Salutogenic Health Indicator Research Articles

Health promoting resources and lifestyle factors among higher education students in healthcare and social work programmes: a survey with a longitudinal multicentre design

BackgroundIt has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work.MethodsThis longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions.ResultsThe survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems.ConclusionsStudents’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.

Occupational balance and associated factors among students during higher education within healthcare and social work in Sweden: a multicentre repeated cross-sectional study

ObjectiveThe aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work.DesignThe...

Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey.

To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession. A cross-sectional survey. Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests. Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Validity and reliability study of the Turkish version of the Salutogenic Health Indicator Scale.

The aim of this study was to assess the validity and reliability of the Salutogenic Health Indicator Scale (SHIS) among a sample of Turkish university students. This study was conducted with 291 university students. The SHIS was evaluated in terms of language equivalence, validity and the reliability. Content validity was assessed with the content validity index (CVI). Construct validity was determined by confirmatory factor analysis (CFA). A Cronbach's alpha reliability coefficient was used for the analysis of internal consistency, a Pearson's correlation coefficient was used for parallel form reliability, and the intraclass correlation coefficient (ICC) was used for the test-retest technique. The CVI of the SHIS was between 0.80 and 1.00. When the results of the CFA were examined, the factor loadings of all items were above 0.50. A statistically significant moderate positive correlation was found between the SHIS and the Sense of Coherence (SOC) scores for parallel form reliability (r = 0.489). Within the scope of the test-retest analysis, an ICC = 0.762 was determined (p < 0.001). The findings obtained from this validity and reliability study carried out on a sample of Turkish university students showed that the SHIS was both valid and reliable.

Care workers' positive health during the COVID-19 pandemic: Psychometric properties of the Finnish version of the Salutogenic Health Indicator Scale and an 18-month follow-up.

There is a need to shift from biomedical and pathogenic approaches to salutogenic approach. To validate the Finnish version of the SHIS by testing its psychometric properties in care workers and to assess the SHIS score over time. We first conducted a survey in 2020 (T1) and tested the psychometric properties of SHIS among care workers. We repeated the survey in spring 2022 (T2) among the same subjects. We analyzed the changes in SHIS, self-rated health (SRH), work ability (WAS), sickness absence and occupational calling between T1 and T2. Thereafter, we compared changes between health care sectors' and the other sectors' care workers. The results showed an increase in positive health measured with the SHIS and the occupational calling, a decrease in the SRH, and an increase in the number of sickness-related absences among all the care workers between T1 and T2. There was no change in their WAS. The health care workers had a lower SHIS than the other sectors' care workers in both T1 and T2, but the increase in their SHIS was parallel to that of the other workers. SHIS is a useful and reliable measure of positive health and can be used in studies when determining subjective health instead of, or in addition to, diagnoses. It was able to detect the health changes caused by the COVID-19 pandemic. SHIS is capable of capturing the underlying salutogenic approach of health promotive resources.

Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study

BackgroundEducational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.MethodsThis cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).ResultsOf 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.ConclusionsSwedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Evaluating the usability of two salutogenic instruments on health and work experience, using cognitive interviewing

Workplace surveys are used in workplace health promotion as a basis for improvements at the workplace. But there is lack of psychometrically and qualitatively validated work-health related instruments with a salutogenic approach. The purpose of this study was, therefore, to evaluate the two instruments, the Salutogenic Health Indicator Scale and the Work Experience Measurement Scale, among staff of different professions in a healthcare setting. These instruments were evaluated with cognitive interviews conducted at a hospital in Sweden. The respondents were purposefully selected from various criteria such as profession, age, and sex (N = 14). The respondents read the items aloud and then spoke about how they experienced the items. A deductive (partly inductive) content analysis was done from Tourangeau’s four concepts of respondent actions: comprehension, retrieval, judgment, and response. Two main categories emerged: (1) interpreting and (2) responding, and an additional six subcategories: difficulty, essence, direction, keywords, strategy, and alternatives. The results showed strengths and weaknesses of the instruments. The results were discussed from various validity aspects: face validity, content validity, and user validity. The validity aspects were connected to concepts of respondent actions as well as to questionnaire and respondent factors for motivation.

Workplace relationships impact self-rated health: A survey of Swedish municipal health care employees.

