Online Appendix2
Table: Psychometric properties of instruments to assess spirituality
AuthorsKey articles / Instrument name,
number of items, and goal(s) / Subscales, factors, or dimensions underlying the spirituality construct / Validation Population
Psychometrics properties
General SpiritualityReed,198637 / The Spiritual Perspective Scale
10 items, 6 point Likert scale
To measure persons’ perspective on the extent to which spirituality permeates their lives and they engage in spirituality-related interactions. / Spiritual behaviours
Spiritual beliefs / N=300 terminally ill hospitalized cancer patients (mean age = 61.1 ±14.6 years), non terminally ill hospitalized patients (mean age = 60.2 ±13.6 years) and healthy persons (mean age = 60.5±10.8 years)
Cronbach’s =0.93 to 0.95
Test-retest: 0.68 to 0.57
Concurrent validity: Correlation with Index of Well-Being (Pearson correlation = 0.22 in terminally ill hospitalized cancer patients).
Underwood, 200238 / The Daily Spiritual Experience Scale (DSES)
16 items, 6 point Likert scale
To measure everyday ordinary spiritual experience rather than particular beliefs or behaviours. It intends to transcend the boundaries of particular religions. / One factor, 9 dimensions:
Connection with the transcendent
Sense of support from transcendent
Wholeness
Transcendent sense of self
Awe
Gratitude
Compassion
Mercy
Longing for the transcendent / N= 1’845; 233 women from Study of Women Across the Nation (mean age=46.8 ± 2.7 years), 45 patients with arthritis pain (mean age not available), 122 individuals from the University of Chicago (27.7 ±13.4 years), 1,445 individuals from a random representative sample of the US population (mean age =45.6 ±17.1 years).
Cronbach’s =0.94
Test-retest (2 days interval) for 6 items: reported data for N=47 substances users =0.73
Concurrent validity: negative correlation with State –Trait Anxiety Inventory =-0.39; Center for Epidemiologic Studies-depression =-0.22; Cohen Perceived Stress Scale =-0.19; alcohol consumption = -0.20. Positive correlation with Scheirer’s Optimism Scale = 0.35; Berkman’s scale of Perceived Social Support =0.18; Quality of life SF-36 =0.24
Howden, 199239 / Spirituality Assessment Scale
28 items, 5 point Likert scale
To assess individual’s spirituality. / 4 subscales:
Purpose and Meaning.
Innerness
Inter-connectedness
Transcendence / N=149 adults living in the community; age ranging from 40 to 60 years
Cronbach’s =0.91
Fetzer Institute National Institute on Aging, 199940
Idler, 200341
Stewart, 200642 / The Multidimensional Measure of Religiousness / Spirituality (MMRS)
88 items
The Brief Multidimensional Measure of Religiousness / Spirituality
38 items
To combine religiousness and spirituality in a same instrument and to propose a brief measure of spirituality /religiousness based on items from different domains identified by experts. / 5 factors:
Meaning
Guilt
Religious practice and religiousness
Spirituality
Loving, forgiving God / N= 1445, nationally representative sample 41; mean age=46.5 years.
Cronbach’s = 0.54 to 0.91
N=515; 355 students and 160 patients receiving treatment for alcoholism42; mean age patients=38 years.
Cronbach’s =0.56 to 0.95
Test-retest reliability (2 months average) : prepost stability coefficient ranged from 0.61 to 0.84
Criterion validity: correlation of each factors with Religious Orientation Scale (Spearman correlation ranged from 0.40 to 0.55 excluding Guilt);and with Spiritual well-Being Scale (Spearman correlation ranged from 0.55 to 0.64 excluding Guilt).
Hatch, 199843 / The Spiritual Involvment and Beliefs Scale (SIBS)
26 items, 5 point Likert scale
To develop a comprehensive and widely applicable instrument to assess spiritual status in clinical practice and research. / 4 factors:
External / ritual practices
Internal beliefs/ Fluid
Existential / Meditative Beliefs
Humility / Personal Application / N=83; 50 patients from rural family practice and 33 family practice professionals; mean age=49.7±17.7 years
Cronbach’s =0.92
Test-retest (7 to 9 months interval) stability coefficient =0.92
Criterion validity: Correlation with The Spiritual Well-Being Scale (reliability coefficient=0.80)
Kass, 199144 / The Index of Core Spiritual experience
INSPIRIT
7 items, 4 point Likert scale
To assess belief in a relationship with God or a higher power. / One factor:
Relationship with God or a higher power / N=83 adults outpatients at a behavioral medicine program (relaxation for stress-related components of illness)
Cronbach’s =0.90
Concurrent validity: Correlation with The Inventory of Positive Psychological Attitudes to Life: Significant for Life Purpose and Satisfaction subscale r =0.14; Not significant for Self-Confidence During Potentially Stressful Situations subscale.
