Changes In Sense Of Coherence Research Articles

Promoting sense of coherence: Salutogenesis among people with psoriasis undergoing patient education in climate therapy.

BackgroundThere is a need for further investigation of sense of coherence (SOC), the central concept of salutogenesis, and its relationship with long-term illnesses such as psoriasis. The aim of this study is to investigate the development of SOC during patient education in the context of climate therapy and to explore factors that may predict changes in SOC among people with psoriasis.MethodsA prospective design included a baseline assessment and two follow-ups after a 3-week patient education and climate therapy programme (follow-up 1) and again 3 months later (follow-up 2). A total of 254 adults (aged 20–80) with psoriasis participated. SOC was measured by the SOC Questionnaire, illness perception was measured by the Revised Illness Perception Questionnaire, and positive and active engagement in life was measured by the positive and active engagement subscale of the Health Education Impact Questionnaire. Paired-sample t tests were used to evaluate changes in SOC from the baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables, illness perception and positive and active engagement in life to predict the changes in SOC.ResultsThe SOC score changed significantly by 2.65 points, (95% CI = 0.621, 3.685) from the baseline to follow-up 1. SOC score was still improved by 1.15 points (95% CI = 0.073, 0.223) at follow-up 2.Baseline and change in positive and active engagement in life were linked to change in SOC with standardized beta 0.170 (95% CI = 0.024, 0.319) and 0.259 (95% CI = 0.092, 0.428), respectively. In addition illness coherence perception at baseline and change in emotional representations were significantly associated with the change in SOC with standardized beta 0.212 (95% CI = 0.073, 0.361) and –0.270 (95% CI = –0.481, –0,077), respectively.ConclusionsSOC improved significantly from before to after patient education in the context of climate therapy. The results indicate that improving positive and active engagement in life, coping with emotional distress and a coherent understanding of the illness might provide important opportunities to improve SOC among people with psoriasis.

2114 – A pilot study on promoting sense of coherence through person-centered therapy in older adults

Older adults’ sense of coherence (SOC) is often challenged by changes in later adulthood. Therefore, this study aims to explore if a brief eight-session individual person-centered therapy (PCT) intervention on older adults can promote their SOC, as compared with a control group (waiting list). We posited that participants and randomized to PCT would report improvements in SOC from pre- to post-intervention compared to those in waiting list. The Sense of Coherence Scale (SOCS).and demographics were assessed at the baseline (t 1 ), post-treatment (t 2 ) and at the 12-month follow-up (t 3 ), in a group of 87 participants between 65-86 years ( M =71.9 SD =4.77). Results indicated that participants in PCT evidenced greater improvements as to their SOC (31.4%) than those in waiting list (2.3%). Both at the post-intervention, and at follow-up, participants who underwent PCT had a significantly higher SOC (M=4.76, SD=.524). In addition, results revealed no significant between group differences in any socio-demographic variable ( P's >.05) in t 1 , t 2 and t 3 . Changes in SOC were positive and maintained, thus, findings suggest that PCT is favorable to enhancing SOC. In this context, PCT is also a personal resource to promote SOC. Moreover, since SOC is shown to be associated with healthrelated well-being among older populations, SOC development in old age should be focused.

Development of sense of coherence during two group interventions

Burnout is a serious occupational hazard. This study investigated the possibility to develop an effective salutogenic group intervention among employees suffering from severe burnout symptoms. Participants consisted of employees aged 31 to 59 years working in different public service occupations, such as police officers, tax officers, (and other public service officers), and assigned to three different groups: analytic (N = 25), psychodramatic (N = 24) and controls (N = 28). The intervention comprised 16 separate days over a nine-month period. Changes in sense of coherence (SOC) were measured four times with the 13-item Orientation to Life Questionnaire during the intervention and at six-month follow-up, and analyzed by general linear model (GLM) and using Cohen's d to estimate effect sizes. Change in SOC between the three groups was statistically significant (F(4,148) = 2.65, p = 0.036). The psychodrama group showed a higher increase in SOC than the analytic group during the intervention, while the improvement in the analytic group was significant during the six-month follow-up. Total effect size from baseline to follow-up was in the analytic group 0.71, in the psychodrama group 0.47, and in the control group from baseline to end of intervention 0.09. The results show that it is possible to improve SOC by group intervention in the occupational healthcare context. The dialogue-based analytic method and action-based psychodramatic method differ in their specific effects.