The impact of positive social relationships on the health of municipal employees in the elder care sector in Sweden needs further examination. To explore the association between health and relationships among elderly care employees using a salutogenic perspective. Survey of all employees (n = 997) in special housing, home care and Disabled Support and Services in a Swedish municipality. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, social climate, and health-promoting workplace relationships. The response rate was 69% . Results of a multivariable linear regression model showed four significant predictors of health: general work experiences, colleague belongingness and positive relationships with managers and care recipients. In another model, colleague belongingness was significantly related to satisfaction with care recipients, work, length of employment as well as general work experiences and relationships with managers. Strengthening of positive work relationships, not only between workmates but also with managers and care recipients, seems to be an essential area for employee health promotion. Colleague belongingness may be deepened by development of a positive work climate, including satisfactory work experiences, positive manager relationships and a stable work force.

Recovery, work-life balance and work experiences important to self-rated health: A questionnaire study on salutogenic work factors among Swedish primary health care employees.

BACKGROUND:There is a lack of information on positive work factors among health care workers.OBJECTIVE:To explore salutogenic work-related factors among primary health care employees.METHOD:Questionnaire to all employees (n = 599) from different professions in public and private primary health care centers in one health care district in Sweden. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, recovery, leadership, social climate, reflection and work-life balance.RESULTS:The response rate was 84%. A multivariable linear regression model, with SHIS as the dependent variable, showed three significant predictors. Recovery had the highest relationship to SHIS (β= 0.34), followed by experience of work-life balance (β= 0.25) and work experiences (β= 0.20). Increased experience of recovery during working hours related to higher self-rated health independent of recovery outside work.CONCLUSION:Individual experiences of work, work-life balance and, most importantly, recovery seem to be essential areas for health promotion. Recovery outside the workplace has been studied previously, but since recovery during work was shown to be of great importance in relation to higher self-rated health, more research is needed to explore different recovery strategies in the workplace.

Psychometric analysis of the Salutogenic Health Indicator Scale (SHIS) in adolescents.

The aim of this study was to test the psychometric properties of the Salutogenic Health Indicator Scale (SHIS) in an adolescent population. The investigation was performed among Swedish students aged 13-15 years ( n = 817; 58% girls). The SHIS was assessed for respondent acceptability, and its psychometric properties were evaluated according to classical test theory (regarding unidimensionality, targeting, reliability, and external construct validity). The adolescents found it easy to complete the questionnaire, which was completed in an average of 4 minutes. Exploratory factor analysis, which is based on polychoric correlations, identified one factor, supporting the instrument's unidimensionality. Floor/ceiling effects were ⩽ 3.3%. Reliability estimates yielded a Cronbach's alpha value of 0.93; the test-retest reliability ( n = 50; 2-week interval) coefficients were 0.89 for the total SHIS score and 0.52-0.79 for item scores. Spearman correlations with other variables were based on a priori expectations (self-rated general health, 0.595; depressive symptoms, -0.773; anxiety, -0.577; and sleep problems, 0.519). Our observations support both the acceptability and the psychometric properties of the SHIS as a brief, unidimensional assessment tool for salutogenic health in adolescents. Further studies using modern test theory are needed to better understand the measurement properties of the SHIS, including the functioning of its response categories and its comparability between adolescents and adults.

Workplace health in dental care - a salutogenic approach.

ObjectiveThe purpose was to explore self‐reported psychosocial health and work environments among different dental occupations and workplaces from a salutogenic perspective. A further purpose was to analyse possible associations between three salutogenic measurements: The Sense of Coherence questionnaire (SOC), the Salutogenic Health Indicator Scale (SHIS) and the Work Experience Measurement Scale (WEMS).MethodsEmployees in the Public Dental Service in a Swedish county council (n = 486) were invited to respond to a self‐reported web survey including demographics, work‐related factors, the SOC, the SHIS and the WEMS.ResultsThis study showed positive associations between employee characteristics and self‐reported overall psychosocial health as well as experienced work environment. Autonomy was reported more among men than women (P < 0.000) and to a higher degree by dentists and dental hygienists than dental nurses (P < 0.000). Meaningfulness, happiness, job satisfaction, autonomy and positive to reorganization were reported by personnels aged less than 40 years (P ≤ 0.047). Clinical coordinators reported significant better health (SOC, SHIS) and experienced more autonomy, better management and more positive to reorganization than other dental professions. Dental hygienists and nurses experienced less time pressure than dentists (P ≤ 0.007). Better health and positive work experiences were also seen in smaller clinics (P ≤ 0.29).ConclusionDental professionals reported a high degree of overall psychosocial health as well as a positive work experience. Some variations could be seen between employee characteristics such as gender, years in dental care, professionals, managing position and workplace size. Identify resources and processes at each workplace are important and should be included in the employee's/employers dialogue.

