Generalized Resistance Resources Research Articles

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study

ObjectivesTo identify the associated factors of self-neglect in older adults from a salutogenic perspective. MethodsA cross-sectional correlational study was conducted in two communities in Beijing with 486 older adults recruited from April to December 2022. Data were collected by a set of questionnaires. ResultsSense of coherence (β=-0.138), socio-demographic generalized resistance resources (GRRs) (smoking: β=0.156), social GRRs (living alone: β=0.093), psychological GRRs (self-esteem: β=-0.126), and motivational GRRs (powerful others locus of control: β=-0.199, chance locus of control: β=0.119) were all associated with self-neglect among older adults (p<0.05). ConclusionsSense of coherence and GRRs are vital to improve self-neglect in older adults. It is suggested to increase the level of self-esteem and the tendency of the health locus of control to largely facilitate self-neglect management in older adults.

Salutogenesis intervention improves cardio-cerebrovascular health in at-risk office workers: A quasi-experimental study.

Cardio-cerebrovascular disease is the major cause of work-related deaths. Salutogenesis indicates individual differences in health levels occur owing to differences in the sense of coherence (SOC). A salutogenesis-based intervention may promote cardio-cerebrovascular health at work. This study examined the effects of a SOC promotion program based on salutogenesis. Quasi-experimental study. Fifty-six office workers who were above the "low risk" of cardio-cerebrovascular disease from two workplaces were included in the final analysis. Data collected pre- and postintervention. To determine the intervention's effectiveness, repeated-measures analysis of variance was used. The intervention group was provided with the SOC promotion program, whereas the control group was provided with educational materials alone for 12weeks. Generalized resistance resources (GRRs; knowledge of cardio-cerebrovascular disease prevention, stress-coping strategies, and social support) and SOC significantly improved in the intervention group. The intervention group showed significant improvements in occupational stress, physical activity, dietary behavior, total cholesterol level, fasting glucose level, hemoglobin A1C level, body mass index, waist circumference, diastolic and systolic blood pressure, and cardio-cerebrovascular risk. Systematic salutogenesis-based SOC promotion programs should be established to enhance the cardio-cerebrovascular health of office workers at-risk of cardio-cerebrovascular diseases. Trial Registration Number is KCT0007029. The date of registration is February 23, 2022.

Exploring how people achieve recommended levels of physical activity, despite self-reported economic difficulties: a sense of coherence perspective

BackgroundThe salutogenic theory forms the basis for health promotion and describes health as a continuum from a dis-ease pole of health to an ease pole. The core concept for the salutogenic theory is sense of coherence (SOC). For a strong SOC, general resistance resources, such as solid economic situation, are essential. The aim was to explore how people – despite self-reported economic difficulties – comprehend, manage and find it meaningful to achieve the level of physical activity recommended by World Health Organisation (WHO).MethodThe study is based on interviews with people achieving the recommended physical activity (PA) level despite economic difficulties. The interviews were conducted at primary health care centres and family centres after a targeted health dialogue. We used a qualitative deductive content analysis based on sense of coherence as the main category, with the three generic categories of comprehensibility, manageability and meaningfulness.ResultThe findings elucidate a pattern of a process. In this process, the participants comprehend their knowledge of the health benefits of PA and have a plan for performing their PA. They utilise their resources in order to manage to apply their knowledge and plan for PA in their lives despite their challenges. When PA becomes meaningful to them, they have an intrinsic motivation to perform it and experience its benefits.ConclusionThis study suggests a possible process that might help in achieving the recommended PA level among people with economic difficulties and other challenges. The findings might be used in health promotion work, such as targeted health dialogues in primary health care, to reduce health inequalities when supporting people who are not achieving the recommended levels of PA.Trial registrationNot applicable.

Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health.

to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit. qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison. 13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole. knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.

