1. bookVolume 59 (2020): Issue 3 (September 2020)
Journal Details
License
Format
Journal
First Published
29 Jul 2010
Publication timeframe
4 times per year
Languages
English
access type Open Access

Validation of the Croatian Version of the Sense of Coherence 29-Item Scale in Croatian Nurses

Published Online: 25 Jun 2020
Page range: 155 - 163
Received: 19 Dec 2019
Accepted: 26 May 2020
Journal Details
License
Format
Journal
First Published
29 Jul 2010
Publication timeframe
4 times per year
Languages
English
AbstractIntroduction

The aim of the study was to validate the Croatian version of the Sense of Coherence 29-item instrument (SOC-29) within a nursing population.

Methods

The cross-sectional study was conducted between December 2017 and June 2018 at the University Hospital Centre Sisters of Mercy (UHCSM) in Zagreb, Croatia. A total of 711 nurses participated in this study. Internal consistency reliability was evaluated using Cronbach’s alpha coefficient (α), while the structure of the questionnaire was verified by exploratory factor analysis (EFA) (method of extraction: principal component analysis (PCA)) and confirmatory factor analysis (CFA).

Results

The instrument demonstrated high internal consistency (α=0.885). PCA analysis has identified five factors that together account for 48% of the variance. However, the observed factors could not be interpreted. In the CFA, none of the models fitted well, although the fit of the three-factor model (CMIN/DF=4.786, CFI=0.767, RMSEA=0.073) was slightly better in comparison with the one-factor model (CMIN/DF=6.072, CFI=0.685, RMSEA=0.084). As the three-factor model in PCA has been shown to be uninterpretable, and all three factors were mutually positive and significantly correlated (correlation coefficients: 0.365–0.521), this indicated a single factor in the background. All items also showed saturation with the first factor (accounting for 25.7% of the variance).

Conclusions

The Croatian version of the SOC-29 instrument successfully fulfilled the necessary psychometric criteria for being used on the population of Croatian nurses. The study proposes that potential users use the single-factor structure.

Keywords

Ključne besede

INTRODUCTION

The Sense of Coherence (SOC) is a key concept of salutogenic model proposed in 1979 by the American-Israeli medical sociologist Aaron Antonovsky (1). It was seen as a coping resource that helped individuals to identify and use their external and internal resources for solving problems and managing life events (1). In order to measure the SOC, Antonovsky developed a special instrument: the Orientation to Life questionnaire, also named the SOC scale. The original version of the instrument consisted of 29 questions (SOC-29), while a shorter version contained 13 questions (SOC-13) (2). Current research by Mittelmark et al. indicates that the SOC-29 and SOC-13 have been used in at least 49 different languages in at least 48 different countries around the world (2). Both instruments were also assessed for their reliability and validity in different population groups, from the general population to various groups of patients (2, 3, 4, 5, 6, 7, 8 , 9). The results of validation studies proved both instruments to be reliable and cross-culturally appropriate tools (2, 3, 4). In these studies, a one-factor structure was often tested against a three-factor structure. Some authors have concluded that the SOC scale is more appropriate as a one-dimensional scale (3, 7), while others have suggested a multidimensional concept (2).

Research has proved that nurses constitute a vulnerable population group that faces significantly more stress compared to other professions (10), which may have a negative impact on their health (3, 4, 5, 6, 7, 8, 9, 11, 12, 13, 14). Research findings on SOC in the nursing profession have so far shown that SOC is a protective factor against stressors in the work environment (15). A strong SOC is also a good predictor of nurses’ ability to function healthily in the workplace, protecting them against burnout (16). Burnout is also a feature of the nursing profession in Croatia (11, 17). According to Mijakoski et al. (17), Croatian nurses reported high levels of depersonalisation and of organisational and emotional work demands. The study highlighted the need for specific organisational interventions to be implemented in hospital settings. An exploration of SOC among Croatian nurses is therefore urgently required.

In 2005 the SOC-29 was translated into Croatian (SOC-29-CRO) and psychometrically tested on the sample of 822 individuals from the general population (18). It has not, however, so far been used to assess the Croatian nursing population. Moreover, to our knowledge the literature currently contains only a handful of studies that attempt to validate the SOC-29 among nurses (19, 20). The study aimed to validate the SOC-29-CRO for use as part of health promotion research among Croatian nurses. Its objective study was to assess selected psychometric characteristics of the instrument within this particular occupational group.

