Generalized Resistance Resources Research Articles

Toward a Unified Language (and Application) of Salutogenic Design: An Opinion Paper.

This opinion paper posits that there is a misalignment of how the theory of salutogenesis is defined by scholars and the way that salutogenesis is reflected in architectural practice. Many practitioners use this term to describe their work without a clear understanding of the social theory behind it. A background on the original theory, brief review of its subsequent development, and the importance of stress in determining health are explored. Antonovsky, originator of the salutogenesis theory, believed that health was represented by a spectrum ranging from disease to wellness and that stress and an individual's ability to respond to it determined where they would be on that spectrum. His work indicates that one's resources determined the impact of a stressor. The elements Antonovsky termed environmental generalized resistance resources (GRR) are considered because they are within the purview of design practitioners to influence. While Antonovsky's work became focused on an aspect of salutogenesis he termed sense of coherence (SOC), he encouraged exploration of additional aspects. This article proposes an expanded definition of salutogenesis that includes five aspects of environmental GRR that can address or alleviate specific causes of stress-SOC, biophilia, relaxation response, self-empowerment, and prospect and refuge. A more specific language and a common, consistent way of understanding what makes an environment salutogenic emerges with examples of each described. A common language will bring consistency to design practice and make complex social theories more accessible for practitioners, leading to them being more rigorously and universally applied in design.

Rethinking sense of coherence: Perceptions of comprehensibility, manageability, and meaningfulness in a group of Palestinian health care providers operating in the West Bank and Israel.

Drawing on a salutogenic perspective, we explored sense of coherence (SOC) in a group of Palestinian mental health care providers living and working in Israel and the occupied Palestinian territories (West Bank). Specifically, we conducted a qualitative exploration of the cultural characteristics of SOC and its components (comprehensibility, manageability, and meaningfulness) in two groups of Palestinian Muslim helpers. We found that context-specific features of SOC can mobilize generalized resistance resources for coping with traumatic and stressful experiences, even in an environment characterized by political instability, military violence, and social trauma. Ten main themes emerged from the thematic content analysis: acceptance, reacting to adversity, acknowledging human insecurity (comprehensibility), self-control, talking to family, education as a resource for survival, connecting to the severity of the event, responsibility as a source of control (manageability), religiosity, and sense of belonging (meaningfulness). The Islamic faith, as expressed through the concepts of Sumud and Taslim, seemed to permeate individuals' ability to attribute meaning to historical and transgenerational trauma, as well as to their ongoing traumatic conditions, thus acting as their ultimate source of health and wellbeing. A holistic, spiritual, and collectivist outlook helped respondents to approach their lives with optimism. We discuss the implications for mental health care providers and future research directions.

Validation study of an Italian version of the revised Sense of Coherence Scale (SOC-R)

The present study aims to validate the Italian version of the revised Sense of Coherence Scale (SOC-R). The scale was administered to a large sample of Italian adults (N = 689; 54.3% females, Mage = 34.09, SD = 16.27, range = 18–84) along with measures of related psychological concepts. Confirmatory factor analyses indicated adequate fit for the three-factor structure of the scale (i.e., manageability, balance, and reflection). Internal consistency and temporal stability indices confirmed the reliability of the scale and associations with related constructs, including personality, general resistance resources, well-being, and stress, provided evidence of its validity. This study demonstrated that the Italian version of the SOC-R is a valid and reliable measure that can be utilized for clinical and research purpose.