Criterion validity: Correlation with Religious Orientation Inventory: significant for intrinsic subscale r =0.69 and non significant for extrinsic subscale.
Piedmont, 1999 45 / The Spiritual Transcendence Scale
24 items, 5 point likert scale
To capture aspects of the individual that are independent of the qualities contained in the Five-Factor Model of Personality. / 3 factors:
Universality
Prayer fulfilment
Connectedness / N=356 students; mean age=19.7±4.6 years
Cronbach’s =0.85
Concurrent validity: Correlation of each subscale with psychosocial functioning scores (attitudes toward abortion, internal health locus of control, vulnerability to stress, sexual attitudes, and prosocial behaviors).
Criterion validity: Correlation with religious variables (frequency of reading bible or religious literature, frequency of prayer, frequency of attendence to services) Pearson’s coefficient ranging from 0.12 to 0.58
Veach, 199246
Korinek, 200447 / The Spiritual Health Inventory (SHI)
28 items, 5 point Likert scale
To assess whether patients’ spiritual needs are satisfactorily met for self-actualization, relationships, and hope. / 3 factors:
Spiritual experience.
Spiritual locus of control
Spiritual well-being / N=243; 93 male felony offenders in a residential treatment center; mean age=32 years (range 18-47) and 150 patients in a 6-week outpatient substance abuse treatment program, mean age=38 years (range 17-67)
Cronbach’s =0.77
King, 199548
King, 200149 / The Royal Free Interview for Religious and Spiritual Beliefs
Interview based
20 items
(15 questions are rated on a visual analogue scale)
The Royal Free Interview for Religious and Spiritual Beliefs
Self report
18 items
To measure spiritual, religious and philosophical beliefs. / 2 subscales:
Spiritual scale.
Philosophical scale. / N= 305; 153 health professionals, mean age=35 ± 11.4 years; 123 general practice attenders not acutely ill, mean age= 42±17.3 years; 29 religious persons, mean age=46±12.7 years. 48
Cronbach’s =0.60 (philosophical scale) and = 0.81 (spiritual scale).
Test – retest (N=103 from staff; 7days interval) reliability coefficient =0.95 (spiritual scale) and 0.91 (philosophical scale).
Criterion validity: Correlation with frequency of practice of religious faith (Pearson correlation =0.41)
N=287; 102 health professionals (mean age=40.1 ± 14.7 years), 173 community dwelling persons (mean age=38.8±15.8 years), 22 fundamentalist Christian church ( mean age=54.8±12.7 years) 49
Cronbach’s =0.74 to 0.89
Test-retest (health professionals): Kappa ranged from 0.76 to 0.86 and intraclass correlation coefficient ranged from 0.72 to 0.94
Criterion validity. Correlation with Intrinsic Religious Motivation Scale (Pearson coefficient= 0.66)
Delaney C, 200550 / The Spirituality Scale
23 items, 6 point likert scale
To measure the beliefs, intuitions, lifestyle choices, practices, and rituals representative of the human spiritual dimension and to guide spiritual interventions. / 3 factors:
Self discovery.
Relationships.
Eco-awareness. / N=226 patients with chronic illness (inpatients, outpatients and from community settings); mean age=64.0±18.8 years
Cronbach’s =0.94
Test-retest (2 weeks) Pearson’s coefficient=0.84
Ostermann, 200451
Bussing, 200552
Bussing, 200553 / SpREUK (Erfassung der Spirituellen und Religösen Einstellung und des Umgangs mit Krankheit)
29 items, 5 points Likert scale
To measure patient’s attitude towards spirituality and religiosity and their adjustment to disease coping.
SpREUK-P
25 items
To differentiate spiritual, religious, existentialistic and philosophical practices. / 5 factors:
Search for meaningful support.
