Validity and reliability study of the Turkish version of the Salutogenic Health Indicator Scale

AIMS

The aim of this study was to assess the validity and reliability of the Salutogenic Health Indicator Scale (SHIS) among a sample of Turkish university students.

METHODS

This study was conducted with 291 university students. The SHIS was evaluated in terms of language equivalence, validity and the reliability. Content validity was assessed with the content validity index (CVI). Construct validity was determined by confirmatory factor analysis (CFA). A Cronbach's alpha reliability coefficient was used for the analysis of internal consistency, a Pearson's correlation coefficient was used for parallel form reliability, and the intraclass correlation coefficient (ICC) was used for the test-retest technique.

RESULTS

The CVI of the SHIS was between 0.80 and 1.00. When the results of the CFA were examined, the factor loadings of all items were above 0.50. A statistically significant moderate positive correlation was found between the SHIS and the Sense of Coherence (SOC) scores for parallel form reliability (r = 0.489). Within the scope of the test-retest analysis, an ICC = 0.762 was determined (p < 0.001).

CONCLUSION

The findings obtained from this validity and reliability study carried out on a sample of Turkish university students showed that the SHIS was both valid and reliable.

Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index

Measurement of human flourishing represents a salutogenic approach to epidemiological and behavioral research emphasizing factors contributing to "good lives" rather than pathology. The objective of this study was to translate and psychometrically test the 10-item Flourish Index (FI) and 12-item Secure Flourish Index (SFI) in a convenience sample of Danish adults. A total of 325 participants completed a cross-sectional survey, with 148 of those participants completing the survey a second time (retest). Confirmatory factor analysis in a structural equation modelling framework was used to establish structural validity by comparing four different pre-specified models of the indexes. Additionally, internal consistency, convergent and incremental validity, and retest reliability were examined. The FI models exhibited superior structural validity compared with similar models of the SFI, although all models had good fits. Internal consistencies with McDonald's omega were 0.89 and 0.87 for the FI and SFI, respectively. The five (FI) or six (SFI) domains were happiness & life satisfaction, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability (λ4  = 0.51-0.91). Convergent and incremental validity tests supported predefined hypotheses. Retest analyses with the FI and SFI showed a high degree of retest reliability. Based on the psychometric evidence reported in this study, the Danish Flourish Index and Secure Flourish Index seem suitable for use with healthy adult Danes. The authors hope that this psychometric evaluation of the FI and SFI will stimulate research on patterns, health and economic outcomes, and predictors of human flourishing in Denmark.

The characteristics of organized sport and physical activity initiatives for older adults in Sweden

There is a common understanding that sport and physical activity can be important to address healthy aging. There are individual-level recommendations about how much physical activity people of different ages should engage in to gain health benefits, but at the same time there are no recommendations for how organizations should organize physical activities to suit as many people as possible for as long as possible. The purpose of this study was to explore the characteristics of sport and physical activity initiatives that older adults participate in. Different ongoing sport and physical activity initiatives that involve older adults were investigated regarding their focus, organization, intensity and organizer, and in relation to their costs, booking opportunities and recruitment. The study was conducted with a cross-sectional design using the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ). The study included 27 different initiatives with 372 participants (60% women) ranging from 60 to 96 years of age. A health-promoting, salutogenic settings-based approach, and specifically the concepts drop-in, drop-through and drop-over were used in discussing recommendations for the organization of sport and physical activity for older adults. The main findings were that who organizes the sport and physical activity initiative seems to affect the characteristics of how it is organized and what characterizes the participants in it. Despite the differing characters of sport and physical activity initiatives, the majority of older adults are recruited by internal contacts like friends and family. Which older adults participate in which initiatives is explained mostly by the age and gender of the participants. In conclusion, to attract as many older adults as possible, organizations should work with lowering the thresholds, as well as within and between, organizations, and raise the threshold for dropping out of sports and physical activity.

Music-based environmental therapy and training programme: a qualitative evaluation study, Norway

Various authors have emphasized music's value as beneficial intervention, with few or hardly any side effects. Further studies are called for on how music-based environmental treatment in nursing homes works in practice. The aims of the study are first to explore the subjective experiences, opinions and attitudes of health personnel from nursing homes participating in the 'music-based environmental therapy programme (MB programme); and second, to examine why and how this programme impacts on patients and staff, and how it works in practice. It is the first qualitative study to evaluate the impact of the programme on health personnel's daily practice in nursing homes. The sample was strategically selected by means of convenience sampling, and consisted of 26 (n = 26) nurses, managers, physiotherapists, social workers and carers from 11 nursing homes in the south-east of Norway. Data were collected in autumn 2019 using a methodological triangulation of in-depth interviews, focus groups and passive observation, and the data were analyzed using systematic text condensation. With systematic use of music in daily activities in the nursing homes, users became calmer and less outspoken, and the use of psychotropic drugs was greatly reduced. The MB programme seems to be a successful intervention that provides a unique opportunity to improve patients' health and well-being with minimal adverse effects. This new focus on non-pharmacological approaches makes investigation of alternatives to medication vital.

