MRS ROSA SUÑER-SOLER (Orcid ID : 0000-0002-7928-9112)

Accepted Article
Article type : Original Article

Title: Relationship between sense of coherence, health status, and work engagement among

nurses.

Short title: SOC and work engagement among nurses

Authors: Malagon-Aguilera, M C*1, 2; Suñer-Soler, R1, 2; Bonmatí-Tomas, A1,2; Bosch-Farré,

C1, 2; Gelabert-Vilella, S1; Juvinyà-Canal, D1, 2

1
Nursing Department. Faculty of Nursing, University of Girona, Girona, Catalonia, Spain

2
Health and Health Care Research Group, Nursing Department, University of Girona,

Girona, Catalonia, Spain

*Corresponding author: Rosa Suñer-Soler

Faculty of Nursing

Emili Grahit, 77 17003 Girona Tel. 972419657

Email: rosa.sunyer@udg.edu

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jonm.12848
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 Authorship

All authors have made a substantial contribution to study conception and design; acquired,
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analysed, or interpreted the data; contributed to drafting the article or critically revised the

article for important intellectual content; given their final approval of the version to be

published; agreed to be accountable for all aspects of the work, ensuring that questions

related to the accuracy or integrity of any part of the article are appropriately investigated and

resolved. No further writing assistance other than basic copyediting has been provided.

Acknowledgements

Special thanks to all the nurses who participated. Elaine Lilly, Ph.D., provided guidance in

the translation and assistance with final English language revision of the article.

Conflict of Interest Statement

The authors declare that they have no competing interests or conflicts of interest.

Ethical Approval

The study was approved by the Dr. Josep Trueta University in Girona (Spain) hospital

research ethics committee (reference number 138/12).

This article is protected by copyright. All rights reserved.

 Abstract

Aim: To examine the sense of coherence (SOC) among registered nurses and its relationship
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with health and work engagement.

Background: SOC is a global orientation to view life as structured, manageable, and

meaningful and have the capacity to cope with stressful situations. A high SOC score

indicates that an individual can understand, manage, and attribute meaning to events in his or

her life as well as in the work environment. Registered nurses face many workplace stressors

that may be easier to manage with a strong SOC; however, the effect of this score on their

self-reported health status and work engagement remains unknown.

Methods: In a cross-sectional study, 109 registered nurses working in a long-term care setting

responded to a self-administered questionnaire. Social support, work-related family conflicts,

SOC, self-reported health status, and work engagement variables were analysed using

multiple linear regression models.

Results: Nurses with a high SOC score reported no work-related family conflicts (mean

difference -6.91; 95% CI -10.65 to -3.18; p = 0.000), better health (r =0.408), and greater

work engagement (r =0.223), compared to their peers with lower SOC. The association

between SOC and self-reported health was confirmed by linear regression modelling (β =

0.276, p = 0.003).

Conclusions: Nurses with a higher SOC had better health and greater work engagement. The

work engagement variable showing the highest association with SOC was dedication.

Implications for nursing management: Implementing interventions that increase SOC among

nurses can increase commitment to their work, to the institution, and to building more

engaged teams.

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 Keywords: Sense of coherence; work engagement; self-reported health; registered nurses;

long-term care, workplace.

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Introduction

The World Health Organization (WHO) has named health promotion in the workplace

(HPW) as a priority objective for the 21st century. The workplace has an influence on

physical, mental, economic, and social well-being (WHO, 2017).

Nurses are subjected to a great number of occupational stressors (Fronteira & Ferrinho, 2011;

Van Bogaert et al., 2014) and the International Labour Organisation (2017) recognises stress

among workers as a factor that conditions occupational health. Its recommendations for the

prevention of stress are related to leadership, justice at work, job demands, social support,

physical environment, work–life balance and working time, recognition at work, protection

from offensive behaviour, job security, information, and communication. Nurses are

considered a point of reference in the care of patients, and the personal and health

characteristics of these professionals can affect their work-engagement (American Nursing

Association, 2011; International Council of Nursing, 2017). Registered nurses working in

long-term care settings have to cope with the discomfort of patients who must adapt to a new

home and a high level of dependence because of their health problems. The present study

aimed to assess registered nurses’ skills for coping with stress, using Antonovsky’s sense of

coherence (SOC) concept (Antonovsky, 1988), and the relationship between SOC, self-

reported health status, and work engagement.

