Teaching Salutogenesis

Posted by: Marguerite Daniel, Jake Sallaway-Costello & Eva Langeland

We need to talk about teaching salutogenesis as a health promotion process and as a part of life-long learning. A mature body of literature advocates the application of salutogenic perspectives on a range of professional practices, necessitating the teaching of Salutogenesis in the training of those professions. From the traditional salutogenic spheres of medicine (1) and nursing (2), to innovative applications in sport science (3) and space exploration (4), there are strong disciplinary calls for the teaching of Salutogenesis across diverse fields. Similarly, the implementation of salutogenic principles as a pedagogic framework is well-developed in the educational literature, offering progressive insights on the potential salutogenic orientation on teaching delivery (5), assessment, and pastoral care (6). Beyond advocating the teaching of salutogenic concepts, and using Salutogenesis to theorise healthful pedagogy, what remains unquestioned is the skilful and impactful teaching of Salutogenesis itself. How is Salutogenesis – as theory, as skill, as human capacity – taught?

The Global Working Group on Salutogenesis is excited to launch a new body of work on the teaching of salutogenic theory, initiated with a workshop on Monday 13^th of November 2023. Involving teachers of salutogenesis from Canada, Israel, Italy, Norway, Sweden, Switzerland, and the UK, the workshop sparked critical discussion using a reflective approach, inviting higher education teachers to share both that which has been successful in their teaching of Salutogenesis, and experiences which could be improved. To explore our initial learnings, we reflect on the themes of discussion concerning the content of teaching (“what to do?”), the pedagogic orientation of delivery (“how to do it?”), and the wider context of teaching practice (“how to be it?”) (7).

Teaching Salutogenesis: What to do?

The workshop first considered teaching methods and exercises from a content perspective, examining which of the axioms of salutogenic theory are pertinent to different fields, and how they are delivered in the classroom. This, it appears, is both highly discipline-specific and also temporal, reflecting the potential for salutogenic concepts to disrupt pathogenic orientation of health professions even in the latter stages of training. An insightful anecdote shared by a colleague in Switzerland concerned his introducing of salutogenic concepts to medical doctors in the final years of their training, through asking them thought-provoking questions such as “When was the last time you had a diagnosis of health?”. This exercise embodies the salutogenic rejection of health as normative-stasis, challenging medical students to question the origins of health and disease to which their profession relates. An example of a participatory exercise from the UK focused on the River of Life, describing a performative teaching exercise in which a student has hypothetically fallen in a river close to the university, and the class must identify assets and skills which will support their survival against the currents. This task, concluding with a class reflection that “we are all in the River of Life, always swimming against the tide”, presents a novel opportunity to reify Antonovsky’s metaphor (8) in ways which speak to a local health threat of concrete value to student interests. Numerous colleagues reflected that their teaching of salutogenic concepts occurs in the latter stages of a university degree, creating pedagogic challenges as they seek to present Salutogenesis as complementary, rather than auxiliary, to the typically dominated pathogenic narratives of the course.

Teaching Salutogenesis: How to do it?

When considering How to teach salutogenesis one of the most important aspects to focus on is the coherence or alignment between what is being learned and taught and how it is being learned. For example, if the subject being taught concerns ‘relational skills’ in therapy, learning should occur in a relational way rather than individually and independently. When there is coherence between what is learned, how it is learned and how the newly learned knowledge is assessed, this is called ‘constructive alignment’ (9). How do we teach salutogenesis in a way that aligns with what we are teaching? When teaching the dimensions of Sense of Coherence, how do we generate a sense of meaningfulness in the learners, awareness of own resources to resist stress in own practice or in own culture?

Langeland, Ausland et al. (7) illustrate the ‘how to do it’ in an example of ‘Teaching group leaders of salutogenic talk-therapy groups’. They emphasise the central competence of the leaders is their ability to integrate the theoretical knowledge (the ‘what’) in the way they use self in a salutogenic way (the how) in the provision of therapy. They describe how they use ‘dialogue-based lectures’ to teach this skill. This method encourages students to investigate their own experiences of particular phenomena and then to reflect jointly with others on the processes involved. Learning occurs though experiencing both the role as group leader and the role as a participant in the group in what they call “realistic sessions” (7, p. 615). This resonates with what Biggs (9) calls ‘functioning knowledge’ – i.e., knowledge that functions in practice; and what Hanstedt (10) calls ‘authority’ which is generated when students are placed in situations where they must assume it!

Teaching Salutogenesis: How to be salutogenic?

When you have knowledge of how to do it, the next step is to translate this knowledge into practical skills.  A salutogenic approach looks at what to achieve rather than what to avoid. The aim and thus the main direction we investigate is to come into a positive interplay between SOC and GRR/SRR and to promote active adaptation in this interplay as this is the ideal in the salutogenic approach. Antonovsky conceptualizes it in the following way: “When one searches for effective adaptation of the organism, one can move beyond post-Cartesian dualism and look to imagination, love, play, meaning, will, and the social structures that foster them.” (8, p. 9). High quality on social relations and participation in creating outcomes are cornerstones in creating meaning and health. Thus, the communication aims to facilitate creating meaning and confidence where the teacher or health professional aims to have a high level of empathy, unconditional positive regard, open mind and genuineness (11, 12). To create a salutogenic climate It is also important to be aware of that these attitudes to some degrees are perceived/experienced by the student(s) or person(s) with health challenges. Then they feel freer and safer to express their own truth. Social support and identity are crucial resources and the mutual interplay between these two are key to focus on in the dialogue or group (13, 14).

To create meaning we must investigate own feelings, social relations, major activity and existential issues (8). In a salutogenic approach it might be health promoting to give reflection assignments as home task between meetings to stimulate the investment in these crucial spheres. Examples are: What is a good day for you? What dreams/wishes do you have for the future? What is important for you? Who do you thrive together with? (12, 15).

An advantage in salutogenic talk therapy groups is that participants might learn and support each other. This quote illustrates this: “To look in another participant’s eyes and see that she understands is a very good feeling” (14).

In this blog we make a start at talking about teaching salutogenesis – we hope to take it up with you in person at the Salutogenesis Conference in Lodz in June 2024. Come and share your experiences and ideas with us!

 References

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