Analysis of the importance of family in the development of sense of coherence during adolescence

García-Moya I, Rivera F, Moreno C, Lindström B, Jiménez-Iglesias A. Analysis of the importance of family in the development of sense of coherence during adolescence. Scandinavian Journal of Public Health. 2012;40(4):333-339. © 2012 the Nordic Societies of Public Health. Doi:10.1177/1403494812449924 Analysis of the importance of family in the development of sense of coherence during adolescence Irene García-Moya Department of Developmental and Educational Psychology, University of Seville. Spain. Francisco Rivera Department of Clinical, Experimental and Social Psychology, University of Huelva. Spain. Carmen Moreno Department of Developmental and Educational Psychology, University of Seville. Spain. Bengt Lindström Folkhälsan Research Centre, Finland, & Nordic School of Public Health, Sweeden. Antonia Jiménez-Iglesias Department of Developmental and Educational Psychology,University of Seville. Spain. Corresponding author: Irene García-Moya Mailing address: Department of Developmental and Educational Psychology. University of Seville. C/ Camilo José Cela s/n 41018 Seville (Spain) Telephone number: +34 954554331 E-mail: ire[email protected] Word count: 3122; Abstract word count: 166 Tables: 2; Figures:0 Abstract Aims: The aim of this work was to study the influence of several family dimensions on SOC in adolescence, controlling the possible effects from the demographic variables, gender and age. Methods: The sample consisted of 7580 adolescents between the ages of 13 and 18, who had taken part in the 2010 edition of the WHO Health Behaviour in School-aged Children study in Spain. Results: The results showed that there were no significant gender differences in SOC levels. However, age had a significant influence on SOC. Higher levels of SOC were found in adolescents aged 13 and 14 compared to older participants. Family variables explained 18 per cent of SOC variability, with affection, easy communication with parents and parental knowledge as the most outstanding variables. In addition, positive relationships between parents and family affluence had a significant role in explaining SOC levels. Conclusion: The results suggest that the family context plays an important role in providing meaningful experiences for the development of a strong SOC in adolescence. Key Words: sense of coherence, salutogenesis, family, adolescence. Introduction A new approach to health, the salutogenic theory and model, was proposed by Aaron Antonovsky in 1979 as an alternative to the pathogenic model that historically had dominated Public Health[1]. The salutogenic model involves three main changes in the study of health and its determinants. Firstly, replacing the dichotomy between health and disease with a new perspective where health is seen as a continuum between the health/ease and the unhealth/dis-ease endpoints. As a result of this, interventions in Health Promotion are broadened to involve the whole population, not only people who are ill or at risk. Finally, the salutogenic model focuses on the identification of factors promoting health, so called salutary factors, instead of focusing only on risks or factors related to different diseases. The original salutogenic model is a sociological system-approach to health that can be seen as an interdisciplinary framework under which several concepts from Positive Psychology can be included. The model has been useful to guide the direction of research and interventions in Health Promotion[2-5], because it shares the basic principle that Health Promotion should be aimed at the population as a whole in the context of daily life, instead of only focusing on people at risk of disease[6]. Since the 90s a significant amount of research has been devoted to the core concept of the salutogenic model: sense of coherence (SOC). More than 500 studies about this topic were carried out between 1992 and 2003 and the trend is on an increase[7,8]. SOC has been defined as ‘a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable (comprehensibility); (2) the resources are available to one to meet the demands posed by the stimuli (manageability); and (3) these demands are challenges, worthy of investment and engagement (meaningfulness)’[9]. The reason why SOC has become so popular is twofold. Not only is SOC a relevant construct in understanding stress perceptions and coping, but it also has shown strong positive associations with health, emotional well-being and quality of life[7,8]. Despite its important role in explaining health, little research has been devoted to the mechanisms that promote the development of a strong SOC, since the vast majority of research has focused on the study of the relationships between SOC and health outcomes. Antonovsky[9] pointed out that social and historical factors but also daily-life contexts may have an important role in providing meaningful experiences in SOC development and empirical support has been found for the importance of proximate contexts in explaining SOC[10], a