Cochrane Library databases to retrieve relevant peer-reviewed articles. A total of 1152 publications were identified. Our final review included 17 articles that underwent data extraction and quality assessment.

The included studies found evidence of LOC associations with several patient and provider communication-related outcomes including satisfaction with care; medical decision-making and communication preferences; adherence; and patient-provider rapport. As opposed to generalized approaches to communication, assessing patient LOC may allow clinicians to tailor their approaches to match patients’ LOC. Our findings provide a starting point and highlight the need for future studies.

Effective patient-provider communication is widely considered a central tenet of patient-centered care and essential to ensuring positive patient outcomes. When communication between patients and providers is effective, it can reduce patients’ uncertainty and increase their engagement in treatment as well as their satisfaction with care. However, poor communication can result in decreased patient adherence to treatment plans and delays or avoidance in seeking care. ( Patak et al., 2009 ) Further, it is estimated that 30% of all medical malpractice suits involve or are caused by ineffective communication. ( CRICO, 2021 ; Levinson, 1994 )

Patient-provider communication is complex and bi-directional, with multiple external and internal factors that influence both the delivery and the receipt of the exchange. Setting, duration, and other external factors have been shown to influence patient-provider communication quality. Individualized, internal factors such as lived experience, culture, and beliefs – on the side of both the patient and the provider –also impact communication preferences, styles, and quality. ( Bulsara, Ward, & Joske, 2004 ) These factors may serve as barriers or facilitators to effective healthcare communication and thus impact the delivery of care and patient outcomes.

Locus of Control theory, developed by Rotter (1966) is part of the Social Learning Theory ( Bandura & Walters, 1963 ; Bandura, 2001 ), which describes an individual’s expectancy beliefs about their ability to control most outcomes. ( Rotter, 1966 ) According to his LOC theory, an individual’s expectancy beliefs exist on a continuum between internal – the belief that most outcomes are caused by one’s own actions – and external – the belief that outcomes are controlled by other forces outside of one’s control. ( Frakking et al., 2018 ; Rotter, 1966 )

Levenson (1973) expanded on Rotter’s original LOC with the Multidimensional Locus of Control ( Levenson, 1973 ), which measures three LOC dimensions: internal, powerful others, and chance. Both chance and powerful others measure external beliefs but specify whether an individual believes that outcomes are determined by people in positions of authority (powerful others) or by fate or happenstance (chance). Since then, several other theoretical models of LOC have been proposed in the literature, including domain or sphere-specific LOC. ( Musich, Wang, Slindee, Kraemer, & Yeh, 2020 ; Reich & Infurna, 2017 )

While LOC as a psychological construct has been used to describe personality and predict educational and vocational outcomes, ( Ng-Knight & Schoon, 2017 ) the adoption of LOC to predict health behavior and outcomes came later and was widely used in the field of health psychology. The Multidimensional Health LOC (HLOC), developed by Wallston, Wallston, and DeVellis (1978) measures the extent to which one believes that health is within one’s control (internal) or controlled external forces such as doctors, powerful others, God or chance. ( Wallston, Wallston, & DeVellis, 1978 ) The HLOC is not intended to fully explain health behaviors. Rather, it interacts with sociodemographic factors – including age, education, and health status – and healthcare experiences and attitudes. This increases HLOC and LOC’s explanatory power for variance in health behavior.

In the published literature, LOC is associated with health behavior, ( Clark et al., 2017 ) including diet, exercise, health screening, adherence, and trust in one’s physician. ( Brincks, Feaster, Burns, & Mitrani, 2010 ) Internal LOC is positively related to engaging in these health behaviors and health outcomes. ( Berglund, Lytsy, & Westerling, 2014 ; Infurna & Gerstorf, 2014 ; Musich, Wang, Slindee, Kraemer, & Yeh, 2020 ; Zuercher-Huerlimann et al., 2019 ) However, for external LOC, findings differ based on where an individual attributes control. ( Burns & Mahalik, 2006 ) Powerful others and doctors LOC are associated with trust in providers as well as adherence to physician recommendations. ( Brincks, Feaster, Burns, & Mitrani, 2010 ) Chance and God LOC is negatively associated with positive health behaviors and trust in providers. LOC has also been studied in clinical care because it predicts care outcomes and how treatments increase patients’ LOC internality. ( Musich, Wang, Slindee, Kraemer, & Yeh, 2020 ; Zuercher-Huerlimann et al., 2019 )

