ABSTRACT
INTRODUCTION
Numerous instruments have been developed to assess spirituality and measure its association with health outcomes. This study’s aims were to identify instruments used in clinical research that measure spirituality; to propose a classification of these instruments; and to identify those instruments that could provide information on the need for spiritual intervention.
METHODS
A systematic literature search in MEDLINE, CINHAL, PsycINFO, ATLA, and EMBASE databases, using the terms “spirituality" and “adult$," and limited to journal articles was performed to identify clinical studies that used a spiritual assessment instrument. For each instrument identified, measured constructs, intended goals, and data on psychometric properties were retrieved. A conceptual and a functional classification of instruments were developed.
RESULTS
Thirty-five instruments were retrieved and classified into measures of general spirituality (N = 22), spiritual well-being (N = 5), spiritual coping (N = 4), and spiritual needs (N = 4) according to the conceptual classification. Instruments most frequently used in clinical research were the FACIT-Sp and the Spiritual Well-Being Scale. Data on psychometric properties were mostly limited to content validity and inter-item reliability. According to the functional classification, 16 instruments were identified that included at least one item measuring a current spiritual state, but only three of those appeared suitable to address the need for spiritual intervention.
CONCLUSIONS
Instruments identified in this systematic review assess multiple dimensions of spirituality, and the proposed classifications should help clinical researchers interested in investigating the complex relationship between spirituality and health. Findings underscore the scarcity of instruments specifically designed to measure a patient’s current spiritual state. Moreover, the relatively limited data available on psychometric properties of these instruments highlight the need for additional research to determine whether they are suitable in identifying the need for spiritual interventions.
Similar content being viewed by others
References
Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. New York, NY: Oxford University Press; 2001.
Koenig HG, Larson DB. Religion and mental health: Evidence for an association. Int Rev Psychiatry 2001;13:67–78.
Shuman J, Meador K. Heal Thyself. Spirituality, Medicine, and the Distortion of Christianity. New York,NY: Oxford University Press; 2003.
Chandler CK, Holden JM, Kolander CA. Counseling for spiritual wellness: Theory and practice. Journal of Counseling & Development 1992;71:168–175.
Moberg DO. Assessing and measuring spirituality: Confronting dilemmas of universal and particular evaluative criteria. Journal of Adult Development 2002;9:47–60.
Miller WR, Thoresen CE. Spirituality, religion, and health: An emerging research field. Am Psychol 2003;58:24–35.
Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology 1999;8:417–428.
McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 2003;361:1603–1607.
Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study. Arch Intern Med 2001;161(15):1881–1885.
Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000;284(22):2907–2911.
Bell IR, Caspi O, Schwartz GE, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002;162:133–140.
Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 2002;42 3:24–33.
Puchalski C, Ferrell B, Virani R et al. Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. J Palliat Med 2009;12:885–904.
Sinclair S, Pereira J, Raffin S. A thematic review of the spirituality literature within palliative care. J Palliat Med 2006;9:464–479.
Mularski RA, Dy SM, Shugarman LR et al. A systematic review of measures of end-of-life care and its outcomes. Health Serv Res 2007;42:1848–1870.
Vivat B. Measures of spiritual issues for palliative care patients: a literature review. Palliat Med 2008;22:859–868.
Stefanek M, McDonald PG, Hess SA. Religion, spirituality and cancer: current status and methodological challenges. Psychooncology 2005;14:450–463.
Shorkey C, Uebel M, Windsor L. Measuring dimensions of spirituality in chemical dependence treatment and recovery: research and practice. Int J Ment Health Addiction 2008;6:286–305.
Zinnbauer BJ, Pargament KI, Cole B, et al. Religion and spirituality: Unfuzzying the fuzzy. Journal for the Scientific Study of Religion 1997;36:549–564.
Allport GW, Ross JM. Personal religious orientation and prejudice. Journal of Personality & Social Psychology 1967;5:432–443.
Koenig H, Parkerson GR, Jr., Meador KG. Religion index for psychiatric research. Am J Psychiatry 1997;154:885–886.
Ellison CW. Spiritual well-being: Conceptualization and measurement. J Psychol Theol 1983;11(4):330–340.
Moberg DO. Spiritual well-being: background and issues. Review of Religious Research 1984;25.
Stewart AL. Psychometric Considerations in Functional Status Instruments. In: Wonca Classification Committee, ed. Functional Status Measurement in Primary Care. New York: Springer-Verlag;1990; 3–26
Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 2006;119:166–16.
Larson D, Swyers.J.P., McCullough ME. Scientific resaerch on spirituality and health: A consensus report. Larson D, Swyers.J.P., McCullough ME, editors. Bethesda MD, National Institute for Healthcare Research; 1998.
