The purpose of this study was to explore the extent to which consumers choose to act autonomously in making decisions about care when dealing with the health care system. The antecedent variables included selected demographics, health locus of control, and previous experience with the health care delivery system. The consequent variables were self-care agency and autonomous decision-making.

The instrument included demographic data followed by the Exercise of Self-Care Agency Scale (Kearney & Fleischer, 1979), and the Multidimensional Health Locus of Control Scale (MHLC) (Wallston et al, 1978) with its three subscales: Internal Health Locus of Control, Chance Health Locus of Control, and Powerful Others Health Locus of Control scale. The final section of the survey consisted of six brief clinical scenarios to which the participants responded. Each scenario was followed by three pairs of forced-choice responses focusing on different aspects of the construct of autonomous decision-making: expert authority, social support, and seeking additional information about a condition.

The sample consisted of 328 participants; 282 were enrolled in a baccalaureate program for adults seeking a business degree while 46 had a high school education or less.

Analysis of demographic data revealed that mean scores on the ESCA scale were higher for Blacks than for Hispanics and higher for subjects who had some college than those with high school education or less. Occupation and education (good predictors of socioeconomic status) had the strongest relationship to autonomous decision-making about health care.

The relative contribution of IHLC, CHLC, and previous experience with health care system to ESCA was about 20 percent. PHLC did not contribute to the regression. Most of the variables did contribute to prediction of autonomous decision-making in a modest way.

Correlations between ESCA and three subscales of decision-making (authority, social, and additional information) were significant but weak. Correlations between ESCA, the scenario score and two subscale scores (medical and surgical) were not significant.

The effort to replicate the factor analysis by Riesch and Hauck (1988) of the ESCA scale was moderately successful. Three of their four factors were closely replicated.