Importantly, while an internal LOC is associated with more positive health behaviors and outcomes, it is also positively associated with higher income and non-racial/ethnic minority status. ( Zahodne et al., 2015 ) Lower-income people, racial and ethnic minority groups, and those who experienced numerous adverse events tend to have a more external LOC. ( Culpin, Stapinski, Miles, Araya, & Joinson, 2015 ; Gross, Mendelsohn, Gross, Scheinmann, & Messito, 2016 ; Peer, Lombard, Steyn, Levitt, & Annunziato, 2020 ; Spalding, 1995 ) Older age has also been shown to increase LOC externality. ( Robinson & Lachman, 2016 ) In the recent years, the medical literature is increasingly considering LOC as a psychosocially or culturally influenced belief after findings showed that sociocultural factors predict an individual’s LOC beliefs ( Robinson & Lachman, 2016 ) and that these beliefs are associated with a patients’ preferences for information and communication around their health. This includes degree of involvement in treatment decision-making, as well as provider communication style.

Until recently, the standard for patient care was “universalism,” - treating all patients the same regardless of their backgrounds, attributes, or traits. ( Institute of Medicine [IOM], 2003 ) Even patients’ desire for autonomy over their health and related decisions were long considered universal in American health care. Researchers now acknowledge individual and circumstantial factors that influence patients’ preferences around shared decision-making ( Chewning et al., 2012 ; Morling, 2016 ) When a patient’s desired level of involvement does not match their actual involvement in medical decisions, this has a negative effect on patients’ satisfaction with care, their health outcomes, and the quality of the patient–provider relationship.

Studies have also shown that physicians’ own lived experiences, influence their communication with patients. Physicians serving patients with dissimilar cultural backgrounds and LOC beliefs may use communication approaches that do not match the beliefs, communication expectations, and preferences of their patients and which are, therefore, less effective. ( Chewning et al., 2012 ) A recent review on patient empowerment, medication adherence, and HLOC found that high levels of self-efficacy along with Internal HLOC, as well as Doctor HLOC, promoted medication adherence. ( Náfrádi, Nakamoto, Schulz, Asnani, & Asnani, 2017 ) Communication between providers and patients is known to influence medication adherence and be influenced by patient as well as the provider LOC.

To our knowledge, no systematic review has been done of the empirical evidence on patient or provider LOC as it influences communication quality and outcomes in health-care settings. The primary aim of this systematic review is to collate the current state of the literature on the relationships between patient and provider LOC and communication.

Materials and Methods

Protocol and registration.

The study protocol for this systematic review was registered in Prospero (308478) and is available online: ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308478 .

Literature Review

A systematic literature review was conducted by a medical librarian (C.D.P) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ( Page et al., 2021 ) We searched the electronic databases PubMed/MEDLINE, Embase, PsycInfo, and Cochrane Library through February 18, 2022. A combination of controlled vocabulary and text words was used. Terms included: “locus of control,” “internal-external control,” “control preference*,” “health communication,” “patient-provider communication,” “patient-physician communication,” “communication skills,” “patient-centered communication,” “patient participation,” and “shared decision making.” (For the full search strategies, see Supplement 1 ). The searches were conducted without any geographical restrictions and were limited to English-language articles published between 1995 and 2022.

Study Selection

All references were imported into Endnote 20 reference management software (Clarivate, Philadelphia, PA) and de-duplication was carried out. They were then uploaded to Covidence (Veritas Health Innovation, Melbourne, Australia), an online literature review management tool. Further de-duplication was performed, followed by screening of the articles against the eligibility criteria, first based on the title and abstract and then based on the full text. Each article was independently assessed by two of the three reviewers (C.S.-H, C.D. P, and A.R.) and screeners were blinded to each other’s decisions. Conflicts were resolved by discussion and consensus of the research team or by the lead reviewer (C.S.-H). Details of the article screening and key decisions were preserved in Covidence.

Studies were included in the systematic review if they met the following criteria: (1) peer-reviewed publication; (2) written in English; (3) published between 1995 and 2022; (4) participants were adult patients and/or providers in primary care or in-patient settings; (5) study measured outcomes specifically related to patient and provider communication. Exclusion criteria included: (1) patients and/or providers in mental/behavioral health; (2) pediatric patients; (3) health communication in a non-clinical setting; (4) studies where locus of control was an outcome rather than a variable; (5) references that were not research studies (e.g., reviews, editorials, etc.) or lacked full peer-reviewed publication (e.g., conference abstracts, protocols, etc.). Studies with qualitative outcomes only were also excluded due to the difficulty of extracting this type of data.

