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patterns, consistencies, and variations in the findings, without applying formal quality assessment frameworks. Results: The SOC scale demonstrated consistent structural validity, high internal consistency, and adequate cross-cultural validity across multiple contexts. Criterion and construct validity were supported by consistent associations with variables related to mental health, coping, and well-being. Responsiveness was adequate in the studies that assessed it. However, reliability varied according to context and population, and measurement error was poorly assessed or inconsistently reported. Content validity was scarcely addressed, constituting a significant gap. Conclusion: The SOC scale demonstrates adequate overall psychometric performance and remains useful in health research. However, some properties—especially reliability, measurement error, and content validity—require cautious interpretation. Strengthening methodological rigor and expanding its validation in diverse contexts are recommended.

Keywords: Review, Scientific evidence; Sense of coherence; Public health; Evaluation Studies as Topic; Surveys and Questionnaires; Holistic Health; Community Health Indicators.

Propiedades de medici de la escala de Sentido de Coherencia (SOC): una revisi narrativa

Introduction

Instruments are operational tools for collecting information that contribute to indirectly quantifying and measuring a phenomenon of interest in the most transparent, accurate, relevant and consistent way possible. Therefore, before use, validation of the quality of scientific evidence is necessary for understanding and adaptation to the objects or subjects studied, since research conducted with poor-quality outcome measurement instruments is a waste of time and resources and results in unreliable or unethical inferences [1].

In 1979, Aaron Antonovsky introduced the salutogenic theory based on the “Sense of Coherence (SOC)” as a global orientation to see the world and the individual environment as understandable (ability to understand what is happening around), manageable (ability to handle the situation by oneself or through other important people in one’s social network) and meaningful (ability to make sense of the situation) [2].

The salutogenic model represents a paradigm shift from the traditional pathogenic approach, as it focuses on health-promoting resources rather than disease, emphasizing how individuals mobilize internal and external resources to maintain and improve their well-being [3]. In this framework, the three dimensions of SOC—comprehensibility, manageability, and meaningfulness—should not be understood as isolated components, but as interrelated elements that together shape a global orientation toward life. This integrated functioning allows individuals to interpret their environment as structured, perceive available resources as sufficient to cope with demands, and attribute meaning to life experiences, which has been associated with better health outcomes, resilience, and adaptive capacity across populations [4].

Meanwhile, another central concept is General Resilience Resources (GRR) [2], such as self-identity, knowledge, intelligence, coping strategies, social support, commitment and cultural stability. SOC becomes a lasting and dynamic manifestation of an individual’s confidence in their use of the resources they need to cope with the stimuli present at throughout their life, and the GRR that provide the prerequisites for the development of SOC are those material or intangible resources inherent to the individual or present in their immediate and distant environment [5].

The theory presented is a paradigmatic approach that goes beyond risk factors—a pathogenic approach—by arguing that the way people view their lives has a positive influence on their health. Therefore, ten years later, Antonovsky developed the “Life Orientation Scale” (OLQ), also called the “Sense of Coherence Scale,” and examined its properties. It measures functioning capacity and is a positive and fundamental element for both individual and collective health, that is, people with a high sense of coherence may have healthy practices and lifestyles and a lower burden of disease [6].

The Sense of Coherence Scale (SOC) has been validated in different languages, regions and populations, including studies in the Colombian context [7] .The results have shown that it is valid and reliable for application. Some systematic reviews of SOC have focused on validity and reliability [2]; on the salutogenic concept, Sense of Coherence (SOC) and its correlation with quality of life (QoL) [2]; on the sense of coherence in adolescents, health and reliability of the meaning of the scale versions [5,6]; empirical evidence on the association between SOC and oral health behaviours, as well as on oral health in relation to quality of life [8,9]. More recent studies have examined SOC in university populations during the COVID-19 pandemic, highlighting its role in coping and mental health [10].

Recent evidence shows the systematic review of the association between SOC, burden and mental health outcomes in informal carers [11]; dental caries [12] and finally a review that analyses possible correlations with different individual and work-related variables [13,14].

As a result of the above, there is interest in conducting studies using the SOC, whose validity is characterised by its robustness and high quality, based on the evaluation of its measurement properties, the result of a detailed methodology, such as a literature review whose results contribute to demonstrating its psychometric properties. Despite the widespread use of the SOC scale, inconsistencies remain regarding its psychometric properties across different populations and versions. Therefore, a comprehensive synthesis of evidence on its reliability, validity, and factor structure is needed to support its appropriate use and selection in health research.

