[Health locus of control and cholesterol representations. Results of the FRACTION survey].

Unlabelled: The concept of the health locus of control (HLC) proved fruitful in predicting individual health behavior, in particular a person's ability to actively comply with a preventive approach. It is interesting to apply such a concept to the field of cardiovascular risk, where too many people still disregard to various degrees measures designed to control hypercholesterolemia. Now, hypercholesterolemia is recognized as a major modifiable risk factor for cardiovascular disease.

Objectives: From a survey designed to explore the health beliefs concerning cholesterol and hypercholesterolemia in 1,398 subjects followed up for hypercholesterolemia by a general practitioner, we tried to determine whether the socio-demographic, clinical and cognitive characteristics of the population were related to the type of HLC of each subject (internal, chance or medical power).

Method: All the subjects filled out a 27-item questionnaire that included one question aimed to determine their HLC type. These data were completed by a short identification sheet, encompassing various clinical data, given by the GP. A global level of dietary knowledge was computed from a question on nutritional properties of 11 foods according to the direct or indirect contribution of each food to the blood cholesterol level.

Results: Population consisted of 59.7% males and 40.3% females. Mean age was 57.9 +/- 11.5 years. Educational level was low (< 9 years of education) for 38% of the subjects and medium/high (10 years or more of education) for 62% of them. Hypertension was associated to hypercholesterolemia for 46.4% of the subjects, diabetes mellitus for 13.3% and coronary heart disease for 11.4% of them; 18.2% were current smokers and 34.6% past-smokers; 86.1% were already treated by lipid lowering drugs. Based on the answers to the HLC question, 42.3% of the study population can be considered as characterized by an internal HLC, 30.5% by a medical power HLC, and 27.1% by a chance HLC. An internal HLC was associated with a younger age (p < 0.008), a higher educational level (p < 0.001), less hypertension (p = 0.002), and a lower body mass index (p = 0.02). An internal HLC was also associated with several representations testifying an appropriate level of knowledge, for example: cholesterol is a basic component of the body (p = 0.001), or the presence of cholesterol in blood is normal (p = 0.04), or the desirable cholesterol level in the blood is < 2 g/l (p = 0.01) and with fewer mis-conceptions about cholesterol and hypercholesterolemia, for example: overweight individuals are more prone to have cholesterol problems (p = 0.001), or too much cholesterol may lead to cancer (p = 0.03). It was also associated with a closer identification between cholesterol and modem lifestyle (p = 0.005), with the belief that the best way of lowering cholesterol is to diet (p = 0.001) and with a lesser degree of demotivation when being aware of the role of heredity in a health problem (p = 0.001) as well as with fewer mentions of paradoxical or disappointing counter-examples of close people treated for hypercholesterolemia (p = 0.04). Finally, internal HLC subjects put forward less excuses for not to comply with dietary constraints, for example: being on diet is only possible with the spouse/family (p = 0.007), or dieting is impossible if one has an active lifestyle including eating out (p < 0.001).

Conclusion: In spite of the very simple way used for assessing HLC in our study, without turning to a standardized multi-item inventory, these results should encourage physicians to take into account the HLC of their hypercholesterolemic patients to pass personally tailored educational messages and to motivate them to take responsibility for their own health.