Since there is no clear consensus on the use of the term, “locus of control,” we did not limit our search to this phrase. Therefore, many studies included by the searches measured aspects of control in patient communication but were ultimately excluded because the full-text screening showed that they were not related specifically to LOC theory. For instance, several studies included the term “control preferences” which measures a patients’ desired level of control over medical decisions, but does not incorporate the concept of LOC, which refers to beliefs about who or what actually determines outcomes, including health. LOC may influence an individuals’ control preferences along with other preferences around health care and behavior.

Among the outcomes of interest were patient reports regarding the quality of communication; patient adherence to clinical recommendations; health and health behavior outcomes; and observed instances of shared-decision-making between provider and patient.

Data Extraction and Quality assessment

References that passed the screening process underwent data extraction and quality assessment by a member of the review team (C.S.-H or A.R.) using a customized form created in Covidence. The data extraction form collected information on the study and participant characteristics – such as study design, number of patients and/or physicians, inclusion and exclusion criteria, method of recruitment, study design, and data collection method, – along with the major outcomes. In addition, a quality assessment form based on the 25-item Mixed-Methods Appraisal Tool (MMAT-2018) developed by ( Hong et al., 2018 ) was used to evaluate each study. Full data and quality assessment tables are available on request.

A total of 1225 articles were imported into Covidence. After removal of 73 duplicates, we screened the title and abstract of 1152 studies and excluded 1024 of them because they did not meet our inclusion criteria. Full text was reviewed for the remaining 128 studies. Ultimately, 17 studies underwent data extraction and quality assessment. The PRISMA flow diagram is displayed in Figure 1 .

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram.

Participants

The majority of the studies were conducted in the United States or Europe ( n = 12). The remaining studies were conducted in Asia ( n = 3) and Australia ( n = 2). Other studies included patients diagnosed with chronic diseases, such as cancer ( n = 8), or patients in primary care or general practice ( n = 5). While most included patient participants only, ( n = 11), four included patient provider dyads, and two included solely physician participants. Table 1 provides an overview of the sample characteristics.

Relationships between Locus of Control and aspects of patient-provider communication

Note: CI = confidence interval; EP = estimated probability; (H)LOC = (health) locus of control; I-E LOC = internal-external locus of control; M(H)LOC = multi-dimensional (health) locus of control; SD = standard deviation; SE = standard error

Measurements

The included studies fell into the category of either quantitative studies ( n = 10) or mixed methods studies ( n = 7). Most of these studies were observational (15), with two quasi-experimental designs. Survey methodology was used in all 17 studies, and 88% of these were cross-sectional design. A variety of qualitative data collection methods were employed in mixed methods studies to capture the patient-provider relationship and communication. The most common strategies were recordings of medical consultations and clinical and simulated interviews ( N = 4)

To measure LOC, three studies used a one-dimensional LOC scale measuring the internal domain only. One study used a two-dimensional LOC scale intended to measure the internal and powerful others domains. The remaining studies used multi-dimensional LOC (internal; powerful others; chance) or multi-dimensional Health Locus of Control (HLOC) scales with two studies utilizing variations tailored to their specific study populations. Most studies ( n = 13) employing a multi-dimensional LOC scale established a positive relationship between at least one LOC dimension and aspects of the patient–provider relationship or communication. See Table 1

A number of scales and measures were used to assess different aspects of the patient–provider relationship both subjectively and objectively. The most common measured dimensions of patient-provider communication were:

• patient preferences for autonomy and involvement in medical decision-making, ( n = 7),
• patient satisfaction with care received ( n = 6),
• information and communication preferences ( n = 5),
• providers’ use of patient-centered communication ( n = 5),
• the patient–physician relationship ( n = 3), and
• patient adherence ( n = 2).

For studies reporting more than one outcome related to patient-provider communication, each outcome is listed separately.

