Domains of spiritual well-being and development and validation of the Spiritual Well-Being Questionnaire
Introduction
The concept of “spiritual health” is doubly problematic in view of the way in which the two terms “spiritual” and “health” have themselves undergone considerable development and revisions in recent years. Classical definitions of spirituality have tended to concentrate on the religious, ecclesiastical, or matters concerned with the soul, while current studies in spirituality adopt much wider definitions, integrating all aspects of human life and experiences (Muldoon & King, 1995, Schneiders, 1986). There has been a similar widening in understanding of what counts as health and wellness, in that, current emphasis in medicine tends to give greater concern for the whole person, rather than just the treatment of disease. According to Coward and Reed (1996), wellness reflects a sense of well-being that is derived from an intensified awareness of wholeness and integration among all dimensions of one's being, which also includes the spiritual elements of life.
In recent years, several attempts have been made to link the two concepts of spirituality and health within the idea of spiritual well-being. For example, Hateley (1983) wrote about spiritual health in terms of relationship to self, empathy in the community, and relationship with God. Young (1984) mentioned the interrelatedness of body, mind, and spirit within the context of inner peace, and in terms of relationships with others and with nature. Goodloe and Arreola (1992) spoke of meaning and purpose with self-transcendence, social and spiritual actions with others, oneness with nature, and personal relationship with God. For Hood-Morris (1996), spiritual health included transcendent and existential features pertaining to an individual's relationships with the self, others and a higher being, coupled with interactions with one's environment. The National Interfaith Coalition on Aging (1975) suggested that spiritual well-being is the affirmation of life in a relationship with oneself (personal), others (communal), nature (environment), and God (or transcendental other). Integrating these concepts together, spiritual well-being can be defined in terms of a state of being reflecting positive feelings, behaviours, and cognitions of relationships with oneself, others, the transcendent and nature, that in turn provide the individual with a sense of identity, wholeness, satisfaction, joy, contentment, beauty, love, respect, positive attitudes, inner peace and harmony, and purpose and direction in life.
Using the domains proposed by the NICA (1975) as a framework, Fisher (1998) interviewed 98 secondary school teachers in terms of what they thought were important indicators of spiritual well-being in their students. The interview used questions reflected in a number of measures for spiritual well being. These included the Spiritual Well-Being Scale (Ellison, 1983), the Spiritual Orientation Inventory (Elkins, Hedstrom, Hughes, Leaf, & Saunders, 1988), the Mental, Physical and Spiritual Well-Being Scale (Vella-Brodrick & Allen, 1995), the Spiritual Assessment Inventory (Hall & Edwards, 1996), the Perceived Wellness Survey (Adams, Bezner, & Steinhardt, 1997), and the JAREL Spiritual Well-Being Scale (Hungelmann, Kenkel-Rossi, Klassen, & Stollenwerk, 1996). Consistent with the NICA (1975) model, quantitative analyses of their responses led Fisher (1998) to also conclude that spiritual well-being reflects the extent to which people live in harmony within relationships with oneself (personal), others (communal), nature (environment), and God (or transcendental other).
According to Fisher (1998), the personal domain deals with how one intra-relates with oneself with regard to meaning, purpose and values in life. The communal domain expresses in the quality and depth of inter-personal relationships, between self and others, and includes love, justice, hope, and faith in humanity. The environmental domain deals with care and nurture for the physical and biological world, including a sense of awe, wonder and unity with the environment. The transcendental domain deals with the relationship of self with some-thing or some-one beyond the human level, such as a cosmic force, transcendent reality, or God, and involves faith towards, adoration and worship of, the source of mystery of the universe. Fisher also suggested that these four spiritual well-being domains cohere to determine a person’s overall or global spiritual well-being. It is to be noted that in Fisher’s model, the term “well-being” is associated with the different domains to cohere with existing literature, and to be consistent with the NICA (1975) model. Thus its use in Fisher’s model does not necessarily imply positive or better well-being (Fisher, 1998).
In a subsequent study, Fisher, Francis, and Johnson (2000) used a questionnaire to examine primary school teachers’ views about important indicators of spiritual well-being. The questionnaire comprised a checklist of items covering spiritual health in terms of personal, communal, environment, and transcendental domains. The items included were those that were identified as important for spiritual well-being in Fisher’s (1998) earlier study. Factor analysis of the responses of this questionnaire supported Fisher’s four dimensional model of spiritual well-being. Also, the items comprising the questionnaires were highly correlated with each other, raising the possibility that the four spiritual well-being domains may cohere to form a higher order global spiritual well-being dimension, as proposed by Fisher (1998).
In another study, Fisher (2001) used a questionnaire comprising items for each of the four spiritual well-being domains to explore teachers’ views of current practice and priority for nurturing secondary school students’ spiritual well-being. Factor analyses of responses for both current practice and priority supported Fisher’s four dimensional model of spiritual well-being. Consistent with Fisher’s (1998) view of a second order global spiritual well-being dimension, the items comprising the questionnaires were highly correlated with each other.
