Monica Eriksson and Bengt Lindstrm

1
Adopting a salutogenic approach - does it make
any change?

• Monica Eriksson and Bengt Lindström
• Folkhälsan Research Centre
• Health Promotion Programme
• Helsinki Finland

2
Objective

• To provide a more comprehensive and deeper
  understanding of the SOC concept
• To clarify the contribution of the SOC concept to
  the development and maintenance of health,
  quality of life and wellbeing

3
Background

• Systematic review on the SOC concept
• Material and procedure
• 458 scientific papers
• 13 doctoral thesis
• review protocols
• Time period 1992 2003

4
The Salutogenic concept
Sense of Coherence a global orientation, a view
of life

• Comprehensibility
• Manageability
• Meaningfulness
• General Resistance Resources

Antonovsky 1979, 1987
1923-1994
5
Criterias for inclusion exclusion
In
Out

• Scientific papers using some version of the
  LOQ-SOC
• Post graduate papers and doctoral thesis
• Quantitative, qualitative and intervention
  studies
• Papers published in English, Finnish, Danish,
  Swedish and Norwegian
• Studies with a careful description of the
  translation process of the SOC scale to other
  languages than English
• Studies with an acceptable validity and
  reliability
• Papers published in 1992-2003

• Papers without references to Antonovskys concept
  (primary or secondary references)
• Studies not using Antonovskys SOC scale for
  measuring coherence
• Papers published in other languages than the
  above mentioned
• Double published papers
• Papers with weakness in power
• Papers with insufficient validity of the SOC
  scale
• Papers on master level or lower

6
Method

• Research synthesis which summarizes, analyses and
  presents the state of knowledge
• An extensive summary of statistical data in
  tables (52 pages)
• Cross-sectional and longitudinal studies are
  analysed separately and so are quantitative and
  qualitative studies
• Effect sizes are considered as follows (Cohen J
  1988)
• r 0.10 small r 0.30 medium
  r gt0.50 large
• The interpretations and conclusions regarding
  validity, health, qol/wellbeing are based on
  studies using multivariate methods for the
  analysis and controlling for potential
  confounders
  

7
SOC-scale Validity Reliability

• The SOC scale seems to be a reliable, valid and
  cross culturally applicable instrument for
  measuring health (face, construct, criterion,
  predictive, responsiveness, consensual)
• Internal consistency for SOC-29 range 0.70-0.95
  (124 studies) and for SOC-13 0.70-0.92 (127
  studies)
• Mean SOC (29 items) range 100.5 (SD 28.5) 164.5
  (SD 17.1) points and (13 items) 35.4 (SD 0.1)
  77.6 (SD 13.8) points.
• Test-retest correlation range from 0.69 (1 year)
  to 0.54 (10 years)

8
Salutogenesis makes change Results

• The SOC scale has been used in 32 countries in 33
  different languages in different cultures on
  people in different ages, professions, patients
  and general population
• The SOC seems to have a main, moderating and
  mediating effect on health independent of age,
  gender, ethnicity and nationality
• The SOC seems to be a health resource promoting
  capacity and competence to cope with stress
• A strong SOC contributes to the development of a
  positive subjective state of health - especially
  mental health, quality of life and wellbeing
• The structure of the scale seems to be
  multi-dimensional rather than uni-dimensional
• The SOC seems to be relatively stable over time
  but not as stable as Antonovsky initially
  assumed.

9
Criticism of the theory
The evidence shows.
Criticised from the point of view...

• No evidence that SOC is stable over the adult
  life course. (Geyer 1997)
• What does it measure? Trait or state?
• (Schnyder 2000)
• Only a few have considered the SOC concept to be
  worth examining and those are mostly members of
  Antonovskys own research groups in Israel and
  Sweden. (Bengel et.al 1999)
• A critic on a psychometric point of view.
  (Larsson and Kallenberg 1999)

• SOC seems to relatively stable but not as stable
  as Antonovsky assumed. SOC seems to increase with
  age. The oldest people report the highest SOC.
  (Eriksson and Lindström 2005)
• It measures a global orientation or view of life.
  Strongly related to factors measuring mental
  health. (Eriksson and Lindström 2005)
• The SOC instrument has been used in at least 32
  countries in 33 languages in different cultures
  on more than 200 000 persons in different ages.
  (Eriksson and Lindström 2005, 2006)
• The critic is justified. The SOC construct seems
  to be multi-dimensional rather than
  uni-dimensional. (Eriksson and Lindström 2005)

10
Implementation in practice

• Building capacity and coherence on individual,
  group and societal level by strengthening the
  General Resistance Resources
• Building Healthy Public Policy
• Using the concept in treatment and intervention
  on an individual level
• Internalizing the salutogenic perspective in
  ourselves this has an effect on our thinking,
  being and acting as individuals, professionals,
  researchers

11
Thank you for your attention!
Monica Eriksson, Researcher monica.eriksson_at_folkha
lsan.fi Bengt Lindström, Research Director,
Professor bengt.lindstrom_at_folkhalsan.fi