Abstract
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.
You have full access to this open access chapter, Download chapter PDF
Similar content being viewed by others
Keywords
Introduction
Antonovsky (1987) developed a questionnaire to measure the sense of coherence. The original form, the Orientation to Life Questionnaire , consists of 29 items, 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, where 1 and 7 indicate extreme feelings about questions (and statements) about how one’s life is experienced (e.g., ‘when you talk to people, do you have the feeling that they do not understand you?’ is scored from 1 = never have this feeling to 7 = always have this feeling). The questionnaire is a summed index with a total score ranging from 29 to 203 points for the original scale of 29 questions (SOC-29) . A shorter version of 13 questions (SOC-13) of the original form was developed by Antonovsky (1987), where the score ranges between 13 and 91 points. Antonovsky intended that the sense of coherence scales be scored with a single total score and not component scores (Fig. 12.1), since he theorized that it was the sense of coherence in its totality that influenced movement along the ease/dis-ease continuum . This issue is taken up again later in this chapter.
Examples of items measuring the comprehensibility dimension are as follows (Antonovsky, 1987, p. 190ff.):
-
When you talk to people, do you have a feeling that they don’t understand you? (from ‘never have this feeling’ to ‘always have this feeling’)
-
Do you have a feeling that you are in an unfamiliar situation and don’t know what to do? (from ‘very often’ to ‘very seldom or never’)
The following items are examples that measure manageability:
-
When something unpleasant happened in the past your tendency was: (from ‘to eat yourself up about it’ to ‘to say “ok that’s that, I have to live with it” and go on’)
-
When you do something that gives you a good feeling: (from ‘it’s certain that you’ll go on feeling good’ to ‘it’s certain that something will happen to spoil the feeling’)
Meaningfulness is measured with items like these:
-
Doing the things you do every day is: (from ‘a source of deep pleasure and satisfaction’ to ‘a source of pain and boredom’)
-
When you think about your life, you very often: (from ‘feel how good it is to be alive’ to ‘ask yourself why you exist at all’)
Comprehensibility , the cognitive dimension , refers to the extent to which one perceives internal and external stimuli as rationally understandable, and as information that is orderly, coherent, clear, structured rather than noise—that is, chaotic, disordered, random, unexpected, and unexplained (Antonovsky, 1991, p. 39). The ability to create structure out of chaos makes it easier for us to understand one’s context and one’s own part in it, for example, one’s role in the family or in the workplace. A prerequisite to be able to cope with a stressful situation is that one can to some extent understand it. What one comprehends is easier to manage.
Manageability , the instrumental or behavioral dimension , defined as the degree to which one feels that there are resources at one’s disposal that can be used to meet the requirements of the stimuli one is bombarded by (Antonovsky, 1991, p. 40). Formal resources include, for example, social services and care staff in public and private organizations. Informal resources include, for example, family, circle of friends, colleagues, and significant others; in other words, people who are trusted and who can be relied on difficult situations. Coping also requires that one is motivated to solve the problems that cause stress, is willing to invest energy to solve the problem, and finds meaning in being able to manage the situation. This leads to the third dimension of the sense of coherence, meaningfulness.
Meaningfulness, the motivational dimension , refers to the extent to which one feels that life has an emotional meaning, that at least some of the problems faced in life a face are worth commitment and dedication, and are seen as challenges rather than only as burdens (Antonovsky, 1991, p. 41). One needs to have a clear desire to resolve difficulties, and willingness to invest energy to get through experiences of stress that have the potential to cause distress.
The Validity and Reliability of the Sense of Coherence
Face validity : The sense of coherence scales have been empirically tested in different cultures, both Western and cultures in Africa and Asia. Studies have been conducted on different samples: general populations, different professions, in persons with disabilities, different patient groups as well as in children, adolescents, adults, and elderly, in families, in organizations, and also on a societal level. A systematic research review shows that as of 2003, the SOC-29 and SOC-13 had been used in at least 33 different languages in 32 different countries (Eriksson & Lindström, 2005). An update shows that another 16 languages can be added: Albanian (Roth & Ekblad, 2006), Croatian (Singer & Brähler, 2007), Brazilian (Bonanato et al., 2009), Hungarian (Biro, Balajti, Adany, & Kosa, 2010), Korean (Han et al., 2007), Lingala (Bantu language spoken in parts of Africa) (Pham, Vink, Kinkodi, & Weinstein, 2010), Persian, Swahili (Rohani, Khanjari, Abedi, Oskouie, & Langius-Eklöf, 2010) as well as local languages in Africa Afar, Bilein, Hidareb, Kunama people, Nara, Saho, Tigre, and Tigrinya (Almedom, Tesfamichael, Mohammed, Mascie-Taylor, & Alemu, 2007).