Psychosocial work experiences related to health: A study of Lithuanian hospital employees.

Research in the area of workplace health promotion from a salutogenic perspective is lacking in Eastern Europe. To evaluate the relationship between psychosocial work environment and health from a salutogenic perspective among Lithuanian hospital workers. Using a cross-sectional design a questionnaire was distributed to staff in a large hospital in Lithuania. Out of 811 employees, 714 completed the survey: 151 physicians, 449 nurses and 114 other staff members (e.g., psychologists, technicians, therapists). A response rate of 88.0% was achieved. The Work Experience Measurement Scale (WEMS) and the Salutogenic Health Indicator Scale (SHIS) were linguistically adapted and used for the first time in a Lithuanian context. Logistic and multiple linear regression models were used for the analyses. Supportive working conditions, positive internal work experiences and time experience contributed the most to good health, defined as a high SHIS index. Having an executive post was significantly related to good work experiences, i.e. a high WEMS score, while being at the age of 40-54 years was associated with a low WEMS score. Physicians had the highest score on supportive working conditions; while nurses had the lowest scores on autonomy. A salutogenic approach enables an organisation to identify how to improve working conditions for the employees by focusing on possibilities and resources. Individual activities for workplace health promotion among different work groups seem necessary.

Leader-Based Workplace Health Interventions — A Before–After Study in Norwegian and Swedish Small-Scale Enterprises

The purpose of this study is to contribute to knowledge about leader-based workplace health interventions by investigating changes in psychosocial working conditions and health in Norwegian and Swedish small-scale enterprises (SSEs). The study also aims to investigate whether there are differences between position, and countries. In total, 30 leaders and 149 coworkers in 34 SSEs participated in two intervention and two reference groups. Leaders and coworkers completed the validated questionnaires (Nordic Questionnaire on Positive Organizational Psychology ([N-POP]), Work Experience Measurement Scale (WEMS), and Salutogenic Health Indicator Scale (SHIS), which cover different psychosocial working conditions and health outcomes. The interventions were carried out by advisors from occupational health services (OHSs) over a one-year period and consisted of analyses of health and psychosocial working conditions, company visits, education and networking meetings, including information and tools on issues such as leadership, work environment and health, and leadership support. The statistical methods used included principal component analyses, reliability tests, paired samplettests and three-way ANOVA. The results indicate a significant positive development concerning external job performance in the intervention groups. Regarding internal job performance, both the Norwegian intervention group and the reference group showed positive improvements. However, there were negative or nonsignificant developments for several of the psychosocial working conditions and health outcomes in the intervention groups. With regard to associations and interactions between the studied variables, there were significantly positive developments with regard to external job performance and sickness absences in the total intervention group. The study indicates that more thorough procedures and testing of leader-based interventions in SSEs are required.

Work environment perceptions following relocation to open-plan offices: A twelve-month longitudinal study

A workplace's design can have various positive or negative effects on the employees and since the 1970s the advantages and disadvantages of open-plan offices have been discussed. The aim of this study was to investigate perceived health, work environment and self-estimated productivity one month before and at three, six and twelve months after relocation from individual offices to an open-plan office environment. Employees from three departments within the same company group and who worked with relatively similar tasks and who were planned to be relocated from private offices to open-plan offices were invited to participate. Questionnaires comprising items from The Salutogenic Health Indicator Scale, The Work Experience Measurement Scale, the questionnaire by Brennan et al. about perceived performance and one question from the Work Ability Index were sent to participants one month before relocation (baseline) to open-plan offices and then at three, six and twelve months after relocation. At baseline, 82 questionnaires were sent out. The response rate was 85%. At the follow-ups 77-79 questionnaires were sent out and the response-rate was 70%-81%. At follow-ups, perceived health, job satisfaction and performance had generally deteriorated. The results of the study indicate that employees' perception of health, work environment and performance decreased during a 12 month period following relocation from individual offices to open-plan offices.

Adaptation and Validation of a Positive Health Scale for Adolescents

There is a demonstrated need to develop alternative approaches to measuring health from a positive health perspective in order to support systematic planning and evaluation of health promotion in schools. The Salutogenic Health Indicator Scale (SHIS) aims to measure health from a positive perspective. However, it has not been developed, or previously been tested, for use with adolescents between the ages of 12 and 16, at which age youth often exhibit a need for extra support in order to be successful in school and life. Inspired by the SHIS, we generated a Positive Health Scale (PHS) appropriate for 12–16-year-olds and determined its validity and reliability using principal component analysis (PCA). In the study, the scale was tested in a sample of 1,527 Grade 6–9 students, using PCA. The findings indicated the need to reduce the scale to nine items, which was then shown to be valid and reliable for use with both adolescent boys and adolescent girls. We conclude that the PHS can be used in systematic health promotion planning and evaluation. Communities and schools can use this scale to examine and improve health determinants in different adolescent settings.

