572691
research-article2015
PED0010.1177/1757975915572691Original ArticleG. Rajesh et al.
Original Article The validity and reliability of the Sense of Coherence scale among Indian university students Gururaghavendran Rajesh1, Monica Eriksson2, Keshava Pai3, S Seemanthini3, Dilip G. Naik4 and Ashwini Rao1
Abstract: Background: The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India. Methods: The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Testretest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed. Results: The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC. Conclusions: SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India. Keywords: salutogenesis, psychometric properties, sense of coherence, India
Introduction The traditional focus in the control of diseases has been the search for ‘causes of disease’. Recently, this conventional approach has been supplemented with the search for the ‘origin of health’ (1,2). Focus has shifted to what creates health rather than what causes disease (3,4). This approach has been termed
as salutogenesis. Salutogenesis is derived from the words ‘Salus’ meaning ‘health’, and ‘genesis’ meaning ‘origin’ (1,2,5). Salutogenesis deals with the study of health rather than disease and deals with personal resources essential to moving toward and maintaining health. The Sense of Coherence (SOC) reflects the extent to which individuals cope with stressful
1. Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India. 2. Department of Nursing, Health and Culture, Center on Salutogenesis, University West, Trollhättan, Sweden. 3. Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India. 4. Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India. Correspondence to: G Rajesh, Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Light House Hill Road, Mangalore, 575001, Karnataka, India. Email: [email protected] (This manuscript was submitted on 10 July 2014. Following blind peer review, it was accepted on 28 November 2014) Global Health Promotion 1757-9759; Vol 0(0): 1 –11; 572691 Copyright © The Author(s) 2015, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975915572691 http://ghp.sagepub.com Downloaded from ped.sagepub.com at University of Otago Library on October 8, 2015
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situations (1,2). The salutogenic theory is here operationalized by using the Sense of Coherence (SOC-13) scale. In this context, health is viewed as a dynamic construct that extends along an ease/dis-ease continuum (6). Investigators believe that the health status of individuals shifts along this continuum. The salutogenic model of health helps us identify the generalized and specific resistance resources among individuals that are essential resources for moving toward the health (ease) end. Research has identified a global, pervasive and cross-cultural construct that helps people stay healthy, which is reflected by the SOC scale (1,2,5). SOC is defined as ‘a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (i) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable, and explicable (comprehensibility); (ii) the resources are available to one to meet the demands posed by these stimuli (manageability); and (iii) these demands are challenges, worthy of investment and engagement (meaningfulness)’ (2). Studies have shown that the SOC scale is a reliable and valid instrument that can be used to assess how individuals manage stress and stay healthy (7–9). The SOC scale has been tested among healthy individuals (10–12), physically active older individuals (13–15), as well as those with systemic diseases such as cardiac diseases and psychopathology (16–18). Research findings have shown that the SOC was strongly correlated with perceived health (6), especially mental health, and also with quality of life (19). The SOC has a main, moderating or mediating role for explaining health and finally, it predicts health (3). The SOC is shown to have an association with adult oral health knowledge, attitude and behaviors (20–22), adult oral health parameters (23), adolescents’ oral health, oral health-related behaviors and oral health-related quality of life (5,24–26). The SOC may be an important approach for health promotion (3,6,27,28) and might have significant contributions to make toward oral health promotion (29,30). Suraj and Singh (31) have previously reported findings from a study among Indian graduate students in Chandigarh using the SOC-29 item questionnaire. They have reported an internal consistency of 0.85 with the SOC-29. Tyagi et al.
have reported a Cronbach’s alpha value of 0.72 among students pursuing their post-graduation in anesthesiology in India (27). The aim of this study was to assess the psychometric properties, validity and reliability of the SOC-13 scale among Indian university students.
Methods SOC-13 scale The SOC-13 scale contains five items for comprehensibility and four each for manageability and meaningfulness domains. Each of the items in the scale is scored on a seven-point semantic differential scale anchored by two phrases. A total of five items in the scale are reverse coded. The total SOC score is obtained by adding the individual responses to 13 items of the scale. The range of the scores is 13–91 points, with higher scores indicating a stronger SOC.
Study population The present study was carried out among university students in Mangalore, Karnataka, India. The list of all institutions in Mangalore city was obtained from Mangalore University. Three institutions were randomly chosen and a total of 512 individuals were invited to participate in the study. Inclusion criteria included co-education institutions, second-year degree students, familiarity of study participants with the English language and availability during the study period from July 2013 to September 2013. Excluded were institutions not willing to consent, students undergoing orthodontic treatment, students who suffered from health/ mental health problems in the last year, students with known systemic illness and students who were currently under treatment for known health/mental health problems. A total of 452 individuals (response rate of 88.28%) consented to participate in the study. The average age of the participants was 20.17 years (SD = 0.78). The number of respondents who were males was 267 (59.07%) and females was 185 (40.93%). The number of study participants belonging to commerce, science and management streams were 280 (61.95%), 111 (24.56%) and 61 (13.50%), respectively.
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Data collection procedure Validity Item face validity: Face validity consists of expert opinion on appropriateness, relevance, comprehensiveness and understandability of the scale (32,33). Face validity of the scale was first ascertained, wherein the investigators assessed the aforementioned aspects of the scale. Further, the scale was assessed by five subject experts and, based on their input, modified accordingly. The SOC-13 was administered to the study participants in the English language. A huge majority of the population in India is familiar with the English language. The English as used by the India population, however, is considerably different from the English employed in the Western hemisphere of the world. Moreover, the local vernacular languages that are in use in Mangalore, where the study was conducted, are Kannada, Tulu and Konkani. The dialects that are spoken by people belonging to different castes and classes are different. Some groups of individuals use a dialect of Kannada that is considerably different from that employed by other groups of individuals. Moreover, there are different dialects used in different parts of Mangalore as well. Keeping all these issues in mind, as the first step in introducing the SOC in India and for issues related to feasibility and practicality, the authors employed the scale in English rather than the local vernacular languages. Subject experts recommended the use of the word ‘that’ in item 9 of the scale. Item 9 of SOC-13 was modified as ‘Does it happen that you have feelings inside that you would rather not feel?’ A pretest of the SOC-13 was thereafter carried out among peers and 30 study participants. The word ‘seldom’ in the scale was replaced by the word ‘rarely’ based on input from study participants. Content validity: Content validity assesses how adequately the items in the scale match concepts being measured (32,33). Content validity of the scale was ascertained by employing inter-item correlations. Construct validity: Construct validity indicates the extent to which items of the scale are tapping into underlying theory and are applied by using convergent and discriminant validity (32,33). Convergent validity indicates that the items
related to a particular domain within a scale should be correlated among themselves and is assessed by Cronbach’s alpha. Discriminant validity indicates that the items related to different domains should not be correlated and is assessed by factor analysis.