Since 2003, the SOC-29 and the SOC-13 has been used in a further 13 countries (Eriksson, 2014): Eritrea (Almedom et al., 2007), Croatia (Pavicic Bosnjak, Rumboldt, Stanojevic, & Dennis, 2012), Hungary (Biro et al., 2010), India (Suraj & Singh, 2011), Iran (Rohani et al., 2010), Italy (Ciairano, Rabaglietti, Roggero, & Callari, 2010), Korea (Han et al., 2007), Kosovo, the Democratic Republic of Congo (Pham et al., 2010), Spain (Virues-Ortéga, Martinez-Martin, Del Barrio, Lozano, & Grupo Espanol, 2007), Sudan (Abdelgadir, Shebeika, Eltom, Berne, & Wikblad, 2009), Taiwan (Tang & Li, 2008), and Turkey (Öztekin & Tezer, 2009). More recent research shows three additional countries: Austria (Mautner et al., 2014), Estonia (Höjdahl, Magnus, Mdala, Hagen, & Langeland, 2015), and Malaysia (Rostami, Lamit, Khoshnava, & Rostami, 2014).
In sum, the SOC-29 and the SOC-13 have been used in at least 49 different languages in at least 48 different countries around the world (Fig. 12.2).
Construct validity : The structure of the sense of coherence is complex. Recent research shows that the sense of coherence seems to be a multidimensional construct rather than a unidimensional as proposed by Antonovsky (1987), with all three dimensions constantly interacting with each other and together to form a common, overarching factor, sense of coherence. Following from that, Antonovsky maintained that on theoretical grounds, one should avoid lifting out individual dimensions in order to examine them separately.
Nevertheless, recent research has focused on the study of the structure and content of sense of coherence. There are studies that support Antonovsky’s idea of the sense of coherence as a general factor with three dimensions (Antonovsky, 1993; Drageset & Haugan, 2015; Klepp, Mastekaasa, Sørensen, Sandanger, & Kleiner, 2007; Rajesh et al., 2015; Söderhamn & Holmgren, 2004; Söderhamn, Sundsli, Cliffordson, & Dale, 2015; Spadoti Dantas et al., 2014). Söderhamn et al. (2015) found evidence in a confirmatory factor analysis that confirmed the SOC-29 as one theoretical construct with three dimensions, comprehensibility, manageability, and meaningfulness. In a cross-sectional survey among Norwegian cognitively intact nursing home residents , Drageset and Haugan (2015) found that the three-factor model fit their data. However, the item ‘has it happened in the past that you were surprised by the behavior of people whom you thought you knew well?’ was troublesome, and removing this item resulted in a better fit. Recent research suggests that the sense of coherence seems to be a multidimensional concept consisting of many different dimensions rather than a single factor (Eriksson & Lindström, 2005; Feldt, 2007; Naaldenberg, Tobi, van den Esker, & Vaandrager, 2011). Figure 12.3 shows the sense of coherence as a multidimensional construct.
Sandell et al. (1998) examined the sense of coherence instrument among a sample of Swedes and could not find support for a common factor, nor the three dimensions of comprehensibility, manageability, and meaningfulness. Three more or less stable dimensions emerged, where lust and depression were two extremes which could best be referred to the dimension of meaningfulness. Antonovsky’s concepts comprehensibility could in this study be seen in the form of tolerance versus intolerance. The third factor, manageability, was reflected by trust and distrust (Sandell et al., 1998, p. 701).
Consensual validity is a term that indicates the extent to which various scientists agree on the properties of an instrument (Cooper, 1998). The consensual of validity is somewhat weak. While many researchers use either the SOC-29 or the SOC-13 , there are also many different modified versions in use, with different numbers of questions and different possibilities of response options. Most of the modified versions have partially abandoned the original scale of 1–7 points (but the wording of the questions is usually the same as in the SOC-29 and SOC-13). Results from a research review 1992–2003 showed that there were at least 15 different modified forms from form consisting of only three questions to 28 questions (Eriksson & Lindström, 2005). This includes the special version adapted for families (FSOC) (Antonovsky & Sourani, 1988; Sagy & Antonovsky, 1992), for children (Margalit & Efrati, 1996), and a version for a school context (Nash, 2002). The Children’s Orientation to Life Scale consists of 16 questions plus 3 distracters (Idan & Margalit, 2014; Margalit & Efrati, 1996). The response options follow a scale of 1–4, where 4 indicates the highest degree of sense of coherence. There are also two variants of the FSOC , the original with 26 questions and a shorter version with 12 questions (Antonovsky & Sourani, 1988; Sagy, 2008; Sagy & Antonovsky, 1992). The questions are the same as in the original form, but tailored to the child or to a family context. Table 12.1 provides a summary of some of the other sense of coherence scales in the literature, demonstrating a range of items from 3 to 16, and intended for use by various sociodemographic groups.
Antonovsky (1979) originally described the sense of coherence as an individual property. He later widened the perspective (Antonovsky, 1987) with sense of coherence also conceived at the family level. Recent research shows that the sense of coherence concept and measurement also can be applied in organizations such as a workplace (Bauer & Jenny, 2012; Bringsén, 2010; Bringsén, Andersson & Ejlertsson, 2009; Forbech & Hanson, 2013; Graeser, 2011; Mayer & Krause, 2011; Mayer & Boness, 2011; Nilsson, Andersson, Ejlertsson, & Troein, 2012; Orvik & Axelsson, 2012; Vogt, Jenny & Bauer, 2013).
