title: Promoting sense of coherence: Salutogenesis among people with psoriasis undergoing patient education in climate therapy.
abstract: BACKGROUND
  There is a need for further investigation of sense of coherence (SOC), the central concept of salutogenesis, and its relationship with long-term illnesses such as psoriasis. The aim of this study is to investigate the development of SOC during patient education in the context of climate therapy and to explore factors that may predict changes in SOC among people with psoriasis.
  
  
  METHODS
  A prospective design included a baseline assessment and two follow-ups after a 3-week patient education and climate therapy programme (follow-up 1) and again 3 months later (follow-up 2). A total of 254 adults (aged 20-80) with psoriasis participated. SOC was measured by the SOC Questionnaire, illness perception was measured by the Revised Illness Perception Questionnaire, and positive and active engagement in life was measured by the positive and active engagement subscale of the Health Education Impact Questionnaire. Paired-sample t tests were used to evaluate changes in SOC from the baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables, illness perception and positive and active engagement in life to predict the changes in SOC.
  
  
  RESULTS
  The SOC score changed significantly by 2.65 points, (95% CI = 0.621, 3.685) from the baseline to follow-up 1. SOC score was still improved by 1.15 points (95% CI = 0.073, 0.223) at follow-up 2. Baseline and change in positive and active engagement in life were linked to change in SOC with standardized beta 0.170 (95% CI = 0.024, 0.319) and 0.259 (95% CI = 0.092, 0.428), respectively. In addition illness coherence perception at baseline and change in emotional representations were significantly associated with the change in SOC with standardized beta 0.212 (95% CI = 0.073, 0.361) and -0.270 (95% CI = -0.481, -0,077), respectively.
  
  
  CONCLUSIONS
  SOC improved significantly from before to after patient education in the context of climate therapy. The results indicate that improving positive and active engagement in life, coping with emotional distress and a coherent understanding of the illness might provide important opportunities to improve SOC among people with psoriasis.
authors.affiliation: Faculty of Health and Social Sciences, Institute of Nursing, Bergen University College, Møllendalsveien 6, 5009 Bergen, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Langeland
authors.affiliation: Medical Faculty, Department of Health Sciences, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway.
authors.forename: Hilde S
authors.initials: HS
authors.lastname: Robinson
authors.affiliation: Medical Faculty, Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.affiliation: Medical Faculty, Department of Health Sciences, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway ; Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Forskningsveien 1, 0373 Oslo, Norway.
authors.forename: Marie H
authors.initials: MH
authors.lastname: Larsen
authors.affiliation: Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital, Forskningsveien 1, 0373 Oslo, Norway ; Medical Faculty, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway.
authors.forename: Anne-Lene
authors.initials: AL
authors.lastname: Krogstad
authors.affiliation: Medical Faculty, Department of Health Sciences, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway.
authors.forename: Astrid K
authors.initials: AK
authors.lastname: Wahl