As noted earlier, currently there are a number of self-rating questionnaires that provide measures for spiritual well-being. However, no questionnaire exists that includes a balance in all the four domains identified by Fisher (1998). For example, the widely used Spiritual Well-Being Scale (Ellison, 1983, Ellison & Smith, 1991, Ledbetter et al., 1991, Tjeltveit et al., 1996) has dimensions for existential well-being (fusion of Fisher’s personal, communal, and transcendental domains) and religious well-being (comparable to Fisher’s transcendental domain). The items of the Spiritual Orientation Inventory (Elkins et al., 1988) clusters around two dimensions, namely the experiential dimension and the value dimension (Tloczynski, Knoll, & Fitch, 1997). These questions essentially relate to personal and communal aspects of spiritual health, with fleeting references to the environment and a deliberate exclusion of religion and any mention of a transcendent other. The spiritual part of the Mental, Physical and Spiritual Well-Being Scale (Vella-Brodrick & Allen, 1995) has dimensions for existential and religious well-being. The Spiritual Assessment Inventory (Hall & Edwards, 1996) is entirely focused on relationship with God. The subscale for spiritual wellness in the Perceived Wellness Survey (Adams et al., 1997) is limited to the personal domain as proposed by Fisher. The JAREL Spiritual Well-Being Scale consists of questions focusing on self, on others, and on the transcendent, but not on the environment (Hungelmann et al., 1996). Spiritual well-being has been featured in a number of quality of life questionnaires, such as the McGill Quality of Life Questionnaire (Cohen, Mount, Bruera, Provost, Rowe, & Tong, 1997). According to Cohen et al. (1997), most quality of life instruments exclude the existential domain.
Overall, therefore, existing questionnaires do not provide an adequate operationalization of the definition of spiritual well-being as embraced by the four domains identified by Fisher (1998). Against this background, the aim of the studies reported here were to develop and validate a self-rating measure of spiritual well-being in terms of Fisher’s (1998) model. The development of such a self-rating questionnaire for spiritual well-being would be useful as existing data show that some aspects of spiritual well-being (in particular the transcendental) may be associated negatively with happiness (Fehring, Brennan, & Keller, 1987), and other aspects of spiritual well-being (such as personal) are positively associated with psychological well-being (Barcus, 1999). Thus a broad based spiritual well-being questionnaire will enable data to be obtained for a more heuristic model of spiritual well-being, and thereby facilitate advancement in research in this area. Using Fisher’s (1998) model, four separate studies were conducted over a period of 3 years to develop a questionnaire (Study 1), examine its factorial structure using exploratory factor analysis (Study 2) and confirmatory factor analysis (Studies 3 and 4), and also its reliability and validity (Studies 2, 3 and 4).
Section snippets
Overview
Study 1 reports on the development of a self-rating questionnaire for measuring personal well-being, communal well-being, environmental well-being, and transcendental well-being, as conceptualised in Fisher’s spiritual well-being model. More specifically, beginning with an initial questionnaire containing 12 items for each of the spiritual well-being domains and using exploratory factor analysis, a shorter 20-item questionnaire, comprising five items for each spiritual well-being domain is
Results and discussion
An exploratory factor analysis using principal component analysis with oblimin rotation was conducted with all items of the PSWBQ. This resulted in a four-factor solution, with eigenvalues more than 1. Together, these four factors accounted for 51.33% of the variance. Based on a factor loading of 0.35, Factor 1 included 10 personal well-being items and 4 communal well-being items. Factor 2 comprised 11 of the transcendental items and 1 communal item, while Factor 3 comprised all 12
Overview
Study 2 examined the factor structure of the 20 items SWBQ (see also Table 1), using exploratory factor analysis. As noted earlier, Fisher (2001) has proposed that the four spiritual well-being domains are all subsumed by a second-order global spiritual well-being dimension. Study 2 also examined this hypothesis. In addition, it reports some data on the internal consistency, and convergent and discriminant validity of the SWBQ.
Participants
The total sample comprised 537 students from four different types of
Overview
Study 3 examined the factor structure of the SWBQ using confirmatory factor analysis (CFA). Based on the results of Studies 1 and 2, it first examined support for a four-factor oblique model in which the relevant items for personal, communal, environmental, and transcendental spiritual well-being loaded on four separate first order factors, with the factors freely correlated. It then examined a second order CFA model, in which all the four first order factors loaded on a single higher order
Overview
Study 4 also used CFA to examine the SWBQ models tested as part of Study 3. The reliability of the SWBQ was established by examining the composite reliability, variance extracted and internal consistency of the four spiritual well-being factors and the overall spiritual well-being factor. The validity was established by examining (1) the factorial independence of the spiritual well-being dimensions from the personality dimensions, (2) the relationships of the spiritual well-being dimensions
General discussion
Consistent with Fisher’s model, the results of the exploratory factor analyses (Studies 1–3) and the confirmatory factor analyses (Studies 3 and 4) reported here indicated that spiritual well-being can be conceptualized in terms of the four domains of personal well-being, communal well-being, environmental well-being, and transcendental well-being. Also, in line with Fisher’s model, there were significant and moderate to high correlations between these domains (Studies 2–4). Both exploratory
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