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Sense of Coherence: A Relevant Resource in the

Coping Process of Mothers of Deaf and


Hard-of-Hearing Children?
Manfred Hintermair
University of Education, Heidelberg, Germany

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This study examined the importance of reported sense of does not refer to the opposite in the sense that it is
coherence (Antonovsky, 1987) in mothers of children with devoted to the origin and maintenance of health as
hearing impairment. Sense of coherence was explored as
an absolute state. Rather, it refers to the fact that
a factor in relation to the experience of stress and subjective
life satisfaction and in the context of other relevant variables people are to be considered more or less healthy
in coping (e.g., social support, additional handicaps of the while at the same time being more or less ill. Thus
child, child’s hearing status, means of communication). Two the question here is: How does a person become
hundred thirty-five mothers completed a questionnaire, and
path analysis corroborated a theoretical model in which sense
healthier and less ill? (Bengel et al., 1998, S. 24; tr.
of coherence was delineated as a factor contributing directly Debbie Johnson).
to stress perception. Both sense of coherence and the ex-
perience of social support were identified as resources that Research should therefore try to establish the
reduced reported stress and improved quality of life, with factors that contribute to the optimization of health
sense of coherence especially important in reducing stress.
while keeping in mind that optimal health is not always
Child variables, including additional handicaps and extent
of hearing impairment, intensified reported stress for the achieved during life. Within this salutogenic perspec-
mothers, but mode of communication with the deaf child did tive, the concept of sense of coherence has a central role,
not affect stress experience. The findings are discussed since it is a psychological factor that varies among
within the context of socialization theory. Recommendations
individuals and is implicated in establishing a health-
for further research (e.g., longitudinal data, control designs,
socio-economic status, applicability to fathers) are made. driven rather than a pathology-driven outlook. Ac-
cording to Antonovsky, SOC especially influences
In recent years the concept of sense of coherence (SOC) the ability to deal with stressful life experiences
(Antonovsky, 1987) has received increased attention (Antonovsky, 1987; Antonovsky & Sourani, 1988).
in social and medical science. Its rising importance is This makes Antonovsky’s approach especially useful in
closely connected to changing conceptions of health. considering the outlook and strategies of deaf and
This has moved from a pathogenic view to one that hard-of-hearing children and their families.
includes a broader notion of relative well-being, or According to Antonovsky, sense of coherence
salutogenesis. The change can be described as follows: means ‘‘a global orientation that expresses the extent
to which one has a pervasive, enduring though dynamic
Thinking pathogenically means examining the feeling of confidence that (1) the stimuli, deriving from
origin and the treatment of disease. Salutogenesis ones internal and external environments in the course
I would like to thank Trixi Bücker for help with the English translation. of living are structured, predictable and explicable; (2)
Correspondence should be sent to Manfred Hintermair, University of
Education, Heidelberg, Zeppelinstrasse 3, D-69121, Heidelberg,
the resources are available to one to meet the demands
Germany (e-mail: hintermair@ph-heidelberg.de). posed by these stimuli; and (3) these demands are

Journal of Deaf Studies and Deaf Education vol. 9 no. 1 Ó Oxford University Press 2004; all rights reserved. DOI: 10.1093/deafed/enh005
16 Journal of Deaf Studies and Deaf Education 9:1 Winter 2004

challenges, worthy of investment and engagement’’ found a significant correlation with the factor ‘‘anxi-
(Antonovsky, 1987, p. 19). Sense of coherence thus is ety’’ (r 5 .52) in this study, but an equally significant
both a basic feeling and a certain view of the world connection with four secondary factors. They con-
that assumes that we have sufficient understanding of clude, therefore, that Antonovsky’s SOC is a highly
the things happening around us and that we are able complex personality disposition that cannot be ex-
to influence these events through the recruitment of plained solely through its high negative correlation
internal and external resources. with ‘‘anxiety.’’ Current research is not sufficiently
Sense of coherence is made up of three components: advanced to allow more definitive conclusions con-
First, it encompasses a sense of comprehensibility. People cerning this (Bengel, Strittmatter, & Willmann, 1998,
who have this sense of comprehensibility feel that they p. 44).
can approach all experiences, including novel ones, as Concerning the coping process of mothers with