Effects of the variety of general resistance resources and sense of coherence on stress response in salutogenic model Part 1: Mediation effects and moderation effects

Effects of the variety of general resistance resources and sense of coherence on stress response in salutogenic model Part 1: Mediation effects and moderation effects

A salutary childbirth education program: Health promoting by design. A discussion paper

Pregnancy is an ideal time to focus on health promotion. Many women and their partners attend childbirth education classes to prepare themselves for pregnancy, birth and parenting. However, rather than promoting health, these classes have been criticized for preparing women and their partners for a medicalized birth, which has become the norm in many well-resourced countries. This paper describes the development of a childbirth education program using the theory of salutogenesis. While much has been written about the theory, few have attempted to operationalize the theory for health service delivery, particularly in the maternity care context. The aim of the program was to move individuals participating in the program towards greater health on the health-ease/dis-ease continuum by increasing their sense of coherence, focusing on generalized resistance resources and strengthening the key components comprehensibility, manageability and meaningfulness. This paper describes the development of the program.

Sense of coherence among Bedouin women in polygamous marriages compared to women in monogamous marriages

ABSTRACTWe compared sense of coherence (SOC) among Bedouin women in polygamous with those in monogamous marriages. SOC is a global orientation toward life as comprehensible, manageable, and meaningful, and is derived from generalized resistance resources that promote effective coping in stressful life situations. Strong SOC may be a resource for strengthening resilience and promoting health. We administered questionnaires to 464 Indigenous Arab Bedouin women (ages 18–49 years) in 2008–2009 using the 13-item SOC questionnaire. Contrary to our hypothesis, SOC was higher among women in polygamous compared to monogamous marriages. Husband‘s education, husband’s abandonment of the household, living in unrecognized villages, and low mastery (perception of one’s ability to control life situations) were associated with higher SOC. These results might suggest that polygamy may provoke new coping mechanisms among women as they reappraise life amidst low mastery, accept cultural norms, and marshal new resources, thereby increasing key elements of SOC, including comprehensibility, manageability, and meaningfulness. Interventions and services seeking to empower women in polygamous marriages should build on their resilience.

Rural paramedics’ capacity for utilising a salutogenic approach to healthcare delivery: a literature review

Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. ResultsFifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health.

The Impact of Formal and Informal Institutions on ART Drug Adherence.

A successful antiretroviral therapy (ART) drug adherence is achieved when patients follow their prescribed regimen. This is determined by patient’s motivation that is influenced by resources associated with the patient, society, and relevant institutions. The aim of this study is to assess the impact of formal and informal actors on patients’ ART drug adherence. A qualitative study approach was conducted through face-to-face in-depth interviews of HIV-infected patients and key informants. The analysis was guided by a salutogenic model focusing on generalized resistance resources and a sense of coherence. The finding shows that 76% of the study participants achieved the recommended 95% adherence level. Several resources attributed to individuals, society, and public institutions influencing patients’ day-to-day life and their drug adherence were identified. Patients who are able to use the available resources easily develop sense of coherence and follow their prescribed drug regimen. Therefore, encouraging HIV-infected patients through formal and informal actors can enhance ART drug adherence.

A Salutogenic Approach to Physical Education in Schools

Schools are an excellent setting for health promotion in children and adolescents. In particular the school subject physical education (PE) offers high potential in this regard. The following paper applies thesalutogenic model of Aaron Antonovsky to PE in schools. This approach focuses on strengthening the sense of coherence with its central factors: comprehensibility, manageability and meaningfulness. A high sense of coherence mobilizes generalized resistance resources, results in positive coping strategies and contributes to well-being and health. The presented modified and adapted salutogenic model of health for PE may serve as one element of a schools’ general concept for health promotion.

Implementing a salutogenic treatment model in a clinical setting of emergency child and adolescent psychiatry in Sweden.

Emergency care in child and adolescent psychiatry often lacks a coherent treatment model. This study reports on the development and implementation of a salutogenic treatment model at the Child & Adolescent Psychiatric Emergency Unit in Malmö, Sweden. The development and implementation involved all staff categories and was guided by a recognized authority on salutogenesis. Generalized resistance resources (GRR) were identified that could be implemented at the unit to improve patients' sense of coherence. Eight GRR were developed and implemented at the unit. During the 6-month period following the implementation, patients (n = 41) and parents reported satisfaction with the treatment, while mental health improved between admission and discharge, and both treatment length and readmission rates were reduced. A salutogenic treatment model involving GRR seems to be a promising approach in child and adolescent psychiatric emergency treatment.