METHODS
Study Design and Study Population

This cross-sectional study was carried out as part of a larger research project on the impact of SOC on work ablity of nurses at University Hospital Centre Sisters of Mercy (UHCSM) in Zagreb, Croatia between December 2017 and June 2018. The total population of 1,465 nurses of different profiles (registered nurses, Bachelors of nursing, Masters of Science in nursing) employed in different departments of the UHCSM were considered for inclusion in the study regardless of their education level. However, due to various absences (sick leave, annual leave, study leave), questionnaires could only be delivered to 1,300 nurses.

Description of the SOC-29 Study Instrument

SOC-29 is an instrument with 29 items, each of them being scored on a seven-point scale (1) (Table 1). Thirteen items are formulated negatively and have to be reversed in scoring. The measure given by SOC-29 is a summary score, obtained by adding the values of individual responses to all 29 items, ranging from 29–203 points, with higher scores indicating a stronger SOC (2, 3).

Sense of Coherence 29-item instrument: items, their placement within three dimensions, and scoring (1).

Item noQuestion*DimensionScoring
Item_1When you talk to people, do you have the feeling that they don’t understand you?CR
Item_2Think of the people with whom you come into contact daily, aside from the ones to whom you feel closest. How well do you know most of them?CO
Item_3Has it happened in the past that you were surprised by the behaviour of people whom you thought you knew well?CR
Item_4In the past ten years your life has been: (full of changes without your knowing what will happen next – completely consistent and clear)CO
Item_5Do you have the feeling that you are in an unfamiliar situation and don’t know what to do?CO
Item_6When you face a difficult problem, the choice of a solution is: (always confusing and hard to find – always completely clear)CO
Item_7Your life in the future will probably be: (full of changes without knowing what will happen next – completely consistent and clear)CO
Item_8Do you have very mixed-up feelings and ideas?CO
Item_9Does it happen that you have feelings inside you would rather not feel?CO
Item_10Does it happen that you have the feeling that you don’t know exactly what’s about to happen?CO
Item_11When something happened, have you generally found that: (you overestimated or underestimated its importance – you saw things in the right proportion)CO
Item_12In the past, when you had to do something which depended upon cooperation with others, did you have the feeling that it: (surely wouldn’t get done – surely would get done)MaO
Item_13Has it happened that people whom you counted on disappointed you?MaR
Item_14Do you have the feeling that you’re being treated unfairly?MaO
Item_15What best describes how you see life: (one can always find a solution to painful things in life – there is no solution to painful things in life)MaR
Item_16When something unpleasant happened in the past your tendency was: (“to eat yourself up about it” – to say “OK that’s that, I have to live)MaO
Item_17When you do something that gives you a good feeling: (it’s certain that you’ll go on feeling good – it’s certain that something will happen to spoil the feeling)MaR
Item_18Do you think that there will always be people whom you’ll be able to count on in the future?MaR
Item_19Many people – even those with a strong character – sometimes feel like sad sacks (losers) in certain situations. How often have you felt this way in the past?MaR
Item_20When you think of the difficulties you are likely to face in important aspects of your life, do you have the feeling that: (you will always succeed in overcoming the difficulties – you won’t succeed in overcoming the difficulties)MaR
Item_21How often do you have feelings that you’re not sure you can keep under control?MaO
Item_22Do you have the feeling that you don’t really care about what goes on around you?MeR
Item_23Life is: (full of interest – completely routine)MeR
Item_24Until now your life has had: (no clear goals or purpose at all – very clear goals and purpose)MeO
Item_25Most of the things you do in the future will probably be: (completely fascinating – deadly boring)MeR
Item_26When you think about your life, you very often: (feel how good it is to be alive – ask yourself why you exist at all)MeR
Item_27Doing the things you do every day is: (a source of deep pleasure and satisfaction – a source of pain and boredom)MeR
Item_28You anticipate that your personal life in the future will be: (totally without meaning or purpose – full of meaning and purpose)MeO
Item_29How often do you have the feeling that there’s little meaning in the things you do in your daily life?MeO

Legend:

= the questions from the questionnaire are reprinted with the permission of the copyright holder; C=comprehensibility; Ma=manageability; Me=meaningfulness; O=original; R=reverse

Written permission to use SOC-29-CRO was obtained from the translators, as well from the copyright holders of the original SOC-29 instrument.