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potentially understandable. They feel less exposed to deaf and hard-of-hearing children, an important
situations that are chaotic, arbitrary, inexplicable, or question is what role does sense of coherence play in
difficult to understand. Such people are therefore able dealing with stress situations? Its main function is usually
to see any arising problems or stress factors within seen to be that it heightens flexibility in the face of
a broader context. Secondly, people who experience new demands, by activating the appropriate resources
a sense of manageability are convinced that the problems according to the situation. SOC may ‘‘work as a flexible
they encounter in life can be solved. They feel directing principle, as a conductor who orchestrates the
competent in their ability to manage available resources, implementation of different coping styles according to
or to acquire them, in order to deal with even the most the demands to be met’’ (Bengel et al., 1998, p. 30). In
difficult of demands. These resources do not necessarily his argument concerning functionality of sense of
have to be their own. However, they have confidence coherence, Antonovsky closely follows Lazarus (1991),
that problems can be solved with the help of other whose stress theory differentiates between an apprais-
people or of higher forces if necessary. Thirdly, ing process (primary appraisal, secondary appraisal,
Antonovsky emphasizes a sense of meaningfulness as the reappraisal) and the coping process itself. In the context
most important component. This mostly concerns how of hearing impairment, the following deduction con-
far someone feels his or her life to be emotionally cerning the quality of the coping process may be made:
meaningful and has aims that are worth striving for. A parent with a strong SOC feels confident in his or her
These three components of sense of coherence are ability to make an internal assessment of the situation
not always individually detectable through factor and then to choose and pursue an appropriate strategy
analysis with the SOC questionnaire developed by for coping with the stressor (in this case, the situation
Antonovsky. However, in principle, the questionnaire brought about by diagnosis). This does not mean that
items can be considered to reflect these components to suffering and sorrow are somehow spirited away, but
a different degree. It should also be mentioned that rather that they can be integrated into the parent’s life.
there is considerable overlap of these ideas with similar However, as many authors following Antonovsky have
concepts (dispositional optimism: Scheier & Carver, pointed out, SOC is not really a special coping style but
1987; hardiness: Kobasa, 1982; locus of control: Rotter, rather has a higher functionality by helping to take the
1966; self-efficacy: Bandura, 1977). Also, there are high measures appropriate to the specific situation and
correlations of SOC with anxiety, neuroticism, and specific individual.
depression. This has led some authors to deny the The evolution of sense of coherence, according
status of SOC as an independent construct (Geyer, to Antonovsky (1987), takes place in the course of
2000; Schmidt-Rathjens, Benz, van Damme, Feldt, & childhood and adolescence. Experience gained during
Amelang, 1997). Mlonzi and Strümpfer (1998) arrive this phase is particularly relevant for the development
at a more nuanced conclusion. They analyzed the of sense of coherence. If there are many internal and
correlation of sense of coherence with the secondary external resources available during this time—Anto-
factors of the 16PF questionnaire after Cattell. They novsky talks of ‘‘generalized resistance resources,’’
Sense of Coherence in Mothers 17

including individual factors (e.g., physical factors, resources (e.g., support from partner, family members,
intelligence, etc.) but especially social and cultural relatives, friends, acquaintances, experts, self-help
factors such as social support, financial options, and groups, etc.), and child variables (e.g., extent of
cultural stability—there is a good chance that a strong handicap, age, sex, additional handicap, temperament,
sense of coherence will develop. Antonovsky sees even etc.). All of these affect the level of stress reported by
larger opportunities of change in adolescence because parents and the degree of life satisfaction and quality
of the many reorientation processes natural to this they feel they can achieve. There are also a number of
phase. At about the age of 30, however, sense of studies within the specific field of coping research in
coherence in his opinion is relatively firmly formed and families with deaf and hard-of-hearing children that
thereafter remains largely stable. arrive at similar conclusions (e.g., Backenroth, 1984;
Although according to Antonovsky’s theory a per- Calderon & Greenberg, 1999; Lederberg & Golbach,

