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Se propone un “modelo sinérgico” para avanzar en la integración de elementos clave de la salutogénesis y el modelo de activos para la salud, utilizando como marco para esta articulación la teoría bioecológica de Bronfenbrenner. El sentido de coherencia es clave para facilitar la transformación de recursos potenciales en activos disponibles, produciendo un desarrollo positivo de la salud. El modelo sinérgico puede aportar a la contextualización de las ideas en políticas y prácticas de salud pública, fortaleciendo la dimensión salud-bienestar y contribuyendo al desarrollo de modelos de salud más integrados y colectivos. more...

Salutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community.This study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application.A qualitative study using framework analysis.A tertiary institution in Singapore.Nursing students who were taught the salutogenic theory for 'Healthy Community Living' module.Data were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework.Four themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited.Much work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community. more...

This chapter presents and discusses theoretical considerations and empirical findings regarding the concepts generalized resistance resources (GRRs) and generalized resistance deficits (GRDs). Recent research findings are presented, showing how these resources or deficits impact sense of coherence (SOC). Suggestions for future research directions (e.g., individuals’ differential susceptibility to environmental effects and eudaimonia/hedonia perspectives) and interventional implications are presented. more...

Part II starts with a description of the theoretical framework of the salutogenic model of health, with special focus on the key concepts and reflection on the ontological and epistemological background of the health model, which so far is little explored and described (Chap. 10.1007/978-3-030-79515-3_9). In Chap. 10.1007/978-3-030-79515-3_10, the focus is on how the sense of coherence (SOC) influences stressor appraisal, positively as well as negatively. In Chap. 10.1007/978-3-030-79515-3_11, measurement issues are addressed concerning Aaron Antonovsky’s original SOC questionnaires of 29 items and of 13 items, as well as several modified translations applicable at the individual, the family, the organization, and the community levels. Chapter 10.1007/978-3-030-79515-3_12 presents and discusses theoretical considerations and empirical findings regarding the concepts: generalized resistance resources (GRRs) and generalized resistance deficits (GRDs). Part II closes with a discussion of the conceptual and concrete differences between generalized and specific resistance resources in the salutogenic model of health (Chap. 10.1007/978-3-030-79515-3_13). more...

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one’s movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky’s original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal’s work to strengthen salutogenesis as a theory base for health promotion. more...

Currently, the world faces a shift to an older population. For the first time in the history, now most people can expect to live into their 60s and beyond. Within this trend of people living longer, many grow very old; 80, 90 and 100 years. Today, 125 million people are 80 years or older; the proportion of ≥80 years increases the most. Age is not an illness, still most chronically ill are older people. Consequently, all countries in the world face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift. Globally, finding new and effective ways to improve people’s health is crucial. Thus, in the years to come, health promotive initiatives will become ever more important. Accordingly, learning how to reorient the health care sector in a health promotion direction is highly needed. The salutogenic approach seems useful for such a reorientation.Salutogenesis is a resource-oriented theoretical approach which focuses on the origin of health along with people’s abilities and capacities for well-functioning and well-being. Salutogenesis is an area of knowledge and learning, a way of relating to others, and a way of working in a health-promoting manner. From the salutogenic point of view, health is a movement on a continuum between ease and dis-ease. In this approach, no one is categorized as healthy or diseased; we are all somewhere between the imaginary poles of total wellness and total illness.This chapter, as well as this book, comprehend the salutogenic health theory as a model of health and a life orientation, representing a vital theoretical basis for the health promotion field. Accordingly, this chapter presents some important points in the development of the health promotion field, followed by the core principles and strategies of health promotion and the promising potential of the salutogenic health theory. more...

This chapter focuses on mental health promotion with a salutogenic understanding of mental health as an individual’s subjective well-being encompassing both feelings and functioning. Mental health is an ever-present aspect of life, relevant for everybody; thus, to promote mental health is a universal ambition. Our chapter is written with adults with mental illness in need of mental health nursing in mind. To understand the present and make suggestions for the future, knowledge of the past is needed. We elaborate on historical trends of nursing, nursing models, and the hospital setting to support our statement; persons with mental illness need a more complete mental health nursing care, including salutogenic mental health promotion. In the last part of the chapter, we introduce the salutogenic-oriented mental health nursing, and further showing how salutogenesis can be integrated in nursing care for persons with mental illness. As well as elaborating on the features of salutogenic-oriented mental health nursing, and briefly present the Act-Belong-Commit framework for mental health promotion as an example of salutogenesis in nursing practice. more...

