established. Health and disease are not mutually exclusive states, but extreme poles on a continuum (the health ease/dis-ease continuum). In between are states of relative health and relative disease.
The search for specific causes of disease, also referred to as the pathogenic approach, must be supplemented by the search for health-promoting or health-maintaining factors, known as the salutogenic approach. Antonovsky termed these factors “generalised re- sistance resources”. There are individual resistance resources, for example, physical fac- tors, intelligence or coping strategies, as well as social and cultural resistance resources like social support, financial power or cultural stability. Asking about resistance resources places the focus on the whole person and his or her biography and not on his or her ill- ness or symptoms only.
Antonovsky’s model proceeds in the tradition of stress and coping research. According to this approach, health is endangered by the detrimental influence of different kinds of stressors. In contrast to other stress researchers, Antonovsky contends that stressors are omnipresent and that their effects are not necessarily hazardous to health. Antonovsky proposes a distinction between tension and stress. In his opinion, the first reaction to stress is physiological tension. Whether or not this results in stress and is followed by processes detrimental to health depends on the appraisal and the coping reactions of the individual. The most important dimension that determines the outcome of these appraisal and coping reactions, as Antonovsky sees it, is the sense of coherence.
“The sense of coherence is a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable, and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engage- ment” (Antonovsky, 1987a, p. 19).
The stronger one’s sense of coherence, the more success one will have staying healthy. The SOC is made up of three components:
– The feeling of comprehensibility, – The feeling of manageability, and – The feeling of meaningfulness.
The feeling of comprehensibility refers to the ability to perceive the world as being ordered and structured and not as chaotic, arbitrary, random or inexplicable. The feeling of manageability concerns the conviction that problems have solutions and that one has
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Research and Pr actice of Health Promotion, Volume 4 enough resources available to meet the demands of the situation. The feeling of mean- ingfulness describes the extent to which one experiences life as emotionally meaningful and that problems and challenges are worth investing energy in.The special thing about the SOC is its orchestrating function. According to Antonovsky, the strength of the SOC determines the flexible and appropriate implementation of gen- eralised resistance resources which include the different coping styles.
The SOC develops in the course of childhood and adolescence. This development is com- plete at about the age of 30 and remains relatively stable thereafter. Antonovsky thus describes the SOC as a dispositional orientation. However, it is not comparable to a personality trait. In Antonovsky’s opinion, whether a weak or a strong SOC develops depends on the social circumstances and the socialisation in the family. He feels that a fundamental change in adulthood is only possible to a limited extent. Altering the SOC by means of psychotherapy can only be accomplished by long, hard work.
In order to measure the SOC, Antonovsky developed a questionnaire, the “Orientation to Life Questionnaire”, also called the SOC-scale, which is available in an abbreviated and in an extensive form. The empirical evidence from the examination of the questionnaire to date shows that the three dimensions of the SOC (comprehensibility, manageability, meaningfulness) cannot be observed individually, i.e., the scale measures only the total strength of the SOC. The instrument proves to have high reliability; in other words, it is an accurate measure.
Current State of Research
Despite the popularity of the concept of salutogenesis, our research revealed that, in the twenty years since Antonovsky introduced his model, no more than 200 studies have been published which examine the empirical foundation of the model. This shows that the model has attracted little attention in the scientific community. Even in the USA, which leads research in the health sciences, only few studies have been conducted.
The empirical foundation of the salutogenic model is limited to cross-sectional studies, which measure the relation between the SOC and diverse parameters of psychological and physical health and personality traits (e.g., physical complaints, anxiety, life satisfaction, stress perception, social support and health-related behaviour). These correlations do not allow conclusions to be drawn about causal relationships. If significant relationships between a high SOC and a health variable are established, it cannot be regarded as proof that the SOC is a causal factor (that is, a prerequisite or a cause) for health and health maintenance.
The SOC shows a high negative correlation with measures of mental health, like anxiety and depression; e.g., people that have a high SOC value are less anxious and depressed than those with a lower SOC value.