Research that examines and discusses salutogenesis and the sense of coherence at a societal level is sparse. Braun-Lewensohn and Sagy (2011) report findings from studies using an instrument adapted for societal sense of coherence (Sense of Community Coherence), which contains seven questions describing how the individual experiences the society in terms of comprehensibility, manageability, and meaningfulness. Comprehensibility at the societal level addresses the experience of society as more or less organized in a way that makes life somewhat predictable, that the structure of society can be more or less understood, and that society is perceived as more or less safe and secure. Manageability is a state in which the individual experiences a society with resources that support individuals, for example , in emergencies or in critical situations. Societal support includes, for example, programs to support young people’s mental health and initiatives to create conditions so that people from different generations can meet each other. Meaningfulness refers to the experience that society supports people to experience fulfillment, to develop their abilities, and to feel satisfaction with life (Braun-Lewensohn & Sagy, 2011, p. 535).
The relevance of salutogenesis and the sense of coherence to the building of healthy public policy has also been a focus of theorizing and research (Eriksson, Lindström, & Lilja, 2007; Lindström & Eriksson, 2009). To develop a social policy based on the salutogenic framework means to identify resources for health and welfare of the society, in the past as well as in the present, including risks of illnesses, and how this knowledge and the most effective measures can be used to resolve the current challenges. The core of such policy is to create coherence and synergies, from individuals to groups and organizations in the local community, and finally to the whole of society (Eriksson & Lindström, 2014; Lindström & Eriksson, 2009).
Criterion validity: Eriksson and Lindström (2005) present information about the relation between the SOC-29 to other instruments measuring health, perceived self, stressors, quality of life, well-being, attitudes, and behaviors. The correlation with health ranges in general from slight to good, using instruments such as the General Health Questionnaire, the Health Index, the Hopkin’s Symptom Checklist, and the Mental Health Inventory, with such health measures explaining up to 66 % of the variance in the SOC-29. There are numbers of studies on the relation between SOC and quality of life and well-being. In general, they show that a high SOC is related to a high quality of life Eriksson and Lindström (2005).
Predictive validity : The ability of an instrument to predict how, for example, health develops in the future is called predictive validity (Abramson & Abramson, 1999). The predictive validity of the sense of coherence questionnaire seems to be relatively good, based on a review of longitudinal studies (Eriksson & Lindström, 2005). There are studies that support predictive ability (Lundman et al., 2010; Luutonen, Sohlman, Salokangas, Lehtinen, & Dowrick, 2011; Poppius, Virkkunen, Hakama & Tenkanen, 2006; Surtees, Wainwright, Luben, Khaw, & Day, 2003), whereas other studies have not done so (Norekvål et al., 2010). It seems the time for follow-up is an important factor for the predictive ability of the instrument. The results of a study among elderly persons, the Umeå 85+ study, show that the sense of coherence predicted mortality at 1-year follow-up, but not at follow-up after 4 years (Lundman et al., 2010).
Reliability : SOC-29 test–retest correlations range from 0.69 to 0.78 (1 year), 0.64 (3 years), 0:42 to 00:45 (4 years), 0:59 to 0.67 (5 years), and finally 0:54 after the 10-year follow-up (Eriksson & Lindström, 2005). The internal consistency measured by Cronbach’s alpha ranges from 0.70 to 0.95 using SOC-29 (124 studies) and 0.70 to 0.92 (127 studies) using SOC-13 (Eriksson & Lindström, 2005, p. 463). The sense of coherence scale shows high internal consistency.
Critique of the SOC-29 and SOC-13
One indirect form of criticism has practical roots: as mentioned earlier, various sense of coherence measures have been developed that are shorter than even the SOC-13, as short as just three items. This reflects the reality that in many health survey applications, questionnaires must be very short. More directly, the SOC-29 and SOC-13 have been criticized on the basis of supposed shortcomings in the instruments’ psychometric properties (Korotkov, 1993; Larsson & Kallenberg, 1999; Schnyder, Büchi, Sensky, & Klaghofer, 2000). It is asserted also that the sense of coherence concept does not deal adequately with emotional aspects of life experience (Flannery & Flannery, 1990; Flensborg-Madsen, Ventegodt, & Merrick, 2006c; Korotkov, 1993; Korotkov & Hannah, 1994). Inconsistent evidence about the lability/stability of the sense of coherence over the life course has also been noted by critics (Geyer, 1997). Criticism of salutogenesis generally includes implicit doubt about efforts to measure the sense of coherence via any means (Bengel, Strittmatter, & Willman, 1999; Kumlin, 1998). The leveling of such criticism is welcome as part of the healthy evolution of a ‘living’ theory or model, and responses to the critics are published (Eriksson, 2007; Lindström & Eriksson, 2010).