Background The theory of salutogenesis focuses on resources for health and health-promoting processes. In the context of midwives’ work, this is not well described despite the importance for occupational health and the intention to remain in the profession. In order to promote a healthy workplace, it is necessary to consider the facilitating conditions that contribute to a sustainable working life. Therefore, the aim of this study was to explore health-promoting facilitative conditions in the work situation on labour wards according to midwives. Methods A constant comparative analysis was applied to face-to-face interviews with midwives that constituted the empirical material in this classical grounded theory study. Results The substantive theory of Professional courage to create a pathway within midwives’ fields of work emerged as an explanation of the health-promoting facilitative conditions in midwives’ work situation. The theory consists of a four-stage process with prerequisite contextual conditions: visualising midwifery, organisational resources and a reflective and learning environment, that were needed to fulfil the midwives’ main concern a Feasibility of working as a midwife. This meant being able to work according to best-known midwifery theory and practice in each situation. Positive consequences of a fulfilled main concern were a professional identity and grounded knowledge that enabled the development of the resistant resource professional courage. The courage made it feasible for midwives to move freely on their pathway within the different fields of work extending between normal and medicalised birth and being autonomous and regulated. Conclusions A professional courage was required to create a pathway within midwives’ fields of work, to move freely depending on what actions were needed in a particular work situation. Professional courage could be seen as a resistance resource, enabling midwives to become resilient when dealing with the unpredictable work situation. However, there are vital organisational preconditions that needed to be fulfilled for workplaces to become facilitative, organisational resources, visualising midwifery and a reflective environment. The theory can be used to foster health-promoting and sustainable work situations for midwives, which is possible if the organisational preconditions are met. This could be a key factor in retaining midwives in the profession. more...

The Covid-19 pandemic has demonstrated the vulnerability of our health care systems as well as our societies. During the year of 2020, we have witnessed how whole societies globally have been in a turbulent state of transformation finding strategies to manage the difficulties caused by the pandemic. At first glance, the health promotion perspective might seem far away from handling the serious impacts caused by the Covid-19 pandemic. However, as health promotion is about enabling people to increase control over their health and its determinants, paradoxically health promotion seems to be ever more important in times of crisis and pandemics. Probably, in the future, pandemics will be a part of the global picture along with the non-communicable diseases. These facts strongly demand the health care services to reorient in a health promoting direction.The IUHPE Global Working Group on Salutogenesis suggests that health promotion competencies along with a reorientation of professional leadership towards salutogenesis, empowerment and participation are required. More specifically, the IUHPE Group recommends that the overall salutogenic model of health and the concept of SOC should be further advanced and applied beyond the health sector, followed by the design of salutogenic interventions and change processes in complex systems. more...

This article proposes to advance the connections between salutogenic theory and assets models for health improvement. There is a need to integrate their use in public health and health promotion so that their respective potentials can be fully developed. This requires their synergies to be made more explicit so that a more coherent approach can be taken to their utilization. A mechanism is therefore needed that helps to raise awareness of them and their value as a resource together. Bronfenbrenner’s bioecological theory provides one framework that can support better integration of salutogenesis with the applied nature of assets-based models. This paper proposes a new ‘synergy model for health’ that integrates key concepts associated with salutogenic theory—generalized and specific resistance resources (GRRs/SRRs) and generalized and specific resistance deficits and the sense of coherence (SOC). In doing so, it highlights those GRRs and SRRs which are assets that, either individually or collectively, help to develop a stronger SOC. Higher levels of SOC can then support the transformations of potential resources into available assets (that people can understand, manage and make sense of), capable of producing positive health development. The proposed ‘Synergy model of health’ aims to contribute to a deeper theoretical understanding of health and development through the integration of the key elements of both salutogenesis and assets models. This can facilitate a better contextualization of the ideas into public health policy and practice by making the salutogenic theory more action-oriented and the assets model more theoretical. This paper is supported by the Vice-Rectory for Research and Development, University of Concepción (VRID 217.089.007-1.0IN). more...

Background: There is extensive research on how nurses experience their working conditions and environment; this research shows high job stress, job dissatisfaction and intention to leave the workplace. Objective: To explore and describe success factors explaining why hospital nurses remain in work and the profession. Methods: The salutogenic theory was used as a basis for the interview guide, which contained semi-structured, open-ended questions about factors important to explaining why nurses remain in work and the profession. Data collection took place from March to June 2018. Individual interviews with twelve registered nurses working in a hospital in western Sweden were conducted. The data were analyzed using content analysis; additionally, sense of coherence (and its three dimensions: comprehensibility, manageability, and meaningfulness) was used as a tool to structure analyses of the qualitative data. Results: The following factors emerged from the analysis: having fun at work, being acknowledged, feeling togetherness in the team, having varying tasks with a manageable workload, good interaction between colleagues and patients, doing good work, feeling committed to and pride in the professional role, and having a balance between work and leisure time.Conclusions: One precondition of improving registered nurses’ health and well-being was having clear leadership. Another precondition was having a sense of coherence in relation to both the working group and the organization. Experiencing job satisfaction and being acknowledged for one’s good work were important; acknowledgement was received not only from patients, but also from colleagues, other professionals and the nurse manager. In this way, the nurses felt acknowledged and could create a sense of meaningfulness, manageability and comprehensibility in their work. more...

