Introduction

The Salutogenic theory performed by Aaron Antonovsky in the late 1970s developed a significant and radical approach to the study of health and disease ¹, generating a change from the pathogenic perspective to the conceptualization of health, emphasizing the causes of health, its maintenance and enhancement, and not what causes disease ². From this point of view, Antonovsky defines health as the movement of the person along the wellbeing-illness continuum ³; in order to optimize this wellbeing it is necessary to identify the resources, conditions and factors aimed to generate health ⁴. This theory has two key constructs, that is, the generalized resistance resource (GRR) and the sense of coherence (SOC).

The GRR are a set of features showed by an individual, group or community that allow them to effectively face the stressors that daily life presents, helping to promote the development and strengthening of the SOC, such as money, knowledge, social relationships, beliefs, religion, self-esteem, meaning of life, among others ^5-6. The SOC is the orientation that an individual takes to manage and adapt to the course of life, and stay healthy ⁵. The SOC is made up of three integrally cohesive dimensions, that is, comprehensibility, which is a cognitive component where the individual perceives the complex and changing organization of his life and environment; Manageability, which is a behavioral component that means the ability to identify and mobilize available resources; and meaningfulness, a motivational component and force that gives meaning to the challenges faced by people in their lives, considering that life has meaning ^3,5,7-8. When an event occurs, people has to understand, learn how to handle, and give meaning to such an event.

The SOC is considered useful in coping and adapting to the requirements of different stages of the life course. Recent studies have observed that SOC increases over the years, and this is consolidated from adolescence onwards, which will contribute to moderating adverse events in the next stage of adulthood ^5,8. The approach from a positive vision of health is essential to act in the young adult population, considered a stage of risk ⁹, due to the increasing exposure to stress in daily life, both because of the changes that transcend in the process of their social development, as well as in their susceptibility to the social environment ¹⁰. From this approach, the potential of people of this age can be increased in order to transform those aspects considered stressful or negative, into challenges that enrich the various areas that make people to be better, since the evidence shows that when the SOC is stronger, the people feels their life has a better quality and their mental health is better, in addition to a healthier behavior, predisposition to do physical activity, and choose healthy foods. Similarly, it favors the development of positive coping strategies, lower consumption of alcohol, tobacco, and drugs ^5,11.

Therefore, the SOC is essential to approach health from a positive viewpoint, as it provides the ability to act to act flexibly and constructively in the face of negative events and challenges that people constantly face in today's world ¹². Therefore, it is essential to investigate the SOC in young adults in the various situations they face on a daily basis as it is considered a coping resource ⁵. This coping resource has an important health-promoting effect on people and generates strategies by the nursing professional, in conjunction with other health professionals, thus forming a multidisciplinary health team in favor of the health of this group. Therefore, the objective of this review was to identify the role of the sense of coherence and the factors that influence young adults.

Methodology

Integrative review ¹³ conducted during July 2020, with a 6-stage methodology according to Botelho, Cunha, Macedo ¹⁴. The PICO guiding question was: What is the role of the SOC and what factors influence young adults? For the search strategy, these English descriptors were used: Sense of coherence, Salutogenesis, Young Adult, with Booleans OR and AND, in databases, such as: Web of Science (WOS), Elsevier's abstract and citation database (SCOPUS) and United States National Library of Medicine (PubMed), and Scientific Electronic Library Online (SciELO); in the latter one, the descriptor sense of coherence, in Spanish, was used. Subsequently filters were applied regarding time (last 5 years), type of article and language (English, Spanish, and Portuguese) in each of them.

For the selection, the inclusion criteria were: articles published in the last 5 years that addressed the SOC in young adults, available in full text, in Portuguese, English, or Spanish, and the exclusion criteria were: literature reviews, articles that did not state the type of design, and gray literature. A total of 3507 publications were identified in the databases (WOS= 2573; PubMed= 429; SCOPUS= 475; SciELO= 30), and when applying filters it yielded 1161 potential publications (Table 1).

Based on stage 3 of identification of the pre-selected studies according to Botelho ¹⁴, the title, abstract and key words were read to verify the inclusion/exclusion criteria and the elimination of duplicate publications, of which 27 articles were subject to critical reading, based on the adaptation of a brief guide proposed by Cobos ¹⁵, leaving a sample of 11 articles ^16-26, (Figure 1).

Source: Self-Development

Figure 1 Flow chart of selected articles, 2020. 

For the collection of data from the published articles, a matrix was prepared to synthesize the relevant data, which included: Article title, authors, key words, place, year, objective, methodology (design, sample, instruments), results, and relevant conclusions, which were analyzed independently by the authors.

Results

The temporal distribution of the articles was 55% from 2019 ^21-26, 36% from 2016 ^16-19 and 9% from 2018 ²⁰. Regarding the geographical distribution the articles were concentrated in the European continent ^16-18,21,26, the rest were distributed in the Asian continent ^19,25 and American ^22,24, only two articles were developed in students of two nationalities, contrasting the Asian culture with the European one ^20,23. The design of the articles was varied, with a quantitative approach predominating ^16,19-25 over qualitative ¹⁸, and 18% of the articles used mixed design ^17,26, (Table 2).