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 Background

Sense of coherence
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The sense of coherence (SOC) is the main construct of the salutogenic model (Antonovsky,

1988), which is characterized by its ease / disease continuum. This conceptual model of

coping with stress considers the sociocultural context and its influence on an individual’s

health (Lindström & Eriksson, 2005). A strong SOC allows the individual to perceive life

events as comprehensible, manageable, and meaningful, and contributes to a capacity to

identify available resources in order to confront difficulties in a healthy manner, with

confidence and self-assurance (Antonovsky, 1988; Mayer & Thiel, 2014). In this way, SOC

influences well-being and is considered essential in satisfactorily confronting elements that

provoke stress in life (Garrosa et al., 2014).

The concept of health has evolved towards a multidimensional and positive vision (WHO,

2016), in which the projection of people’s lives toward health should lead to a state of well-

being, coexisting even with illness (Antonovsky, 1979). Many studies have looked for the

causes and factors enabling some people to enjoy better health than others. Antonovsky’s

work has led to the development of SOC as an indicator that allows a measurement of health

status. SOC is a self-reported health indicator, which is considered a global measure

including different health dimensions, permitting even people with physical limitations to

refer to having a good perception of health owing to their relationships with their

environment and loved ones and to their emotional or intellectual satisfaction (Rebollo et al.,

2005). Self-reported health has been positively related to characteristics of the personality

such as SOC (Apers et al., 2012; Schneider et al., 2004).

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 The role undertaken by the nurse in caring for people with health needs is conditioned by

occupational stressors, such as end-of-life processes, death, pain control, ethical conflicts,
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professional-user–family member relations, and work demands resulting from rapid changes

in care, among others (Ando, 2016). This set of stressors makes it especially interesting to

study the SOC in this population (Antonovsky, 1988) and its repercussions on their quality of

life and perceived health (Eriksson & Lindström, 2006).

Specifically, a positive relationship has been identified in nurses between SOC and health

(Tabandele, 2008), and low SOC has been associated with health problems such as

depression (Basinska et al., 2011). The available literature also describes the relation between

SOC and age (Leino-Loison et al., 2004) and socioeconomic status (Basinska et al., 2011),

although not all authors have reported this relationship (Ward et al., 2014). SOC has been

found to be a protective factor against stressors, specifically the lack of social support

(Engström et al., 2005; Malinauskiene et al., 2009) and difficulties in reconciling work and

family life (Eriksson & Lindström, 2006). Others have pointed out that SOC is a personality

variable that can influence other aspects of a person’s life, beyond health issues (Eriksson &

Lindström, 2006; Garrosa et al., 2014). Few studies have assessed the relationship between

SOC and self-reported health among registered nurses working in long-term care facilities

(Ward, 2014).

Work engagement

Simpson (2009) and Salanova et al. (2011) reported that the characteristics of nurses’

workplaces and the stressors that they work with highlight the importance of studying work

engagement. The concept of work engagement has also arisen from the study of positive

occupational health (Shaufeli et al., 2002) and has taken on greater prominence because it has

been found to be involved in the well-being of workers (Schaufeli, 2017). Work engagement

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 is considered to be an affective–cognitive state of a person in a job setting that is

characterised by high vigour (levels of energy and resistance despite difficulties faced during
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work), high dedication (high level of commitment to the job, accompanied by a sense of

meaningfulness, enthusiasm, inspiration, pride, and challenge) and high absorption (the

person is completely concentrated in his or her work, time passes quickly, and he or she has

difficulty disconnecting due to the pleasure being felt) (Schaufeli et al., 2002).