Aim The aim was to explore the process of involving mental healthcare service users in a mental health promotion research project as research advisors and to articulate features of the collaboration which encouraged and empowered the advisors to make significant contributions to the research process and outcome. Background There is an increasing interest in evaluating aspects of service user involvement in nursing research. Few descriptions exist of features that enable meaningful service user involvement. We draw on experiences from conducting research which used the methodology interpretative phenomenological analysis to explore how persons with mental disorders perceived mental health. Apart from the participants in the project, five research advisors with service user experience were involved in the entire research process. Design We applied a case study design to explore the ongoing processes of service user involvement. Methods Documents and texts produced while conducting the project (2012-2016), as well as transcripts from multistage focus group discussions with the research advisors, were analysed. Results The level of involvement was dynamic and varied throughout the different stages of the research process. Six features: leadership, meeting structure, role clarification, being members of a team, a focus on possibilities and being seen and treated as holistic individuals, were guiding principles for a salutogenic service user involvement. These features strengthened the advisors' perception of themselves as valuable and competent contributors. Conclusion Significant contributions from research advisors were promoted by facilitating the process of involvement. A supporting structure and atmosphere were consistent with a salutogenic service user involvement. more...

SummaryReorientation of healthcare services towards more efficient health promotion interventions is an urgent matter. Despite policies and guidelines being in place, it is the least developed key action area of the Ottawa charter. User involvement, or the voice of the patient, is missing from the knowledge base of health promotion in the mental healthcare services. The aim of this study was to add experiential knowledge from former patients. We explored the lived experience of 12 former inpatients at a mental healthcare hospital. We describe what they perceive as mental health promoting efforts. A salutogenic theoretical framework and the methodology of interpretative phenomenological analysis were used. The analysis revealed an appetite for learning in order to develop an in depth understanding of their former experiences. This was motivated by a desire to master daily life despite living with an illness and to increase health and well-being. The participants perceived the learning processes within the healthcare setting as mental health promoting. This craving for a better life is compatible with health promotion. It may turn out to be an opportunity to complement the curative activity of healthcare services with health promotion educational activities. more...

Objective: This study examines people’s experiences of how to live with a chronic disease, their learning needs and their reasons for participating in a health education programme. The aim of the study was to examine if and how a Sense of Coherence (SOC) might guide an understanding of learning processes in health education. Methods: This study has a qualitative study design with data collected through five group interviews. Interviews were analysed using qualitative content analysis to identify principal categories of response. Directed content analysis was then used to reference the categories emerging in the first step to the study’s theoretical framework. Results: Three main categories were found: (1) the ability to cope with daily life, (2) assets for a better life both in the present and for the future, and (3) the need for knowledge. A synthesis of empirical findings with reference to the first stage of analysis, the three main aspects of learning, and the three dimensions of a SOC revealed that a SOC may be useful in guiding an understanding of learning processes in health education as a life-oriented mastering resource. Conclusion: SOC offers a useful framework for informing health education. Research is needed to deepen an understanding of how salutogenic theory can strengthen the development of health education programmes and understanding of participants’ learning. more...

In salutogenic theory, individual/contextual, immaterial/material characteristics enabling movements towards health are labelled Specific and Generalised Resistance Resources, SRRs/GRRs, and characteristics counteracting such movements Specific and Generalised Resistance Deficits, SRDs/GRDs. The aim of this paper was to present SRDs and GRDs described by caregivers as stemming from themselves and their care recipient. Guided by salutogenic theory, an explorative design was used to collect data through interviews with 32 Swedish informal caregivers. During the theory-driven analysis, SRDs were unravelled using within-case approaches. To be able to unite them as GRDs across cases, a serviceable GRD definition was developed from the existing theoretical GRR definition. In findings, SRDs are visualised in citations and GRDs described in detail. Caregivers' experiences of SRDs/GRDs are presented as themes: 'Experiencing personal deficiencies', when stemming from themselves; and 'Struggling with an uncooperative co-worker', when stemming from their care recipients. Findings indicate that if these themes dominate a caregiver's view of life, she/he seems to have reached the 'breaking point' when caregiving ends due to lack of usable SRRs/GRRs. To prolong the time until this occurs, support, making otherwise unusable SRRs/GRRs usable, is needed. When designing this type of 'salutogenic' support, it seems essential to involve the target group (e.g. caregivers, care recipients), to ascertain what their SRRs/GRRs and SRDs/GRDs may consist of. Such knowledge regarding SRRs/SRDs could be used to design individualised support, and regarding GRRs/GRDs to design generalised support at group level. This study suggests how such new knowledge regarding resistance resources and deficits could be acquired. more...