In the limits of this chapter, we focus on just the critical ideas of Trine Flensborg-Madsen, Søren Ventegodt and Jaov Merrick. The critique stems from their conclusion that the SOC-29 and SOC-13 are only moderately-to-weakly related to various measures of physical health (Flensborg-Madsen, Ventegodt, & Merrick, 2005a), leading them to construct and test a new measure of the sense of coherence, intended to overcome limitations in the SOC-29 and SOC-13 (Flensborg-Madsen, Ventegodt, & Merrick, 2006a, 2006b). Their critique can be summarized in this way:
-
Antonovsky presumed that one’s internal and external environment have to be predictable in order for a person to have a high sense of coherence
-
Predictability should not be included in conceptualizing and measuring the sense of coherence, because lack of predictability is not necessarily unhealthy
-
Rather, unpredictability is what makes life matter in the first place; it can provide a state of initiative, energy, and positive attitudes
Since the SOC-29 includes several items that have to do with predictability, Flensborg-Madsen, Ventegodt, and Merrick (2005b) regard the instrument as flawed and they developed an alternative 9-item measure that excluded the concept of predictability, but that otherwise was purportedly built, as they write, on the exact same idea, theory, and conceptualization used by Antonovsky (Flensborg-Madsen et al., 2006a, 2006b).
Their conclusion about a weak association between the SOC-29 and SOC-13 and physical health is based on a review of about 50 studies (2005a). They categorize the health instruments in the reviewed studies as having foci on: physical health, biological measures, psychological measures, health measures incorporating psychological aspects, stress, and behavioral aspects. They conclude that the SOC scales are unable to explain health that is measured only by means of physical terms (Flensborg-Madsen et al., 2005a, p. 665). As a solution, Flensborg-Madsen et al. (2006c) propose the concept of ‘emotional coherence’ in relation to physical health and ‘mental coherence’ in relation to psychological health supported by Endler, Haug, and Spranger (2008).
Such fragmentation of the concept of the sense of coherence into physical and mental components breaks significantly from Antonovsky’s fundamental notion of an ‘orientation to life’ (1979, 1987). Such fragmentation also reinforces the physical health/mental health divide in modern health care (and in the public’s imagination), which has been challenged vigorously (WHO, 2001).
We move on to the issue of excluding predictability in sense of coherence measurement; to do so is to depart emphatically from ‘the exact same idea, theory and conceptualization’ used by Antonovsky’, who wrote:
From the time of birth, or even earlier, we constantly go through situations of challenge and response, stress, tension, and resolution. The more these experiences are characterized by consistency, participation in shaping outcome, and an underload-overload balance of stimuli, the more we begin to see the world as being coherent and predictable. When, however, one’s experiences all tend to be predictable, one is inevitably due for unpleasant surprises that cannot be handled, and one’s sense of coherence is weakened accordingly. Paradoxically, then, a measure of unpredictable experiences-which call forth hitherto unknown resources—is essential for a strong sense of coherence. One then learns to expect some measure of the unexpected. When there is little or no predictability, there is not much one can do except seek to hide until the storm (of life) is over, hoping not to be noticed. Or else one strikes out blindly and at random until exhaustion sets in. No defense mechanisms can be adequate. We must note an implicit assumption here. If a strong sense of coherence is to develop, one’s experiences must be not only by and large predictable but also by and large rewarding, yet with some measure of frustration and punishment. (Antonovsky, 1979, p. 187)
As this extended passage makes clear, reasonable predictability functions inextricably with many other aspects of experience to shape the sense of coherence.
Sense of Coherence Develops Over Time
According to Antonovsky (1987) sense of coherence develops until the age of about 30 years, thereafter sense of coherence was estimated to remain relatively stable until retirement, after which a decrease was expected. This assumption finds no support in subsequent empirical research. The sense of coherence seems to be relatively stable over time , but not as stable as Antonovsky assumed. Research shows that sense of coherence develops over the entire life cycle, that is, it increases with age (Feldt et al., 2007; Nilsson, Leppert, Simonsson & Starrin, 2010). Nilsson and coauthors were able to demonstrate on a sample of 43,500 Swedish respondents, aged 18–85 years, that sense of coherence increases with age in both men and women. Support for a corresponding development of the sense of coherence over time could also be seen in a longitudinal study of more than 18,000 Finns, in the Health and Social Support Study, where the sense of coherence continuously increased with age. A strong sense of coherence initially appears to determine its development over time (Feldt et al., 2011). There is a lack of longitudinal studies with long-term follow-up. The longest follow-up is that of 13 years (Hakanen, Feldt, & Leskinen, 2007). Table 12.2 shows findings from longitudinal studies with different time spans for follow-ups.
Salutogenesis Is More than the Measurement of the Sense of Coherence
Salutogenesis, focusing on health and on people’s resources, is something more than the measurement of the sense of coherence. Today, we can talk about salutogenesis as an umbrella concept with many different theories and concepts with salutogenic elements and dimensions (Lindström & Eriksson, 2010). There is extensive research that focuses on the resources of individuals, groups, and communities. All this and more can be accommodated under the common umbrella. Figure 12.4 shows some related concepts to the sense of coherence collected under an umbrella.
References
Abdelgadir, M., Shebeika, W., Eltom, M., Berne, C., & Wikblad, K. (2009). Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation. Tohoku Journal of Experimental Medicine, 217, 45–50.
