OBJECTIVE: To evaluate the reliability and validity of the Spirituality Index of Well-Being (SIWB) Scale in a patient population.
STUDY DESIGN: Cross-sectional survey.
POPULATION: Community-dwelling elderly individuals (n = 277) recruited from primary care clinic sites in the Kansas City metropolitan area.
OUTCOMES MEASURED: Internal consistency, concurrent construct validity, discriminant validity, and factor analysis with Varimax rotation.
RESULTS: The initial version of the SIWB contained 40 items: 20 from a self-efficacy domain and 20 from a life scheme domain. Factor analysis yielded 6 items loaded most strongly on factor 1 (intrapersonal self-efficacy) and 6 other items loaded strongly on factor 2 (life scheme). The self-efficacy subscale had an of .83 and the life scheme subscale had an of .80; the total 12-item SIWB scale had an of .87. The SIWB had significant and expected correlations with other quality of life measures related to subjective well-being: EuroQol (r = .18), Geriatric Depression Scale (r = -.35), the Physical Functioning Index from the Short Form 36 (r = .28), and the Years of Healthy Life Scale (r = -.35). Religiosity did not correlate significantly with the SIWB (r = .12; P = .056).
CONCLUSIONS: The 12-item SIWB scale is a valid and reliable measure of subjective well-being in an older patient population.
Spirituality and religion are embedded within contemporary American culture1 and have become an increasingly important part of the patient experience of health and illness.2 There is growing interest in examining the association of spirituality, religion, and health-related outcomes in the United States, particularly in the areas of health behavior and promotion3 and psychoneuroimmunology.4 Despite this interest, the absence of operational definitions of spirituality and religion, the contamination of spirituality items with measures of religion, and the lack of valid and reliable instruments that gauge these constructs continue to be major limitations to work in this area.5
Conceptually, religion or religiosity is often viewed in terms of the various organized, individual, and attitudinal manifestations of different faith traditions, and spirituality connotes and expresses a sense of meaning, purpose, or power from within or from a transcendent source.6 There is no shortage of instruments that measure dimensions of either construct, and researchers from the fields of sociology,7 psychology,6 and pastoral theology and chaplaincy8 have developed a variety of scales of religion and spirituality.9 It remains unclear, however, whether these constructs can be extended to health care settings or whether these instruments are applicable and useful as measures of individual or population health. For example, frequency of religious service attendance is often a single-item measure used as an independent variable in studies of health outcomes, such as health status.10 Although service attendance is associated with self-reported health in community-dwelling elderly individuals, the effect of this activity on perceived health disappears when functional status is controlled.10 Therefore, can religious service attendance be considered an independent variable, or is it simply a proxy of functional status within a geriatric population?11
This example highlights the importance of context in the use of any measure of religion or spirituality. It also points to the health-related quality of life field as a useful orientation for conceptualizing spirituality and religion in health care settings. Health-related quality of life, an individual’s or group’s perception of health over time, is predicated on the assumption that a patient’s experiences, beliefs, expectations, and perceptions directly influence the physical, psychological, and social domains of health.12 Spirituality and religion have been proposed as mediators of 1 characteristic of psychological health, subjective well-being, in 4 ways: by ensuring social support and integration within a community, by establishing personal relationships with a divine other, by promoting a salubrious personal lifestyle that is congruent with a personal faith tradition, and by providing systems of meaning and existential coherence.13
To identify and describe elements of spirituality that are linked to subjective well-being, our prior qualitative work explored the patient perspective. We found that patients consider spirituality in predominantly cognitive terms and incorporate the domains of life scheme and positive intentionality, or self-efficacy, as primary components Figure 1.14 In addition to suggesting a dynamic conceptual framework, this research supported the assumption that patients associate spirituality with well-being largely through the provision of systems of meaning and coherence.
The current study builds on this work and describes the development and evaluation of a brief research instrument, the Spirituality Index of Well-Being (SIWB), which is designed to measure the effect of spirituality on subjective well-being. Several assumptions guided our study design and analysis. First, we recognized that there are no global yet parsimonious instruments that capture the complexity and depth of spirituality in any context, health care or otherwise. Second, based on our qualitative work, we viewed spirituality as subsumed within the psychological rather than within the social or physical domain. Third, we considered the SIWB as a health-related quality of life measure, one to be used in studies of individual or population health, rather than as an assessment tool.