Background There is extensive research on how nurses experience their working conditions and environment; this research shows high job stress, job dissatisfaction and intention to leave the workplace. The aim was to describe and explore success factors explaining why hospital nurses remain in work and profession. Methods A qualitative, descriptive and explorative study based on a theory-driven (the salutogenic theory by Antonovsky) approach was conducted. Data collection took place from March to June 2018. Individual semi-structured interviews with twelve registered nurses working in a hospital in western Sweden were conducted. The sense of coherence and its three dimensions, comprehensibility, manageability and meaningfulness, were used as a tool to structure the analyses of the qualitative data. Hence, a deductive (theory-driven) and an inductive (data-driven) approach with qualitative content analysis of manifest and latent content were used. Results The results showed that a sense of meaningfulness, manageability and comprehensibility involved the factors having fun at work, being acknowledged, feeling togetherness in the team, having varying tasks with a manageable workload, good interaction between colleagues and patients, doing good work, feeling committed to and pride in the professional role, and having a balance between work and leisure time. Conclusions One precondition of improving registered nurses’ health and well-being was having clear leadership. Another precondition was having a sense of coherence in relation to both the working group and the organization. Experiencing job satisfaction and being acknowledged for one’s good work were important; acknowledgement was received not only from patients, but also from colleagues, other professionals and the nurse manager. In this way, the nurses felt acknowledged and could create a sense of meaningfulness, manageability and comprehensibility in their work. more...

Background Extensive research describes how nurses experience their work environment. The conditions are described as stressful and dissatisfying with nurses intending to leave their workplace. Knowledge about the personal perception regarding why nurses consider leaving the hospital workplace is limited. The purpose of this study was to understand why hospital nurses remain in their workplace, which facilitates their continuation in the profession. Objective The objective was to explore and describe factors explaining why hospital nurses remain in the workplace. Methods This was a descriptive qualitative study with a purposive sample of hospital nurses in Sweden. The salutogenic theory was the basis for the interview guide and the semi-structured questions. Individual interviews were conducted in a hospital in western Sweden. Content analysis was performed to organize the coded data according to the sense of coherence. Results Data saturation was achieved with 12 interviews. Within the three themes of coherence (comprehensibility, manageability, and meaningfulness), ten subthemes were categorized from the data as follows: job satisfaction and fun at work, acknowledgement and productivity, togetherness and team security, manageable workload, variable work and challenging situations, workplace and personal space balance, collaboration and supportive leadership, valued role and good work, commitment and involvement, and pride in the professional role. Conclusions The main findings of this study have shown the critical importance of being in a meaningful, comprehensible and manageable work context that supports nurses in maintaining their professional identity. more...

Objective: Health care is far from reaching the goal of people being part of their own care, and research is lacking on how to understand their perspective. This study explores people’s intentions with the act of learning before attending a health education programme at a Learning and Mastery Centre (LMC) in Norway. The aim of this study was to understand participants’ learning strategies for learning about their own health care in a health education setting. Methods: Data were collected through five group interviews and analysed using qualitative content analysis. Results: Findings revealed that participants’ intentions of how and what to learn were influenced by their life experiences and interactions with the health care system. Three main categories of experience emerged: (1) sharing experiences, (2) second opinion and (3) capturing the news, brought together under the comprehensive theme: searching and dealing, confirmation and feeling, which reflects the underlying meaning of the categories. Conclusion: Results encourage us to see learning as an active construction process underpinned by health literacy, including both people’s competencies and the health care system. If LMCs and similar health education initiatives are to make an important contribution to improving people’s health literacy, significant attention should be given in the planning and implementation of initiatives. more...

A need for research on young children’s mental health has been identified. Moreover, there is a need to enhance teachers’ skills regarding health promotion work in preschool. The aim of the study is to examine the impact of a specific course on mental health promotion among Swedish preschool teachers. Data were gathered through interviews and documentation. A qualitative content analysis was used. Three categories: ‘attention’, ‘belonging’ and ‘personal growth’ – and six subcategories emerged from the analysis. The latent content of these categories is described in the theme: ‘Increased awareness, in thoughts and actions, of promoting mental health may create a sense of trust at preschools’. The results show that a specific course to promote mental health enhanced the teachers’ awareness of mental health which improved their work with children. This contributed to the development of a sense of trust at preschools, which is important to children’s mental health. more...

