Professional Documents
Culture Documents
125-733, 1993
Printed in Great Britain. All rights reserved
THE
STRUCTURE
Department
of the Sociology
Copyright
AND PROPERTIES
OF THE
COHERENCE
SCALE
SENSE
OF
AARON ANTONOVXY
of Health,
University
of the Negev,
Abstract-Previous
work of the author presents a salutogenic
theoretical
model designed to explain
maintenance
or improvement
of location on a health ease/disease
continuum. The models core construct,
the Sense of Coherence (SOC), was consciously formulated
in terms which are thought to be applicable
crossculturally.
The SOC scale which operationalizes
the construct
is a 29-item semantic differential
questionnaire,
its design guided by Guttmans facet theory. A 13-item version of the scale has also been
used. The purpose of the present paper is to present the extant evidence from studies conducted
in 20
countries for the feasibility, reliability and validity of the scale, as well as normative data.
In 26 studies using SOC-29 the Cronbach
alpha measure of internal consistency
has ranged from
0.82 to 0.95. The alphas of 16 studies using SOC-13 range from 0.74 to 0.91. The relatively few test-retest
correlations
show considerable
stability, e.g. 0.54 over a 2-year period among retirees.
The systematic procedure
used in scale construction
and examination
of the final product by many
colleagues points to a high level of content, face and consensual validity. The few data sets available point
to a high level of construct validity.
Criterion validity is examined by presenting correlational
data between the SOC and measures in four
domains: a global orientation
to oneself and ones environment
(19 rs); stressors (11 rs); health, illness
and wellbeing (32 rs); attitudes and behavior (5 rs). The great majority of correlations are statistically
significant. All available published normative data on SOC-29 and SOC-13 are presented, data which bear
upon validity using the known groups technique. Finally, the factor structure of the scale is considered,
pointing to one clear dominant
factor.
Key nsords-salutogenic
model,
Sense of Coherence,
facet design,
feasibility,
reliability,
validity
AARON ANTONOVSKV
726
721
RELIABILITY
Internal consistency
The Cronbach alpha measure of internal consistency
has been reported to me for 26 studies using SOC-29.
The average alpha, unweighted for sample size, in the
8 published studies is 0.91 (range, 0.86-0.95); in the
3 theses/dissertations,
0.85 (range, 0.82-0.86); in
the 15 unpublished studies, 0.88 (range, 0.83-0.93).
The alpha in those studies which have used SOC-13
is somewhat lower, as expected with fewer items, but
still acceptable. The average alpha, unweighted for
sample size, in the 5 published studies is 0.82 (range,
0.74-0.91); in the 4 theses/dissertations, 0.81 (range
0.78-0.84); in the 7 unpublished studies, 0.78 (range,
0.74-0.84). Kalimo and Vuori [23], using a method
developed by Tarkkonen, reported a reliability coefficient of 0.93 in their Finnish national study of 706
adults aged 31-44.
An instrument can be said to be reliable only with
respect to a given population. The fact that consistently high internal consistency has been found in
a considerable variety of populations, in different
languages and cultures-though
all Western-is
of
significance. It should also be noted that the fact that
the scale includes the three SOC components does not
lower internal consistency, an issue dealt with below
in the section on factor analysis.
Test-retest
VALIDITY
AARON ANWJNOVSKY
728
Table 1. Correlations
1st author
Ref. No.
Sample
validity
(from published
studies)
Variable
148
581
107
162
0.44
0.63
0.49
0.50
AntonovskyC
11
Israeli adolesc.
418
Camel
Hart (SOC- 13)
Radmacher
18
22
38
93
59
307
Anxiety: trait
state (routine)
state (exam)
Anxiety: trait
Anxiety: trait
Anxiety (MAACL-R)
Margalit
34
742
(SOC-13)
Margalit
(SOC-13)
Margalit
34
33
B. Perceived stressors
Camel
18
Kibbutz mothers,
control group
742
fathers of disabled,
127
Camel (SOC-13)
Larssond
I6
26
Kibbutz members
Swedish factory supervisors
93
68
230
217
Radmacher
38
U.S. undergrads.
307
Ryland (SOC-13)
Williams
39
45
U.S. faculty
284
U.S. nurses
162
19
Dahlin
Fiorentino
Ryland (SOC- 13)
Sagy
20
21
39
41
16
16
19
Kibbutz members
Kibbutz members
U.S. male patients,
55+
55+
Physical wellbeing
Functional ability
6 months predict to:
disability days
bed days
doctor visits
hosp., ER contact
Physical symptoms
Syst. blood pressure
Diast. blood pressure
Cholest., triglyc., and glucose
Serious. of illness
U.S.
