Salutogenic Approach Based Interview With People With Schizophrenia
Condition: Salutogenesis; Mental Health Disorder; Schizophrenia; Sense of Coherence
MeSH terms: Schizophrenia; Mental Disorders
Study type: Interventional

Summary: 
      This study determines the effectiveness of the interviewing based on salutogenic approach on
      the sense of coherence and resilience of people with schizophrenia. For this, while the
      intervention group was subjected to salutogenic approach-based interview consisting of 16
      sessions twice a week. The control group continued their routine activities and was
      interviewed face-to-face 5 times.
    

Detailed description: 
      Schizophrenia is a chronic and serious disease that affecting 20 million people in the world.
      Because of the problems these individuals face in cognitive, emotional, and behavioral
      domains, they have frequently difficulty in adapting to their environment, have to struggle
      against stigmatization, have an increased risk of committing suicide due to ever decreasing
      functioning and hopelessness they experience, and they need a long-term care and support due
      to their difficulty in compliance to treatment.

      The sense of coherence and resilience are important components for individuals diagnosed with
      schizophrenia to cope with problems in cognitive, emotional, and behavioral domains. Sense of
      coherence reflects the capacity of a person to respond stressful situations. It is associated
      with a person's emotional responses and resources, making sense of the world, use of required
      resources, and respond to demands. Powerful sense of coherence helps a person to protect own
      health, to cope with the stress factors, to manage the strain, and to activate their
      resources.

      Resilience is described as the capacity of individuals to recover or adapt after problems,
      difficult periods, and stressful life crises that they face during their life. This term can
      also be understood as the ability to ensure and/or maintain a state of coherence.

      The model addressing the concepts of sense of coherence and resilience is salutogenic model.
      Salutogenic model (1996) which was developed by Aaron Antonovsky (1923-1994) is an
      alternative model to pathogenesis approach. While pathogenesis focuses on how the disease has
      occurred, salutogenesis focuses on how wellbeing is formed. Salutogenic approach attempts to
      explain why some people better cope with the strain, stressful life events and difficulties
      they face and how they maintain their health and wellbeing better compared to others. The
      most significant factor in personal evaluation of an external stimulus and in coping with the
      strain is explained with sense of coherence which is specified in the model. Sense of
      coherence is the fundamental concept of salutogenic theory and consists of three components.
      These are comprehensibility, manageability, and meaningfulness. Comprehensibility expresses
      that internal and external stressors experienced by a person are "expected" and "explainable"
      in the life. Manageability is the sense about that individual has the internal and external
      resources to cope with the situation caused by stressor. Meaningfulness states a person's
      perception on how they struggle against negative life events.

      Lindström and Eriksson (2010) describe salutogenesis as an "umbrella". Under this umbrella,
      there are also concepts of "empowerment", "self-efficacy", "quality of life", "resilience",
      "welfare", and "competence" as well as the sense of coherence. It is accepted that all of
      these concepts are associated with salutogenic dimensions and provide significant
      contributions to describe, explain, analyze, and promote health.

      There are studies applying intervention programs based on salutogenic model in people with
      mental disorder or groups at risk in terms of mental disorder. The first intervention program
      based on salutogenic model is talk therapy. The major goal of this application is to increase
      awareness and confidence of the participants and to promote their sense of coherence, coping
      skills, mental health, and welfare level by allowing them to recognize internal/external
      resources and potentials. With the talk therapy application, it is provided to manage
      stressful situations effectively by bringing out personal and collective resistance
      resources.

      The intervention based on salutogenic model has five fundamental components. (1)
      Sustainability of health, (2) Story of the person, (3) Factors to promote health, (4)
      Understanding the health promotion power of tension and strain, (5) Active adaptation.

      Traditional therapy which is recommended for recovery focuses on negative life events,
      diagnosis, and medication. In the talk therapy based on salutogenic approach, resources and
      coping potential of a person are addressed and three recovery factors are focused for the
      recovery process. These factors are (1) participants' perception about themselves as more
      than only a diagnosis and disease, (2) getting respected about discovering themselves and
      getting discovered by other people, (3) having control of their own lives. Psychiatric nurses
      take part as group leaders in the intervention. Focus of the talk therapies is their speech.

      It is stated that it could be possible for a person diagnosed with schizophrenia to gradually
      regain the ability of functioning independently, to rebuild family relationships, and to
      fulfil professional roles and functions with the practices to be made by the help of
      salutogenic model. Therefore, these people should be empowered to decide about their lives.
      By this means, it is possible to lead a satisfying life for them against the restrictions
      caused by the disease. A study evaluating sense of coherence and quality of life for people
      diagnosed with schizophrenia revealed that sense of coherence was an indicator for the
      quality of life. Bengtsson-Tops and Hansson (2001) concluded in their literature review on
      sense of coherence that the studies using methods regarding care, support and recovery of
      people diagnosed with schizophrenia or schizoaffective disorder could be useful in terms of
      recovery. In the light of these findings, Bengtsson-Tops and Hansson concluded that actions
      to improve cognitive abilities of people in order to facilitate the recovery could be
      increased by the concepts of sense of coherence. Menzies (2000) providing detailed
      information about how salutogenic approach should be applied for a person diagnosed with
      schizophrenia highlighted that psychiatric nurse would develop a person's hopes allowing them
      to cope with symptoms and problems, would enhance their self-esteem supporting their
      abilities and skills, would contribute development of their personal identity, and would
      increase the sense of coherence.

      It is stated in the literature that practices based on salutogenic model and talk therapy
      based on this model could be used for people diagnosed with schizophrenia. In the
      international literature, there is no study in which salutogenic-based talk therapy program
      is applied to only people diagnosed with schizophrenia. In Turkey, there has been no study
      examining the efficacy of any intervention program based on this model.
    

Intervention name(s): Salutogenic Approach Based Interview
Intervention type(s): Behavioral
Intervention description(s): Salutogenic Approach Based Interview has five basic components. (1) Continuity of health, (2) The story of the person, (3) Health promoting factors, (4) Understanding the health promoting power of tension and strain, (5) Active adaptation In traditional therapy recommended for recovery, more emphasis is placed on negative life events, diagnosis and medication. In the salutogenic approach-based interview, the resources and coping potential of the person are discussed and three healing factors are focused on for the recovery process. These factors are that the participants (1) perceive themselves as more than just a diagnosis and disease, (2) self-discovery and respect for other people's self-discovery, (3) control over their own lives. In the intervention, mental health nurses take part as group leaders. The focus in interviews is therapeutic conversations.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Salutogenesis; sense of coherence; resilience; schizophrenia