Extensive research describes how nurses experience their work environment. The conditions are described as stressful and dissatisfying with nurses intending to leave their workplace. Knowledge about the personal perception regarding why nurses consider leaving the hospital workplace is limited. The purpose of this study was to understand why hospital nurses remain in their workplace, which facilitates their continuation in the profession.The objective was to explore and describe factors explaining why hospital nurses remain in the workplace.This was a descriptive qualitative study with a purposive sample of hospital nurses in Sweden. The salutogenic theory was the basis for the interview guide and the semi-structured questions. Individual interviews were conducted in a hospital in western Sweden. Content analysis was performed to organize the coded data according to the sense of coherence.Data saturation was achieved with 12 interviews. Within the three themes of coherence (comprehensibility, manageability, and meaningfulness), ten subthemes were categorized from the data as follows: job satisfaction and fun at work, acknowledgement and productivity, togetherness and team security, manageable workload, variable work and challenging situations, workplace and personal space balance, collaboration and supportive leadership, valued role and good work, commitment and involvement, and pride in the professional role.The main findings of this study have shown the critical importance of being in a meaningful, comprehensible and manageable work context that supports nurses in maintaining their professional identity. more...

To explore the level of sense of coherence among Swedish nursing staff.An explorative quantitative study design was adopted using a short form for measuring sense of coherence.Data were collected in January 2018 from nurses working in full-time positions at two hospitals in Western Sweden. A total of 93 nurses completed the 13 item questionnaire measuring sense of coherence. Descriptive statistics were applied to obtain means and standard deviations. Spearman's rank correlation was used to describe strength of association between sense of coherence and socio-demographic categories. Between-group differences were defined using the nonparametric tests of Mann Whitney U test and Kruskal-Wallis test.The internal consistency of the SOC-13 was low. An inter-item-correlation test indicated that two items decreased the internal consistency of the scale. The level of the three dimensions of sense of coherence varied; manageability was weakest and decreased the total sense of coherence. The meaningfulness dimension was as strongest.On a national level, nurses reported weaker sense of coherence (SOC) than the general population, but stronger in an international comparison of nurses. They found their work difficult to manage, but meaningful.On a national level, the nurses reported weaker SOC than the general population, but stronger in an international comparison of nurses. Findings from this study will have an impact on how nurses can manage work related stress in terms of sense of coherence. There will also be an impact on nurses' well-being, which in a long run benefits patients.目的: 探讨瑞典护理人员的一致感水平。 设计: 采用探索性的定量研究,并使用简易格式来测量一致感。 方法: 2018年1月,数据收集自瑞典西部两家医院的全职护士。共有93名护士完成了13项问卷,以测量其一致感。我们采用描述性研究来获取均值和标准差。我们使用Spearman的秩相关性来描述一致感和社会人口统计分类之间的关联强度。我们使用了曼-惠特尼U检验(Mann Whitney U test)和克鲁斯卡尔-沃利斯检验(Kruskal-Wallis test)这样的非参数检验来定义组间差异。 结果: SOC-13的内部一致感较低。项目内部相关测试表明,两个项目降低了量表的内部一致感。一致感三个维度的水平不同;可管理性是最弱的,降低了整体的一致感。有效性维度最强。 结论: 从全国来看,护士的一致感(SOC)比普通人群弱,但从国际比较来看,护士的一致感更强。护士们发现他们的工作虽然难以管理,,但很有意义。 影响: 从全国来看,护士的一致感(SOC)比普通人群弱,但从国际比较来看,护士的一致感更强。此次研究结果将影响护士从一致感的角度来处理与工作相关的压力的方式。这也会对护士的健康产生影响,从长远来看,这也能使患者受益。. more...

Research using salutogenic factors to promote health is extensive. Salutogenesis, and its core concept ‘sense of coherence’ (SOC), is a resource-oriented theory and framework, applicable in different contexts. Research combining health promotion and doctoral supervision in higher education is scarce. This article places research supervision in a broader context of sustainable working life by focusing on stress management. It is about health promotion in an area of research supervision, a new approach not described earlier. Research on supervision in general is extensive, focusing on co-generative mentoring, counselling and coaching. A new salutogenic model, ‘The Collegial Model’, is presented as an example of practical application. The aim of the present article is to introduce and discuss how the salutogenic theory and model of health can be applied to research supervision of postgraduate students. Knowledge about how SOC impacts health and learning has benefit from a systematic review on salutogenic research covering published papers from 1992 to 2003 and until today. ‘The Collegial Model’ examines fundamental characteristics of supervision related to ethics and sense of coherence: relations, communication, processes, reciprocity, reflection, learning, comprehensibility, manageability, meaningfulness and coherence. Principles for carrying out supervision ‘the salutogenic way’ are suggested. The conclusion is that doctoral supervision involves mutual learning processes between colleagues in the supervisory team. Supervision has to be theory driven, implying that supervisors could benefit from applying a salutogenic way of thinking and working, particularly in development of guidelines for research supervision. more...