Instrument Administration

After obtaining the approval of the Ethics Committee, a meeting was held at which the participants were informed of the objectives of the research and the overall procedure. After the meeting, all study instruments were distributed in sealed envelopes to all hospital departments. Participants were given the possibility of taking the questionnaire home, filling it in and returning it to the workplace. All questionnaires were returned anonymously in sealed envelopes to protect nurses’ privacy.

Psychometric Validation

In order to assess the instrument’s reliability, internal consistency was assessed by calculating Cronbach’s alpha coefficient (α). The instrument was considered to be internally consistent if α≥0.80 (21). In order to assess the instrument’s validity, the factor structure of the instrument was assessed by using exploratory factor analysis (EFA) as well as confirmatory factor analysis (CFA). In EFA, the data screening, assumption testing and sampling adequacy were performed first using the Kaiser-Meyer-Olkin (KMO) statistic with appropriate values >0.5 and Bartlett’s sphericity test with appropriate values p≤0.05 (22). The Kolmogorov-Smirnov (K-S) test was also performed for testing the normality of distributions. The principal component analysis (PCA) was then used as the extraction method. In CFA, the robust maximum likelihood estimator was applied and the following fit measures used in the assessment: the relative chi-square (chi-square/degree of freedom) (CMIN/DF), the comparative fit index (CFI), and the root mean squared error of approximation (RMSEA). The criteria for fit measures were: CMIN/DF<5 (23), RMSEA<0.060 (24) and CFI>0.950 (24). Two models were defined and tested: the one- and three-factor model. Statistical analysis was performed using SPSS software, version 23.0 (SPSS Inc., Chicago, IL, USA), except for the CFA, where AMOS software was used.

RESULTS
Study Participants’ Characteristics

Of the 1,300 nurses eligible for inclusion, 713 participated in the study (response rate 54.7%). The group consisted of 630 women and 83 men. The mean age was 38.4±12.5 years (range: 19–65 years). All other characteristics of the study participants are presented in Table 2.

Socio-demographic and work-related characteristics of the study participants (n=713).

CharacteristicCategoryN(%)
GenderMale8311.6
Female63088.4
Age19–3024734.6
31–4016122.6
41–5015922.3
51–6514520.4
Marital statusMarried37152.0
Divorced486.7
Widowed182.5
Single18626.1
Life partnership8912.5
Level of educationHigh school education42960.2
Bachelor of nursing25635.9
Master of nursing283.9
Work departmentInternal unit17925.3
Surgery unit15722.2
Operating room334.7
Intensive care unit7310.3
Gynaecology unit527.3
Polyclinical unit233.2
Oncology and haematology unit588.2
Dermatology unit131.8
Emergency unit273.8
Ophthalmology unit284.0
Psychiatry unit344.8
Paediatrics unit314.4
Length of serviceLess than 1 year233.2
1–19 years39154.8
20 or more years29941.9

The SOC-29-CRO instrument was completed by 711 participants. The mean value of the SOC-29-CRO summary score in our study was 145.0±22.1 points. The coefficient of relative variation was 15.2%. The statistical properties of the distribution of the individual item values are shown in Table 3.

Statistical properties of the distribution of values of items of the Sense of Coherence 29-item scale in the validation study of Croatian nurses (n=711).

Itemx¯{\rm{\bar x}}SDMeIQR
Item_14.81.654–6
Item_24.61.454–6
Item_33.81.443–5
Item_43.81.743–5
Item_54.81.654–6
Item_64.71.454–6
Item_74.31.543–5
Item_85.61.565–7
Item_95.01.754–6
Item_104.81.754–6
Item_114.61.465–7
Item_125.21.454–6
Item_133.81.543–5
Item_144.51.853–6
Item_155.61.565–7
Item_165.01.754–7
Item_174.91.754–6
Item_185.81.565–7
Item_194.41.453–6
Item_205.11.454–6
Item_215.01.754–6
Item_224.61.454–6
Item_233.81.443–5
Item_243.81.743–5
Item_254.81.654–6
Item_264.71.454–6
Item_274.31.543–5
Item_285.61.565–7
Item_295.01.754–6

Legend: x¯{\rm{\bar x}} =mean; s=standard deviation; Me=median; IQR=interquartile range

Psychometric Validation
Reliability

Cronbach’s alpha coefficient was high (α=0.885), indicating high internal consistency of the instrument.

