Effectiveness of salutogenic-based interventions on sense of coherence and, quality of life and self-efficacy among community dwelling older adults: A systematic review and meta-analysis.

Abstract

Background: Salutogenesis is a health promoting orientation and sense of coherence (SoC) is a vital intrinsic coping factor associated with quality of life (QoL) and self-efficacy. Although salutogenic-based interventions (SBIs) show potential in improving health outcomes, its effectiveness on SoC, QoL and self-efficacy among community-dwelling older adults remains unclear. Development of SBIs also requires an understanding towards the use of approaches and SoC strengthening mechanisms.

Aims: This review aims to (1) evaluate the effectiveness of SBIs on SoC, QoL and self-efficacy in community dwelling older adults; and (2) consolidate evidence on salutogenic approaches and potential SoC strengthening mechanisms. Methods: Databases systematically searched include PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, Medline, PsycINFO and ProQuest Dissertations & Theses Global electronic databases. Two reviewers screened the eligibility of the titles and abstracts of studies identified; and assessed risk of bias of included randomised controlled trials (RCTs) independently. Using the RevMan 5.4 software, meta-anayses on SoC and QoL were performed. Results: The search yielded 1278 records. A total of eight studies including 1201 older adults were included in this review. Subgroup analysis on SoC showed significant effects favouring SBIs using the empowering-self management model and strengths/resource-based approach but not for the reflection approach. No significant effect favouring SBIs on QoL outcomes was found. There are high heterogeneity with the outcome of self-efficacy, and a narrative synthesis was performed. Conclusion: Effectiveness of SBIs on SoC, QoL and self-efficacy in community dwelling older adults remain inconclusive. Salutogenic approaches is deemed to support two SoC strengthening mechanisms: empowerment and reflection. Development of a SBI theory and checklist via these mechanisms would inform and standardise future SBIs. Longitudinal and large scale RCTs are recommended for future studios to provide more strong evidence.