Factor analysis Factor analysis attempts to look at underlying concepts and factors related to the items instead of reporting all the items (32). The SOC-13 was subjected to confirmatory factor analysis with a varimax rotation. We tested for a one-factor and three-factor solution of the SOC scale by confirmatory factor analysis with varimax rotation with Kaiser normalization. The three factors reflected the three components of SOC as propounded by Antonovsky: comprehensibility, manageability and meaningfulness. Varimax criterion for a simple factor solution is to maximize variations for loadings of factors across items, with factor loadings moving toward 0 or 1 (34). A scree plot was employed to ascertain the factor structure of the scale. The number of factors to be extracted was based on the scree plot and the eigenvalues resulting from factor analysis.
Reliability and internal consistency Internal consistency reliability of the scale was assessed by employing (i) average inter-item correlation, (ii) average item total correlation, (iii) split-half reliability, (iv) Cronbach’s alpha (36) and (v) test-retest reliability (32). The scale was re-administered to study participants after a period of 15 days to assess test-retest reliability.
Ethics Ethics clearance was obtained from the Institution Ethics Committee, Manipal College of Dental Sciences (MCODS), Mangalore (Protocol Ref No: 11064). Permission to carry out the present study was obtained from the dean, Manipal College of Dental Sciences, Manipal University, Mangalore and also from the principals of educational institutions included in the present study. Informed consent was obtained from the study participants. IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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Results Descriptives The mean SOC-13 was found to be 51.65 (±8.20) and the median value was 52. Table 1 shows the descriptive data related to SOC-13 among the study participants.
Reliability and internal consistency Reliability analysis of the SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). All inter-item correlations were found to be positive ranging from 0.06 to 0.42 (Table 2). Item-total correlations indicate that deleting any of the items in the scale did not increase the Cronbach’s alpha value more than the overall Cronbach’s alpha of 0.76 (Table 3). Content validity: Inter-item correlations are shown in Table 2. It can be observed that all correlations are positive, with the highest value being 0.42 between items 2 and 3. Construct validity: Results indicate that the Cronbach’s alpha value of the scale was 0.76. This indicates that the scale had adequate convergent validity when tested in this population.
Factor analysis A three-factor solution was confirmed with eigenvalues >1.0 and explained variance. Confirmatory factor analysis revealed a threefactor solution explaining 40.53% of the total variance in the SOC (Table 4). The first factor accounted for 13.94% of total variance, while the second and third factors accounted for 13.47% and 13.12% of total variance, respectively. The results of the present study did not support a one-factor solution for the SOC-13. Factor loadings for the SOC items by employing principal component analysis with varimax rotation are shown in Table 5. Scree plots with rotated factor solutions are presented in Figure 1. The scree plot indicates a three-factor solution for SOC-13 and the scale does not follow the one-factor solution as originally proposed by Antonovsky. The scale also does not correspond to the SOC theory as hypothesized by
Antonovsky. Factor loadings indicate that the items do not fully correspond with the theoretical dimensions of comprehensibility, manageability and meaningfulness (Tables 5 and 6).
Discussion Salutogenesis has increasingly been applied in different areas all over the world. The important contributions that SOC can make toward public health have now been recognized (36). The present study was undertaken to assess the psychometric properties, validity and reliability of the SOC-13 scale among Indian university students. It is the first investigation to explore the same in an Indian population. Earlier investigations by Suraj and Singh (31), and Tyagi et al. (27) have only partially assessed the internal consistency of the scale by using Cronbach’s alpha. There are no studies that have tested the psychometric properties of the SOC in India. Testing the psychometric properties of the SOC will render measurements that are more reliable and will facilitate comparisons across different populations (37). Students enrolled in co-education institutions were included in the study. Stressors and salutogenic factors might operate differently among co-education institutions when compared to institutions for only boys or girls. Students in the first year of study might change their courses, while those in their final year might be more engrossed in their studies. Hence, students in their second year of study were included in the present study. Students suffering and/or undergoing treatment for any health/mental health problems or those undergoing orthodontic treatment in the last year were excluded, as the aforementioned health issues might have an impact on their SOC values and render them considerably different from those without these health issues. The present study was undertaken to introduce the concept of the SOC in India. The scale has also to be tested in other Indian vernacular languages and dialects to further validate the scale in an Indian context. The SOC-13 was found to be a reliable and valid tool among the study population. Reliability statistics reveal values above 0.70 for the scale. Antonovsky had reported a Cronbach’s alpha in the range of 0.74–0.93 in a review of the SOC scale (7). In their systematic review of 127 studies on SOC-13, Lindstrom and Eriksson have reported a Cronbach’s alpha of 0.70 to 0.92 (8) (Table 7). The findings of
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Table 1. Descriptive data: median and standard deviation of items of the SOC-13. Item
Domain
1. Do you have the feeling that you don’t really care about what goes on around you? 1 (Very rarely or never) to 7 (Very often) 2. Has it happened in the past that you were surprised by the behavior of people whom you thought you knew well? 1 (Never happened) to 7 (Always happened) 3. Has it happened that people whom you counted on disappointed you? 1 (Never happened) to 7 (Always happened) 4. Until now your life has had: 1(No clear goals or purpose at all) to 7(Very clear goals or purpose) 5. Do you have the feeling that you’re being treated unfairly? 1 (Very often) to 7 (Very rarely or never) 6. Do you have the feeling that you are in an unfamiliar situation and don’t know what to do? 1 (Very often) to 7 (Very rarely or never) 7. Doing the thing you do every day is: 1 (A source of deep pleasure and satisfaction) to 7 (A source of pain and boredom) 8. Do you have very mixed-up feelings and ideas? 1 (Very often) to 7 (Very rarely or never) 9. Does it happen that you have feelings inside (that) you would rather not feel? 1 (Very often) to 7 (Very rarely or never) 10. Many people – even those with a strong character – sometimes feel like sad sacks (losers) in certain situations. How often have you felt this way in the past? 1 (Never) to 7 (Very often) 11. When something happened, have you generally found that: 1 (You overestimated or underestimated its importance) to 7 (You saw things in right proportion) 12. How often do you have the feeling that there’s little meaning in the things you do in your daily life? 1 (Very often) to 7 (Very rarely or never) 13. How often do you have feelings that you’re not sure you can keep under control? 1 (Very often) to 7 (Very rarely or never)
Meaningfulness
3.76
4.00
1.41
Comprehensibility
4.44
5.00
1.57
Manageability
4.41
5.00
1.45
4.31
4.00
4.36
4.00
4.03
4.00
3.27
3.00
3.58
3.00
3.80
4.00
1.46 1.35
Manageability
4.09
4.00
1.34
Comprehensibility
3.99
4.00
1.37
Meaningfulness
3.62
4.00
1.48
Manageability
4.00
4.00
1.48
51.65
52.00
8.20
Meaningfulness Manageability Comprehensibility Meaningfulness Comprehensibility Comprehensibility
Total SOC score
Mean
Median
SD
1.48 1.57 1.44 1.40
SOC-13: Sense of Coherence 13-item scale. SD: standard deviation.
the present study are in line with those reported in the aforementioned review. The split-half reliability values of the present study are also in agreement with those reported by Lindström and Eriksson (8) and Naaldenberg et al. (15). The test-retest reliability values of the present study are in agreement with the findings of Lindström and Eriksson (8) and Rohani
et al. (11). The inter-item correlation values in the present study are in agreement with those reported by Naaldenberg et al. (15). However, higher inter-item correlation values were reported by Tang and Dixon (38). All the inter-item correlation values were positive and this indicates that the items were related, IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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Table 2. Inter-item correlation of items of the SOC-13.