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son’s sense of coherence is more or less completed in 2002; Morgan-Redshaw, Wilgosh, & Bibby, 1990;
adulthood, the validity of the stability hypothesis is Pipp-Siegel, Sedey, & Yoshinaga-Itano, 2002).
under discussion: Many researchers hold conflicting The role of SOC as a personal resource in the
opinions, and the available statistical studies arrive at coping process of parents of deaf and hard-of-hearing
different conclusions (Sack, Künsebeck, & Lamprecht, children has not been previously researched.
1997; Sack & Lamprecht, 1994; Sandell, 1997). If we see
the theoretical discussion concerning consistency of
SOC in the light of more recent approaches in identity Theoretical Model
research (see Keupp et al., 1999), it may be better viewed We have developed a theoretical model formulated as
not as a fixed asset once gained, but as something to be a path diagram, which was tested empirically in the
recreated over and over in the course of life. The need to present study (see Figure 1). The model links some of
recreate also implies the ability to recreate. the personal, social, and child-related variables that
The aim of the study presented here is to describe have proved especially significant, both theoretically
and clarify the relevance of sense of coherence as and empirically, in previous studies on the stress
a personal resource in the coping process of mothers of situation of mothers of deaf and hard-of-hearing
deaf and hard-of-hearing children. children. In addition, the model includes a communi-
Since Antonovsky assigns to sense of coherence cation mode factor. This last aspect is especially
something like a control function in stress manage- relevant for the situation of the education of the deaf
ment, we must examine whether that is the case and, if and hard-of-hearing children in Germany, which is still
so, its relative importance in relation to other factors dominated by methodological debate on the issue of
relevant to coping. There are now several empirical sign versus oralism.
studies describing relevant factors in the coping pro- Sense of coherence (as a personal resource) and
cess of mothers of handicapped children. The recent experienced social support (as a social resource) are
metanalyses of Scorgie, Wilgosh, and McDonald considered relevant factors influencing stress process-
(1998) and Yau and Li-Tsang (1999) have extracted ing and (re-) achievement of life satisfaction (Calderon
the essential variables that help or hinder coping for & Greenberg, 1999; Hintermair, Lehmann-Tremmel,
families with handicapped children (see also Li-Tsang, & Meiser, 2000; Meadow-Orlans, 1994; Quittner,
Yau, & Yuen, 2001; Wilgosh, Scorgie, & Fleming., Glueckauf, & Jackson, 1990). In addition, an additional
2000). Even though coming to terms with a child’s handicap of a deaf or hard-of-hearing child (Beyzavi,
handicap is always a highly individualized process, 1993; Hintermair, 2000; Hintermair et al., 2000;
with various factors coming into play in varying Meadow-Orlans et al., 1997, Pipp-Siegel et al., 2002)
intensity (Yau & Li Tsang, 1999, p. 41), certain aspects as well as the child’s hearing status (Calderon &
appear to be universal. Other than socio-economic Greenberg, 1999; Frey, Greenberg, & Fewell, 1989;
status and education level, these include personal Henggeler, Watson, Whelan, & Malone, 1990; Hinter-
resources (e.g., problem-solving abilities, self-efficacy, mair & Horsch, 1998; Hintermair et al., 2000) are
locus of control, optimistic view of life, etc.), social treated as stress-intensifying factors. With regard to
18 Journal of Deaf Studies and Deaf Education 9:1 Winter 2004

in considering mothers of deaf and hard-of-hearing


children.

The role of mothers in the parenting process. While


the moral discourse concerning male and female roles in
parenting has shifted to a position where roles are shared
more equitably, in most Western societies social realities
tell another story. Mothers, not fathers, still spend much
more time on caregiving and parenting. In all prob-
ability, this is no different for families with children with
hearing impairment. It may even be exaggerated, in view

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of the perception of ‘‘special education’’ for such
children. In a German study on the situation of families
with handicapped children, Engelbert (1999) was able
to show clearly that it is still the mothers who
are responsible for parenting, care, and stimulation.
Parental task sharing seems to be especially difficult
when a child is handicapped (see also Bristol &
Gallagher, 1986; Li-Tsang et al. 2001, S. 68). Engelbert
Figure 1 Theoretical Model for a Path Analysis of the
Coping Process of Mothers of Deaf and Hard-of-Hearing (loc. cit., p. 289f) holds the opinion that intensified stress
Children (SOC 5 sense of coherence; STRS 5 parental due to the handicap of a child may lead to the re-
stress; ZA 5 overall life satisfaction; ZUU 5 social support; traditionalization of family roles, favoring long-familiar
BEH 5 additional handicap; HRVN 5 hearing status of the
role patterns. Mothers of handicapped children are thus
child; LOGN 5 parents’ use of signs).
especially challenged in their parenting tasks, and the
question of resources is particularly vital.
the means of communication used, we adopt the
majority opinion in psychological literature that the
The role of the child in modern times. During the
decisive factor for a deaf or hard-of-hearing child’s
last 80 years, the meaning of children to their parents
successful psycho-social development is an adequate,
working, and child-centered use of a language com- in western societies, and consequently the status of
munication system, regardless of modality (Greenberg, children, has changed drastically (for an overview of
Kusché, & Speltz, 1991). We assume therefore that the the situation in Germany, see for example Beck-
communication modality does not affect the mothers’ Gernsheim, 1998, chapter 5). While in earlier times the
stress experience (indicated by a dotted line). rationale for child bearing and child rearing was largely
Since many of these factors have been shown to economic, today parents hope to satisfy emotional
intercorrelate, additional covariances were integrated needs through their children. Because of this, parents
in the theoretical model. These included (inter alia) have been increasingly held responsible by society for
the relationship between social support and personal raising children successfully, especially in the early
resources (Flannery & Flannery, 1994; Vuori, 1994) years. They can no longer lightly afford to make
and the connection between additional handicap and mistakes which may have irreversible consequences for
social support (Hintermair et al., 2000; Meadow- their child’s chances in life. Parenting seems possible
Orlans, Mertens, Sass-Lehrer, & Scott-Olson, 1997). only if one acquires enough information and has
sufficient commitment. Parents with (hearing-) im-
paired children thus are confronted with a highly
Socialization Theory
challenging situation: They are usually caught in the
The following section indicates why the variables in net of parenting advice and rules of behavior that is
the theoretical model are of particular importance hard to escape without risking reproach. Since mothers
Sense of Coherence in Mothers 19

