https://www.mdu.se/

Research on the well-established construct of sense of coherence (SOC)—from Antonovsky’s salutogenic model of health—and on the newer tripartite construct of meaning in life (3MIL)—from (positive) psychology—have been done quite separately from each other, and the similarities and differences between these two constructs have never been fully discussed. The aim was first to give a brief overview of these two constructs and then discuss their similarities and differences as well as some implications for future research. This study revealed that SOC—consisting of the three subconstructs comprehensibility, manageability, and meaningfulness—is affected by generalized resistance resources that contribute to life experiences characterized by consistency, participation in shaping outcomes, and underload–overload balance. Furthermore, that SOC is conceptualized as a relatively stable, not easily changeable, and not dynamic disposition concerned with coping with stress. 3MIL, on the other hand— consisting of the three subconstructs comprehension/coherence, purpose, and significance/ mattering—is affected by both generic structures (e.g., meaning frameworks) and specific factors (e.g., reliable patterns in environment). Furthermore, that 3MIL is conceptualized as a less stable, more changeable, and dynamic existential perspective on life. The following topics were suggested for future research: (a) more attention should be given to measure SOC and 3MIL in specific life domains; (b) the need to construct a measurement instrument that can be used to study the dynamic aspects of MIL more easily; and (c) the importance to study the stability and changeability of SOC and 3MIL further.

BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years).

METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time.

RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE).

CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.

In this chapter, the author discusses theoretical issues, including the dimensionality of the sense of coherence (SOC) scale, questioning whether the three components of comprehensibility, manageability and meaningfulness can be measured separately or not; a plea for longitudinal data to study SOC as the causal variable; whether SOC can be strengthened and thus function as an outcome variable or not; the concept of domain-specific SOC; the concept of a boundary in the measurement of SOC; the dichotomization and trichotomization of SOC to investigate more thoroughly if a weak SOC or a strong SOC is crucial for health and well-being; the importance of relating SOC to salutogenic outcome measures such as perceived wellness or a healthy lifestyle; and additional issues such as the collective SOC, measuring other central constructs in the salutogenic model and the importance of literature reviews and meta-studies. Excellent recommendations are given for ways forward.

Aim: Empathy is a crucial component of the nurse–patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes. Design: The design was a comparative cross-sectional study. Methods: A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy. Results: Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least. 

Although physical therapist students must be well prepared to integrate biopsychosocial and behavioral perspectives into their clinical reasoning, there is a lack of knowledge regarding factors that influence such competence. This study explored the associations among the independent variables-knowledge, cognition, metacognition, psychological factors, contextual factors, and curriculum orientation vis-a-vis behavioral medicine competencies-and the dependent variables-outcomes of input from client (IC), functional behavioral analysis (FBA), and strategies for behavior change (SBC) as levels in physical therapist students' clinical reasoning processes. This study used an exploratory cross-sectional design. The Reasoning 4 Change instrument was completed by 151 final-semester physical therapist students. Hierarchical multiple regression analyses for IC, FBA, and SBC were conducted. In the first step, curriculum orientation was inserted into the model; in the second step, self-rated knowledge, cognition, and metacognition; and in the third step, psychological factors. All independent variables except contextual factors explained 37% of the variance in the outcome of IC. Curriculum orientation explained 3%, cognitive and metacognitive factors an additional 22%, and attitudes another 15%. Variance in the outcomes of FBA and SBC were explained by curriculum orientation only (FBA change in R-2=0.04; SBC change in R-2=0.05). Higher scores of the dependent variables were associated with a curriculum having behavioral medicine competencies. The limitations of this study are that it was cross-sectional. Cognitive and metacognitive capabilities and skills and positive attitudes are important predictors of physical therapist students' clinical reasoning focused on behavior change at the IC level. Curricula with behavioral medicine competencies are associated with positive outcomes at all clinical reasoning levels.

Antonovsky introduced the salutogenic model whose aim is to explain the origins of health and to describe how health can be promoted. Sense of coherence (SOC) is the core concept in the model and is defined as the degree of meaningfulness, comprehensibility, and manageability that people feel in their life. The aim of this article is to bring attention to some topics on SOC that need to be explored in future research. First, SOC and how it is measured are briefly described. Thereafter, there is a brief discussion of the following seven topics: (a) the dimensionality of the SOC scale, (b) SOC as the causal variable, (c) SOC as the outcome variable, (d) general SOC versus domain-specific SOC, (e) the concept of boundary in the measurement of SOC, (f) SOC as a continuous versus a dichotomized or trichotomized variable, and (g) the importance of relating SOC to salutogenic outcome measures. In conclusion, the salutogenic model, with its core concept of SOC, is an excellent guide for research on health and well-being, but there are still some parts of this model that deserve further theoretical and empirical attention. 

Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (alpha range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

Although physical therapy students need to be well prepared to integrate strategies to effect health-related behavior change into their clinical reasoning, educators lack knowledge regarding which factors contribute to such competence. This study’s aim was to investigate the degree to which knowledge, cognitive, psychological and contextual factors as well as curriculum orientation influences students’ clinical reasoning focused on behavior change.

151 physical therapy students in the final semester completed the web-based Reasoning 4 Change instrument (1). 61 students attended a physical therapy education program with a behavioral medicine approach. Hierarchical multiple regression analysis was used to investigate the degree to which curriculum orientation, self-rated knowledge, cognition, metacognition, attitudes, self-efficacy and contextual factors influence three outcomes of the clinical reasoning process, i.e., Input from Client, Functional Behavioral Analysis (FBA) and Strategies for Behavior Change (SBC).

37% of the total variance in Input from Client was explained by all variables (p<.001), except contextual factors. Cognitive and metacognitive factors and attitudes were most important. Attending a physical therapy program with a behavioral medicine curriculum orientation was the only variable in the model that explained FBA (adjusted R2=.04;p<.05) and SBC (adjusted R2=.04;p<.01).