Positive interpretation of disease.
Trust in external guidance.
Support in relation with the external life through spirituality/religiosity.
Support of the internality through spirituality/religiosity.
6 factors:
Conventional religious practice.
Existentialistic practice.
Unconventional spiritual practice.
Humanistic practice.
Nature-oriented practice.
Guardian angel. / N=129 in and out patients with acute or chronic diseases; 51 mean age=54±14.3 years
Cronbach’s =0.62 to 0.89
N=257 inpatients with acute or chronic diseases; 52 mean age=53.3±13.4 years
Cronbach’s =0.90 to 0.95
N=354 inpatients with chronic diseases and healthy controls; 53 mean age=49.0±12.5 years
Cronbach’s =0.85
McSherry, 200254
Wallace, 200755 / Spirituality and Spiritual Care Rating Scale
17 items, 5 point Likert scale
To explore individual nurses beliefs and values regarding spirituality and spiritual care and then used to measure nursing home residents’ spirituality and perception of spiritual care. / 4 factors:
Spirituality (existential elements).
Spiritual Care.
Religiosity.
Personalised Care. / N=549 ward-based nurses; 54(mean age not available)
Cronbach’s =0.64
Nursing home older residents (>65 years); 55 Agerange: 65-100 years
Cronbach’s =0.73
LeBron McBride J, 199856 / The Brief Pictorial Instruments for Assessing Spirituality
3 questions
5 points response scale
To assess spirituality with charts and provide a quick assessment of spirituality in primary care settings. / 3 factors:
Feeling of closeness to God or higher power.
Spiritual practices.
Spiritual experiences. / N=442 patients (random sample in a family practice residency program), age rangimg from 41 to 50 years
Test-retest (1 week) r=0.83 to 0.97
Concurent validity: correlations with other charts measuring overall health (r=0.09 to 0.21), physical pain (r=0.13 only with spiritual experiences domain), and feelings of anxiety (r=0.10 to 0.21).
Criterion validity: Correlations with the INSPIRIT score: r =0.62 to 0.66
Rowan, 200657 / The Higher Power Relationship Scale
17 items, 5 point Likert scale
To assess the strength of a relationship with a higher power in the treatment of alcoholism and drug addiction. / One factor / N=350 outpatient and inpatient treated for chemically dependant behaviours (39% alcohol, 26% cocaine); mean age=37.8 years (range: 18 to 65).
Cronbach’s =0.96
Criterion validity: correlation with the spiritual belief subscale of the Twelve-Step Ambivalence Scale r=0.61
Goldfarb, 199658
Galanter, 200659 / Orientation toward religion and spirituality index
12 items, 5 point Likert scale
Spirituality Self rating Scale
6 items
To measure the individual’s intrinsic orientation to religion and spirituality / One factor / N= 101 inpatients with both diagnosis of substance abuse and psychiatric disorder; mean age not available)
N=119 Students (mean age=23.52.0 years)
Cronbach’s (patients)=0.86
Crohnbach’s alpha (students)=0.86
MacDonald D, 200028 / The Expressions of Spirituality Inventory
98 items, 5 point Likert scale
To measure expressions of spirituality / 5 dimensions:
Cognitive orientation toward spirituality
Experiential-phenomenological
Existential well-being
Paranormal beliefs
Religiousness / N=938 students; mean age=20.9±4.3 years
Cronbach’s =0.85 to 0.97
Criterion validity: Correlations with Religious Orientation Scale r=-0.15 to 0.79, Spirituality Self Assessment Scale r=0.21 to 0.50, Spiritual Well Being Questionnaire r=0.25 to 0.79, Death Transcendence Scale r=-0.19 to 0.61, and Spiritual Well-Being Scale r=0.25 to 0.78.
Genia V, 199760 / The Spiritual Experience Index
23 items, 6 point Likert scale
To measure mature faith that transcends idiosyncratic beliefs and that can be used for persons of diverse spiritual affiliation. / 2 factors:
Spiritual support
Spiritual openness / N=211 students, residential life personnel, religious professionals.