generally face the task of parenting to a greater extent the school in a sealed envelope, with the school passing
than do fathers, they not only carry the major burden on the questionnaires to the university in bulk. Three
of care, but can also carry a high responsibility for the hundred thirty of 1395 questionnaires originally issued
quality of parenting for their (deaf and hard-of- (23.7%) were suitable for the final evaluation. Forty-
hearing) child. seven parents were excluded from this analysis because
of missing data for various demographic character-
Early development of attachment with children. Im- istics. The empirical analysis thus used 283 question-
portant insights into the success of parenting efforts naires (mothers: N 5 235; fathers: N 5 48). Only the
have been reported from the findings of attachment mothers’ sample is dealt with here.
research (see Ainsworth, Blehar, Waters, & Wall, 1978; The sample’s representative character was checked
Main, 1995). According to these, attachment qualities by comparing the educational status of the responding

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are very important for child development, and the group with the distribution of educational status in the
sensitivity of the child’s attachment figures has a pivotal overall population of Germany. For comparison, we
role here. The child’s development is especially en- used data from the Statistisches Bundesamt (Federal
dangered when a (hearing) impairment is diagnosed Statistical Office) on the distribution of population
and the child may be sent signals that may be inter- and gainful employment in Germany as of April 1998
preted incorrectly, and which may require expert (Statistisches Bundesamt, 1998) and correlated the
knowledge and intervention. Again, the mother will data listed there with the school-leaving qualifications
feel a challenge to her responsibility for her (handi- of the mothers in our sample. The comparison showed
capped) child. She must now explore this ambivalent statistically relevant differences (v2 5 21.26; df 5 2, p 
network of fears, hopes, and wishes in the context of .000). Mothers with low school-leaving qualifications
her changed life perspective. And, not least, she will were underrepresented in the sample, while the group
always be confronted with the expectations of various of mothers with high school-leaving qualifications was
social authorities that she spend a great deal of time and overrepresented compared to the distribution in the
energy on raising her handicapped child. overall German population.
The stress experience of mothers of (hearing-)
impaired children and their subjective life satisfaction Statistical Verification of the Theoretical Model
thus seem especially at risk. Under these conditions,
we ask whether sense of coherence might assume The theoretical model (see Figure 1) was tested
a particular stress managing function, as postulated in empirically by means of path analysis. Path analysis
Antonovsky’s theory (1987). allows a statistical determination of the relative im-
portance of various variables within a theoretically
founded model. The path analysis was calculated with
Method
LISREL 8.50 software. For analysis, the respective
Participants parametrical conditions of relevant variables were
calculated by way of the additional program PRELIS
The study presented here was carried out by question-
2.50, which generated input masks that allow optimum
naire survey from October to December 2000. Ten
calculation.
schools for deaf and hard-of-hearing children in North
Rhine-Westphalia, the most densely populated German
Instruments and Measures
state, were included.
The parents were contacted through the schools, Sense of Coherence questionnaire (SOC/Short Form). We
which forwarded the questionnaires to all families with used the short form of Antonovsky’s SOC questionnaire
children up to middle school level. The children’s ages, in a version authorized for Germany. The thirteen
accordingly, were between 1 and 13 years (M 5 8.13; questionnaire items of the short form are supposed to
s 5 3.1). The parents had a choice of either sending in cover basic attitude towards life in terms of dispositional
the filled-in questionnaire directly or handing it back to orientation. Thirteen items were used, with a 7-point
20 Journal of Deaf Studies and Deaf Education 9:1 Winter 2004

rating scale. Sample items include: Do you feel rather covered by the scale, 12 of the 20 items have a special
indifferent about what goes on around you, at times? How relevance to stress caused by caregiving, therapy, and
often do you feel the things you do are meaningless? Do interaction with the handicapped child. Sample items
you sometimes feel you are in an unfamiliar situation and include the following: I feel that my child’s handicap is
you do not know what to do? Have you ever felt unlucky? serious; I feel overtaxed in raising my child; I feel I’m
How often do you have feelings that make you fear you under pressure in raising my child; I think I’m in good
are losing control? health.
In order to test the content structure of the The scale’s reliability regarding internal consis-
coherence concept, we carried out a factor analysis tency shows optimal results for Cronbach’s alpha of
(main components analysis) with subsequent varimax .83, and reliability values—depending on the method
rotation. The resulting two-factor solution accounted used—between r 5.76 and .85. The reliability check of

