Jump to content

Salutogenic Approach to Wellness

Original Editor - Thalia Zamora Gómez

Top Contributors - Naomi O'Reilly, Jess Bell, Kim Jackson, Vidya Acharya, Lucinda hampton and Carin Hunter  

Introduction

Salutogenesis translates to “the origins of health”, from the Latin 'Salus' meaning health, and the Greek 'Genesis' meaning origin or beginning.[1] It is an approach that focuses on factors that promote health, resilience and well-being rather than disease and pathology.[2] The term was coined in 1979 by the medical sociologist Aaron Antonovsky in his book Health, Stress and Coping.[3]

Antonovsky proposed that the way people perceive and respond to their life experiences has a direct influence, either positive or negative, on their health. This idea emerged from an epidemiological study[4] he conducted in 1971 of Israeli women who had survived concentration camps during the Holocaust. He observed that despite their shared experience of extreme adversity, some had maintained good health while others had not.[4] These observations led Antonovsky to develop the salutogenic theory.

At the time, health research focused on identifying risk factors for disease, and stress was widely viewed as a factor that undermined health. Antonovsky challenged this view, arguing that stress, change, and disease are unavoidable features of life rather than anomalies. Instead of asking why people became ill, he asked how people manage to stay well despite constant exposure to stressors. Over time, his thinking placed greater emphasis on the nature of the stressor, the person's ability to cope with it, and their broader environment.[5]

Figure 1. The Ease/Dis-ease Continuum

Salutogenic Concepts

Antonovsky developed the salutogenic theory based on two concepts: sense of coherence and general resistance resources.[6][7][8]

The Ease/Dis-ease Continuum

Central to salutogenic theory is the idea that health is not a binary state — a person is not simply healthy or sick. Rather, health exists on a continuum between ease and dis-ease. Antonovsky proposed that the stressors we encounter in daily life push us towards the dis-ease end of the continuum, while the resources available to us help to counter that movement.[6][1]

Sense of Coherence

A sense of coherence can be understood as the way a person perceives and responds to life's stressors. People with a strong sense of coherence are more likely to see the world as comprehensible (understandable), manageable, and meaningful.[6][9]

Comprehensibility refers to how much a person perceives a problem or event as understandable — the sense that an event is structured, predictable, and they can make sense of it. Manageability reflects a person's ability to cope with and find solutions to problems. Meaningfulness refers to the meaning we ascribe to our lives — the sense that demands are challenges worthy of our time and investment.[6][10][11]

In practical terms, these three dimensions describe how a person moves along the ease/dis-ease continuum: through their ability to comprehend their situation, their capacity to make use of the resources available to them, and their sense of meaning in moving towards health.

Figure 2. The original view of the sense of coherence and its three dimensions (Antonovsky, 1987)[12]
Figure 3. The Sense of Coherence as a Multidimensional Construct.[13] 1) Antonovsky, 1987, 2) Sandell, Blomberg, & Lazar, 1998 , 3) Sakano & Yajima, 2005

Orientation to Life Questionnaire

Antonovsky developed the 29 Item Orientation to Life Questionnaire to measure a person's sense of coherence. The original 29-item version includes questions across all three dimensions: comprehensibility (11 items), manageability (10 items), and meaningfulness (8 items), scored on a 7-point scale with total scores ranging from 29 to 203.[1] A shorter 13-item version and other scales for community and family levels were also developed. This questionnaire has been widely adopted, with translations into at least 49 languages and use in at least 48 countries. Research across these contexts has shown the sense of coherence to be a multidimensional rather than unidimensional construct.[14]

General Resistance Resources

In the salutogenic approach, resources are "the biological, material and psychosocial factors that make it easier for people to perceive life as understandable, structured and consistent.”[15] Antonovsky described two types: generalised resistance resources (GRRs) and specific resistance resources (SRRs).