Change in sense of coherence (SOC) and symptoms of depression among old non-demented persons 12 months after hospitalization

We studied whether SOC of older adults (≥65 years) without cognitive impairment had changed 1-year after medical hospitalization (T2) and to examine what factors were associated with the change. At baseline (T1) and (T2), the 13-item version of the SOC scale assessed coping, and the Hospital Anxiety and Depression (HAD) Scale assessed symptoms of depression and anxiety. The cognitive state was assessed by means of the mini-mental state examination (MMSE). Physical health was measured with the Charlson Index and functional status with Lawton and Brody's scales for physical self-maintenance (PSMS) and the instrumental activities of daily living (I-ADL). In all, 97 (51 men) persons with a mean age of 75.3 (SD 6.3) years and Mini Mental State Evaluation (MMSE) score of 28.0 (SD 1.6) participated. The SOC improved significantly from baseline to 1-year later (mean 76.5, SD 11.4 vs. mean 79.1, SD 9.1, p≤0.01). Improved SOC was associated with a low SOC at baseline and living without assistance during the study period. The prevalence of depression (HAD-D≥8) and the mean depression (HAD-D) score did not change between the first and second data collection (HAD-D≥8: 3.1% vs. 4.1% and HAD-D score: mean 1.8, SD 2.3 vs. mean 2.4, SD 2.4). However, an improved SOC and reduced anxiety symptoms at the second time point were associated with reduced HAD-D. The mean SOC improved 1-year after hospitalization. The symptoms of depression did not change, but reduction of symptoms of depression at the second time point was associated with improved SOC.

Effects of intensive strength-power training on sense of coherence among 60-85-year-old people with hip fracture: a randomized controlled trial

Older people with disabilities are at increased risk of psychological health decline. There are no earlier studies on the effects of resistance training on sense of coherence (SOC) among older people with a history of hip fracture. The aim of this study is to test the effects of intensive 12-week strength-power training on SOC among older adults after hip fracture. A clinical sample of 60-85-year-old community-dwelling men and women was studied, 0.5. to 7.0 years after hip fracture. Forty-six had no contraindications for participation and were randomized into training (n=24) and control groups (n=22). The training group participated in a 12-week, individually tailored, strength-power training program, twice a week in a senior gym and supervised by an experienced physiotherapist. SOC was assessed with Antonovsky's short 13-item scale. Data were collected at baseline and after intervention. Intensive 12-week strength-power training had no effect on participants' SOC level. Results indicated no change in SOC after 12-week physical exercise training among participants after hip fracture. Further studies on SOC among older people with disabilities and potential ways of increasing it are needed.

Changes in sense of coherence in old age – a 5‐year follow‐up of the Umeå 85+ study

This study aims to describe the changes in sense of coherence (SOC) over time and relate these changes to negative life events among very old people. Prospective and longitudinal study. 190 old women and men participated, of whom 56 could be included in the 5-year follow-up. The mean SOC score from the first and second data collection were compared using a paired sample t-test. The relationship between the index of negative life events and the changes on SOC score between the two data collections was investigate using linear regression. Antonovsky's SOC scale and an index of negative life events including severe physical and mental diseases, various losses as losses of spouses, cognitive and functional ability. For the whole group of subjects (n = 56), the SOC scores was higher (70.1 vs. 73.7, p = 0.029) at the second point measure. The most common negative life events at follow-up were loss of independence in activities in daily living and decrease in cognitive function. A significant correlation between the index of negative life events and changes in SOC over 5 years was found (p = 0.025). The more negative life events, the more decrease in SOC. We concluded that there is a risk of decreased SOC and thereby quality of life when negative life events accumulate among very old people. Nursing interventions might play an important role for maintaining and perhaps strengthening SOC among old people exposed to negative life events.

