|Year : 2016 | Volume
| Issue : 3 | Page : 136-140
Impact of Locus of Control and Job Type on the Perception of Autopsy among Medical and Nonmedical Workers in a Nigerian Tertiary Health Institution
Uwom Okereke Eze1, Mfon E Ineme2, Helen O Osinowo3
1 Department of Pathology, University College Hospital, Ibadan, Nigeria
2 Department of Psychology, University of Uyo, Uyo, Nigeria
3 Department of Psychology, University of Ibadan, Ibadan, Nigeria
|Date of Web Publication||30-Sep-2016|
Uwom Okereke Eze
Department of Pathology, University College Hospital, Ibadan
Source of Support: None, Conflict of Interest: None
The impact of locus of control and job type on the perception of autopsy among medical and nonmedical workers in University College Hospital, Ibadan, was investigated. Ninety-two medical and 46 nonmedical workers from the hospital participated in the study. An ex post facto design was used. The Autopsy Perception Scale and Locus of Control Scale were used as instruments. The t-test result (t = −2.03; P < 0.05) showed that hospital workers with an internal locus of control reported to have a more positive perception of autopsy than those with an external locus of control; the t-test result (t = −2.29; P < 0.05) showed that medical workers reported a more positive perception of autopsy than nonmedical workers. However, the t-test result (t = −0.82; P > 0.05) showed that there was no significant difference between workers who had had an autopsy conducted on their deceased relatives and those who had not. The results were discussed in line with existing literature.
Keywords: Autopsy, hospital workers, job type, locust of control, perception
|How to cite this article:|
Eze UO, Ineme ME, Osinowo HO. Impact of Locus of Control and Job Type on the Perception of Autopsy among Medical and Nonmedical Workers in a Nigerian Tertiary Health Institution. J Forensic Sci Med 2016;2:136-40
|How to cite this URL:|
Eze UO, Ineme ME, Osinowo HO. Impact of Locus of Control and Job Type on the Perception of Autopsy among Medical and Nonmedical Workers in a Nigerian Tertiary Health Institution. J Forensic Sci Med [serial online] 2016 [cited 2022 Dec 7];2:136-40. Available from: https://www.jfsmonline.com/text.asp?2016/2/3/136/191463
| Introduction|| |
It is universally accepted that death is inevitable; all living things, including human beings, are expected to die someday. However, despite this axiom, death often raises concerns, suspicion or uncertainty about cause(s) of death and may result into attribution of cause(s) of death to God and other external sources.  This disposition is not uncommon in Africa where someone or some means is usually blamed for the death of a person rather than being a natural death. This suspicion about the cause (s) of deaths may result in an examination of what the true cause may be. In a typical African setting, findings were made by consulting sorcerers, native doctors, soothsayers, and the likes, to ascertain the cause (s) of death and other human harms.  However, with education, civilization, and advancement in science and technology, there arose a more scientific way of ascertaining the causes of the death. This is known as an autopsy. It involves three major processes: external examination, internal examination, and reconstruction of the body. 
Autopsies are used in clinical medicine for the clarification of a cause of death that was not clinically apparent, in addition to the identification of medical error. A systematic review of autopsy studies calculated that in about 25% of autopsies, a major diagnostic error would be revealed. 
Autopsy has been established to be of great benefit, as it provides knowledge that may be used for future application, and adds to data on the local epidemiology of disease and on the quality control in investigations. 