1 2 3 4 5 6 7 8 9 10 11 12 13
1
2
3
4
5
6
7
8
9
10
11
12
13
1.00 0.298 0.186 0.235 0.235 0.244 0.208 0.250 0.200 0.187 0.160 0.094 0.165
0.298 1.00 0.423 0.226 0.154 0.187 0.106 0.181 0.220 0.227 0.188 0.123 0.062
0.186 0.423 1.00 0.099 0.064 0.112 0.184 0.095 0.104 0.220 0.125 0.125 0.075
0.235 0.226 0.099 1.00 0.241 0.320 0.093 0.274 0.232 0.107 0.185 0.121 0.200
0.235 0.154 0.064 0.241 1.00 0.352 0.167 0.284 0.354 0.135 0.210 0.177 0.170
0.244 0.187 0.112 0.320 0.352 1.00 0.107 0.300 0.256 0.083 0.301 0.243 0.140
0.208 0.106 0.184 0.093 0.167 0.107 1.00 0.236 0.176 0.192 0.176 0.136 0.095
0.250 0.181 0.095 0.274 0.284 0.300 0.236 1.00 0.388 0.147 0.231 0.207 0.326
0.200 0.220 0.104 0.232 0.354 0.256 0.176 0.388 1.00 0.154 0.270 0.137 0.334
0.187 0.227 0.220 0.107 0.135 0.083 0.192 0.147 0.154 1.00 0.081 0.180 0.103
0.160 0.188 0.125 0.185 0.210 0.301 0.176 0.231 0.270 0.081 1.00 0.122 0.218
0.094 0.123 0.125 0.121 0.177 0.243 0.136 0.207 0.137 0.180 0.122 1.00 0.296
0.165 0.062 0.075 0.200 0.170 0.140 0.095 0.326 0.334 0.103 0.218 0.296 1.00
SOC-13: Sense of Coherence 13-item scale.
Table 3. Item-total correlation of items of the SOC-13. Item
Scale mean if item deleted
Scale variance if item deleted
Corrected itemtotal correlation
Squared multiple correlation
Cronbach’s alpha if item deleted
1 2 3 4 5 6 7 8 9 10 11 12 13
47.2014 46.6978 46.6942 46.7590 46.7266 46.9496 47.5863 47.3633 47.2266 46.9029 47.0360 47.2446 47.0072
63.317 62.269 64.856 62.602 61.254 62.279 65.897 61.279 62.060 65.785 65.053 64.445 63.726
0.406 0.392 0.292 0.384 0.417 0.439 0.300 0.484 0.470 0.294 0.370 0.318 0.354
0.195 0.283 0.216 0.185 0.233 0.272 0.134 0.281 0.289 0.123 0.170 0.164 0.233
0.738 0.739 0.750 0.740 0.737 0.734 0.749 0.729 0.731 0.749 0.742 0.747 0.744
SOC-13: Sense of Coherence 13-item scale.
but not overlapping. The item-total correlation values in the present study were lower than those reported by Tang and Dixon (38). The Cronbach’s alpha values on deletion of the items were not higher than the overall Cronbach’s alpha value of 0.76. Deletion of any item of the SOC-13 did not lead to any increase in the overall Cronbach’s alpha in the study population. Analysis of construct validity by means of factor analysis revealed a three-factor structure of the SOC-13 with good explained variance. This is in
contrast with the one-factor solution reported by Antonovsky (2). However, Lindström and Eriksson (8) have reported that the SOC seems to be a multidimensional concept. The factor loadings in this study indicate that the items do not fully correspond with the theoretical dimensions of comprehensibility, manageability and meaningfulness. This is in agreement with the findings reported by Sardu et al. (12), Jakobsson (14) and Larsson and Kallenberg (40). Lerdal et al. (41) have highlighted the need for further investigations on dimensions of the SOC.
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Table 4. Confirmatory factor analysis of items of the SOC-13. Component Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Item 12 Item 13
Dimensions of SOC-13
Initial eigenvalues
Rotation sums of squared loadings
Total
% of variance
Cumulative %
Total
% of variance
Cumulative %
Meaningfulness Comprehensibility Manageability Meaningfulness Manageability Comprehensibility Meaningfulness Comprehensibility Comprehensibility Manageability Comprehensibility Meaningfulness Manageability
2.561 1.522 1.186 1.029 0.959 0.901 0.842 0.814 0.773 0.693 0.610 0.587 0.523
19.700 11.709 9.122 7.917 7.380 6.929 6.479 6.259 5.945 5.329 4.694 4.515 4.023
19.700 31.408 40.530 48.447 55.828 62.757 69.236 75.495 81.439 86.768 91.462 95.977 100.000
1.812 1.751 1.705
13.941 13.471 13.119
13.941 27.412 40.530
SOC-13: Sense of Coherence 13-item scale. Note: Extraction method: principal component analysis.
Table 5. Factor loading of items of the SOC-13. Scale component
SOC-13 item number
Principal components loads 1
2
3
Comprehensibility
2 6 8 9 11
0.203 0.629 0.287 0.316 0.453
−0.076 0.190 0.609 0.522 0.252
0.740 −0.019 0.094 0.166 0.083
Manageability
3 5 10 13
−0.015 0.606 −0.135 0.180
−0.030 0.071 0.310 0.626
0.719 0.066 0.351 −0.111
Meaningfulness
1 4 7 12
0.237 0.672 −0.247 0.024
0.024 −0.001 0.394 0.595
0.534 0.078 0.402 −0.060
SOC-13: Sense of Coherence 13-item scale.