A salutary welcome: the role of Sense of Coherence and Generalized Resistance Resources in refugee settlement

PurposeGuided by the salutogenic model of health and well-being, this study aims to use empirical measures of sense of coherence (SOC) and generalized resistance resources (GRRs) to gain a better understanding of the facilitators of successful transition and integration of refugees to Canada and relate these findings to current program development and delivery for the settlement of refugees.Design/methodology/approachSurvey research and structural equation modeling.FindingsThe authors found that newcomers with a stronger SOC were more likely to report successful integration outcomes. GRRs were found to have both direct and indirect effects on the positive settlement of refugees, with the SOC acting as a strong mediator of indirect effects.Research limitations/implicationsOwing in part, to the disruption caused by the global pandemic, the authors’ data collection period was protracted and the final sample size of 263 is smaller than the authors would have preferred. Another limitation of this study has to do with its cross-sectional design, which limits the articulation of cause-and-effect relationships among the variables.Practical implicationsIn terms of program development and delivery for the settlement of refugees, the authors’ results provide further evidence that refugee participation in socially valued decision-making represents a key determinant of healthy resettlement.Originality/valueMuch research on refugee settlement originates within “a pathogenic paradigm” that focuses on the stressors and obstacles encountered by people who have been displaced. Taking its cue from Israeli health sociologist, Aaron Antonovsky’s salutogenic model of health and well-being, this study uses empirical measures of Antonovsky’s interrelated concepts of SOC and GRRs to gain a better understanding of the facilitators of successful transition and integration of refugees to a prairie province in Canada and relate these findings to current program development and delivery for the settlement of refugees.

Coping With Stressors and General Resistance Resources Used by Individuals Experiencing Homelessness in Minneapolis Tent Camps

Homelessness remains a significant public health issue across the United States, particularly in urban areas. Individuals become and remain homeless for multifaceted and complex reasons that are linked to well-being. The aim of this study was to understand the well-being of persons experiencing homelessness (PEH) and living in tent camps using Aaron Antonovsky’s salutogenic model of health (SMH). To address well-being, we conducted a basic qualitative study with thirty adults over age 18 who self-identified as homeless and living in tent camps within the city of Minneapolis. With a semi-structured interview guide that centered on the SMH, we analyzed data using Johnny Saldaña’s qualitative coding method. Sources of stress themes, including (1) “family trauma” (depression/trauma related to the death of a loved one and drugs, imprisonment, and abuse), (2) “mental health” (depression/trauma related to the death of a loved one, loneliness living in tent camps, substance use, mental illness), and (3) “change and threats” (constant fear of aggression, lack of stability of the tent camp, bad people causing problems, cliques in the camp). Themes of general resistance (GRRs) resources (coping with stress), or GRRs emerged, including (1) “systems knowledge,” (2) “coping strategies,” (3) “sense of community,” (4) “camp stability,” and (5) “human dignity” emerged during data collection and analysis. These findings can inform policy decisions related to increasing services to exit homelessness, funding for sustainable tent camps, and sweeps of tent camps in the city of Minneapolis and beyond.

Development and effects of salutogenesis program for adolescents with moyamoya disease: A randomized controlled trial.

Disease-specific interventions for management and health behavior implementation are needed to improve the health and quality of life of adolescents with moyamoya disease. This study aimed to develop a program for adolescents with moyamoya disease based on the salutogenesis theory, which focuses on the process of enhancing health through successful adaptation to external stressors, and to evaluate its effectiveness. A randomized controlled trial was performed according to the CONSORT guidelines. This preliminary research and experimental treatment were conducted at a Severance Hospital ward and outpatient clinic among 48 participants randomized into the intervention (seven sessions of salutogenesis program, n = 24) or the control group (one session of one-to-one moyamoya disease education program, n = 24) from September 6, 2018 to January 4, 2019. Changes in the following study outcomes were reported: "knowledge of moyamoya disease," "social support," "sense of coherence," "moyamoya disease health behavior," "stress," "depression," "subjective health status," "frequency of ischemic symptoms," and "quality of life". The salutogenesis program improved the knowledge and social support of adolescents with illness-related problems and helped them attain healthy behaviors and stress reduction. It was confirmed to be effective in improving their quality of life. The salutogenesis program for adolescents with moyamoya disease effectively improved the generalized resistance resources and sense of coherence in adolescents with moyamoya disease. Korean Clinical Research Information Service registry, KCT0006869.