Generalised resistance resources are broad, ongoing factors that support a person's ability to manage life's challenges. Examples include income and housing, social support, self-esteem, cultural stability, knowledge and experience, healthy behaviours, and a preventive health orientation.[16] Access to these resources supports a person's ability to cope with stressors and to build a strong sense of coherence.[6][11]

Specific resistance resources are drawn on in particular situations — for example, contacting a crisis helpline during a mental health emergency, or receiving a vaccination during flu season.[6]

Generalised resistance resources contribute to a strong sense of coherence — an enduring confidence in one's ability to manage whatever challenges life presents.[17]

Figure 4. The definition of Generalised Resistance Resources (Antonovsky, 1979)[18]

Salutogenic Interventions

Salutogenic interventions focus on strengthening an individual's sense of coherence and their ability to identify and use available resources to maintain and improve health. Rather than targeting disease prevention and risk reduction alone, they aim to build on existing strengths and resources to improve well-being.[19]

Interventions can be designed to address each of the three components. Group-based or individual narrative sharing tasks can support comprehensibility as they help people make sense of their experiences. Teaching people coping strategies, as well as goal-setting and problem-solving skills, can increase manageability. Finding meaning can be developed through approaches that encourage reflection on purpose and meaning, such as therapeutic dialogue or reminiscence therapy.[19]

Research suggests that individuals with a stronger sense of coherence are more resilient and better able to cope with stress. They are also more likely to draw on available resources in ways that improve their well-being and health outcomes.[19]

The salutogenic model has been applied across a range of settings, including schools,[20] communities,[21] health systems,[22] and within different population groups such as children,[23] people with chronic diseases,[15][24] and migrants.[25] A scoping review by Álvarez et al.[15] found that 85% of studies of salutogenic interventions reported positive health outcomes with no adverse effects, with benefits including reduced anxiety and depression, improved perceived health and quality of life, better functional capacity, and greater psychological and social well-being.

Summary

The salutogenic model offers a framework for understanding health that goes beyond the identification and treatment of disease. By focusing on what keeps people well — their sense of coherence, the resources available to them, and their position on the ease/dis-ease continuum — it provides a basis for interventions that build on strengths. For rehabilitation professionals, this perspective can support a more holistic approach to patient care, recognising that a person's ability to comprehend their situation, make use of available resources, and find meaning in moving towards health are central to recovery and well-being.

