Self-efficacy and the sense of coherence: narrative review and a conceptual synthesis

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial

BACKGROUND

In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only.

METHODS

A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data.

RESULTS

Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention.

CONCLUSION

Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention.

TRIAL REGISTRATION

This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

Predicting mental burnout among Israeli Home Front Command soldiers during the COVID-19 pandemic

BACKGROUND

The present study examined personality, situational and organizational predictors of burnout during COVID-19 in a military setting, based on the salutogenic theory of health (Antonovsky, 1987).

METHOD

Questionnaires were completed by 116 reserve Israeli Home Front Command medical staff (71% males). Background variables (e.g., gender), personality variables (self-efficacy and sense of coherence - SOC), situational variables (state-anxiety, self-rated health and sense of threat) and organizational variables (satisfaction with military's and government's handling of the COVID-19 crisis) were measured as predictors of burnout.

RESULTS

Females had higher levels of state anxiety and burnout compared to males. Females also reported a lower level of satisfaction with the military's handling of the COVID-19 crisis than males. SOC and state anxiety were the only statistically significant predictors of burnout after controlling for sociodemographic variables. The entire model explained 59.4% of the burnout variance.

CONCLUSION

In accordance with salutogenic theory, SOC is associated with active adaptation through use of generalized and specific resistance resources to avoid burnout in a stressful milieu. Psychological support, psychoeducation and simulation training are offered to increase manageability in crisis situations.

LIMITATIONS

Following a large dropout rate due to being quarantined, the final sample size was much smaller than planned. Also, although previous longitudinal studies have found SOC to be a causal factor in burnout, the present cross-sectional design limits such conclusions.

Exploring the role of social capital, self-efficacy and social contagion in shaping lifestyle and mental health among students representing the future healthcare workforce in Palestine: social cohort study protocol

INTRODUCTION

Non-communicable diseases (NCDs) and depression form an unhealthy mix. The project focuses on potentially effective psychosocial factors shaping health-related habits and mental health. The study is conducted among health domain students. Understanding what shapes their health will determine their quality of care. The study is implemented at An-Najah National University in Palestine. This zone of continuous conflict psychological stress is high and mental health problems are stigmatised.

METHODS AND ANALYSIS

Students who are enrolled in second and third year will be invited to fill in a baseline and two follow-up online questionnaires. The questionnaires will assess: health behaviours and outcomes (health-related habits, obesity and mental health), main predictors (social capital, social network, self-efficacy), confounders (general and sociodemographic characteristics) and effect modifiers (sense of coherence (SOC) and family SOC). Friendships within participating students will be identified by allowing students to name their friends from a pull-down menu of all students. Descriptive statistics and scores will describe participant's characteristics. The relationship between health behaviour, outcomes and main predictors will be examined by regression and structural equation models. Clustering of health behaviours and outcomes will be assessed by permutation tests. Their spread within the network of friends will be investigated by longitudinal generalised estimating equations.

DISCUSSION

The study will identify the prevalence of NCD-related health habits and mental health aspects in the future healthcare workforce in Palestine. It will be the first study to address the role of psychosocial factors for the targeted students. It has the potential to identify targets for promoting physical and mental health among these future professionals.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Ethikkommission Nordwest- und Zentralschweiz (EKNZ) in Switzerland and the Institutional Review Board Committee (IRBC) in Palestine. Participation in the study is voluntary and requires informed consent. The data management methodology ensures the confidentiality of the data. The outcomes of the study will be published as scientific papers. In addition, it will be presented in stakeholder conferences and to students at An-Najah National University.

Toward a Unified Language (and Application) of Salutogenic Design: An Opinion Paper

This opinion paper posits that there is a misalignment of how the theory of salutogenesis is defined by scholars and the way that salutogenesis is reflected in architectural practice. Many practitioners use this term to describe their work without a clear understanding of the social theory behind it. A background on the original theory, brief review of its subsequent development, and the importance of stress in determining health are explored. Antonovsky, originator of the salutogenesis theory, believed that health was represented by a spectrum ranging from disease to wellness and that stress and an individual's ability to respond to it determined where they would be on that spectrum. His work indicates that one's resources determined the impact of a stressor. The elements Antonovsky termed environmental generalized resistance resources (GRR) are considered because they are within the purview of design practitioners to influence. While Antonovsky's work became focused on an aspect of salutogenesis he termed sense of coherence (SOC), he encouraged exploration of additional aspects. This article proposes an expanded definition of salutogenesis that includes five aspects of environmental GRR that can address or alleviate specific causes of stress-SOC, biophilia, relaxation response, self-empowerment, and prospect and refuge. A more specific language and a common, consistent way of understanding what makes an environment salutogenic emerges with examples of each described. A common language will bring consistency to design practice and make complex social theories more accessible for practitioners, leading to them being more rigorously and universally applied in design.