Meaningfulness is not the most important component for changes in sense of coherence

Sense of coherence is a theoretical construct which is used to measure the degree to which a person finds the world comprehensible, manageable and meaningful. The main aim of the present study was to assess the hypothesis of Antonovsky that meaningfulness is the most crucial component in sense of coherence. The second aim was to explore the importance of its components and factors at baseline on sense of coherence changes and if the findings can be used in cardiac rehabilitation. One hundred patients, who suffered a primary myocardial infarction were followed during two years. The instruments used were; sense of coherence questionnaire-13, 12-item short-form health survey questionnaire, the Seattle angina questionnaire and health curve. Thirty-nine percent of the participants fulfilled Antonovsky's hypothesis. Comprehensibility and the baseline factors of smoking, alcohol use, marital status and disease perception proved to be of importance for sense of coherence changes over time. The hypothesis that meaningfulness is the most crucial component in sense of coherence is rejected for patients with primary myocardial infarction. Comprehensibility is more important than meaningfulness for changes in sense of coherence. Nurses therefore have an important task to increase comprehensibility and sense of coherence by providing information and knowledge about myocardial infarction and lifestyle changes at an early stage. The information should be given in an individualized and easily understandable way from a salutogenic perspective, which means to identify and work with factors that can contribute to preserving and promoting health.

Development of sense of coherence in adulthood: a person-centered approach. The population-based HeSSup cohort study

We sought to identify the most typical patterns of change in sense of coherence (SOC) in adulthood. This prospective population-based Health and Social Support (HeSSup) study was based on four age cohorts including men and women initially aged 20-24 years (n = 4,682), 30-34 years (n = 4,248), 40-44 years (n = 4,598), and 50-54 years (n = 4,997). SOC was assessed at baseline and at the 5-year follow-up point. Factor Mixture Modeling was used to identify the latent classes of persons whose mean changes in SOC were similar over time. Three development classes were supported by the data. In all age cohorts, the largest class consisted of those people whose SOC was high at baseline and increased thereafter (46-58% of participants depending on the age group). A class of high SOC with a decreasing trend and that of low SOC with an increasing trend were also found. In all age groups, the rank-order stability was high in the first development class (0.84-0.98) but low in other classes (0.35-0.44). This analysis shows continuous increase in the level of SOC over time to be common in adulthood, irrespective of age. High SOC, rather than higher age, seems to determine a stable development of the SOC.

Employment trajectories and changes in sense of coherence

Knowledge of the associations between labour market position and sense of coherence (SOC) comes mainly from cross-sectional studies. We investigated whether change in employment status is associated with change in SOC and whether such an association varies when young (<30 years) and older employees are compared. Data were derived from two studies: a cohort of initially non-permanent employees (n = 1898) was followed up for four years, and a cohort representing the national workforce (n = 9623) was followed up for five years. Labour market position at baseline and at follow-up (permanent/fixed-term job/unemployed) was used to locate the participants into six or nine different employment trajectories depending on the cohort. SOC was measured with a 13-item questionnaire. Associations of the employment trajectories with changes in SOC were analysed with general linear models. In both cohorts the change of SOC was significantly associated with type of employment trajectory. The results supported the hypothesis of more favourable development of SOC among those whose trajectories were directed upward: the associations of poor SOC with unemployment are indisputable, whereas the effects of fixed-term employment seem to be neutral or even positive. The analysis by age revealed that the effects of employment trajectory on SOC are particularly strong among individuals aged below 30 years. This longitudinal study provided evidence for the interpretation that stabilisation of SOC associates with stabilisation of the labour market position. Moreover, the fluctuations of SOC seem to depend on the type of trajectory throughout adult life.

