Keywords

Introduction

Aaron Antonovsky’s theory of salutogenesis (Antonovsky, 1987, 1996) has been used as a conceptual framework in Finnish literature since the 1980s in fields such as social policy (Söderqvist & Bäckman, 1988; Järvikoski, 1994; *Raitasalo, 1995, 1996; *Marski, 1996), medicine (*Uutela, 1992; *Vahtera, 1993; Suominen, 1993) and other health sciences (e.g. Pietilä, 1994, 1998). There have been certain features in the use of the theory of salutogenesis specific to the Finnish discussion. In the late 1980s, the discussion focused on the relationship between the concepts of life control and sense of coherence . Söderqvist and Bäckman (1988) expanded Antonovsky’s concept to include the idea of life satisfaction , naming the resulting concept as life control. Despite criticism directed at this idea, life control has been used in many studies (e.g. *Uutela, 1992; Häggman-Laitila, 1992; Härkäpää, 1993; Pietilä, 1994), and connections between life control and multidimensional health aspects , factors improving health choices and people’s ability to stay healthy have been identified. Bäckman (1990) and Suominen (1993) suggested that persons with strong life control consider themselves healthier than individuals with poor life control. Based on earlier research (*Vahtera, 1993; Pietilä, 1994; Söderqvist & Bäckman, 1988; Suominen, 1993), it is possible to find connections between life control, the sense of coherence, health, health choices and stress and a person’s ability to use his/her own resources successfully. The sense of coherence has been seen as an internal resource affecting the individual’s ability to use external resources (e.g. *Vahtera, 1993).

In this chapter, we focus on the research literature on salutogenesis published in Finnish. Our aim is to describe emerging themes. We also reflect on how salutogenesis is related to creating health as addressed in the Finnish literature.

Literature Searches

We conducted systematic literature searches in Melinda, a joint database for literature for all universities in Finland , and Medic, a national, scientific database for Finnish research publications. We used search terms concerning the theory of salutogenesis (e.g. koherenssi*, sense of coherence and salutogen*). We limited our search to the Finnish language and publications between 1980 and 2014. We included doctoral dissertations, chapters of text books and research papers . In addition, we conducted manual searches based on the reference lists of the selected publications and were able to find additional publications by using this approach.

We found 12 dissertations (Table 38.1), 9 chapters in textbooks (marked as * in the reference list) and six research papers (marked as ** in the reference list). The dissertations included qualitative and quantitative studies, as well as combinations of these approaches, for example mixed methods (Miettola, 2011). The literature included a cross-sectional study (Honkinen, 2009), follow-up studies (Kukkurainen, 2006; Ylilehto, 2005) and a study based on documents (Järvikoski, 1994).

Table 38.1 Doctoral dissertations in Finnish and aims/purpose
Full size table

Theoretical Basis of Salutogenesis

The textbook chapters were focused on the theoretical basis of salutogenesis. Lindström and Eriksson (2010) described a salutogenic approach to health (see also *Vertio, 2003; *Pietilä, 2010). They also summarised the meaning of the theory on the resources of health. *Raitasalo (1995) explored factors connected to coping in the context of social policy, and this book included discussion of well-being and coping strategies, and life control and sense of coherence. *Marski (1996) described the dimensions of welfare (threats, opportunities and new challenges). The well-being of the Finnish population was examined through questions concerning health, autonomy of agency, sense of coherence and standard of living (*Marski, 1996, see also Karisto et al.1992). A book by *Raitasalo, (1996) on the meaning of coping as a social policy concept was based on lectures and comments of researchers and report analysis.

Theoretical Explanations and Applications

The research papers focused on theoretical explanations and applications of salutogenesis or related concepts (e.g. **Häggman-Laitila, & Pietilä, 1993; Härkäpää, 1993). Salutogenesis as a theory or an approach was described in some articles, also including the context of diseases (**Lindström, & Eriksson, 2008; **Pietilä, Kangasniemi, & Halkoaho, 2013; Miettola, 2011). In a systematic review (**Pietilä, Matero, Kankkunen, & Häggman-Laitila, 2008), sense of coherence was considered to define a personal, global orientation. The aim was to describe and evaluate sense of coherence and related factors among adults with a long-term disease.

The themes that emerged in the dissertations (Table 38.1) focused on certain diseases and coping processes as well as resources, hope and strengthening factors among young people, the sense of coherence and health and also connections between these and mental health.