One psychological factor that may influence (or impact) the perception of autopsy (or perception of any other phenomenon) is the locus of the control of the individual (s). When describing locus of control, it has been postulated that every human being has a "place" - the locus - where he/she feels the control of his/her life rests; this place or locus of control can either be internal or external and it is this position that creatively determines how much "in control" an individual feels about his/her life  (and events that happen around him/her). People with an internal locus generally feel that they have control over their lives and circumstances; they take initiative and seek to positively change their lives. Individuals with an external locus feel that their lives are controlled by circumstances; they feel disempowered to do anything about their lives, leaving everything to fate.  It has been found that more education leads to an increase in one's internal locus of control, , that cultural background and ethnicity may contribute to one's locus of control,  and that there is a direct relationship between locus of control and one's health. ,
| Theory of Locus of Control|| |
This theory was developed by Rotter, who defined the locus of control as the cause to which individuals attribute their successes and failures.  It has been popularized by Forte.  Rotter identified two different types of control - internal and external; those with a high internal locus believe that their will and behavior are directed by their own internal decisions, and thus feel that they have more influence on their environment, while those with a high external locus believe that their behavior and results are guided by circumstances out of their own control (fate, luck, etc.). 
Attribution theory focuses on how people attribute events and how those beliefs interact with self-perception. Attribution theory defines three major elements of cause:
In relation to this study, those with an internal locus of control are likely to accept death as being a function of internal problems (possibly by mistake) that affect the physiology of the dead. However, while many people accept that an autopsy will confirm the actual cause, those with an external locus of control may attribute the cause (s) of any death to external (spiritual) sources and may not believe in a scientific process, like autopsy, to determine the cause.
- Locus is the location of the perceived cause. If the locus is internal (dispositional), feelings of self-esteem and self-efficacy will be enhanced by success and diminished by failure
- Stability describes whether the cause is perceived as static or dynamic over time. It is closely related to expectations and goals, in that when people attribute their failures to stable factors such as the difficulty of a task, they will expect to fail in that task in the future
- Controllability describes whether a person feels actively in control of the cause. Failure on a task which "one thinks she or he cannot control" could lead to feeling of humiliation, shame and/or anger. 
Purpose of the study
- To examine the impact of locus of control on the perception of autopsy among medical and nonmedical workers in a tertiary health institution
- To investigate the impact of job type on the perception of autopsy among medical and nonmedical workers in a tertiary health institution
- To assess the impact of having an autopsy performed on a deceased relative on the perception of autopsy among medical and nonmedical workers in a tertiary health institution.
| Operational Definition of Terms|| |
Locus of control
The extent to which an individual believes is that he/she is responsible for what happens to him/her. This is known as the internal and external locus of control; those who are internally controlled believe that they are responsible for what happens to them, while those who are externally controlled attribute events in their lives to fate, other human beings, and other external sources. In this study, the locus of control was determined with the Locus of Control Scale.  The norm of the scale is 14; scores below the norm indicate an external locus of control, while scores at the norm and above indicate an internal locus of control.
Perception of autopsy
Perception of autopsy entails its understanding, acceptance, and impression by an individual. In this study, this was measured using the Autopsy Perception Scale, which was developed and validated in the course of this study. The norm of the scale is 11; scores below the norm indicated a negative perception of autopsy, while scores at the norm and above indicated a positive perception of autopsy.
Medical workers are hospital workers who have direct dealings with patients; for this study, they included doctors, nurses, laboratory scientists, and pharmacists.
Nonmedical workers are hospital workers whose services do not demand direction contact with patients and their illnesses; for this study, they included administrative staff, ward maids, maintenance staff, and cleaners.
Relatives include fathers, mothers, brothers, sisters, first cousins, or grandparents.
A cross-sectional survey design was used for the study. This is because a survey (or descriptive) research design would attempt to describe and explain conditions of the present using numerous participants and questionnaires (instruments) to fully describe a phenomenon. 
Participants for the study were 138 employees of the University College Hospital (UCH), Ibadan. They included 78 males and 60 females. Ninety-two were medical staff, while 46 were nonmedical staff. Their ages ranged from 25 to 63 years, with a mean age of 41.30 years, 99 were Christians, while 39 were Muslims.
This study was conducted at the UCH, Ibadan. The hospital is a long-standing and renowned hospital in Nigeria and the entire West African Subregion and has existed and contributed to health-care delivery for about 60 years at the conduction of this study. It has many functional departments, including the Department of Pathology, which undertakes forensic pathology caseloads and conducts autopsy frequently.