Thibault JM. A conceptual framework for assessing the spiritual functioning and fulfillment of older adults in long-term care settings. J Relig Gerontol 1991;7(4):29–45.
MacDonald D. Spirituality: Description, Measurement, and Relation to the Five Factor Model of Personality. J Pers 2000;68:153–197.
Idler EL, Kasl SV. Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability. J Gerontol Soc Sci 1997;52(6):S306-S316.
Emanuel EJ, Fairclough DL, Emanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA 2000;284:2460–2468.
Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378–382.
Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs 1992;17(10):1251–1259.
Warner SC, Williams JI. The Meaning in Life Scale: determining the reliability and validity of a measure. J Chron Dis 1987;40:503–512.
Roberts KT, Aspy CB. Development of the Serenity Scale. J Nurs Meas 1993;1:145–164.
Christo G, Franey C. Drug users' spiritual beliefs, locus of control and the disease concept in relation to Narcotics Anonymous attendance and six-month outcomes. Drug Alcohol Depend 1995;3:51–56.
Nelson-Becker H. Development of a spiritual support scale for use with older adults. Journal of Human Behavior in the Social Environment 2005;11:195–212.
Reed PG. Religiousness among terminally ill and healthy adults. Res Nurs Health 1986;9:35–41.
Underwood LG, Teresi JA. The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Ann Behav Med 2002;24:22–33.
Howden JW. Development and psychometric characteristics of the Spirituality Assessment Scale. Unpublished doctoral dissertation. Texas Women’s University;1992
Fetzer Institute National Institute on Aging. Multidimensional measurement of religiousness/spirituality of use in health research: a report of the Fetzer Institute on aging working group. Kalamazoo, MI: John E.Fetzer Institute ed.; 1999.
Idler EL, Musick MA, Ellison CG, et al. Measuring Multiple Dimensions of Religion and Spirituality for Health Research. Research on Aging 2003;25(4): 327–365.
Stewart C, Koeske GF. A Preliminary Construct Validation of the Multidimensional Measurement of Religiousness/Spirituality Instrument: A Study of Southern USA Samples. International Journal for the Psychology of Religion 2006;16(3):181–196.
Hatch RL, Burg MA, Naberhaus DS, Hellmich LK. The Spiritual Involvement and Beliefs Scale. Development and testing of a new instrument. J Fam Pract 1998;46:476–486.
Kass JD, Friedman R, Leserman J, Zuttermeister PC. Health outcomes and a new index of spiritual experience. Journal for the Scientific Study of Religion 1991;30:203–211.
Piedmont RL. Does spirituality represent the sixth factor of personality? Spiritual transcendence and the Five-Factor Model. J Pers 1999;67:985–1013.
Veach TL, Chappel JN. Measuring spiritual health: a preliminary study. Substance Abuse 1992;13(3):139–147.
Korinek AW, Arredondo RJ. The Spiritual Health Inventory (SHI): Assessment of an Instrument for Measuring Spiritual Health in a Substance Abusing Population. Alcoholism Treatment Quarterly 2004; 22(2):55–66.
King M, Speck P, Thomas A. The Royal Free interview for religious and spiritual beliefs: development and standardization. Psychol Med 1995;25:1125–1134.
King M, Speck P,Thomas A. The Royal Free Interview for spiritual and religious beliefs: Development and validation of a self-report version. Psychol Med 2001;31(6):1015–1023.
Delaney C. The Spirituality Scale: Developement and Psychometric Testing of a Holistic Instrument to Assess the Human Spiritual Dimension. Journal of Holistic Nursing 2005;23:145–167.
Ostermann T, Bussing A, Matthiessen PF. Pilotstudie zur Entwicklung eines Fragebogens zur Erfassung der spirituellen und religiosen Einstellung und des Umgangs mit Krankheit (SpREUK). Forsch Komplementarmed Klass Naturheilkd 2004;11:346–353.
Bussing A, Ostermann T, Matthiessen PF. Role of religion and spirituality in medical patients: confirmatory results with the SpREUK questionnaire. Health and Quality of Life Outcomes 2005;3:10.
Bussing A, Matthiessen PF, Ostermann T. Engagement of patients in religious and spiritual practices: Confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life research. Health and Quality of Life Outcomes 2005;3:53.
McSherry W, Draper P, Kendrick D. The construct validity of a rating scale designed to assess spirituality and spiritual care. Int J Nurs Stud 2002;39:723–734.
Wallace M, O'Shea E. Perceptions of spirituality and spiritual care among older nursing home residents at the end of life. Holistic Nursing Practice 2007; 21(6): 285–289.
LeBron McBride J, Lloyd Pilkington, Gary Arthur. Development of a Brief Pictorial Instruments for Assessing Spirituality in Primary Care. J Ambulatory Care Manage 1998;21:53–61.
