Antonovsky's Concept Research Articles

Salutogenesis in Type 2 Diabetes Care: A Biopsychosocial Perspective.

Type 2 diabetes has emerged as a major threat to global public health. In spite of best efforts by health care professionals, persons with diabetes, and the community at large, remain unsatisfied with the approach to diabetes management. This brief communication utilizes Antonovsky's concept of salutogenesis, to suggest a person friendly and community friendly framework for diabetes care. Salutogenesis is used as a means of studying the biopsychosocial domains of diabetes, and as a guiding principle for health related communication. Adoption of a salutogenic approach to diabetes care should help improve outcomes and satisfaction with health care.

A Sense of Coherence: Supporting the Healing Process

Can patient recovery be actively aided by a well‐designed hospital setting? The evidence is that it can. Drawing on sociologist Aaron Antonovsky's concept of salutogenesis, architect, industrial and interior designer Giuseppe Boscherini argues that an environment which balances calming reassurance with constructive stimulation can help instil the positive mindset that people need in order to overcome illness. Referring to buildings by practices he has worked for, and a student project he has led, he shows how light, sound, texture and colour can all contribute to health‐giving architecture.

Healthy Residential Environments for the Elderly

This study aims to analyze the environmental elements of residential facilities for elderly people by using Antonovsky's salutogenic concept. The relationship between the environment and health is clearly identified. This information facilitates the presentation and development of residential facilities with healthy living conditions for elderly people in South Korea. The concept includes providing a residential environment that is safe from a variety of dangers by applying a barrier-free concept to address the physical changes of elderly people. It also provides an environment equipped with a continuous protection system that considers both the physical and sociopsychological aspects of this particular treatment environment.

Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study

BackgroundAccording to Antonovsky’s salutogenic concept, a strong sense of coherence is associated with physical and psychological health. The goal of this study was to analyze the association of Antonovsky’s sense of coherence with physical and psychosocial health components in patients with hip and knee osteoarthritis before and after in- and outpatient rehabilitation.MethodsProspective cohort study with 335 patients, 136 (41%) with hip and 199 (59%) with knee osteoarthritis. The outcome was measured by Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Sense of Coherence (SOC-13). Baseline scores of the SF-36 and WOMAC scales and the observed effect sizes after rehabilitation were correlated with the baseline SOC-13. These correlations of the SF-36 scales were compared to the Factor Score Coefficients for the Mental Component Summary of SF-36, which quantify the factor load on the psychosocial dimension. Predictive impact of the baseline SOC-13 for the SF-36 and WOMAC scales (baseline scores and effect sizes) was then determined by multivariate linear regression controlled for possible confounders.ResultsAt baseline, the SOC-13 correlated with the WOMAC scores between r = 0.18 (stiffness) and r = 0.25 (pain) and with the SF-36 scores between r = 0.10 (physical functioning) and r = 0.53 (mental health). The correlation of these SF-36 correlation coefficients to the Factor Score Coefficient of the SF-36 Mental Component Summary was r = 0.95. The correlations for the effect sizes (baseline → discharge) with the baseline SOC-13 global score were all negative and varied between r = 0.00 (physical functioning) and r = −0.19 (social functioning). In the multivariate linear regression model, the explained variance of the SF-36 scores by the baseline SOC-13 increased continuously from physical to psychosocial health dimensions (from 12.9% to 29.8%). This gradient was consistently observed for both the baseline scores and the effect sizes. The results of the WOMAC were consistent with the physical health scales of SF-36.ConclusionsThe sense of coherence was associated with psychosocial health dimensions but hardly with physical health. The higher the load of a scale on the psychosocial dimension the higher was its correlation to the sense of coherence. This is in contrast to the idea of Antonovsky who predicted high associations with both mental and physical health.