Association between sense of coherence and health and well-being among older survivors of a natural disaster: a prospective outcome-wide study

We examined whether pre-disaster Sense of Coherence (SOC) mitigated the impact of housing damage on health and well-being of older survivors after the 2011 Japan Earthquake and Tsunami. A panel survey was conducted in a city located 80 km west of the epicenter seven months before and three years after the disaster (3594 respondents). Among respondents with lighter property damage, higher SOC was inversely associated with mental distress (coefficient − 0.29, 95% CI (confidence interval) − 0.39, − 0.19, p < .01), unhappiness (coefficient − 0.33, 95% CI − 0.43, − 0.23, p < .01), low expectation of mutual help (coefficient − 0.17, 95% CI − 0.27, − 0.07, p < .01), and weak community attachment (coefficient − 0.20, 95% CI − 0.30, − 0.11, p < .01). Conversely, among those who experienced housing loss, higher SOC was no longer protectively associated with health and well-being. Loss of generalized resistance resources due to serious damage led to difficulties in stress coping.

Opplevelse av sammenheng i fag- og yrkesopplæring: Et longitudinelt perspektiv

This longitudinal study explores the resources vocational students need to balance stress and develop vocational competence in school- and work-based learning. As a theoretical framework, the concepts of sense of coherence (SOC) and general resistance resources (GRR) are used, as proposed by Antonovsky in his salutogenic theory. SOC consists of three components: comprehensibility, manageability, and meaningfulness. GRR is about how a person, group or community use internal and external resources to promote SOC. Participants are interviewed at the end of their school part of the education and again at the end of the apprenticeship. The two interviews are compared using comparative analysis methods to explore how participants’ GRRs develop. The study shows that comprehensibility increases when practice and theory are integrated into work tasks during the apprenticeship. The manageability component, developed throughout the educational process, helps them master stress and to face unpredictable situations. The GRRs promoting meaningfulness are almost similar in the two interviews and appear to be stable over time and central for participants to engage in learning situations and develop vocational competence.

Predicting sense of coherence among caregiving partners of persons with multiple sclerosis.

Within the framework of the Salutogenic Model of Health, this study aimed to investigate sense of coherence among caregiving partners of persons with multiple sclerosis (PwMS), and its relationship with perceived social support and illness beliefs conceived as generalized resistance resources in tension management. In this cross-sectional study, 398 caregiving partners of PwMS (Mage = 44.62; 34.9% women and 65.1% men) filled in questionnaires measuring sense of coherence (Sense of Coherence Scale-13), perceived social support from family, friends and significant others (Multidimensional Scale of Perceived Social Support), and illness beliefs (Revised Illness Perception Questionnaire). Hierarchical linear regression analysis was performed to assess the contribution of perceived support and illness beliefs to sense of coherence, controlling for sociodemographic and clinical variables. Perceived support from family and beliefs concerning illness-related emotional representations, illness coherence, and treatment control emerged as significant predictors of participants' sense of coherence. Higher perceived support from family and stronger beliefs in illness coherence and treatment control were associated with higher sense of coherence, while more negative emotional representations were related to lower sense of coherence values. Findings lend support to the relevance of a salutogenic approach to caregiving in multiple sclerosis. They further suggest the usefulness of interventions that can promote caregivers' sense of coherence and successful coping in life by benefitting from family support, favoring the construction of a coherent illness view, offering comprehensive information and expert guidance on treatment and rehabilitation opportunities, and promoting adaptive management of negative emotions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland

A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession.

Sense of Coherence at End of Life in Older People: An Interpretive Description.

