Developing sense of coherence in educational contexts: Making progress in promoting mental health in children

Abstract

The notion of salutogenesis was developed by Aaron Antonovsky to achieve a fundamental innovative approach to promoting mental health. Within the concept of salutogenesis, the author defined the sense of coherence (SOC) as a global life orientation, and he suggests that it emerges in the early years of childhood. In order to develop coherence and its components it is necessary to explore certain health resources. In this paper the following questions will be discussed: (1) which are the individual and social resources to keep healthy, and (2) how can these resources be activated? Selected empirical findings will be presented to respond to these research questions. The results show that resources such as self-worth and a sense of belonging are fundamental health factors. They can be developed most effectively in the early years of childhood and through the formal educational system, e.g. in kindergartens and primary schools. However, the findings show that professionals need to be trained to be able to deliver educational programmes in terms of salutogenesis. At the same time, experience shows that promoting health resources in children successfully depends on the participation of the parents and their support by the professional educators. This paper aims to present new ideas and experiences in the area of a practical realization of the concept of salutogenesis in educational systems. Particularly, health promotion programmes, for example ‘The I am I programme' (), could be implemented successfully in kindergartens with a high quota of children with an immigrant background, due to the fact that this programme includes the reflection and experience of cultural traditions, food, songs, dancing, and family rituals.

Introduction

The subjective feeling of being healthy is always the sum of mental and physical health, and is indicated by how well individuals master situations in real life. Children's experiences during the initial stages at school determine the further development of their self-worth and mental health. Schools today, especially in Germany, tend to be harmful to health; they represent one of the most important stress factors for young children. Preventive measures at an early stage of schooling may help to maintain the children's mental health. However, first of all the character of schools has to be changed fundamentally if this task is perceived as a worthwhile challenge.

The question is: Do schools make our children ill? Do school conditions produce illness? What does happen to the child's self when he/she starts school? Are we able to prevent a weakening of the children's subjective well-being? How should we deal with the problem where children have an immigration background?

Methods

This paper presents selected data from longitudinal studies in which the development of the self in childhood and adolescence was investigated. Data is shown from projects which aimed to develop and evaluate health-promoting measures in cooperation with parents and teachers.

Procedure

Study 1: A sample of 226 children were studied for 5 years: They were followed from age 5 to age 10. The aim was to investigate how children begin to construct the school and learning self and how it influences the general self-concept and self-worth.

Study 2: School beginners and their parents were interviewed. This investigation was combined with the compulsory medical examination. Children were questioned about their subjective well-being and their health behaviour patterns. The children of eight selected schools of two German cities took part in a health promotion programme. In the fourth grade the longitudinal sample consisted of 285 students. The aim was to maintain and strengthen the self-worth of these children in order to enhance their mental health.

Instruments

A combination of different methods was used (Krause et al., 2004). All of them were designed to obtain information about one's self: self image, self-worth, and well-being. The methods consisted of both quantitative and qualitative methods: the ‘Well-Being Profile’ and the pictorial representation ‘That's what I like to do’, self-description, sentence-completion test, and thematic paintings.

‘The I am I Programme’: Health-promotion by self-worth reinforcement

This programme was first developed for primary schools and includes health lessons for the first to fourth grades (6 to 10 years old children). The main goal of the programme is to help children deal with the difficulties and stresses of everyday life and to offer support so that they become capable of coping the demands and ordinary situations in their lives without harming their feeling of self-worth.

After the trial phase (1995–1999) and the experimental studies of programme effectiveness (2000–2005) the modified programme was started in kindergarten. (Krause, 2009; Krause et al., 2000, 2001). During the experimental phase the authors started to elaborate and present the training programme for parents: ‘It doesn‘t work without parents.’ The Well-Being Profile was developed to measure the effectiveness. The validation is on its way. At present the authors are preparing the evaluation of the kindergarten-programme.

The aims of the programmes are:

• To promote a sense of self-worth and well-being.

• To promote of a sense of belonging and well-being within the peer-group.

• To gain competencies to resolve conflicts.

• To learn the coping strategies to overcome immanent stressors and challenges.

