Search

IntroductionThe maintenance of health is a central objective of public health initiatives. Within the salutogenic paradigm, health promotion is focused on understanding the mechanisms of health development. Models serve as indispensable tools. One of the leading paradigms in the health sciences is the Salutogenic Model developed by Aaron Antonovsky. However, it lacks sufficient specification to reflect the complexity of the environmental dimensions that have emerged from research in environmental health science. The interactions and impact pathways between these dimensions on health status are not adequately distinguished. The objective of this study is to address this gap by extending Antonovsky’s model to encompass environmental dimensions, that is, the interactions between humans and their environment. Furthermore, the study will integrate examples of models and theories from various disciplines to illustrate how a more comprehensive and holistic explanation of health development can be provided from an interdisciplinary environmental public health perspective.MethodologyAs part of a three-step approach, a Basic Model was first developed that integrates the five environmental dimensions—Natural, Built-Material, Socio-Cultural, Psycho-Social, and Individual—into the Salutogenic Model. Subsequently, narrative non-exhaustive literature research was used to identify interdisciplinary example models. The models were used to identify gaps in the Basic Model through a critical lens and to synthesize them into a more holistic model.ResultsThe synthesis of fifteen interdisciplinary models resulted in the development of an integrative Salutogenic Environmental Health Model (SEHM), which comprises twelve principal components of health development and their interactions and pathways. Links to the original models permit the user to refer back to them.DiscussionThis integrative approach offers a comprehensive understanding of the development of health by synthesizing disparate explanatory models and theories from various disciplines through theoretical analysis. The various environmental dimensions and the determinants of health contained therein, as well as their mental and physical processing and the associated components of health development and their interactions, are summarized in this new model. The SEHM thus enables a differentiated analysis of health determinants and serves as an operational framework for health promotion and pathways to well-being in contemporary research contexts.

Background: The sense of coherence (SOC) is reported to influence health, but health may also have an impact on SOC. The objective of this study was to examine the longitudinal associations between SOC and selected self-reported and physician-assessed health outcomes over a period of 10 and 20 years and to determine the predominant direction of the associations.Methods: We conducted a population-based, longitudinal study, involving 392 participants (188 females and 204 males; mean age 43.01 years) who were followed for a median of 10 and 18 years. Analyses of variance were carried out to examine the longitudinal associations between SOC at baseline and health outcomes (i.e., self-rated health status, SHS; physical health status assessed by a physician, PHS; self-reported satisfaction with life, SWL) at follow-ups. The direction of associations was examined using a cross-lagged model on correlation coefficients.Results: There were significant group effects for SOC at baseline on SHS at 20-year follow-up (F = 4.09, p = 0.018, ηp2 = 0.041), as well as on SWL at 10-year (F = 12.67, p < 0.01, ηp2 = 0.072) and at 20-year follow-up (F = 8.09, p < 0.1, ηp2 = 0.069). SHS (r = 0.238, p < 0.01), PHS (r = −0.140, p < 0.05) and SWL (r = 0.400, p < 0.01) predicted SOC at 10-year follow-up stronger than vice versa. The direction of associations between SOC and health parameters at 20-year follow-up was less consistent.Conclusions: The long-term associations between SOC and self-reported and physician-assessed health may be reciprocal in community-dwelling adults. More research is needed to examine the predictive power of health on SOC and whether interventions targeted at improving health parameters, may impact SOC.

Sammendrag Bakgrunn: Det er sterke helsepolitiske føringer for at personer med demens skal bo hjemme så lenge som mulig, og det forventes at pårørende skal bidra i omsorgsarbeidet. Pårørendeskolen skal bidra til læring og mestring hos pårørende. Metode: Studien er basert på kvalitative intervju med 16 pårørende som hadde deltatt på pårørendeskoler i nordnorske kommuner i perioden 2010–2017. Intervjuene ble analysert ved hjelp av stegvis-deduktiv induktiv metode i lys av Antonovskys begrep om «opplevelse av sammenheng». Resultater: Deltakerne i studien uttrykte i all hovedsak positive erfaringer med pårørendeskolen, og tilbudet bidro til å gjøre pårørendes livssituasjon mer begripelig, håndterbar og meningsfull. Deltakerne pekte også på utfordringer relatert til temaene organisering og styring, åpenhet og utlevering, at kunnskap kunne oppleves både godt og vondt, udekte tematikker, og behov for videre oppfølging. Konklusjon: Studien tyder på at pårørendeskolen kan bidra til å gjøre pårørendes livssituasjon mer begripelig og håndterbar, og til mer åpenhet rundt demenssykdom. Tilbudet kan imidlertid ikke erstatte individuell og langvarig oppfølging av familier der en person har demenssykdom.