Medical decision-making preferences measures patients’ preferred degree of involvement in the process of Marton and colleagues (2020) found that HLOC explained heterogeneity in people’s control preferences. ( Marton et al., 2020 ) Lower external LOC (internal LOC orientation) was positively associated with greater preference for the active and collaborative roles. Doctor HLOC was related to differences in “active” (estimate = 0.53, SE = 0.14, p < .001), “active collaborative” (estimate = 0.56, SE = 0.15, p < .001), and “collaborative” roles (estimate = 0.37, SE = 0.16, p = .024). Similarly, Steginga and Occhipinti (2004) found that for men diagnosed with prostate cancer, internal HLOC was a significant predictor, ( p = .05) and powerful HLOC was a moderate predictor ( p = .07) of the men’s preferred roles in medical decision-making (F(3, 98) = 0.258, p = .856). ( Steginga & Occhipinti, 2004 )

However, Schumacher et al. (2022) found minimal agreement about decision LOC between patients and providers and Nomura and colleagues concluded that HLOC was not significantly related to decision-making preferences ( Nomura, Ohno, Fujinuma, & Ishikawa, 2007 ; Schumacher et al., 2022 )

Autonomy preference measures patients’ preferences for participating in medical decision-making and obtaining personal health information, as well as information-seeking attitudes and behaviors. One study found that preference for involvement (autonomy preference) was associated with HLOC, but that the relationship between HLOC and preferences was explained by age; low preference for involvement was significantly associated with higher external HLOC in younger patients. Low preference for information was associated with higher fatalistic HLOC, higher depression scores and age. ( Schneider et al., 2006 )

In a study by Stadtlander et al. (2015) of older adults in assisted living facilities found that those with a high internal LOC were more likely to ask for a referral from their primary care provider than those with a low score (r (34) = 0.431, p < .01). ( Stadtlander et al., 2015 ) Among participants with high a higher external LOC, those with high powerful others LOC were more likely to have an escort to their healthcare visits and those with a high chance LOC were less likely to confront a health provider if they were dissatisfied with their care.

Patient information and communication preferences refer to a patients’ desire for information and communication related to diagnosis, prognosis, and treatment. One study established a significant relationship between faith/God LOC – along with gender and purpose of medical consultation – and oncology patients’ preferences for the amount of information shared during medical consultations. Patients who believed that their illness was controlled by a higher power preferred to receive less health information with minimal details. ( Butow, Maclean, Dunn, Tattersall, & Boyer, 1997 )

Martins and Carvalho (2013) found that oncology patients’ preferences for providers’ delivery of bad news varied significantly with HLOC scores. ( Martins & Carvalho, 2013 ) While 77.8% of the patients preferred an “empathetic professional,” 12.5% preferred a “distanced expert” and 9.7% preferred an “emotionally burdened expert.” Patients who preferred “the empathetic professional” scored significantly higher in internal LOC ( p = .015) and significantly lower in powerful others LOC ( p = .006) than patients who preferred the other two models.

Patients’ satisfaction with care refers to a patients’ assessment of the quality of care delivered, including the length of the healthcare consultation and the provider’s interpersonal manner. Hitz et al. (2013) found that external HLOC (chance/fate) was not a significant predictor of patient satisfaction with treatment decisions for patients with advanced cancer. ( Hitz et al., 2013 ) In another study, by Cvengros, Christensen, Hillis, and Rosenthal (2007) , greater patient/physician concordance on internal HLOC was significantly associated with patient satisfaction with care (F (2, 133) = 7.14, p = <0.01). ( Cvengros, Christensen, Hillis, & Rosenthal, 2007 ) For discordant dyads where patients were less internally focused than their physicians, patients reported lower satisfaction ( p = <0.01) than patients in concordant dyads. McCann and colleagues, study of a communication intervention, found that for those in the communication intervention group, those with a low powerful others HLOC reported higher satisfaction with the medical consultation compared to controls matched for LOC orientation (low PLC intervention = 4.44(0.4); low PHLC controls = 4.03 (0.55); p = .02). ( McCann & Weinman, 1996 )

The patient-physician relationship is based on trust that the physician will uphold their ethical responsibility to care for patients using sound judgment and prioritizing their patients’ needs above all other interests. In a study by Gabay and team, internal LOC, contributed to 8% of the explained variance of trust. Namely, when perceived control over health was high (internal LOC) and perceived communication was participative, trust was higher. ( Gabay, 2015 ) Another study reported that relationship with the doctor (b = 0.25, p < .001), internal LOC (b = 0.23, p < .001), and chance LOC (b = 0.14, p < .05) were significant predictors of patient-provider rapport. ( Chawak & Chittem, 2020 )