Reimagining Healthcare: Human-Animal Bond Support as a Primary, Secondary, and Tertiary Public Health Intervention

The emergence of human-animal support services (HASS)-services provided to help keep people and their companion animals together-in the United States has been driven by two global public health crises. Despite such impetuses and an increasing recognition of One Health approaches, HASS are generally not recognized as public health interventions. The Ottawa Charter, defining health as well-being and resources for living and calling for cross-sector action to advance such, provides a clear rationale for locating HASS within a public health framework. Drawing from Ottawa Charter tenets and using the United States as a case study, we: (1) recognize and explicate HASS as public health resources for human and animal well-being and (2) delineate examples of HASS within the three-tiered public health intervention framework. HASS examples situated in the three-tier framework reveal a public health continuum for symbiotic well-being and health. Humans and their respective companion animals may need different levels of intervention to optimize mutual well-being. Tenets of the Ottawa Charter provide a clear rationale for recognizing and promoting HASS as One Health public health interventions; doing so enables cross-sector leveraging of resources and offers a symbiotic strategy for human and animal well-being.

Association Between Sense of Coherence and Health Outcomes at 10 and 20 Years Follow-Up: A Population-Based Longitudinal Study in Germany

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.

How Does Office Design Support Employees' Health? A Case Study on the Relationships among Employees' Perceptions of the Office Environment, Their Sense of Coherence and Office Design

This study investigated the current design circumstances of an office as well as employees’ perceptions of the office environment in relation to their perceived health, drawing on sense of coherence theory (comprehensibility, manageability, and meaningfulness). Previous studies have related the physical office environment to employee health. However, most studies have focused on alleviating negative effects, while health-promoting potential, including employee sense of coherence, has been overlooked. This study adopted a mixed method case study approach, combining semi-structured interviews with employees, structured observations, and analysis of architectural drawings. The results indicated that employees’ perceptions did not always align with the ideas behind the architectural design and that employees understood the environment differently. The study also highlighted the interrelations (and contradictions) among the different components of sense of coherence. The findings imply that organizations may need to prioritize which components of coherence should be supported most by the office environment. It also suggests that case-specific design aspects should play a more central role in studying and conceptualizing healthy office design and that design solutions should be continuously modified during the use phase, while ensuring employees’ participation. The study concluded that an ‘ideal’ office environment should not be the goal. Instead, office design should provide an environment in which employees are able to cope with challenges in comprehensible, manageable and meaningful ways.

Meaningfulness among frail older adults receiving home-based care in Finland

Meaningfulness is a fundamental aspect in the promotion of frail older adults’ health and well-being. From a salutogenic point of view, meaningfulness is a vital component of a sense of coherence (SOC), since having a strong SOC aids toward assembling the resources needed to cope with stressors and manage tensions with success. In order to respond to the challenges of population aging and the need to enable frail older adults to live at home for as long as possible, it is important to explore their meaningfulness in the context of home-based care. A salutogenic framework was used to study meaningfulness. The aim was to explore what promotes meaningfulness among frail older adults. The study uses a hermeneutical approach and has a qualitative design. In total, 17 frail older adults were interviewed. The data were analyzed by content analysis. The results uncovered four themes that the respondents considered important in enhancing meaningfulness in daily life: home care personnel, outdoor activities and green spaces, cultural activities and spirituality. Our study revealed the important role of home care personnel as a resource in promoting meaningfulness in the context of home-based care. Hence, this group should be given sufficient resources, knowledge and competence for enabling meaningfulness and thus a SOC amongst frail older adults.

Self-identified motivators for physical activity: Perspectives of older residential care facility residents

OBJECTIVES

To inform strategies to increase physical activity amongst Older Residential Care Facility Residents (ORCFR), this research explored self-identified motivators for, benefits of and barriers to physical activity engagement.

METHODS

The research was framed within a salutogenic model of health, viewing health as a continuum shaped by one's health resources and life stressors. This exploratory qualitative research examined the physical activity experiences of seven ORCFR in Brisbane, Australia. Semi-structured interviews with open-ended questions assessed basic demographics, Physical Activity (PA) levels, perceived benefits of and barriers to PA. The resulting data underwent thematic analysis.