Relationship of sense of coherence to stressful events, coping strategies, health status, and quality of life in women with breast cancer

To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) predicts stressful events, coping strategies, health status, and quality of life (QoL) in a cohort of postmenopausal women (n = 131) with newly diagnosed primary or recurrent breast cancer. Regression analyses of longitudinal data at baseline through 6 months following breast cancer diagnosis examined the relationships between SOC (13-item version), daily assessment of coping with stressful events, health status, and QoL (EORTC QLQ-30). The findings support Antonovsky's concept of SOC. Women with strong SOC reported fewer stressful events and more days without stressful events. They used more coping strategies and more frequently used distraction, situation redefinition, direct action, and relaxation, but seldom religion, to cope with stressful events, and reported better health status and QoL. Women with weak SOC experienced more distress and used fewer coping strategies, and they more frequently used coping strategies such as catharsis and seeking social and spiritual support, but seldom acceptance of the situation. They reported worse health status and QoL, regardless of disease stage or treatment. The relationships between SOC and health status and QoL were linear. Sense of coherence significantly predicts distress, number and type of coping strategies such as direct action and relaxation, health status, and QoL in women with breast cancer. Our data suggest that the SOC scale may be a useful screening tool to identify individuals particularly vulnerable to distress and unable to cope adequately. Assessing SOC strength may assist health care providers to provide individualized patient interventions.

Workplace health resources based on sense of coherence theory

PurposeIn workplace health promotion, enhancing resources are less explored than risk factors. The aim of this paper is to explore the usability of the sense of coherence (SOC) theory to identify considerable and positively perceived work‐related factors and processes.Design/methodology/approachThe study had a salutogenic approach to workplace health promotion. A total of 13 focus group interviews were conducted with hospital employees in Sweden. A deductive analysis was made with the SOC theory as a framework.FindingsWork‐related specific enhancing resources (SER) were identified and analysed into the three components of SOC: comprehensibility, manageability, and meaningfulness. SER's implication in daily performance is explained by employee expressions. Through increased understanding and awareness, SER could contribute to savoring positive experiences, and enhance SOC among employees. Antonovsky's concept Generalized Resistance Resources is suggested to be enlarged based on the expressed significance of concrete daily positive work occurrences to increase one's SOC.Research limitations/implicationsNot all hospital professions were represented in the study. Further studies are required to involve physicians, paramedics, managers, as well as other settings, to compare and complement with additional experiences of workplace resources.Practical implicationsThe study presents an opportunity to explore, understand, and foster workplace resources through assistance from the SOC theory. The SER presented in this study may serve as initial examples in workplace discussions about work‐related resources contributing to a sense of coherence.Originality/valueThis study contributes to public health research and workplace health promotion with a salutogenic focus on how to explore enhancing work‐related resources with the assistance of the practical SOC theory.

Salutogenesis as a possible link between conventional medicine and complementary methods

Background Understanding the genesis of health is a fundamental theme in the medical professions. However, conventional medicine with its focus on causal explanations of diseases has led to a neglect of this issue. In recent times, the question was brought back into the focus of scientific enquiry within the framework of salutogenesis. The term originates in the work of medical sociologist Aaron Antonovsky (1923–1994). He raised the question how certain survivors of the Holocaust could remain healthy despite their terrifying experiences in concentration camps. He developed the concept of the “sense of coherence”, with which he tried to explain how people manage psychosocial stress and do not succumb to ill health. He proposed salutogenesis as a completion of the pathogenetical paradigm in modern medicine. However, the theme of salutogenesis is not new in medicine. Starting with Hippokrates, medical history shows a multitude of approaches to the understanding of hygieia, i.e. health. Nowadays various concepts of complementary medicine use a salutogenetical approach by empowering self-healing processes. But Antonovsky's concept of salutogenesis is not totally congruent with approaches in complementary medicine. A main difference is that Antonovsky focuses on mechanisms of psychosocial resistance, while complementary medicine focuses on the whole organism and its possibility to regain health. Nevertheless, the basic perspectives on health and sickness seem similar. Methods The present work explores two approaches in complementary medicine, by naturalist L.R. Grote (1886–1960) and the founder of Anthroposophical Medicine, Rudolf Steiner (1861–1925). Reviewing the fundamental assumptions of their work, it will be proposed to use Antonovsky's concept of salutogenesis as a theoretical framework to link concepts of conventional medicine and complementary methods. Results In his work, Antonovsky shows that the pathogenetic paradigm of conventional medicine is limited by its focus on repairing health-defects. He argues that health is not a passive matter, but an active process, present even during illness. This suggests that medical practice should find ways to facilitate this process in order to heal diseases. Unlike conventional medicine, both Grote and Steiner address this in their different approaches. In different ways, they substantiate Antonovsky's claim for the completion of the pathogenetical paradigm in modern medicine.