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for 45.4% of overall variance. The load pattern our own sample for internal consistency yielded very
indicated a general factor, F1, accounting for just under good values as well (Cronbach’s alpha 5 .84).
30% of the variance. Items of all three components load Although the SOEBEK stress scale, in contrast to
on this factor. The items for comprehensibility and other measures such as the Parenting Stress Index
meaningfulness in particular meet in this factor almost (Abidin, 1995), does not yield differentiated data for
exclusively and with partly very high values. Three different aspects of stress, it is nevertheless a reliable
items load on the second factor F2, which accounts for and valid gauge of general subjective stress experience.
roughly 15% of overall variance. This factor is uneven My own analysis of a (albeit very small) sample of
and cannot be clearly interpreted since it contains items parents of deaf and hard-of-hearing children (Hinter-
from two components. The factor analysis result thus mair et al., 2000, p. 62f) showed a highly significant
suggests that further analyses should use the overall correlation between the SOEBEK stress scale and the
scale values rather than individual component scores. Parenting Stress Index Total Domain Score (r5.91, p 
This is in accordance with the results of many other .001). There was also a highly significant correlation
studies (e.g. Broda, Bürger, & Dinger-Broda, 1995, p. between the stress score and both PSI subdomains
117; Dana, Hoffman, Armstrong, & Wilson, 1985; (Child Characteristics Domain, r 5 .84, p  .001;
Frenz, Carey, & Jorgensen, 1993; Hawley, Wolfe, & Parenting Characteristics Domain, r 5 .83, p  .001).
Cathey, 1992; Holm, Ehde, Lamberty, Dix, & Thomp- Sarimski (2001) was able to show similar results with
son, 1988; Sack et al., 1997), which also suggest that the a larger sample of 30 parents with a Down’s syndrome
overall value of the SOC questionnaire is more reliable child. Again, there was a significant correlation of the
and valid than subscale scores. SOEBEK stress questionnaire and both the PSI Total
The available studies regarding the questionnaire’s Domain Score (r 5.87, p , .001), Child Characteristics
reliability show very satisfactory values for internal Domain (r 5 .70, p , .001) and Parenting Character-
consistency (Cronbach’s alpha of .82 and higher) and istics Domain (r 5 .80, p , .001).
test-retest reliability with time intervals of 7 to 30 days
(r 5 .92 and higher). A reliability check of our own Life satisfaction scale. A measure of psychological
sample for internal consistency yielded very satisfac- well-being was used in order to assess its relation to
tory results as well (Cronbach’s alpha 5 .80). SOC. In previous studies (Hintermair et al., 2000),
mothers responded to two items (I am satisfied with my
Stress questionnaire (SOEBEK). Krause and Peter- life as it is right now; I am satisfied with the way I feel
mann’s (1997) questionnaire on the social orientation right now) using a 5-step rating scale, from ‘‘not true at
of parents of handicapped children includes a 20-item all’’ to ‘‘very true.’’ An internal consistency check
stress scale that (with the exception of 2 items) parents showed a Cronbach’s alpha value of .81. This reliable
answer by using a 5-step rating scale (from ‘‘never measure of overall life satisfaction or subjective well-
true’’ to ‘‘true very often’’). The authors point out being provides additional information beyond that of
that, regardless of the multitude of stress factors stress experience.
Sense of Coherence in Mothers 21

Social support. Experienced social support was mea- Table 1 Statistical index values of model variables
sured by responses to a single item (I am satisfied with with interval/ordinal scale level
the support I receive from my social environment N M s Median Skewness Kurtosis
[family, relations, parents, friends, acquaintances, etc.]) SOC 235 63.6 12.3 — .33 .46
on a 5-step rating scale. This provides a necessarily STRS 235 35.8 10.1 — .46 .33
approximate assessment of their currently experienced ZA 235 6.9 1.9 7.0 .29 .26
ZUU 235 3.3 1.3 3.0 .24 1.13
social-support situation (which must, of course, be
Index: SOC 5 sense of coherence; STRS 5 parental stress; ZA 5 overall
treated with caution) in relation to SOC. life satisfaction; ZUU 5 social support; BEH 5 additional handicap (1 5
no, 2 5 yes); HRVN 5 hearing status of the child (1 5 moderately hard of
Demographics. On an additional sheet, mothers gave hearing: ,70 dB; 2 5 severely hard of hearing: 71–90 dB; 3 5 profoundly
deaf: .90 dB); LOGN 5 parents’ use of signs (1 5 no; 2 5 yes).
information about various data concerning themselves