Providers’ use of patient-centered communication refers to eliciting and understanding patient perspectives, psychosocial and cultural contexts, and values, with the goal of reaching a shared understanding of treatment plans and goals. This concept includes different aspects of effective communication, including empathy and the quality and appropriateness of the information provided. Two studies reported a positive relationship between physician external LOC and their provision of more appropriate and less premature information during simulated and clinical interviews. Libert et al. (2003) found that physicians with external LOC provided more appropriate information in a (highly emotional) simulated interview. They also gave less premature information in an actual clinical interview than those with internal LOC. ( Libert et al., 2003 ) In the simulated interview, the mean frequency of the appropriate information was significantly higher in physicians with external than in physicians with internal LOC. In the clinical interview, mean frequency of premature information giving was significantly lower for physicians with external LOC than for those with internal LOC. ( Libert et al., 2003 )

In a subsequent study by the same authors, the mean frequency of premature information provided was significantly lower in physicians with an external LOC ( M = 18.8; SD = 7.7) compared to an internal LOC ( M = 26.1, SD = 12.5) ( t = 2.247; P = .031) and the mean frequency of supportive utterances (empathy, reassurance) was significantly higher in the external LOC group ( M = 1.3; SD = 1.3) compared to the internal LOC group ( M = 0.5; SD = 0.7) ( t = −2.276; p = .029). ( Libert et al., 2006 ) The mean frequency of assessment functions (assessing, checking, and summarizing) was significantly higher in physicians with an external LOC ( M = 26.8, SD = 7.7) compared to an internal LOC ( M = 19.0, SD = 9.1) ( t = 2.714; P = .010). ( Libert et al., 2006 )

Other examined outcomes related to patient-centered communication include consultation length; patient questions and participation; patients’ perceived understanding of provided information, and physician’s understanding of patient concerns. In a study involving an intervention to encourage patient-provider communication, doctors’ rating of understanding of patient problems revealed no significant differences between intervention (enhanced communication) and control groups. However, among patients with a low chance LOC orientation, doctor’s ratings of understanding were significantly higher for those in the intervention group (4.25 (0.61), compared to those with a low chance LOC in the control group (3.75(0.78); p = .03. ( McCann & Weinman, 1996 )

Patient adherence is defined by the extent to which a patient follows, or intends to follow, the treatment guidelines and recommendations made by their healthcare provider. Chawak and colleagues (2020) found that a high external Doctor LOC, patient comfort with communication, and patient-physician rapport predicted compliance intent, with Doctor LOC identified as the greatest predictor. ( Chawak & Chittem, 2020 ) Another study found patient-provider concordance on internal HLOC was positively associated with patient adherence; on the other hand, for providers with higher internal LOC than their patients, patient adherence was significantly lower. ( Cvengros, Christensen, Hillis, & Rosenthal, 2007 )

Quality Review

The quality of the studies included varied widely in methodology and reporting of results. Seven studies failed to provide full information on inclusion or exclusion criteria, two did not include detailed recruitment methods, and 7 did not report on response rates. Two failed to provide complete information on statistical methods. The samples included had restricted race/ethnicity or socioeconomic status in their study population ( n = 11), and 9 did not report on race and ethnicity, or socioeconomic status as they relate to LOC or communication outcomes. Due to the disparate methods employed, we could not identify patterns of statistical significance among the findings.

In the present article, we reviewed the literature on patient-provider LOC as it influences communication quality and outcomes in healthcare. The primary finding based on this review is that LOC is associated with most patient-provider relationship and communication outcomes. One study found a positive link between powerful others/doctor LOC and important aspects of communication such as comfort with communication, intent to be adherent, and desired involvement. LOC (internal and external) orientation also predicted patients’ preferences for medical information and their desired level of engagement in medical decisions.

Three studies established a negative relationship between powerful others LOC and a preference for more empathetic providers over more distant experts, as well as with the likelihood of bringing a companion to the consultation. There was also a connection between lower powerful others LOC and preference for a more active role in decision-making. One study established a negative relationship between God LOC and desire to engage and receive information from the provider.