Me and You in Caregivinghood – Dyadic resistance resources and deficits out of the informal caregiver's perspective

ABSTRACTObjective: To present Specific and Generalized Resistance Resources (SRRs/GRRs) and Deficits (SRDs/GRDs) described by 32 informal caregivers as originating from themselves and their older adult carerecipients as dyads.Method: Salutogenic interviewing was used to assemble data from caregivers. A theory-driven, memo-guided and comparative analysis using within- and across- case analysis was applied to unravel resources and deficits influencing the outcomes when they managed tension associated with caregiving.Findings: Living in fellowship in a well-functioning dyad unites the essence of having access to dyadic SRRs/GRRs. Such access enables dyads to use their specific dyadic tension management to resolve challenges through cooperation, derives ‘positive’ life-experiences and preserves dyad functioning. Struggling alone in a malfunctioning dyad indicates the presence of dyadic SRDs/GRDs counteracting such a development. If these SRDs/GRDs accumulate, the dyad become less able to resolve challenges, ‘negative’ life-experiences accumulates, the carerecipient's capability to cooperate decreases, caregiver's workload increases, the dyad becomes increasingly malfunctioning and moves towards the point where caregiving ends due to lack of usable SRRs/GRRs.Conclusions: Findings reveals the complex duality of caregiving and the necessity to assess all available SRRs/GRRs and SRDs/GRDs for caregiving dyads, including out of the carerecipient's perspective. Appropriate ‘salutogenic’ support reduces SRDs/GRDs, makes available SRRs/GRRs usable or provides alternative SRRs/GRRs, thereby dyadic tension management and dyadic functionality is preserved during this phase of life labelled Caregivinghood. The study adds new knowledge to the salutogenic framework regarding central, theoretical concepts and suggests how data for health promoting initiatives conducted the ‘salutogenic way’ may be acquired.

Unravelling salutogenic mechanisms in the workplace: the role of learning

ObjectiveTo explore the moderating and mediating role(s) of learning within the relationship between sense of coherence (SOC) and generalized resistance resources. MethodCross-sectional study (N=481), using a self-administered questionnaire, of employees working in the healthcare sector in the Netherlands in 2017. Four residential healthcare settings and one healthcare-related Facebook group were involved. Multiple linear regression models were used to test for moderating and mediating effects of learning. ResultsSocial relations, task significance, and job control significantly explained variance in SOC. Conceptual, social, and instrumental learning, combined, moderated the relationship between SOC and task significance. Instrumental learning moderated the relationship between job control and SOC. Social learning also mediated this relationship. Conceptual learning did not show any moderating or mediating effect. ConclusionsThe relationship between SOC and the three GRRs seems to be strengthened or explained−to a certain extent−by instrumental and social learning. Healthcare organizations are recommended to promote learning through formal activities as well as through cooperation, feedback, sharing experiences, and job challenges. This requires employee participation and a multilevel interdisciplinary approach.

The mechanisms behind the formation of a strong Sense of Coherence (SOC): The role of migration and integration.

Considering how much we know about the impact of the Sense of Coherence (SOC) on different health-related outcomes, we know surprisingly little about how a strong SOC actually develops. In this study we examine the mechanisms behind the formation of a strong SOC and study the role of migration, integration and general resistance resources (GRRs) in this process. We held 46 life-story interviews with women of Turkish, Moroccan and Surinamese descent. We divided the respondents in a relatively strong and weak SOC group in order to discern patterns of life experiences associated with SOC development. We find that, as Antonovsky predicted, experiencing consistency and load balance are associated with a strong SOC. In opposition to Antonovsky's claims, decision making power is not a necessary condition to develop meaningfulness. Moreover, the women's life narratives show that migration and integration are related to the mechanisms shaping SOC, yet, the impact is subjective and depends on the availability and use of GRRs. Our findings provide improvements to Antonovsky's salutogenic theory and provide suggestions for interventions aimed at strengthening SOC.