Workers with high levels of engagement are proactive people who seek and accept

responsibilities related to their profession, have values that coincide with those of the

organisation, and organise their work in such a way as to receive positive feedback (Salanova

and Schaufeli, 2008). Work engagement has repercussions on their well-being, perceived

health, and job satisfaction (Jenaro et al., 2011; Santos et al., 2016). The analysis of work

engagement in nurses is mostly associated with work environment (Havens et al., 2013),

social support, family issues, and personal factors such as optimism and self-efficacy

(Freeney &Tiernan J, 2009; Keyko et al., 2016). Garcia-Sierra et al. (2016) found no specific

studies on work engagement among registered nurses in long-term care facilities. According

to Garrosa et al. (2011) and Keyko et al. (2016), work engagement is influenced by workers’

positive personal characteristics. One of these is SOC, which has been shown to be relevant

in predicting work engagement in a group of volunteers (Garrosa et al., 2014).

Given the importance of maintaining good workplace health and strong work engagement

among nurses in order to ensure good results and continuous improvements in patient care,

SOC could be an influential personal variable. The simultaneous study of both constructs in

nurses is therefore of potential importance, especially for registered nurses working in long-

term care facilities.

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 In contrast to the role of nurses working in hospitals or primary care settings, for example,

nurses who work in long-term facilities care for and assist dependent individuals
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experiencing discomfort and separation from their family during a process of disease or

aging, helping them to feel “at home” (Bandman & Bandman, 2002). This requires dealing

with complex situations and life experiences that are negative for these individuals, along

with a lack of recognition for this work and a care setting with high demand pressure, a high

patient-to-nurse ratio, time constraints, and a lack of specialized staffing (Carlon et al., 2014).

In the present study, the following hypotheses were considered (see Figure 1):

H1: Sense of coherence among nurses is positively related to social support.

H2: Sense of coherence among nurses is negatively related to work-related family conflicts.

H3: Sense of coherence is positively related to the self-reported health of nurses.

H4: Sense of coherence is positively related to the work engagement of nurses.

Material and methods

Study design: A cross-sectional survey design was used.

Sample/participants: All registered nurses working with older adults in long-term care

facilities in Girona, a province of Catalonia, in north eastern Spain. No sampling technique

was employed because the entire population was invited to participate (11 centres; n: 156).

All nurses who agreed to participate in the study, independently of the characteristics of their

job contracts, were included in the study. Nurses who carried out their work exclusively at

outpatient services and those who were temporarily on leave when data were gathered were

excluded; 109 nurses voluntarily participated in the study (response rate: 69.8%).

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 Data collection: Between May 2014 and February 2015, an ad hoc logbook was used for data

collection. It consisted of an anonymous questionnaire that included sociodemographic,

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occupational, and health variables, together with three validated questionnaires to measure

sense of coherence (SOC-13), self-reported health (EQ-5D-5L), and work engagement

(UWES-17). The questionnaires were distributed among nurses at their units and were

collected there 24 hours later by a member of the research team to avoid participation by

managers or other staff. The participants were informed about the purpose of the study and

signed written, informed consent. Their participation was voluntary, and the confidentiality

and anonymity of the data were guaranteed.

Measures: A questionnaire enquired about sociodemographic, occupational, and health-

related variables: age, sex, marital status, social support, educational level, perceived

socioeconomic level, years in the profession, health care unit, chronic health problems, and

work-related family conflicts (such as facing difficulties with their family schedule or coping

with their commitments as a consequence of the responsibilities of their jobs).

The SOC-13 questionnaire (Spanish version) has 13 items corresponding to the

comprehensibility, manageability, and meaningfulness dimensions, with responses based on a

1-to-7 Likert-type scale (Virués-Ortega et al., 2007). The total score on these 13 items ranges

from 13 to 91 points, reflecting the respondent’s SOC (i.e., the higher the score, the higher

the SOC). A sample question is “Are you surprised by the behaviour of people whom you

thought you knew well?” with responses from “Never” to “Always” (Eriksson & Lindström,

2006). Cronbach’s alpha was 0.75 for the entire questionnaire (Malagón-Aguilera et al.,

2012).

