SOC has attracted Walden student interest, as a result of Dr. Wagenfeld’s research in the area. Consequently, he has worked with a number of students in health services, public health, and psychology. To illustrate the utility of this model, four of these former students, now alumni, have generously agreed to share their research with us.

1. Bowe, N. (2003). The Relationship Between Sense of Coherence, Depression, and Burden in Male Primary Caregivers to Women With Breast Cancer.

The purpose of this study was to understand the experience of primary caregiving in the growing number of men in this role. The researcher investigated the relationship between SOC and perceived caregiver burden and depression in male primary caregivers to women with breast cancer, in order to (a) generate gender-appropriate support and education interventions and (b) affect policy regarding this group. Intervening variables included length of illness, stage of disease at diagnosis, and type of breast cancer. Research questions were guided by the importance of these variables in the literature.

The study involved a convenience sample of men providing primary care to women with breast cancer. The methodology consisted of a survey design with surveys self-administered on a passcode-secured Web site. Instruments measured SOC, caregiver burden, and depression. A total of 68 surveys was the statistical basis for this study.

A correlational design addressed the primary research questions with multiple regression analysis to determine the degree of variance between the selected predictor variables and SOC, the independent variable. SOC was used to predict the dependent variables of emotional outcomes, burden and depression, in male primary caregivers and the subsequent impact on quality-of-life issues for breast cancer patients.

Data were derived from three scales, measuring SOC, depression, and caregiver burden:

1. SOC scale (Antonovsky, 1987)
2. Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff & Locke, 1986; Radloff, 1977)
3. Zarit Burden Inventory (Zarit, 1999)

The respondents provided demographic information on the breast cancer patients in their care with patients ranging in age from 30 to 75 (mean age of 48.5 years). The patients had been ill a maximum of 9 years and a minimum of 3 months; on average, these patients had a diagnosis of breast cancer for 3 years. Invasive cancers were diagnosed in 69% of the patients, and 34% were already at stage 2 when the disease was first identified. Almost 30% of the patients were in stages 3–4 on diagnosis. In-situ cancers were reported at a rate of 24%.

Stage 0–1 cancers were reported in 36% of the women. A startling statistic found in the study, yet consistent with the literature, was that 50% of the African-American respondents and 50% of the Hispanic respondents reported that their family members were first diagnosed with invasive breast cancer in stages 3–4, compared to 23% of white family members.

The results of the study showed significant inverse relationships between SOC and the experience of burden and depression. Higher participant SOC scores were associated with lower scores for burden and depression. There were also significant correlations between length of illness, stage of disease at diagnosis, and the emotional outcomes.

The findings demonstrated that the diagnosis of breast cancer and the length of illness were significantly related to caregiver burden. As breast cancer progressed, burden increased. However, burden and depression did not seem to be related to treatment strategy.

SOC was thought to be a protective factor in the experience of caregiver burden, moderating the impact of negative life events. The study demonstrated a high significance between SOC scores and the participants’ self-reports of caregiver burden. Higher SOC scores correlated with significantly lower scores of caregiver burden. The study demonstrated significance of SOC across age groups and in relation to other caregiver factors: stage of disease, type of disease, length of illness, treatment strategy, and ethnicity of participants.

The study demonstrated a great significance between SOC scores and the participants’ self-reports of caregiver depression symptoms. Higher SOC scores correlated with significantly lower scores of caregiver depression. The study demonstrated significance of SOC across age groups and in relation to other caregiver factors: stage of disease, type of disease, length of illness, treatment strategy, and ethnicity of participants.

Although the caregiver burden scores appeared higher in the ethnic minority participants, other factors such as type of disease, stage of disease, and length of illness correlated significantly without ethnicity considerations. The strong relationships found in this study between SOC and emotional outcomes makes a case for using the SOC scale as a screening tool when determining the appropriate assistance and interventions in the care of breast cancer patients and their male primary caregivers.

2. Grota, B. L. (2005). The Relationship Among Coping Strategies, Perceived Stress, and Sense of Coherence.

This study addressed the lack of identified differences between those who manage stress well and those who do not. Specifically, the study investigated the distinctions among those who score as weak, moderate, or strong on the SOC scale with regard to (a) the total number of routinely used coping strategies, (b) the number of adaptive and less-adaptive coping strategies, and (c) the amount of perceived stress, either high or low. 