Some studies (4 out of 13 studies) established a positive association between internal LOC and several aspects of the patient-provider communication. One study also found internal LOC to be a predictor of patient-provider rapport. Another found a connection between higher internal LOC and preference for an empathetic style of communication from the provider. The other two studies found a positive association between internal LOC and increased likelihood to request referrals and between internal LOC and patient involvement in decision-making, respectively.

A previous systematic review by Nafradi, Nakamoto, Schulz, Asnani, and Asnani (2017) , found that internal HLOC is associated with patient adherence, along with self-efficacy. ( Nafradi, Nakamoto, Schulz, Asnani, & Asnani, 2017 ) While our findings align with these authors, they extend to include the bidirectional influence of patient-provider LOC as it relates to patient adherence through physician communication. Our review indicates that physician LOC predicts the appropriateness and effectiveness of their communication with patients, which in-turn influences patient adherence. This is especially true for physicians with internal LOC when caring for patients with external LOC orientations. LOC belief and attitudinal concordance between the doctor and patient were associated with positive patient outcomes compared to dissimilar doctor and provider LOC.

These findings may extend to all disadvantaged patient populations where an external LOC is more prevalent. Researchers piloted a communication tool, based on LOC theory, to facilitate health-care provider communication with patients with diabetes, using language reflecting patients’ own worldviews and health beliefs. Application of the tool resulted in providers reporting improved communication with patients and better patient (clinical) diabetes outcomes. ( Clark, Connor, Lauten, Mac Neill, & Sandy, 2011 ; Connor, Kessler, de Groot, Mac Neill, & Sandy, 2019 )

Healthcare Implications

As part of patient-centered care, assessment of patient LOC may allow clinicians to tailor communication and decision-making approaches, to achieve better outcomes. Although more studies are needed, findings related to the benefits of LOC concordant patient-provider dyads suggest that provider awareness of their own LOC and the impact of heterogeneity in LOC orientation is needed. This may encourage more personalized medicine since it challenges the assumptions of universality in preferences for health-care communication.

The results of this study could also have implications on communication skills training for medical professionals, particularly in how to communicate effectively with patients with external LOC. Medicine is practiced largely by members of the upper middle class and therefore reflects associated values, such as economic independence, and autonomy, as well as internalized LOC beliefs. A high internal LOC may influence physicians to expect that all people view themselves as autonomous agents of their own health and result in ineffective communication with patients with incongruent LOC beliefs. Communication is a fundamental clinical skill that, if performed competently, can facilitate trust between the provider and the patient. ( Chichirez & Purcarea, 2018 )

Research Implications

Given the findings of this review, more research is warranted, especially studies including more racial and ethnic minorities, low socio-economic status patients, and other populations that are known to have a more external LOC. While many studies that include LOC are solely descriptive or include LOC change (internal-external) as an outcome of empowering or disempowering healthcare experiences, few examined LOC as a predictor of health-related outcomes, and even fewer measured the direct influence of LOC on healthcare provider communication used by providers or preferred by patients. This is an important avenue for future research, especially for populations exhibiting externalized control beliefs.

Most of the studies employed surveys to measure patient-provider communication. They were usually retrospectively and at times focused on hypothetical scenarios. Many used convenience sampling and reported largely homogenous study populations in terms of race, ethnicity and even LOC type. These methods were likely employed due to their feasibility with limited time, funding, and other resources. While these factors present risks for bias and other challenges to interpretation of the findings, the selected studies are important for adding to our general understanding of LOC and the hypothesized relationships between LOC and several health care outcomes.

Future target outcomes could include more objective outcome measures, including health metrics such as weight loss or changes in hemoglobin A1C for patients with diabetes. Further, more studies including direct measures of actual communication, rather than retrospective patient reports are needed.

Limitations

This review is limited by studies that were identified for inclusion. We did not examine non-English language articles or solely qualitative studies and therefore may have missed or excluded relevant studies during our review. However, we used several variations of terms related to the concepts of interest since there is no clear consensus on many of the terms, such as “locus of control.” Overall, there were very few studies on LOC on patient-provider communication and these studies employed a wide range of patient populations, settings, and study designs.

The range of countries represented in the sample creates even more variability in culture, which is known to influence beliefs around communication and patient–doctor relationships. For instance, western societies tend to have and value internal LOC beliefs more highly than Eastern societies. ( Kang, Chang, Chen, & Greenberger, 2015 ; Morling, 2016 ) Even within Western societies, the US health care is vastly different from the rest of the Western hemisphere in terms of healthcare spending, access, quality, and outcomes. Therefore, the generalizability of our study findings across health statuses and healthcare systems is limited.

