In today’s healthcare landscape, the concept of patient empowerment is a buzzword, it is an idealised fiction. The ‘empowered patient’ constitutes a very narrow demographic, as described in other articles. There are a number of systemic obstacles in the way of the majority to becoming empowered. But it ought to be a necessity. Everybody ought to be empowered. As health systems shift toward more personalised, participatory models of care, the traditional view of the passive patient is being replaced by a more dynamic one: individuals who are engaged, informed and actively involved in decisions that affect their health and wellbeing. This is where the fiction takes hold. It is assumed that it is already the case, that the empowered patient is the norm, rather than the tiny minority.

But for those that are empowered, what drives this kind of engagement at a psychological level? One key factor is a person’s internal locus of control. Let us examine what it means to be empowered. Empowered patients are not merely compliant, but they are collaborators in care. They ask questions, evaluate options and contribute meaningfully to their own health outcomes. Central to this shift is the belief that one’s actions directly impact health. This is a defining feature of the internal locus of control.

Internal Locus of Control in Chronic Disease Management

Chronic diseases like diabetes, hypertension, asthma and heart disease require continuous self-monitoring, lifestyle changes and adherence to treatment plans. Unlike acute conditions, these illnesses are rarely ‘fixed’ in a single intervention. Managing them successfully often hinges on what patients do outside the clinic: tracking blood sugar, regulating diet, taking medications, managing stress, exercising and diary completion - if you ever have to do a health-related diary, compliance to this is much harder than you would think.

An internal locus of control plays a decisive role in these everyday health behaviours. Individuals who believe they are responsible for their own health outcomes are more likely to:

Make informed lifestyle choices, such as quitting smoking or reducing salt intake.

·       Monitor their own symptoms and adjust behaviours accordingly.

·       Engage in preventive care, including regular screenings and vaccinations.

·       Follow prescribed treatment plans consistently and without coercion.

In contrast, patients with an external locus of control may see their condition as something that happens to them, regardless of their actions. This mindset can lead to resignation, dependency on doctors to ‘fix’ them and poor follow-through on care recommendations or prescriptions, whether drug or non-drug based.

The Relationship Between Control and Adherence

One of the most persistent challenges in medicine is ensuring treatment adherence, the extent to which patients take medications, follow diets and stick to behavioural recommendations. Numerous studies have shown that individuals with a strong internal health locus of control are more adherent to treatment regimens. They tend to believe their effort matters, so they are more likely to persevere with lifestyle changes or complete multi-step treatment plans.

For example, a person managing Type 2 diabetes who believes they control their health is far more likely to check their blood glucose levels daily, maintain a consistent meal plan and remain physically active. On the other hand, someone with a more external orientation may rely solely on medication and feel helpless when complications arise, believing outcomes are dictated by genetics, chance or healthcare professionals alone.

Strengthening Trust and Collaboration

Patients with a strong internal locus are also more likely to build collaborative relationships with their healthcare providers. They see themselves as part of a partnership, bringing their own goals, questions and preferences to the table.

This co-production of care is at the heart of patient-centred medicine. It encourages:

·       Shared decision-making, where treatment choices reflect both medical evidence and the patient’s values.

·       Open communication, with patients feeling confident in voicing concerns and asking questions.

·       Mutual respect, where healthcare professionals recognise and support the patient’s role in managing their health.

Ultimately, this leads to better outcomes, not only because care is more tailored, but because the patient is more likely to follow through.

Empowerment in Action: Two Patient Scenarios

Let us consider two hypothetical patients recently diagnosed with hypertension:

Patient A believes their health is largely determined by external forces, such as “It runs in my family”, “My doctor knows best” or “What’s meant to happen will happen”. They fill their prescriptions but do not monitor their salt intake or change their physical activity. When they miss a follow-up appointment, they shrug it off, assuming it will not make a difference.

Patient B, by contrast, has an internal locus of control. They see the diagnosis as a wake-up call and begin researching lifestyle changes. They ask their provider about alternative medications with fewer side effects and use a home blood pressure monitor to track trends. They stay active and accountable.

Over time, Patient B is far more likely to stabilise their blood pressure and avoid complications. The key difference is belief as well as behaviour. One patient feels empowered; the other does not.

The Uneven Playing Field

Despite its clear benefits, an internal locus of control is not equally distributed. Socioeconomic status, education level, mental health, cultural background and past experiences with the healthcare system all influence how people perceive control over their health.

For instance, individuals from historically marginalised groups. Those who have experienced medical racism, discrimination or systemic disempowerment may have internalised a sense of futility. Others may come from cultural backgrounds that emphasise deference to authority, making it harder to assert one’s own voice in medical contexts.

Moreover, low health literacy can compound the issue. Patients who don’t fully understand their condition or treatment options may default to a passive role. This is not because they want to, but because they feel unequipped.

Building the Bridge

The good news is that an internal locus of control can be nurtured, and it is not fixed. Healthcare systems and providers have a critical role to play in cultivating this mindset. This can be done through:

·       Patient education: Explaining conditions in accessible language in helping patients understand how their actions influence outcomes.

·       Motivational interviewing: A counselling approach that help patients explore their own reasons for change and build confidence.

·       Self-management programmes: Group or individual coaching sessions that provide tools for daily disease management.

·       Supportive technology: Apps and remote monitoring tools that give patients real-time feedback and a greater sense of ownership.

Even subtle changes in language, like shifting from “You need to take this pill” to “This medication can help you meet your goals”, can reposition the patient as an active agent rather than a passive recipient.

Empowerment Begins with Belief

At the intersection of psychology and healthcare lies a powerful truth: what we believe about control shapes how we care for ourselves. An internal locus of control is more than a personality trait. It is a cornerstone of patient empowerment. It encourages people to engage, question, persist and lead their own health journeys.

In the broader conversation about improving outcomes, increasing adherence and reducing healthcare disparities, encouraging this belief may be one of the impactful and humanising strategies available.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025