MEN DEALING WITH MEMORIES OF CHILDHOOD SEXUAL ABUSE: CONDITIONS AND POSSIBILITIES OF ‘POSITIVE DEVIANCE’

This article explores how sexually abused men can move away from an identity formed by the abuse. Based on Antonovsky's concept of a ‘sense of coherence’, the stories of three men who were sexually abused when young are analysed with an eye to research and therapy. Contrary to the often harm‐oriented descriptions, these men demonstrate how, with or without professional assistance, they story their experiences in ways leading to an identity less determined by the abuse. The knowledge the men share about ways ‘to manage’ points at the importance for the researcher to respect singularity and remember who is the expert. This also applies to the therapist. He should acknowledge his position as ‘not knower’ and not an expert on ‘good stories’.

Sense of Coherence and Physical Health. A “Copenhagen Interpretation” of Antonovsky's SOC Concept

According to Antonovsky's (Aaron Antonovsky, 1923–1994) sense of coherence (SOC) model, persons with a high SOC have the ability to benefit from their general defense mechanisms in order to overcome stressful situations. In a health-disease continuum, this leads to the development towards health. However, Antonovsky's global hypothesis that the strength of the SOC may influence the physical health status of a person could not be proven.Flensborg-Madsen et al. from Copenhagen were able to provide a new access regarding SOC and health. They investigated the mixture of emotional aspects and mental constructions as a possible cause for fairly low correlation between SOC and physical health. Thus, in an empirical way, they described “emotional coherence” in relation to physical health, while “mental coherence” was linked to psychological health. These authors introduced the idea of applying a shortened version of the original 29-item SOC questionnaire, but have not yet developed or tested the shortened questionnaire. Backed by their important findings, it appears to be promising to consider the use of the SOC questionnaire as standardized by Antonovsky, but cleared of the items regarding “predictability”, i.e., Flensborg-Madsen et al. suggested that the items on “predictability” be excluded from the SOC scale when a correlation to physical health is to be investigated. Further investigations in this area of research will be of high impact, not only for health sciences, but also for medical practice.

Sozialmedizinische Bedeutung des Konzepts der Salutogenese für Neurologie und Psychiatrie

The so-called "sense of coherence" (SOC) is the central idea of Antonovsky's concept of salutogenesis. The structure and the meaning of SOC for a person's ability to cope with stress are discussed as well as the overall health-promoting effect of SOC. At the end of the study's first part the question of proving the SOC empirically and of the SOC's construct validity are critically discussed. The second part of the article demonstrates the relevance of salutogenic mechanisms for psychiatry and neurology, especially regarding the social aspects of both disciplines. Health promotion and disease prevention are already important issues in the Mental Health Community. But also in neurology, which is much more grounded in the physical medicine than psychiatry, the concept of salutogenesis can help patients to prevent illness or to cope better with the consequences of diseases. Finally, the necessity to supply the current health care system in psychiatry and neurology with much more salutogenic input is questioned.

Sozialmedizinische Bedeutung des Konzepts der Salutogenese für Neurologie und Psychiatrie

The so-called sense of coherence (SOC) is the central idea of Antonovsky's concept of salutogenesis. The structure and the meaning of SOC for a person's ability to cope with stress are discussed as well as the overall health-promoting effect of SOC. At the end of the study's first part the question of proving the SOC empirically and of the SOC's construct validity are critically discussed. The second part of the article demonstrates the relevance of salutogenic mechanisms for psychiatry and neurology, especially regarding the social aspects of both disciplines. Health promotion and disease prevention are already important issues in the Mental Health Community. But also in neurology, which is much more grounded in the physical medicine than psychiatry, the concept of salutogenesis can help patients to prevent illness or to cope better with the consequences of diseases. Finally, the necessity to supply the current health care system in psychiatry and neurology with much more salutogenic input is questioned.

