Monica Eriksson

Validity of Antonovsky’s sense of coherence scale: a systematic review

Study objective: The aim of this paper is to systematically review and analyse the validity and reliability of Antonovsky’s life orientation questionnaire/sense of coherence scale (SOC). Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992–2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: The SOC questionnaire has been used in at least 33 languages in 32 countries with at least 15 different versions of the questionnaire. In 124 studies using SOC-29 the Cronbach’s α ranges from 0.70 to 0.95. The α values in 127 studies using SOC-13 range from 0.70 to 0.92, and in 60 studies using a modified SOC scale range from 0.35 to 0.91. Test-retest correlation show stability and range from 0.69 to 0.78 (1 year), 0.64 (3 years), 0.42 to 0.45 (4 years), 0.59 to 0.67 (5 years) to 0.54 (10 years). The means of SOC-29 range 100.50 (SD 28.50) to 164.50 (SD 17.10) points and SOC-13 from 35.39 (SD 0.10) to 77.60 (SD 13.80) points. After 10 years SOC seems to be comparatively stable, but not as stable as Antonovsky initially assumed. SOC tends to increase with age. The factorial structure of SOC seems rather to be multidimensional than unidimensional. SOC predicts a positive outcome in a long term perspective, although there are divergent findings reported. The SOC scale seems to be a reliable, valid, and cross culturally applicable instrument measuring how people manage stressful situations and stay well.

Antonovsky’s sense of coherence scale and the relation with health: a systematic review

Study objective: The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions. Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992–2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: SOC is strongly related to perceived health, especially mental health. The stronger the SOC the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the SOC seems to be able to predict health. SOC is an important contributor for the development and maintenance of people’s health but does not alone explain the overall health. Conclusion: SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date.

Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review

The aim of this paper is to synthesise findings on the salutogenic concept, sense of coherence (SOC), and its correlation with quality of life (QoL). This study is descriptive and analytic, with a systematic integration of the contemporary knowledge base on the salutogenic research published in 1992–2003. This review includes 458 scientific publications and 13 doctoral theses on salutogenesis. In all, 32 papers had the main objective of investigating the relationship between SOC and QoL. This study is based on scientific publications in eight authorised databases, doctoral theses and available books. The SOC seems to have an impact on the QoL; the stronger the SOC, the better the QoL. Furthermore, longitudinal studies confirm the predictive validity of the SOC for a good QoL. The findings correspond to the core of the Ottawa Charter—that is, the process of enabling people to live a good life. Therefore, a certain possibility to modify and extend the health construct is becoming discernible, implicating a construct including salutogenesis and QoL. The SOC concept is a health resource, influencing QoL.

A sense of coherence and health. Salutogenesis in a societal context: Åland, a special case?

Background: Antonovsky’s salutogenic concept of a sense of coherence (SOC) has proved most influential in the way that health is now perceived. Aim: To (1) describe the distribution of SOC among 40–70-year-old Ålanders; (2) examine the distribution of depression in Åland, Finland, and its relationship with SOC; and (3) discuss the findings within a salutogenic framework in a societal context. Design: A cross-sectional study design was adopted. Antonovsky’s SOC Questionnaire (13 items) and the Beck Depression Inventory (13 items) were used. In addition, in a separate questionnaire, sociodemographic information about each participant was sought, together with a question specific to this study and designed to measure self-rated health. Setting: Åland, an autonomous island province of Finland. Results: The proportion of respondents reporting good health was high (64%). The overall mean (SD) SOC was 70.7 (11.7) points, whereas for farmers and fishermen it was 73.88 (8.8) and 74.33 (9.2) points, respectively. SOC was significantly and strongly related to the self-rated health score. The higher the SOC, the better was the health of the respondents. Furthermore, the study provided clear evidence of the potential of the SOC concept as a positive mental health indicator. Conclusion: The SOC seems to be a health-promoting resource that supports the development of a positive subjective state of health.