Most of the research was conducted in a healthy university population ^16,19-26, while others addressed SOC in a young adult population with degenerative and congenital pathologies ^17-18. The objectives of these consisted of measuring SOC and its dimensions ^16,19-26, identifying the relationships with various psychological factors of well-being ^16,20,21,26, and discomfort ^19,25,26, lifestyles ^22,24, and others aimed to understand the perceptions and coping strategies of young adults ^17-18. To quantify it, 3 versions of the SOC scale were used; 55% of the investigations used the 13-item version ^{17,20-22,24,25}, 27% of 29 items ^16,23,26, and 9% of 9 items ¹⁹, ranging from high ^{16,20,22,23,26} to medium ^{17,20,21,23,25} scores.

Among the discoveries, it was found that a strong SOC exerts a protective role in young people ^16-26, since it is related to the different coping strategies ^16-18,21 and to the health-promoting lifestyle ^22,24, characterized by less stress, depression and distress ^25,26. Finally, it should be noted that this may be influenced by certain factors, such as gender ^16,23, educational level ^16,22, economic income ^17,19 and social support ^17-19.

Discussion

Based on the objective of identifying the role of SOC and the factors that influence young adults, it has been shown that, in terms of geographic distribution, the countries that developed the most research on SOC in young people were China, Japan and Germany ^{19,20,23,25,26} and there is also a growing study of this topic on the Latin American continent ^22,24. One of the interesting discoveries in this study was the cultural contrasts of SOC in young adults, in which it was identified that there was a difference in the strength of SOC among European young people versus Asian young people. Thus, some researchers compared the SOC of Japanese and Finnish students ²⁰, and in Chinese and German university students ²³, resulting in both studies that young Europeans have higher scores compared to Asians. Several studies in young people found different levels of SOC, suggesting that SOC may vary according to country of origin ^{10,17,21,22,26-28}. In contrast, one study showed that there were no statistically significant cultural differences when comparing the SOC of young adults of different nationalities; Australians, Finns and Turks ²⁹. Given these results, analysis of a larger sample of different nationalities is necessary to ensure the presence or absence of influence of culture on SOC.

Among the variables that influenced the SOC of young adults, it was identified that men had significantly higher SOC scores than women ¹⁶. Likewise, it was evidenced that SOC according to sex, independent of nationality the score was significantly higher in Chinese and German women with respect to men of both nationalities ²³, these results diverge from other studies, in which no significant difference was observed with respect to sex ^{21-22,24,28-30}.

Furthermore, according to educational level, those young people who had postgraduate studies had significantly higher SOC scores ¹⁶, as well as those with more years of studies had higher scores, however, they were not statistically significant ²², i.e., the level of studies could influence the development of SOC. In view of this, the level of study was related to the field of knowledge, a characteristic that is framed in the GRRs, which enhance and develop SOC ⁵.

Social support ⁵ was another factor identified, a variable that can contribute to the development of SOC ¹⁹, similar to the results of several studies ^17,31 where the capacity of people to receive and be satisfied with social support contributed to their level of SOC. This is evidenced in the results presented by researchers ^{(18, 19)}, in which young people with strong SOC possessed a large support base and good relationships with their peers. In other words, social support influenced the development of SOC and, at the same time, this provides the ability to manage their relationships.

Regarding economic income, several authors identified that those young people who had a paid job were associated with a strong SOC ¹⁷, likewise young people who had sufficient economic income were positively associated with higher levels of SOC ¹⁹, which is similar to what was mentioned in a study where it was established that, within the GRR, money was also found to be a factor ⁶.

Young adults who presented a strong SOC were characterized by being; positive, resilient, sociable, perceived good health and lower stress, were able to cope with adverse situations with adaptive coping, had better academic performance, high awareness about their health and nutrition, focusing on healthy lifestyles and sought professional mental health help when needed ^16-26.

Finally, it is worth mentioning that, given the rise of the positive approach to health in recent years, the temporal distribution of SOC studies in young adults increased during 2019, with the main focus being on the university population, a situation that is explained by the fact that universities play an important role as organizations for the promotion of health and well-being ²⁶.

The limitations of the present review were the limited analysis of studies with respect to temporality, as well as language. It is worth mentioning that the observational design of some studies did not allow the interpretation of the factors associated with SOC, as well as the credibility and transfer of knowledge was reduced in those studies that worked with a small sample.

Conclusions

According to the studies analyzed, the SOC of young adults is associated with various factors, such as country of origin, culture, financial income, educational level, and social support. However, the results are not consistent. Therefore, further studies of methodological quality are required to allow an objective analysis of the factors associated with SOC.

There is no doubt that it is important to strengthen the SOC in young adults, as it plays a protective role in the face of the various adverse and/or stressful situations they face, whether in their daily or educational environment or even in the health-disease cycle.

Considering the above, the nursing professional, who has the advantage of being in contact with people throughout their life cycle, should approach the young adult from this innovative orientation, through the implementation of health promotion strategies, since this not only focuses on health, but also sees the ability of people to transform negative experiences into positive experiences, which will aim to direct them towards the well-being and, therefore, to a better quality of life.

Conflicts of Interest

The authors stated no conflicts of interest.

Financing

No funding was received for this article.