Stroke patients' well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur's interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants' awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment. [ABSTRACT FROM AUTHOR]

Background: For cardiac surgery patients who were employed prior to surgery, the return to their professional life is of special importance. In addition to medical reasons, such as pre-existing conditions, the success of the operation or postoperative course and patient-intrinsic reasons, which can be assessed with the Sense of Coherence (SOC) scale by Antonovsky, may also play a role in the question of a possible return into working life.Methods: In this study 278 patients (invasive coronary artery bypass graft surgery and/or surgery on heart valves, age < 60 years, employed) were questioned postoperatively via post with the SOC questionnaire. The SOC questionnaire was used in addition to questions about return to work. The cohort was stratified according to the time of return to work. Subsequently, the point of maximum sensitivity and specificity was determined for the total SOC score and the prediction power was considered.Results: Of the 278 patients, 61 questionnaires (22%) were considered as eligible and included in the analysis. Of these, 47 participants had returned to work after undergoing cardiac surgery and 14 participants had not. We observed significant differences in SOC values between both groups (146.07 ± 29.76 versus 124.29 ± 28.8, p = 0.020). Patients that returned to work within the first 6 months after surgery showed even higher SOC scores (148.56 ± 28.98, p = 0.034).Conclusion: Patients with an SOC score < 130 are at greater risk not to return to their professional life after cardiac surgery. The SOC is an easily obtainable score that reliably predicts the probability of return to work after cardiac surgery. [ABSTRACT FROM AUTHOR]

The project manager's team role and sense of coherence can significantly influence the project role. A pilot study was conducted by a web survey; 35 IT project managers from Swedish public authorities participated. Questionaries' from Belbin's and Antonovsky's books was used for the web survey. Research findings showed that Belbin's team role shaper was the strongest and implementer was the second strongest. Twelve of the respondents had a strong sense of coherence, 21 had normal, and two had weak. [ABSTRACT FROM AUTHOR]

The literature suggests that, despite some challenges in their implementation, player/athlete-centred, inquiry-based approaches to teaching games and coaching team sport can improve game playing ability, increase player/athlete motivation and provide positive affective experiences of learning. A range of these approaches, including Teaching Games for Understanding, Game Sense, Play Practice and the Tactical-Decision Learning Model vary in detail but share enough in common to be referred as game-based or game-centred approaches. This includes the central role that dialogue, reflection and purposeful social interaction play in facilitating learning and the deep understanding that they can promote. While these approaches are widely referred to as instructional models for teaching and coaching consideration of the common pedagogical features they share offers an alternative conception that creates possibilities for promoting the same positive learning outcomes in sports beyond team games. In this article, we examine the concept of Positive Pedagogy as an extension of Game Sense pedagogy beyond games and team sports to explore what it has to offer coaching across a range of sports. [ABSTRACT FROM PUBLISHER]

Background: in Western countries, caesarean section rates are increasing at an alarming rate. This trend has implications for women's health and calls into question the use of pathogenesis to frame maternity services. The theory of salutogenesis offers an alternative as it focuses on health rather than illness. Sense of coherence (SOC), the cornerstone of salutogenesis, is a predictive indicator of health. This study aimed to explore associations between pregnant women's SOC, their birthing outcomes and factors associated with SOC changes. Methods: a longitudinal survey was conducted where women completed a questionnaire in the antenatal and postnatal period. Questionnaire one provided information on SOC scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Questionnaire two provided information on SOC scores, EPDS scores and birthing outcomes. Findings: 1074 women completed questionnaire one and 753 women completed questionnaire two. Compared to women with low antenatal SOC, women with high antenatal SOC were less likely to experience caesarean section (OR 0.437 95% CI 0.209-0.915) and more likely to experience assisted vaginal birth (AVB) (OR 3.108 95% CI 1.557-6.203). Higher birth satisfaction, higher antenatal EPDS scores and lower antenatal SOC were associated with an increase in SOC. Epidural, AVB and decreased birth satisfaction were associated with a decrease in SOC. Conclusion: high sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with low sense of coherence. Women's sense of coherence is raised and lowered by degree of satisfaction with their births and lowered by some labour interventions. [ABSTRACT FROM AUTHOR]

Background: as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman's SOC and the childbirth choices she makes in pregnancy. Methods: the study aims to investigate the relationship between SOC and women's pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Findings: 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women's pregnancy choices. Conclusion: this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women's birthing outcomes. [ABSTRACT FROM AUTHOR]