The study population comprised 385 undergraduate students from a small liberal arts university in the northeastern United States. Using a cross-sectional design, data was collected from three instruments: (a) the SOC scale, (b) the Perceived Stress Questionnaire, and (c) the Coping Orientations to Problems Experienced scale (COPE). Analysis of variance was the statistical method used to analyze the data. 

Results indicated that those with greater levels of SOC experienced less perceived stress, used more adaptive coping, and used significantly fewer of the less-adaptive coping strategies compared to those with lower levels of SOC. The total number of routinely used coping strategies was higher for those who were experiencing greater stress. Those low in perceived stress used fewer coping techniques in both the adaptive and less-adaptive categories. Those with moderate levels of SOC scored more consistently in the number and types of coping strategies employed with either high or low perceived stress.

This study provided empirical support of Antonovsky’s theory that those with a stronger SOC perceive less stress and can gather and effectively use the valuative/attitudinal GRR. Research results may be interpreted to help with the design of interventions to enhance the level of SOC, reduce stress, and ideally reduce the pathogenic hazards of stress for a wide range of populations, including emergency response personnel who operate in the post-9/11 environment of the United States.

3. Hollister, M. C. (2004). Protective Factors for Early Childhood Caries.

Dental caries are among the most common childhood diseases. Early Childhood Caries (ECC) is a severe form of dental decay in young children. Because biological, behavioral, cognitive, and social factors all contribute to the disease, researchers have proposed the use of a multidimensional causal model. Several health models have been applied to the study of dental caries, including SOC, health belief model (HBM), locus of control (LOC), and self-efficacy.

SOC theory uses salutogenesis, the process of studying health, as opposed to pathogenesis, the study of disease. This study used a salutogenic approach to study high-risk families with decay-free children. The investigation used an inductive process to gather evidence from healthy families to verify if any of the previously named theories were consistent with oral health practices in families with decay-free children. The purposes of this qualitative study were to
(a) determine protective psychosocial factors for ECC and (b) validate the usefulness of a health behavior theory for ECC.

Themes identified in the interviews showed that families in a high-risk population were able to maintain good oral health by creating a network of resources and incorporating knowledge and healthy practices into daily life. Resource networks showed great variety, but in each case the families constructed their unique network of personal resources and used those resources to create successful strategies in the home.

Protective psychosocial factors for ECC identified in this study were accurate information, physical resources, and support. Each family in this study constructed a network of accurate information, physical resources, such as nutritious foods and professional services, and both emotional and social support. Each network was different; networks depended on personal values, availability of services, and individual experiences.

Theory validation included comparing the practices reported in individual cases with common patterns identified in the cross-case analysis to each of the four theories. There was little evidence of HBM and LOC. Self–efficacy and SOC both fit the evidence with some limitations. Combining self-efficacy and SOC produced a very good overall fit for the evidence.

SOC theory fit the evidence on a community level. By using a variety of community and personal resources, families were able to (a) manage stressors, (b) understand how and why poor habits could lead to conditions, such as obesity and dental decay, and (c) take the time to use available resources to incorporate good health habits into daily life.

Self-efficacy fit the evidence on a personal level, most notably in individuals taking the amassed resources and developing strategies to use those resources. Families showed enactive attainment, vicarious learning, and verbal persuasion to use resources to form successful strategies in the home.

The findings of this research validate the use of a blended model of SOC and self-efficacy in studying ECC.

4. Lord, T. (2002). The Influence of a Sense of Coherence and Coping Skills on Women's Success in Substance Abuse Treatment, Walden University.

The premise for this research was that women who have completed substance abuse treatment have a greater range of coping skills than do women who are currently in treatment.

The study utilized a combination of qualitative and quantitative tools in a phenomenological research design. Twenty women in a small town in rural Arizona were given the SOC scales and the Multidimensional Health Profile–Psychosocial (MHP-P) subscales for coping skills and social supports. The researcher also interviewed these respondents. The interviews focused on what the women saw as their strengths and challenges. Ten of these women had completed treatment for substance abuse, and the other ten were currently in treatment.

The study found no difference between the two groups in their SOC. This lack of statistical significance may have implications for future applications of the SOC with certain populations. Four of the six subscales of the MHP-P reported significant differences, and there were significant differences in the coping skills, as measured by the interviews.

The interviews showed a substantial increase in the number and quality of coping skills in the women who had completed treatment. When the interview results were combined with the results of the MHP-P, it was shown that women who have completed treatment have greater coping skills than those who are in treatment.