Abramson, J. H., & Abramson, Z. H. (1999). Survey methods in community medicine. Epidemiological research programme evaluation clinical trials (5th ed.). Edinburgh: Churchill Livingstone.
Almedom, A. M., Tesfamichael, B., Mohammed, Z. S., Mascie-Taylor, C. G. N., & Alemu, Z. (2007). Use of “Sense of Coherence (SOC)” scale to measure resilience in Eritrea: Interrogating both the data and the scale. Journal of Biosocial Science, 39(1), 91–107.
Antonovsky, A. (1987). Unraveling the mystery of health. How people manage stress and stay well. San Francisco: Jossey-Bass Publishers.
Antonovsky, A. (1993). The salutogenic approach to aging. Lecture held in Berkeley, January 21, 1993.
Antonovsky, A., & Sourani, T. (1988). Family sense of coherence and family adaptation. Journal of Marriage and Family, 50, 79–92.
Bauer, G., & Jenny, G. J. (2012). Moving towards positive organisational health: Challenges and a proposal for a research model of organisational health development. In J. Houdmondt, S. Leka, & R. R. Sinclair (Eds.), Contemporary occupational health psychology: Global perspectives on research and practice (Vol. 2). Oxford: Wiley-Blackwell.
Bengel, J., Strittmatter, R., & Willman, H. (1999). What keeps people healthy? The current state of discussion and the relevance of Antonovsky’s salutogenic model of health. Cologne: Federal Centre for Health Education (FCHE).
Bergman, E., Årestedt, K., Fridlund, B., Karlsson, J.-E., & Malm, D. (2012). The impact of comprehensibility and sense of coherence in the recovery of patients with myocardial infarction: A long-term follow-up study. European Journal of Cardiovascular Nursing, 11(3), 276–283.
Biro, E., Balajti, I., Adany, R., & Kosa, K. (2010). Determinants of mental well-being in medical students. Social Psychiatry and Psychiatric Epidemiology, 45, 253–258.
Bonanato, K., Paiva, S. M., Pordeus, I. A., Ramos-Jorge, M. L., Barbabela, D., & Allison, P. J. (2009). Relationship between mothers’ sense of coherence and oral health status of preschool children. Caries Research, 43, 103–109.
Braun-Lewensohn, O., & Sagy, S. (2011). Salutogenesis and culture: Personal and community sense of coherence among adolescents belonging to three different cultural groups. International Review of Psychiatry, 23(6), 533–541.
Bringsén, Å. (2010). Taking care of others—What’s in it for us? Exploring workplace-related health from a salutogenic perspective in a nursing context. Doctoral thesis. Lund: Lund University.
Bringsén, Å., Andersson, I. H., & Ejlertsson, G. (2009). Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS). Scandinavian Journal of Public Health, 37(1), 13–19.
Ciairano, S., Rabaglietti, E., Roggero, A., & Callari, T. C. (2010). Life satisfaction, sense of coherence and job precariousness in Italian young adults. Journal of Adult Development, 17, 177–189.
Cooper, H. (1998). Synthesizing research. A guide for literature review. Thousand Oaks, CA: Sage.
Drageset, J. & Haugan, G. (2015). Psychometric properties of the Orientation to Life Questionnaire in nursing home residents. Scandinavian Journal of Caring Sciences, August 29, doi:10.1111/scs.12271
Endler, C. P., Haug, T. M., & Spranger, H. (2008). Sense of Coherence and physical health. A “Copenhagen interpretation” of Antonovsky’s SOC concept. The Scientific World Journal, 8, 451–453.
Eriksson, M. (2007). Unravelling the Mystery of Salutogenesis. The evidence base of the salutogenic research as measured by Antonovsky’s Sense of Coherence Scale. [Doctoral thesis]. Åbo Akademi University, Department of Social Policy. Folkhälsan Research Centre, Health Promotion Research Programme, Research Report 2007:1. Turku: Folkhälsan.
Eriksson, M. (2014). The salutogenic framework for health promotion and disease prevention. In D. I. Mostofsky (Ed.), The handbook of behavioral medicine. Hoboken: Wiley-Blackwell.
Eriksson, M., & Lindström, B. (2005). Validity of Antonovsky’s sense of coherence scale—A systematic review. Journal of Epidemiology & Community Health, 59(6), 460–466.
Eriksson, M., & Lindström, B. (2014). The salutogenic framework for well-being: Implications for public policy. In T. J. Hämäläinen & J. Michaelson (Eds.), Well-being and beyond. Broadening the public and policy discourse (pp. 68–97). Cheltenham: Edward Elgar.
Eriksson, M., Lindström, B., & Lilja, J. (2007). A sense of coherence and health. Åland, a special case. Journal of Epidemiology and Community Health, 61(8), 684–688.
Feldt, T., Metsäpelto, R.-L., Kinnunen, U. & Pulkkinen, L. (2007). Sense of coherence and five-factor approach to personality. Conceptual relationships. European Phychologist, 12(3), 165–172.