The Work Experience Measurement Scale (WEMS): A useful tool in workplace health promotion

To present validity data for the Work Experience Measurement Scale (WEMS), an instrument measuring multifaceted work experience from a salutogenic health resource perspective as a contrast to the more common pathogenic risk perspective, by exploring WEMS relationship to established measurements that are positively related to health and work. A salutogenic perspective focuses on finding conditions and resources in life, for example at work, that can enhance the individual's health and strength, instead of those causing illness and weakness. This study was carried out in 2009 at a Swedish hospital with a web-based survey (WEMS) to 770 employees. Different occupational groups at the hospital participated. Additional questionnaires used at the same time were the Utrecht Work Engagement Scale (UWES-9), the Salutogenic Health Indicator Scale (SHIS), the General Self-Efficacy scale (GSE), and three questions about self-rated health, general well-being, and quality of life. Cronbach's Alpha of WEMS sub-indices were in the interval of 0.85-0.96. Convergent validity and discriminant validity of WEMS and its sub-indices were shown to be satisfying by correlations. In addition, WEMS demonstrated the ability to discriminate between groups. WEMS sub-indices discriminated even better between groups than the total index. The WEMS proved to be a workplace health promotion questionnaire that was able to measure experiences of work from a salutogenic perspective. The WEMS has a potential of being a useful tool in workplace health promotion to enhance positive human capabilities and resources to improve work performance.

Work experience and school workers’ health evaluated by salutogenic health indicators

Background. The aim of the study was to establish relations between work experience and health, evaluated by salutogenic health indicators, among school workers. Materials and methods. Teachers (n = 180) and other school workers (n = 154) from randomly selected Panevėžys district schools were questioned using instruments developed by scientists of the Kristianstad University: the Work Experience Measurement Scale (WEMS) and Salutogenic Health Indicator Scale (SHIS). The questionnaire of personal data contained questions about sociodemographic and work-related characteristics. The differences among the mean values were tested by the independent samples t-test and one-way ANOVA. The Cronbach’s alpha coefficient was used to check the internal consistency. The significance level was accepted at p = 0.05. Results. In the teachers’ group, 86.7% were females (75.3% among others), 20.4% were older than 55 years (30.7% in other goups), 18.9% held an executive position (8.5% among others). Teachers, as compared with other school workers, scored higher the domain of internal work experience, (76.9 vs. 62.8, respectively), while other school workers gave higher standardized scores for the time experience domain (71.9 vs. 63.7, p &lt; 0.001 respectively). The SHIS scores among teachers varied from 54.7 (worst experience) to 78.0 (best experience), p &lt; 0.001. In the group of other school workers, the SHIS mean scores varied from 51.9 to 80.0, p &lt; 0.001. Conclusions. Teachers more positively evaluated the domain of internal working experience, while other school workers were more satisfied with time experience at the workplace. The established strong correlation between work experience and health, measured by salutogenic health indicators, encouraged the idea to implement workrelated health promotion at school. Keywords: work experience, health, school, salutogenic health indicators

Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS)

Current health measurement instruments tend to measure aspects of ill-health rather than health in general. There is a need for a salutogenic perspective when describing health and developing a health measurement instrument. The aim of this article is to present the development process and quality assessment of a salutogenic health indicator scale. A description of health, emanating from the concept of health, positive health and well-being, was used as a basis for the construction of the scale. The scale is a semantic differential consisting of 12 indicator items covering nine heath-related dimensions. A principal component analysis was performed, and three health indicator indexes were constructed. Correlation with self-rated health questions was investigated, weighted kappa values were calculated, and Cronbach's alpha (CA) was used to check internal consistency. The analysis resulted in a two-factor model, and the indexes were named intrapersonal characteristics (CA= 0.90) and interactive function (CA= 0.84), summarised into health complete (CA= 0.92). Kappa values ranged from 0.44 to 0.67, and correlations with self-rated health status were stronger than those with self-rated sick-leave. Our health description was characterized by complexity, but the instrument is a short salutogenic health indicator scale. The shortness increases the usability. The instrument seems to be able to offset the current problem of there being a lack of salutogenic health measurement instruments. The results indicate that further testing is justified.