References

  1. ↑ 1.0 1.1 1.2 Mijač S, Vitale K, Lončarek K, Slivšek G. How the salutogenic pattern of health reflects in type 2 diabetes mellitus: a narrative review. Diabetology. 2025; 6(11):124.
  2. ↑ Badwaik G, Kadam P, Kaliaperumal C. Spirituality and neurosurgery: A salutogenic current perspective. Clin Neurol Neurosurg. 2025 Jul;254:108922.
  3. ↑ Antonovsky, A.Health, Stress and Coping. San Francisco: Jossey-Bass, 1979
  4. ↑ 4.0 4.1 Antonovsky A, Maoz B, Dowty N, Wijsenbeek H. Twenty-five years later: A limited study of the sequelae of the concentration camp experience. Social Psychiatry. 1971 Dec 1;6(4):186-93. https://doi.org/10.1007/BF00578367
  5. ↑ Lindström B, Eriksson M. Contextualizing salutogenesis and Antonovsky in public health development]. Health promotion international. 2006 Sep 1;21(3):238-44. Available from: https://doi.org/10.1093/heapro/dal016
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Public Health Ontario/Sante Publique Ontario. Salutogenesis and Health Promotion, 2024.
  7. ↑ Eriksson M. The sense of coherence in the salutogenic model of health. InThe handbook of salutogenesis 2017 (pp. 91-96). Springer, Cham. https://doi.org/10.1093/heapro/dal016
  8. ↑ Shami M, Abbaspoor Z, Shokravi FA, Ghanbari S, Javadnoori M. A mixed methods study protocol to develop an educational program based on salutogenesis theory to improve the postpartum quality of life among nulliparous women. Sci Rep. 2025 Mar 5;15(1):7695.
  9. ↑ Antonovsky, A. Unraveling the Mystery of Health. How People Manage Stress and Stay Well. San Francisco: Jossey-Bass, 1987.
  10. ↑ Vinje HF, Langeland E, Bull T. Aaron Antonovsky’s Development of Salutogenesis, 1979 to 1994. 2016 Sep 3. In: Mittelmark MB, Sagy S, Eriksson M, et al., editors. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. Chapter 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435860/ doi: 10.1007/978-3-319-04600-6_4
  11. ↑ 11.0 11.1 Settley C. Examining salutogenesis and psychological wellbeing in persons affected by substance addiction: A scoping review. Acta Psychol (Amst). 2025 Jul;257:105070.
  12. ↑ Eriksson M., Mittelmark M.B. (2017) The Sense of Coherence and Its Measurement. In: Mittelmark M. et al. (eds) The Handbook of Salutogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-04600-6_12
  13. ↑ Eriksson M., Mittelmark M.B. (2017) The Sense of Coherence and Its Measurement. In: Mittelmark M. et al. (eds) The Handbook of Salutogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-04600-6_12
  14. ↑ Eriksson M, Mittelmark MB. The Sense of Coherence and Its Measurement 12. The handbook of salutogenesis. 2017;97. https://doi.org/10.1007/978-3-319-04600-6_12
  15. ↑ 15.0 15.1 15.2 Álvarez ÓS, Ruiz-Cantero MT, Cassetti V, Cofiño R, Álvarez-Dardet C. Salutogenic interventions and health effects: a scoping review of the literature. Gac Sanit. 2021 Sep-Oct;35(5):488-494.
  16. ↑ Idan O, Eriksson M, Al-Yagon M. The salutogenic model: The role of generalized resistance resources. InThe handbook of salutogenesis 2017 (pp. 57-69). Springer, Cham. https://doi.org/10.1093/heapro/dal016
  17. ↑ Lindström B, Eriksson M. Salutogenesis. Journal of Epidemiology & Community Health. 2005 Jun 1;59(6):440-2. https://doi.org/10.1093/heapro/dal016
  18. ↑ Eriksson M. The Sense of Coherence in the Salutogenic Model of Health. 2016 Sep 3. In: Mittelmark MB, Sagy S, Eriksson M, et al., editors. The Handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. Fig. 11.4, [The definition of generalized resistance resources (Antonovsky, , s. 103)]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435812/figure/ch11.Fig4/ doi: 10.1007/978-3-319-04600-6_11
  19. ↑ 19.0 19.1 19.2 Liu X, Zhao H, Song S, Wen R, Liu B, Luo Y. Effectiveness of a salutogenic intervention on self-perception of aging and sense of coherence for community-dwelling older adults: A quasi-experimental study. Geriatr Nurs. 2026 Feb 16;69:103943.
  20. ↑ Jensen BB, Dür W, Buijs G. The application of salutogenesis in schools. In The Handbook of Salutogenesis 2017 (pp. 225-235). Springer, Cham.https://doi.org/10.1093/heapro/dal016
  21. ↑ Vaandrager L, Kennedy L. The application of salutogenesis in communities and neighborhoods. InThe handbook of salutogenesis 2017 (pp. 159-170). Springer, Cham. https://doi.org/10.1093/heapro/dal016
  22. ↑ Pelikan JM. The application of salutogenesis in healthcare settings. The Handbook of Salutogenesis. 2017 Jun 8:261. https://doi.org/10.1093/heapro/dal016
  23. ↑ Taylor JS. Salutogenesis as a framework for child protection: literature review. Journal of advanced nursing. 2004 Mar;45(6):633-43. https://doi.org/10.1046/j.1365-2648.2003.02954.x
  24. ↑ Aujoulat I, Mustin L, Martin F, Pélicand J, Robinson J. The application of Salutogenesis to health development in youth with chronic conditions. InThe Handbook of Salutogenesis 2017 (pp. 337-344). Springer, Cham. https://doi.org/10.1007/978-3-319-04600-6_32
  25. ↑ Bonmatí-Tomas A, Malagón-Aguilera MC, Gelabert-Vilella S, Bosch-Farré C, Vaandrager L, García-Gil MD, Juvinyà-Canal D. Salutogenic health promotion program for migrant women at risk of social exclusion. International journal for equity in health. 2019 Dec 1;18(1):139. https://doi.org/10.1186/s12939-019-1032-0
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Salutogenic_Approach_to_Wellness&oldid=377039"