finding that has been replicated by different works that have shown that family[11], school[12] and neighbourhood factors[13,14] are significantly associated with people’s SOC. Focusing on family influences, Antonovsky[9] stated that childhood conditions related to the family social position, economic situation and social relationships influenced individuals’ SOC. The importance of family experiences in promoting a strong SOC can be understood when taking into account the characteristics of the positive experiences for SOC development described by Antonovsky[9]. Creating a consistency in life experiences, which involves the perception that environmental events are ordered and structured more than chaotic, promotes the sense of comprehensibility. A proper balance between demands and resources to deal with them strengthens the individual’s perception that stressors can be tackled easily, thus promoting the manageability component. Lastly, participating in outcomes implies person’s perception of having an active role in their life and destiny, increasing people’s motivation to face challenges and commit themselves to different domains of life (meaningfulness dimension). Despite the rather small amount of research about family influences and SOC, the family context seems to be one of the most influent scenarios in shaping a strong SOC[11], since trusting relationships with at least one of the parents[15], closeness in family relationships[10] and the absence of family conflict[13] seem to have positive effects in adolescents’ SOC. Furthermore, adolescence is a relevant period to study the factors that shape adult SOC because it’s a crucial stage in the life span where the personal identity and health-related behaviours are formed. Besides, studying the factors that influence the development and maintenance of a strong SOC in adolescence has been proposed as the way to gain knowledge about the origins and the development process of SOC[11,13]. Taking into account the importance of family in adolescents’ well-being, this work is aimed at examining the role of different dimensions of the family context in the development of SOC. The influence of demographic variables is also analyzed since this is one of the first works that studies SOC in Spanish population. Methods This study is based on data from the Spanish portion of the 2010 edition of the international survey Health Behaviour in School-aged Children (HBSC) study, a WHO international project that collects data about adolescents’ lifestyles every four years in about 40 countries from different continents. Participants As part of the 2010 edition of the international survey Health Behaviour in School-aged Children (HBSC) in Spain, a national representative sample of adolescents was drawn. Adolescents between the ages of 13 and 18 were selected from the original Spanish sample for this study. Therefore, the sample consisted of 7580 adolescents (3672 boys and 3908 girls) with a mean age of 15.41. Measures Variables were measured using the relevant items from the 2010 edition HBSC Spanish questionnaire. The questionnaire had been approved by the Research Ethical Committee of the University of Seville. The following variables were included: -Sociodemographic variables: gender and age. -Family affluence. Taking into account adolescents’ difficulties in answering direct questions about their family’s socioeconomic status, this variable was assessed by means of the Family Affluence Scale II, FAS-II[16]. Total scores range from 0 to 9, and three ordinal levels can be differentiated according to Boyce, Torsheim, Currie, et al.[17]. - Perceived family wealth. Adolescents were asked How well off do you think your family is? For the descriptive data analysis this variable was coded in three levels: Low (not so well off and not at all well off), Medium (average and quite well off) and High (very well off). - Affection. The affection dimension of the short version (PBI-BC) of the classic Parental Bonding Instrument was used[18]. Scores ranged from 0 to 2. -Ease of communication with parents. Participants were asked How easy is it for you to talk to the following persons about things that really bother you? For the data analysis this variable was collapsed into three levels: difficult communication, easy communication and very easy communication. -Parental knowledge. The measure of parental knowledge was based on the scale developed by Brown, Mounts, Lamborn et al.