Health promotion seeks to empower individuals by providing them with greater self-confidence in the use of skills to increase control and improve their health. In the 70s, the Israeli sociologist Aaron Antonovsky introduced the term Salutogenesis, in response to the search for the factors that maintain and promote the health of people, rather than the risks and causes of the disease. The proposed model can be considered as a theoretical framework for health promotion because it focuses on finding solutions, helping people identify and using the necessary resources to overcome the problems that arise and maintain well-being (Nilsen, Bakke, Rohde, & Gallefoss, 2015). The central concepts of the salutogenic theory are the Sense of Coherence (SC) and the General Resources of Resistance (RGRs).
The SC is composed of three domains: comprehensibility (cognitive component), manageability (instrumental component) and significance (motivational component), the latter being the most important (Kocjan, 2015), the three interact with each other. The SOC develops from childhood with the experiences of life and is strengthened by using what he called General Resistance Resources RGRs, may be internal (physical and biochemical, valuative-attitudinal and cognitive-emotional) or external (material, interpersonal-relational and macro-sociocultural). Together the SOC and the RGRs are characteristics that help to manage and make sense of life; if a person has them at their disposal, there is a better opportunity to face the challenges of life (Højdahl, Magnus, Hagen, & Langeland, 2014).
A strong SOC allows people to see life as something coherent, organized, be able to handle it and feel that their own life is oriented towards goals that they want to achieve. Therefore, it represents the capacity to perceive that one is capable of handling any situation in life, giving it internal confidence and security to identify resources and use them in a way that promotes health (Trap, Rejkjær, & Hansen, 2016).
The aim of the integrative review was to synthesize the evidence in published studies that adopted a salutogenic framework to explore the relationship between sense of coherence physical and mental health as an approach that promotes health in people.
METHODOLOGY
In this integrative review, the methodology proposed by Whittemore and Knafl was followed that included problem identification, literature search, data evaluation, data analysis and presentation of results. At the literature search stage, performed a computerized search of the literature published from 2010 to December 2017 in the following databases: PUBMED / MEDLINE, CINAHL (EBSCO), PsychInfo (OVID), SCOPUS and SCIELO. Keywords used for this review were ”salutogénesis”, “sense of coherence", "adults". The studies were reviewed based on the following inclusion criteria: (i) original articles, (ii) available in full text, (iii) explicit use of the theoretical salutogenic framework. The exclusion criteria were the following: (i) persons under 18 years of age, (ii) publications other than English and Spanish.
In the data analysis process, data from primary sources are ordered, coded, categorized, and summarized into a unified and integrated conclusion. The evaluation of the quality was made taking into account the criteria of the CASPe critical reading guides. For the analysis of the data, a process of data reduction, data visualization, data comparison, schematization and extraction of conclusions was carried out. Of the 442 articles initially selected, 227 duplicate studies were eliminated, obtaining 215. On the basis of the inclusion and exclusion criteria, the title, summary and content were examined to reduce the 215 to 9 studies.
RESULTS
Characteristics of the studies
We identified nine quantitative studies, all conducted in European high-income countries, with 1493 participants. The sample varied from 84 to 509 participants. Product of the review were four studies that evaluated variables related to physical health such as presence of symptoms, physical limitation and healthy behaviors. On the other hand, five studies included psychological aspects such as the use of coping strategies, perception of the disease, satisfaction with treatment and emotional well-being.
Sense of coherence and physical health
The evidence in salutogenic research shows that SOC has an impact on health behaviors, the stronger the SOC the healthier the behavior. A person with a strong SOC less alcohol intake and cigarettes, performs more frequently and consumes a healthy diet (Silarova et al., 2014). On the contrary, a low SOC predicts some risk behaviors for health, higher risk of poor management of their disease and self-care. People with strong SOC may be better able to understand, adopt healthy behaviors and respond better to health-related advice.
Sense of coherence and mental health
To successfully face daily stimuli and stay healthy, the person must know how to deal with something, be able to carry it out and grasp the meaning of the actions taken. Patients with chronic disease with high SOC were better at it, perceived better health, quality of life and greater emotional well-being (Silarova, Nagyova, Rosenberger, Van Dijk, & Reijneveld, 2016). Therefore, a strong SOC protects from anxiety, depression, exhaustion and hopelessness. In contrast, people with weak SOC report more experience of symptoms such as mental fatigue, manifested in a negative perception of the disease, less motivation and difficulty concentrating in daily activities.
CONCLUSIONS
The salutogenic model has been able to play an important role in the development of health promotion, since it focuses on three aspects: problem solving / finding solutions, identifying the RGRs that help the person to move in the direction of positive health and the sense of coherence as a sense of the individuals, groups or populations that enable them to have a health-promoting orientation, which is associated with better physical and mental health.
The evidence demonstrates a greater application of salutogenic theory in Europe, the lack of studies in Latin America may reflect the lack of knowledge of salutogenic principles, which could have an impact on the development of health promotion programs.
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