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 Perceived health-related quality of life was studied through the EQ-5D-5L questionnaire

(Brooks, 1996; Rabin et al., 2001) validated for a Spanish population (Badia et al., 1999).
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The EQ-5D-5L evaluates five domains: mobility, self-care, usual activities, pain/discomfort,

and anxiety/depression. The responses for the five dimensions can be combined as a 5-digit

number describing the respondent’s health status, which may be converted into a single index

value. Furthermore, the EQ-5D-5L has a vertical standardized visual analogue scale for rating

general health status (EQ-5D VAS) ranging from 0 points (the worst health you can imagine)

to 100 points (the best health you can imagine). An example item is “Pain/Discomfort” with

responses from “I have no pain or discomfort” to “I have extreme pain or discomfort”. After

the data were gathered, the index value was calculated for state of health through the

algorithm proposed by the EuroQol group (Badia et al., 1999). In a second section of the

questionnaire, the respondent must score his or her state of health on a visual analogue scale

(VAS), from 0 (the worst health you can imagine) to 100 (the best health you can imagine)

(EuroQol Group, 2011). The internal validity calculated through Cronbach’s alpha was 0.53

(López et al., 2009).

A work engagement questionnaire (UWES-17), in a version translated into Spanish, consisted

of 17 items corresponding to three subscales (vigour, dedication and absorption), with six

response options, ranging from “Never” to “Always” on a Likert-type scale. A simple item

for this scale is “When I am working, I forget everything else around me”. The higher the

score, the greater the work engagement, vigour, absorption or dedication (Salanova

&Schaufeli, 2004). The internal validity calculated through Cronbach’s alpha was 0.93 for

work engagement (Schaufeli & Bakker, 2003).

Data analysis: The Statistical Package for Social Sciences (SPSS) version 19.0 for Windows

(SPSS, Inc., Chicago, IL, USA) was used to conduct descriptive and inferential statistical

analyses. Descriptive statistics were calculated for all study variables. The Kolmogorov-

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 Smirnov test was used to determine the normality of the distribution of the variables. To find

the relationship of SOC and the three dimensions (comprehensibility, manageability,

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meaningfulness) to the demographic, social, and workplace variables studied (sex, age, place

of residence, perceived socioeconomic level, marital status, chronic health problem[s],

perceived social support, level of studies, years working as a nurse, type of contractual status,

category within the team, and family conflicts related to work). Student t-test was used, and

one-factor ANOVA to compare mean scores according to marital status

(Married/Single/Other). Spearman Rho test was used for the correlation of quantitative

variables to assess the association of SOC and each dimension (comprehensibility,

manageability, meaningfulness) with self-reported health status and work engagement

(vigour, absorption, dedication). Multiple linear regression models were fitted to determine

independent variables related to health and work engagement (age, chronic health problem,

SOC, and work-related family conflicts). In all cases, significance (p) was set at <0.05.

Validity and reliability/rigour: Other authors who studying Spanish populations have

validated the questionnaires used. The internal validity of the questionnaires from the sample,

calculated using Cronbach’s alpha, was >0.50.

Ethical consideration

The study was carried out in accordance with the Declaration of Helsinki and European

Medicines Agency Guidelines for Good Clinical Practice. The study was approved by the Dr.

Josep Trueta University in Girona (Spain) hospital research ethics committee (reference

number 138/12).

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 Results

The registered nurses were mainly women (Table 1a), with a mean age of 37.7 years (median
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36, mode 34) and a mean SOC score of 67.9 (median 70, mode 72). In relating

sociodemographic, occupational, and health variables to SOC (Table 1a, Table 1b), the means

did not differ by age group (mean difference -0.29; 95% CI -4.36 to 3.77; p = 0.886).