Sandell et al. (34) have reported similar findings among clinical and non-clinical samples. Their analysis did not confirm Antonovsky’s one-factor solution or a theoretical three-factor solution. Antonovsky has pointed out that the SOC scale was designed to assess the individual’s ability to move
toward the health end of the health–ease–dis-ease continuum. The scale was not intended to measure separately the components of comprehensibility, manageability and meaningfulness (7). Sandell et al. (34) have, however, reported that it might not be entirely meaningless to look at the components of the IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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Figure 1. Scree plot. Table 6. Factor-wise selection of items of the SOC-13 based on factor loadings. Factor
SOC-13 item number and domain
SOC-13 item
1
4 – Meaningfulness
6 – Comprehensibility
5 – Manageability
11 – Comprehensibility
2
13 – Manageability
8 – Comprehensibility 12 – Meaningfulness
9 – Comprehensibility
3
2 – Comprehensibility
3 – Manageability
1 – Meaningfulness
Until now your life has had: no clear goals or purpose at all/very clear goals or purpose at all Do you have the feeling that you are in an unfamiliar situation and don’t know what to do? Very often/very rarely or never Do you have the feeling that you’re being treated unfairly? Very often/very rarely or never When something happened, have you generally found that: you overestimated or underestimated its importance/you saw things in right proportion How often do you have feelings that you’re not sure you can keep under control? Very often/very rarely or never Do you have very mixed-up feelings and ideas? Very often/very rarely or never How often do you have the feeling that there’s little meaning in the things you do in your daily life? Very often/very rarely or never Does it happen that you have feelings inside you would rather not feel? Very often/very rarely or never Has it happened in the past that you were surprised by the behavior of people whom you thought you knew well? Never happened/always happened Has it happened that people whom you counted on disappointed you? Never happened/always happened Do you have the feeling that you don’t really care about what goes on around you? Very rarely or never/very often
SOC-13: Sense of Coherence 13-item scale. IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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0.76
Cronbach’s alpha
Range six months to 2 years 0.77–0.41
SOC-29, SOC-13 0.74–0.93
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SOC: Sense of Coherence SOC-13: Sense of Coherence 13-item scale. SOC-29: Sense of Coherence 29-item scale.
28.00% of coping capability
Range 0.44–0.94 0.49–0.70
0.89
SOC-13
Range one year to 10 years 0.69–0.54
127 studies Range 0.70– 0.92
SOC-13
Antonovsky, Tang and Eriksson and Lindström, 1993 (7) Dixon, 2002 (38) 2005 (8)
Inter-item 0.06–0.42 correlation Item-total Range correlation Coe: oneConfirmatory factor 40.53% factor analysis: three solution factors explaining 42.9%
Split-half reliability 0.71 Guttman split-half 0.70 reliability Test-retest reliability 0.71
SOC-13
SOC
Present study
Table 7. Comparison of findings from other validation studies.
0.87
0.82
Threefactor solution 52%
SOC-29
SOC-13
The theoretical construct could not be supported
0.08–0.71
0.75
0.80
SOC-13
Naaldenberg Schmidt Sardu et al., 2011 and et al., (15) 2012 (12) Dantas, 2011 (39)
36%
0.84
0.77, 0.82 0.72
SOC-13
Tyagi et Rohani al., 2012 et al., 2010 (11) (27)
28%, 41%
SOC-29, SOC-13 0.79, 0.61
Spadoti Dantas et al., 2014 (18)
Original Article 9
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SOC scale. They observe that if the scale had to be considered in its entirety, then there was probably no need to propose the domains in the scale in the first place. The factor structure of the SOC is compounded by the fact that the items of the scale do not ‘cleanly’ refer to one or the other domain of the SOC. Hence, further studies on the factor structure of the SOC might be essential to shed more light on the same. The SOC-13 employs a seven-point Likert scale for its responses. While employing a Likert scale, one has to consider potential biases such as endaversion bias, positive skew and the halo effect (32). Further studies are needed to shed more light on the influence of these biases. The results of the present study indicate that the SOC-13 is a reliable and valid tool in an Indian context. The literature indicates that the salutogenic approach has been adopted in different sectors. The present study might open up further vistas for research pertaining to salutogenesis across different sectors in India. This might pave the way for addressing health inequalities in this and other developing countries. Psychometric properties of different versions of the SOC among different age groups (14,42), gender (43), in individuals with different health-related conditions (16–18,44), and in different settings (39,45) are essential. Longterm stability of the SOC (46) should also be investigated in the Indian context. The present study might provide valuable baseline information towards the same.
Conclusions The present study showed that the SOC-13 is a reliable and valid tool in an Indian context. Results indicate that the SOC-13 has good psychometric properties when tested among students in India. The present study paves the way for further research on salutogenesis and its myriad implications in developing countries like India. Funding This research received funding from the Indian Council of Medical Research (ICMR).
Conflict of interest None declared.
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sample of schizophrenic patients living in the community. J Adv Nurs. 2001; 33: 432–438. 17. Bengtsson-Tops A, Brunt D, Rask M. The structure of Antonovsky’s sense of coherence in patients with schizophrenia and its relationship to psychopathology. Scand J Caring Sci. 2005; 19: 280–287. 18. Spadoti Dantas RA, Silva FS, Ciol MA. Psychometric properties of the Brazilian Portuguese versions of the 29- and 13-item scales of the Antonovsky’s Sense of Coherence (SOC-29 and SOC-13) evaluated in Brazilian cardiac patients. J Clin Nurs. 2014; 23: 156–165. 19. Eriksson M, Lindström B. Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review. J Epidemiol Community Health. 2007; 61: 938–944. 20. Lindmark U, Hakeberg M, Hugoson A. Sense of coherence and its relationship with oral healthrelated behaviour and knowledge of and attitudes towards oral health. Community Dent Oral Epidemiol. 2011; 39: 542–553. 21. Savolainen J, Knuuttila M, Suominen-Taipale L, Martelin T, Nordlad A, Niskanen M, et al A strong sense of coherence promotes regular dental attendance in adults. Community Dent Health. 2004; 21: 271–276. 22. Savolainen JJ, Suominen-Taipale AL, Uutela AK, Martelin TP, Niskanen MC, Knuuttila ML. Sense of coherence as a determinant of toothbrushing frequency and level of oral hygiene. J Periodontol. 2005; 76: 1006–1012. 23. Bernabe E, Watt RG, Sheiham A, Suominen-Taipale AL, Uutela A, Vehkalahti MM, et al Sense of coherence and oral health in dentate adults: findings from the Finnish Health 2000 survey. J Clin Periodontol. 2010; 37: 981–987. 24. Freire MCM, Hardy R, Sheiham A. Mothers’ sense of coherence and their adolescent children’s oral health status and behaviours. Community Dent Health. 2002; 19: 24–31. 25. Bonanato K, Paiva SM, Pordeus IA, Ramos-Jorge ML, Barbabela D, Allison PJ. Relationship between mothers’ sense of coherence and oral health status of preschool children. Caries Res. 2009; 43: 103–109. 26. Khatri SG, Acharya S, Srinivasan SR. Mothers’ sense of coherence and oral health related quality of life of preschool children in Udupi Taluk. Community Dent Health. 2014; 31: 32–36. 27. Tyagi A, Kumar S, Sethi AK, Dhaliwal U. Factors influencing career choice in anaesthesiology. Indian J Anaesth. 2012; 56: 342–347. 28. Antonovsky A. The salutogenic model as a theory to guide health promotion. Health Promot Int. 1996; 11: 11–18. 29. Watt RG. Emerging theories into the social determinants of health: implications for oral health promotion. Community Dent Oral Epidemiol. 2002; 30: 241–247. 30. Lindmark U, Abrahamsson K. Oral health-related resources—a salutogenic perspective on Swedish 19-year-olds. Int J Dent Hyg. 2015; 13: 56–64. 31. Suraj S, Singh A. Study of sense of coherence health promoting behavior in north Indian students. Indian J Med Res. 2011; 134: 645–652.
32. Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to their Development and Use. PDQ Statistics series. Oxford: Oxford University Press; 1995. 33. Abramson JH, Abramson ZH. Survey methods in community medicine. Epidemiological research programme evaluation clinical trials. 5th ed. Edinburgh: Churchill Livingstone; 1999. 34. Sandell R, Blomberg J, Lazar A. The factor structure of Antonovsky’s sense of coherence scale in Swedish clinical and nonclinical samples. Pers Individ Dif. 1998; 24: 701–711. 35. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951; 16: 297–334. 36. Lindström B, Eriksson M. Salutogenesis. J Epidemiol Community Health. 2005; 59: 440–442. 37. Bonanato K, Barbabela D, Mota JP, Ramos-Jorge ML, Kaeppler KC, Paiva SM, et al Trans-cultural adaptation and psychometric properties of the ‘Sense of Coherence Scale’ in mothers of preschool children. Interam J Psychol. 2009; 43: 144–153. 38. Tang ST, Dixon J. Instrument translation and evaluation of equivalence and psychometric properties: the Chinese Sense of Coherence Scale. J Nurs Meas. 2002; 10: 59–76. 39. Schmidt DRC, Dantas RAS. Analysis of validity and reliability of the adapted Portuguese version of Antonovsky’s Sense of Coherence Questionnaire among nursing professionals. Rev Lat Am Enfermagem. 2011; 19: 42–49. 40. Larsson G, Kallenberg K. Dimensional analysis of sense of coherence using structural equation modelling. Eur J Pers. 1999; 13: 51–61. 4 1. Lerdal A, Fagermoen MS, Bonsaksen T, Gay CL, Kottorp A. Rasch analysis of the sense of coherence scale in a sample of people with morbid obesity—A cross-sectional study. MBC Psychology. 2014; 2: 1. 42. Rivera F, García-Moya I, Moreno C, Ramos P. Developmental contexts and sense of coherence in adolescence: a systematic review. J Health Psychol. 2013; 18: 800–812. 43. Hittner JB. Factorial invariance of the 13-item Sense of Coherence scale across gender. J Health Psychol. 2007; 12: 273–280. 44. Luyckx K, Goossens E, Apers S, Rassart J, Klimstra T, Dezutter J, et al The 13-Item Sense of Coherence Scale in Dutch-speaking adolescents and young adults: structural validity, age trends, and chronic disease. Psychol Belg. 2012; 52: 351–368. 45. van Schalkwyk L, Rothmann S. Validation of the Orientation to Life Questionnaire (OLQ) in a chemical factory. SA Journal of Industrial Psychology. 2008; 34: 31–39. 46. Togari T, Yamazaki Y, Nakayama K, et al. Construct validity of Antonovsky’s sense of coherence scale: Stability of factor structure and predictive validity with regard to the well-being of Japanese undergraduate students from two-year follow-up data. Japanese Journal of Health and Human Ecology. 2008; 74: 71–86. IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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research-article2015
PED0010.1177/1757975915572691Original ArticleG. Rajesh et al.
Original Article The validity and reliability of the Sense of Coherence scale among Indian university students Gururaghavendran Rajesh1, Monica Eriksson2, Keshava Pai3, S Seemanthini3, Dilip G. Naik4 and Ashwini Rao1
Abstract: Background: The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India. Methods: The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Testretest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed. Results: The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC. Conclusions: SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India. Keywords: salutogenesis, psychometric properties, sense of coherence, India
Introduction The traditional focus in the control of diseases has been the search for ‘causes of disease’. Recently, this conventional approach has been supplemented with the search for the ‘origin of health’ (1,2). Focus has shifted to what creates health rather than what causes disease (3,4). This approach has been termed
as salutogenesis. Salutogenesis is derived from the words ‘Salus’ meaning ‘health’, and ‘genesis’ meaning ‘origin’ (1,2,5). Salutogenesis deals with the study of health rather than disease and deals with personal resources essential to moving toward and maintaining health. The Sense of Coherence (SOC) reflects the extent to which individuals cope with stressful
1. Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India. 2. Department of Nursing, Health and Culture, Center on Salutogenesis, University West, Trollhättan, Sweden. 3. Department of Psychiatry, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India. 4. Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India. Correspondence to: G Rajesh, Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Light House Hill Road, Mangalore, 575001, Karnataka, India. Email: [email protected] (This manuscript was submitted on 10 July 2014. Following blind peer review, it was accepted on 28 November 2014) Global Health Promotion 1757-9759; Vol 0(0): 1 –11; 572691 Copyright © The Author(s) 2015, Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1757975915572691 http://ghp.sagepub.com Downloaded from ped.sagepub.com at University of Otago Library on October 8, 2015
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situations (1,2). The salutogenic theory is here operationalized by using the Sense of Coherence (SOC-13) scale. In this context, health is viewed as a dynamic construct that extends along an ease/dis-ease continuum (6). Investigators believe that the health status of individuals shifts along this continuum. The salutogenic model of health helps us identify the generalized and specific resistance resources among individuals that are essential resources for moving toward the health (ease) end. Research has identified a global, pervasive and cross-cultural construct that helps people stay healthy, which is reflected by the SOC scale (1,2,5). SOC is defined as ‘a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (i) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable, and explicable (comprehensibility); (ii) the resources are available to one to meet the demands posed by these stimuli (manageability); and (iii) these demands are challenges, worthy of investment and engagement (meaningfulness)’ (2). Studies have shown that the SOC scale is a reliable and valid instrument that can be used to assess how individuals manage stress and stay healthy (7–9). The SOC scale has been tested among healthy individuals (10–12), physically active older individuals (13–15), as well as those with systemic diseases such as cardiac diseases and psychopathology (16–18). Research findings have shown that the SOC was strongly correlated with perceived health (6), especially mental health, and also with quality of life (19). The SOC has a main, moderating or mediating role for explaining health and finally, it predicts health (3). The SOC is shown to have an association with adult oral health knowledge, attitude and behaviors (20–22), adult oral health parameters (23), adolescents’ oral health, oral health-related behaviors and oral health-related quality of life (5,24–26). The SOC may be an important approach for health promotion (3,6,27,28) and might have significant contributions to make toward oral health promotion (29,30). Suraj and Singh (31) have previously reported findings from a study among Indian graduate students in Chandigarh using the SOC-29 item questionnaire. They have reported an internal consistency of 0.85 with the SOC-29. Tyagi et al.
have reported a Cronbach’s alpha value of 0.72 among students pursuing their post-graduation in anesthesiology in India (27). The aim of this study was to assess the psychometric properties, validity and reliability of the SOC-13 scale among Indian university students.
Methods SOC-13 scale The SOC-13 scale contains five items for comprehensibility and four each for manageability and meaningfulness domains. Each of the items in the scale is scored on a seven-point semantic differential scale anchored by two phrases. A total of five items in the scale are reverse coded. The total SOC score is obtained by adding the individual responses to 13 items of the scale. The range of the scores is 13–91 points, with higher scores indicating a stronger SOC.
Study population The present study was carried out among university students in Mangalore, Karnataka, India. The list of all institutions in Mangalore city was obtained from Mangalore University. Three institutions were randomly chosen and a total of 512 individuals were invited to participate in the study. Inclusion criteria included co-education institutions, second-year degree students, familiarity of study participants with the English language and availability during the study period from July 2013 to September 2013. Excluded were institutions not willing to consent, students undergoing orthodontic treatment, students who suffered from health/ mental health problems in the last year, students with known systemic illness and students who were currently under treatment for known health/mental health problems. A total of 452 individuals (response rate of 88.28%) consented to participate in the study. The average age of the participants was 20.17 years (SD = 0.78). The number of respondents who were males was 267 (59.07%) and females was 185 (40.93%). The number of study participants belonging to commerce, science and management streams were 280 (61.95%), 111 (24.56%) and 61 (13.50%), respectively.
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Data collection procedure Validity Item face validity: Face validity consists of expert opinion on appropriateness, relevance, comprehensiveness and understandability of the scale (32,33). Face validity of the scale was first ascertained, wherein the investigators assessed the aforementioned aspects of the scale. Further, the scale was assessed by five subject experts and, based on their input, modified accordingly. The SOC-13 was administered to the study participants in the English language. A huge majority of the population in India is familiar with the English language. The English as used by the India population, however, is considerably different from the English employed in the Western hemisphere of the world. Moreover, the local vernacular languages that are in use in Mangalore, where the study was conducted, are Kannada, Tulu and Konkani. The dialects that are spoken by people belonging to different castes and classes are different. Some groups of individuals use a dialect of Kannada that is considerably different from that employed by other groups of individuals. Moreover, there are different dialects used in different parts of Mangalore as well. Keeping all these issues in mind, as the first step in introducing the SOC in India and for issues related to feasibility and practicality, the authors employed the scale in English rather than the local vernacular languages. Subject experts recommended the use of the word ‘that’ in item 9 of the scale. Item 9 of SOC-13 was modified as ‘Does it happen that you have feelings inside that you would rather not feel?’ A pretest of the SOC-13 was thereafter carried out among peers and 30 study participants. The word ‘seldom’ in the scale was replaced by the word ‘rarely’ based on input from study participants. Content validity: Content validity assesses how adequately the items in the scale match concepts being measured (32,33). Content validity of the scale was ascertained by employing inter-item correlations. Construct validity: Construct validity indicates the extent to which items of the scale are tapping into underlying theory and are applied by using convergent and discriminant validity (32,33). Convergent validity indicates that the items
related to a particular domain within a scale should be correlated among themselves and is assessed by Cronbach’s alpha. Discriminant validity indicates that the items related to different domains should not be correlated and is assessed by factor analysis.
Factor analysis Factor analysis attempts to look at underlying concepts and factors related to the items instead of reporting all the items (32). The SOC-13 was subjected to confirmatory factor analysis with a varimax rotation. We tested for a one-factor and three-factor solution of the SOC scale by confirmatory factor analysis with varimax rotation with Kaiser normalization. The three factors reflected the three components of SOC as propounded by Antonovsky: comprehensibility, manageability and meaningfulness. Varimax criterion for a simple factor solution is to maximize variations for loadings of factors across items, with factor loadings moving toward 0 or 1 (34). A scree plot was employed to ascertain the factor structure of the scale. The number of factors to be extracted was based on the scree plot and the eigenvalues resulting from factor analysis.
Reliability and internal consistency Internal consistency reliability of the scale was assessed by employing (i) average inter-item correlation, (ii) average item total correlation, (iii) split-half reliability, (iv) Cronbach’s alpha (36) and (v) test-retest reliability (32). The scale was re-administered to study participants after a period of 15 days to assess test-retest reliability.
Ethics Ethics clearance was obtained from the Institution Ethics Committee, Manipal College of Dental Sciences (MCODS), Mangalore (Protocol Ref No: 11064). Permission to carry out the present study was obtained from the dean, Manipal College of Dental Sciences, Manipal University, Mangalore and also from the principals of educational institutions included in the present study. Informed consent was obtained from the study participants. IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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Results Descriptives The mean SOC-13 was found to be 51.65 (±8.20) and the median value was 52. Table 1 shows the descriptive data related to SOC-13 among the study participants.
Reliability and internal consistency Reliability analysis of the SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). All inter-item correlations were found to be positive ranging from 0.06 to 0.42 (Table 2). Item-total correlations indicate that deleting any of the items in the scale did not increase the Cronbach’s alpha value more than the overall Cronbach’s alpha of 0.76 (Table 3). Content validity: Inter-item correlations are shown in Table 2. It can be observed that all correlations are positive, with the highest value being 0.42 between items 2 and 3. Construct validity: Results indicate that the Cronbach’s alpha value of the scale was 0.76. This indicates that the scale had adequate convergent validity when tested in this population.
Factor analysis A three-factor solution was confirmed with eigenvalues >1.0 and explained variance. Confirmatory factor analysis revealed a threefactor solution explaining 40.53% of the total variance in the SOC (Table 4). The first factor accounted for 13.94% of total variance, while the second and third factors accounted for 13.47% and 13.12% of total variance, respectively. The results of the present study did not support a one-factor solution for the SOC-13. Factor loadings for the SOC items by employing principal component analysis with varimax rotation are shown in Table 5. Scree plots with rotated factor solutions are presented in Figure 1. The scree plot indicates a three-factor solution for SOC-13 and the scale does not follow the one-factor solution as originally proposed by Antonovsky. The scale also does not correspond to the SOC theory as hypothesized by
Antonovsky. Factor loadings indicate that the items do not fully correspond with the theoretical dimensions of comprehensibility, manageability and meaningfulness (Tables 5 and 6).
Discussion Salutogenesis has increasingly been applied in different areas all over the world. The important contributions that SOC can make toward public health have now been recognized (36). The present study was undertaken to assess the psychometric properties, validity and reliability of the SOC-13 scale among Indian university students. It is the first investigation to explore the same in an Indian population. Earlier investigations by Suraj and Singh (31), and Tyagi et al. (27) have only partially assessed the internal consistency of the scale by using Cronbach’s alpha. There are no studies that have tested the psychometric properties of the SOC in India. Testing the psychometric properties of the SOC will render measurements that are more reliable and will facilitate comparisons across different populations (37). Students enrolled in co-education institutions were included in the study. Stressors and salutogenic factors might operate differently among co-education institutions when compared to institutions for only boys or girls. Students in the first year of study might change their courses, while those in their final year might be more engrossed in their studies. Hence, students in their second year of study were included in the present study. Students suffering and/or undergoing treatment for any health/mental health problems or those undergoing orthodontic treatment in the last year were excluded, as the aforementioned health issues might have an impact on their SOC values and render them considerably different from those without these health issues. The present study was undertaken to introduce the concept of the SOC in India. The scale has also to be tested in other Indian vernacular languages and dialects to further validate the scale in an Indian context. The SOC-13 was found to be a reliable and valid tool among the study population. Reliability statistics reveal values above 0.70 for the scale. Antonovsky had reported a Cronbach’s alpha in the range of 0.74–0.93 in a review of the SOC scale (7). In their systematic review of 127 studies on SOC-13, Lindstrom and Eriksson have reported a Cronbach’s alpha of 0.70 to 0.92 (8) (Table 7). The findings of
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Table 1. Descriptive data: median and standard deviation of items of the SOC-13. Item
Domain
1. Do you have the feeling that you don’t really care about what goes on around you? 1 (Very rarely or never) to 7 (Very often) 2. Has it happened in the past that you were surprised by the behavior of people whom you thought you knew well? 1 (Never happened) to 7 (Always happened) 3. Has it happened that people whom you counted on disappointed you? 1 (Never happened) to 7 (Always happened) 4. Until now your life has had: 1(No clear goals or purpose at all) to 7(Very clear goals or purpose) 5. Do you have the feeling that you’re being treated unfairly? 1 (Very often) to 7 (Very rarely or never) 6. Do you have the feeling that you are in an unfamiliar situation and don’t know what to do? 1 (Very often) to 7 (Very rarely or never) 7. Doing the thing you do every day is: 1 (A source of deep pleasure and satisfaction) to 7 (A source of pain and boredom) 8. Do you have very mixed-up feelings and ideas? 1 (Very often) to 7 (Very rarely or never) 9. Does it happen that you have feelings inside (that) you would rather not feel? 1 (Very often) to 7 (Very rarely or never) 10. Many people – even those with a strong character – sometimes feel like sad sacks (losers) in certain situations. How often have you felt this way in the past? 1 (Never) to 7 (Very often) 11. When something happened, have you generally found that: 1 (You overestimated or underestimated its importance) to 7 (You saw things in right proportion) 12. How often do you have the feeling that there’s little meaning in the things you do in your daily life? 1 (Very often) to 7 (Very rarely or never) 13. How often do you have feelings that you’re not sure you can keep under control? 1 (Very often) to 7 (Very rarely or never)
Meaningfulness
3.76
4.00
1.41
Comprehensibility
4.44
5.00
1.57
Manageability
4.41
5.00
1.45
4.31
4.00
4.36
4.00
4.03
4.00
3.27
3.00
3.58
3.00
3.80
4.00
1.46 1.35
Manageability
4.09
4.00
1.34
Comprehensibility
3.99
4.00
1.37
Meaningfulness
3.62
4.00
1.48
Manageability
4.00
4.00
1.48
51.65
52.00
8.20
Meaningfulness Manageability Comprehensibility Meaningfulness Comprehensibility Comprehensibility
Total SOC score
Mean
Median
SD
1.48 1.57 1.44 1.40
SOC-13: Sense of Coherence 13-item scale. SD: standard deviation.
the present study are in line with those reported in the aforementioned review. The split-half reliability values of the present study are also in agreement with those reported by Lindström and Eriksson (8) and Naaldenberg et al. (15). The test-retest reliability values of the present study are in agreement with the findings of Lindström and Eriksson (8) and Rohani
et al. (11). The inter-item correlation values in the present study are in agreement with those reported by Naaldenberg et al. (15). However, higher inter-item correlation values were reported by Tang and Dixon (38). All the inter-item correlation values were positive and this indicates that the items were related, IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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Table 2. Inter-item correlation of items of the SOC-13.
1 2 3 4 5 6 7 8 9 10 11 12 13
1
2
3
4
5
6
7
8
9
10
11
12
13
1.00 0.298 0.186 0.235 0.235 0.244 0.208 0.250 0.200 0.187 0.160 0.094 0.165
0.298 1.00 0.423 0.226 0.154 0.187 0.106 0.181 0.220 0.227 0.188 0.123 0.062
0.186 0.423 1.00 0.099 0.064 0.112 0.184 0.095 0.104 0.220 0.125 0.125 0.075
0.235 0.226 0.099 1.00 0.241 0.320 0.093 0.274 0.232 0.107 0.185 0.121 0.200
0.235 0.154 0.064 0.241 1.00 0.352 0.167 0.284 0.354 0.135 0.210 0.177 0.170
0.244 0.187 0.112 0.320 0.352 1.00 0.107 0.300 0.256 0.083 0.301 0.243 0.140
0.208 0.106 0.184 0.093 0.167 0.107 1.00 0.236 0.176 0.192 0.176 0.136 0.095
0.250 0.181 0.095 0.274 0.284 0.300 0.236 1.00 0.388 0.147 0.231 0.207 0.326
0.200 0.220 0.104 0.232 0.354 0.256 0.176 0.388 1.00 0.154 0.270 0.137 0.334
0.187 0.227 0.220 0.107 0.135 0.083 0.192 0.147 0.154 1.00 0.081 0.180 0.103
0.160 0.188 0.125 0.185 0.210 0.301 0.176 0.231 0.270 0.081 1.00 0.122 0.218
0.094 0.123 0.125 0.121 0.177 0.243 0.136 0.207 0.137 0.180 0.122 1.00 0.296
0.165 0.062 0.075 0.200 0.170 0.140 0.095 0.326 0.334 0.103 0.218 0.296 1.00
SOC-13: Sense of Coherence 13-item scale.
Table 3. Item-total correlation of items of the SOC-13. Item
Scale mean if item deleted
Scale variance if item deleted
Corrected itemtotal correlation
Squared multiple correlation
Cronbach’s alpha if item deleted
1 2 3 4 5 6 7 8 9 10 11 12 13
47.2014 46.6978 46.6942 46.7590 46.7266 46.9496 47.5863 47.3633 47.2266 46.9029 47.0360 47.2446 47.0072
63.317 62.269 64.856 62.602 61.254 62.279 65.897 61.279 62.060 65.785 65.053 64.445 63.726
0.406 0.392 0.292 0.384 0.417 0.439 0.300 0.484 0.470 0.294 0.370 0.318 0.354
0.195 0.283 0.216 0.185 0.233 0.272 0.134 0.281 0.289 0.123 0.170 0.164 0.233
0.738 0.739 0.750 0.740 0.737 0.734 0.749 0.729 0.731 0.749 0.742 0.747 0.744
SOC-13: Sense of Coherence 13-item scale.
but not overlapping. The item-total correlation values in the present study were lower than those reported by Tang and Dixon (38). The Cronbach’s alpha values on deletion of the items were not higher than the overall Cronbach’s alpha value of 0.76. Deletion of any item of the SOC-13 did not lead to any increase in the overall Cronbach’s alpha in the study population. Analysis of construct validity by means of factor analysis revealed a three-factor structure of the SOC-13 with good explained variance. This is in
contrast with the one-factor solution reported by Antonovsky (2). However, Lindström and Eriksson (8) have reported that the SOC seems to be a multidimensional concept. The factor loadings in this study indicate that the items do not fully correspond with the theoretical dimensions of comprehensibility, manageability and meaningfulness. This is in agreement with the findings reported by Sardu et al. (12), Jakobsson (14) and Larsson and Kallenberg (40). Lerdal et al. (41) have highlighted the need for further investigations on dimensions of the SOC.
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Table 4. Confirmatory factor analysis of items of the SOC-13. Component Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 Item 11 Item 12 Item 13
Dimensions of SOC-13
Initial eigenvalues
Rotation sums of squared loadings
Total
% of variance
Cumulative %
Total
% of variance
Cumulative %
Meaningfulness Comprehensibility Manageability Meaningfulness Manageability Comprehensibility Meaningfulness Comprehensibility Comprehensibility Manageability Comprehensibility Meaningfulness Manageability
2.561 1.522 1.186 1.029 0.959 0.901 0.842 0.814 0.773 0.693 0.610 0.587 0.523
19.700 11.709 9.122 7.917 7.380 6.929 6.479 6.259 5.945 5.329 4.694 4.515 4.023
19.700 31.408 40.530 48.447 55.828 62.757 69.236 75.495 81.439 86.768 91.462 95.977 100.000
1.812 1.751 1.705
13.941 13.471 13.119
13.941 27.412 40.530
SOC-13: Sense of Coherence 13-item scale. Note: Extraction method: principal component analysis.
Table 5. Factor loading of items of the SOC-13. Scale component
SOC-13 item number
Principal components loads 1
2
3
Comprehensibility
2 6 8 9 11
0.203 0.629 0.287 0.316 0.453
−0.076 0.190 0.609 0.522 0.252
0.740 −0.019 0.094 0.166 0.083
Manageability
3 5 10 13
−0.015 0.606 −0.135 0.180
−0.030 0.071 0.310 0.626
0.719 0.066 0.351 −0.111
Meaningfulness
1 4 7 12
0.237 0.672 −0.247 0.024
0.024 −0.001 0.394 0.595
0.534 0.078 0.402 −0.060
SOC-13: Sense of Coherence 13-item scale.
Sandell et al. (34) have reported similar findings among clinical and non-clinical samples. Their analysis did not confirm Antonovsky’s one-factor solution or a theoretical three-factor solution. Antonovsky has pointed out that the SOC scale was designed to assess the individual’s ability to move
toward the health end of the health–ease–dis-ease continuum. The scale was not intended to measure separately the components of comprehensibility, manageability and meaningfulness (7). Sandell et al. (34) have, however, reported that it might not be entirely meaningless to look at the components of the IUHPE – Global Health Promotion Vol. 0, No. 0 201X
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G. Rajesh et al.
Figure 1. Scree plot. Table 6. Factor-wise selection of items of the SOC-13 based on factor loadings. Factor
SOC-13 item number and domain
SOC-13 item
1
4 – Meaningfulness
6 – Comprehensibility
5 – Manageability
11 – Comprehensibility
2
13 – Manageability
8 – Comprehensibility 12 – Meaningfulness
9 – Comprehensibility
3
2 – Comprehensibility
3 – Manageability
1 – Meaningfulness
Until now your life has had: no clear goals or purpose at all/very clear goals or purpose at all Do you have the feeling that you are in an unfamiliar situation and don’t know what to do? Very often/very rarely or never Do you have the feeling that you’re being treated unfairly? Very often/very rarely or never When something happened, have you generally found that: you overestimated or underestimated its importance/you saw things in right proportion How often do you have feelings that you’re not sure you can keep under control? Very often/very rarely or never Do you have very mixed-up feelings and ideas? Very often/very rarely or never How often do you have the feeling that there’s little meaning in the things you do in your daily life? Very often/very rarely or never Does it happen that you have feelings inside you would rather not feel? Very often/very rarely or never Has it happened in the past that you were surprised by the behavior of people whom you thought you knew well? Never happened/always happened Has it happened that people whom you counted on disappointed you? Never happened/always happened Do you have the feeling that you don’t really care about what goes on around you? Very rarely or never/very often
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0.76
Cronbach’s alpha
Range six months to 2 years 0.77–0.41
SOC-29, SOC-13 0.74–0.93
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SOC: Sense of Coherence SOC-13: Sense of Coherence 13-item scale. SOC-29: Sense of Coherence 29-item scale.
28.00% of coping capability
Range 0.44–0.94 0.49–0.70
0.89
SOC-13
Range one year to 10 years 0.69–0.54
127 studies Range 0.70– 0.92
SOC-13
Antonovsky, Tang and Eriksson and Lindström, 1993 (7) Dixon, 2002 (38) 2005 (8)
Inter-item 0.06–0.42 correlation Item-total Range correlation Coe: oneConfirmatory factor 40.53% factor analysis: three solution factors explaining 42.9%
Split-half reliability 0.71 Guttman split-half 0.70 reliability Test-retest reliability 0.71
SOC-13
SOC
Present study
Table 7. Comparison of findings from other validation studies.
0.87
0.82
Threefactor solution 52%
SOC-29
SOC-13
The theoretical construct could not be supported
0.08–0.71
0.75
0.80
SOC-13
Naaldenberg Schmidt Sardu et al., 2011 and et al., (15) 2012 (12) Dantas, 2011 (39)
36%
0.84
0.77, 0.82 0.72
SOC-13
Tyagi et Rohani al., 2012 et al., 2010 (11) (27)
28%, 41%
SOC-29, SOC-13 0.79, 0.61
Spadoti Dantas et al., 2014 (18)
Original Article 9
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SOC scale. They observe that if the scale had to be considered in its entirety, then there was probably no need to propose the domains in the scale in the first place. The factor structure of the SOC is compounded by the fact that the items of the scale do not ‘cleanly’ refer to one or the other domain of the SOC. Hence, further studies on the factor structure of the SOC might be essential to shed more light on the same. The SOC-13 employs a seven-point Likert scale for its responses. While employing a Likert scale, one has to consider potential biases such as endaversion bias, positive skew and the halo effect (32). Further studies are needed to shed more light on the influence of these biases. The results of the present study indicate that the SOC-13 is a reliable and valid tool in an Indian context. The literature indicates that the salutogenic approach has been adopted in different sectors. The present study might open up further vistas for research pertaining to salutogenesis across different sectors in India. This might pave the way for addressing health inequalities in this and other developing countries. Psychometric properties of different versions of the SOC among different age groups (14,42), gender (43), in individuals with different health-related conditions (16–18,44), and in different settings (39,45) are essential. Longterm stability of the SOC (46) should also be investigated in the Indian context. The present study might provide valuable baseline information towards the same.
Conclusions The present study showed that the SOC-13 is a reliable and valid tool in an Indian context. Results indicate that the SOC-13 has good psychometric properties when tested among students in India. The present study paves the way for further research on salutogenesis and its myriad implications in developing countries like India. Funding This research received funding from the Indian Council of Medical Research (ICMR).
Conflict of interest None declared.
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