16
19
Kibbutz members
U.S. male patients,
20
26
148
217
35
U.S. minority,
581
Petrieb
Dahlin
Sagy
(SOC- 13)
37
20
42
162
230
240
homeless women
107
adults
-0.27
PO.56
230
230
240
45
Nyamathi
PO.24
-0.40
0.42
0.32
Williams
Dahlin
Larssond
-0.24
- 0.67
Global
Global
217
55+
-0.32
NS
--0.22
-0.33
0.28
805
260
(SOC- 13)
0.32
0.11~.51
NS-0.24
0.47
0.46
0.19
0.62
26
Camel
Coe
0.26
0 22
0.20
148
118
284
Larssond
lrseS
Stressor perception:
at entry
end of 2nd year
Recent life events
Work load
Work control
Perceived stressors:
life events
Global Inventory
Perceived stressors:
life stress
work stress
Perceived strcssors:
life events
Global Inventory
-0.36
-0.17
0.23
6 months predict to
perceived health
Global health eval.
Health status
General wellbeing
240
adults
Eysenck personality:
neuroticism
psychoticism
extraversion
Fam. Env. Scale:
relationship
personal growth
system maint.
Fam. Env. Scale:
relationship
personal growth
system maint.
-0.61
NS
-0.31
PO.69
-0.75
-- 0.47
148
805
health index
health index
Psycho]. wellbeing
6 mos. predict to:
morale (ment. health)
Psychosom. (SCL-90)
Psych. symptoms
Subj. wellbeing
Subj. health status
Health measures:
emot. distress
somatic complaints
Millon Inventory:
wellbeing
distress
Quality of life
Life satisfaction
0.21
0.12
-0.35
-0.31
-0.22
NS
-0 26
-0.31
-0.17
NS
- 0.39
n.23
0.71
-0.70
-0.59
0.40
0.25
-0.63
- 0.46
0.64
-0.50
0.76
0.54
[continued
129
Table l-continued]
Larsso&
Notes
Used
%sed
Used
Used
U.S. undergrads.
12-l 6 year old Israelis
U.S. minority, homeless women
59
742
581
Interpars. support
Social skills
Sot. support avail.
Israeli retirees
805
26
217
35
42
581
805
22
34
35
9
Antonovsky
Nyamathi
Sagy
Sample
Ref. No.
1st author
(SOC-13)
Variable
,
NS
0.27
0.14
-0.39
NS
0.29
-0.53
-0.24
0.26
Prior to my publication of the SOC scale, two independent attempts were made to build scales designed
to measure the construct, based on its presentation
in my earlier book [l]. The researchers, being North
Americans, were, I believe, influenced by a cultural
emphasis on control and mastery. Rumbaut and
his colleagues at the University of California, San
Diego, developed a 22-item scale. In unpublished
data, they report a correlation of 0.64 between their
scale and SOC-29 in a study of 336 undergraduates.
Dana [47] found a correlation of 0.72 between the two
measures among 179 undergraduates. Danas study
also reported a significant though much lower correlation of 0.39 with the 40-item scale developed by
Payne [48].
In this context, one further study should be mentioned. Colby, an anthropologist at the University of
California, Irvine, and his colleagues have developed
the construct of Adaptive Potential, consisting of
three components:
adaptivity in the ecological
world, altruism in the social world, and creativity
in the interpretive world. The construct is measured
by a lOCitern scale. In an unpublished paper,
Colby carefully discusses the conceptual congruence and difference between adaptive potential
730
AARON
ANT~NOVSKY
2. Normat~vc
data
from
correlation
between the SOC and some measure of
health, illness and wellbeing. Of the 32 correlations,
only those for emergency room contacts and hospitalization in one study, and for levels of cholesterol,
triglycerides and glucose in another are not significant. The large majority of measures are based on
self-report,
which raises the question
of possible
contamination,
an issue of great import but which
cannot be discussed here. It should also be noted that
though the salutogenic
model assigns a primary
ruusal role to the SOC (though it rejects a simplistic
linear mode of thought and considers feedback), the
present paper excludes consideration
of the issue of
causality.
Finally, Part D presents data from five studies
relating to attitudes and behavior. It is of interest that
the two correlations
with a social support measure
are very low. It would take us too far afield to discuss
the theoretical issue raised, but one brief point may
be in place. In our discussion of the strong negative
relationship between the SOC and perceiving losses in
retirement [9], we noted that a person with a strong
SOC adopts attitudes and behaviors which are functional for coping. She or he activates those resources
which are seen as appropriate
when the need arises.
We may also note the correlations
with problem
(positive)
and emotion
(negative)-focused
coping,
which surely need exploring.
Swedish
hi-risk
childhood.
Kibbutz
fathers
(controls)
Israeli
retirees:
Kibbutz
Kibbutz
Israeh
Kibbutz
Finnish
Kibbutz
men. lge 65
mothers
grped.
the SOC-29
SD
CVA
14x
152.6
22.0
0.144
20
67
152 5
14.5
0.095
33
42x
152.
22 8
0. I87
41
130
152.2
22.8
0.150
41
33
(ccl~rtr<>l>)
Ref. No.