Perceived socioeconomic level was significantly associated with SOC: the higher the

socioeconomic level, the higher the SOC (mean difference 5; 95% CI 0.46 to 9.48; p =

0.030). Furthermore, nurses who had no chronic health problems had higher overall SOC

(mean difference -5.85; 95% CI -10.98 to -0.71; p = 0.027) and comprehensibility (mean

difference -3.09; 95% CI -5.59 to -0.60; p = 0.015) (Table 1a), compared to those with health

problems. Nurses who received social support reported higher SOC (mean difference 10;

95% CI 5.47 to 14.52; p = 0.000) and greater comprehensibility (mean difference 4; 95%CI

1.71 to 6.28; p = 0.001), manageability (mean difference 3.91; 95% CI 2.25 to 5.58; p =

0.000), and meaningfulness (mean difference 2.08; 95% CI 0.75 to 3.41; p = 0.002) than

nurses who reported a lack of social support. Finally, nurses who reported no work-related

family conflicts had higher SOC (mean difference -6.91; 95% CI -10.65 to -3.18; p = 0.000)

showed greater comprehensibility (mean difference -2.87; 95% CI -4.82 to -0.91; p = 0.004),

manageability (mean difference -2.32; 95% CI -3.72 to -0.91; p = 0.001), and meaningfulness

(mean difference -1.72; 95% CI -2.86 to -0.58; p = 0.003) than nurses who reported such

conflicts (Table 1a, Table 1b).

As shown in Table 2, nurses with high SOC had the highest EQ-5D VAS scores (r = 0.408),

and this association was significant for all three SOC dimensions: comprehensibility (r =

0.338), manageability (r = 0.343), and meaningfulness (r = 0.365). This positive association

was also confirmed through the multiple linear regression model (β = 0.276, p = 0.003) (Table

3). Moreover, the SOC of registered nurses working in long-term care was correlated with

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 work engagement (r =0.223) (Table 2), but this association could not be confirmed by the

linear regression model (β = 0.196, p = 0.054) (Table 4).

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Overall SOC and comprehensibility, manageability, and meaningfulness scores were all

positively correlated with dedication (r = 0.345, r = 0.300, r = 0.253, and r = 0.341,

respectively) (Table 2).The regression analysis also showed that nurses without work-related

family conflicts showed greater work engagement (β = 0.202, p = 0.043) (Table 4). The

relationship of SOC with social support, work-related family conflicts, self-reported health

status, and work engagement among nurses working in a long-term care setting is shown in

Figure 2.

Discussion

In this sample of nurses working in long-term care settings, the mean SOC (67.9) was high in

comparison with studies of nurses who work in other areas such as hospitals (SOC 63.6)

(Tselebis et al, 2001), mental health services (SOC 60.6) (Levert et all, 2000), and operating

suites (SOC 66.7) (Michael and Jenkins, 2001), as well as unemployed nurses (SOC 60.19)

(Leino-Leison et al., 2004).

Eriksson and Lindström (2006) found that SOC increased with age, while others report that

SOC seems to stabilize at around 30 years of age (Feldt et al., 2007). In our results, as in

other studies (Ward et al., 2014), SOC among nurses did not increase with age. We would

note that our sample was very young, with 45% younger than 35 years; in contrast, 79% of all

nurses in Catalunya are at least 35 years old (Generalitat de Catalunya, 2018).

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 The association of a SOC with nurses’ perceived socioeconomic level has been observed by

several authors in different populations, such as nurses employed in general care hospitals
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(Basinska et al., 2011) or in general population (Larsson & Kallenberg, 1996). In the present

study, nurses with a perception of having a higher socioeconomic level also reported greater

manageability. This could be due to people with a higher socioeconomic level having a

greater capacity to manage appropriately with the larger amount of resources they have.

Nurses with a higher SOC reported receiving more social support (Hypothesis 1 was

confirmed). In this respect, Engström et al. observed that nurses with good family relations

presented a high SOC and described significantly higher scores in the meaningfulness

dimension. Malinauskiene et al. (2009) also found a strong positive association between

social support in the workplace and SOC. Moreover, people with higher SOC respond better

to different life situations, and this facilitated personal relations with others (Basinska et al.,

2011).