How stable is sense of coherence? Changes following an intervention for unemployed individuals

The present investigation was concerned with the changeability of sense of coherence. We examined changes in sense of coherence (SOC) over a six-month period in a sample of Finnish unemployed individuals (n = 74) participating in an intervention program designed to boost re-employment. Over the study period, participants' sense of coherence improved significantly and re-employed individuals reported the greatest changes. Different changes in the subcomponents of SOC, comprehensibility, manageability and meaningfulness, were found. Contrary to expectations, participants younger than 30 years of age did not show greater changes in their SOC. Initial personal resources were predictors of both positive and negative changes in SOC.

The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey

Background Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence. Objectives The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems. Design The study has a prospective design including a baseline assessment and one-year follow-up. Settings The community mental health care system in a large city in Norway. Participants The sample comprised 107 people with mental health problems. The inclusion criteria were: 18–80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures. Methods Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions). Results The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P = 0.016), mental symptoms did not (standardized beta coefficient −0.07, P = 0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P = 0.019). Conclusions The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.

Longitudinal association of adolescents’ sense of coherence with tooth‐brushing using an integrated behaviour change model

To determine the association between adolescents' sense of coherence (SOC) and their tooth-brushing behaviour. This 18-month longitudinal study involved a representative sample of 8th-graders (n = 1025) from 11 randomly selected public high schools in the Limpopo Province, South Africa. Data collected by means of a self-administered questionnaire included respondents' socio-demographic profiles, vulnerability to depression, smoking status, dental treatment attendance pattern, frequency of and motivation for tooth-brushing. Based on the responses to the question on readiness to change brushing behaviour and in line with the integrated change model, respondents were also categorized as being in the pre-contemplation, contemplation or preparation/action stages. Respondents' SOC was measured using a six-item adapted Antonovsky SOC scale. Data analysis included chi-squared analysis, t-tests and step-wise multiple logistic regression. At baseline, 72.6% (n = 744) of the respondents reported that they were not consistently brushing twice daily. Of those who did not brush twice daily and were followed up on (n = 578), those living with their mother at baseline not only presented with a greater increase in their SOC over time (follow-up minus baseline), but they were also more likely to be brushing twice daily at the time of the follow-up (15.4% versus 10.6%; P = 0.04). Adding baseline intention state to a multivariate model attenuated the influence of baseline SOC to a statistically insignificant level. However, increasing within-subject SOC changes (beta = 0.16; P < 0.01), living with the mother (beta = 0.11; P < 0.05), smoking (beta = -0.14; P < 0.05), being depression vulnerable (beta = -0.23; P < 0.01) and in the preparation/action stage (beta = 0.13; P < 0.05) remained associated with the transition to twice-daily tooth-brushing. In planning oral health promotion interventions, it should be considered that children's psychological predisposition and family environment might significantly influence their tooth-brushing behaviour.

Sense of coherence in three cross-sectional studies in Northern Sweden 1994, 1999 and 2004 — patterns among men and women

To explore changes in sense of coherence (SOC) over a 10-year period in the general population in northern Sweden. Three cross-sectional surveys from 1994 (n=1802), 1999 (n=1698) and 2004 (n=1777), conducted within the northern Sweden MONICA Project, were compared. Participants answered questions about gender, age, experience of disease, perceived health, psychosocial factors and Antonovsky's SOC scale with 13 items. A small, but significant, decrease in SOC medians and a shift of cumulative distributions towards slightly lower SOC values were seen both in the total study population and in its male and female subgroups between 1994 and 1999. No changes were seen between 1999 and 2004, with the exception of women between 25 and 44 years of age, who showed a continuous decrease. The present study shows that SOC at a population level in northern Sweden, within a 10-year span, is relatively stable, not withstanding minor changes. These small changes might be attributed to societal changes in Sweden during the 1990s and an increase in "minor'' psychiatric complaints in the Swedish population as a whole during the same period.