Sense of Coherence as a Moderator of the Effects of Stressful Life Events on Health

Study objective: To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) moderates (that is, buffers) the health impacts of stressful life events in a population based sample. Design: Multiple linear and Poisson regression analyses of longitudinal data from a national survey of population health were used to examine the relations among SOC, the experience of recent stressful life events (for example, family breakdown, financial crisis, physical abuse), and two outcomes, self reported health status (SRH) and self reported number of physician visits during the previous year. Setting: General population of Canada. Participants: Nationally representative sample of household residents aged 30 years of age or greater surveyed in 1998 and 2000 (n = 6505). Main results: After controlling for age, sex, and previous health status, a significant moderating effect (t = 2.24, p = 0.025) in the expected direction was found on respondents' SRH. The mean difference in SRH between those who did and did not experience a recent stressful life event was 0.24 (95% CI: 0.16, 0.32) in people with a below average SOC and 0.04 (95% CI: –0.04, 0.11) in people with a higher than average SOC score. The postulated moderating effect of SOC was not significant (t = 1.1, p>0.05) in predicting the number of visits to a physician. Conclusions: SOC seems to buffer the impact of recent stressful life events on SRH.

Hazardous alcohol consumption and sense of coherence in emergency department patients with minor trauma

Background The concept of sense of coherence (SOC) measures the extent to which people are able to cope with stressful life events. Since excessive alcohol consumption may be, in part, the result of failed coping strategies, further investigations between hazardous alcohol consumption and SOC are necessary. Methods Survey in an Emergency Department in an inner city university hospital. Overall, 1833 patients were screened for hazardous alcohol consumption, illicit drug use, smoking status, socioeconomic status and sense of coherence. Results Mean age of participants was 34 ± 12 years and 62% were male. Overall, 23% of patients showed a pattern of hazardous alcohol consumption, 23% had abused illicit drugs and 46% were smokers. Mean SOC score was 48.9 ± 8.6 points, with no difference between genders. Lower SOC-quartiles were associated with significantly higher prevalence of hazardous alcohol consumption as well as illicit drug abuse and smoking. Lower SOC-quartiles were associated with significantly lower values on socioeconomic variables (e.g. lower income, less education). The negative association between SOC and alcohol consumption was independent of age, gender, smoking, illicit drug use and all socioeconomic variables. Conclusion SOC and hazardous alcohol consumption were significantly associated. Our data support Antonovsky's original concept of increased alcohol consumption as a result of failed coping strategies.

Making sense of different illness realities: Restructuring of illness meaning among Swedish-born women

This study explores restructuring of illness meaning among eight Swedish-born female patients, assessed as somatizing, encountering caregivers imposing a “psychological language” of distress. Data were collected 1997–2001 from 32 interviews and analysed with a Grounded Theory approach. Two major trends were identified in the participants’ process of restructuring illness meaning: first, a trend of accepting a “psychological language” of understanding distress and then of paying attention to stress and demanding work conditions. The term “burnout” was introduced. For participants, giving meaning to illness had been a continuous and interactive process in which new meanings had been integrated within a framework of both constancy and change. Restructuring illness meaning had not been uncomplicated. Participants tried to bridge illness perspectives and treatment strategies within their daily life situations of handling distress. The social context had been important for bridging gaps in illness perspectives and in creating coherence between frames of meanings. The results support the view that Antonovsky's concept of Sense of Coherence (SOC) may have relevance when considering the process of restructuring illness meaning, and that constructing coherence between experience, expression, past and new meanings given to illness, may be significant for patients’ recovery. The results stress the importance of research exploring the interaction between individuals and social and cultural groups in multicultural milieus in order to obtain insights as to how people make sense of their clinical encounter.

Restructuring illness meaning through the clinical encounter: a process of disruption and coherence.

