Youth and Health as an Issue of Research in Social Work – Two Examples of Current Research
Gabriele Stumpp, Institut für Erziehungswissenschaft, University of Tübingen
Health issues under aspects pertaining to social work are currently being investigated in our department under two main perspectives. The study of (1) Youth, Health, and Internet is based on experiences with a project of e-mail counseling for youths we have been running in our department for one year so far. Our thesis is that the internet has become an important platform for youngsters in general as well as concerning health issues specifically. So far, however, little is known about the ways youths address their health related problems in the net. We believe that research in this area is badly needed since future concepts of effective health improvement and prevention for youths cannot ignore this medium. (2) Biography and Health is our second focus of investigation, addressing deficiencies in the empirical research of Aaron Antonovsky´s salutogenetic concept that has lately become quite popular in many health discussions. Drawing from biographical methods we are currently investigating the development of the so called „sense of coherence“ – the center piece of salutogenesis.
2 Youth, Health, and Internet
Even though at first sight youths appear to be the healthiest population group, new research results, like the WHO Youth Survey (Hurrelmann et al. 2003), are pointing out severe deficiencies concerning the health status of youngsters. There is evidence that a growing number of youths is confronting living conditions not offering adequate resources for coping with daily demands, challenges of growing up and stress. Dependant on socio-economic status, gender or ethnic background, these deficiencies of resources can result in severe health hazards. Studies show that physiological, psychological and social aspects of health are linked in a complex manner and there is a highly significant connection between psychic health and satisfaction with life
One of the resources youths are inceasingly and multifunctionally using is the Internet. The internet has become part of young people´s lives by offering access to information and communication as well as networks and help institutions that can be easily reached round the clock. It can be assumed therefore that issues addressed by youths in the net are also health related ones, as we find in our email counseling project . So far we have done a first step analysis of 287 cases of help requests, most of them including complex, multiple problem areas. According to a wide definition of health, refering to social as well as physical and psychological aspects, we find health related distributed as follows: Problems within social networks (59%), psychological problems (like depression, anxiety) (27%), sexual problems (22%), violence and sexual abuse (14%), suicidal tendencies (12%), drug related problems (10%), school problems (8%), self destructive behavior (8%), eating disorders (7 %) as well as physical complaints (4%).
Our experience over one year shows that we are facing an increasing number of requests (daily average now between 5 und 10). We also find that detailed knowledge about other internet support agencies is needed in order to connect youths with the best possible support, especially when it comes to specific problems like suicidal tendencies or eating disorders. Also, an increasing number of requests requires continuous counseling rather than single contacts for acute crisis intervention. Further analysis of the request mails shows that obviously there is a lack of social resources in the networks of many youths. Complaints about isolation, unability to communicate, problems with families, friends and other relevant people are very common. Anonymity and easy access of email counseling as well as other internet services therefore seem to be important reasons why youngsters are using such services, and health as well as health related issues are ranging farly high on the score of urgency.
Our intended further investigation will first focus on a general examination on how young people address health issues in the internet, which services they use and in which contexts health is a subject of concern. Secondly, we will take a closer look at the requests for help addressed to www.sorgenchat.de. Systematically, we will analyse help requests in order to find out which health concerns are being presented. Furthermore, we will conduct an evaluation of the counselling service by sending out questionnaires with each answer. Our research mainly aims towards two issues: (1) the analysis of internet use patterns related specifically to health issues; (2) the conception of professional standards for the design of internet sites addressing health and prevention issues for young people.
3 Biography and Health
Our project on this subject is addressing the construction of coherence in biography. The so called „sense of coherence“ can be seen as the center piece of Aaron Antonovsky´s concept of „salutogenesis“. This concept presents a view on health focusing on the question of the origins of health rather than on the origins of disease which is the main focus of traditional health and medical research. Under a salutogenetic view, generalized resistance resources play a major role in searching for answers why some individuals are more successful than others in coping with daily hazards, stress and health hazards. According to the concept, these resistance resources are being managed by a persons so called „sense of coherence“, a global orientation, consisting of three dimensions (comprehensibility, manageability and meaningfulness) determining the way challenges are handled in order to stay or become healthy.
This over 30 year old concept includes many aspects regarded as important in current theoretical and practical discussions about health, health improvement and prevention. In many ways, it shows close links with theoretical health concepts already present in social work practice and theory, like for instance empowerment. The problem is that during the 30 years of its existence the concept has not been thoroughly investigated according to its theoretical as well as empirical foundations. One of the main deficiencies arises from the fact, that „sense coherence“ has always been understood- in Antonovsky´s original sense – as an item measurable by questionnaires. We believe that this methodical approach presents a limitation asking for further research. Assuming that coherence is a far more complex construction, rooted in a persons subjective theory of health we have conducted biographical interviews with various groups of people: older men and women, single mothers, chronically mentally ill men as well as women with self destructive behaviour. With these interviews we were trying to find out, how coherence is being constructed during biography and within the subjective theory of health, related to gender aspects. Our findings so far show that health is biographically constructed in close relation to what we can call a „construct of resistance“ that shows a wide range of similarities with the salutogenetic understanding of the sense of coherence. We also find that the development of coherence is closely linked to life long processes of identity management. Coherence turns out to be a subjective construction centered aound very individual themes that are crucial in the biography in question. In interviews with chronically ill people or with people in severe crises we find that symptoms of illness can be understood as resistance resources functioning to maintain a certain level of coherence under adverse conditions thus enabling a person to maintain or achieve a certain level of health preventing total desintegration. Further research is being done to find out how static or flexible the sense of coherence is proving under severe conditions of stress and health endangerment and how attacks towards identity are influencing the core construct of a persons sense of coherence.
Antonovsky, A. 1987: Unraveling the mystery of health. How people manage stress and stay well. San Francisco.
Döhring, N. 2000: Selbsthilfe, Beratung und Therapie im Internet, in: Batinic, B. (ed.): Internet für Psychologen. Göttingen, pp. 508-547.
Hurrelmann, K, Klocke, A., Melzer, W. and Ravens-Sieberer, U. (eds.) 2003: Jugendgesundheitssurvey. Internationale Vergleichsstudie im Auftrag der Weltgesundheitsorganisation WHO, Weinheim/München: Juventa.
Stumpp, G. 2003: Biographie und Gesundheit. Subjektive Gesundheitstheorien als widerspenstige Konstrukte. Paper presented at the DGFE Kommissionstagung/Sektion Sozialpädagogik, June 2003.
Dr. Gabriele Stumpp
University of Tübingen
Institut für Erziehungswissenschaft
72070 Tübingen, Germany