Locus of control is a psychological concept focused on an individual’s beliefs about there being  a causal relationship between their own behavior and specific outcomes or rewards. In other words, it is a belief centered on how a person perceives life events to be due to either their own actions (i.e., internal) or the result of outside forces beyond their control (i.e., external). Health locus of control (HLOC) refers specifically to a person’s subjective beliefs about their ability to control their own health status.

Individuals with a higher external HLOC tend to attribute health outcomes to factors such as fate, luck and the actions of others. People with a higher internal locus of control, on the other hand, believe that their own behaviors can directly impact their health outcomes. From a health perspective, having a high internal locus of control is a consistent predictor of improved physical health and psychological well-being, as well as having better self-assessed mental and physical health. Additionally, a higher internal locus of control is associated with having more self-control and self-efficacy, taking part in more preventive health behaviors and performing health-related behaviors across multiple settings.

While self-control, self-efficacy and locus of control are distinct concepts, they amplify one another and all three may help clients live a healthy life by enabling them to resist temptation, complete health-related tasks and achieve long-term goals.

The following is an example of how an external HLOC can influence the decisions a person makes. If a client’s physician (called a “powerful other” in the research on locus of control) tells them that a specific medication or lifestyle change will impact their health in a positive way, the client may be willing to do what is recommended because they believe the physician can influence their health. However, if the powerful other is instead a friend or family member, for example, who does not believe that lifestyle change can positively impact health, then that person may be able to sway the client in the opposite direction.

How Is Locus of Control Measured?

Traditionally, measuring locus of control has relied on the use of questionnaires that utilized scaling questions to gain a deeper understanding of how much a person feels they have control over things that happen to them. While it is not necessary for exercise professionals and health coaches to assess locus of control formally using a questionnaire, scaling questions can be used in conversation to dig a little deeper. For example, you might ask a client, “On a scale of 1 to 5, how much do you think your diet impacts your health?” In addition, it is important for you to be aware of the types of language your clients are using when discussing their health behaviors, which can be accomplished via active listening. Listen for clients to say things like, “It’s just luck,” “It’s a game of chance whether I end up with diabetes or not,” or other comments that may offer clues that a client may have a more external HLOC.

How To Help Clients Increase Their Internal HLOC

If people with a higher degree of internal locus of control are more likely to engage in positive behavior changes like following a healthy diet and exercising to improve quality of life and are less likely to engage in unhealthy behaviors, how can exercise professionals and health coaches support clients in shifting to a more internal locus of control?

First, it is important to increase awareness about the connection between behavior and health. For example, imagine your client has high blood pressure and currently believes that it is simply the result of bad luck and that a change in behavior will not help improve their situation. It may be important to explore the connection between specific dietary patterns and exercise and the role that core drivers of healthy living play in managing blood pressure. It is not so much about having a lack of knowledge, but rather increasing awareness that health outcomes are not just left to fate, especially when dealing with lifestyle diseases.

Second, highlight past successes and personal strengths. Help clients recall a time when they worked hard to achieve a goal. This is an example of actions influencing outcomes or rewards.  What strengths do they have that helped them to achieve that goal and how can they be applied to leading a healthier lifestyle? The more past, current and future examples a client can think of, the more they may start to shift their perceptions about the role they personally play in optimizing their health and living their fullest life.

Third, use cognitive behavioral coaching to restructure cognitive distortions (irrational and harmful thought patterns) and replace inefficient beliefs with efficient ones. For example, if a client jumps to the conclusion that eating healthier won’t help them manage their weight because they always seem to gain weight no matter what they eat, you can work with them to further explore this belief and help them to restructure this unhelpful way of thinking. Ask the client, “What is the evidence to support the idea that no matter how you eat you will only gain weight?” Or, ask the client to tell you more about their experience with eating and their weight. Both approaches can open the door to reframing. It’s important to note that cognitive behavioral coaching may not be appropriate for all clients, so use your professional judgement.

Conclusion

The journey toward optimal health is as much a psychological endeavor as it is a physical one. While HLOC often operates quietly in the background of a client’s mind, its influence on their long-term success is profound. By moving the dial away from "chance" and "fate" and toward an internalized belief in one's own agency, health coaches and exercise professionals do more than change a mindset—they unlock the door to sustainable behavior change.

If you are interested in learning more about how to guide individuals to make meaningful, lasting changes in their lives, consider the ACE Behavior Change Specialist Program (worth 2.5 ACE CECs). This program provides you with the expertise to make a profound impact on clients' health and well-being by addressing the root of counterproductive behaviors and fostering sustainable, positive habits.