Cronbach’s = .89
Criterion validity: Correlation of spiritual support subscale with the Spiritual Well-Being Scale r =0.71
Ironson, 200261 / The Ironson-Woods Spirituality/Religiousness Index (short form)
22 items, 5 point Likert Scale
To measure both spirituality and religiousness. / 4 factors:
Sense of peace
Faith in God
Religious behaviour Compassionate view of others / N=279 HIV positive patients (mean age=40.0 ±7.7 years) and long term survivors of AIDS (mean age =37.7 ±8.5 years)
Cronbach’s =0.96
Test-retest reliability (average of 18 months)=0.88
Concurrent validity: Correlation with perceived stress r=-0.21; Hopelessness r =-0.45; Optimism r =-0.38; Anxiety r =-0.30; Depression r =-0.29; Social support r =0.33
Criterion validity: Correlation with Hoge Intrinsic religious Motivation Scale r=0.66, Duke religion Index r=0.60, COPE r=0.70
King, 200662 / The Beliefs and Values Scale
20 items, 5 point Likert Scale
To measure spirituality that goes beyond conventional religious belief for use in psychological and health research. / 2 factors / N= 372 patients with advanced cancer receiving palliative care and people without cancer from community; age≥18 years
Crohnbach’s =0.94
Test-retest reliability (2 weeks) = 0.56 to 0.93
Criterion validity: Correlation with Hoge Intrinsic religious Motivation Scale r=0.70
Christo, 199535 / The Spiritual Beliefs Questionnaire
7 items, 5 point Likert scale
To measure spiritual beliefs in drug users patients, beyond religious behaviours. / One dimension / N=101 polydrugs users presenting for abstinence based treatment; mean age=30.55.9 years
Crohnbach’s =0.82
Seidlitz, 200263 / The Spiritual Transcendence Index
8 items, 6 point Likert scale
To measure cognitive, affective, motivational, and transcendent concomitants of spirituality. / 2 subscales:
God subscale
Spiritual subscale / N=348 (116 persons from community, 90 persons from clergy or religious leaders attending a regional Presbyterian church, 142 students from Theological seminary); mean age=56.517.8 years
Cronbach’s = 0.97
Concurrent validity: correlation with Medical Outcomes Study, SF-36 (Pearson correlation=0.31)
Criterion validity: Correlation with Duke Religion Index (Pearson correlation = 0.93 in community sample and 0.70 in seminary sample).
Hodge, 200364 / The Intrinsic Spirituality Scale
6 items, scale ranging from 0 to 10
To assess the degree to which spirituality functions as an individual’s master motive, for both theistic and non-theistic populations, both within and outside of religious frameworks. / 1 factor / University students from a Baptist affiliated University (N=172)
Mean age=19.26(SD=1.35)
Crohnbach’s =.96
Concurrent validity: Correlation with alcohol use r =-0.49; frequency of binge drinking r=-.46; tobacco use r=-.37; secure attachment r=.22
Criterion validity: Correlation with Allport and Ross measure of intrinsic religion r=-0.91
Spiritual well-being
Brady, 200265 / The Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale
(FACIT-Sp)
12 items, 5 point Likert scale
To measure spirituality as another reality for patients than religion or religiosity.
To provide an inclusive measure of spirituality that could be used in research with people with chronic and/or life-threatening illness. / 2 factors
Meaning/ Peace
Faith (aspects of the relation between illness and one’s faith and spiritual beliefs) / N=1’617 (83% with cancer, 17% with HIV/AIDS) 65; mean age=54,6 years (range 18-90 years)
Cronbach’s = 0.87
Concurrent validity: Correlation with quality of life measure (Functional Assessment of Cancer Therapy – General, spearman rho=0.58); Correlation with subjective mood states (Profile of Mood State, spearman rho = -0.54)
N=131 (patients beginning chemotherapy for any solid tumor or hematological malignancy);7 mean age=56 years (range 20 – 82 years)
Cronbach’s =0 .86
Criterion validity: Correlations with Organizational religious activity, Non-organizational religious activity, Spiritual beliefs and religious support, Coherence, and Intrinsic religiosity, spearman rho = 0.25 to 0.46
Ellison, 198322 / The Spiritual Well-Being Scale (SWBS)
20 items, 7 point Likert scale
To measure an underlying state of spiritual health or quality of life for research purpose. / 2 subscales:
Religious well-being (relation to God)
Existential well-being (sense of life purpose and life satisfaction without any specific religious references) / N=100 students; mean age (not available)
Cronbach’s =0.89
Test-retest (2 days interval): r=0.93
Concurrent validity:correlation with UCLA Loneliness Scale, spearman rho = -0.29; Purpose in Life Test, spearman rho =0.52
Criterion validity: correlation with the Intrinsic Religious Orientation (spearman rho =0.67); Extrinsic Religious Orientation (spearman rho =0.26).