BACKGROUND Fructose intake may lead to hyperuricaemia, which is associated with increased risk and progression of kidney disease. We aimed to explore the acute effects of fructose loading from different sources, with and without a pizza, on levels of serum uric acid in patients with chronic kidney disease (CKD), type 2 diabetes (T2D) without CKD, and in healthy subjects (HS). METHODS The study included six HS, and three CKD stage 4-5 and seven T2D patients. Drinks consumed were blueberry drink (17.5 g fructose), Coca-Cola (18 g fructose) and fructose drink (35 g fructose). The drinks were also combined with pizza, in total six interventions. Serum samples were collected fasting and 30, 60, 90 and 120 minutes after intake and also 240 minutes after drink + pizza, and analysed for fructose, uric acid and triglycerides. Postprandial responses were explored using repeated-measure ANOVA. RESULTS Baseline serum uric acid levels were increased in CKD (P = 0.037). There were significant differences in serum fructose and serum uric levels over time between drinks and drinks + pizza for all groups (P more...

Aims and objectives To explore the associations between illness perceptions of fatigue, sense of coherence and stress in patients one year after myocardial infarction. Background Post-myocardial infarction fatigue is a stressful symptom that is difficult to cope with. Patients’ illness perceptions of fatigue guide professionals in predicting how individuals will respond emotionally and cognitively to symptoms. Individuals’ sense of coherence can be seen as a coping resource in managing stressors. Design A cross-sectional study design was used. Method One year post-myocardial infarction, a total of 74 patients still experiencing fatigue completed four questionnaires: the Multidimensional Fatigue Scale Inventory -20, the Brief Illness Perception Questionnaire, the Sense of Coherence scale (sense of coherence-13) and a single-item measure of stress symptoms. Descriptive statistics, correlations and stepwise regression analysis were carried out. Results Strong negative associations were found between illness perceptions of fatigue, sense of coherence and stress. Sense of coherence has an impact on illness perceptions of fatigue. Of the dimensions of sense of coherence, comprehensibility seemed to play the greatest role in explaining illness perceptions of fatigue one year after myocardial infarction. Conclusion To strengthen patients’ coping resources, health-care professionals should create opportunities for patients to gain individual-level knowledge that allows them to distinguish between common fatigue symptoms and warning signs for myocardial infarction. Relevance to clinical practice There is a need to improve strategies for coping with fatigue. It is also essential to identify patients with fatigue after myocardial infarction, as they need explanations for their symptoms and extra support. more...

In this interpretative phenomenological analysis study, we explored how persons with mental disorders perceive mental health. Adapting a salutogenic theoretical framework, 12 former inpatients were interviewed. The analysis revealed experiences of mental health as a movement, like walking up and down a staircase. Perceived mental health is expressed both verbally in an everyday language and through body language. Mental health is an aspect of being that is always present and which is nourished by four domains of life: the emotional; physical; social and spiritual domains. Mental health is experienced in everyday life as a sense of energy, and as more or less wellbeing. Exploring persons' meanings of mental health from a subjective perspective can extend the knowledge base that can be used in mental health promotion strategies. more...

Higher sense of coherence (SOC) has been associated with lower depression in Western societies; however, it is not clear whether this association manifests similarly in non-Western cultural contexts.To examine the associations between different levels of SOC and depressive symptoms (DS) among indigenous-minority Arab Bedouin women in Israel and explore possible explanatory variables for this association.We conducted face-to-face interviews with 464 women (aged 18-49 years). DS was measured based on the Center for Epidemiologic Studies Depression Scale. We used the SOC-13 questionnaire and conducted path analysis using Structural Equation Modeling to examine the contribution of two levels of SOC (low/high) to predict DS beyond psychological resources and socioeconomic position.The mean score of SOC was 3.42, standard deviation (SD) = 1.15. While high SOC (mean = 4.38, SD = 0.66, range = 3.5-6.38) was positively and significantly associated with DS (r = 0.46), SOC was not associated (r = 0.02) with DS in the low SOC group (mean = 2.4, SD = 0.56, range = 1-3.42).Relationships between high versus low SOC and DS among Bedouin women differ from those found in Western societies. This raises questions about the use of SOC as a universal tool in different cultural contexts. more...

Population ageing is a global trend. For example, in the EU-27 population the share of the older population (65 and above) increased from 13.9 % in 1991 to 17.5 % in 2011. It is expected that by 2060 the share of those 65 years and overwill account for 29.5 % of the EU-27 population (Eurostat, 2013). The ageing of the population results from decreasing fertility rates, but also from increasing life-expectancy rates and the progressive ageing of the ageing population itself.These latter trends are partially attributable to improved quality of nutrition, and advances in medicine, especially knowledge about diseases and their control, and to developments such as early detection of colorectal and breast cancer in screening programmes which increase the chances of survival. Improvements in housing, nutrition, and sanitation standards have also contributed to improved life expectancy (Staehelin, 2005).In developed countries, years added to life are generally lived in good health. However, because more people live into old age and because chronic diseases more frequently occur in the older population, the burden of disease will alsoincrease. The ageing of the population will have an impact on healthcare, housing and community facilities, consumption patterns, and also on social security costs. In response, health professionals, researchers, and policymakers are increasingly concerned with healthy ageing, where ageingin-place is used as a key concept. In this chapter, we first discuss the meaning of the concept of healthy ageing, and how Sense of Coherence contributes to this process. Next, we discuss the characteristics of the community in whicholder people live their lives and how the community can provide resources (GRR and SRR) to strengthen Sense of Coherence and hence perceived well-being and quality of life. more...