This study explores restructuring of illness meaning among ten Turkish-born women, assessed as somatizing, encountering caregivers imposing a "psychological language" for understanding distress. Participants were referred from local health care services in Western Stockholm, Sweden. Data were collected between 1997 and 2001 from 37 interviews with ten women. Data were analyzed using a qualitative method with a grounded theory approach to construct an understanding of meaning making from an emic perspective. Participants' restructuring included loss of earlier meanings given to illness, shifts in expressions and healing strategies, and a push toward giving illness and suffering a psychological or psychiatric meaning. Restructuring had in many ways been a disruptive and complicated experience. In their everyday context participants were engaged in bridging gaps between different perspectives of looking upon their illness. They had poor support from their social context in creating coherence between frames of meaning. On the basis of the results the author suggests that Antonovsky's concept of sense of coherence (SOC) may have relevance to the process of restructuring illness meaning, and that constructing coherence between experience, expression, past, and new meanings given to illness may be significant for patients' recovery. For clinical care, results indicate that restructuring should be done so as not to impose too alien a reordering of the disruptive experiences of illness. With regard to further research, results indicate the importance of gaining insight into how individuals and social and cultural groups make sense of their interaction with caregivers and local health care services.

Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses.

When a person is diagnosed with a life-threatening disease, existential questions are easily triggered. The aims of this study were to explore to what extent brain tumour patients and their next of kin were able to cope, understand and create meaning in their situation, to explore whether spirituality could be supportive and to analyse whether these concepts are related to Antonovsky's concept of sense of coherence. Using a purposive sampling technique, 20 patients and 16 of their next of kin took part in tape-recorded interviews. A content and context analysis was performed using a hermeneutic approach. We found that comprehensibility was to a large extent constructed by the patient's own thoughts and theories, despite an insecure situation. Manageability was achieved by active information-seeking strategies, by social support and by coping, including positive reinterpretation of the situation. Meaningfulness was central for quality of life and was created by close relations and faith, as well as by work. A crucial factor was whether the person had a 'fighting spirit' that motivated him or her to go on. As only three patients were believers, trust in God had generally been replaced by a belief and confidence in oneself, in science, in positive thinking and by closeness to nature. Sense of coherence as a concept can explain how exposed persons handle their situation. In its construction, sence of coherence integrates essential parts of the stress/coping model (comprehensibility, manageability) and of spirituality (meaning).

Women's perceptions of childbirth and childbirth education before and after education and birth

Objective: to illuminate women's perceptions of childbirth and childbirth education before and after education and birth. Design: qualitative, using tape-recorded interviews to collect data. Interpretation was performed from Antonovsky's concept sense of coherence. Setting: childbirth education, a part of parent education in Sweden. Participants: eleven women expecting their first child, where the pregnancy was planned and normal Measurements and findings: the development of perceptions of childbirth and childbirth education was described. The women adopted the content of the education in different ways. Fear as well as unreflected knowledge seemed to block acquisition of new knowledge. Factors which contributed to a childbirth experience worse than expected were lack of or inconsistent information. Increased knowledge about childbirth and experiences of confirmation during childbirth contributed to a good or better experience than expected. Key conclusion: any model of childbirth education which does not take into consideration the individual woman's perceptions of childbirth and childbirth education seems to be inadequate. Implications for practice: the findings stress the importance of individual assessment of expectations of and experiences of childbirth education. Consistency in information given before and during childbirth supports a sense of comprehensibility, manageability and meaningfulness.

The Origins of Health and Strength: From ‘Salutogenesis’ to ‘Fortigenesis’

It is argued that Antonovsky's concept of ‘salutogenesis’, referring to the origins of health, should be broadened to ‘fortigenesis’, which refers to the origins of psychological strength in general. The argument is based on his own writings. A number of related constructs are referred to in which the metaphor of strength is also inherent. Research on the development of psychological strength through appropriate work experiences, through military and combat experience, and through work force participation in the case of homemakers is reviewed.

A simplified way of measuring sense of coherence

Antonovsky's concept sense of coherence (SOC) has gained much attention during the last few years as an important factor in the understanding of social factors behind health and illness. The questionnaire developed to measure SOC may, however, for practical reasons be difficult to use. In a recently conducted population survey in Sweden, we were faced with the problem of incorporating the ideas behind SOC without being able to include the 29-item instrument. Instead, 3 questions were constructed in order to capture each of the 3 dimensions included in SOC, namely manageability, meaningfulness and comprehensibillity. In this research note we present our simplified version of SOC and the properties of the measure obtained. We conclude that the simplified measure we have suggested might be a useful substitute for the original scale, especially In cases where information on SOC would otherwise have been totally omitted.