Antonovsky’s Orientation to Life questionnaires were developed to measure sense of coherence (SOC). Although the SOC 13 instrument is widely used to measure health in general populations, it has not been assessed in pregnant women. If the SOC 13 is to be used to assess women’s childbearing health, it requires further examination. The purpose of the research is to assess the psychometric properties of Antonovsky’s SOC 13 questionnaire in pregnant women. When administered to 718 pregnant Australian women, the construct validity of the SOC 13 was difficult to establish. The SOC 9 was created by removing 4 items and provided best data fit. The SOC 13 and SOC 9 were found to have sound criterion validity, internal reliability, and equivalence between versions. It is hoped that the present study will stimulate additional research on SOC scales to examine their ability to assess women’s childbearing health. [ABSTRACT FROM PUBLISHER]

A vital part of many teenagers' lives is participation in club sports. Despite this, many adolescents drop out of club sports. Since physical inactivity is increasing among young people, this is of great political concern. One aim of this study is to explore why young people in their late teens continue to participate in organized club sports. Another aim is to examine the perceived levels and intensity of physical activity among participants and non-participants (n = 377). The results show that primary reasons to continue participating in club sports are having fun and the sense of enjoyment, the sense of belonging, and the sense of improving sport skills. Of lesser importance, however, is the desire to compete. A large amount of club sports participants (74%) report that they are regularly physically active in an intense form of exercise compared to a significantly smaller amount (12%) of non-participants. The findings are discussed in relation to Aaron Antonovsky's salutogenic approach and his concepts of sense of coherence (SOC). [ABSTRACT FROM AUTHOR]

Aaron Antonovsky wrote extensively, although disjointedly, about the roles of culture in salutogenesis. This paper provides a synopsis of his work in this arena. A literature review identified those of his English language writings in which culture was a subject, and relevant text segments were analysed using an inductive followed by a deductive method. Using thematic network analysis, text segments were sorted inductively by open coding and then analysed. This was followed by deductive text segment coding guided by the constructs of the salutogenic model of health. The analysis revealed that Antonovsky had an expansive interest in the roles of culture in salutogenesis. His writings included attention to the role of culture in: (a) shaping life situations; (b) giving rise to stressors and resources; (c) contributing to life experiences of predictability, load balance and meaningful roles; (d) facilitating the development of the sense of coherence and (e) shaping perceptions of health and well-being. Antonovsky’s writings about culture were sometimes conjectural, as well as being obviously influenced by his life experience in the USA and then in Israel, and by the spirit of the times in which he lived. However, he also drew extensively on his own and others’ empiricism, leading him to view culture as an integral aspect of the salutogenic model of health. The present analysis provides salutogenesis scholars with a roadmap of Antonovsky’s reflections, ponderings and conclusions about culture in the context of salutogenesis. It provides assistance in the form of an overview of Antonovsky’s treatment of culture in the context of salutogenesis. [ABSTRACT FROM PUBLISHER]

Objectives: Antonovsky's salugenetic model focuses on factors that promote health and well-being. The objectives of this paper were to review the existing research literature related to Antonovsky's Sense of Coherence Scale (SOC) and establish implications for psychiatric and mental health nurses. Methods: Electronic databases were searched with selected studies compared for sample, sample size, study designs and basic results. Cross-sectional studies were reviewed for correlations between personality traits, stress, burnout, disease-scales, job satisfaction and the SOC scale, with Intervention studies used to establish the impact of training on the SOC. Results: The review discovered serious methodological difficulties, including interpretations of Antonovsky's philosophical values and the apparent use of the SOC scales as a measure of disease absence. Conclusion: The review was able to draw important conclusions for psychiatric and mental health nurses (PMHNs) related to stress, burnout, dealing with psychiatric emergencies and the selection of new recruits to the profession. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Data 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 sample: A 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 findings: The 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). Conclusion: Health 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. [Copyright &y& Elsevier]

