Internal locus of control, health literacy and health, an Israeli cultural perspective

Orna Baron-Epel, Diane Levin-Zamir, Vicki Cohen, Asher Elhayany

Research output: Contribution to journalArticlepeer-review


The association between health literacy (HL) and health outcomes, including self-perceived health (SPH) has been well documented. Yet the complexity of this association is not yet completely clear. Drawing on the Health Literacy Scale (HLS) study in Israel, we examined the association between HL, Internal Health Locus of Control (IHLOC) and SPH among Jews and Arabs. A face-to-face survey was conducted among 242 Arabs and 358 Jews. The questionnaire measured SPH, IHLOC and two measures of HL: a European HLScale (HLS-EU-16) and the Hebrew/Arabic Health Literacy Test (H/AHLT), based on the Short Test Of Functional Health Literacy in Adults. Analysis included multivariable logistic regressions and bootstrapping to identify mediation effects. Among Jews, IHLOC seems to be a significant mediator between HL and SPH. IHLOC was strongly associated with SPH (OR = 6.13; CI = 3.2, 11.8), while HL was not significantly associated directly with SPH. Similar results were observed when using the H/AHLT as a measure of HL. Among Arabs a different pattern emerges; IHLOC was neither associated with SPH nor was it a mediator of the association between HL and SPH. The two measures of HL seem to have different associations with SPH among Arabs, as only H/AHLT was associated significantly with SPH, and not HLS-EU-16. Thus, those with higher levels of IHLOC assess their health as better than those with low IHLOC only among Jews, and not among Arabs. IHLOC seems to be a significant mediator between HL and SPH among some cultures.

Original languageEnglish
Pages (from-to)248-257
Number of pages10
JournalHealth Promotion International
Issue number2
StatePublished - 1 Apr 2019

Bibliographical note

Funding Information:
The study was supported by a grant from the Israel National Institute for Health Policy Research, Israel.

Publisher Copyright:
© The Author 2017. Published by Oxford University Press. All rights reserved.


  • Arabs
  • Jews
  • health literacy
  • internal locus of control
  • self-perceived health

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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