A systematic review of adolescents’ sense of coherence and health

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Global figures suggest that there are currently 1.2 billion adolescents between the ages of 10 and 19 that they make up approximately one‐fifth of the worldwide population 1. Adolescents have been recognised as a healthy group in the general population, but there are wide variations between – and within – regions when it comes to country profiles of adolescent health 3. Health is an ambiguous concept, but as widely agreed, it is not only as the absence of disease but also as a state of complete physical, mental, social and spiritual well‐being 4. Due to the high potential to improve the future health of adolescents, health promotion focusing on this area has been approached from a salutogenic perspective, which focuses on factors that support human health and well‐being, rather than on factors that cause disease 5. As Antonovsky 7 later stated, disease and stress occur everywhere and all the time. He turned the traditional question about the causes of diseases upside down and asked what factors could make people maintain and develop their health, even under difficult external circumstances. The most important research question to consider is what causes health (salutogenesis) not what causes disease (pathogenesis) 6 and the key factor is not what resources are available, but how to use and reuse them for the intended purpose 8.
The main concept behind the salutogenic approach is sense of coherence (SOC), which creates a comprehensive source and guide for research and action in health promotion 5. SOC is defined as a global orientation that expresses the extent to which one has a pervasive and enduring, but dynamic feeling of confidence, that the stimuli deriving from one′s internal and external environments are structured, predictable and explicable. In addition, the resources that are available to meet the demands posed by these stimuli and requirements are challenges worthy of investment and engagement [7]. SOC is defined as an orientation that helps people to perceive life as comprehensive, manageable and meaningful 8. There has been a great deal of scientific research into salutogenic orientation, which has resulted in SOC being promoted as a health resource, strengthening resilience and developing a positive subjective state of health. SOC is strongly related to health, especially mental health, and partly explains health. The interpretation could be that SOC is not the same as health, but that it is still an important disposition for people's development and maintenance of their health. [10.] A strong SOC is associated with healthier behaviour choices, independent of social class and education 11.
Sense of coherence instruments have been developed and widely tested based on Antonovsky's theory. The original instrument consists of 29 items with a seven‐point response scale, which measures comprehensibility (11 items), manageability (10 items) and meaningfulness (eight items) as the three dimensions of health. The shorter version is a selection of 13 items from the original instrument, including five items covering comprehensibility and four items covering both manageability and meaningfulness. [7.] There are also several modified versions of the questionnaire, ranging from three to 28 items 12. The three‐item SOC scale has been used, but it has had severe distribution problems compared to the original scales 13. In contrast, the original SOC scales have proved to be a reliable, valid and cross‐culturally applicable instrument that measure how people manage stressful situations and stay well 12.
The relationship between SOC and health has been widely studied among adolescents and has been found to be similar to the position in adults, in that the better the health is perceived to be, the higher the SOC 10.
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