RESULTS

After seven interviews, data saturation was reached, revealing three major themes and seven subthemes. These were positive socialisation (inclusion) with subthemes of enjoying social contact and avoiding "zombieland" (loneliness). Negative socialisation (isolation) with subthemes of avoiding conflict and feeling awkward. Maintaining independence was the benefit, with subthemes of getting around to socialise, activities of daily living and preserving health to socialise.

CONCLUSION

Conventional physical activity programs emphasising medical and clinical benefits are disconnected from ORCFR motivators, as residents perceive benefits in terms of mobility and socialisation. This disconnect partially explains poor acceptability and uptake of ORCFR physical activity interventions over the last 25 years.

Learn, Have Fun and Be Healthy! An Interview Study of Swedish Teenagers' Views of Participation in Club Sport

In Sweden, participation in club sport is a vital part of many children’s lives. Despite this, many stop in their teenage years, raising questions concerning if and in what ways club sport can provide health-promoting activities via longer, sustained participation. The aim of this cross-sectional study is to explore and discuss young people’s views of club sport from a health-promoting perspective. The analysis draws on three sets of qualitative data: results from focus groups interviews conducted in 2007 (n = 14) and in 2016 (n = 8) as well as 18 in-depth interviews conducted 2008. Antonovsy’s salutogenic theory and his sense of coherence (SOC) model inspired the analysis. Teenagers want to be a part of club sport because of a sense of enjoyment, learning, belonging and feeling healthy. Teenagers stop when sport becomes too serious, non-flexible, time-consuming and too competitive. The urge for flexibility and possibilities to make individual decisions were emphasised in 2016. The organisation of club sport, it seems, has not adapted to changes in society and a generation of teenagers’ health interests. Club sport has the potential to be a health-promoting arena, but the focus should be on changing the club sport environment, instead of a focus on changing young people.

Is it possible to gain energy at work? A questionnaire study in primary health care

OBJECTIVES

The area of regenerative work is still close to unexplored. The aim was to explore the possibility for employees to gain energy at work.

METHODS

Questionnaire to all employees (n = 599) from different professions in public and private primary health care centers in one health care district in Sweden. The questionnaire, which had a salutogenic perspective, included information on self-rated health, psychosocial work environment and experiences, recovery, social climate, and energy. Having an energy-building experience was defined by a positive response to two combined questions regarding energy at work. Analyses were performed with bivariate correlation and multiple logistic regression.

RESULTS

The response rate was 84%. Health and energy correlated positively (r = 0.54). In total, 44.5% of the employees reported having an energy-building experience. Predictors for having an energy-building experience were recovery [positive odds ratio (POR) = 2.78], autonomy (POR = 2.26), positive workplace characteristics (POR = 2.09), and internal work experiences (POR = 1.88).

CONCLUSIONS

The results support the hypothesis that it is possible to gain energy at work, an area that is still close to unexplored. There is a high correlation between energy and health. Employees' energy-building experiences relate to well-being at work and correlates to recovery, autonomy, positive workplace characteristics, and positive internal work experiences. This knowledge can help in improving future work environment development.

'Singing has empowered, enchanted and enthralled me'-choirs for wellbeing?

Singing in groups is a global phenomenon and there is a growing body of evidence that singing can affect health and wellbeing. This is the first gender-based study to explore how women's perceptions of their own health and wellbeing can be affected by singing in a choir; and also how choral singing may have an impact on social inclusion. Qualitative data was collected from nine choirs in two regions of Norway. The sample consisted of 19 (n = 19) women aged 21-75 (mean age, 51.3.) who had sung in choirs from 6 months to 20 years (mean, 6.2 years). The sample population included those who identified as 'healthy' and those experiencing health issues such as cancer, depression, anxiety or fatigue. Two focus groups and 16 semi-structured interviews were carried out and the data were analyzed using grounded theory. Findings were that choral singing can affect women's perceptions of their wellbeing in four distinct ways: (i) through the joy of singing, (ii) experiencing singing as essential for survival, (iii) group singing as a route to social connection, which enhanced a sense of identity and of belonging, and thereby increased self-confidence and self-esteem and (iv) through promoting social inclusion. In the context of these findings, choral singing can be understood as a 'salutogenic' activity, that is, one that supports health and wellbeing. This has implications for self-care practice, social prescribing programs and public health policy.