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and/or their children. In this way we received in-
formation about age, sex, additional handicaps, co-  One-factor ANOVAs with the demographic
chlear implants, and hearing status of the children and information as independent variables and the SOC
the mothers, as well as the mothers’ educational status as dependent variable showed a significant result only
and the means of communication used in the family for educational status (F 5 3.86, df 5 2, p  .02). This
(speech/sign). We also received information about the is in accordance with the results of several other stud-
time interval since diagnosis. ies (for an overview, see Geyer, 1997). The Scheffe test
established that it is the difference between parents
with an elementary education (Grundschule and/or
Hauptschule; M 5 62.9) and parents with secondary
Results
education qualifications (Abitur) or a university degree
Before presenting the empirical realization of the path (M 5 67.4) that was significant (parents with inter-
model, other relevant findings are summarized: mediate qualification [Realschule], M 5 64.0).

 Regarding the strength of sense of coherence, the The time elapsed since diagnosis failed to correlate
mean value of SOC for mothers of deaf and hard-of- with SOC. We compared the SOC value for mothers
hearing children (M 5 63.6, s 5 12.3, N 5 235) was for whom diagnosis was less than a year previously with
comparable to that of a German random female that of all other parents (M,1 year 5 64.5; M.1 year 5
sample (M 5 64.0, s 5 12.1, N 5 766; Franke, Elsesser, 64.3; F 5 .01, df 5 1, p  .93). Even though the
Sitzler, Algermissen, & Kötter, 1998) as well as that available data are not longitudinal, so that we cannot
of a German representative female sample (M 5 64.3, make any statements about individual courses of
s 5 11.5, N 5 1089; Schumacher, Gunzelmann, & change and above all about the strength of sense of
Brähler, 2000). coherence before diagnosis, we can nevertheless
 The mean measure of stress (M 5 35.8, s 5 10.1, surmise that the parents’ sense of coherence does not
N 5 235), using the standardization sample of the suffer a setback (at least not a severe or persisting one)
validation process for the mothers’ sample, was through diagnosis (for a differing view, see Margalit,
generally low (the mean value of 35.8 corresponds to Leyser, & Avraham, 1988). On the contrary, these
the 15th percentile). This suggests that, overall, suc- findings support the view, in accordance with Anto-
cessful coping seems to have taken place in this sample novsky’s theoretical position, that the strength of sense
with slightly older children (M 5 8.13, s 5 3.1; for of coherence at the time of diagnosis is an important
a discussion of current stress values for mothers of factor helping (or hindering, as the case may be)
deaf and hard-of-hearing children in different age parents to deal or cope with the child’s impairment
groups see Lederberg & Golbach, 2002). However, the in an adequate way. This view is also supported by
distribution of scores indicates some high values. High qualitative data collected from the mothers about their
stress values do not appear to be correlated with the (remembered) experience at the time of diagnosis and
age of the child (F 5 1.23, df 5 1, p  .27). the present (not reported here) (Hintermair, 2002).
22 Journal of Deaf Studies and Deaf Education 9:1 Winter 2004

Table 2 Statistical index values of model variables with respect to stress processing (STRS). Mothers
with nominal scale level with a stronger sense of coherence had an advantage in
N 1 (N) 2 (N) 3 (N) Mode coping with the experience of raising a deaf and hard-
BEH 235 189 46 — 1 of-hearing child over mothers with lower SOC scores
HRVN 235 71 78 86 3 (path coefficient of .39). Sense of coherence was of
LOGN 235 188 47 — 1 relatively greater importance than that of experienced
Index: SOC 5 sense of coherence; STRS 5 parental stress; ZA 5 overall social support (ZUU, .25), bearing in mind that
life satisfaction; ZUU 5 social support; BEH 5 additional handicap (1 5
no, 2 5 yes); HRVN 5 hearing status of the child (1 5 moderately hard of interpretation of this factor must rest on responses to
hearing: ,70 dB; 2 5 severely hard of hearing: 71–90 dB; 3 5 profoundly a single question. Overall, the model confirms that
deaf: .90 dB); LOGN 5 parents’ use of signs (1 5 no; 2 5 yes).
both personal and social resources play an important
role in coping with an impairment, as suggested by