Factor Structure

Both the KMO statistic (KMO=0.913) and Bartlett’s sphericity test (p<0.001) indicated adequate properties for the PCA. The K-S test did not show statistically significant deviations from the normal distribution (p=0.063). PCA analysis has identified five factors which together accounted for 48% of the variance (Table 4). However, the observed factors could not be interpreted. A PCA limited to three factors also showed an uninterpretable structure.

Results of exploratory factor analysis (extraction method: principal component analysis) in the validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

ComponentInitial EigenvaluesExtraction sums of squared loadings
Total% of varianceCumulative %Total% of varianceCumulative %
17.45325.70025.7007.45325.70025.700
22.3968.26233.9622.3968.26233.962
31.6935.83939.8011.6935.83939.801
41.2364.26244.0631.2364.26244.063
51.1433.94348.0051.1433.94348.005
60.9823.38851.393
70.9553.29454.687
80.9353.22357.910
90.8973.09261.003
100.8412.90063.903
110.8112.79766.699
120.7672.64669.345
130.7252.50071.846
140.7002.41574.261
150.6812.34976.610
160.6432.21778.827
170.6232.14780.975
180.5932.04683.021
190.5651.94784.968
200.5471.88686.854
210.5341.84288.695
220.5151.77690.471
230.4711.62392.095
240.4481.54693.640
250.4171.43995.079
260.3891.34096.419
270.3661.26197.680
280.3451.18998.869
290.3281.131100.000

The statistical properties of both models defined and tested using CFA are presented in Table 5. None of the models fitted well (Table 5). Moreover, all three factors in the three-factor model were mutually positive and significantly correlated (r=0.365–0.521).

Results of confirmatory factor analysis in validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

Statistical propertyone-factor modelthree-factor model
Chi-square2289.111790.13
Degrees of freedom377374
p<0.001<0.001
CMIN/DF6.0724.786
CFI0.6850.767
RMSEA0.0840.073

Legend: CMIN/DF=relative chi-square (chi-square/degree of freedom); CFI=comparative fit index; RMSEA=root mean squared error of approximation

Additionally, in PCA all the items have shown first factor, which accounted for 25.7% of the variance (Table 4), loading. The factor loadings, which were considered satisfactory, are shown in Table 6.

Factor loadings greater than 0.200 in the validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

ComponentComponent loads
1st2t3t4st5st
Item_10.4430.363
Item_20.3420.320−0.325
Item_30.3520.5210.2620.257
Item_40.2770.626−0.340
Item_50.4830.277−0.416
Item_60.4680.392−0.394
Item_70.3050.600−0.290
Item_80.5470.241−0.301−0.236−0.216
Item_90.5650.404−0.306
Item_100.3990.246−0.292
Item_110.5150.383
Item_120.5420.2030.315
Item_130.4030.5270.266
Item_140.5120.383−0.362
Item_150.520−0.317
Item_160.497−0.225
Item_170.4960.217
Item_180.581−0.2040.210
Item_190.5000.317
Item_200.589−0.211−0.203
Item_210.4300.3370.219
Item_220.3550.240−0.2100.340
Item_230.551−0.352−0.260
Item_240.626−0.310
Item_250.677−0.355−0.207
Item_260.718−0.243
Item_270.625−0.2660.244
Item_280.667−0.404−0.223
Item_290.3450.3100.209
DISCUSSION

The results of our study show that the SOC-29-CRO successfully fulfilled the required psychometric criteria for being used within the Croatian nursing population.

The results of the reliability analysis in our study are consistent with the results reported in other similar studies. First, the reliability obtained in our study is in the upper range of values for this measure obtained in other similar studies in general (range 0.70–0.95) (2, 3, 4, 5).

Finally, the results of our study are similar to the results of the study conducted among Portuguese nurses with a reported Cronbach’s alpha value of 0.87 (19). The reliability obtained in our study is also completely consistent with the reliability obtained in the study by Kardum et al. (18). The value of Cronbach’s alpha coefficient in this study was almost identical (α=0.88).