Feldt, T., Leskinen, E., Koskenvuo, M., Suominen, S., Vahtera, J., & Kivimäki, M. (2011). Development of sense of coherence in adulthood: A person-centered approach. The population-based HeSSup cohort study. Quality of Life Research, 20(1), 69–79.
Feldt, T., Lintula, H., Suominen, S., Koskenvuo, M., Vahtera, J., & Kivimäki, M. (2007). Structural validity and temporal stability of the 13-item sense of coherence scale: Prospective evidence from the population-based HeSSup study. Quality of Life Research, 16(3), 483–493.
Flannery, R. B., & Flannery, G. J. (1990). Sense of coherence, life stress, and psychological distress: A prospective methodological inquiry. Journal of Clinical Psychology, 46(4), 415–420.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2005a). Sense of coherence and physical health. A review of previous findings. The Scientific World Journal, 5, 665–673.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2005b). Why is Antonovsky’s sense of coherence not correlated to physical health? Analysing Antonovsky’s 29-item Sense of Coherence Scale (SOC-29). The Scientific World Journal, 5, 767–776.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2006a). Sense of coherence and physical health. Testing Antonovsky’s theory. The Scientific World Journal, 6, 2212–2219.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2006b). Sense of coherence and physical health. A cross-sectional study using a new scale (SOC II). The Scientific World Journal, 6, 2200–2211.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2006c). Sense of Coherence and physical health. The Emotional Sense of Coherence (SOC-E) was found to be the best-known predictor of physical health. The Scientific World Journal, 6, 2147–2157.
Forbech, V. H., & Hanson, A. L. (2013). Salutogenic presence supports a health-promoting work life. Journal of Social Medicine, 6, 890–901.
Geyer, S. (1997). Some conceptual considerations on the sense of coherence. Social Science & Medicine, 44(12), 1771–1779.
Government Offices of Sweden. (2006). The Convention of the Rights of the Child. [Elektronic]. Retrieved December 30, 2015, from http://www.regeringen.se/content/1/c6/04/09/98/b8de24c7.pdf
Government Offices of Sweden. (2008). UN:s convention on the Rights of Persons with disabilities. [Elektronic]. Retrieved December 30, 2015, from http://www.regeringen.se/content/1/c6/10/19/18/516a2b36.pdf
Government Offices of Sweden. (2011). United Nations. The Universal Declaration of Human Rights. [Elektronic]. Retrieved December 30, 2015, from http://www.regeringen.se/content/1/c6/18/37/41/3014596d.pdf
Graeser, S. (2011). Salutogenic factors for mental health promotion in work settings and organizations. International Review of Psychiatry, 23(6), 508–515.
Hakanen, J. J., Feldt, T., & Leskinen, E. (2007). Change and stability of sense of coherence in adulthood: Longitudinal evidence from the Healthy Child Study. Journal of Research in Personality, 41, 602–617.
Han, K., Lee, P., Park, E., Park, Y., Kim, J., & Kangh, H. (2007). Family functioning and mental illness a Korean correlational study. Asian Journal of Nursing, 10, 129–136.
Höjdahl, T., Magnus, J. H., Mdala, I., Hagen, R., & Langeland, E. (2015). Emotional distress and sense of coherence in women completing a motivational program in five countries. A prospective study. International Journal of Prisoner Health, 11(3), 169–182.
Holmberg, S., & Thelin, A. G. (2010). Predictors of sick leave owing to neck or low back pain: A 12-year longitudinal cohort study in a rural male population. Annals of Agricultural and Environmental Medicine, 17(2), 251–257.
Honkinen, P. L., Suominen, S., Helenius, H., Aromaa, M., Rautava, P., Sourander, A., et al. (2008). Stability of the sense of coherence in adolescence. International Journal of Adolescent Medicine and Health, 14(4), 587–600.
Idan, O., & Margalit, M. (2014). Socioemotional self-perceptions, family climate, and hopeful thinking among students with learning disabilities and typically achieving students from the same classes. Journal of Learning Disabilities, 47(2), 136–152.
Kalimo, R., Pahkin, K., Mutanen, P., & Toppinen-Tanner, S. (2003). Staying well or burning out at work: Work characteristics and personal resources as long-term predictors. Work & Stress, 17(2), 109–122.
Klepp, O. M., Mastekaasa, A., Sørensen, T., Sandanger, I., & Kleiner, R. (2007). Structure analysis of Antonovsky’s sense of coherence from an epidemiological mental health survey with a brief nine-item sense of coherence scale. International Journal of Methods in Psychiatric Research, 16(1), 11–22.
Korotkov, D. (1993). An assessment of the (short-form) sense of coherence personality measure: Issues of validity and well-being. Personal and Individual Differences, 14(4), 575–583.
Korotkov, D., & Hannah, E. (1994). Extraversion and emotionality as proposed superordinate stress moderators: A prospective analysis. Personal and Individual Differences, 16(5), 787–792.
Kumlin, T. (1998). Sense of coherence in theory, empiri and criticism. [In Swedish]. (Vol. 9). Stockholm: The Swedish Research Council.