Psychological Resilience of Volunteers in a South African Health Care Context: A Salutogenic Approach and Hermeneutic Phenomenological Inquiry

Volunteering in non-Western countries, such as South Africa, is subject to poor infrastructure, lack of resources, poverty-stricken conditions and often conducted by volunteers from lower socio-economic spheres of society. Sustaining the well-being of volunteers in this context is essential in ensuring their continued capacity to volunteer. To do so, it is important to understand the psychological resilience of these volunteers and the resistance resources they employ to positively adapt to their challenging work-life circumstances. The aim of this qualitative hermeneutic phenomenological study was to explore volunteers’ psychological resilience from a salutogenic perspective. In-depth interviews were conducted with eight volunteers servicing government-run hospitals. Data were analysed through phenomenological hermeneutical analysis. Findings show a characteristic work-life orientation to be at the root of volunteers’ resilience. Their work-life orientation is based on a distinct inner drive, an other-directedness and a “calling” work orientation. It is proposed that this work-life orientation enables volunteers in this study context, to cope with and positively adapt to challenging work-life circumstances and continue volunteering. The elements of their work-life orientation are presented as intrapersonal strength resources fundamental to their psychological resilience. It is suggested that organisations invest in developmental interventions that endorse and promote these intrapersonal strengths.

Workplace relationships impact self-rated health: A survey of Swedish municipal health care employees

BACKGROUND

The impact of positive social relationships on the health of municipal employees in the elder care sector in Sweden needs further examination.

OBJECTIVE

To explore the association between health and relationships among elderly care employees using a salutogenic perspective.

METHOD

Survey of all employees (n = 997) in special housing, home care and Disabled Support and Services in a Swedish municipality. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, social climate, and health-promoting workplace relationships.

RESULTS

The response rate was 69% . Results of a multivariable linear regression model showed four significant predictors of health: general work experiences, colleague belongingness and positive relationships with managers and care recipients. In another model, colleague belongingness was significantly related to satisfaction with care recipients, work, length of employment as well as general work experiences and relationships with managers.

CONCLUSION

Strengthening of positive work relationships, not only between workmates but also with managers and care recipients, seems to be an essential area for employee health promotion. Colleague belongingness may be deepened by development of a positive work climate, including satisfactory work experiences, positive manager relationships and a stable work force.

Wellness and Thriving in a Student Registered Nurse Anesthetist Population

With the creation of its Wellness Program, the American Association of Nurse Anesthetists (AANA) has advocated for renewed emphasis in education, research, and practice on anesthesia provider wellness. This research was designed to explore the relationship between student registered nurse anesthetists' perceived wellness and students' thriving throughout their academic program. Because of the multifactorial nature of wellness and its alignment with the AANA's wellness model, a salutogenic wellness framework provided the theoretical basis for this study. Four variables related to thriving in a nurse anesthesia program were studied in relationship to students' perceived wellness, measured using the Salutogenic Wellness Promotion Scale (SWPS): self-efficacy, academic achievement, technical clinical competence, and patients' perceptions of students' relational skills. Measurements were taken at 5 points during the academic program. There was a significant correlation, using multiple regression analysis, between SWPS and self-efficacy at times 1, 2, and 3, but not at times 4 and 5. The Emotional Score subscale of the SWPS significantly correlated with self-efficacy at the same intervals. Within the variable of student academic achievement, overall wellness negatively correlated with the National Board of Certification & Recertification for Nurse Anesthetists' Self-Evaluation Examination scores. These results have potential implications on nurse anesthesia education.

Good work ability among unemployed individuals: Association of sociodemographic, work-related and well-being factors

AIMS

The aims of this study were to describe the perceived work ability of unemployed individuals and to explore the association between perceived good work ability and sociodemographic, work-related and well-being factors.

METHODS

The data were derived from the Finnish Regional Health and Well-being Study (ATH) collected by postal and Internet-based questionnaires in 2014-2015. The random sample was selected from the Finnish National Population Register. The present study includes data from unemployed or laid-off respondents ( n=1975) aged 20-65 years. Logistic regression was used in the statistical analysis. Perceived work ability was measured with the Work Ability Score.

RESULTS

Factors significantly associated with good work ability were having young children living in the household, short-term unemployment, low or moderate physical strain in most recent job, moderate mental strain in most recent job, satisfaction with most recent job, good self-rated health and good quality of life. Good self-rated health (odds ratio=10.53, 95% confidence interval 5.90-18.80) was the most substantial factor in the multivariate model.

