A 3 year follow-up study of health care students’ sense of coherence and related smoking, drinking and physical exercise factors

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Abstract

The purpose of the study was to describe the sense of coherence (SOC) of three groups of Finnish polytechnic students (n=287) at the beginning of their studies and to follow it during a period of 3 year amongst the health care students (n=63) of this group. The associations between SOC and smoking, drinking and physical exercise were also studied. The data were collected with a questionnaire which included Antonovsky's (Adv. Nurs. Sci. 1(1983)37) SOC scale. Data analysis was with SPSS statistical software. The students showed a strong sense of coherence at the beginning of their studies. Physical activity was related to the strength of SOC, but no association was found with smoking and drinking. Health care students showed a stronger SOC at the beginning of their studies than the two other groups. During the follow-up focused on the health care students, SOC weakened in 6%, remained unchanged in 65% and strengthened in 32% of the participants. Smoking, drinking and physical exercise showed no association with these changes. Future research should be focused on identifying factors that are related to SOC during education.

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

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