The analysis of factor structure in our study first identified five factors (a similar result was obtained in the studies conducted by Frenz et al. (7) and Paika et al. (5). In both studies in continuation one-factor structure was revealed. In the study by Frenz et al., subsequent analysis of the factor scores suggested the scale had one core factor. The authors stated that the results suggested that the SOC was best understood as having a single core factor (7). Paika et al. repeated the factor analysis using the fixed number of factors as the extracted model, which resulted in one factor being extracted. Their study revealed that an SOC-29 one-factor structure showed a coherent structure with remarkable stability (5). The study conducted among Portuguese nurses also confirmed the one-factor structure (19). As in our study all the items showed saturation with the first factor, we decided to use the one-factor structure advocated by other authors (5, 7). This was despite the fact that the percentage of the explained variance could not be considered satisfactory. However, we can justify this by the fact that we investigated a specific sample, i.e. a population of nurses employed in a precisely designated hospital. The coefficient of relative variation for SOC can also be considered low. Unlike our study, the study by Kardum et al. (18) showed a three-factor structure. However, in their conclusions they drew on the use of the overall result rather than the three components. This was because they discussed the inadequacy of their functional differentiation. In order to make a comparison with this study, we also tested a three-factor model. However, the three-factor structure deviated significantly from the structure advanced by other authors and, in our case, also proved uninterpretable, despite the rotations. For this reason, we decided to adopt the one-factor structure. These leads us to conclude that authors generally prefer the one-factor structure of the instrument. The one-factor model was also advocated by Antonovsky himself, since the instrument was not intended to measure dimensions individually (1).

Since the SOC-29-CRO has been already validated among the Croatian general population (18), it is important to explain why the authors considered it necessary to validate the instrument again on a specific nursing population. The first reason has been already presented: in the first SOC-29-CRO validation study, the factor structure of the instrument was not clear, even though the authors had proposed that a one-factor structure be used. This ambiguity could be the result of the internal heterogeneity of the sample of the general population. Consequently, we decided that it was important to reexamine the factor structure on a specific population (like the nursing population addressed in this study) for the purposes of further research. The nursing population predominantly consists of women who are of reproductive age, have a higher level of education and are also exposed to extremely high levels of workplace stress (12). A study on the perception of stress conducted in Slovenia, a country similar to Croatia, found that employed women with at least college-level education were at very high risk of suffering from frequent stress perception (25). Various studies show that differences exist between the genders as regards experience of stress, with women estimating stressors as more severe than men and tending to report higher rates of psychological distress (26). The reason for this may lie in the fact that employed women have to cope with various roles in their professional and private lives and that their experience of the environments in which they live and work is probably different from that of men. It is therefore reasonable to conclude that this group deviates very significantly from the general population, which could also be reflected in the results of the instrument validation.

Our study has some potential limitations. First, one can argue that this study only includes nurses from one hospital in Croatia. A counter-argument would be that this hospital is a typical large healthcare institution that employs a large number of nurses of different profiles. This allows in-depth research into health problems related to the nurses’ workplace. Second, the response rate/number of participants was towards the lower recommended limit, but nevertheless still within the values that allow robust correct conclusions to be drawn. Third, one could argue this study used no method of measurement of stability of the instrument over time, e.g. the test-retest method. We counter this by the fact that the reliability of any self-reported outcome measure can be evaluated using measurement stability methods and/or measurement equivalence methods. The latter were developed from social science research for situations in which it was not possible to perform repeated measurements because the measured phenomenon had changed or could change over time (27). Finally, one can argue that this study tested only one- and three-factor models. Our argument here is that, in accordance with the existing theoretical assumptions (2), the results of other studies (2, 3, 4, 5, 7, 8) that have the confirmed one- and three-factor structure of the SOC questionnaire, and with the results of PCA in our study, it was rational to test only the one- and the three-factor models.

The study also has several important strengths, the most prominent being that it provided additional and important information and knowledge about the psychometric properties of the SOC-29-CRO when evaluated in a Croatian nursing population. The study showed the one-factor structure more directly than the study on the general population. As a result, the one-factor structure of the SOC-29-CRO can be more reliably used in subsequent research on nurses. Finally, the fact that the study was conducted among the nurses of a single hospital only can be an advantage as well as a limitation, since this institution is similar to many other institutions in countries that are experiencing similar transition processes to Croatia. The results of this study could apply to these hospitals as well, especially those in the countries of former Yugoslavia.