Older patients' attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery-a gap between awareness and action

Purpose

Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery.

Methods

This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semi-structured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9).

Results

Nine participants were male, median age was 75 years (range 70–91). The theme, ‘a gap between awareness and action’, was identified based on two main categories: ‘Attitudes towards preoperative physical exercise have a multifactorial base’ and ‘Preoperative physical exercise is possible with a push in the right direction’. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap.

Conclusions

A gap between the patients’ awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual’s current physical activity and preoperative attitude towards physical exercise.

Change in sense of coherence and health-related quality of life after injury - a prospective cohort study

PURPOSE

To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena.

MATERIALS AND METHODS

A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36).

RESULTS

Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health.

CONCLUSIONS

Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus.IMPLICATIONS FOR REHABILITATIONAn injury may change an individual's sense of coherence to be stronger or weaker.For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective.Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course.

Sense of coherence among Bedouin women in polygamous marriages compared to women in monogamous marriages

We compared sense of coherence (SOC) among Bedouin women in polygamous with those in monogamous marriages. SOC is a global orientation toward life as comprehensible, manageable, and meaningful, and is derived from generalized resistance resources that promote effective coping in stressful life situations. Strong SOC may be a resource for strengthening resilience and promoting health. We administered questionnaires to 464 Indigenous Arab Bedouin women (ages 18-49 years) in 2008-2009 using the 13-item SOC questionnaire. Contrary to our hypothesis, SOC was higher among women in polygamous compared to monogamous marriages. Husband's education, husband's abandonment of the household, living in unrecognized villages, and low mastery (perception of one's ability to control life situations) were associated with higher SOC. These results might suggest that polygamy may provoke new coping mechanisms among women as they reappraise life amidst low mastery, accept cultural norms, and marshal new resources, thereby increasing key elements of SOC, including comprehensibility, manageability, and meaningfulness. Interventions and services seeking to empower women in polygamous marriages should build on their resilience.

The effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: a randomized controlled trial

Background

Being elderly and retired are related phenomena that overlap in a time symmetry. The present study aimed to assess the effect of an empowering self-management model on the self-efficacy and sense of coherence (SOC) in retired elderly with chronic diseases.

Methods

A randomized controlled trial that included 60 elderly people was carried out in Bushehr (Iran) in 2016. The participants were randomly assigned to either a control group or an intervention group. Based on an empowering self-management model, the intervention group participated in a five-stage plan: 1) self-awareness of changes and understanding their personal level of performance and expectations; 2) optimal goal setting; 3) planning; 4) adjusting physical, psychological, and social structures; and 5) evaluation. Self-efficacy and SOC were measured using the questionnaires developed by Sherer and Antonovsky, respectively, before and after the intervention. The results of the observed differences between the groups were subsequently compared. Data were presented as mean±SD.

Results

The mean change of the self-efficacy score in the intervention and control groups was 9.48±5.32 and 1.68± 6.04, respectively, (t[56]=5.20, P<0.001). The mean change of the SOC score in the intervention and control groups was 24.17±12.05 and 0.10±13.42, respectively, (t[56]=7.18, P<0.001).

Conclusion

The applied empowering self-management model led to an improved self-efficacy and SOC among the retired elderly with chronic diseases. This model can be used to empower the elderly to achieve comprehensibility, manageability, and meaningfulness in their lives.

Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households: A study protocol

AIMS

To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore.

BACKGROUND

In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people.

DESIGN

A stratified randomized control trial with process evaluation is proposed.

METHODOLOGY

The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme.

DISCUSSION

The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senior-only households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life.

Influence of rural non-smoking adolescents' sense of coherence and exposure to household smoking on their commitment to a smoke-free lifestyle

This 18-month longitudinal study examined the influence of adolescents' sense of coherence (SOC) and exposure to household smoking on their commitment to a smoke-free lifestyle. This study investigated a representative sample of 8th graders from 21 randomly selected high schools in the rural Limpopo Province of South Africa (n = 2,119). Of the total sample of 2,119 participants, 294 (14%) reported smoking at baseline and were therefore excluded from further analysis. Of those who did not smoke at baseline, 98.1% (n = 1,767) reported no intention of smoking in the upcoming 12 months. Of those who completed follow-up and had no intention of smoking at baseline (n = 1,316), 89.1% still did not smoke and remained committed to being smoke-free. Having a lower SOC, reporting alcohol binge-drinking at baseline, and having a household member who regularly smokes indoors (OR = 0.46: 0.26-0.82), as compared to not having any smoker in the household, were associated with lower odds of honoring a commitment to a smoke-free lifestyle. Furthermore, those who identified themselves as black Africans, as opposed to belonging to other race groups, were more likely to maintain a smoke-free lifestyle. Our findings suggest that interventions to prevent adolescent smoking should prioritize stress-coping skills and promote smoke-free homes.