The objective of this study is to synthesize and critically interpret the available evidence on the measurement properties of the Sense of Coherence (SOC) scale, focusing on validity, reliability, and structural characteristics across diverse contexts and populations.

Methodology

A narrative review with an interpretative approach was conducted to examine the measurement properties of the Sense of Coherence (SOC) scale across its different versions. Given the heterogeneity in study designs, populations, and reported psychometric outcomes, this approach allowed for a critical synthesis of the available evidence. The analysis focused on identifying patterns, consistencies, and methodological variations in the validation processes of the instrument. To ensure methodological rigor and transparency in the narrative synthesis, the review was assessed using the Scale for the Assessment of Narrative Review Articles (SANRA), which is appropriate for evaluating the quality of narrative reviews [15].

Table 1. Search strategies

Analysis of Measurement Properties

The psychometric properties reported in the included studies were analyzed to provide a comprehensive understanding of the validation processes of the Sense of Coherence (SOC) scale. The analysis focused on key properties such as structural validity, internal consistency, reliability, measurement error, construct validity, cross-cultural validity, criterion validity, and responsiveness.

Patterns, consistencies, and variations were identified in how these properties were assessed and reported across different contexts and populations. This interpretive approach allowed for a critical understanding of the instrument’s strengths and limitations without applying rigid evaluation frameworks. Although quantitative indicators reported in the studies were considered, the analysis did not aim to produce a formal quality rating, but rather to support an interpretative understanding of the evidence.

Results

The results were synthesised according to measurement properties, allowing identification of convergences and inconsistencies across studies rather than isolated descriptions, allowing an interpretative synthesis of patterns and variations across studies.

In the first search filter, 123 articles were selected based on their title. The databases from which most of the manuscripts were selected were Google Scholar and Scopus, with 39% and 32%, respectively. Eleven duplicate articles were excluded, and the full abstracts of those that continued the process were reviewed. This analysis resulted in the elimination of 47 manuscripts that did not meet the established inclusion criteria.

The final selection filter allowed for the exclusion of documents whose content or language did not meet the inclusion criteria defined for the study. The final analysis was performed on 24 manuscripts, corresponding to 19.5% of the total initially selected (Figure 1).

Table 3. General characteristics of the items

Discussion

This review evaluated the measurement properties reported in 24 studies that analysed the psychometric properties of the Sense of Coherence Scale (SOC). The aim of this work was to provide a theoretical and methodological contribution through the analysis of the results corresponding to each psychometric criterion evaluated.

Structural validity in this study, assessed in 22 articles, demonstrated high methodological quality with representative samples. In this regard, Guilbert, cited by Baladr et al. [42], suggests that validity should be understood as the degree of precision with which an instrument measures what it intends to measure, including aspects such as reliability, objectivity, and content relevance. Similarly, Hernández and Domínguez [43] argue that structural validity is based on the analysis of the homogeneity of the items included in an instrument, as this analysis provides statistical evidence supporting whether the instrument measures the construct it intends to assess and whether each item corresponds appropriately to its respective theoretical dimension.

These findings are consistent with recent psychometric studies that confirm the structural stability of the SOC scale across different populations and cultural contexts. Several validation studies conducted in Europe, Asia, and Latin America have reported acceptable factorial fit indices for the SOC-13 version and confirmed the theoretical components proposed by Antonovsky [44-46].

Regarding internal consistency, the results indicate that the SOC-13 demonstrated adequate psychometric properties. Specifically, the scale showed that all items measure the same underlying construct, reflecting a single latent theoretical dimension in which items are correlated with one another [47]. According to Vega Martínez et al. [18], the analysis of consistency through Cronbach’s alpha is central when evaluating the reliability of an instrument, with acceptable values typically ranging between 0.70 and 0.90. In the present study, internal consistency values for the items analysed were greater than 0.70, supporting the reliability of the scale.

Recent studies have reported similar reliability values for the SOC-13 scale in diverse contexts, reinforcing the stability of this measurement property across populations. For example, Domínguez-Salas et al en 2022 [48] and Mafla et al. [49] en 2021 reported Cronbach’s alpha values above 0.80 in clinical and community populations. Likewise, other studies conducted in university and working populations have reported similar reliability results, supporting the robustness of the instrument in different sociodemographic contexts [50].