The study results are significant for occupational medicine, health organisations and nursing management in Croatia and beyond. Nurses are often exposed to occupational hazards in their work environment which can lead to stress (11). The outcome of these stressful events depends on how nurses cope with stress. Weak SOC prevents nurses from actively managing stressful events, which can lead to work-related health problems. The SOC-29-CRO instrument could be used by nursing managers to identify nurses with weak SOC and implement interventions to create healthy working environments and protect and promote nurses’ health. Actively managing nurses’ health can help to increase their work ability. This instrument could also be helpful when planning the introduction of coping strategies among nursing students as well as among students of other healthcare professions, since it has already been proven that high levels of perceived stress predispose health students to anxiety and a lower quality of life (28). A number of challenges remain for those studying the use of SOC-29-CRO in nursing populations. The dynamics/stability of the SOC-29-CRO must first be checked over a longer period of time in time, especially in relation to those nurses with more demanding jobs (e.g. in intensive care departments). With a focus on studying the properties of the SOC-29-CRO in the nursing population, our work could usefully be continued by analysing additional aspects of validity, e.g. criterion validity.

CONCLUSIONS

The adequate psychometric properties of the instrument indicate that SOC-29-CRO is a reliable tool for use in further research. In the near future, it may also be important to the process of designing measures for enhancing nurses’ internal resources for the management of workloads.

Results of exploratory factor analysis (extraction method: principal component analysis) in the validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

ComponentInitial EigenvaluesExtraction sums of squared loadings
Total% of varianceCumulative %Total% of varianceCumulative %
17.45325.70025.7007.45325.70025.700
22.3968.26233.9622.3968.26233.962
31.6935.83939.8011.6935.83939.801
41.2364.26244.0631.2364.26244.063
51.1433.94348.0051.1433.94348.005
60.9823.38851.393
70.9553.29454.687
80.9353.22357.910
90.8973.09261.003
100.8412.90063.903
110.8112.79766.699
120.7672.64669.345
130.7252.50071.846
140.7002.41574.261
150.6812.34976.610
160.6432.21778.827
170.6232.14780.975
180.5932.04683.021
190.5651.94784.968
200.5471.88686.854
210.5341.84288.695
220.5151.77690.471
230.4711.62392.095
240.4481.54693.640
250.4171.43995.079
260.3891.34096.419
270.3661.26197.680
280.3451.18998.869
290.3281.131100.000

Results of confirmatory factor analysis in validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

Statistical propertyone-factor modelthree-factor model
Chi-square2289.111790.13
Degrees of freedom377374
p<0.001<0.001
CMIN/DF6.0724.786
CFI0.6850.767
RMSEA0.0840.073

Socio-demographic and work-related characteristics of the study participants (n=713).

CharacteristicCategoryN(%)
GenderMale8311.6
Female63088.4
Age19–3024734.6
31–4016122.6
41–5015922.3
51–6514520.4
Marital statusMarried37152.0
Divorced486.7
Widowed182.5
Single18626.1
Life partnership8912.5
Level of educationHigh school education42960.2
Bachelor of nursing25635.9
Master of nursing283.9
Work departmentInternal unit17925.3
Surgery unit15722.2
Operating room334.7
Intensive care unit7310.3
Gynaecology unit527.3
Polyclinical unit233.2
Oncology and haematology unit588.2
Dermatology unit131.8
Emergency unit273.8
Ophthalmology unit284.0
Psychiatry unit344.8
Paediatrics unit314.4
Length of serviceLess than 1 year233.2
1–19 years39154.8
20 or more years29941.9

Factor loadings greater than 0.200 in the validation study of the Sense of Coherence 29-item scale among Croatian nurses (n=711).

ComponentComponent loads
1st2t3t4st5st
Item_10.4430.363
Item_20.3420.320−0.325
Item_30.3520.5210.2620.257
Item_40.2770.626−0.340
Item_50.4830.277−0.416
Item_60.4680.392−0.394
Item_70.3050.600−0.290
Item_80.5470.241−0.301−0.236−0.216
Item_90.5650.404−0.306
Item_100.3990.246−0.292
Item_110.5150.383
Item_120.5420.2030.315
Item_130.4030.5270.266
Item_140.5120.383−0.362
Item_150.520−0.317
Item_160.497−0.225
Item_170.4960.217
Item_180.581−0.2040.210
Item_190.5000.317
Item_200.589−0.211−0.203
Item_210.4300.3370.219
Item_220.3550.240−0.2100.340
Item_230.551−0.352−0.260
Item_240.626−0.310
Item_250.677−0.355−0.207
Item_260.718−0.243
Item_270.625−0.2660.244
Item_280.667−0.404−0.223
Item_290.3450.3100.209

Statistical properties of the distribution of values of items of the Sense of Coherence 29-item scale in the validation study of Croatian nurses (n=711).