Improving quality of life using compound mind-body therapies: evaluation of a course intervention with body movement and breath therapy, guided imagery, chakra experiencing and mindfulness meditation

Assess changes in quality of life and in sense of coherence (SOC), after an intervention involving a self-development course using mind-body medicine (MBM) activities. A questionnaire study using a health-related quality of life (HRQOL) instrument, the SWEDQUAL, with 13 subscales and scores ranging from 0 to 100, combined with the SOC-13 scale, healthcare utilisation, medication and sick listing data. A training centre for MBM. Eligible course attendants (study group, SG, n = 83) assessed their HRQOL before and 6 months after a 1-week course. A control group (CG) of individuals who had previously attended the course (n = 69), matched for age, sex and length of course time to the SG, also made assessments. Changes in HRQOL and SOC in SG and CG. Of the 13 HRQOL subscales, eight showed clinically significant improvement in the SG (>9%, p < 0.01), namely, General health perceptions (9%), Emotional well-being [negative (45%) and positive (26%)], Cognitive functioning (24%), Sleep (15%), Pain (10%), Role limitation due to emotional health (22%) and Family functioning (16%). Sexual, marital and physical function and role in the SG as well as all CG scores were similar to average population values. The assessed SOC also improved in the SG after intervention (p < 0.01), challenging previous statements of 'the stableness of SOC'. Use of psychotropic medication was slightly reduced in the younger aged SG participants after intervention. This group of men and women (SG), starting from a clinically significant low health assessment, had improved their HRQOL and SOC after the course intervention.

Sense of coherence and recovery from major depression: A four-year follow-up

ObjectiveThe aim of this exploratory study was to identify and follow persons with a first episode of major depression to determine whether sense of coherence changes over time. An additional purpo ...

Follow-up study on the effects of sense of coherence on well-being after two years in Japanese university undergraduate students

Considering first- and second-year university undergraduate students as subjects, this study examined the effect of the sense of coherence (SOC) at the baseline level and subsequent changes in SOC after two years on aspects related to the students’ well-being in their third and fourth school years. These aspects included good physical and mental well-being and the successful resolution of developmental themes. A follow-up survey was performed based on a self-administered questionnaire for 406 undergraduates at two universities in Tokyo. The first survey was conducted in June 2000 and the second, in September 2002. Valid responses were received from 281 students (response rate: 69.2%). A multiple regression analysis showed that high baseline-SOC and later SOC-change were predictors of high physical and mental well-being, which consisted of three domains such as somatic symptoms, and so on, and high psycho-social well-being, which consisted of six domains such as growing interest in learning, clarity regarding one’s own career, and so on. Moreover, the effects on well-being differed slightly between males and females. These results demonstrate that Antonovsky’s theory that SOC influences well-being, including successfully responding to the developmental theme, can be confirmed in male students; however, this is only partially confirmed in female students.

Stability of the sense of coherence in adolescence

The aim of this prospective study was to explore the stability of sense of coherence (SOC) in adolescents from the age of 15 to 18 years. A prospective population-based follow-up study of 1294 first-born children was started in 1986. When the children were 15 (N = 846) and 18 (N = 792) years old, SOC was measured using questionnaires filled out at home. The mean change in SOC scores (0.10, SD 10.2; in percentages 1.98%, SD 18.4) in the whole sample between the ages of 15 and 18 years was negligible and non-significant (p = .788). At the individual level, some changes were seen in the scores. The SOC scores of boys at the ages of 15 and 18 years were significantly higher than those of girls (mean 65.4 vs. 60.8 and 65.4 vs. 61.7, respectively). The SOC scores of adolescents living with both parents were higher than those with one parent or other guardian (mean 64.5 vs. 59.9), and the difference was significant in both age groups (p < .001). Contrary to assumptions made in Antonovsky's theory, we found no significant change in SOC between the ages of 15 to 18 years, and coherence stability did not depend on the initial SOC. Some fluctuation in SOC scores was seen at the individual level. For planning of interventions, it is important to know that SOC seems to be reasonably stabilized before the age of 15 years.

