*3.1. Characteristics of the Participating Students*

921 students answered the questionnaire voluntarily, 751 were women (81.54%) and 170 were men (18.46%). This number of responses meant 80.09% of the population of CNA in the Valencian Community. The average age of the participants was 28.52 (SD = 11.43, Range = 16–57).

The characteristics of the studied population studied are shown in Table 1.


**Table 1.** Characteristics of the studied population.

*3.2. Qualitative Analysis: Mapping the HA Identified by CNA Students*

The qualitative analysis of the answers offered by the participants allowed the researchers to design a qualitative map of HA identified by the CNA students, which is shown in Figure 1.

**Figure 1.** Map of health assets (HA) articulated by CNA students.

*3.3. Quantitative Analysis of HA Identified by CNA Students*

The quantitative analysis of the students' responses is presented in Table 2, which shows the frequencies of each one of the different HA identified by the participants.




**Table 2.** *Cont*.

According to HA identified in this study, it is observed that in the case of intrapersonal ones, a great variety of them was identified by the CNA students. However, 9% of students refer to the fact of "caring for others" as one of the prior inner assets. Regarding interpersonal HA, the couple and the family nucleus (more or less extensive) were identified by up to 89% of students and the group of close friends by 6.4% of them. Finally, and concerning extrapersonal HA, a high number of groups and institutions were identified. On one hand, it is essential to highlight the social group (friends, classmates)—which was identified as an asset by 43% of students—and sporting institutions, identified by 15.4% of students. In addition, a wide variety of physic spaces was also identified by these students; however, they highlighted the recreational spaces (26%) and natural outdoor spaces (beach by 14.2% and mountain by 13.6%) and or specific spaces to do sports activities (6.8%). Interestingly, another 11.5% also identified their own home as an asset for well-being and health.

When analyzing the HA identified by the participants based on specific descriptive characteristics of the population, several differences are found, some of them statistically significant (chi-squared test). Table 3 shows these differences according to the gender, age and employment situation of CNA students.


**3.**HAidentifiedbyCNAstudentsaccordingtotheirgender,agegroupandemploymentsituation.

#### *3.4. Relationship between SOC and HA*

The results on the SOC-13 obtained by this population and its relationship with academic performance can be read in a previously published study [32]. However, a summary is exposed below: the mean score (M) for total SOC measurement was 56.38 (SD = 12.24). Regarding the SOC dimensions, the average score for each subscale was: (i) *manageability* Mean = 16.45 (SD = 4.53); (ii) *comprehensibility* Mean = 19.27 (SD = 5.642; 30) and (iii) *meaningfulness*, Mean = 20.65 (SD = 4.48; 23).

When studying the relationship between the intrapersonal HA identified and the scores in SOC, it is found that those students who outlined aspects related to 'taking care of others' got higher scores in SOC than those who identified other introspective features of behavior, although these differences were not statistically significant (Kruskal–Wallis test). All these differences are shown in Table 4.


**Table 4.** SOC scores, according to intrapersonal HA identified by CNA students.

In the case of the relationship with interpersonal HA, shown in Table 5, it is found higher values of SOC in those who identified their children as health and well-being generating factors than those who identified other members of their family or their group of friends. These differences were statistically significant (Kruskal–Wallis test).

**Table 5.** SOC scores, according to interpersonal HA identified by CNA students.


The post hoc study to analyze intergroup differences found in some cases statistically significant differences (*p* < 0.007, with Bonferroni correction) in SOC scores obtained by students who identified their descendant relatives (the highest values) as HA and those who identified the other interpersonal HA. Table 6 shows mean differences in SOC scores, when comparing them among groups, considering as a reference those who identified their descendent relatives as HA.

**Table 6.** Post hoc analysis. Differences in SOC scores according to interpersonal HA identified by CNA, students, considering as reference the scores obtained by those who consider their descendent relatives as HA.


\* Mean differences are the differences between the scores obtained by CNA students who identified descendent relatives (reference group) as HA and the scores obtained by those who identified the HA shown in each row.

In this post hoc analysis, other statistically significant differences were found when comparing scores obtained in other groups such as in the case of people who identified as HA their parents and people who identified their family and friends as HA, but only in the scores of SOC *meaningfulness* dimension (*p* = 0.003).