Some research themes focused on adolescents and families. One issue concerned the maintenance and strengthening of hope among young people (Tikkanen, 2012). The study pointed out that it is important that young people have faith in the existence of hope and that other people respect the hope of the young people.

Unique longitudinal research by Honkinen (2009) observed that childhood behavioural problems at the age of three predicted poor sense of coherence at the age of 18. Poor sense of coherence was associated with psychological symptoms and behavioural problems in adolescence. Contrary to assumptions in Antonovsky’s theory, there was no significant change in sense of coherence from the ages of 15–18, and the stability of sense of coherence did not depend on the initial level. Slight fluctuation at the individual level was perceived in the sense of coherence scores. When studied cross-sectionally, insufficient physical exercise, less than excellent marks in mathematics, weak sense of coherence, insufficient social support from teachers and perceived various problems in class climate were associated with perception of poor health in 12-year-old school children.

Eirola’ s (2003) dissertation aimed to produce evidence-based information for the promotion of the health of families. Life control was approached from the perspectives of life control potential: as a sense of coherence , satisfaction with life and interpersonal relationships. As a result, the parents’ self-esteem, motivation to develop their skills and commitment to the requirements of family life increased. The life satisfaction and social relationships were improved. Furthermore, the life control skills of the families with small children were enhanced.

A salutogenic study on women’s experiences during the puerperium indicated that those who suffered from severe depression were not devoid of coping methods (Ylilehto, 2005). The most important coping methods included seeking social support, keeping a distance, physical exercise, relaxation by reading, cognitive methods, religion and humour. The support given by one’s husband or significant other played an essential role in recovery.

Challenging questions have been addressed regarding integration processes, the sense of coherence typology and sense of coherence in persons belonging to vulnerable social groups. This research has included a focus on how changes in immigrants’ sense of coherence were connected to their social activities, Finnish language studies and work orientation during the integration process (Mammon, 2010).

A dissertation by Tuloisela-Rutanen (2012) examined the sense of coherence typology with the grounded theory method and found that the higher scores in the sense of coherence resulted in a higher amount of factors in the typology that increases integrity. The way in which various difficulties in everyday life are perceived by the individual is essential. Enhanced integrity improved the ability to deal with the challenges of life. We also found a study considering vulnerable groups of people; Kallio’s (2005) dissertation pointed out that prisoners’ sense of coherence strengthened when they received treatment for their substance abuse issues.

Kukkurainen (2006) described the sense of coherence, social support and quality of life of fibromyalgia patients. Health-related quality of life improved in the lowest sense of coherence category. Sense of coherence was higher among those who were satisfied with their life as a whole. Sense of coherence also correlated positively with the support received from relatives, health-related quality of life and life satisfaction.

Miettola’s (2011) mixed methods dissertation included a cohort survey and interviews regarding sense of coherence. The health survey produced information about the prevalence of metabolic syndrome (MetS) and its link to lifestyles, health-related quality of life (HRQoL) , mood and views of health. Three potential welfare intervention strategies were identified for the prevention of MetS, of which the first is the reinforcement of understanding and valuing of health. The second strategy involves strengthening inadequate external resistance resources, and the third one includes strengthening insufficient internal resistance resources.

Sohlman (2004) produced a functional model of mental health. This study concluded that respondents living in rural areas had a stronger sense of coherence and were more frequently satisfied with themselves than those living in urban areas. Men had stronger sense of coherence than women. A good socioeconomic situation and living with another person were factors that strengthened positive mental health.

Jaari (2004) investigated global self-esteem factors among Finnish men and women using the questionnaire presented by Morris Rosenberg (1965). He found no connection between gender and strength of the participants’ self-esteem. Higher level of education indicated better self-esteem. Poor life control and cynicism were linked to low self-esteem, whereas experiences of work-related skills and successes significantly enhanced the participants’ self-esteem.

Järvikoski (1994) analysed rehabilitation with different theoretical frameworks, including sense of coherence. She concluded that the clinical paradigm of rehabilitation does not meet the comprehensive problems caused by cultural and societal changes. She suggested introducing a concept of life control in rehabilitation , which covers the dimensions of experience, action and descriptive aspects of the life course.

Conclusions

A substantial part of the salutogenesis literature in Finnish appears in the form of doctoral dissertations. For pragmatic reasons, Finnish researchers select international journals in the English language for publishing their work. This invokes the question: are the authors of dissertations subsequently publishing aspects of their work in international journals, or is this considerable corpus of salutogenesis scholarship ‘trapped’ in the Finnish language?