Validity of Antonovsky's Sense of Coherence Scale – a systematic review

Nordic School of Public Health, Box 12133, S-40242 Gothenburg, Sweden.
Journal of Epidemiology &amp Community Health (Impact Factor: 3.5). 07/2005; 59(6):460-6. DOI: 10.1136/jech.2003.018085
Source: PubMed


The aim of this paper is to systematically review and analyse the validity and reliability of Antonovsky's life orientation questionnaire/sense of coherence scale (SOC).
The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses.
Worldwide, based on postgraduate scientific publications in eight authorized databases, doctoral theses, and available books.
The SOC questionnaire has been used in at least 33 languages in 32 countries with at least 15 different versions of the questionnaire. In 124 studies using SOC-29 the Cronbach's alpha ranges from 0.70 to 0.95. The alpha values in 127 studies using SOC-13 range from 0.70 to 0.92, and in 60 studies using a modified SOC scale range from 0.35 to 0.91. Test-retest correlation show stability and range from 0.69 to 0.78 (1 year), 0.64 (3 years), 0.42 to 0.45 (4 years), 0.59 to 0.67 (5 years) to 0.54 (10 years). The means of SOC-29 range 100.50 (SD 28.50) to 164.50 (SD 17.10) points and SOC-13 from 35.39 (SD 0.10) to 77.60 (SD 13.80) points. After 10 years SOC seems to be comparatively stable, but not as stable as Antonovsky initially assumed. SOC tends to increase with age. The factorial structure of SOC seems rather to be multidimensional than unidimensional. SOC predicts a positive outcome in a long term perspective, although there are divergent findings reported. The SOC scale seems to be a reliable, valid, and cross culturally applicable instrument measuring how people manage stressful situations and stay well.

Download full-text


Available from: Bengt Lindström, Jul 16, 2014
  • Source
    • "The questionnaire has been discussed and found to be valid and reliable [31]. Weak SOC is estimated at a cut-off of ≤57 and strong SOC as ≥75 [30] [31]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: j o u r n a l h o m e p a g e : w w w. S c a n d i n a v i a n J o u r n a l P a i n. c o m • Patients with chronic pain treated at a conventional pain clinic showed high complexity of pain and pain-related problems. • Patients' suffering included very low health-related quality of life, high pain-related disability and insomnia. • One year after a multimodal rehabilitation programme, patients' health-related quality of life, insomnia, pain-related disability and kinesiophobia had significantly improved. • Multimodal rehabilitation at a conventional pain clinic is a successful treatment option. a b s t r a c t Background and aims: Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment , there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. Methods: A prospective, observational study with a one-year follow-up was performed. Subjects: A total of 42 individuals (38 females, age 44.0 ± 12.3 years and 4 men age 40 ± 8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records. Results: The PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1 ± 0.282, and EQ VAS of 32.67 ± 20.1), moderate insomnia (ISI 18.95 ± 6.7), doubtful cases of depression and anxiety (HADS-depression 9.35 ± 4.1 and HADS-anxiety 9.78 ± 3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8 ± 9.8), as well as moderate current pain (VAS 61.31 ± 20.4). The sense of coherence was weak (SOC of 51.37 ± 14). At one-year follow-up, significant (p ≤ 0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified. Conclusions: MMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics. Implications: Since access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.
    Scandinavian Journal of Pain 01/2016; 10(10):36-42. DOI:10.1016/j.sjpain.2015.08.008
  • Source
    • "In a systematic review regarding the validity and reliability of the SOC scale, the Cronbach α ranged from 0.70 to 0.92(Lindstrom and Eriksson 2005). Our study reported a Cronbach α value of 0.784 which is acceptable. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To assess the content validity and reliability of the 13-item Sense of Coherence (SOC) scale among 13-15 year old school children in Chennai city. Participants: A total of 258, 13 – 15 year old ethnic Dravidian students from two randomly selected schools within Chennai city, present on both days of the study were included. Study design: A cross sectional study. Method: The 13-item Sense of Coherence questionnaire was translated to the vernacular, back translated and subjected to expert opinion to check its validity. The 13-item SOC questionnaire was used to assess the Sense of Coherence of the selected school students. The questionnaire was re-administered after one week to measure to measure Internal consistency reliability and Infraclass correlation coefficient. Results: The Internal consistency reliability checked using Cronbach α was found to be 0.784. The intra class correlation coefficient was 0.7 and remained the same with an item deleted. Conclusion: Our results suggest that the 13 item SOC questionnaire is a valid and reliable epidemiological tool among an adolescent Dravidian population in Chennai city. Further studies are recommended to assess the stability of SOC concept over a period of time.
  • Source
    • "The questionnaire is based on self-report, and the scale consists of 13 items on a seven-point Likert scale, and they cover the three dimensions of SOC: comprehensibility – the cognitive component (five items); manageability – the instrumental or behavioral component (four items); and meaningfulness – the motivational component (four items), The SOC-13 scale is regarded as a reliable and valid instrument, with a reported internal consistency (Cronbach's α) of 0.70-0.92 (Eriksson and Lindström, 2005). In the present study, the Cronbach's score was 0.65. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose - The purpose of this paper is to investigate changes in, and associations between, sense of coherence (SOC) and emotional distress in women who participated in an accredited motivational program (VINN) in correctional institutions in five countries. Design/methodology/approach - A prospective study with a pre- and post-test design included 316 participants from Sweden, Estonia, Denmark, Russia and Norway. Global emotional distress was measured by the Hospital Anxiety and Depression Scale. SOC was measured using the 13-item Orientation to Life Questionnaire. One-way analysis of variance and multilevel regression models were used in the statistical analyses. Findings - An increase in SOC was associated with a decrease in emotional distress. Emotional distress decreased significantly -3.80 points (95 percent CI (-4.61, -2.97)), and SOC significantly improved from pre- to post-measurement by 1.82 points (95 percent CI (0.72, 2.92)), regardless of country and correctional institution. Practical implications - The results add new knowledge regarding a coherent theoretical foundation of a motivational program for women. The ability of a program promoting health is important for researchers, health-care workers and facilitators delivering programs for women in correctional facilities. An increase in SOC can act as a protective factor in order to manage stressors and risk factors among women serving in correctional facilities. Originality/value - The present study indicates that enhancing women's coping resources and providing income alternatives to crime is fundamental to their capacity to desist from criminal behavior.
    International Journal of Prisoner Health 09/2015; 11(3):169-82. DOI:10.1108/IJPH-10-2014-0037
Show more