According to the description by Le et al. [51], intercultural validity allows for the evaluation of the relationships between the different components that constitute an instrument and how these components function across cultural contexts. In this sense, the methodological quality of the studies included in this review was generally very good, and in terms of risk of bias, only one article was classified as doubtful.

Reliability and measurement error were properties whose qualitative and quantitative evaluations showed comparatively lower results when analysing the different measurement parameters. In this regard, methodological quality was often rated as doubtful, indeterminate, or insufficient. Some authors argue that new analytical approaches should be considered for evaluating measurement error, such as the use of confidence intervals to provide more precise estimates [52]. Measurement error is also inherent in self-report instruments, which may introduce a certain degree of subjectivity in participants’ responses [53]. Likewise, other studies emphasize the importance of conducting further analyses to obtain more accurate estimates of these measurement properties [54].

Recent methodological studies also recommend complementing traditional reliability analyses with additional indicators such as the standard error of measurement and minimal detectable change, which allow for a more precise interpretation of measurement error in psychometric instruments [55].

The results of this review also demonstrated high-quality evidence for criterion validity in the instruments analysed. This finding is consistent with Evers et al., cited by Nlega et al. [56], who argue that although different types of validity evidence are important and complementary when adapting an instrument, criterion validity becomes particularly relevant when the objective is to make predictions or analyse behavioural responses to specific phenomena. Furthermore, this type of validity allows researchers to examine not only the measurement of a single construct but also its relationship with other relevant variables [57].

Recent research supports these findings by demonstrating significant associations between sense of coherence and health-related outcomes such as mental well-being, resilience, and quality of life. Several studies have shown that higher SOC scores are associated with lower levels of stress, anxiety, and psychological distress, highlighting its role as a protective psychosocial resource [58].

Construct validity was also supported by the results of this study. This was evidenced through statistically significant correlation coefficients (p < 0.05) with other instruments designed to analyse constructs conceptually related to the Sense of Coherence. According to Di Luciano et al. [59], this type of validity is essential, as it requires verification through comparisons with other measures that assess similar constructs, demonstrating statistical correspondence between them.

Finally, the evaluation of responsiveness in the analysed articles was rated as high quality. For García et al. [60], this psychometric property is necessary insofar as it allows for the estimation of responsiveness to change and sensitivity (ability to detect changes), mainly in instruments that seek to analyse specific health states [61, 62].

Overall, the findings of this review reinforce the evidence that the Sense of Coherence Scale presents adequate psychometric properties across different populations and contexts, supporting its continued use as a reliable instrument in health promotion, mental health research, and public health studies.

Conclusions

This narrative review achieved its objective by synthesizing and critically interpreting the available evidence on the measurement properties of the Sense of Coherence (SOC) scale across diverse populations and contexts. More explicitly, the findings indicate that the scale demonstrates consistent structural validity, supported by adequate model fit indices in most studies; high internal consistency, with Cronbach’s alpha values generally above 0.70; and adequate cross-cultural validity, reflected in its stable performance across different contexts and population groups. In addition, criterion and construct validity were consistently supported, showing coherent associations with variables related to mental health, coping, and well-being, while responsiveness was also found to be adequate, confirming the scale’s ability to detect changes over time. Overall, these findings confirm a globally adequate psychometric performance and support the SOC scale as a robust instrument for health research.

However, the synthesis of evidence also reveals important methodological limitations and gaps in the literature. In particular, reliability showed heterogeneous results across studies, reflecting variability in the temporal stability of the instrument, while measurement error was insufficiently assessed or inconsistently reported, limiting the precision of its estimates. Furthermore, content validity was rarely evaluated, representing one of the most significant gaps identified in the current evidence.

In this context, although the SOC scale is widely applicable across different populations and settings, some of its measurement properties require cautious interpretation, particularly in methodologically heterogeneous contexts. Therefore, future research should prioritize strengthening the methodological rigor of psychometric evaluations, including more standardized and robust assessments of reliability and measurement error, as well as the systematic incorporation of content validity analyses. Expanding validation efforts in underrepresented populations and contexts is also essential.

Addressing these gaps will contribute to consolidating the psychometric evidence of the SOC scale and enhancing its application in public health and mental health research.