Kuuppelomäki, M., & Utriainen, P. (2003). A 3 year follow-up study of health care students’ sense of coherence and related smoking, drinking and physical exercise factors. International Journal of Nursing Studies, 40(4), 383–388.
Larsson, G., & Kallenberg, K. (1999). Dimensional analysis of sense of coherence using structural equation modelling. European Journal of Personality, 13, 51–61.
Lindström, B., & Eriksson, M. (2009). The salutogenic approach to the making of HiAP/healthy public policy: Illustrated by a case study. Global Health Promotion, 16(1), 17–28.
Lindström, B., & Eriksson, M. (2010). The Hitchhiker’s Guide to Salutogenesis. Salutogenic pathways to health promotion. Helsinki: Folkhälsan and IUHPE Global Working Group on Salutogenesis.
Lövheim, H., Graneheim, U. H., Jonsén, E., Strandberg, G., & Lundman, B. (2013). Changes in sense of coherence in old age—A 5-year follow-up of the Umeå 85+ study. Scandinavian Journal of Caring Sciences, 27, 13–19.
Lundman, B., Forsberg, K. A., Jonsén, E., Gustafson, Y., Olofsson, K., Strandberg, G., et al. (2010). Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study. Archives of Gerontology and Geriatrics, 51(3), 329–332.
Luutonen, S., Sohlman, B., Salokangas, R. K. R., Lehtinen, V., & Dowrick, C. (2011). Weak sense of coherence predicts depression: 1-year and 9-year follow-ups of the Finnish Outcomes of Depression International Network (ODIN) sample. Journal of Mental Health, 20(1), 43–51.
Margalit, M., & Efrati, M. (1996). Loneliness, coherence and companionship among children with learning disorder. Educational Psychology, 16(1), 69–80.
Mautner, E., Ashida, C., Greimel, E., Lang, U., Kolman, C., Aalton, D., & Inoue, W. (2014). Are there differences in the health outcomes of mothers in Europe and East-Asia? A cross-cultural health survey. BioMed Research International, doi:10.1155/2014/856543
Mayer, C. H., & Boness, C. (2011). Concepts of health and well-being in managers. An organizational study. International Journal of Qualitative Studies on Health and Well-being, 6. doi:10.3402/qhw.v3406i3404.7143.
Mayer, C.-H., & Krause, C. (2011). Promoting mental health and salutogenesis in transcultural organizational and work contexts. International Review of Psychiatry, 23(6), 495–500.
Naaldenberg, J., Tobi, H., van den Esker, F., & Vaandrager, L. (2011). Psychometric properties of the OLQ-13 scale to measure Sense of Coherence in a community-dwelling older population. Health and Quality of Life Outcomes, 23(9), 37. doi:10.1186/1477-7525-9-37.
Nash, J. K. (2002). Neighborhood effects on sense of school coherence and educational behavior in students at risk of school failure. Children & Schools, 24(2), 73–89.
Nilsson, P., Andersson, I. H., Ejlertsson, G., & Troein, M. (2012). Workplace health resources based on sense of coherence theory. International Journal of Workplace Health Management, 5(3), 156–167.
Nilsson, K. W., Leppert, J., Simonsson, B., & Starrin, B. (2010). Sense of coherence and psychological well-being: Improvement with age. Journal of Epidemiology and Community Health, 64(4), 347–352.
Norekvål, T. M., Fridlund, B., Rokne, B., Segadal, L., Wentzel-Larsen, T., & Nordrehaug, J. E. (2010). Patient-reported outcomes as predictors of 10-year survival in women after acute myocardial infarction. Health and Quality of Life Outcomes,8, 140.
Orvik, A., & Axelsson, R. (2012). Organizational health in health organizations: Towards a conceptualization. Scandinavian Journal of Caring Sciences, 26(4), 796–802.
Öztekin, C., & Tezer, E. (2009). The role of sense of coherence and physical activity in positive and negative affect of Turkish adolescents. Adolescence, 44, 421–432.
Pavicic Bosnjak, A., Rumboldt, M., Stanojevic, M., & Dennis, C. L. (2012). Psychometric assessment of the croatian version of the breastfeeding self-efficacy scale-short form. Journal of Human Lactation, 28(4), 565–569.
Pham, P. N., Vink, P., Kinkodi, D. K., & Weinstein, H. M. (2010). Sense of coherence and its association with exposure to traumatic events, posttraumatic stress disorder, and depression in eastern democratic Republic of Congo. Journal of Traumatic Stress, 23, 313–321.
Poppius, E., Virkkunen, H., Hakama, M., & Tenkanen, L. (2006). The sense of coherence and incidence of cancer - role of follow-up time and age at baseline. Journal of Psychosomatic Research, 61, 205–211.
Rajesh, G., Eriksson, M., Pai, K., Seemanthini, S., Naik, D. G., & Rao, A. (2015). The validity and reliability of the Sense of Coherence scale among Indian university students. Global Health Promotion, April 20, doi:10.1177/1757975915572691
Rohani, C., Khanjari, S., Abedi, H. A., Oskouie, F., & Langius-Eklöf, A. (2010). Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: Psychometric properties. Journal of Advanced Nursing, 66, 2796–2806.
