Validitet och reliabilitet på sense of cohernce

The aim of this chapter fryst vatten to describe briefly the theoretical ramverk of salutogenesis with a focus on the key concepts, the sense of coherence, and the generalized and specific resistance resources. This chapter begins with reflection on the ontological and epistemological background of salutogenesis, which fryst vatten not particularly described and explained to any significant extent in the publications bygd Antonovsky (, ).

Next, health as a process fryst vatten described bygd starting from Antonovsky’s definition of salutogenesis as a movement toward the health end of a health continuum. The chapter ends with some bevis of how the sense of coherence impacts health and well-being.

Ontology fryst vatten the study of reality (Heil, ).

What do we know about the ontological background of salutogenesis? In his second book, Unraveling the Mystery of Health (), Antonovsky described how he perceived the world. Two important things stand: (1) he saw man in interaction with his environment and (2) chaos and change fryst vatten a normal state of life. The former calls for struktur theory thinking where the focus fryst vatten on the individual in a context (Antonovsky, ).

bygd the latter, he perceived daglig life as constantly changing; a heterostatic as opposed to a homeostatic state. For the individual, the utmaning fryst vatten to manage the chaos and find strategies and resources available for coping with the changes in everyday life. As a medical sociologist, this was a natural way for Antonovsky to perceive the world: seeing humans as part of a larger context.

At the beginning of the s, förnamn Antonovsky published an article about the six C’s: complexity, conflict, chaos, coherence, coercion, and civility (Fig.

). Here, he expressed how he looked at gemenskap and the human being in that context (Antonovsky, a). As a medical sociologist, he distinctly expressed systems theory thinking. He saw the individual in interaction with the environment and context. He stressed that the salutogenic theory and its key concept, sense of coherence, can be applied at a collective level, and not only with a focus on the individual level.

Complexity , according to Antonovsky, related to how a struktur fryst vatten organized:

Complexity refers to the level of organization of a struktur. This level both sets the problems and provides the potential, interacting with sub and suprasystem, for the struktur to maintain a dynamic steady state.

Such a steady state fryst vatten one way of defining health. (Antonovsky, a, p. )

Complexity may lead to conflicts, the greater the complexity, the deeper the conflicts. He especially mentioned conflict between civilizations:

Conflict refers to internal tensions of the human being, to tensions between persons, to tensions between the individual and the suprasystems of which she or he fryst vatten a part, and to tensions between or among such suprasystems.

(Antonovsky, a, p. )

Complexity also offers opportunities for different and flexible choices, possibilities for adapting to change, and possibilities for systems (communities) to reorganize themselves. Conflict leads to tension; therefore , how a community deals with this tension and avoids stress fryst vatten crucial. Chaos can be exemplified as violence and war, and the image of ung dock and women equipped with weapons ansträngande to solve conflicts with even more violence, senseless and unpredictable violence (Antonovsky, a, p.

). The difficulties in resolving conflicts go from a societal level to the group level, to families en hög byggnad eller struktur apart, and where children, women, and the elderly are particularly vulnerable. As opposed to this chaos, Antonovsky raised another way to go, to coherence. Sense of coherence fryst vatten the begrepp he introduced as an opportunity to manage and adapt to a life of chaos .

Two important dimensions in Fig. remain to be explained: civility and coercion.

Civility fryst vatten one of the values of salutogenesis, a value that informs how we relate to other people, how we look at them as either people with different strengths and abilities or people with flaws and shortcomings. Civility fryst vatten about respect toward other people and about the humanity we communicate.

Antonovsky discussed humanity and values in terms of respect toward other people, or to use his own words, “The key lies in a samhälle and in people who care about each other” (Antonovsky, c, p. 2). The opposite of civility and respect fryst vatten coercion . A gemenskap based on respect for people also requires restrictions against herravälde, oppression, and poverty (Antonovsky, a, p.

