Keywords

Introduction

In 1987–1988 Aaron Antonovsky spent a year as visiting professor at the University of Lund, invited and hosted by Professor Marianne Cederblad. This has influenced the development of the Swedish research in a decisive way. His stay in Sweden gave the Swedish researchers an opportunity to personally meet and discuss the salutogenic model of health. It gave inspiration and encouraged researchers to conduct salutogenic research in Sweden. According to Antonovsky, cited in Hansson and Cederblad (1995), the Swedish version translated from the English version of the sense of coherence questionnaire was developed by Lisa Dahlin, Margareta Furu, and Carol Tishelman, at the University of Lund in consultation with Aaron Antonovsky, as the standard version to be used in Sweden.

Two research groups emerged as pioneers in the early Swedish research on salutogenesis. The research team led by Marianne Cederblad and Kjell Hansson at the University of Lund (with colleagues at the Department of Child and Adolescent Psychiatry) conducted groundbreaking research on salutogenesis in the treatment of families and children at risk for developing mental illnesses. Their early cross-sectional studies were followed by longitudinal studies with various time intervals for follow-ups (Cederblad, 1996; Cederblad, Dahlin, & Hagnell, 1994; Dahlin et al., 1990; Dahlin & Cederblad, 1993).

The research group in nursing at the Karolinska Institute in Stockholm, headed by Professor Hjördis Björvell and Professor Ann Langius Eklöf (Langius & Björvell, 1993, 1996, 2001; Langius, Björvell, & Antonovsky, 1992) focused on validating the sense of coherence questionnaire in the Swedish context , both in the general population of Swedes and also among different patient groups.

During his stay in Lund, Antonovsky held lectures at the former Nordic School of Public Health (NHV) in Gothenburg, invited by another front figure in salutogenesis, Professor Bengt Lindström. Here Antonovsky introduced the salutogenic model of health to a Nordic audience of students and professionals. Professor Lindström was at the same time working with his doctoral thesis on the quality of life of Nordic children, adopting a salutogenic approach (Lindström, 1994). In an address at NHV in 2006, Lindström highlighted the valuable contribution of Antonovsky for Nordic research in general and Swedish research in particular (Lindström, 2006). For many years thereafter university courses in salutogenesis were organized at NHV. Students and professionals from the Nordic countries became inspired and encouraged to adopt the salutogenic approach in their different contexts. Inspired by the contacts with Antonovsky, other university courses in salutogenesis were started, for example at the Karolinska Institute in Stockholm. In sum, Antonovsky’s visiting year in Lund influenced Swedish research on salutogenesis in a very positive way.

Research Seminars

In 1998, the Swedish Research Council organized a cross-sectional scientific conference on the salutogenic concept of the sense of coherence. Active researchers in the field of salutogenesis were invited to participate. A conference report was produced by (Kumlin, 1998), who was inspired to critically analyze the salutogenic research by Antonovsky, and giving mainly a negative critique focused on many issues. He claimed the salutogenic theory was (a) full of contradictions, (b) that Antonovsky had created a new dichotomy between the salutogenic and pathogenic perspective, both excluding the other, (c) that the salutogenic theory did not contribute to the understanding and explanation of health, and (d) the theory did not represent any new perspective on health. Kumlin’s pathogenic examination of the salutogenic concept was presented to 15 senior researchers, who all individually responded in written statements (and also collectively) pronouncing many of Kumlin’s statements as being unfair and lacking substance (Röster om kasam, 1998).

The experts were scientists who for decades had conducted research based on the salutogenic theory. In addition, many of them had met Antonovsky, and therefore had the opportunity to engage in direct detailed discussions about the salutogenesis and its constructs. Cederblad (1998) raised the question of what makes a theory valuable for research. One way is to empirically test it. She explicitly pointed out that Kumlin ignored the results of all the empirical studies on the sense of coherence concept. Instead, he chose some kind of scientific theoretical analysis. Konarski (1998) objected to Kumlin’s vendetta and how Kumlin tried to marginalize Antonovsky and his ambitions as a scientist.