Rowan NL, Faul AC, Cloud RN, Huber R. The Higher Power Relationship Scale: a validation. Journal of Social Work Practice in the Addictions 2006;6:81–95.
Goldfarb LM, Galanter M, McDowell D, Lifshutz H, Dermatis H. Medical student and patient attitudes toward religion and spirituality in the recovery process. Am J Drug Alcohol Abuse 1996;22:549–561.
Galanter M, Dermatis H, Bunt G, Williams C, Trujillo M, Steinke P. Assessment of spirituality and its relevance to addiction treatment. Journal of Substance Abuse Treatment 2007; 33:264.
Genia V. The Spiritual Experience Index: Revision and reformulation. Review of Religious Research 1997;38:344–361.
Ironson G, Solomon GF, Balbin EG, et al. The Ironson-woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Ann Behav Med 2002;24:34–48.
King M, Jones L, Barnes K, et al. Measuring spiritual belief: Development and standardization of a Beliefs and Values Scale. Psychol Med 2006;36:417–425.
Seidlitz L, Abernethy AD, Duberstein PR, Evinger JS, Chang TH, Lewis BL. Development of the Spiritual Transcendence Index. Journal for the Scientific Study of Religion 2002;41:439–453.
Hodge D. A new six-item instrument for assessing the salience of spirituality as a motivational construct. J of Social Service Research 2003;30(1):41–61.
Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Ann Behav Med 2002;24:49–58.
WHOQOL SRPB Group. A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Soc Sci Med 2006; 62:1486–1497.
Hungelmann J, Kenkel-Rossi E, Klassen L, Stollenwerk R. Development of the JAREL spiritual well-being scale. In: Carrol-Johnson RM, editor. Classification of Nursing Diagnosis:proceedings of the eight conference, North American Diagnosis Association. Philadeplphia: JB Lippincott, 1989:393–398
Daaleman TP, Frey BB, Wallace D, Studenski S. The Spirituality Index of Well-Being: Development and testing of a new measure. J Fam Pract 2002; 51(11): 952.
Daaleman TP, Frey BB. The Spirituality Index of Well-Being: A New Instrument for Health-Related Quality-of-Life Research. Annals of Family Medicine 2004;2:499–503.
Holland JC, Kash KM, Passik S, et al. A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness. Psychooncology 1998;7:460–469.
Mohr S, Gillieron C, Borras L, Brandt PY, Huguelet P. The assessment of spirituality and religiousness in schizophrenia. J Nerv Ment Dis 2007;195:247–253.
Ai AL, Tice TN, Peterson C, Huang B. Prayers, Spiritual Support, and Positive Attitudes in Coping With the September 11 National Crisis. J Pers 2005;73:763–791.
Hermann C. Development and testing of the spiritual needs inventory for patients near the end of life. Oncol Nurs Forum 2006;33:737–744.
Taylor EJ. Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncol Nurs Forum 2006;33:729–735.
Yong J, Kim J, Han SS, Puchalski CM. Development and validation of a scale assessing spiritual needs for Korean patients with cancer. J Palliat Care 2008;24:240–246.
Büssing A, Balzat HJ, Heusser P. Spiritual needs of patients with chronic pain diseases and cancer—validation of the spiritual needs questionnaire. Eur J Med Res 2010;15:266–273.
Miller DK, Chibnall JT, Videen SD, Duckro PN. Supportive-Affective Group Experience for persons with life-threatening illness: reducing spiritual, psychological, and death-related distress in dying patients. J Palliat Med 2005;8:333–343.
Bormann JE, Smith TL, Becker S, et al. Efficacy of frequent mantram repetition on stress, quality of life, and spiritual well-being in veterans: a pilot study. Journal of Holistic Nursing 2005;23:395–414.
Rummans TA, Clark MM, Sloan JA et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol 2006;24:635–642.
Kristeller JL, Rhodes M, Cripe LD, Sheets V. Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 2005;35:329–347.
Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE. Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol 2006;24:1620–1626.
Brennan M, Heiser D. Introduction: Spiritual assessment and intervention: Current directions and applications. Journal of Religion, Spirituality and Aging 2004;17:1–20.
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Electronic Supplementary Materials
Below is the link to the electronic supplementary material.
Online Appendix 1
(DOC 32 kb)
Online Appendix 2
(DOC 118 kb)
Online Appendix 3
(DOC 50 kb)
Rights and permissions
About this article
Cite this article
Monod, S., Brennan, M., Rochat, E. et al. Instruments Measuring Spirituality in Clinical Research: A Systematic Review. J GEN INTERN MED 26, 1345–1357 (2011). https://doi.org/10.1007/s11606-011-1769-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-011-1769-7