Objectives:The present study investigated the relationship between Antonovsky's sense of coherence (SOC) and well-being in a sample of Flemish elderly. In addition, the mediating role of Erikson's developmental task of integrity versus despair was examined in the relationship between SOC, depression, and life satisfaction. Method:Data on sociodemographic variables, SOC, depressive symptoms, life satisfaction, ego-integrity, and despair were collected. In total, 100 older persons with a mean age of 76.5 years participated. Mplus was used to test the mediating role of integrity and despair in the relationship between SOC and both life satisfaction and depression. Results:A positive relationship between SOC and well-being was found. More precisely, elderly individuals with a strong SOC experienced less depressive symptoms and higher levels of satisfaction with their life. In addition, mediation analysis indicated that the relationship between SOC and depressive symptoms was partially mediated by the positive resolution of the integrity–despair crisis, whereas the relationship between SOC and life satisfaction was fully mediated by integrity and despair. Conclusion:Our findings indicate that SOC might be a resource for greater well-being in the elderly. Furthermore, our study offers a partial explanation for the relations found and points to the importance of finding integrity and resolving despair in this stage of life. [ABSTRACT FROM PUBLISHER]

Background: Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. Discussion: In this paper we present a new perspective to neonatal care based on Aaron Antonovksy's Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. Summary: Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned. [ABSTRACT FROM AUTHOR]

The internet has democratised access to health and diagnostic information, enabling patients to mobilise social support from peers and advocate their interests in encounters with medical personnel. Research has shown that these possibilities are particularly important for patients and caregivers confronting a rare medical condition. However, little research has focused on how the act of searching for and accumulating information via the internet can be important for coping emotionally with a situation characterised by uncertain prospects and inadequate information from health personnel. This paper explores the experiences of 10 Norwegian parents whose children have different rare genetic disorders and who used the internet as a resource. The analysis draws on the theoretical framework of the medical sociologist Aaron Antonovsky, who emphasises people's inherent ability to manage extremely stressful life experiences. Analysing the process of adjusting to and coping with life parenting a child suffering from a rare genetic disorder, this study shows that becoming knowledgeable about a child's condition is essential for gradually comprehending and managing a situation that initially seems unmanageable and distressful. It also suggests that as parents adjust, so do the frequency and purpose of their internet searches. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the experiences of men caring for spouses suffering from dementia from a salutogenic perspective. The study focused on the experiences of ten men caring for a spouse with dementia. Primarily qualitative analysing methods were utilized. Data were obtained from semi-structured interviews conducted with male spouses of patients with dementia. An orientational analysis approach was followed and the data was analysed in terms of Antonovsky's sense of coherence construct. Qualitative findings were compared to participant responses to quantitative measures. Stressors most often reported were cognitive impairment, behaviour problems, a lack of free-time, erosion of the relationship, family conflict and financial concerns. Factors facilitating caregiver coping included support from their daughters, their ability to find meaning and satisfaction within the context of the care-giving task, and the successful utilization of active, problem-focused coping strategies. Men generally appear to be effective and capable caregivers. However, their approach to care giving differs from that of their female peers. Task-oriented problem-solving, effective use of the available support resources and the ability to find both meaning and satisfaction in their caring appear characteristic of effective male caregivers of demented spouses. [ABSTRACT FROM AUTHOR]

Twenty years have passed since the philosophy and principals were formulated in the Ottawa Charter for health promotion. A critical reflection of the content and success of the Ottawa Charter was published before the IUHPE World Conference in Vancover in June 2007. This paper contextualizes and discusses Salutogenesis and Antonovsky in the development of health promotion practice and research and, further, relates the salutogenic concept Sense of Coherence (SOC) to the Ottawa Charter. An overview of the development of health pro- motion and the salutogenic theory of health is presented. In addition, this is illustrated in a new way using the metaphors of 'health in the river of life' and 'SOC in a life course perspective'. Health promotion, including the Ottawa charter, lacks a clear theoretical foundation. The results of a systematic review of salutogenic research are used to demonstrate how the salutogenic framework could support the philosophical and practical intentions of the OC. The salutogenic model contributes to the maintenance and development of health and quality of life (QoL), i.e. the process and outcome of the principles of the OC. The metaphor of the river and the life cycle are new ways of demonstrating the paradigm shift provided by the Salutogenesis and health promotion in relation to public health and medicine. The salutogenic theory is an important contribution to the theory base of health promotion research and practice. [ABSTRACT FROM AUTHOR]

The article examines various literature for evaluation studies that might fulfill the criteria of evidence-based medicine (EBM) in the specialism of supported education for people with long-term mental health needs. It aims to justify the efficacy of these initiatives and attracting the associated funding. The methodologies for the study were first examined for appropriateness to the initiative and to what extent it complied with EBM. The study found literature with few examples of programme evaluations that met EBM criteria.

