Dimensions of client control

The purposes of this study were to identify activities that give patients a sense of control during their hospitalization and to characterize the kinds of people who find control in various ways. Bandura's (1977) social learning theory and the relationship between control and stress formed the theoretical framework; Q methodology was central to implementation and replication of the descriptive design. Consistent with Q methodology, major and replication samples were purposively selected, each consisting of 30 medical-surgical inpatients of both sexes, ranging from 24 to 75 years of age. Instruments used were the Client Control Q Set, Health Opinion Survey (HOS), a demographic data form, and a semi-structured interview. Q factor analysis and the construction of factor arrays resulted in three dimensions of client control in the original data set which replicated and were supported by interview and HOS data. These orthogonal dimensions were: knowing and fulfilling the patient role, being involved in making decisions, and directing interpersonal and environmental components. A theme common to all dimensions was the importance patients attached to having cognitive control over diagnostic tests, surgery, and treatment and to understanding concomitant life-style implications. Identification of the kinds of people who find control in various ways remains elusive, although patients hospitalized for diagnosis and/or treatment of cancer were predominant among those who wanted to be involved in making decisions.