Structural validity and temporal stability of the 13-item sense of coherence scale: Prospective evidence from the population-based HeSSup study

To investigate whether the structure of Antonovsky's [Unraveling the Mystery of Health. How People Manage Stress and Stay Well. San Francisco: Jossey-Bass, 1987] 13-item Sense of Coherence (SOC) scale remains invariant across time and across age groups and whether any differences in stability of and mean changes in SOC can be seen between young people and individuals aged 30 or above. Prospective study with a population-based sample of 18,525 Finns of whom 4,682 were under age 30 and 13,843 over age 30 at both the baseline and 5-year follow-up surveys (the HeSSup study). Confirmatory factor analysis supported the correlated 3-factor solution for the SOC scale and its equivalent second-order factor structure at both measurement times and in both age groups. According to Structural Equation Modelling (SEM), SOC was more stable among subjects over 30 years (stability coefficient 0.81) than among younger adults (0.70). The mean level of SOC was higher among subjects over age 30 than subjects under age 30 at both times. The level of SOC increased during the follow-up period in both age groups but to a greater extent among the younger than older age group. These data suggest relatively high structural validity and high stability for the 13-item SOC measure and support the notion that SOC becomes more stable following maturation. The 13-item SOC measure seems to provide a psychometrically sound survey instrument for testing Antonovsky's theory on life orientation and health.

Adaptation of wives to prostate cancer following diagnosis and 3 months after treatment: A test of family adaptation theory

Background Prostate cancer challenges not only the men with the disease, but also their partners. Existing studies have focused on the relationship between type of treatment and sexual and urinary function in men, with recent qualitative work suggesting that men and their spouses have differing responses to the illness. Factors predicting women's adaptation to prostate cancer have not been examined. Objectives Using a model derived from family stress and adaptation theory, this study examined (1) the contribution of urinary and sexual symptoms, sense of coherence, marital resources and situational appraisal to wives’ global adaptation (PAIS) and emotional adaptation (POMS), and (2) the role of situational appraisal as a mediator between the set of independent variables and PAIS and POMS. Design In a prospective, correlational design, data were collected from 70 women following their partners’ diagnosis and again 3 months later. Methods and results Using a path analysis approach, between 30% and 62.7% of the variance in global adjustment and mood disturbance was explained across model tests. Sense of coherence was a strong and consistent predictor. Appraisal acted as a mediator only at time 2, mediating the effect of symptom distress on global adaptation. Change in sense of coherence and change in family resources predicted global adaptation and emotional adaptation at time 2, and predicted the change between time 1 and 2 in those variables. Conclusions The findings suggest nursing interventions that mobilize and build wives’ sense of the manageability, meaningfulness and comprehensibility of life events, and that foster cohesion and flexibility within the marital relationship. Interventions that mitigate the impact of urinary symptoms and the appraisal of threat in the illness event are also indicated. Additional model-testing studies based on family adaptation theory with patients and family members in other types of cancer would help build nursing knowledge for interventions in cancer.

The Adjustment Process for Individuals With Spinal Cord Injury

This study investigated the relationship between perceived changes in sense of coherence from pre- to postinjury and adjustment for a group of individuals with spinal cord injury. It was hypothesized that after a spinal cord injury, an individual's belief that he or she had significantly reduced his or her sense of coherence would be associated with reduced adjustment. Forty-eight individuals with spinal cord injury completed Antonovsky's Sense of Coherence Scale and Livneh and Antonak's Reactions to Impairment and Disability Inventory. Results indicated a positive relationship between adjustment and strengthened sense of coherence. Rehabilitation counselor implications are discussed.