This in-depth survey of salutogenesis shows the breadth and strengths of this innovative perspective on health promotion, health care, and wellness. Background and historical chapters trace the development of the salutogenic model of health, and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence, that differentiate it from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts, from positive psychology to geriatrics, from small towns to corrections facilities, and from school and workplace to professional training. Perspectives from scholars publishing in languages other than English show the global relevance of the field.Among the topics in the Handbook: Emerging ideas relevant to the salutogenic model of health Specific resistance resources in the salutogenic model of health The sense of coherence and its measurement The application of salutogenesis in communities and neighborhoods The application of salutogenesis to health development in youth with chronic conditions The application of salutogenesis in mental health care settings The Handbook of Salutogenesis summarizes an increasingly salient field for graduate and professional students of public health, nursing, psychology, and medicine, and for their instructors. It will also appeal to health-related academicians and professionals who wish to have a thorough grounding in the topic. more...

Antonovsky developed the 29 item Orientation to Life Questionnaire to measure the sense of coherence, having 11 items measuring comprehensibility, 10 items measuring manageability, and 8 items measuring meaningfulness. The response alternatives are a semantic scale of 1 point to 7 points. The questionnaire yields a summed score with a range from 29 to 203. A shorter version of 13 questions of the original form was developed by Antonovsky, where the score ranges between 13 and 91 points, and other scales have been developed, for example, to measure the sense of coherence at the family and community levels. Antonovsky’s scales have been used in at least 49 different languages in at least 48 different countries. Recent research shows that the SOC seems to be a multidimensional construct rather than unidimensional as Antonovsky believed. Antonovsky maintained that the SOC develops until the age of 30 years, thereafter remaining relatively stable until retirement, and decreasing in old age. This assumption finds no support in subsequent empirical research. As Antonovsky hypothesized, a wealth of research shows his scales to be reliable, valid, and cross-culturally applicable instruments. Criticism of the SOC concept is described and discussed. more...

This chapter describes the background and the development of scholarship on salutogenesis in Swedish. It starts from the time when Antonovsky visited the University of Lund and introduced the salutogenic model of health to the Swedish audience of health scientists. Research on the sense of coherence construct is extensive in English, so just describing articles and theses published in Swedish do not give a fair picture of the Swedish research. Therefore, this chapter begins with a summary of the total number of sense of coherence studies in the period 1983–2013 and thereafter shows some trends in research in Swedish, ending up in current research. The chapter does not claim to be a systematic literature review of Swedish research on salutogenesis and the core concept of the sense of coherence; instead, it intends to be a sketch of Swedish salutogenesis research, showing some steps in the development from the past to the current situation. more...

This chapter reviews and integrates conceptual and empirical research focusing on the role of Generalized Resistance Resources (GRRs) within the Salutogenic model. In particular, this chapter discusses findings regarding the conceptual and empirical progress seen in the study of GRRs at the individual, family, and community ecological levels in understanding individual differences in sense of coherence (SOC). First, the present chapter briefly describes the theoretical assumptions and findings regarding the concepts of the GRRs and the GRDs (Generalized Resistance Deficits). Next, this chapter presents an overview of findings regarding the empirical progress seen in the study of GRRs at the individual, family, and community ecological levels. We end with suggestions for future research directions and interventional implications. more...

This section aims to describe the salutogenic construct of the sense of coherence. It begins with a reflection of the ontological and epistemological background of salutogenesis, which is not particularly described and explained to any significant extent in the publications by Antonovsky. The core concepts, the sense of coherence and the generalized resistance resources within the salutogenic model of health are explained. The measurement of the sense of coherence and the validity and reliability of the sense of coherence scales are extensively described. The sense of coherence is a concept that can be applied at different system levels, at an individual level, a group (family), on organizations and societal level. Therefore, a life cycle perspective is adopted for this section, describing sense of coherence in children and families, in adolescents and in older adults. Finally, salutogenesis, a resource-oriented approach on peoples’ abilities, is much more than the measurement of the sense of coherence. The salutogenic umbrella is here used as a metaphor for showing some related concepts. more...