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Path Analysis coping theory. Also in line with expectations was the
finding that personal resources are more important in
Tables 1, 2, 3, 4, and 5 show the outcome of mea-
coping with a crisis or critical event in life than
surements, the correlations of the model variables and
external resources (Ell, Mantell, Hamovitch, &
the structural equations. Figure 2 shows the graphic
Nishimoto, 1989; Schröder, 1997, p. 337; Willutzki,
realization of the path model. Major findings are
2000, p. 196).
enumerated below.
4. Overall life satisfaction (ZA) showed a differ-
1. The theoretical model (Figure 1) is confirmed ent, and complementary, pattern to stress processing
by the empirical data (v2 5 1.61; df 5 3; p 5.658). The (STRS). Although sense of coherence (SOC) had both
sample size of N 5 235 may be considered sufficient direct (.18) and indirect effects (by way of stress
for minimizing the risk of erroneous conclusions experience, .20) on this factor, experienced social
(Backhaus, Erichson, Plinke, & Weiber, 1996, S. 425). support (ZUU) seemed to be relatively more impor-
2. Thirty-eight percent of stress experience vari- tant here (.38). Findings of other studies support the
ance, and 37 % of overall life satisfaction variance, can importance of available social resources for the general
be explained by the variables integrated into the subjective well-being of mothers with handicapped
model. Path direction is the same as in the theoretical children (Hintermair et al., 2000).
model in all cases, i.e. hypothesized causal connections 5. The extent of the child’s hearing loss (HRVN,
between the individual variables may be considered as .17), and especially an additional handicap of the deaf
generally statistically safe. It must be recorded, or hard-of-hearing child (BEH, .27) were stress-
however, that 62% or 63% of the model variance intensifying factors in the mothers’ coping process.
cannot be explained by the variables. Once again, there is empirical support for the higher
3. Sense of coherence (SOC) performed in stress situation of this group.
a manner congruent with Antonovsky’s formulation 6. The means of communication used in raising

Table 3 Correlation matrix of model variables (polychoric correlations)


ZA STRS SOC ZUU BEH HRVN
ZA 1.00
STRS .45*** 1.00
SOC .40*** .46*** 1.00
ZUU .53*** .44*** .34*** 1.00
BEH .16* .28*** .00 .17* 1.00
HRVN .00 .11 .06 .08 .14* 1.00
LOGN .08 .12 .10 .06 .10 .49***
Index: SOC 5 sense of coherence; STRS 5 parental stress; ZA 5 overall life satisfaction; ZUU 5 social support;
BEH 5 additional handicap (1 5 no, 2 5 yes); HRVN 5 hearing status of the child (1 5 moderately hard of hearing:
,70 dB; 2 5 severely hard of hearing: 71–90 dB; 3 5 profoundly deaf: .90 dB); LOGN 5 parents’ use of signs (1 5
no; 2 5 yes).
Sense of Coherence in Mothers 23

Table 4 Structural equations (v2 5 1.61; df 5 3; p 5 .658)


ZA ¼ .202*STRS þ.177*SOC þ.384*ZUU Error ¼ .632 R2 ¼ .368
Standard
Error (.063) (.060) (.059) (.059)
T Score 3.20 2.94 6.44 10.70
Index: SOC 5 sense of coherence; STRS 5 parental stress; ZA 5 overall life satisfaction; ZUU 5 social support;
BEH 5 additional handicap (1 5 no, 2 5 yes); HRVN 5 hearing status of the child (1 5 moderately hard of hearing:
,70 dB; 2 5 severely hard of hearing: 71–90 dB; 3 5 profoundly deaf: .90 dB); LOGN 5 parents’ use of signs
(1 5 no; 2 5 yes).

a deaf or hard-of-hearing child (LOGN) had no effect and this link is specifically reaffirmed by our findings.
on the mothers’ stress experience (.04). This result If it is still mothers—especially those of handicapped

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is in conformity with our hypothesis and with other children—who bear the brunt of work of parenting and
studies showing that language modality need have no caregiving, we must assume that they are particularly
relevance for predicting stress experience (Pipp-Siegel exposed to various kinds of stressors. At the same
et al., 2002). time, sense of coherence can be viewed as a personal
approach for tackling necessary tasks in a constructive
Discussion
way. Mothers with a high sense of coherence may be
A number of variables, tested through questionnaire expected to manage experiences with their deaf or
items, were found to account for a significant part of hard-of-hearing child more efficiently and therefore
the variance in reported experience of stress and over- relieve strain more readily. (We have been able to
all life satisfaction (around 40%). Thus, while the document this effect in a separate qualitative study;
variables examined do not account for most of the Hintermair, 2002.)
variance in these factors, nevertheless their influence is As well as the importance of sense of coherence
considerable. In particular, we have identified sense of and social support, the child’s hearing status (HRVN)
coherence as an important intervening variable that, and especially an additional handicap (BEH) have a
through its moderating effect on reported stress, stress-intensifying effect on mothers, as predicted
appears to play an important role in perceived quality by socialization theory. If the mother is primarily held
of life for mothers of hearing impaired children. responsible for the child’s development, and herself
If we compare the data of this study in terms of the accepts that responsibility, it is understandable that the
theoretical aspects of role and responsibility attribution mothers’ stress experience increases with an increased
in the socialization process in the family that we have number of stressors (e.g., a hearing impairment and an
outlined (see above), sense of coherence (SOC) can be additional handicap). In the end it is the mothers, after
distinguished from a measure of social support (ZUU) all, who must somehow cope with this situation. This
in relation to the mothers’ subjective stress experience connection is also supported by the findings of other
(STRS) in coping with the child’s hearing impairment studies (Pipp-Siegel et al., 2002).
and the tasks to be dealt with in raising the child. Directed counseling and intervention should firstly
Antonovsky (1987) points out that sense of coherence is concentrate on boosting the resources that mothers
especially important in coping with stress situations, need for coping and try to diminish the effect of stress-