The paper assesses the validity of Antonovsky's (1996) assertion that health promotion should use the salutogenic model of health to guide practice, by drawing on the results of an evaluation of a supported further education programme for people with long-term mental health needs. Three consecutive cohorts of further education (FE) students with a long-term mental health diagnosis were assessed before and after participation, using Antonovsky's (1987) short form Sense of Coherence questionnaire (SOC-13). Students with SOC13 scores 52 and above at entry showed no significant change. However, students with entry SOC13 scores below 52 made statistically significant positive gains in their exit scores. A causation model was developed from qualitative evidence from students' accounts of participation in the programme. The results of short questionnaires provided numerical data for building a model of the relationships between the themes and SOC13 scores. The model suggests that peer support is an important factor in the success of the programme and that the activity of learning reduced symptoms and raised positive affect. The results of this study support the value of Antonovsky's salutogenic health perspective for mental health promotion staff and allied professionals, and highlight the need for mental health professionals to pay attention to the pathogenic and salutogenic paradigms for understanding the health needs of people with long-term mental health needs. [ABSTRACT FROM AUTHOR]

More than 20 years have passed since the American-Israeli medical sociologist Aaron Antonovsky introduced his salutogenic theory 'sense of coherence' as a global orientation to view the world, claiming that the way people view their life has a positive influence on their health. Sense of coherence explains why people in stressful situations stay well and even are able to improve their health. The origin of salutogenesis derives from the interviews of Israeli women with experiences from the concentration camps of the Second World War who in spite of this stayed healthy. Sixty years after the Holocaust this paper aim to shed light on the salutogenic theory in the context of public health and health promotion. In addition, other approaches with salutogenic elements for the explanation of health are considered. A potential direction for public health of the early 21st century is proposed. The historical paradox is to honour the victims of the Holocaust and see the birth of post-modern public health and the salutogenic framework through the experience of its survivors in the ashes of Modernity. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2005; 19; 280–287 The structure of Antonovsky's sense of coherence in patients with schizophrenia and its relationship to psychopathology The main aim of the study was to investigate whether the three hypothesized subscales of Antonovsky's sense of coherence (SOC) scale: comprehensibility, meaningfulness and manageability, can be found when measuring SOC in a sample of patients with schizophrenia living in the community. A further aim was to study the relationship between SOC and psychopathology. The concept of SOC has been proposed to explain successful coping with life stressors. A total of 120 patients completed the SOC scale and the Brief Psychiatric Rating Scale (BPRS) was used to assess the psychopathology of the patients. The SOC scale was analysed by means of a factor analysis with a varimax rotation and the Spearman rank correlation test was used to test for associations between subscales, factors and psychiatric symptoms. A four-factor model presented the best solution and explained 48% of the total variation in SOC. The first factor, which included 12-items of the SOC scale, turned out to be the most salient factor explaining 29% of the total variation. All factors displayed some overlapping between items. Affective symptoms were negatively related to all the three subscales and the four factors of SOC, while positive symptoms were similarly related to two of the subscales and two of the factors while negative symptoms were not associated with any of the factors or subscales. The findings in this study corroborate those in studies with other patient groups and indicate that the theoretical framework of SOC should not be adopted uncritically. Furthermore, the use of the three subscales in the SOC scale in studies of patients with a severe mental illness is questioned and a further investigation of the relationship between SOC and psychopathology is proposed. [ABSTRACT FROM AUTHOR]

Development of a theoretical framework describing relatives’ involvement in palliative care Background. The present study is based on four earlier studies in which the authors classified the relative’s involvement in palliative care into different categories and described the involvement as ‘involvement in the light’ or ‘involvement in the dark’. Aim. The aim of the study was to develop a theoretical framework concerning the involvement of relatives based on an in-depth analysis of the results of the four earlier studies. Method. Walker & Avant’s (1995) strategies for theory construction were used for development of the framework. A number of different concepts, assumptions and statements about relatives’ involvement were penetrated in an in-depth analysis. Results. From the concepts two theoretical ‘blocks’ of the relatives’ involvement were developed and these constitute the foundation for the framework. One is based on concrete descriptions of the concepts ‘to know’, ‘to be’ and ‘to do’. The other describes how the concepts of ‘involvement in the light’ and ‘involvement in the dark’ differ. Factors that promoted involvement in the light were professional care based on humanistic values, a stronger sense of coherence on the part of relatives, an appropriate illness trajectory, and other available resources. The opposite was the case for those who were involved in the dark. Five assumptions successively developed which together form the theoretical framework. Conclusions. An important conclusion that can be of importance in palliative care is that the manner in which the staff act toward the patient and relatives influence relatives’ possibilities for involvement, patients’ possibilities for an appropriate death, and the possibilities the staff have to give good care. [ABSTRACT FROM AUTHOR]