title: Internal health locus of control in users of complementary and alternative medicine: a cross-sectional survey.
abstract: BACKGROUND
  Complementary and alternative medicine (CAM) is widely used in Germany, with some treatments eligible for health insurance reimbursements. CAM encourages patients to play an active role in their healing process. The belief that a person's own behavior influences health is assessed as the internal health locus of control (IHLOC). Studies on the association between IHLOC and CAM use yield inconsistent results. Using various indicators of CAM use, we evaluated whether there were differences in IHLOC between different groups of CAM users.
  
  
  METHODS
  A cross-sectional online survey was conducted. IHLOC was compared between participants with high and low appraisal of CAM, between participants who used different types of medications (none, CAM, conventional, both), and who consulted with different health care professionals (none, CAM, conventional, both). Independent samples t-tests and ANOVAs were conducted for the total group and for subgroups of chronically ill and healthy participants. Post-hoc, we conducted a multivariate linear regression evaluating which indicators of CAM use or other characteristics showed the strongest association with IHLOC.
  
  
  RESULTS
  A total of 1,054 undergraduate students completed the survey. Participants with high CAM appraisal showed higher IHLOC than those with low CAM appraisal, regardless of whether they were chronically ill (p < .001). Participants without chronic conditions showed higher IHLOC when only using CAM medications than when using either conventional medications alone or both conventional and CAM medications (p < .05). All participants showed higher IHLOC when visiting only CAM practitioners than when visiting either only conventional or both conventional and CAM practitioners (p < .05). CAM appraisal was associated the strongest with IHLOC in the linear regression model.
  
  
  CONCLUSIONS
  Generally, participants using CAM more or exclusively, and participants with higher appraisal of CAM showed higher IHLOC than those with less CAM use or lower CAM appraisal. Because of the cross-sectional design, it is not possible to determine whether differences in IHLOC are reasons for or consequences of CAM use. Research using a longitudinal design is needed. The sample, though more representative than most student samples, might not represent the general population. Studies evaluating clinical populations might add to the findings.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany. lena.schuetzler@charite.de.
authors.forename: Lena
authors.initials: L
authors.lastname: Schützler
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Witt
mesh_terms: D000328:Adult; D001294:Attitude to Health; D000529:Complementary Therapies / Q000523:psychology* / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D007389:Internal-External Control; D008297:Male; D012017:Referral and Consultation; D013334:Students / Q000523:psychology; D055815:Young Adult