Are Generalized Resistance Resources (GRRs) associated with fear of movement level?

Are Generalized Resistance Resources (GRRs) associated with fear of movement level?

“Self-Employed” in Caregivinghood: The Contribution of Swedish Informal Caregivers’ Environmental and Contextual Resistance Resources and Deficits

Informal caregivers provide the majority of care for older adults residing in their own homes. Caregivinghood, a new evidence-based concept, describes a time of life when relatives provide care at home. These caregivers need knowledge regarding resources to help them resolve the challenges they encounter. The theoretical framework underpinning this study is Antonovsky’s salutogenic theory of health. This study had two aims: (1) to examine the salutogenic core concepts Generalized and Specific Resistance Resources and Deficits (GRRs/SRRs and GRDs/SRDs) described by Swedish informal caregivers as originating from the environmental and contextual domain of caregivinghood and (2) to discuss how this new knowledge might contribute to the development of health promotion initiatives. This qualitative and theory driven study used inductive and deductive data analysis. Data were gathered through salutogenically guided face-to-face interviews of 32 Swedish informal caregivers. In addition, the study relied on the salutogenic core concepts Specific and Generalized Resistance Resources and Deficits originating from their environment and context. Being in empowering surroundings reflects the presence of usable SRRs/GRRs, whereas Struggling in impeding surroundings reflects the presence of SRDs/GRDs. The results indicate that health-enhancing support has to be individualized (SRRs/SRDs) and generalized (GRRs/GRDs). This study’s salutogenic approach and the methodology enhance the understanding of the mechanisms behind the development of Sense of Coherence. The results contribute both empirically and theoretically to strengthen health promotion research and practice when developing activities and support for caregivers in stressful situations, such as informal caregiving.

Factors promoting sense of coherence among university students in urban areas of Japan: individual-level social capital, self-efficacy, and mental health.

Sense of coherence (SOC) is a concept that helps to explain the relation between personal intentionality as psychosocial factors and health-related behaviors. Thus, it is essential to enhance SOC when encouraging a healthy lifestyle. However, the factors that promote SOC have not been fully investigated among university students. The objective of this study was to clarify the general resistance resources (GRRs) that may promote the development of the SOC among university students. Therefore, we examined the relationship between SOC and social capital (SC), self-efficacy, and mental health. Participants included 443 students from nine academic departments at eight universities in the Kanto or Kinki metropolitan areas of Japan. Participants completed an anonymous questionnaire. Individual-level cognitive and structural SC, generalized self-efficacy, mental health inventory (from SF-36v2), and SOC were measured. Confirmatory factor analysis using structural equation modeling was conducted to verify the factor structure of the SOC-13 scale. Stepwise multiple regression analysis and two-way layout analysis of variance were performed with SOC as the dependent variable. The factor structure of SOC indicated the optimal model fit in the second-order three-factor model of the 12 items. SOC was predicted by five variables: age, cognitive SC, structural SC, mental health, and self-efficacy. For students from urban areas, SOC was predicted by the interaction between cognitive and structural SC. SOC was significantly related to cognitive SC, structural SC, and self-efficacy as well as mental health in university students from urban areas. Furthermore, the combination of higher-level cognitive SC and higher-level structural SC exerted an inhibitory influence on SOC among students who previously and currently live in urban areas. Therefore, the findings indicated that both cognitive and structural SC as well as self-efficacy may act as GRRs that promote the development of SOC, and similarly, good mental health may promote a strong SOC.