The significance of the salutogenic concept for health promotion

Sense of coherence and mental health

Antonovsky (1923–1994) described health as a dynamic process of developing and remaining healthy and stated that each individual finds him-/herself on a continuum between ‘maximum health’ and ‘maximum disease/death’. He rejected the classification of either healthy or sick and to health promoting protective factors which he called ‘general resistance resources’(GRRs). These state: ‘We are all mortal. At the same time, as long as we are still alive we are to a certain degree healthy’ (Antonovsky, 1987, p. 23). He was the first to change the focus from risk factors. GRRs are the basis of ‘a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one's internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected’ (Antonovsky, 1979, p. 23). For this global orientation he created the notion ‘sense of coherence’ (SOC). Health is supposed to depend on the strength of the SOC, whether individuals can cope well with the challenges of life and how competent they feel to take care of their own health. The more success they have, the more positively they experience a general sense of well-being such as happiness, contentedness and health.

General resistance resources comprise physical resources, personal resources, material resources, social, and sociocultural resources as well. Developed within educational systems, the GRRs focus first of all on personal and social resources. It is assumed that the personal resource ‘feeling of self-worth’ and the social resource ‘sense of belonging’ are the most important personal resources in developing children's SOC.

Which experiences do children need to improve the three components of their SOC? Figure 1 shows these three components.

Figure 1. The components of the Sense of Coherence.

How does sense of coherence improve?

According to Antonovsky (1987) for developing these components of SOC the child needs experiences in communicative situations with regard to:

• consistency of relationships,

• perceiving and acknowledging a need to learn,

• the possibility of influencing and participating in social decision-making processes.

Experiences of consistency are the basis for the development of comprehensibility (Figure 2). In positive cases, children have feelings of security and acceptance in social relations (Krause & Lorenz, 2009).

Figure 2. Comprehensibility (Krause & Lorenz, 2009).

Experiences of self-efficacy are the basis for the development of manageability (Figure 3). This component grows if the requirements for children are available to their developmental level and if they experience the acceptance of their individual progress.

Figure 3. Manageability (Krause & Lorenz, 2009).

The motivational and emotional component meaningfulness is increasing when children have the possibility to influence and participate in social decision-making processes (Figure 4). The experience of resonance on their behaviour and engagement, the acceptance and respect of their strengths and weaknesses support the development of a sense of meaningfulness.

Figure 4. Meaningfulness (Krause & Lorenz, 2009).

From the salutogenic point of view it is an important pedagogic challenge to support the development of children's health factors. Teachers in kindergarten and elementary school should be able to support children's ability to keep healthy.

Health promotion includes promotion of pre- conditions of the development of SOC components, and providing participation and involvement are the keys to success in health promotion. Participating in socially accepted activities creates a feeling of belonging and develops and strengthens the self-worth.

The salutogenic concept feelings of belonging and self-worth referred to are considered the main general resistance resources.

The resource ‘feeling of self-worth’

Many studies have shown that a sense of self-worth seems to play a key role in developing and maintaining health (e.g. Filipp, 1984; Fuhrer et al., 2000; Krause, 1987, Krause et al. 2004; Rosenberg & Kaplan, 1982; Schachinger, 2002; Stern, 1923). It has also been shown how children's sense of self-worth is affected by the experience of going to school. The problems of those youngsters who are not successful at school and therefore become losers in our performance-orientated society are well known (e.g. Chapman et al., 1980; Entwisle et al., 1987, Krause, 1993, 1994).

The results of new brain research have shown a strong connection between self-worth and cultural environment. Although the advances in this research field have produced many new questions in relation to the consciousness (Metzinger, 2010; Roth, 2003; Singer, 2002) it is possible to argue that the human brain is able to produce a sense of selfhood on the basis of experiences of resonance, mutual reflection and mirroring (e.g. between mother and baby). All information that is processed by a person is evaluated and thus provokes emotional states of excitement, which result in a certain behaviour. This is even more the case when the information concerns one's own self, as ‘information about oneself is ‘hot’, that is, it has something to do with our well-being and can influence it’ (Filipp & Frey, 1987, p. 36). If the information corresponds with the child's natural needs (e.g. the need to be accepted and loved), the development of self-worth and well-being is supported.

The self consists out of various self-concepts: the social self, the body self, the school and learning self, the professional self, etc.

The ‘we’ is constructed through the membership of individuals to a group. This group is always embedded in a sociocultural environment with its own norms and values. Therefore, the self is viewed as a ‘cultural self’ (Brockmeier, 2006; Shimada, 2006). (This term appears only in the newer literature.) The self is always a cultural self since all individuals inherit the values, rituals and customs of their culture and accept these normally as their own.

