A 3 year follow-up study of health care students’ sense of coherence and related smoking, drinking and physical exercise factors
Introduction
The concept of sense of coherence (SOC) was coined by Aaron Antonovsky (1979), Antonovsky (1983), Antonovsky (1987), Antonovsky (1996) to explain why some people remain healthy in the face of stressful situations and others fall ill. Antonovsky says that people have internal and external resources they can use in these kinds of situations. Sense of coherence refers to the individual's ability to apply these resources, which consist of three components: comprehensibility, manageability and meaningfulness. Comprehensibility refers to the ability to seek order and logical connections in what happens in the environment and belief in life's predictability. It also comprises the ability to understand other people and to control one's own thoughts and emotions. Manageability is faith in one's ability to cope and to exert an impact in life; it also includes a positive outlook on life in general. Finally, meaningfulness means that the individual is happy with life and considers it to have a meaning and purpose. Antonovsky's scale for the measurement of sense of coherence was published in 1983.
Antonovsky's theory of sense of coherence has received support from a number of studies which have shown that strong SOC correlates positively with low stress and the ability to cope with stress (e.g. Flannery et al., 1994; Bowman, 1996; Gilbar, 1998). It has also been reported that strong SOC is associated with good self-perceived health (Suominen, 1993; Harri, 1998; Sanden-Eriksson, 2000; Feldt, 2000). However, our knowledge of how SOC is associated with specific health habits remains patchy.
Earlier research has shown that strong SOC correlates positively with life-satisfaction and good quality of life (Motzer and Stewart, 1996; Karlsson et al., 2000). Furthermore it has been found that people with a strong SOC show less fatigue, depression, loneliness and anxiety than those with a weak SOC (Carstens and Spangenberg, 1997; Gilbar, 1998; Karlsson et al., 2000).
It seems that gender is not associated with the strength of SOC (e.g. Harri, 1998), but it has been found that SOC is strongest in young adults (Suominen, 1993; Carsten and Spangenberg, 1997; Harri, 1998). In addition, high socio-economic status correlates positively with strong SOC (Suominen, 1993).
Earlier research has shown that sense of coherence is dynamic by nature and changes over the individual's life-course. For instance, Karlsson et al., (2000) reported that 41% of coronary artery bypass patients showed changes in their SOC during a 1 year follow-up (15% stronger, 27% weaker). The measurements were taken before the operation and 1 year after the operation. Lundqvist (1995) demonstrated the impact of a planned intervention on sense of coherence, with medical and psychosocial therapy strengthening the SOC of young drug users. Nonetheless, our knowledge about how SOC changes and how it can be influenced remains incomplete.
Earlier studies have explored SOC in several different groups, but not among higher education students. However, Antonovsky (1987) points out that youth and student years are, a particularly, significant period to the development of SOC. It has been reported that weak life-control among young people is associated with unhealthy living habits, mental health problems, poor school success and marginalisation (Pietilä, 1994; Kunttu, 1997).
The purpose of this study was to measure the strength of SOC among Finnish polytechnic students and to monitor its development for 3 years among health care students. In addition we studied the association of smoking, drinking and physical exercise on sense of coherence. The study was anchored to Antonovsky's theory of sense of coherence. We address the following questions:
- (1)
What kind of SOC do health care, business and technology students show at the beginning of their studies at polytechnic and how are smoking, drinking and physical activity associated with the strength of SOC?
- (2)
How does the SOC of health care students at polytechnic change during the course of their studies and how are smoking, drinking and physical activity associated with the change?
Section snippets
Data collection instrument
The data were collected with a structured questionnaire which included 51 items, two of which concerned the respondents’ background. Sense of coherence was measured SOC as follows: There were 11 items concerning the comprehensibility of life: the respondent's and his or her fellow human beings’ ability to understand one another, experiences of the meaningfulness and logic of life's events, the ability to act and make decisions even in surprising situations and to understand and control one's
Associations of smoking, drinking and physical activity with SOC of all students
The mean SOC score for all three groups of students (n=287) at the beginning of their studies was 5.04 (range 2.96–6.46, S.D. 0.61). One-quarter (27%) showed a moderate SOC and the majority (73%) a strong SOC, indicating that these students are in a position to make good use of their internal and external resources to cope with stress. None of the students showed a weak SOC. Smoking and drinking was not associated with the strength of SOC. As far as physical exercise was concerned we found that
Discussion
The results of this pilot study showed that the SOC of health care, business and technology students at a Finnish polytechnic varied from moderate to strong at the beginning of their studies. Frequent physical activity was associated with a strong sense of coherence. Earlier studies have not reported any such connection. By contrast it has been reported in several studies that good self-perceived health correlates with a strong SOC (e.g. Harri, 1998; Sanden-Eriksson, 2000). Studies that have
Limitations
The participants in this study were recruited from one single polytechnic, so the results can only be generalised with caution to other polytechnic students in Finland. The number of health care students involved in the follow-up study was quite small and therefore the results reported here (such as those concerning the association of health habits with SOC) should be re-examined in the future with a larger sample. In keeping with Antonovsky's (1987) recommendation our examination of changes in
References (21)
The sense of coherence among nurse educators in Finland
Nurse Education Today
(1998)Cronic cannabis use and the sense of coherence
Life Sciences
(1995)Health, Stress and CopingNew Perspectives on Mental and Physical Well-being
(1979)The sense of coherence as a determinant of health
Advances in Nursing Science
(1983)Unraveling the Mystery of Health.How People Manage Stress and Stay Well
(1987)The salutogenic model as a theory to guide health promotion
Health Promotion International
(1996)Cross-cultural validation of Antonovsky's sense of coherence scale
Journal of Clinical Psychology
(1996)- et al.
The Practice of Nursing ResearchConduct Critique & Utilization
(1997) - et al.
Major depressiona breakdown in sense of coherence?
Psychological Reports
(1997) - Feldt, T., 2000. Sense of Coherence. Structure, Stability and Health Promoting Role in Working Life. Jyväskylä studies...
Cited by (81)
Association Between Sense of Coherence and Tobacco Use Among Brazilian Adolescent Students
2023, Substance Use and MisuseAre health behaviors associated with mental health among tertiary education students? A systematic review of cohort studies
2023, Journal of American College Health