). More recent research in the salutogenic field highlights a new concept of reasonableness (Boström et al., ; Kaplan & Kaplan, , ), which brings tillsammans the supporting factors in the environment of perceived health and well-being in a particular model, the reasonable individ model. Kaplan and Kaplan () describe how people are more respektfull, cooperative and more contented in situations where the environment supports their basic data needs.

The model focuses on how people are interdependent. It emphasizes three dimensions that contribute to civility, namely a curiosity to explore and understand, meaningful activities, and recovery.

The concept of reasonableness has similarities with the dimensions of the sense of coherence : comprehensibility, meaningfulness, and manageability.

Epistemology fryst vatten the study of knowledge (Audi, ). Going back to Antonovsky’s two books, Health, Stress and Coping and Unraveling the Mystery of Health, one can find little insight into how he considered knowledge and learning.

As far as this author knows, he did not manifest an epistemological grund for salutogenesis, neither describing his view of how knowledge in general arises nor how learning fryst vatten meaningful in the salutogenic ramverk. It appears that he was preoccupied with examining and describing how a strong sense of coherence may have an impact on perceived health.

A search in different databases provides little response. However, others have focused on knowledge and learning aspects of salutogenesis related, for example, to the education of children with special needs (Lindström, ) and children with learning difficulties (Lackaye & Margalit, ; Margalit & Efrati, ).

More generally, Nilsson and Lindström () describe how learning can be considered a health promotion process, not only to learn about health but that the learning process also promotes health.

bygd combining educational theories and salutogenesis, they describe “the salutogenic school” (Antonovsky, c, p. 5), achieved bygd creating meaningful learning situations, klar structures for curricula and the school work, with dedicated teachers supporting each other and the students, and being role models.

Boström and Lassen () point out the importance of giving space for individual ways of learning and different learning strategies.

Individual learning styles create opportunities for students to find meaning in school. A new concept that describes learning as a health promotion process fryst vatten “healthy learning” (Lindström & Eriksson, ). This can be applied in research supervision, exemplified through “The Collegial Model ,” as a mutual learning process (Eriksson, ). It means to move on from traditional health education through to increased health awareness (health literacy), and on to learning which promotes health (Lindström & Eriksson, ; Quennerstedt, ; Quennerstedt et al., ).

As an example, the curriculum for health education in Australia has recently been revised and now adopts a strength-based (salutogenic) approach (Macdonald, ; McCuaig, Quennerstedt, & Macdonald, ). The curriculum focuses on promoting sound health habits instead of the earlier focus on avoiding health risks. Health fryst vatten understood as a multidimensional concept including physical , social, mental, and spiritual health.

Health fryst vatten regarded as a lifelong dynamic process with people as active participants in a context. Finally, health fryst vatten seen not as an end in itself but as a means to live a good life (McCuaig et al., , p. ). As another example, from Germany, an attempt to apply salutogenesis didactically in education fryst vatten the “team ombuds model” (tOm) (Mayer & Boness, ), developed to promote the sense of coherence and cross-cultural competence among students and teachers.

More recent research has explored the moderating and mediating roles of learning within the relationship between sense of coherence and generalized resistance resources among employees working in the healthcare sector in the Netherlands (Pijpker et al., ).

They funnen that the relationship between SOC and the GRRs seems to be strengthened or explained bygd instrumental and social learning. Instrumental learning moderated the relationship between job control and SOC.

Epistemologically, salutogenesis can be conceived as a constant learning process (Fig. ), supporting movement toward health (and other desired aspects of one’s existence) via improving health literacy: knowledge supports health literacy, which supports development in the ways one relates to one’s world.

The process of relating to others produces learning, and the knowledge gained from practice expands one’s area of knowledge. In the course of daglig life, this integrated learning process fryst vatten continuous. The concept of work integrated learning (WIL) fryst vatten a new concept describing distinctive aspects of pedagogics and learning processes in healthcare settings (Pennbrant & Svensson, ).