Rostami, R., Lamit, H., Khoshnava, S. M., & Rostami, R. (2014). The role of historical Persian gardens on the health status of contemporary urban residents: gardens and health status of contemporary urban residents. Ecohealth, 11(3), 308–321. doi:10.1007/s10393-014-0939-6
Roth, G., & Ekblad, S. (2006). A longitudinal perspective on depression and sense of coherence in a sample of mass-evacuated adults from Kosovo. Journal of Nervous and Mental Disease, 194, 378–381.
Sagy, S. (2008). Sense of Coherence in a family context. The International Seminar on Salutogenesis and The 1st Meeting of the IUHPE Thematic Working Group on Salutogenesis, Helsinki Finland, 12–13 May, 2008.
Sagy, S., & Antonovsky, A. (1992). The family sense of coherence and the retirement transition. Journal of Marriage and Family, 54(4), 983–994.
Sakano, J., & Yajima, Y. (2005). Factors structure of the SOC scale 13-item version in Japanese university students. Japanese Journal of Public Health, 52(1), 34–45.
Sandell, R., Blomberg, J., & Lazar, A. (1998). The factor structure of Antonovsky’s sense of coherence scale in Swedish clinical and nonclinical samples. Personality and Individual Differences, 24(5), 701–711.
Schnyder, U., Büchi, S., Sensky, T., & Klaghofer, R. (2000). Antonovsky’s sense of coherence: Trait or state? Psychotherapy and Psychosomatics, 69, 296–302.
Singer, S., & Brähler, E. (2007). Die “Sense of Coherence Scale”. Testhandbuch zur deutschen Version. Göttingen: Vandenhoeck & Ruprecht.
Spadoti Dantas, R. A., Silva, F. S., & Ciol, M. A. (2014). Psychometric properties of the Brazilian versions of the 29- and 13-item scales of the Antonovsky's Sense of Coherence (SOC-29 and SOC-13) evaluated in Brazilian cardiac patients. Journal of Clinical Nursing, 23(1-2), 156–165.
Söderhamn, O., & Holmgren, L. (2004). Testing Antonovsky’s sense of coherence (SOC) scale among Swedish physically active older people. Scandinavian Journal of Psychology, 45, 215–221.
Söderhamn, U., Sundsli, K., Cliffordson, C., & Dale, B. (2015). Psychometric properties of Antonovsky’s 29-item Sense of Coherence scale in research on older home-dwelling Norwegians. Scandinavian Journal of Public Health, 43(8), 867–874.
Suraj, S., & Singh, A. (2011). Study of sense of coherence health promoting behaviour in north Indian students. Indian Journal of Medical Research, 134, 645–652.
Surtees, P., Wainwright, N., Luben, R., Khaw, K.-T., & Day, N. (2003). Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom prospective cohort study. American Journal of Epidemiology, 158(12), 1202–1209.
Tang, S. T., & Li, C.-Y. (2008). The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life. Journal of Psychosomatic Research, 64, 195–203.
Virtanen, P., & Koivisto, A. M. (2001). Wellbering of professionals at entry into the labour market: A follow up survey of medicine and architecture students. Journal of Epidemiology and Community Health, 55(11), 831–835.
Virues-Ortéga, J., Martinez-Martin, P., Del Barrio, J. L., Lozano, L. M., & Grupo Espanol, E. (2007). Cross-cultural validation of Antonovsky’s Sense of Coherence Scale (OLQ-13) in Spanish elders aged 70 years or more. Medicina Clinica, 128, 486–492.
Vogt, K., Jenny, G. J., & Bauer, G. F. (2013). Comprehensibility, manageability and meaningfulness at work: Construct validity of a scale measuring work-related sense of coherence. South African Journal of Industrial Psychology, 39(1), 8.
Volanen, S. M., Suominen, S., Lahelma, E., Koskenvuo, M., & Silventoinen, K. (2007). Negative life events and stability of sense of coherence: A five-year follow-up study of Finnish women and men. Scandinavian Journal of Psychology, 48(5), 433–441.
WHO. (2001). The World health report 2001: Mental health: New understanding, new hope. Geneva: World Health Organization.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Open Access This chapter is distributed under the terms of the Creative Commons Attribution-Noncommercial 2.5 License (http://creativecommons.org/licenses/by-nc/2.5/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
The images or other third party material in this chapter are included in the work’s Creative Commons license, unless indicated otherwise in the credit line; if such material is not included in the work’s Creative Commons license and the respective action is not permitted by statutory regulation, users will need to obtain permission from the license holder to duplicate, adapt or reproduce the material.
Copyright information
© 2017 The Author(s)
About this chapter
Cite this chapter
Eriksson, M., Mittelmark, M.B. (2017). The Sense of Coherence and Its Measurement. In: Mittelmark, M., et al. The Handbook of Salutogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-04600-6_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-04600-6_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-04599-3
Online ISBN: 978-3-319-04600-6
eBook Packages: MedicineMedicine (R0)