Eventually, concerning extrapersonal HA I (groups or spaces), as shown in Table 7, individuals that referred to using open sporting spaces as a HA stood out for higher scores in SOC. In contrast, those who referred to cultural spaces (theatres, cinemas, museums, etc.) showed an average of around 6 points less in SOC. Higher values of SOC with students who used to accomplish volunteer actions and those who identified educational institutions as a health and well-being asset were also perceived. These differences were not statistically significant in all cases (Kruskal–Wallis test).


**Table 7.** SOC scores, according to extrapersonal HA identified by CNA students.

Post hoc analysis to study differences among CNA students according to extrapersonal HA I did not show statistically significant differences in SOC global scores. Nevertheless, in the case of the comprehensibility dimension, students who considered religious institutions as a HA got the lowest scores; these significant differences were found when comparing their scores with those achieved by the students who identified other extrapersonal HA I, such as sporting or educational institutions or their social group (*p* < 0.006, with Bonferroni correction). Furthermore, when comparing SOC global scores, according to HA II identified, no statistically significant differences were found.

#### *3.5. HA According to Motivation for Choosing Nursing Studies*

In light of exploring the calling for CNA's work in our population, 48.2% of students showed a vocational orientation when choosing this career, which was also significantly related to their better self-reported academic records. Furthermore, they scored higher in SOC (both, globally and three dimensions separately), as published previously [32] and those were also the ones who most frequently identified the concept *care for others* within intrapersonal HA (85.7%).

When analyzing the interpersonal HA referred according to this motivational variable, it is observed that the students with a vocational orientation identified their own families as a prior factor providing well-being to them. As for both categories of extrapersonal HA prioritized by these vocation-motivated students, the most valued were to be optimally included in a social group (44.4%), natural spaces (27.7%) and recreational/leisure spaces (24.3%). A lower priority appears in cultural (1.8%) and religious institutions (0.7%).

#### **4. Discussion**

The purpose of this research was to describe the HA identified by a sample of CNA students and to establish a relationship with essential resources to deal with their learning (and life) environment. It was also interesting to explore if having a coherent life meaning—and the presence of attaining their personal goals through an academic achievement- showed relations with vocational factors like taking care of others or owning a *sense of calling* for nursing studies, as the results confirmed.

Concerning intrapersonal HA related to relevant values as 'caring for others,' this study has connected the willingness for care asset-value with consistent scores of SOC, especially were women who referred the chance to 'taking care of others' as an internal resource generating well-being. This aspect and other ones related to patience and fondness provided in care were also referred to as protective assets by informal caregivers of Alzheimer's patients in a study developed by Agulló-Cantos [41]. Another study, which mapped internal HA thorough an intervention with resilient practices (mindfulness) in also informal caregivers determined that this technique—even it cannot be used by itself- could help them to manage a multitude of stressful situations and guarantee a good level of care for another person and even maintain their health and well-being [42]. Reviewing literature in educational contexts, a study mapping HA explained better academic achievement as a factor of well-being for students in a regular schooling experience [5], which justifies the importance of attending self-efficacy from a salutogenic perspective as the present study has observed. Linking to the essence of the salutogenic framework, several works have examined the relationships between SOC and school-related stress [43–45]. In the same line of this research, SOC correlated significantly and positively with school marks, school performance, achievement and success [32,46]. The present study determines that students relating this 'caring for others' asset-value also scored higher in SOC and those variables were significant related to students with a powerful sense of calling as a reason to perform this career. These findings reflect the proposal of Vinje [47] matching vocational element, giving meaningfulness to the chosen profession along with assuming and integrating healthcare strategies as combined, synergic and protective factors in health for nurses. This author even suggests that this chain of phenomena acts like a real snowball providing enthusiasm for the profession called zest for healthcare work, which explains the commitment to the practice of nursing and genuine job engagement [29,30].

In terms of highlighting the interpersonal HA pointed by CNA students, the ubiquity of positive social values provided by family and social network is consistent with findings from other studies which have found positive identity and positive social values [17] and the protective effects of supportive family relationships [48,49], as resources to cope with stressful life events. Concretely, women with children in the moment of the data collection were those who identified them as the main interpersonal assets in their lives. In contrast, men students referred to friendship as their mostly identified HA.

Observing the availability of social support resources in adolescents, they stressed the importance of family, friends and neighbors and the feeling of being supported and taken care of by their parents, community and friends constituting an essential social resource that contributed to resilience [50–52]. Regarding the school context, support from teachers and support from classmates seem to be critical elements during adolescence [6,53]. Besides that, stronger SOC scores were reported by students identifying their children as an interpersonal HA, as the post hoc results also confirmed, these students also obtained higher scores than individuals who identified another interpersonal HA. Based on the findings from the literature review, also those who identified other relatives and friends as HA scored slightly lower in SOC. These findings concur with a study conducted in Spain by Malagón [54], that reported higher SOC levels for nurses accounting for the satisfactory and supportive nuclear familiar network.

Finally, and discussing the extrapersonal HA, it was observed more frequency of response concerning using sporting institutions among CNA male students. In contrast, women identified preferences for educational institutions as healthy resources. These data lead to a reflection about the expression of a society that tends to perpetuate the assignment of roles and stereotypes to women and men in a differentiated way and the need to work in breaking these stereotypes from a salutogenic educational environment. Another interesting relation was observed between higher SOC scores and the fact to undertake some volunteer activities and referred to the frequent use of educational and cultural institutions. On the other hand, those that frequented religious institutions as a coping strategy scored quite lower in SOC at the time of data collection. Even though, in this case, the post hoc analysis did not find statistically significant differences. All in all, for this typology of assets, the results are consistent with those identified as HA in previous researches: neighborhood and community network, sociocultural environment and heritage, sporting and leisure time spaces and natural environments as the most relevant among the population [3,4,40,55,56].

At this stage and analyzing the specific HA map articulated by Valencian CNA students, some aspects must be tackled, such as the consistent connections of the care–relation factor and vocational factor with real health assets reported. Therefore, is the salutogenic and asset-based approach a facilitating strategy to allow CNA nursing students to strengthen SOC, reinforce their *sense of calling*, delve into the *zest for healthcare work* and consequently, enable them to buffer against work-related caregiving stress and thrive in their professions? Even more, could this holistic and positive health-promoting paradigm be early conducted at nursing VET schools and university nursing schools? The findings sustain partial aspects of this postulate. One research focused on undergraduate nursing education emphasized the importance of the role of some personal HA as self-efficacy, emotional intelligence and develop nursing professionalism as inherent aspects to be included in educational strategies for these healthcare students [57]. Mayer and Boness [58] suggested that educational contexts can play a crucial role in creating consistency and a safe and respectful learning environment that promotes social support and enhances SOC. In this regard, a systematic review from the UK released that an Asset–based community development proved a useful 'lens' to view research in schools on the interaction of education and health improvement, having confirmed that there are promising areas for health gain from using schools as 'health assets' [59]. Lindström & Eriksson [12] reflected on the importance of introducing the salutogenic framework in educational science by starting a discussion about the content of health education and health literacy expanding towards healthy learning, with emphasis on positive health promotion.

Then, the commitment seems to point towards the convenience for a decisive introduction of salutogenic orientation in nursing curricula. However, this academic engagement should probably be extended to the rest of health sciences' disciplines as a core component of the study plans [57]. In addition, asset-based interventions must also be implemented in educative programs (as well as in continuing education) and the challenge goes through advocating for teachers being specially trained in salutogenic approaches. That is worthwhile because the salutogenic framework seems to provide a better understanding of the ways to tackle workload and cope with professional stressors, promotes positive health and well-being among future caregivers professionals and could improve, all in all, their efficacy as healing agents.

The implications of our study go in that direction. On one hand, it contributes to the theoretical development of the Salutogenic Model of Health and the Health Assets Model; both have shown to be adequate constructs to improve the health and well-being of any individual from a positive perspective, also in students [2,10]. Furthermore, this is relevant to the extent that this study contributes to reinforcing the growing existing evidence [1,4,6,13], based on non-theoretical population studies. According to the transference to a practical level, it is proposed a transversal implementation of the salutogenic approach in nursing curricula. It is also believed that the implementation of this approach at earlier ages (school) may help to encourage vocational choice in health-related studies, which we have observed to be associated with better academic achievement and higher SOC levels [32]. Salutogenic educative orientation expedites us to train students in order to reinforce their SOC and mainly, dynamize optimal HA against adversities and experiences that caring profession itself will make them live, in addition to improving their academic performance [59]. In this way, we will better prepare future healthcare professionals to be able to adapt to frequently hostile work environments

and their internal threats, with a resilient capacity that will enable them to emerge strengthened from these experiences. This approach would reinforce their self-efficacy and self-esteem [17] and all of these would entail an indirect benefit for the health system itself and society [29].