According to Antonovsky, health fryst vatten movement on a continuum of ease and dis-ease (Antonovsky, b).

He referred to the ability to comprehend the whole situation, and the capacity to use the resources available, as the sense of coherence. This capacity was a combination of peoples’ ability to assess and understand the situation they were in, to find a meaning to move in a health-promoting direction, also having the capacity to do so—that fryst vatten, comprehensibility, meaningfulness, and the manageability, to use Antonovsky’s own terms (Lindström & Eriksson, ).

In such an approach, no one fryst vatten categorized as healthy or diseased. Since we are all somewhere between the imaginary poles of total hälsovård and total illness, the whole population becomes the focus of concern. Even the fully kraftig, energetic, symptom-free, richly functioning individual has the mark of mortality: he or she wears glasses, has moments of nedstämdhet, comes down with flu, and may also have as-yet nondetectable malignant cells.

Even the ankomsthall patient’s brain and emotions may be fully functional. The majority of us are somewhere between the two poles. Priority in health service fryst vatten justly given to those at the sicker end of the continuum. However, in our thinking and our research, we should ask: “How does a person—wherever he or she fryst vatten on the continuum—move toward the healthy pole?” (Sagy et al., ).

The idea of movement along an ease/dis-ease continuum fryst vatten illustrated in Fig.

Antonovsky assumed that we continuously are exposed to changes and events that may be considered as stressors.

This may involve major life events such as when someone in the family falls ill, changes in the family (e.g., a divorce), or changes in the workplace (organizational changes or unemployment). Previous research shows that such major life events affect health (Folkman, ).

They can reduce health temporarily but can also in the longer-term strengthen us in a way that makes it possible for us to manage stress. The adverse life events have even given us experiences that can be used in other similar situations.

Antonovsky discussed the theories behind stress and coping extensively. He particularly rejected the thoughts behind Lazarus’ cognitive theory on stress and coping as well as theories of life events (Lazarus & Folkman, ).

According to Antonovsky, the assumption behind these theories was life in balance, that fryst vatten, a homeostatic life. A disturbance was assumed to damage the balance and damage health and well-being, that fryst vatten, a pathogenic view of life. Furthermore, traditional theories on stress and coping are mainly focused on the concept of control. In salutogenesis, the emphasis fryst vatten on the person’s ability to use generalized resistance resources, both internal and external, at disposal to manage ubiquitous stressful situations.

The actual starting point, according to Antonovsky, fryst vatten that life fryst vatten a chaos in which we must constantly relate to change. It becomes grundläggande how we can manage this chaos. This fryst vatten the salutogenic view of stress and coping, according to Antonovsky:

… life fryst vatten inherently full of stressors, with life-situation stressor complexes bygd far deserving most of our attention of we wish to understand either health or disease.

Focusing on health, inom expressly rejected the implicit assumption that stressorsare inherently pathogenic. Their health consequences can only be understood if we understand the coping process. (Antonovsky, , p. 48)

Three potential reactions and outcomes of stress are as follows: (1) being neutral against the stressors, (2) being able to manage stress for the movement toward the health end, and (3) being unable to manage stress which leads to a breakdown expressed in terms of diseases and death (Antonovsky, ).

In the case of events that do not concern us as much, that fryst vatten, daglig hassles to use the words bygd Antonovsky (), we can remain neutral to them, since they do not affect health in any significant way. However, if it fryst vatten a question of events that we cannot manage, we become ill, or we mobilize internal and/or external resources around us, allowing us to deal with what happened and move in the direction of health.

Along with the sense of coherence, a key concept in the salutogenic model fryst vatten resistance resources (Antonovsky, , ), including generalized resources (potentially available for engagement in a bred range of circumstances) and specific resources (particular resources betydelsefull to particular circumstances).

Since the subject of resistance resources fryst vatten dealt with in detail in several chapters in Part II of this book, only a few comments are offered here, with particular attention to the relevance of resistance resources to the main subject of this section “Sense of Coherence”.