We also acknowledge that the lack of heterogeneity in LOC measures, including non-validated tools in the selected studies, further limits the reliability and generalizability of these findings. However, for many of the concepts included in the study, there is no consensus on their operationalization and therefore no one measure could be used reliably.

Finally, this review did not include all the factors and their interactions associated with LOC and patient-provider communication outcomes. In light of these limitations, we described the current state of the literature and possible future directions for research.

The included studies, conducted in various countries and employing a variety of patient-provider characteristics, found evidence of LOC associations with patient satisfaction, decision-making preferences, adherence, communication preferences, and patient-provider rapport. Our findings highlight the need for future studies on the influence of LOC in patient-provider communication outcomes. Based on the present review, this is an area in need of more uniform and rigorous methods to understand the relationships between LOC, and other psychosocial factors that are likely to impact patient-provider communication.

It has been argued that the basis of trust between patients and their physicians lies in the physician’s adherence to “universalism,” which is defined as treating all patients alike without regard to particular attributes or ascribed traits. However, patient communication preferences differ across cultures and individuals. There is a great deal of variability, across LOC beliefs, in preferences for desired amount of information, degree of involvement in medical decisions, and other factors. The findings of this review underscore the importance of patient-centered care that encourages providers to assess, as well as respect, a patients’ wants, needs, and preferences around participating in medical-decisions.

Supplementary Material

Supplement 1. literature search strategies, supplement 2. data extraction table, supplement 3. quality assessment table.

The work was supported by the NIH National Center for Advancing Translational Science Einstein Montefiore [TR002558].

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that influenced the research reported in this paper or the decision to publish the research findings.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10810730.2023.2192014 .

Data Availability Statement

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How a Baltimore neuroscience study is rewriting Black America’s relationship with medical research

By Alia Sajani June 19, 2024

P riscilla Agnew-Hines will never be able to forget that day in early 2020. On March 26, just weeks after Covid-19 officially became a global pandemic, her son died from an overdose.

Larry, 41, was a chef, a drummer for his gospel church and the son who challenged Priscilla’s barbecue skills during summer cookouts. He also struggled with addiction. That, she knew. But what made him more prone to addiction?

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“What part of the brain triggers mental illness?” Priscilla asked during a recent interview. “If we continue to be quiet, no one will understand the process of mental illness.” So when she learned about researchers looking into the role of genetics in neurological conditions among African Americans, Priscilla was hopeful. Looking for answers, she donated her son’s brain to the study.

Priscilla was among the more than a hundred Black Baltimorians who donated the brains of their deceased loved ones for a groundbreaking initiative that’s seeking to rebuild the medical research community’s tattered relationship with Black Americans.

The study , published in the journal Nature Neuroscience last month, is the first major undertaking from the African Ancestry Neuroscience Research Initiative — a collaboration between Morgan State University, a historically Black research university in Baltimore, the Lieber Institute for Brain Development, and local community leaders. Founded in 2019, the initiative has sought to understand the biological underpinnings of some neurological conditions that are more prevalent among those with African American ancestry.

Researchers from the Lieber Institute, housed at Johns Hopkins University, found that genetics, to some degree, could explain the higher prevalence of conditions like Alzheimer’s and stroke among Black Americans, or the lower prevalence of Parkinson’s. They also speculated that environmental factors, and their impact on gene expression, might better explain higher incidence of mental health conditions like schizophrenia and depression.

The findings could someday lead to personalized therapies informed by genetic ancestry. The researchers, who worried that studies like theirs might rekindle old myths and give validity to a biological basis for race, said the focus should be on how environmental stressors and lived experiences impact gene expression. This interplay of environment and genetics could make people more, or less, prone to certain diseases.

Bianca Jones Marlin, a neuroscientist at the Zuckerman Institute at Columbia University who studies how learned information is passed down generations through genetics, lauded the researchers’ efforts to center African Americans in their study. Marlin said while the findings deepen neuroscience’s understanding of how environmental factors affect genes in the brain, she wished the researchers had zeroed in more on the impact of specific environmental factors, especially social and emotional stressors like racism, which has impacted the African American community for generations.

