Meaningfulness is not the most important component for changes in sense of coherence

Meaningfulness and mortality: exploring the sense of coherence in Eastern Finnish men

AIMS

The sense of coherence scale has been shown to have an epidemiological relationship with mortality. This study aimed to investigate how the three components of sense of coherence (meaningfulness, comprehensibility and manageability) and the individual items of these components relate to mortality.

METHODS

Eastern Finnish men (n=2315) aged 42-60 years at baseline in the 1980s completed a 12-item sense of coherence scale and were followed for 25 years, on average, until death or until the end of 2019. Hazard ratios for mortality were calculated using two models: one adjusted for age and the second for an additional 12 mortality risk factors.

RESULTS

Of the three sense of coherence components, only meaningfulness was associated with all-cause mortality, and in the fully adjusted model, those in the weakest tertile had a 1.14 (95% confidence interval 1.01-1.29, P=0.042) times higher hazard ratio for mortality than those in the strongest tertile. Of the individual sense of coherence items, only the first question, 'How often do you have the feeling that you really don't care about what is going on around you?', was associated with all-cause mortality, and in the fully adjusted Cox model, the hazard ratio of weak versus strong was 1.18 (95% confidence interval 1.03-1.36, P=0.020).

CONCLUSIONS

The sense of coherence component related to meaningfulness, including its first item, 'Caring about what goes on around you', plays a significant role in the association with mortality among middle-aged men in Eastern Finland. This item should be considered a noteworthy patient-reported variable when predicting mortality in public health settings.

The relationship between fear of childbirth and sense of coherence in women expecting their first child

OBJECTIVE

The aim was to investigate fear of childbirth (FOC) and sense of coherence (SOC), and their components in women expecting their first child.

METHODS

A cross-sectional study where 414 women answered the Wijma Delivery Expectancy Questionnaire Version A and the Sense of Coherence Scale. Statistical analyses were performed.

RESULTS

The main results show that women with severe FOC reported lower SOC, and all three components of SOC were lower in women with severe FOC. Comprehensibility turned out to have a significant correlation with FOC. Psychological problems before pregnancy were more common in women with severe FOC and low SOC.

CONCLUSIONS

Women with severe FOC reported lower SOC and lower levels of each of the following components: comprehensibility, manageability and meaningfulness.

SALUTOGENESIS AND CARDIOVASCULAR HEALTH IN ADULTS: A SCOPING REVIEW

ABSTRACT Objective: to identify and synthesize evidence that relates the salutogenic theory proposed by Antonovsky with cardiovascular disease in adults. Methods: we conducted a scoping review as proposed by Arksey and O’Malley. Bibliographic databases were searched for original research articles about salutogenesis and cardiovascular health. The search yielded 29 studies that met the previously defined inclusion criteria. The results were evaluated and summarized in the form of a narrative. Results: the findings of the studies pointed to a correlation among a strong sense of coherence, high quality of life and a greater likelihood of adopting healthy behaviors. Furthermore, the articles showed that social support improves perceived health and well-being of adults with cardiovascular disease. Conclusions: as a central concept of the salutogenic theory, a sense of coherence represents a topic of interest for nursing professionals. Through their interventions, nurses can strengthen and improve people’s skills in the quest for and maintenance of their own health.

'I'm having a baby not a labour': Sense of coherence and women's attitudes towards labour and birth

OBJECTIVE

In Western countries, caesarean section rates are increasing and spontaneous vaginal birth rates are decreasing at a rapid rate. This trend has implications for childbearing women's health and calls into question the use of pathogenesis to frame maternity services. The theory and practice of salutogenesis offers a viable alternative as it emphasises health rather than illness. Sense of coherence and generalized resistant resources (GRRs) are the cornerstones of salutogenesis and sense of coherence is a predictive indicator of health. As strong sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with weak sense of coherence, the objective of this study is to examine the association between sense of coherence and women's attitude towards their birthing experiences.

DESIGN, SETTING AND PARTICIPANTS

This paper reports on the qualitative component only of a longitudinal study where 753 women planning to have their babies in an Australian tertiary maternity service, completed questionnaires in pregnancy and postnatally. Women answered one openended question during the pregnancy and one open-ended question approximately eight weeks postnatally. Data were analysed by qualitative content analysis.

FINDINGS

When the open-text responses of 119 women with strong sense of coherence and 177 women with weak sense of coherence were analysed, the categories of Language, Demeanour and Focus were identified. Women with strong sense of coherence have a positive, relaxed and baby-focused attitude. In salutogenic terms this attitude towards labour and birth can be described as increased comprehensibility, increased manageability, decreased meaningfulness in the experience of giving birth, increased internal GRRs and increased external GRRs. Women with weak sense of coherence have a more negative, worried and labour-focused attitude. In salutogenic terms this attitude towards labour and birth can be described as decreased comprehensibility, decreased manageability, increased meaningfulness in the experience of giving birth, decreased internal GRRs and decreased external GRRs.

KEY CONCLUSION

Strong sense of coherence in childbearing women is expressed through a positive, relaxed and baby-focused attitude while weak sense of coherence is expressed through negative, worried and labour-focused attitude in childbearing women towards labour and birth.

IMPLICATIONS FOR PRACTICE

As sense of coherence is a modifiable predictor of health, application of the study findings could focus on midwifery work including antenatal education that aims to decrease caesarean section rates by strengthening women's sense of coherence in pregnancy.

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

Sense of coherence as a predictor of health-related behaviours among patients with coronary heart disease

AIMS

A high sense of coherence (SOC) has been found to be associated with favourable health-related behaviours. However, evidence is for the most part lacking on the influence of SOC on health-related behaviours among coronary heart disease patients. The aim of this study was to explore the association between SOC at baseline and smoking status, nutrition behaviour, physical exercise and alcohol consumption of coronary heart disease patients 12-28 months after they had undergone different cardiac treatments.

METHODS

A total of 179 coronary heart disease patients (mean age 58.32±6.54 years, 19% female) were interviewed before coronary angiography and 12-28 months after. Self-report data about health-related behaviours were obtained via a structured interview. SOC was measured using the 13-item Orientation to Life Questionnaire. The relationship between SOC and health-related behaviours was examined using regression and cross-lagged path analyses.

RESULTS

SOC at baseline predicted non-smoking and quitting smoking: odds ratio (OR) (95% confidence interval (CI)) per unit increase (over range 38-91) was 1.11 (1.03-1.19) and 1.09 (1.01-1.17), respectively. Moreover, baseline SOC predicted healthy nutrition behaviour among percutaneous coronary intervention patients: the OR per unit increase was 1.08 (95% CI: 1.01-1.15). Lastly, SOC at baseline predicted improvement in alcohol consumption at follow-up among coronary artery bypass grafting patients (standard score result: -0.15, p<0.05).

CONCLUSION

Coronary heart disease patients with a low SOC before treatment are less likely to improve health behaviours after cardiac treatment and should thus get additional attention in health promotion.