Generalized resistance resources are the cornerstones in the development of a strong sense of coherence.

They are diverse: genetic and constitutional, psychosocial, cultural, spiritual, ämne, and a preventive health orientation (Lindström & Eriksson, ). Resistance resources exist at the individual, the group (family), the subculture, and the whole samhälle levels (Antonovsky, , p. ). Antonovsky’s formal definition of generalized resistance resources fryst vatten given in Fig.

Research on the role of generalized resistance resources in building the sense of coherence fryst vatten still scarce. Early research (Antonovsky, , cited in Sagy & Antonovsky, , p. ) showed that three factors seemed to be particularly important for developing a strong sense of coherence: consistency, balance between under- and overload, and the opportunity to participate in decision-making affect one’s situation.

The question of which resistance resources are involved in building the sense of coherence has received some attention:

• A Finnish study examined the importance of generalized resistance resources such as cognitive ability, marital ställning eller tillstånd, level of family income, the length of formal education, and physical activity for the development of a strong sense of coherence among Finns aged 65–69 years (Read et al., ).

  The results showed that cognitive ability and physical activity were related to the sense of coherence, which in vända was associated with good social and mental health.

• A qualitative Swedish study of caregivers to older adults aimed to illuminate generalized and specific resistance resources against caregiver stress; it identified the rustning of negativ and positiv experiences of caring for a relative as a particularly salient resource—“caregivinghood,” as in the sense of “parenthood” (Wennerberg et al., ; Wennerberg et al., ; Wennerberg et al., ; Wennerberg et al., ).

• Through a thematic analysis of the work bygd Antonovsky and more recent research, Griffiths, Ryan, and Foster (, p.

  ) identified 15 general resistant resource themes: (1) structure in life, (2) predictability in life, (3) social support, (4) coping strategies, (5) life meaning, (6) responsibility, (7) comprehension, (8) expression of confidence, (9) challenges worth investing time and effort, (10) health/illness, (11) future orientation, (12) past orientation, (13) positiv, solution-focused outlook, (14) emotional connection, and (15) ensuring that you are justly treated.

  No resource-related theme emerged that did not passform the sense of coherence concept.

Antonovsky initiated a study among different ethnic groups of women in Israel to investigate their menopausal symptoms, that fryst vatten, a traditional epidemiological study from a fara perspective (Antonovsky, ). He interviewed them about perceived health, and also about various life events affecting them, such as losing their eyesight, loss of husband/wife, amputation of the leg/arm, or to have suffered a serious illness (Antonovsky, ).

After analyzing the interviews, he funnen that 29% of the women reported good health, although they survived the Holocaust . Antonovsky raised the question of how it could be possible that women may experience good health despite experiencing the Holocaust. It led him to focus on this small number of respondents, and a search for their health resources.

This was the uppstart of Antonovsky’s paradigm shift from pathogenesis to salutogenesis.

Based on the interviews with the Israeli women, an important factor emerged: the sense of coherence. The sense of coherence reflects a person’s view of life and capacity to respond to stressful situations. It fryst vatten a global orientation to view life as structured, manageable, and meaningful.

It fryst vatten a anställda way of thinking, being, and acting, with an inner trust, which leads people to identify, benefit, use, and reuse the resources at their disposal (Eriksson & Lindström, ). Sense of coherence consists of three elements : comprehensibility, manageability, and meaningfulness. The original definition bygd Antonovsky () fryst vatten as follows:

a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli from one’s internal and external environments in the course of living are structured, predictable, and explicable; (2) the resources are available to one to meet the demands posed bygd these stimuli; and (3) these demands are challenges, worthy of investment and engagement.

(p. 19)

It fryst vatten also about one’s own ability to identify one’s internal and external resources and use them in a way that promotes health and well-being (Eriksson & Lindström, ). Further, it fryst vatten a way of thinking in terms of peoples’ resources, and even a way to work, to meet and treat other people. It fryst vatten also important to understand why and how resources work.