The salutogenic approach to the making of HiAP/healthy public policy: illustrated by a case study

Twenty years have passed since the central document of health promotion, the Ottawa Charter, was constituted. Health was seen as the process enabling individuals and communities to increase control over their determinants of health, thereby improving their health and enabling an active and productive life, that is, a good quality of life. One main strategy was the making of a healthy public policy. At the same time Aaron Antonovsky developed the salutogenic theory and its core concepts the sense of coherence and the generalized resistance resources. This paper integrates Antonovskys salutogenic theory and a salutogenic model of quality of life into the core principles of the Ottawa Charter and exemplifies how to make healthy public policy the salutogenic way. A process-oriented coherent health promotion research model integrating an ecological, a salutogenic and a resilient approach is shown. The objective of this theoretical model is to bring together the whole spectrum of risk factors, protective factors and promotion factors in one model. Further, individual, group and society level are considered. The model suggested aims to contribute to the creation of sense of coherence. This is exemplified in practice in a case study of a Nation, that is, on a national level. The case study of the “Nation” is partly masked. The principles behind these processes are explained in detail while the case study of the “Nation” only includes parts of the process explaining some core issues. The overall aim of this paper is to stimulate health promotion activities along the lines presented and invite the readers to comment and continue the discussion. (Global Health Promotion, 2009; 16 (1): pp. 17—28)

From health education to healthy learning: Implementing salutogenesis in educational science

Aim: The aim is to scrutinise the concept of health education (HE) and to broaden the concept of health literacy (HL) towards a lifelong healthy learning concept. HL is a broader concept than HE. This paper dissects both the health and the education concepts, and puts them into the value system of health promotion (HP) of the Ottawa Charter (OC) using the core principles and values of HP, HL, and action competence (AC) in the light of the salutogenesis (SAL). Conceptually the salutogenic model focuses on the direction towards the healthy end of the health continuum. The salutogenic theory, based on resources and comprehensibility, manageability, and meaningfulness, can be integrated into a learning model. People are seen as active and participating subjects shaping their lives through their AC. Method: a combination of an analysis of the values and intentions of health promotion according to the OC combined with the existing evidence on the salutogenic approach to health, stemming from a systematic research synthesis 1992—2003 and an ongoing analysis 2004—2009 by the authors. In addition, the views from a discussion with the participants of a session in the NHPR Conference 2009 are integrated. Results: The similarities and differences between the salutogenesis, the OC and healthy learning were shown in a graph. Integrating the salutogenesis in educational sciences further expands the concepts of HE and HL into healthy learning. Conclusions: The results of the discussions will further develop and strengthen the concept of healthy learning.

The Handbook of Salutogenesis

This in-depth survey of salutogenesis shows the breadth and strengths of this innovative perspective on health promotion, health care, and wellness. Background and historical chapters trace the development of the salutogenic model of health, and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence, that differentiate it from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts, from positive psychology to geriatrics, from small towns to corrections facilities, and from school and workplace to professional training. Perspectives from scholars publishing in languages other than English show the global relevance of the field.Among the topics in the Handbook: Emerging ideas relevant to the salutogenic model of health Specific resistance resources in the salutogenic model of health The sense of coherence and its measurement The application of salutogenesis in communities and neighborhoods The application of salutogenesis to health development in youth with chronic conditions The application of salutogenesis in mental health care settings The Handbook of Salutogenesis summarizes an increasingly salient field for graduate and professional students of public health, nursing, psychology, and medicine, and for their instructors. It will also appeal to health-related academicians and professionals who wish to have a thorough grounding in the topic.

A Salutogenic Approach to Tackling Health Inequalities

The understanding of any societal health discourse is a complex question involving history, macro-politics, socioeconomic development, culture and traditions of both individual nations and continents as a whole. Interdisciplinary research has a history over the past century involving most social sciences and especially educational sciences supported by many scientists, intellectuals and organisations. This chapter reviews the two themes that have evolved from the new theories on health and life management. First, the salutogenic approach which claims health is open ended and dependent on the skills to organise the resources available in society, the social context and self. This capability has been named the sense of coherence. Second, the theme of resilience claiming there are certain patterns of interaction between the individual and his social context that develop hardiness against stress and the ill-health that could follow.

The validity and reliability of the Sense of Coherence scale among Indian university students.

Background: The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India. Methods: The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Test-retest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed. Results: The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC. Conclusions: SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India.

Older People, Sense of Coherence and Community

Population ageing is a global trend and even though years added to life often are lived in good health; it will have an impact on healthcare, housing and facilities, and social security costs. Healthy ageing in place, especially in one’s own home and community, increasingly receives attention from health professionals, researchers, and policymakers. In this chapter, we first discuss the meaning of the concept of healthy ageing, and how Sense of Coherence contributes to this process. Next, we discuss the characteristics of the community in which older people live their lives and how the community can provide resources (GRR and SRR) to strengthen Sense of Coherence and hence perceived well-being and quality of life.