Table 5 Structural equations (v2 5 1.61; df 5 3; p 5 .658)


STRS ¼ .390*SOC .252*ZUU þ.267*BEH þ.172 HRVN .043*LOGN Error ¼ .619 R2 ¼ .381
Standard Error
(.056) (.057) (.055) (.062) (.061) (.058)
T Score 6.90 4.41 4.87 2.77 .70 10.70
Index: SOC 5 sense of coherence; STRS 5 parental stress; ZA 5 overall life satisfaction; ZUU 5 social support; BEH 5 additional handicap (1 5 no, 2 5
yes); HRVN 5 hearing status of the child (1 5 moderately hard of hearing: ,70 dB; 2 5 severely hard of hearing: 71–90 dB; 3 5 profoundly deaf:
.90 dB); LOGN 5 parents’ use of signs (1 5 no; 2 5 yes).
24 Journal of Deaf Studies and Deaf Education 9:1 Winter 2004

Peck, 1995) suggest a close connection. Knowing the


importance of sense of coherence for coping with
impairment, and in view of the correlation to
educational and social status that has been described,
the aspect of material resources and their implications
for counseling and support concepts cannot be
ignored. If material resources (such as money, housing,
food, education, etc.) are not available at the appropri-
ate level, any pedagogic intervention, however well-
meant or implemented, is bound to fail. In that case,
‘‘coherence support’’ in early intervention and many

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other more strongly educational measures become
mere farce. As Adorno commented, wrong life cannot
be lived rightly.
Figure 2 Path Model (N 5 235; v2 5 1.61; df 5 3; p 5
.658; underlined 5 variance share; dotted lines 5 non- The study presented here is a first attempt at an
significant paths; SOC 5 sense of coherence; STRS 5 empirical evaluation of the importance of the sense of
parental stress; ZA 5 overall life satisfaction; ZUU 5 social coherence for working with parents of deaf and hard-
support; BEH 5 additional handicap; HRVN 5 hearing
of-hearing children. There is still much that remains to
status of the child; LOGN 5 parents’ use of signs).
be done. The emerging consequences for further
research include the following:
intensifying factors as far as possible (see Lederberg &
1. Studies that document the development or
Golbach, 2002; Lederberg & Prezbindowski, 2000;
change of sense of coherence with time, and its
Spencer, 2000). For mothers of deaf and hard-of-
influence on the coping process are required to clarify
hearing children, this could mean that, apart from
the extent to which SOC is a mutable trait during
practical help and advice on how to deal with the child,
parenthood.
counseling in early intervention could focus especially
2. A further study should also include additional
on boosting or confirming the mother’s sense of
control groups (hearing parents/hearing children,
coherence and see to it that social relationships, which
deaf parents/deaf children), in order to assess the
tend to become brittle in the course of diagnosis,
importance of sense of coherence within the frame-
become the object of intense networking efforts
work of communication diversity.
(Hintermair et al., 2000). Both aspects seem to be of
3. In the present sample, mothers with higher
equal importance for mothers in reducing stress and
education are over-represented. It remains to be
achieving life satisfaction. There should be additional
established, therefore, whether the correlations dis-
and perhaps more intense counseling and intervention
cussed here are representative of the population at large.
service offers for mothers with severely deaf children
4. Finally, there must be also a thorough and
or hard-of-hearing children with an additional hand-
detailed study and analysis of the situation of fathers.
icap, since this group of mothers seems to be stressed
Above, all therefore, we must obtain sufficiently large
particularly highly. The results of Greenberg (1983),
samples of fathers, so that the insights gained from the
Meadow-Orlans (1994), and Pipp-Siegel et al. (2002)
group of mothers can be compared with those of
confirm the success of an early family-centered
fathers.
counseling and support strategy.
The data also suggest (ANOVA) that sense of
coherence is related to mothers’ educational status. We
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