Two structured, valid, and reliable psychological instruments were used for this study. They are as follows:
Autopsy perception scale
A 10-item scale designed for the purpose of this study. It is a 3-point Likert-type scale with a response format ranging from "false" (0), "somewhat true" (1), and "very true" (2). The initial version of the scale, which had 15 items, was presented to two clinical psychologists, one consulting pathologist, and one forensic medical practitioner to scrutinize, ensure face and content validity, and ensure population-specific cultural sensitivity. These were then administered to 47 medical and nonmedical workers of the hospital, and their responses were subjected to a reliability analysis using SPSS version 20.0 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Ten items were found to be reliable, with a Cronbach's alpha coefficient of 0.60. It consists of positive and negative items. The lowest score is 10 and the highest score is 20, while the norm of 11 is established at one standard deviation above the mean. Scores below the norm indicate a negative perception of autopsy, while scores at the norm and above indicate a positive perception of autopsy.
Locus of control scale
A 9-item scale was designed to measure the participants, in a "yes" or "no" format. The initial version of the scale by Rotter, which comprised 15 items, was subjected to further revalidation in the current study using 47 Nigerian samples; nine items were reliable with a Cronbach's alpha coefficient of 0.59. The lowest score was 9 and the highest score was 18. A new norm of 11 was established at one standard deviation above the mean; scores below the norm showed an external locus of control, while scores at the norm and above showed a high internal locus of control.
The following were obtained as demographic variables under section A of the instrument: age, sex, profession/occupation, and years in service, religion, and having the need to conduct an autopsy on a deceased relative.
A convenience sampling technique was used to choose the hospital, UCH, and a purposive sampling technique was used to select participants. Only employees of UCH who had worked in the hospital for a minimum of 5 years were allowed to participate in the study.
Those included in the study were only full-time adult employees (medical and non-medical staff) of UCH who had spent at least 5 years in the employ of the University College Hospital, Ibadan.
The study was conducted in two stages. The first stage was the pilot study, which aimed at validating the instruments for the study; the initial versions of the instruments (Locus of Control Scale and Autopsy Perception Scale) were administered to 50 medical and nonmedical staff of UCH, Ibadan, in their offices and wards, and 47 were duly completed and retrieved. The completed instruments were retrieved, and their responses were subjected to a reliability analysis with SPSS version 20.0. The reliable items constituted the final versions of the instruments. At the second stage, the valid and reliable instruments were administered to the 145 participants (UCH workers) in their offices and wards, and 138 were duly completed. Those who participated in the first phase (pilot study) were not allowed to participate in the second phase (main study). At both phases, the purpose of the study was introduced to the intended participants, and the instruments were administered only to the volunteers. The participants were allowed an average of 24 h to complete their responses to the instruments, which were retrieved and subjected to statistical analyses using SPSS version 20.0.
This study was conducted at UCH, Ibadan, in compliance with the Helsinki Declaration on biomedical research in human subjects' guidelines; it was deemed to have a negligible risk and did not require Ethics Committee approval in Nigeria. Confidentiality of subjects' identity was maintained, and personal health information was not disclosed.
Hypotheses 1, 2, and 3 were tested using a t-test for an independent sample because the hypotheses essentially compared two independent groups for the perception of autopsy.
| Results|| |
Hypothesis 1, which stated that UCH workers with an internal locus of control would report more a positive perception of autopsy than those with an external locus of control, was tested using a t-test for independent samples. A summary of the results is presented in [Table 1].
|Table 1: T-test summary table showing the difference between internally controlled and externally workers on perception of autopsy |
Click here to view
[Table 1] shows that workers with an internal locus of control reported having a more positive perception of autopsy than those with an external locus of control (t(136) = −2.03; P < 0.05). The significant difference can be observed in the mean, in which participants with an internal locus of control had a higher mean score (X̅ =18.23) on the perception of autopsy than those with an external locus of control (X̅ =16.98). The hypothesis was therefore confirmed.