As people age, losses accumulate (ie, the death of family and friends, the loss of agility, and the loss of independence). Such losses have an impact on one's Sense of Coherence, that is, one's ability to see the world as comprehensible, manageable, and meaningful. Antonovsky deemed Sense of Coherence as a mostly stable state by the age of 30 years. Until now, there has not been an investigation into how serial loss of resources affects older people as they near the end of life. Sense of Coherence was used as the theoretical framework for this study to answer the question of how older people maintain or regain a Sense of Coherence in the presence of serious illness as they near death. Data were gathered using semistructured interviews and guided by interpretive description. This investigation found new concepts that contribute to Antonovsky's midlevel theory of salutogenesis and the construct of Sense of Coherence. Those are Incomprehensibility and Serial Loss of General Resistance Resources. The results indicate that the crux of a strong Sense of Coherence for this population is excellent communication and a coherent "big-picture" conversation.

RECURSOS PARA MANUTENÇÃO DA SAÚDE EM PESSOAS PRESAS COM HIPERTENSÃO ARTERIAL: UMA ABORDAGEM SALUTOGÊNICA

ABSTRACT Objective: to know the generalized resistance resources of people deprived of liberty with systemic arterial hypertension in a triple border region. Method: a qualitative study based on the theoretical framework of Salutogenesis, in which 38 people deprived of liberty in Foz do Iguaçu, Paraná, Brazil, participated from February to July 2022. Guiding questions were used in the interviews which were submitted to thematic content analysis. Results: 12 generalized resistance resources emerged in the reports of people deprived of liberty with systemic arterial hypertension: health team; access to medications; work; lifestyle habits: food, physical activity and restriction of access to drugs/cigarettes/alcoholic beverages; stress/anxiety control; reading and games; religiosity; family; self-care; cellmates; and employees. Conclusion: people deprived of liberty with systemic arterial hypertension have generalized resistance resources to manage their life and health, which are related to personal care, the social group and the environment. It is noteworthy that once they are identified, the generalized resistance resources can be used by health professionals to manage SAH, other chronic diseases and aid in health promotion.

Sense of Coherence Among Apprentices in Vocational Education and Training in Norway: Exploring General Resistance Resources in Work-Based Learning

Purpose: In the face of constant and rapid development achieving a work–life balance requires highly qualified and motivated professionals who can deal with stress and the demands of the future. In response, by facilitating school- and work-based learning, upper secondary vocational education and training (VET) prepares and qualifies adolescents for professional practice. In relation to VET, two fundamental salutogenic concepts can explain how humans cope with stressful and demanding situations: Sense of coherence (SOC), which entails comprehensibility, manageability and meaningfulness, and general resistance resources (GRRs), theorised as resources within individuals themselves (i.e., internal) and/or in their surroundings (i.e., external). Against that background, in our study we aimed to identify and explore which GRRs contribute to SOC among apprentices in VET and how they influence work-based learning. Methods: Data were collected from 11 VET student in Norway at three time points—at interviews during their final semester of school-based learning (i.e., spring 2020), at interviews during their work-based learning (i.e., spring 2022) and, for register data, following their completion of trade certificates (i.e., autumn 2022). The students' experiences of work-based learning as apprentices formed the basis of this study's analysis. The stepwise deductive–inductive method was used to generate and analyse the data. Findings: The apprentices' GRRs emerged in emotional, cognitive, physical, professional, social, relational, material and cultural dimensions. Identification and utilisation of GRRs were both individually and socially conditioned. The apprentices were able to identify, both consciously and unconsciously, internal GRRs to further identify external GRRs, and vice versa. Each identified GRR appeared to affect at least one, if not all, of the three components of SOC. Conclusion: Salutogenic VET can provide personal, social, environmental and physical resources (i.e., GRRs) that ensure coherent learning experiences. For that reason, by supporting VET students in identifying GRRs, teachers and supervisors can promote their SOC and work-based learning and thereby prepare them to be highly qualified and motivated professionals.