CONCLUSIONS

The findings provide further evidence on the factors related to good work ability of the unemployed. These factors should be considered when designing interventions for promoting work ability and to minimise the harmful effects of long-term unemployment.

Moving to Serene Nature May Prevent Poor Mental Health--Results from a Swedish Longitudinal Cohort Study

Green spaces are recognized for improving mental health, but what particular kind of nature is required is yet not elucidated. This study explores the effect of specific types of recreational nature qualities on mental health. Longitudinal data (1999/2000 and 2005) from a public health survey was distributed to a stratified sample (n = 24,945) of a Swedish population. People from rural or suburban areas (n = 9230) who had moved between baseline and follow-up (n = 1419) were studied. Individual geographic residence codes were linked to five predefined nature qualities, classified in geographic information systems (GIS). Any change in the amount of or type of qualities within 300 m distance between baseline and follow-up was correlated to any change in mental health (as measured by the General Health Questionnaire) by logistic regression models. On average, the population had limited access to nature qualities both pre- and post-move. There was no significant correlation between change in the amount of qualities and change in mental health. However, the specific quality “serene” was a significant determinant with a significantly decreased risk for women of change to mental ill-health at follow-up. The objective definition of the potentially health-promoting quality may facilitate implication in landscape practice and healthy planning.

Attitudinal factors protective against youth smoking: an integrative review

PURPOSE

This review examines recent literature with the purpose of uncovering associations between attitudinal factors and smoking among youth populations.

ORGANIZING CONSTRUCT AND METHODS

Researchers conducted an integrative review of the literature in late 2012 and early 2013. As inclusion criteria, potential articles were measured against the following statement: "There is valid evidence of (an) attitudinal factor(s) potentially associated with smoking among youth."

FINDINGS

Researchers employed the salutogenic model as a theoretical framework to analyze search results. The narrative synthesis indicates that primary attitudinal factors protective against smoking among youth include the following: (a) a perception that there is little benefit to smoking, (b) a belief that smoking is likely harmful and addictive in the short term, and (c) a denial that smoking provides stress abatement, makes one look cool or more grown-up, or is common and accepted. Moreover, research signals that youth who smoke often demonstrate essentially the opposite beliefs and attitudes.

CONCLUSIONS

Findings suggest attitudinal factors play a role in protection against youth smoking. Those youth who assign realistic values to smoking risks and benefits are more equipped to engage in the health-protective behavior of not smoking. Youth, adolescents, and young adults appear vulnerable to inappropriate designation of risk and benefit values of smoking. Theoretical interpretation suggests that bolstering attitudinal factors during youth might counteract immature risk assessment. These findings justify further research related to protective mechanisms against youth smoking and youth-based smoking prevention interventions.

CLINICAL RELEVANCE

The establishment of associations between attitudinal factors and protection against smoking can help determine interventions effective in reducing smoking among youth.

Green qualities in the neighbourhood and mental health - results from a longitudinal cohort study in Southern Sweden

BACKGROUND

Poor mental health is a major issue worldwide and causality is complex. For diseases with multifactorial background synergistic effects of person- and place- factors can potentially be preventive. Nature is suggested as one such positive place-factor. In this cohort study we tested the effect of defined green qualities (Serene, Space, Wild, Culture, Lush) in the environment at baseline on mental health at follow-up. We also studied interaction effects on mental health of those place factors and varied person factors (financial stress, living conditions, and physical activity).

METHODS

Data on person factors were extracted from a longitudinal (years 1999/2000 and 2005) population health survey (n = 24945). The participants were geocoded and linked to data on green qualities from landscape assessments, and stored in the Geographical Information System (GIS). Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated, and multivariate logistic analyses were performed.

RESULTS

Mental health was not affected by access to the chosen green qualities, neither in terms of amount nor in terms of any specific quality. However, we found a reduced risk for poor mental health at follow-up among women, through a significant interaction effect between physical activity and access to the qualities Serene or Space. For men the tendencies were similar, though not significant. Regarding the other three green qualities, as well as amount of qualities, no statistically certain synergistic effects were found. Likewise, no significant synergies were detected between green qualities and the other person-factors. Only advanced exercise significantly reduced the risk for poor mental health among women, but not for men, compared to physical inactivity.

CONCLUSIONS

The results do not directly support the hypothesis of a preventive mental health effect by access to the green qualities. However, the additive effect of serene nature to physical activity contributed to better mental health at follow-up. This tendency was equal for both sexes, but statistically significant only for women.Objective landscape assessments may be important in detangling geographic determinants of health. This study stresses the importance of considering interaction effects when dealing with disorders of multifactorial background.