151.0
15.3
0.101
150.2
16.5
0.1 IO
adult
men
150.2
21.9
0 146
24
children
146.7
19.4
0.133
33
146 I
22.1
0.155
24
145.7
20.2
0. I39
41
145 0
23 4
0.161
41
140. I
22.6
0.161
fathers.
grped.
wine
MeaIl
student? at entq
w~~ple.
disabled
;rdult sample.
women.
w~mrn
age 60
Israeli
retirees:
u0me,,,
Crech
controls
I ci,ncrr
Kibbutz
56
men. age 61
medical
Finnish
41~
studies
.\
Sample
mothers.
qe
60
\tud\
dlxrbled
I45 11
childreti
IX
25
31
5st
139.6
36.4
0.260
I9
Finnish
wcme~~
138.6
23. I
0.167
43
138.6h
136.5
14.9
19.8
0 145
37
?
133.0
26.5
0.199
21
New
Unix. atudcntr.
Zeal.
chrome
lsraeh Jewish
US.
cerebral
pnin.
national
productwri
Israeli
52%
worker,.
pals).
U.S. undergradwees,
7X?;, women
w>plc
76 w~mcri
IX 33
I31
6X0 women
129.5
coeffic~rnt
a sample
0.x
24.5
30
0.189
117.0
of wrlatmn
(standud
dewationmean).
a measure
[49, p. XX]
Used 5 alternatwcs.
Item
I/
Hue
multlphed
by 7,5.
Here
f(,rmer
multlphed
by 29.
38
25
of heterogeneity
of responses in
from published
N
Sample
Kibbutz (religious), mean age 46
U.S. university faculty, men
U.S. university faculty, women
Kibbutz (secular), mean age 43
U.S. male pts at VA clinics, 55f
Israeli adolescent girls
Israeli adolescent boys
U.S. undergraduates
U.S. minoritv homeless women
TVA: coefficient of variation
a sample [49, p. 881.
%sed wording simplification
(standard
105
145
157
125
240
371
371
59
581
deviation/mean),
731
SD
CVA
Ref. No.
68.7
66.7
66.4
66.4
61.9
59.2
58.6
58.5
55.0b
10.0
9.8
10.6
9.9
17.8
11.0
10.4
12.1
0.7
0.146
0.147
0.160
0.149
0.288
0.186
0.177
0.207
-
16
39
39
16
19
34
34
22
35
a measure of heterogeneity
of responses in
in original. Here
former
132
AARON ANTONOVSKY
or
that
Second,
naire
change
as
is only
to improve
I have noted
one
legitimate
above,
tool.
the
been
made
Much
Hum.
question-
as advances
in
1990.
79-92,
Sourani
T. Family
adaptation.
J. Murr.
sense
of
Fam.
SO,
1988.
82, 293~-303,
1987.
20
21
22
23
24
25.
26.
27.
28.
Psych&.
82, 228-232,
1990.
Fiorentino
L. M. Stress: The high cost to industry.
Oct. Hlrh Nurs. 34, 217. 220, 1986.
Hart K. E., Hittner J. B. and Paras K. C. Sense of
coherence.
trait anxiety and the perceived availability
of social support. J. Res. Pers. 25, 1377145, 1991.
Kalimo R. and Vuori J. Work and sense of coherence:
Resources for competence
and life satisfaction.
Behur.
Med.
REFERENCES
Antonovsky
A. Heulth, Stress rmd Coping. Jossey-Bass,
San Francisco,
1979.
Antonovsky
A. Unraveling
the MysrerJ
qf Health.
Jossey-Bass,
San Francisco,
1987.
Antonovsky
A. Breakdown:
A needed fourth step in
the conceptual
armamentarium
of modern medicine.
Sot. Sci. Med. 6, 537-544,
1972.
Antonovsky
A. Conceptual
and methodological
problems in the study of resistance resources and stressful life
events. In Stressful Llje Et,ents: Their Nature und Effects
(Edited
by Dohrenwend
B. and Dohrenwend
B.),
pp. 245-258. Wiley, New York. 1974.
Antonovsky
A. A somewhat
personal
odyssey
in
studying the stress process. Stress Med. 6, 71-80. 1990.
A. and
10 Antonovsky
coherence
and family
questionnaire.
a closed
A. The structural
sources of salutogenic
6 Antonovsky
strengths.
In Personality and Stress: Individual Differences in the Stress Process (Edited by Cooper C. L.
and Payne R.), pp. 67-104. Wiley, New York, 1991.
7 Shye S. (Ed.) Theory Construction and Dafa Analysis
in the Behavioral Sciences. Jossey-Bass,
San Francisco,
1978.
A. The sense of coherence: Development
8 Antonovsky
of a research instrument.
NewsIerI. Res. Rep., W. S.
Schwartz
Research
Center for Behavioral
Medicine,
Tel Aviv University, Vol. 1, I-1 1, 1983.
A., Adler I., Sagy S. and Vise1 R. Attitudes
9 Antonovsky
toward retirement in an Israeli cohort. Inr. J. Aging
16, 76-89,
1990.
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