EPISTEMOLOGY IN MIGRANT COMMUNITY FOR BETTER HEALTH OUTCOMES IN PRIMARY HEALTH CARE OF NORTH INDIA - A CASE STUDY

The migrant community often lacks health care access due to poor health knowledge. Epistemology deals with the nature and scope of knowledge. Epistemology links the migrant community to health system with adequate knowledge to accept the health seeking behavior in lifestyle. Objective: To assess thesalutogenic health promotion model in primary health care for the migrant population. Methods: A qualitative analysis in the migrant community was conducted in a family with an antenatal case as the index case. The epistemological salutogenic health model of General Resistance Resources (GRR) and Sense of Coherence (SOC) was applied. A health promotion model was devised in accordance to the GRR and SOC. A health system intervention was also planned to improve health indicators. Results: The family had a better approach towards heath and preparedness towards the institutional delivery of the child. The children were immunized with appropriate documentation. The success story of the family turned the migrant community to act as a social support group for positive health. There were improvements in the health indicators of the urban slum improved. Conclusion: Usingepistemology aspects and salutogenic health promotion model bridged the gaps in the health system with the migrant community. The migrant community are often ignorant towards their health but with appropriate health promotion models their health needs can be addressed.

Generalized Resistance Resources in the Time of COVID-19: The Role of Sense of Coherence and Resilience in the Relationship between COVID-19 Fear and Loneliness among Schoolteachers

Fear has been the most common emotional response to the COVID-19 pandemic, and excessive fear is associated with various indices of psychological distress, particularly loneliness. Although most people have experienced pandemic-related fear and distress, certain groups who are on the front of service provision have experienced the pandemic in distinct ways, owing to its impact on the nature of their work. Schoolteachers represent one such group; therefore, it is imperative to identify resources that can safeguard against negative mental-health outcomes in schoolteachers. The current study investigated the potential protective role of sense of coherence (SOC) and resilience in the relationship between COVID-19 fear and loneliness. The participants were South African schoolteachers (N = 355); the participants completed the Fear of COVID-19 Scale, the University of California Loneliness Scale, the Connor-Davidson Resilience Scale-10, and the Sense of Coherence Scale-13. The results indicated that SOC and resilience had significant direct effects on loneliness, thereby suggesting their health-sustaining role. SOC and resilience also fully mediated the relationship between COVID-19 fear and loneliness. Therefore, although the provision of material resources is important, it is equally necessary to enhance people’s ability to comprehend, give meaning to, and manage the challenges associated with the pandemic. A salutogenic approach to mental health promotion in the workplace may be beneficial for enhancing SOC and resilience among schoolteachers.

Being Hopeful and Mindful During Adversity: A Longitudinal Study on College Students' Adjustment During COVID-19.

ObjectivesThe current study examined whether hope and mindfulness were associated with changes in two maladjustment measures, internalizing and externalizing behaviors, during the COVID-19 pandemic and tested sense of coherence as a mediator. The salutogenic theory of health, which posits that sense of coherence is central to individuals’ well-being in stressful situations and that individuals derive their sense of coherence from their generalized resistance resources (GRRs), was used to guide the analyses.MethodsOn two occasions separated by about 6 months, 253 Hong Kong college students (mean age = 21.0 years at time 1; 86% of them were women) filled in online questionnaires during the COVID-19 outbreaks. Path analysis was conducted to examine the interrelationships among hope and mindfulness, sense of coherence, and internalizing and externalizing behaviors.ResultsResults indicated that hope and mindfulness at time 1 were associated with internalizing and externalizing behaviors at time 2, even after controlling for confounding variables and prior levels of internalizing and externalizing behaviors. Moreover, sense of coherence at time 1 significantly mediated these associations.ConclusionsFindings pointed to the potential roles of hope, mindfulness, and sense of coherence in understanding Chinese college students’ adjustment during the COVID-19 pandemic. Future research is needed to test whether sense of coherence and behavioral adjustment can be promoted through hope- and mindfulness-based intervention programs. Future research is also needed to examine the interrelationships among health-promoting assets, sense of coherence, and individual adjustment in samples of diverse cultural backgrounds.

