SHIS and WEMS, extensive report

The instruments are linked to a work model for workplace-related health promotion development work, where the instruments are used as dialogue tools.

The two instruments have been developed and scientifically tested in connection with health promotion in the workplace life of two hospitals in the county of Scania in southern Sweden. The results have shown that both measurement instruments, SHIS as well as WEMS, have high degrees of both validity and reliability. The instruments have been described in the following scientific publications.

SHIS:
Bringsén Å, Andersson HI, Ejlertsson G. Development and quality analysis of the Salutogenic Health Indicator Scale (SHIS). Scand J Publ Health 2009; 37:13-9.

WEMS:
Nilsson P, Bringsén Å, Andersson HI, Ejlertsson G. Development and Quality analysis of the Work Experience Measurement Scale (WEMS). WORK 2010; 35: 153-161.

SHIS – Salutogenic Health Indicator Scale

SHIS is related to a salutogenic and holistic description of health, which has been developed with support of theories linked to concepts such as health and well-being.

Health is in itself a positive, subjective overall experience. Health can be measured on the basis of people's feelings, using experiences of physical, mental and social well-being as indicators. Health can be promoted by people's positive feelings and experiences. Health functions as a resource for the individual when handling various stressful situations in everyday life or when striving to fulfill individual goals in life. The experience of illness is important as it may limit the individual's ability to act in various situations.

The SHIS instrument is a semantic differential as each question has response alternatives on a six-grade scale for positive and negative words with opposite meanings. The instrument consists of twelve questions expressing two different dimensions of health indicators, of which one is intrapersonal and one is interactive. They are called IntraPersonal Characteristics (IPC) and InterActive Function (IAF). There are seven questions in IPC and five in IAF. When analyzing the responses, index values relating to the two dimensions are calculated. It is also possible to accumulate the responses from all the questions of the instrument to achieve a total value on health indicators. The higher the value, the better is the health indicator.

This is the procedure: Index values are calculated for each subject. Each question can yield a maximum value of 6 (for positive response) and a minimum value of 1 (for negative response). For IPC, the index value is calculated as the sum of the seven questions included. The maximum index value is 42, and the minimum value is 7. For IAF, use a similar approach, which for the five questions yields a value in the interval between 30 and 5.

A total index for the twelve questions is calculated by adding the two index values. This means a maximum positive index value of 72, and a corresponding minimum index value of 12.

Different groups can be compared by calculating appropriate averages and ranges, e.g. mean and standard deviation for the respective groups. Furthermore, the index values may of course be used for various more or less sophisticated analyses.

With only twelve questions, the instrument has a small scope and is therefore useful in various situations where the aim is to measure health indicators from a salutogenic and holistic perspective.

WEMS – Work Experience Measurement Scale

WEMS is a multi-dimensional survey with questions on experiences of work and work situation. The statements were developed from theories, which can be linked to e.g. a sense of coherence, flow, regenerative work, demand-control-support and effort-reward. The contents are close to the daily activities, and as the statements are formulated in a positive way, the result can be interpreted from a salutogenic perspective.

The instrument contains six dimensions of work experience: supportive working conditions, internal work experience, autonomy, time experience, management, and reorganization.

When analyzing the responses, index values relating to the six dimensions are calculated.

This is the procedure: Index values are calculated for each subject. Each question can yield a maximum value of 6 (for positive response) and a minimum value of 1 (for negative response). For each index, the index value is calculated as the sum of the responses on the related questions. The intervals for the respective indices are as follows:

supportive working conditions (7 questions): 7 – 42
internal work experience (6 questions): 6 – 36
autonomy (4 questions): 4 – 24
time experience (3 questions): 3 –18
management (6 questions): 6 – 36
reorganization (6 questions): 6 – 36

Different groups can be compared by calculating appropriate averages and ranges, e.g. mean and standard deviation for the respective groups. Furthermore, the index values may of course be used for various more or less sophisticated analyses.

The instrument is comparatively brief; it has 32 statements for the respondent to consider using six response alternatives from "Totally agree" to "Totally disagree". The statements are formulated in a positive way, which means that the result can be interpreted from a salutogenic perspective.

For both SHIS and WEMS, the index values can be standardized to make it easier to understand them. The standardization is done in such a way that all indices vary between 0 and 100%, regardless of their original variation spans.

Dialogue Tool

The instruments are linked to a work model for workplace-related health promotion development work, where the instruments are used as dialogue tools. We recommend that the results be used as the basis for some form of structured and participant-based work model for reorganization. A dialogue tool is being developed on the basis of SHIS and WEMS. The work model will be presented in a scientific context and will eventually be posted on our website. Until then, we recommend the following principal approach.

Data collection is done as step 1, using WEMS and SHIS. The result of the measurement is used as the foundation for further discussion in the respective work groups as step 2. If data collection is done via computers, the results should be available for discussion no later than two weeks after data was collected. The work groups should not be too small, as individual responses would then seriously affect the response distribution. On the other hand, they should not be too large, either, as it would then be more difficult to identify and link the responses to the work group. Group sizes of around 20–40 people should be manageable with this respect.

Through dialogue and discussion, the results become relevant for the workplace and will create commitment and energy. Both positive and negative results should be discussed in order to identify resources and processes at the workplace, but also to find areas for improvement. Highlighting positive and strengthening resources and processes at the workplace during the discussions creates positive spirals of recognition of them in the everyday work!

Some results

So far some results from studies using SHIS have been published in dissertations for either bachelor's degree or master's degree. More results, for SHIS and WEMS, will be presented here as soon as they have been published.

Standardized SHIS values (%):

70 - Staff in care for the elderly (69/72 under/over age 40; p=0,003). [Haliti, G. & Thillgren, H. (2010). Salutogena perspektiv för ett friskare arbetsliv. En enkätstudie med fokus på de anställda inom äldreomsorgen (Salutogenic perspectives for a healthier work life. A survey study with focus on the staff in care for the elderly). Kristianstad University, Study Programme in Health Promotion and Education].
72 - Farmers (68/76 under/over age 55; p=0,045). [Jönsson, H. (2010). Salutogena hälsofaktorer hos lantbrukare: En enkätstudie om upplevelsen av faktorer som relaterar till hälsa (Salutogenic health factors among farmers: A survey study on the experience of factors related to health). Kristianstad University, Thesis for Master's Degree in Public Health Science].
67 - Teachers (65/70 under/over age 45; p=0,271). [Candemir, H. & Petersen, E. (2010). Hälsofrämjande skolutveckling – hur påverkar hälsocertifiering lärares upplevelser av hälsa och miljö? (Health promoting school – how will health certification affect teachers´ experiences of health and working environment?) Kristianstad University, Study Programme in Health Promotion and Education].
72 - Adolescents in secondary school (75/70 boys/girls; p=0,039). [Kundo, A. & Olsson, A. (2010). Självskattad hälsa och fysisk aktivitet – En enkätundersökning bland högstadieungdomar. (Self rated health and physical activity - a survey study among adolescents in secondary school). Kristianstad University, Study Programme in Health Promotion and Education].

Usage

People who wish to use SHIS and/or WEMS in connection with health promotion, research or in a student´s essay may contact someone of the undersigned through email.

The instruments are available not only in Swedish, but in English and in Lithuanian as well.

Åsa Bringsén, Petra Nilsson Lindström, Ingemar Andersson, Göran Ejlertsson

Comment: SHIS, WEMS and pertaining dialogue tool have been developed in research projects, supported by funding from the Swedish savings bank foundation and AFA Insurance.