It should be noted that participants who had higher SOC did not report having work-related

family conflicts. (Hypothesis 2 was confirmed.) As Engström et al. (2005) proposed, nurses

with a higher SOC may manage conflicts better and experience greater satisfaction with their

family members and, hence, have less conflict. Ward et al. (2014) also indicate that SOC

contributes to better management of work and family conflicts.

The present study confirms, in a group of registered nurses working in long-term care, the

known relationship between SOC and health observed in many studies in different groups of

workers (Eriksson and Lindström, 2006; Lezwijn et al., 2011; Zielinska-Wieczkowska et al.,

2012; Tebandeke, 2008) (Hypothesis 3 was confirmed).

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 A strong positive association in this population was observed between SOC and work

engagement, similar to previously published results (Van der Colff & Rothmann, 2009). In
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the linear model, however, the results did not reach statistical significance. (Hypothesis 4 was

only partially confirmed.)

Other authors have argued that work engagement not only depends on the health of the

organisation but also on a personal component (García-Sierra et al., 2016; Keyko et al., 2016;

Mauno et al., 2006; Salanova et al., 2011; Xanthopoulou et al., 2007; Wojdylo et al., 2014).

In addition, SOC has been recognised as an influential variable in professionals’ occupational

health (Basinska et al., 2011). Our results indicated that the SOC of the nurses could explain

part of their dedication, which is the emotional component of work engagement; this could

explain its greater association with SOC (Salanova & Schaufeli, 2004). A high SOC can give

nurses a greater capacity to face stressful situations and mobilise the available resources, both

their own and those of their workplace. This could have repercussions in terms of greater

dedication, greater vigour and, ultimately, greater work engagement.

Implications for Managers

The positive linear association observed between SOC and work engagement helps to explain

the constructs. This could have a practical implication as the implementation of programs to

increase SOC among nurses can contribute to increased work engagement, a healthy

workplace, and the empowerment to achieve and maintain good health. To improve SOC

among nurses, managers could work to improve institutional policies related to work-family

balance, strengthen the social support among colleagues and, at the individual level, ensure

that each nurse is assigned meaningful tasks that are acknowledged as important to the

mission of the entire unit.

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 Limitations and future perspectives

The main limitation of the present study is that was not possible to infer causality among a
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sense of coherence, well-being, and work engagement. Concerning the size of the sample, the

number of participants could limit the results of the study, but the high response rate (69.8%)

from the total potential population in the study area should be taken into consideration. This

sample size also guarantees an appropriate statistical power for the analyses required to

achieve the study objectives. For example, for a Cohen f2 effect size of 0.15 in a multivariate

linear regression analysis with a maximum of 10 predictors, and a 0.05 alpha risk, the sample

size of 109 participants will allow detection of a coefficient of determination equal to or

greater than 0.13 with a statistical power of 83%.

In the statistical analysis, the results of the multiple linear regression models were limited

because their determination coefficient values were low, meaning that our model explained

less than 30% of the variability of the dependent variables (for example, Model 1 for self-

reported health status). Moreover, the internal validity of the questionnaires from the sample

had a Cronbach’s alpha over 0.50.

Finally, the SOC-13 and the UWES-17 can be interpreted in various different ways.

Therefore, even when the same instrument has been used, it can be difficult to compare the

results obtained by different researchers.

Further research is needed to elucidate the relationship between SOC and work engagement

in other health care settings, such as inpatient and outpatient nursing care. Similarly, more

studies are needed to establish whether increasing SOC anong nurses is associated with

patient outcomes and to provide evidence of the type of programmes managers could

implement to optimize SOC in the nursing staff and improve outcomes for the patients in

their care.

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 Conclusions

Our sample of registered nurses in a long-term care setting was young, compared to the
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current age distribution of nurses in Catalonia (Spain), and the younger the nurse, the better

the perceived health. The participants had high SOC and the highest scores were associated

with a high perception of having an adequate socioeconomic level and social support system,

along with no reported chronic health problems or work-related family conflicts. This study

also reflected the association between higher SOC and greater work engagement.

