SHIS – Salutogenic Health Indicator Scale

The SHIS is related to a salutogenic and holistic description of health which has been developed with the support of theories related to the concepts of health and well-being:

“Health is a positive subjective experience of oneself as a whole. Health is measurable by using individuals’ feelings/experiences of physical, mental and social well-being as indicators. Health can be promoted by an individual’s positive experiences/emotions, and health serves as a resource for the individual when dealing with the various strains of everyday life or pursuing their individual goals. Illness is important since it might restrict an individual’s ability to act” (Bringsén, Andersson & Ejlertsson, 2009).

Technically, the SHIS questionnaire is a semantic differential, that is composed of opposite words where the response alternatives to each question go from the most positive to the most negative. Each question can be answered with one of the six response alternatives.

The Salutogenic Health Indicator Scale (SHIS) survey form (pdf, 14 kB) 

Using SHIS in a questionnaire survey

The questionnaire consists of twelve questions that were initially linked to two underlying dimensions of health indicators, named IntraPersonal Characteristics (IPC) and InterActive Function (IAF) (Bringsén, Andersson & Ejlertsson, 2009). The first study also showed that the collective results from the questions can be considered as a whole and thus represent health complete. The higher the values, the better the indicators of health. To consider the questions as a complete measure for health overall is common practice and is also supported by more recent methodological research (Garmy, Berg, Clausson, Hagell & Jakobsson, 2016). 

Proceed as follows

For each individual, calculate the index value. Each question can yield a maximum score of 6 (for a positive response) and a minimum score of 1 (for a negative response). A total index is calculated by totalling the value for all twelve questions. This means a maximum positive index value total of 72 (6x12=72) and a corresponding minimum index value of 12 (1x12=12).

Different subgroups/populations can be compared by calculating the appropriate average and dispersion measures, such as mean and standard deviation, for each group respectively. In addition, the index value can of course be used for various more or less sophisticated statistical analyses.

The index value can also be standardised to show a comparable value between 0-100%. The standardisation is done by calculating 100* (index value - lowest possible index value) / (highest possible index value - lowest possible index value).

Threshold value for SHIS as a basis for dialogue at group level

Index value (max. 100)

  1. (≤55.0)
    The health score is at a level that indicates a poorer perception of health and that health promotion interventions are needed. Areas for improvement that can contribute to a positive development of indicators of health need to be identified and prioritised. Focus first on areas that have a high positive impact on the perception of health and then continue with the others.
  2. (55.1-70.0)
    The health score is at a level that indicates that there is a good potential to improve the perception of health and health promotion interventions are needed. Areas for improvement need to be identified and prioritised. Focus first on areas that have a high positive impact on the perception of health and then continue with the others.
  3. (70.1-80.0)
    The health scores are at a level that indicates a relatively positive perception of health in the group but there is room for health improvement. Existing health resources and areas for improvement need to be identified and prioritised to preserve what is good and develop what has potential for improvement. 
  4. (>80.0)
    The health score is at a level that indicates a positive perception of health in the group, which is important to maintain with continuous and systematic health efforts.

Using the SHIS in healthy lifestyle discussions or employee performance reviews

SHIS can also be used as a basis for health communication at individual level with focus on for instance healthy lifestyle or employee performance reviews. The person then fills in their estimate of the perception of their health status by answering the questions in the form. Here, too, the total value of the responses to the questions can be considered as a complete score for their perceptions of their health, which can be communicated and followed up with the support of, for example, motivational interviewing (Miller & Rollnick, 2013). 

The person’s responses can also be used to support healthy lifestyle by answering one question at a time. The individuals are asked to describe their thoughts behind their responses with a focus on both the current situation and the desired situation. This method and approach is a form of cognitive interviewing, or “talk out loud” interviewing, that is also used in research contexts (Tourangeau, Rips, & Rasinski, 2000) and has been used in a study where the SHIS has been tested with a focus on the response perceptions (Nilsson Lindström, Ejlertsson, Andersson & Bringsén, 2018). 

In an employee performance review, the results can be used at the individual or group level to engage in a dialogue about how the employee is feeling in relation to work. Conversations about the employee’s health are important from a work perspective but unfortunately often a forgotten part of employee performance reviews. Sometimes conversations about the individual’s specific health can be difficult from an ethical perspective. Then a working group’s total SHIS results can instead serve as a comparative basis for conversation even in the individual employee performance review.