Still, Marlin is hopeful that the study will inspire future research to investigate how socio-emotional stressors impact gene expression, potentially predisposing Black Americans to certain diseases. By taking into account the social determinants of health , a public health concept that accounts for how biology is impacted by the environment, researchers may gain insight into the policy changes needed to improve health outcomes in the African American community.

Related: A preacher’s new calling: Connecting neuroscience researchers as a way to advance social justice

The landmark study was made possible by the more than 100 brains (and 400 tissue samples from various brain regions) from deceased Baltimorians who self-identified as African American — an achievement in itself given the long history of racism and abuse that has marked Black Americans’ relationship with biomedical research.

In the 1800s, the pseudoscience of phrenology, the idea that bumps present on skulls could identify mental capabilities, was used to justify racism and slavery. More recently in 1951, Henrietta Lacks’ cells were collected by her physician during a cervical cancer biopsy at Johns Hopkins University. Known as HeLa cells, Lacks’ fast growing cancer cells are now used extensively in biomedical research, but were first grown in the lab by her physician without her consent. And, even decades after the infamous Tuskegee Syphilis Study , which started in 1932, a majority of Black Americans still believe that “medical researchers experiment on Black people without their knowledge or consent,” a recent Pew Research Center survey found.

Whether it is due to Black Americans’ mistrust, or because they were excluded, neuroscience research cohorts are typically dominated by participants with European descent. As a result, large genetic databases commonly used in brain research are limited in their use to investigate the disparities in neurological diseases — Black Americans are 20% more likely to experience major mental health problems , and twice as likely to develop Alzheimer’s disease .

In the Lieber Institute study, researchers first collected and sorted brain tissues based on self-reported race, hoping to understand how the lived experience of being African American in the U.S. impacted gene expression. Then, they determined genetic ancestry by analyzing the differences in specific genetic markers — African Americans can have a mix of African and European ancestry as a result of the long history of migration and slave trade.  

To avoid playing into old stereotypes about biological differences between races, researchers sought help from Black neuroscientists. Scientists from Black in Neuro , a nationwide effort of Black scientists established in 2020 during the Black Lives Matter movement, worked closely with the researchers on how to communicate the findings.

Related: Genetic variant common among West African descendants contributes to large cardiovascular disease burden

The researchers found that environmental factors — that could include everything from water quality and air pollution, to racism — impacted neurological health outcomes among people of African descent. Structural changes to DNA mediated by environmental factors, called epigenetics,   accounted for 15% of disease prevalence, while genetics accounts for 60% of differences between people of African and European ancestry.

They also found that genes that determine the body’s immune response, and the structure of blood vessels, were more likely to be elevated in people of African descent compared to people of European descent. The role of the immune system in affecting neurological diseases has recently gained the attention of the scientific community — since stress can affect the immune system, it may be the mechanism that makes some neurological diseases worse in Black Americans, a community that has a long history of experiencing discrimination.

The researchers found that genetics can explain only up to 26% of the likelihood of African Americans experiencing ischemic stroke, 27% for Parkinson’s disease and 30% for Alzheimer’s disease.

While the new findings advance neuroscience’s understanding of the disparities in disease prevalence among those with African-American ancestry, experts told STAT that the study itself is a model for more inclusive medical research.

“We reasoned that if we could demonstrate the success of this model in Baltimore (a city with a largely Black population and a long history of racial trauma and mistrust of medical institutions), we could institute a model that is suitable to be applied throughout neglected communities across the nation,” Alvin C. Hathaway Sr., who co-founded the African Ancestry Neuroscience Research Initiative, wrote in an editorial comment published along with the study.

Hathaway, who retired as the pastor of Union Baptist Church in Baltimore, was a crucial link in researchers’ ability to earn the trust of the African American community. During the 2020 racial reckoning after the murder of George Floyd, Hathaway said he realized going to protests wasn’t enough. Following a conversation with a member of the church, Hathaway decided that bringing more Black Americans into biomedical research was his new calling.

After the early success of the initiative’s first study, Hathaway is now focused on expanding the effort to more historically Black universities in other parts of the country.

For Priscilla, Larry’s mother, the study offered some closure, knowing that her son was part of an effort that could someday result in better medical care for those struggling with neurological and psychiatric conditions. She is now training to become a recovery coach, wanting to help others, like Larry, who are struggling with addiction.

About the Author Reprints

Alia sajani.

AAAS Mass Media Fellow

Alzheimer’s

neuroscience

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