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ccepted Articl
Table 1a. Total SOC scores and their dimensions by sociodemographic, occupational, and health variables

Total
populatio TOTAL Comprehensibilit Meaningfulnes
p p Manageability p p
n n=109 SOC y s
(%)
Sex
Men 10 (9.10) 68.5 (12.7) 26.3 (5.4) 20.7 (4.6) 21.5 (4.0)
0.860 0.304 0.823 0.141
Women 99 (90.8) 67.8 (10.5) 24.5 (5.1) 20.4 (3.9) 22.9 (2.9)
Age†
21 to 35 years 54 (49.5) 67.7 (11.8) 24.0 (5.9) 20.6 (4.3) 23.1 (2.5)
0.886 0.217 0.607 0.413
36 to 66 years 55 (50.4) 68.0 (9.6) 25.2 (4.2) 20.2 (3.5) 22.6 (3.4)
Place of residence
Rural area 28 (25.6) 66.0 (11.3) 23.9 (5.3) 0.35 19.6 (4.1) 0.203 22.5 (3.3)
0.281 0.525
Urban area 81 (74.3) 68.5 (10.5) 24.9 (5.1) 7 20.7 (3.4) 22.9 (2.9)
Socioeconomic level
Very good or good 80 (73.4) 69.2 (10.4) 0.030 25.1 (4.9) 20.9 (3.8) 0.026 23.1 (2.9)
0.138 0.640
Regular or bad 29 (26,6) 64,1 (10,6) * 23.4 (5,8) 19.0 (4.1) * 21.8 (3.1)
Marital status
Married 51 (46.7) 68.2 (10.6) 25.2 (4.8) 20.5 (3.7) 22.5 (3.4)
Single 44 (40.3) 67.1 (11.5) 0.800 24.0 (5.8) 0.531 20.3 (4.3) 0.944 22.8 (2.6) 0.243
Other 14 (12.8) 69.1 (8.6) 24.7 (4.1) 20.3 (3.7) 24.0 (2.6)
Chronic health problem
Yes 20 (18.3) 63.1 (10.9) 0.027 22.1 (5.6) 0.015 20.4 (3.8) 21.9 (3.5)
0.060 0.143
No 89 (81.7) 69.0 (10.4) * 25.2 (4.9) * 20.7 (4.0) 23.0 (2.9)
Student t test
Categorical variables are expressed by the absolute frequency, with percentages in brackets. Quantitative variables are shown by their mean, with standard deviation in brackets.
*p<0.05 is considered significant. **statistical significance p<0.001. †Age grouped according to homogeneous groups for statistical analysis.

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ccepted Articl
Table 1b. Total SOC scores and their dimensions by socio-demographic, occupational, and health variables

Total
TOTAL Comprehensibilit
population p p Manageability p Meaningfulness p
SOC y
n=109 (%)
Social support
Yes, always 84 (77.0) 70.2 (9.7) 0.000* 25.5 (4.8) 0.001 21.3 (3.5) 0.000* 23.3 (2.9)
0.002*
Sometimes 24 (22.9) 60.2 (10.4) * 21.5 (5.3) * 17.4 (3.9) * 21.2 (2.7)
Studies
Diploma or degree 98 (89.9) 67.9 (10.7) 24.6 (5.2) 20.4 (3.9) 22.9 (2.8)
0.981 0.737 0.953 0.650
Master's degree 11 (10.0) 68.0 (10.9) 25.1 (4.7) 20.3 (4.5) 22.4 (4.4)
Years in the profession
0 to 10 years 42 (38.5) 68.6 (11.3) 24.4 (5.7) 20.4 (4.4) 23.3 (2.3)
0.768 0.749 0.926 0.169
More than 10 years 67 (61.4) 67.6 (10.4) 24.8 (4.9) 20.4 (3.6) 22.5 (3.3)
Contractual status
Permanent position 86 (78.9) 67.4 (10.5) 24.4 (5.0) 20.2 (3.7) 22.8 (3.2)
0.441 0.431 0.467 0.777
Eventual 23 (21.1) 69.3 (11.4) 25.3 (5.8) 20.9 (5.5) 23.0 (2.2)
Category within the team
One single function 77 (70.6) 69.3 (9.7) 25.2 (4.6) 20.8 (3.7) 23.1 (2.7)
0.034* 0.059 0.091 0.075
More than one function 32 (29.3) 64.4 (12.3) 23.2 (6.2) 19.4 (4.4) 22.0 (3.5)
Work-related family conflicts
Yes 66 (60.6) 65.1 (11.2) 23.5 (5.5) 0.004 19.5 (4.1) 22.1 (2.9)
0.000* 0.001* 0.003*
No 43 (39.4) 71.7 (8.4) 26.4 (4.0) * 21.8 (3.2) 23.8 (2.8)