[19] that asks adolescents about how much father and mother (separately) knows about five issues: who your friends are?, how you spend your money?, where you are after school?, where you go at night?, what you do with your free time? The final score ranged from 0 to 2, where higher values represent higher levels of parental knowledge. -Frequency of family activities. Participants were asked how often did they and their families spend time together in different activities (watching TV, playing indoor games, eating a meal, going for a walk, playing sports…). An average total score was obtained which ranged from 0 to 7 days. -Quality of the relationships between parents. This variable was measured by means of an item based on Cantril’s Ladder[20]. Adolescents were asked In general how satisfied are you with the relationships between your parents? and answered by ticking the number which best described their feelings from a scale between 0 (My parents have very bad relationships) and 10 (My parents have very good relationships). -Sense of coherence (SOC). This variable was measured by using the SOC-29 Scale[9]. It consists of 29 items answered in a Likert scale of 7 values with two bipolar anchoring phrases. The global score is the average of the answers given to the 29 items and ranges from 1 to 7. The higher the score, the stronger the SOC it represents. In this study the scale showed a Cronbach alpha of 0.87. Procedure Information was obtained by means of anonymous on-line questionnaires that were filled in by the students during a regular school-hour in accordance with the HBSC international standardized procedure. The sessions were supervised by teaching staff. Students' anonymity was guaranteed. One-way ANOVA and effect size statistics (Cohen’s d) were used to evaluate differences in the reported degree of SOC depending on demographic and family variables. Cohen[21] proposed the following criteria for the interpretation of d in social sciences according to which effect size can be considered negligible (lower than 0.20), small (from 0.20 to 0.49), medium (from 0.50 to 0.79) and large (higher than 0.80). An additional criterion by Wolf[22] is available, according to which d values higher than 0.50 are interpreted as practically/clinically significant effects. Secondly, stepwise multiple regression was employed for building the hierarchy of variables in explaining SOC. All variables were used as scales in this analysis, with the exception of gender, which was entered as a dummy variable. Also, separate measures for mother and father were combined in order to avoid multicollinearity problems. Initially, a model was estimated in which all the examined variables were entered. Afterwards, a stepwise process of adjustment was conducted, so that the variables whose contribution to the level of explanation was negligible (rs2 lower than .005) could be removed. The model was estimated again after every removal until a parsimonious final hierarchy was obtained which included only those predictors that made a significant individual contribution to the model. Results Demographic variables and SOC Differences in SOC between boys and girls were negligible (F (1, 7578) = 16.97, p < .001; d = 0.09). In contrast, age had a significant influence since SOC was significantly higher in adolescents aged 13 and 14 than in those aged between 15 and 18 (F (2, 7577) = 79.84, p < .001). Effect size associated with these differences was small with respect to both 15 and 16 years old adolescents (d = 0.27) and 17 and 18 years old (d = 0.37). In addition, differences associated with the combination of gender and age were found (F (5,7574) = 20.76, p <.001). Specifically, girls aged between 15 and 16 showed lower levels of SOC than girls between the ages of 13 and 14 (d = 0.33), whereas these differences were negligible in the case of boys (d = 0.19). In boys, differences were only significant between those aged 13 and 14 compared to the ones aged 17 and 18 (d = 0.31). Family variables and SOC Before elaborating the hierarchy of variables in the explanation of SOC, bivariate analysis, which involved the study of the separate effect of each family variable on SOC, were conducted. As can be seen in Table I, these analyses showed that all family variables had a significant influence on SOC. The final regression model appears in Table II. Results showed that including the variables gender, perceived family wealth and frequency of family activities increased the R² value by only 0.002 points, thus not having a relevant role in explaining SOC levels. Age explained only 1.8% of the variability in SOC scores. However, including family variables, as can be seen in Model 2, implied an increase of 16 Currie C, Molcho M, Boyce W, et al. Researching health inequalities in adolescents: the development of the Health Behaviour in School-aged Children (HBSC) Family Affluence Scale. Soc Sci Med 2008;66:1429-36. 17 Boyce W, Torsheim T, Currie C, et al. The Family Affluence Scale as a measure of national wealth: Validation of an adolescent self-report measure. Soc Indic Res 2006;78:473-87. 18 Klimidis S, Minas IH, Ata AW. The PBI-BC: A brief current form of the parental bonding instrument for adolescent research. Compr Psychiatry 1992;33:374-7. 19 Brown BB, Mounts N, Lamborn SD, et al. Parenting practices and peer group affiliation in adolescence. Child Dev 1993;64:78-92. 20 Cantril H. The pattern of human concerns. New Brunswick, NJ: Rutgers University Press 1965. 21 Cohen J. Statistical power analysis for behavioral sciences. New York: Academic Press 1977. 22 Wolf FM. Meta-analysis: Quantitative methods for research synthesis. Beverly Hills, CA: Sage 1986. 