Ten years later, the first international research seminar on salutogenesis was arranged in Helsinki, followed by annual international meetings and seminars in the Nordic countries and national Swedish conferences in Trollhättan.

Research on Salutogenesis Arouses Interest

A systematic search was undertaken in ProQuest (hosting 12 separate scientific databases) per February 11, 2016, for scholarly journals, dissertations, and thesis in the time span 1983–2016, using the sense of coherence, salutogenesis, and Antonovsky (separate search on each word) as the search strategy. This resulted in 3894 hits, out of which at least 530 papers included Sweden in the title or abstract. Searching on dissertations and student theses at different levels in Swedish shows there are at least 334 publications in the period 1983–2015. There are publications from different disciplines such as medicine, nursing, health sciences, public health, psychology, and social work. A systematic research synthesis showed that in 1992–2003, at least 85 different Swedish samples were investigated in salutogenesis research (Eriksson, 2007). Yet, most of the research on salutogenesis in Sweden is published in English. Table 48.1 shows a selection of papers on the salutogenic concepts published in Swedish.

Table 48.1 A selection of papers on the salutogenic concepts in Swedish
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The focus of previous research on salutogenesis in Sweden was to introduce the salutogenic health model to Swedish researchers, and thereafter translate and develop the Swedish version of the sense of coherence scale as a standard version to be used in Sweden (Hansson & Cederblad, 1995). The research was mainly run by research groups located in Lund (University of Lund) and Stockholm (Karolinska Institute). There followed a period of validation of the Swedish version in different samples in different contexts (see as examples Dahlin et al., 1990; Cederblad & Hansson, 1996; Langius & Björvell, 1993).

However, looking at the current situation, a different image emerges. As of this writing, there is ongoing salutogenesis research at most of the universities in Sweden (Fig. 48.1).

Fig. 48.1
figure 1

Salutogenesis research sites in Sweden

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Examining salutogenesis research in Sweden that is published either in English or in Swedish, one sees these areas of focus: clinical research related to different disease groups, nursing, aging research, workplace health, oral health, education/pedagogy and research on children and youth. Clinical research using the salutogenic approach is mainly focused on how patients are able to manage stress when suffering from serious illness such as cancer, stroke, multiple sclerosis, heart diseases, and chronic diseases generally. This research is mainly that of research groups at the Karolinska Institute, the Sahlgrenska Academy at the University of Gothenburg, and Malmö University.

The salutogenic perspective and the sense of coherence are concepts well-known in nursing research . It has its background in the time when Antonovsky visited Sweden and offered the opportunity for scientists to discuss and learn about salutogenesis. Antonovsky, in his second book, assumed that nurses would be the professional group that mainly would adopt his thoughts. This has happened generally all over the world, but particularly in Swedish nursing research, thanks to forward-thinking researchers at the Karolinska Institute in Stockholm and Umeå University. At Umeå, the focus has been mainly on aging research, and how elderly people are able to manage everyday life in the face of chronic illness.

Workplace health research has its main localization at Kristianstad University, Stockholm University, Mid-Sweden University, Jönköping University, and Karlstad University. Oral health research adopting the salutogenic approach is an area of research that emerged in the mid-2000, mainly located in Jönköping University. In educational research (pedagogics) some research groups are active at Stockholm University, University of Gothenburg, and Örebro University. Research on children and youth has continued at the University of Lund, the place where it all started, but also at Region Halland and Luleå University of Technology.

Research adopting the salutogenic approach and its core concept of the sense of coherence is extensive, and as already mentioned, published mostly in English. Papers in Swedish go back mainly to the 1990s and early 2000, when articles were published in Nordic scientific and professional journals. Nowadays there are many handbooks and textbooks in Swedish on how to use salutogenesis in everyday practice, for example, how to work according to salutogenic principles with the elderly (Westlund, 2013; Westlund & Sjöberg, 2005, 2008). Another example is how to transform salutogenic principles and understanding in leadership in organizations (Hanson, 2010, 2015). A university-level textbook on salutogenesis in Swedish is also available (Eriksson, 2015). This is an outcome of the established of a resource center on salutogenesis established in 2011 at the University West in Trollhättan (www.salutogenesis.hv.se).