Children develop the ability to regard themselves as valuable and treat their own selves kindly and with dignity on the basis of their experiences with other individuals (Satir, 1994). Parents are – mainly in the first years of a child's life – the significant ones from whom children get the messages that decide the initial construction of their worth. These messages include cognitive-related contents (‘this is how you are’, ‘this is what you can do well’, ‘this is what you can still learn’) as well as emotion-related contents (‘you are our joy’, ‘you are special’, ‘we have trust in you’).

On the basis of empirical investigations Harter (1985, p. 114) concluded: ‘One's own global sense of self-worth is more than the sum of the specific evaluative judgements from each domain.’ According to Harter, self-worth can be measured by how far you like yourself, to what degree you can accept yourself as you are, and to what extent you are content with yourself.

The sense of self-worth thus is a phenomenon which exists rather independent of daily situations and remains relatively stable. Self-worth strongly depends on the positive/negative evaluation of self-qualities significant for a person. For instance, individuals who do not trust in their own abilities, who are insecure or even fearful and depressive or aggressive in most cases also suffer from a low sense of self-worth. The sense of self-worth may be described as the affective part of self that develops right from the first day of life. A decisive factor for the formation of a positive sense of self-worth in this early phase is the care and love of an intimate person (mother, father or other caretakers) who instils the child with the basic feeling of security, protection and acceptance. The sense of self-worth without doubt is one of the most important resources for future requirements and also influences the emotional well-being of a child.

Self-worth is the emotional relation to oneself, the acceptance of oneself and the belief in personal potential. A positive feeling of self-worth is a source as well as a result of well-being, a resilience factor in terms of mental and physical health.

The resource ‘sense of belonging’

‘We are we. You belong to us, you are welcome.’ People who experience this kind of invitation might develop a strong sense of belonging. Usually, and particularly in families, children feel welcomed, they feel safe, accepted and loved. Based on research data from neurobiology and resilience studies, it can be stated that experiencing a minimal amount of empathic resonance is a fundamental biological need without which the human being could not survive (Bauer, 2006, p. 107).

If a child feels accepted and acknowledged, he/she feels recognized and gets feedback, which strengthens the self-worth. Then, the child feels safe and protected by the reference person and can participate actively in his/her environment. Experiencing the support of the significant other can become a resource in itself and contributes to the well-being of a person. The relationship between the sense of belonging and the sense of self-worth is obvious: without the feeling of belonging, a person cannot develop a positive self-worth. Self-worth is constructed through communicating with the reference person who supports the self-acceptance and the self-realization of the child.

The sense of belonging is the emotional relation to other perople. It makes the person feel not alone, to be able to get help and feedback.

Results

Study 1

The self of the school beginner

This paper presents some selected results which were decisive for the elaboration of the health promotion programme.

1. The plan for the psychological examination was to verify our hypothesis about the positive self-image of school beginners: pre-school children believe in their own competence. They are optimistic concerning their future, for example their learning at school. According to the Well-Being Scale 81.5% of the children asserted themselves as feeling well most of the time. They identified themselves with a face which showed a happy child. In contrast, about 9% responded that they are tired most of the time (Figure 5).

2. Most school beginners looked forward to attending a school. They believed in their abilities and could not imagine difficulties in their learning. Similarly, the parents’ expectations were high: Only 9% of them foresaw difficulties for their child (Krause, 2000a).

Figure 5. ‘How do you feel mostly?’ Frequency of the response by the children before starting at school.

Changes of the self

If children have mostly negative experiences in their learning processes, they sometimes construct an inappropriate or ill-formed school and learning self. This can have two consequences. First, it could act as a barrier to the further development of this substructure. It was found that children's self-esteem at a later stage of school was lower than it had been at the earlier stages. Second, the decrease of the positive school and learning self related to the decrease of the general self-image, because achievements at school seem to determine the perceptions about self. Poor achievements resulted in a poor self-image and a poor self-image at the early stages at school affected first achievements.

In the longitudinal study the following important results were obtained. By 9 years old children (third grade of primary school) at latest the school and learning self was established. Afterwards it was stable and was functioning as a mediator, being stable across entire school-related situations and educational settings.

The home-to-school transition turned to be a ‘critical life event’ for all children. The successful children (e.g. children with high cognitive dispositions) and the emotionally stable children (children with a good self-worth) were able to strengthen their positive self-image for the following reasons:

• They confirmed the expectations of their parents. They give them pleasure.