23 Sollerhed A, Ejlertsson G, Apitzsch E. Predictors of strong sense of coherence and positive attitudes to physical education in adolescents. Scand J Public Health 2005;33:334-42. 24 Jorgensen RS, Frankowski JJ, Carey MP. Sense of coherence, negative life events and appraisal of physical health among university students. Pers Individ Dif 1999;27:1079-89. 25 Nielsen AM, Hansson K. Associations between adolescents’ health, stress and sense of coherence. Stress Health 2007;23:331-41. 26 Simonsson B, Nilsson K, Leppert J, et al. Psychosomatic complaints and sense of coherence among adolescents in a county in Sweeden. Biopsychosoc Med;2:4. 27 Anson O, Paran E, Neumann L, et al. Gender differences in health perceptions and their predictors. Soc Sci Med 1993;36:419-27. 28 Larsson G, Kallenberg KO. Sense of coherence, socioeconomic conditions and health: Interrelations in a nation-wide Swedish sample. Eur J Public Health 1996;6:175- 80. 29 Suominen S, Blomberc H, Helenius H, et al. Sense of coherence and healthdoes the association depend on resistance resources? A study of 3115 adults in Finland. Psychol Health 1999;14:937-48. 30 Nilsson KW, Starrin B, Simonsson B, et al. Alcohol-related problems among adolescents and the role of a sense of coherence. Int J Soc Welf 2007;16:159-67. 31 Marcia J. Development and validation of ego-identity statuses. 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Ugeskr Laeger 1998;160:7424–9. 43 Buddeberg-Fischer B, Klaghofer R, Schnyder U. Sense of coherence in adolescents. Soz Praventivmed 2001;46:404-10. 44 Grey P. The Family Power Project studying the development of SOC in adolescence in interaction with family. Preliminary results. Finland: Folkhälsan 2011. 45 Kalland M. The Parenthood First Project. Intermediate report. Finland: Folkhälsan 2011. Table I. Mean values and one-way ANOVA of SOC by family variables N M (SD) 95% CI F Cohen’s d Family affluence 62.43* Low (0 to 3) 694 4.37 (.73) [4.31, 4.42] Low-medium 0.23 Medium (4 to 6) 3673 4.54 (.74) [4.52, 4.57] Medium-high 0.20 High (7-9) 3113 4.69 (.76) [4.66, 4.72] Low-high 0.42 Total 7480 4.59 (.75) [4.57, 4.60] Perceived family wealth 95.75* Low 511 4.15 (.78) [4.09, 4.22] Low-medium 0.63 Medium 6907 4.62 (.74) [4.60, 4.64] Medium-high 0.20 High 141 4.48 (.70) [4.36, 4.59] Low-high 0.43 Total 7559 4.59 (.75) [4.57, 4.60] Ease communication with father 264.64* Difficult 2644 4.35 (.72) [4.33, 4.38] Low-medium 0.50 Easy 2985 4.70 (.69) [4.67, 4.72] Medium-high 0.21 Very easy 1474 4.85 (.80) [4.81, 4.89] Low-high 0.67 Total 7103 4.60 (.75) [4.58, 4.62] Ease communication with mother 29.86* Difficult 1334 4.26 (.71) [4.22, 4.30] Low-medium 0.46 Easy 3263 4.58 (.69) [4.55, 4.60] Medium-high 0.27 Very easy 2715 4.78 (.78) [4.75, 4.81] Low-high 0.69 Total 7312 4.59 (.75) [4.58, 4.61] Maternal affection 314.10* Low (0 to 0.5) 240 3.95 (.71) [3.85, 4.04] Low-medium 0.47 Medium (0.51 to 1.25) 1362 4.25 (.65) [4.22, 4.29] Medium-high 0.64 High (1.26 to 2) 5719 4.71(.74) [4.69, 4.72] Low-high 1.04 Total 7321 4.60 (.76) [4.58, 4.61] Paternal affection 338.64* Low (0 to 0.5) 621 4.07(.75) [4.01, 4.13] Low-medium 0.53 Medium (0.51 to 1.25) 2078 4.43(.66) [4.40, 4.46] Medium-high 0.46 High (1.26 to 2) 4290 4.76(.74) [4.74, 4.79] Low-high 0.93 Total 6989 4.60(.75) [4.58, 4.62] Maternal knowledge 166.14* Low (0 to 0.5) 115 4.03(.70) [3.90, 4.16] Low-medium 0.36 Medium (0.51 to 1.25) 1054 4.27(.67) [4.23, 4.31] Medium-high 0.54 High (1.26 to 2) 6092 4.67(.75) [4.65, 4.68] Low-high 0.85 Total 7261 4.60(.75) [4.58, 4.62] Paternal knowledge 281.44* Low (0 to 0.5) 597 4.19(.72) [4.13, 4.25] Low-medium 0.28 Medium (0.51 to 1.25) 1867 4.38(.67) [4.35, 4.41] Medium-high 0.51 High (1.26 to 2) 4471 4.75(.75) [4.73, 4.78] Low-high 0.75 Total 6935 4.60(.75) [4.59, 4.62] Frequency of family activities 152.55* Low (0 to 2) 4320 4.47(.73) [4.45, 4.49] Low-medium 0.42 Medium (2.1 to 3) 2390 4.78(.75) [4.75, 4.81] Medium-high 0.01 High (3.1 to 7) 586 4.77(.80) [4.71, 4.84] Low-high 0.41 Total 7296 4.59(.76) [4.56, 4.61] Quality of the relationships between parents 184.95* Low (0 to 3) 730 4.29(.75) [4.24, 4.35] Low-medium 0.10 Medium (4 to 7) 1467 4.36(.70) [4.33, 4.40] Medium-high 0.46 High (8 to 10) 5263 4.70(.74) [4.68, 4.72] Low-high 0.55 Total 7460 4.59(.75) [4.57, 4.61] * p < .001 Table II. Regression coefficients for linear association between SOC and family variables, controlling the effect of gender and age Variable B Standard error β R² ∆ R² rs² Model 1 .018* -- Age -.072 .007 -.135* Model 2 .198* .181* Age -.043 .006 -.082* .007 Family affluence .030 .005 .070* .005 Affection .165 .014 .177* .018 Parental knowledge .152 .012 .165* .020 Communication .066 .007 .127* .012 Quality of marital relationships .026 .004 .080* .005 Note: The estimation of a contrast model, in which variables that had not been included in the final model (gender, perceived family wealth and frequency of family activities) were entered, resulted in an increase in R² of 0.002, which indicated that they did not contribute significantly in the explanation of SOC. *p < .001