Risk and ilness perception

When it comes to your health, how much control do you feel you have over the outcomes?

Some people believe their actions are directly related to health outcomes, whereas others believe that no matter what actions they take, the end result will ultimately be the same as it is outside of their control. This is known as ‘health locus of control’ and is measured on a scale from ‘external’ to ‘internal’. Those with internal health locus of control are more likely to take control of their own health and maintain physical well-being than those with external locus of control.



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It might be clear to you whether you have an internal or external locus of control, or perhaps you’re somewhere in the middle. If you identify as having an external locus of control, you may find it harder to follow lifestyle advice, and feel motivated to make lifestyle changes. 
Sometimes, we may believe that we have control of our health but do not feel at risk of health implications. It’s common to think “it won’t happen to me”, this is known as ‘unrealistic optimism’ which occurs when people believe that they are less likely to experience the negative health outcome or, if experienced, it will be less severe. Of course, optimism can be extremely beneficial in many areas of our life, however if we’re overly optimistic when it comes to our health, it can impact our decision making e.g., missing a health screening, or not taking action to prevent future health conditions.  

Everyone has different beliefs around health and scientists developed a tool called the health belief model to understand health behaviours. According to the health belief model there are key factors that influence someone’s approach to health:  

  • Barriers: everyone will have different barriers and obstacles that influence health motivation. 
  • Benefits: the benefits to taking action will be different for everyone and will impact the overall motivation to engage in a health behaviour. 
  • Severity and susceptibility to illness: for example, some people will feel at risk of developing health complications if they do not change their behaviour, or feel as though not making changes to their health will have a severe impact on their health, whereas others may believe that the impact of not taking action will not be very severe, or that they are not vulnerable to health risks. 
  • Confidence in ability to change behaviours: for example, feeling confident that you can make changes to your diet and/or physical activity.  
  • Cues: for example, something in the media, a conversation with a friend or healthcare professional or perhaps a reminder about an appointment that prompts you to take an action. 

These are all things that research has found to be important considerations when we look at health behaviour and motivation. Of course, these things will be different for everyone, and influenced by lots of factors including age, gender, where we live, level of our education and our income. 

Why does all this matter?  

As we’ve discussed, there are many different factors that influence how we perceive health, illness, and our risk, which explain why health beliefs and risk perception varies across individuals, cultures, and age. It can be helpful to take some time to reflect on our own health beliefs e.g. 

  • How much control do I have over my health? If you feel you don’t have much control over your health (external locus of control) it can be helpful to make SMART goals and reflect on your progress to understand how the changes you make are having a real impact on your health outcomes. Even though biology influences our health, we have a lot of control too!  
  • Am I unrealistically optimistic when it comes to my health? Perhaps you have had conversations with healthcare professionals, family and friends about your health, but you feel as though you’re unlikely to experience any health issues or complications. If that sounds familiar, it can help to imagine speaking to someone you care about in your position. Would you agree that it’s not worth making changes, or would you encourage them to make changes to their health? 
  • What are the benefits and barriers to changing my behaviour? Identifying the barriers to changing behaviour e.g. obstacles to walking for 15 minutes a day, is the first step to finding solutions to potential obstacles. It’s also helpful to reflect on the benefits to changing behaviour to maintain motivation. 
  • How confident do you feel to make changes? If you’re feeling confident then think about why you’re confident and how to maintain that confidence as you continue to make changes. If you’re not feeling confident then it can be helpful to think about times in the past where you’ve been successful in making changes and identify things that could help to increase confidence e.g. the support of a family member. 


Rosenstock, I. M. (1966). Why people use health services. Milbank Memorial Fund Quarterly, 44, 94-127.  

Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health education monographs, 6(2), 160–170. 

Weinstein, N. D. (1982). Unrealistic optimism about susceptibility to health. Journal of Behavioural Medicine, 5, 441-460