• They confirmed the teachers’ work, giving them the feeling of being successful.

• They got love and affection from their parents as well as praise and care from their teachers.

• This all provided motivation, optimism and a feeling of well-being at school.

Still there were less successful children whose cognitive dispositions did not meet school demands. About 15% of the examined children did not identify themselves with the happy face. They were estimated as emotionally unstable children. The question arises: What would they do if they do not become successful learners? Until now the curricula of schools have not even mentioned the teaching of competences which help to deal with difficulties. This means that these children have to resort to their own strategies. Consequently, disorders in behaviour might also be considered as a strategy to cope with problems. Just to exemplify, the cases in Tables I and II can show the different reflections of two boys (Krause, 2000b).

Table I. Sentence completion: Example 1 (a boy whose experience at school is not marked by success and who also reflects problems of social acceptance).

Start of sentence	First school year	Second school year
If I can't do ...	then I just can't do it.	then I hand it in later.
I don't like ...	real cars.	that everybody picks on me, because I already have a girl-friend.
The other children ...	like to play.	pick on me.
I am afraid ...	of nothing.	to go to school, because I write a dictation.
I am sad ...	when others push me.	sometimes.
I am most happy ...	about food fights.	about Judo.
I am angry ...	when I am not allowed to come.	about my stupidity.
At school ...	mathematics is good.	I like the breaks.

Table II. Sentence completion: Example 2 (a boy who is successful at school, likes to go to school, has friends and experiences the family as a supporting resource).

Start of sentence	First school year	Second school year
If I can't do something ...	then I ask my parents.	then I ask my parents.
I don't like ...	when someone annoys me.	that my friend argues with me.
The other children ...	are my friends.	get on with me.
I am afraid ...	yes, sometimes.	in the dark.
I am sad ...	yes, also sometimes.	when sometimes I don't know how to do something.
I am most happy ...	when I make something for example and my mum likes it.	when I know how to do everything.
I am angry ...	yes, sometimes - when for example someone breaks my toys.	when my friend hits me.
At school ...	I like it.	I enjoy myself.

The expectations of the parents and their reactions to the child's achievement determine the well-being of the pupil. Young school children cannot evaluate their own achievements and progress in learning properly because of their limited cognitive abilities. Once the parents watch their children's achievements they try to judge them by their own standards. They worry about the child's career at an early stage. Drawings by children reveal how they reflect their parents’ reactions.

Table III shows the results of 10 years old children's drawings in the fourth grade (Tschanz & Krause, 1992). The authors could define seven categories of parental reactions. Note that only one child who has got the mark ‘5’ (this is the worst mark in Germany) experienced the reaction ‘encouragement’. Parents seemed to expect the mark ‘1’ (this is the best mark in Germany), some children experienced that their parents did not express happiness when they earned the mark ‘2’.

Table III. How children draw their parents’ reactions on marks.

Mark	Happiness	Sadness	Anger	Practise^a	Punishment	Consolation	Encouragement	Invalid^b	N
1	70	–	–	–	–	–	–	3	73
2	39	–	–	1	–	2	1	6	49
3	4	7	16	2	–	6	4	6	45
4	2	3	13	3	1	2	2	3	29
5	–	6	19	2	4	1	–	3	35
n	115	16	48	8	5	11	7	21	231

^aParents requested their children to practise to improve their grades.

^bThe drawings did not show any reaction of the parents.

The evaluations and judgements by teachers and their reactions to children's achievements determine the development of the school and learning self. They determine the happiness and unhappiness of a child. They can determine well the level of the child's well-being, whether he/she feels accepted or rejected, whether a child enjoys going to school or suffers from aversions and anxiety caused by school. Basically, they entail the whole state of pupils’ health.

Table IV shows the clear connection between chances for higher education and an immigrant background in Germany. In the context of the health promotion project, what will happen with the children further on their school journey was investigated at the end of primary school (10 years old children) (Walczyk, 2009). At the time of the investigation the children knew about the decision which was made concerning their future advancement. The Hauptschule is a special German school for children who are poor learners. Nobody wants to go to this type of school because children and parents perceive it as discrimination and the worst basis for the future.

Table IV. Recommendation of the teachers and decision of the parents on the further schools after primary school (here: the Grammar School and the Hauptschule), n = 210.