General Resistance Resources serving mental health promotion in a Hungarian town in 2012

Background A. Antonovsky’s salutogenic model has inspired several research streams all over the world. According to his basic idea, there are General Resistance Resources (GRRs), which comprise of biological, material and psychosocial factors enabling the person to reach Sense of Coherence, that is, a consistent, structured and understandable life, which in turn promotes health. Health status is widely researched in Hungary, health resources however did not get enough emphasis. Methods A structured assisted questionnaire interview was performed on …

Understanding cancer patients' reflections on good nursing care in light of Antonovsky's theory

PurposeData from an empirical study about cancer patients' perception of good caring are analysed in the light of Antonovsky's theory. The aim was to reflect on whether and how health personnel by giving good care, can function as vital resources at cancer patients disposal in activating their General Resistance Resources (GRRs) in a stressful life situation, and by that contribute to promotion and maintenance of their sense of coherence. Methods and sampleA hermeneutical approach was chosen for analysing the data. The informants were cancer patients in an oncology ward in a regional hospital in Norway. Twenty patients were interviewed, ten women and ten men. The patients had various cancer diagnoses at different stages and had different prognoses. Key findingsThe findings indicate that most of the patients succeeded in activating their GRRs in dealing with the stressor. Nurses, doctors, family and friends can be seen to function as vital resources at their disposal when needed. Most likely good caring supported the patient's promotion and maintenance of the components of meaningfulness, comprehensibility and manageability which form the concept sense of coherence (SOC). ConclusionHealth personnel can support the patients' meaningfulness by listening to the patients' stories about what still gives them meaning in life and their comprehensibility by giving good information. Alleviation of physical suffering may promote and maintain their manageability. Because all three components are intertwined, it is important to focus on all of them when caring for cancer patients.

Integrative review: salutogenesis and health in older people over 65 years old

To synthesize the evidence in published studies that used a salutogenic framework to explore the relationship between generalized resistance resources, a sense of coherence, health and the quality of life in people aged 65years and over. Since 1979, increasing interest has been shown in salutogenesis and the relationship of generalized resistance resources and a sense of coherence with health and quality of life. With populations ageing, it is important to explore how older people can advance in years successfully and continue to enjoy good health and an acceptable quality of life. Integrative review. CINAHL Plus with full text, JSTOR, PsycInfo, PubMed, SCOPUS, Sociological Abstracts and Web of Science were searched for studies published from 1979-2011. The integrative review adopted a five-stage approach - problem identification, literature search, data evaluation, data analysis and presentation. Eight studies - one qualitative and seven cross-sectional quantitative studies - from Western countries were included in the review. In general, a strong sense of coherence among older people was correlated with better physical, social and mental health. The use of generalized resistance resources, such as appraisal, coping strategies and social support, was correlated with their sense of coherence, perceived holistic health and quality of life. In communities, older people who have access to generalized resistance resources are more likely to have a strong sense of coherence, relatively good health and an acceptable quality of life. Further intervention studies should address how older people can develop and employ generalized resistance resources.

Wellbeing for homeless people: a Salutogenic approach

Homelessness affects considerable numbers in the UK and is caused by poverty and social exclusion. Much of the literature on housing and health is disease centric, where the experience of homelessness is described as traumatic, disempowering and socially isolating. Based on the Salutogenic approach, which calls for a positive orientation on health, the aim of this study was to explore the subjective lived experiences of wellbeing in the situated context of homeless people's lives. Nine in-depth qualitative interviews with temporarily housed adults (>25 years) in a socio-economically deprived region of North-west England were held. Accounts of renewed self-confidence, perceived resourcefulness and continual personal participation are said to be supporting wellbeing. A strong belief, or sense of coherence, in internal and external general resistance resources was a critical enabling factor for those living in temporary accommodation. Wellbeing was consistently linked with both social and formal activities; keeping occupied and having a strong sense of purpose were essential to wellbeing. In utilizing a Salutogenic approach we demonstrate how the 'context and meaning' of health actions can improve the understanding about the kinds of factors influencing wellbeing.