Student t-test
Categorical variables are expressed by the absolute frequency with percentages in brackets. Quantitative variables are shown by their mean and standard deviation in brackets.
*p<0.05 is considered significant. **statistical significance p<0.001.

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ccepted Articl
Table 2. Relationship between sense of coherence (SOC), self-reported health status (EQ-5D-5L), and work engagement (UWES-17)
scores (n=109)

Mean SD 1 2 3 4 5 6 7 8 9 10
Sense of coherence 67.9 10.02 1 0.910** 0.887** 0.771** 0.343** 0.408** 0.223* 0.281* 0.037 0.345**
Comprehensibility 24.67 5.2 1 0.748** 0.546** 0.323** 0.338** 0.215* 0.286* 0.052 0.300**
Manageability 20.43 3.91 1 0.563** 0.413** 0.343** 0.158 0.207* -0.006 0.253**
Meaningfulness 22.85 3.04 1 0.187 0.365** 0.227* 0.265** 0.72 0.341**
Health 0.918 0.106 1 0.549** 0.154 0.249** -0.16 0.191*
EQ-5D VAS 85.54 11.38 1 0.241* 0.316** 0.76 0.287**
Work engagement 4.31 0.86 1 0.902** 0.884** 0.870**
Vigour 4.46 0.84 1 0.684** 0.733**
Absorption 3.86 1.05 1 0.643**
Dedication 4.66 1.00 1

Rho Spearman correlation

SD: standard deviation. Correlation expressed as *statistical significance p<0.05, **statistical significance p<0.001. VAS: visual analogue scale for EQ-5D-5L

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ccepted Articl
Table 3. Linear regression model for self-reported health status (n=109)

Dependent variable: Self-reported Health (EQ index value)

B SE 95% IC β p
Age -0.003 0.001 0.005-0.002 -0.319 0.000
Chronic health
problem 0.068 0.024 0.022-0,115 0.250 0,005
Sense of coherence 0.003 0.001 0.001-0.005 0.276 0,003
Work-related family
conflicts -0.003 0,019 0.040-0.035 -0.012 0,895
R2 0.281
Corrected R2 0.253

B: coefficient B; SE: standard error; 95%CI: confidence interval of 95%; β: standardized beta coefficient
R2: R-square, the coefficient of determination; corrected R2: adjusted R-square (adjusted coefficient of determination)

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ccepted Articl
Table 4. Linear regression model for Work engagement (n=109)

Dependent variable: Work engagement

B SE 95% CI β p
Age 0.012 0.001 0.005-0.002 -0.319 0.140
Chronic health problem -0.079 0.024 0.022-0,115 0.250 0.708
Sense of coherence 0.016 0.001 0.001-0.005 0.276 0.054
Work-related family conflicts -0.24 0,019 0.040-0.035 -0.012 0.043
R2 0.134
Corrected R2 0.101

B: coefficient B; SE: standard error; 95% CI: 95% confidence interval; β: standardized beta coefficient
R2: R-square, the coefficient of determination; corrected R2: adjusted R-square (adjusted coefficient of determination)

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Accepted Article

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