Hypothesis 2, which stated that medical workers would report having a more positive perception of autopsy than workers with an external locus of control, was tested using a t-test for independent samples. The result is presented in [Table 2].
|Table 2: Table showing difference between medical and non-medical workers internal and external locus of control on perception of autopsy |
Click here to view
[Table 2] shows that medical workers reported having a more positive perception of autopsy than nonmedical workers (administrative staff) (t(136) = −2.29; P < 0.05). The significant difference may be observed in the mean, in which medical workers scored lower (X̅ =16.96) on the perception of autopsy, while nonmedical workers scored higher (X̅ =18.54). The hypothesis was therefore confirmed.
Hypothesis 3, which stated that workers who have had an autopsy conducted on their deceased relatives would report having a more positive perception of autopsy than workers who have not, was tested using a t-test for independent samples. A summary of the result is presented in [Table 3].
|Table 3: T-test summary table showing the difference between participants who have ever had autopsy conducted on their deceased relatives and those who have not on perception of autopsy |
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The t-test result (t(136) = −0.82; P > 0.05) presented in [Table 3], shows that there was no significant difference in the perception of autopsy between workers who have had an autopsy conducted on their deceased relatives and those who had not. The nonsignificant difference may be observed in the mean, in which participants who had an autopsy conducted on their deceased relatives had a mean score of 17.04 on the perception of autopsy, while those who had not had a mean score of 17.59, a mean difference of only 0.56. The hypothesis was therefore not confirmed.
| Discussion|| |
Based on the results of the study, hospital workers with an internal locus of control reported having a more positive perception of autopsy than those with an external locus of control. This is in line with an earlier finding that revealed that those who held an internal locus of control questioned doctors and nurses more and expressed less satisfaction with the amount of feedback or information they had received from hospital personnel than did external locus patients.  With this dissatisfaction and a quest to understand, those who are internally controlled are likely to demand or accept any explanation that is capable of satisfying their curiosity. Those with an external locus of control may simply embrace any, even delusional, information that may explain the condition or situation; then, they externalize by attributing its causation to external sources. Put differently, those with an external locus of control are known for attributing events in their lives to luck and fate.  They would, therefore, conclusively attribute death to fate, and see no reason to invest the effort to ascertain causation. This is in line with Rotter's attribution theory, in which those with an external locus of control attribute causation to external (spiritual) sources very hastily and strongly maintain them.
In addition, the results show that medical workers (doctors, nurses, and laboratory scientists) reported having a more positive perception of autopsy than nonmedical (administrative) staff. This may be attributed to knowledge (information) and exposure. It was obvious that the medical workers were better informed as far as autopsy was concerned; their knowledge may have prompted them to realize the need for autopsy more than the administrative staff, who might have viewed it as a waste of time and resources.
| Conclusion|| |
The impact of locus of control and self-efficacy on the perception of autopsy among medical and nonmedical workers in UCH, Ibadan, was investigated. Totally, 138 medical and nonmedical workers participated in the study, which tested three hypotheses. The results showed that hospital workers with an internal locus of control reported to have a more positive perception of autopsy than those with an external locus of control and medical workers (doctors, nurses, and laboratory scientists) reported having a more positive perception of autopsy than nonmedical (administrative) staff. Similarly, it was found that there was no significant difference in the perception of autopsy between workers who have had an autopsy conducted on their deceased relatives and those who have not. It is suggested that further studies should be conducted regarding the perception of autopsy. However, such studies should accommodate more participants from different institutions, professions, and social classes. Psychological variables, such as personality, expectation, self-efficacy, and others known to affect perception, should also be considered in further studies.
We remain very grateful to the management of the University College Hospital (UCH), Ibadan, for providing an environment conducive for the present study. We thank the academic staff of the Legal and Criminological Study Unit of the Department of Psychology, University of Ibadan, for their technical and supervisory roles. We are indebted to our participants, the medical and nonmedical workers of the UCH, Ibadan, who voluntarily participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]