Itemx¯{\rm{\bar x}}SDMeIQR
Item_14.81.654–6
Item_24.61.454–6
Item_33.81.443–5
Item_43.81.743–5
Item_54.81.654–6
Item_64.71.454–6
Item_74.31.543–5
Item_85.61.565–7
Item_95.01.754–6
Item_104.81.754–6
Item_114.61.465–7
Item_125.21.454–6
Item_133.81.543–5
Item_144.51.853–6
Item_155.61.565–7
Item_165.01.754–7
Item_174.91.754–6
Item_185.81.565–7
Item_194.41.453–6
Item_205.11.454–6
Item_215.01.754–6
Item_224.61.454–6
Item_233.81.443–5
Item_243.81.743–5
Item_254.81.654–6
Item_264.71.454–6
Item_274.31.543–5
Item_285.61.565–7
Item_295.01.754–6

Sense of Coherence 29-item instrument: items, their placement within three dimensions, and scoring (1).

Item noQuestion*DimensionScoring
Item_1When you talk to people, do you have the feeling that they don’t understand you?CR
Item_2Think of the people with whom you come into contact daily, aside from the ones to whom you feel closest. How well do you know most of them?CO
Item_3Has it happened in the past that you were surprised by the behaviour of people whom you thought you knew well?CR
Item_4In the past ten years your life has been: (full of changes without your knowing what will happen next – completely consistent and clear)CO
Item_5Do you have the feeling that you are in an unfamiliar situation and don’t know what to do?CO
Item_6When you face a difficult problem, the choice of a solution is: (always confusing and hard to find – always completely clear)CO
Item_7Your life in the future will probably be: (full of changes without knowing what will happen next – completely consistent and clear)CO
Item_8Do you have very mixed-up feelings and ideas?CO
Item_9Does it happen that you have feelings inside you would rather not feel?CO
Item_10Does it happen that you have the feeling that you don’t know exactly what’s about to happen?CO
Item_11When something happened, have you generally found that: (you overestimated or underestimated its importance – you saw things in the right proportion)CO
Item_12In the past, when you had to do something which depended upon cooperation with others, did you have the feeling that it: (surely wouldn’t get done – surely would get done)MaO
Item_13Has it happened that people whom you counted on disappointed you?MaR
Item_14Do you have the feeling that you’re being treated unfairly?MaO
Item_15What best describes how you see life: (one can always find a solution to painful things in life – there is no solution to painful things in life)MaR
Item_16When something unpleasant happened in the past your tendency was: (“to eat yourself up about it” – to say “OK that’s that, I have to live)MaO
Item_17When you do something that gives you a good feeling: (it’s certain that you’ll go on feeling good – it’s certain that something will happen to spoil the feeling)MaR
Item_18Do you think that there will always be people whom you’ll be able to count on in the future?MaR
Item_19Many people – even those with a strong character – sometimes feel like sad sacks (losers) in certain situations. How often have you felt this way in the past?MaR
Item_20When you think of the difficulties you are likely to face in important aspects of your life, do you have the feeling that: (you will always succeed in overcoming the difficulties – you won’t succeed in overcoming the difficulties)MaR
Item_21How often do you have feelings that you’re not sure you can keep under control?MaO
Item_22Do you have the feeling that you don’t really care about what goes on around you?MeR
Item_23Life is: (full of interest – completely routine)MeR
Item_24Until now your life has had: (no clear goals or purpose at all – very clear goals and purpose)MeO
Item_25Most of the things you do in the future will probably be: (completely fascinating – deadly boring)MeR
Item_26When you think about your life, you very often: (feel how good it is to be alive – ask yourself why you exist at all)MeR
Item_27Doing the things you do every day is: (a source of deep pleasure and satisfaction – a source of pain and boredom)MeR
Item_28You anticipate that your personal life in the future will be: (totally without meaning or purpose – full of meaning and purpose)MeO
Item_29How often do you have the feeling that there’s little meaning in the things you do in your daily life?MeO

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