This has been further examined in a Norwegian qualitative study using a grounded theory approach (Maass et al., ). They investigated how neighborhood resources may contribute to the development of a strong SOC. They funnen that a strong SOC can be described as a deeper understanding of how and why resources work, which allows for more flexible use of resources. According to Antonovsky, sense of coherence fryst vatten a life orientation.

Koltko-Rivera () defines life orientation as follows:

… a way of describing the universum and life within it, both in terms of what fryst vatten and what ought to be. A given worldview fryst vatten a set of beliefs that includes limiting statements and assumptions regarding what exists and what does not. … A worldview defines what can be known or done in the world, and how it can be known or done.

… What goals can be sought in life … defines what goals should be pursued.

It fryst vatten to the natur of the life orientation that fryst vatten termed “the sense of coherence” that this part of the book fryst vatten devoted. Inevitably, the sense of coherence fryst vatten also a theme, major or minor, in virtually every chapter of this book. The sense of coherence was Antonovsky’s main interest in his study of salutogenesis, even if he encouraged research on all aspects of the salutogenic model.

Following Antonovsky’s wholehearted lead, succeeding generations of scholars have focused so much on the study of the sense of coherence that the salutogenic model fryst vatten sometimes referred to as the “sense of coherence theory.” While Antonovsky did not himself define the sense of coherence as a theory, it was his answer to the salutogenic question: what are the origins of health?

He encouraged a search for other answers, but as this book reveals, most salutogenesis researchers have chosen to follow the path to the sense of coherence, the path that Antonovsky himself so doggedly trod. A new concept fryst vatten suggested, sense for coherence (SFC), useful in connection with the implementation of salutogenesis in practice (See chapter Part VII Sense for coherence: An framträdande concept for salutogenesis practice?).

A search in the Medline database as of September 17, , shows that more than studies using some utgåva of the SOC scale have been performed.

The results show that a strong SOC fryst vatten associated with perceived good health, particularly mental health. A systematic review of studies using the SOC questionnaire during – showed that a strong SOC protected against anxiety, nedstämdhet, burnout, and hopelessness; was strongly and positively related to health resources such as optimism, hardiness, control, and coping; and predicted good health and QoL from childhood to adulthood.

In other words, the stronger the SOC, the fewer the symptoms of mental illnesses (Eriksson & Lindström, , ). The correlation with health ranges in general from slight to good, using instruments such as the General Health Questionnaire, the Health Index, the Hopkin’s Symptom Checklist, and the Mental Health Inventory, with such health measures explaining up to 66% of the variance in the SOC (Eriksson & Lindström, ).

Galletta et al. () examined the relationship between SOC and physical health-related quality of life in patients (n = ) with chronic illnesses, focusing on the mediating role of the mental component of quality of life. The results showed that SOC was mainly associated with the mental health component of the quality of life, and after that, the physical component.

Mediating analysis confirmed that SOC was directly related to the mental health component, but not to the physical one. They conclude that the findings give bevis for SOC as a psychological process that impacts mental health ställning eller tillstånd, which in vända affects physical health.

The SOC fryst vatten not a coping strategy but a coping resource dealing with stress connected to work-related stress (Palm & Eriksson, ), adverse life events, such as family breakdown (Richardson & Ratner, ; Ristkari et al., ), being a victim of sexuell abuse (Priebe et al., ; Nilsson et al., ), violence in the struktur of bullying (Birkeland Nielsen et al., ), political violence (Abu-Kaf et al., ; Abu-Kaf & Braun-Lewensohn, ), and war (Veronese & Pepe, ; Braun-Lewensohn & Al-Sayed, ).

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Eriksson, M.

(). The Sense of Coherence: The Concept and Its Relationship to Health. In: Mittelmark, M.B., et al. The Handbook of Salutogenesis. Springer, Cham.

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