WHOQOL SRPB Group, 2006 66 / WHOQOL SRPB (spirituality, religion and personal beliefs)
32 items, 5 point Likert scale
To propose additional measure of spirituality, religion or personal belief to the WHOQOL-100 (measure of quality of life). Designed to be applicable in people from many different cultures and holding a variety of spiritual, religious or personal beliefs. / 8 factors:
Connectedness to a spiritual being or force
Meaning of life
Awe
Wholeness and integration
Spiritual strength
Inner peace / serenity / harmony
Hope and optimism
Faith / N=5087 community participants in 18 countries; mean age=41.3±15.3 years
Cronbach’s =0.91
Concurrent validity: Correlation with quality of life measure (WHOQOL general) =0.42
Hungelmann, 199867 / JAREL spiritual well-being scale
21 items, 6 point likert scale
To assess spiritual well-being in older adults / 3 factors:
Faith / belief dimension
Life / self responsibility
Life satisfaction /self actualization / N=294; 65 years or older, healthy to terminally ill , from nursing home, acute care facilities, home/apartments, senior centers; mean age=73 ±1 years
Cronbach’s =0.85
Test-retest Pearson correlation =0.88
Daaleman, 200268
Daaleman, 200469 / The Spirituality Index of Well- Being (SIWB)
12 items, 5 points Likert scale
To measure the effect of spirituality on subjective well-being. / 2 factors:
Life scheme (positive pervasive way of viewing the world and one’s life in it)
Self efficacy (individual’s belief in the capacity to organize and perform activities required for a prescribed goal) / N=277 community dwelling elderly individuals;68 mean age=74 years (range 65-90)
Cronbach’s =0.87
Concurrent validity: Correlation with EuroQol r =0.18; Correlation with SF-36 r = -0.28; Poor Health Status (YOHL) r=-0.35; Geriatric Depression Scaler=-0.35; Fear of death (DAP-R subscale) r=-0.39
Criterion-validity: Correlation with religiosityr=0.12
N=509 adults outpatients from family practice;69 mean age=46.8±17.1 years
Cronbach’s =0.91
Test-retest (2 weeks interval): r=0.79
Concurrent validity: Correlation with General Well Being Scaler=0.64; Zung Depression Scale r = -0.42
Criterion validity: Correlation with The Spiritual Well-Being Scale r =0.62
Spiritual Coping Measures
Holland, 199870 / The System of Beliefs Inventory (SBI-15)
15 items, 4 points Likert scale
To measure both the religious and spiritual aspects of coping with a life-threatening illness, and to be used in research on quality of life. / 2 factors:
Beliefs and practice
Social support from religious or spiritual community / N= 301, healthy individuals, individuals within religious communities, psychiatric facility professionals; mean age=40 years (range: 18-82 years)
Crohnbach’s =0.93
Test-retest reliability (2 weeks), stability coefficient=0.95
Concurrent validity: No correlation with quality of life measure (Medical Outcomes Study-short form) and psychological distres (Brief Symptom Inventory).
Criterion validity: Correlation with Religious Orientation Inventory (r =0.23 and r =0 .88).Correlation with Index of Core Spiritual Experience Scale (INSPIRIT) r =0.85
Mohr, 200771 / A Semi-Structured Clinical Interview For Assessment of Spirituality and Religious Coping for Use in Psychiatric Research
Interview based
20 items, Visual analogue scale
To assess religious coping in schizophrenia patients, with an instrument adapted to a variety of spiritual beliefs and various types of religious coping. / 4 factors:
Subjective dimension
Collective dimension
Synergy with psychiatric treatment
Ease of talking about religion with psychiatrist / N=115 psychiatric outpatients; mean age= 39±10 years
Interrater reliability (Kendall’s rank correlations from .64 to .78)
Nelson-Becker, 200536 / The Spiritual Strategies Scale
18 items, 5 point Likert scale
To measure how older adults pragmatically apply spirituality to solve problems and to understand how spirituality facilitates coping with the transitions of aging. / 4 factors: