An investigation of the stability of the sense of coherence for those attending a three-week rehabilitation programme : a thesis in partial fulfilment of the requirements for the degree of Masters of Arts in Rehabilitation at Massey University, Palmerston North, New Zealand
Those with chronic illnesses or disabilities face numerous obstacles and issues as they come to terms with and manage the realities of their situation. How well health care providers and funders understand this can determine the types and quality of services offered. Antonovsky (1993) has developed the Sense of Coherence (SOC) concept, which introduces a salutogenic (health promotion) model of health. This challenges the pathogenic model (origins of disease) that dominates health care. A relationship between the SOC and coping has been established in the literature. Currently, the SOC is widely viewed as a stable personality trait, but emerging evidence suggests that the SOC may be amenable to change. The purpose of the study was essentially to investigate the stability of the SOC in relation to an intervention over time. The study was conducted using a time series design (Pre-admission (T1), admission(T2), discharge (T3), 6-month follow up(T4)). A convenience sample of 120 participants (93 women, 27 men) was recruited for the study. The instruments used as dependant measures were the SOC-29, the Acceptance of Disability Scale ADM (modified) and the SF-36. Analysis of the SOC-29 revealed a significant change over time (p= .05), with the follow up analysis indicating that this change occurred following the intervention. This same finding was also true of the ADM scores (p=0.0005). This was not sustained at 6-month follow up for either the SOC or the ADM. Analyses of the SF-36 scores showed a significant improvement from admission to the 6-month follow up on all scores except general health. Only 72 participants completed at the 6-month follow up and this reduced the power of the study to yield a statistically significant result. Furthermore, a post-hoc analysis revealed that over 93% of the participants had medium to high SOC scores at the beginning of the study and this may have impacted on the outcome. There were significant correlations between the scores on the SOC-29 and the ADM and all scales of the SF-36 except physical function. As the significant change in SOC-29 scores was not sustained at the six-month follow up it could suggest that the SOC is indeed a stable trait. However, there were other factors identified, related to the characteristics of the sample and to wider factors that could have had an impact on the outcome of this study. In particular it is possible that a 3-week programme is not long enough to effect a lasting change in the SOC and this raises questions about health care delivery for those who have chronic illness or disability.