Small business managers and Covid-19-The role of a sense of coherence and general resistance resources in coping with stressors.

BackgroundThe response of small business managers to an external event such as the pandemic can have a profound effect on the work environment, health and well-being for themselves and their employees. Previous research on small business managers during the pandemic has mainly focused on traditional pathogenic effects, and there is a lack of studies looking at the issue from a salutogenic health promotion perspective. The aim of this study is to explore whether a sense of coherence and general resistance resources were experienced by small business managers in Sweden and Norway during the Covid-19 pandemic.MethodsA qualitative design was applied through exploratory interviews with 16 managers of small businesses in Sweden and Norway. A content analysis of the interviews was conducted using the sense of coherence concept by Aaron Antonovsky, with the three main components of comprehensibility, meaningfulness and manageability acting as a conceptual framework for the analysis process.ResultsWithin the three main sense-of-coherence categories, six general resistance resources were identified as being important for the managers to handle uncertainty during the pandemic. These were understanding rules and regulations, social support, optimism, proactivity, problem-solving and flexibility and cooperation.ConclusionsThe small business managers handled the pandemic in a way that worked well in their contexts, and the pandemic generally did not have a negative effect on their businesses or themselves. A salutogenic approach, through which the managers focused on identifying and using resources, was an important factor for managing stressors and adversity during the pandemic. Hence, the concept of salutogenesis may be used as an intervention to foster better health in small businesses, both at a personal and organisational level in order to handle future challenges effectively.

Re-envisioning health promotion: Thinking and acting salutogenically towards equity for historically resilient communities.

This paper explores how the salutogenic theory can enable us to re-envision health promotion work with marginalized communities, towards an approach that acknowledges and honours their resilience. We use the three core concepts in Antonovsky’s salutogenic model of health – sense of coherence, generalized resistance resources and specific resistance resources – to explore the theory’s relevance to health equity, thus presenting new opportunities for how we might radically re-evaluate current health promotion approaches. We conclude that a more equitable health promotion requires increased participation of marginalized communities in shaping their futures and suggest a new model for historically grounded salutogenic health promotion.

A Salutogenic Perspective on End-of-Life Care among the Indigenous Sámi of Northern Fennoscandia.

There is limited empirical data about both health and end-of-life (EoL) issues among the Indigenous Sámi of Fennoscandia. We therefore aimed to investigate experiences of EoL care and support among the Sámi, both from the Sámi community itself as well as from more formalized health and social care services in Sweden. Our primary data source is from focus group discussions (FGDs) held at a Sámi event in 2017 with 24 people, complemented with analysis of previously collected data from 15 individual interviews with both Sámi and non-Sámi informants familiar with dying, death and bereavement among Sámi; “go-along” discussions with 12 Sámi, and individual interviews with 31 Sámi about advance care planning. After initial framework analysis, we applied a salutogenic model for interpretation, focusing on a sense of community coherence. We found a range of generalized resistance resources in relation to the Sámi community, which appeared to support EoL care situations, i.e., Social Organization; Familiarity with EoL Care, Collective Cultural Heritage; Expressions of Spirituality; Support from Majority Care Systems; and Brokerage. These positive features appear to support key components of a sense of community coherence, i.e., comprehensibility, meaningfulness and manageability. We also found relatively few, but notable deficits that may diminish the sense of community coherence, i.e., lack of communication in one’s own language; orientation, familiarity and/or agreement in contacts with formal health and social care systems; and/or support from extended family. The results suggest that there is a robust basis among Sámi for well-functioning EoL care; a challenge is in developing supportive interactions with the majority health and social care systems that support and complement these structures, for partnership in developing care that is meaningful, comprehensible and manageable even in potentially difficult EoL situations.