Relationship between control loci and health-promoting behaviors in Pakistani women with polycystic ovary syndrome: coping strategies as mediators | BMC Women’s Health

Table 1 shows the results of Pearson’s correlations and it can be seen that the other internal and potent HLOCs had significant positive correlations with HPLB, while random HLOC had significant negative correlations with HPLB and its aspects. Among the dimensions of coping strategies, active practical adaptation had significant positive correlations with HPLB and its dimensions. While distractive and avoidance-oriented active adaptation had significant negative correlations with HPLB and its aspects. In addition, a significant negative correlation of active practical coping strategy was observed with avoidance and active distractive coping strategies.

Internal HLOC had a significant positive correlation with active practical adaptation and a significant negative correlation with avoidance and distraction coping strategies. Other potent HLOCs had a significant positive correlation with active practical adaptation and religious adaptation while it showed a significant negative correlation with avoidant and distractive coping strategies. Chance HLOC had a significant negative correlation with active practical adaptation and a significant positive correlation with avoidance and distraction coping strategies.

The results of hierarchical linear regression analyzes with six dimensions of HPLB as criteria are shown in Table 2. It can be seen that the total and direct effects of internal HLOC on six dimensions of HPLB were positive and significant, although the strength of the effects direct was less than total effects. In addition, the total effects of other potent HLOCs were positive and significant for all HPLB dimensions while the direct effects were not significant. The total and direct effects of random HLOC on all dimensions of HPLB were negative and significant, although the strength of the direct effects was weaker. Among the coping strategies, active practical adaptation positively predicted all dimensions of HPLB. Additionally, active distractive adaptation negatively predicts physical activity, health responsibility, and stress management.

The results of multiple linear regression analysis with coping strategies as criteria are given in Table 3. Internal HLOCs and other potent HLOCs positively predicted active practical adaptation. In addition, they negatively predicted active distractive adaptation and avoidance-oriented adaptation. In addition, other powerful HLOCs also positively predicted a religion-driven adaptation. In addition, Table 3 indicates that the random HLOC negatively predicts active practical adaptation and positively predicts active distractive adaptation and avoidance-focused adaptation. The results of Tables 2 and 3 suggest that the practical active adaptation and the active distractive adaptation mediate between HLOC and HPLB following the approach of Baron and Keney. [32]

To further test the mediation hypothesis, the Z test of the Sobel series was applied. The results confirmed that active practical adaptation altered the relationships between internal HLOC and physical activity, nutrition, spiritual growth, health responsibility, interpersonal relationships and stress management, Z = 3, 91, 3.94, 3.92, 3.94, 3.91 and 3.93, respectively, p<0.001. The Sobel Z test also confirmed the finding that active distractive adaptation mediates the relationships of internal HLOC with physical activity, health responsibility, and stress management dimensions of HPLB, Z = 2.99, 2, 96 and 2.98, respectively, p<0.001.

Active practical adaptation has also been observed to mediate relationships between other potent HLOCs and physical activity, nutrition, spiritual growth, health responsibility, interpersonal relationships, and stress management, Z = 3.74, 3.79, 3.74, 3.78, 3.75 and 3.77, respectively, p<0.001. Active coping of distraction mediates relationships between powerful HLOCs of others and physical activity, health responsibility, and stress management dimensions of HPLB, Z = 3.16, 3.12 and 3, 13, respectively, p<0.001.

Sobel’s Z-test also confirmed that active practical adaptation altered the relationships between random HLOC and physical activity, nutrition, spiritual growth, health responsibility, interpersonal relationships, and stress management, Z = – 4.59, – 4.65, – 4.61, – 4.61, – 4.67, – 4.61 and – 4.62, respectively, p<0.001. It was confirmed by applying Sobel's Z test that active distractive adaptation mediates the relationships of random HLOC with physical activity, health responsibility and stress management dimensions of HPLB, Z = - 2.88, - 2.85 and - 2.87, respectively, p<0.001.

Overall, the results suggest that women with polycystic ovary syndrome along with other internal and potent HLOCs use more active, practical coping strategies, which allow them to engage in different forms of health-promoting behaviors. In contrast, high levels of HLOC luck hamper active practical adaptation, which further leads to less involvement in the dimensions of HPLB. Additionally, high internal and potent HLOCs and low HLOC luck levels lead to less active and distracting coping strategies, which in turn lead to greater engagement in some of the health-promoting behaviors.