	Children with immigration background		Children without immigration background
	Hauptschule^a	Grammar school	Hauptschule	Grammar school
Recommendation	61.8%	14.0%	32.2%	86.0%
Decision	76.5%	18.8%	23.5%	81.2%

^aThis type of school only exists in Germany; it is the school for poor learners. For the children it means discrimination when they have to go to this school.

The results called attention to a calamity: children from families with an immigrant background are the biggest group in the Hauptschule.

The children were also asked how far they are satisfied with this decision. The answer ‘I would like to go to another school’ was responded with ‘yes’ by 4% of the children who will go to the grammar school and by 82% of the children who will go to the Hauptschule. The children know the discriminative meaning of this school, they suffer under this hard decision: More than the half of them alleged that they were afflicted with headache, sleeplessness and exhaustion.

Summary

Experiences from the longitudinal study showed that primary school age is an important phase for the development of psychosocial competences, although the foundations are laid much earlier. It was notable that the well-being of some children (15%) at the time of starting primary school was not classified as positive. During the four years at primary school the development of self-worth and well-being of children depended to a great extent on the experiences of results in learning and evaluation of their achievements through parents and teachers.

Therefore, the positive development of self-worth and well-being was encouraged by implementing the health promotion programmes.

Results of Study 2

The most important results of the implementation of the programmes for health promotion are:

1. The programmes support the daily work of teachers. They provide a secure frame to proof new aspects. Although the programmes are implicitly anchored in the educational aims and are explicitly required in educational curricula, the implementation and realization of topics, which are included in the programme, are difficult to integrate into the daily work routine. The programme can purposefully support the systematic implementation of these goals in daily life routines.

2. The intensive relationship with the children, the success in learning and the transfer of the programme contents into the daily work routine in schools are perceived by teachers as enrichment. By implementing the programme the teachers learned a lot about children's desires and sorrows, about their families and variety of values. This leads to the fact that they can do justice to the individuality of each child. The health days provided space and time for testing and mutual confirmation. The individual child is the focus of health lessons.

3. The strengthening of self-worth turned out to be successful. In small and stable groups each child can be perceived and accepted the way he/she is. Whilst preparing health days, teachers often got new ideas. This is very much welcome since each specific situation within a group needs special attention and flexible change at developmental level. The self-trust of the children positively changed during the programme. Also children, who usually did not talk much, became more active and learned to focus on their strength, they won a sense of security and were predisposed toward acting as risk-takers as well.

4. The effectiveness of interventions always depends on the quality of the relationships inside a setting. The most important media in learning processes are the relevant reference people in kindergarten and in school. These individuals – e.g. the teachers – influence the success of all that is done in relation to health promotion. It is well known that only one who is ‘burning’ for his/her own aims towards the children's health is able to inspire the children. To develop or strengthen health resources requires a healthy and coherent relationship between the actors. Lennings & DiPrete (2010) have also found that teacher effects on social and behavioural skills development are larger than teacher effects on academic development.

Finally, Figure 6 presents the frequency of the answer ‘happy’ to the question ‘How do you feel mostly?’ These longitudinal results show the range of the developments over the course of four years. Although all teachers were working with the same programme, the outcomes were very different, however. Only the teacher of the school ‘H’ could really preserve and improve the well-being of the children. At the end of the third grade (t4) the students received their first marks and the consequences of that were very obvious.

Figure 6. ‘How do you feel mostly?’ Frequency of the response ‘happy’ from the first to the fourth grade (t1 = before starting at school, t2 = at the end of the 1st grade, t5 = at the end of the 4th grade).

Conclusions

Children with an immigration background fail to attain the best education in German schools. Failing to get sufficient chances for adequate development of their abilities, they need support in health promotion. In particular, they need help to identify their resources and to maintain as well as strengthen their self-worth and feeling of belonging to the group, to the school, and finally, to society. They require that valuable experience ‘I am welcome, as I am, I am okay’.

Schools are supposed to play an important role in the promotion of children's well-being. Teachers need to be aware of the problems of their students, especially of children with an immigration background. It is important that teachers are able to promote the pre-conditions for the development of SOC components. They are responsible for including all children in socially accepted activities to contribute in a simple and affordable manner to create their sense of meaningfulness.

The findings explicitly show that teachers need to be trained in order to put the advantages of salutogenic education into practice.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.