Aim: To examine how service user involvement can contribute to the development of interpretative phenomenological analysis methodology and enhance research quality. Background: Interpretative phenomenological analysis is a qualitative methodology used in nursing research internationally to understand human experiences that are essential to the participants. Service user involvement is requested in nursing research. Design: We share experiences from four years of collaboration (2012 – 2015) on a mental health promotion project, which involved an advisory team. Methods: Five research advisors either with a diagnosis or related to a person with severe mental illness constituted the team. They collaborated with the research fellow throughout the entire research process and have co-authored this article. We examined the joint process of analyzing the empirical data from interviews. Our analytical discussions were audiotaped, transcribed and subsequently interpreted following the guidelines for good qualitative analysis in interpretative phenomenological analysis studies. Results: The advisory team became ‘the researcher's helping hand’. Multiple perspectives influenced the qualitative analysis, which gave more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants’ accounts. The outcome of the service user involvement was increased breadth and depth in findings. Conclusion: Service user involvement improved the research quality in a nursing research project on mental health promotion. The interpretative element of interpretative phenomenological analysis was enhanced by the emergence of multiple perspectives in the qualitative analysis of the empirical data. We argue that service user involvement and interpretative phenomenological analysis methodology can mutually reinforce each other and strengthen qualitative methodology. ©2016 The Authors.Journal of Advanced Nursing Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License,which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. more...

Background: Acute myocardial infarction (AMI) is a life-changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period.Ai ... more...

Aim: To describe and interpret couples’ thoughts and expectations about their future life after the patient’s discharge following acute myocardial infarction [AMI].Background: An AMI is a challenge ... more...

Returning home from hospital after an acute myocardial infarction [AMI] can be a period of vulnerability both for the patient and his/her partner. This study focuses on the time immediately after discharge.The aim of this study was to describe the patient's and his/her partner's experiences after hospital discharge following AMI.15 couples took part in individual interviews, 4-8 weeks after discharge. Data were analysed using qualitative content analysis.The results are presented by means of three themes, 'at home in one's own home', 'at home within oneself' and 'having normality in sight', comprising ten categories that describe the experiences of both the patient and his/her partner.The patients as well as partners described the period after discharge from hospital comprising ambitions of feeling safety in their home, an inner sense of security and seeking normalisation. The results of this study could be useful for nurses when planning for patient discharge. During hospitalization nurses can prepare both the patient and their partner for what to expect when the patient returns home. more...

BACKGROUND Vascular endothelial growth factor (VEGF) was recently shown to predict survival in prevalent haemodialysis patients. Soluble VEGF receptors (sVEGFR)-1 and -2 are circulating endogenous modulators of VEGF activity. We thus studied the relationship between sVEGFR-1 and -2 and survival in a cohort of prevalent haemodialysis (HD) patients. METHODS Components of the VEGF system were measured (ELISAs) in 185 prevalent HD patients and levels related to clinical characteristics, biochemical markers and survival. The patients were followed up prospectively for a median 31 (20-37) months. RESULTS While ischaemic heart disease was independently associated with a lower sVEGFR-2 (OR = 2.75, P = 0.02), sVEGFR-1 was positively associated with IL-6 (rho = 0.22, P = 0.003) and white blood cell count (rho = 0.22, P = 0.002). In survival analysis, the patients with a high sVEGFR-1 level had a higher all-cause mortality (Kaplan-Meier Chi-Square = 5.6, P = 0.02) and a higher adjusted mortality risk (Cox HR = 1.93, P = 0.009) than those with low levels. CONCLUSION In the first clinical study of sVEGFR-1 and -2 in CKD, we found novel associations between the sVEGFRs and cardiac disease. This may be of clinical importance, as a high sVEGFR-1 was an independent risk factor for all-cause mortality. more...

Twenty years have passed since the central document of health promotion, the Ottawa Charter, was constituted. Health was seen as the process enabling individuals and communities to increase control over their determinants of health, thereby improving their health and enabling an active and productive life, that is, a good quality of life. One main strategy was the making of a healthy public policy. At the same time Aaron Antonovsky developed the salutogenic theory and its core concepts the sense of coherence and the generalized resistance resources. This paper integrates Antonovsky's salutogenic theory and a salutogenic model of quality of life into the core principles of the Ottawa Charter and exemplifies how to make healthy public policy the salutogenic way. A process-oriented coherent health promotion research model integrating an ecological, a salutogenic and a resilient approach is shown. The objective of this theoretical model is to bring together the whole spectrum of risk factors, protective factors and promotion factors in one model. Further, individual, group and society level are considered. The model suggested aims to contribute to the creation of sense of coherence. This is exemplified in practice in a case study of a Nation, that is, on a national level. The case study of the “Nation” is partly masked. The principles behind these processes are explained in detail while the case study of the “Nation” only includes parts of the process explaining some core issues. The overall aim of this paper is to stimulate health promotion activities along the lines presented and invite the readers to comment and continue the discussion. (Global Health Promotion, 2009; 16 (1): pp. 17—28) more...