The Spirituality Index of Well-Being: Development and testing of a new measure

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Original Research

The Spirituality Index of Well-Being: Development and testing of a new measure

J Fam Pract. 2002 November;51(11):1-1

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References

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Address reprint requests to Timothy P. Daaleman, DO, Department of Family Medicine, University of North Carolina at Chapel Hill, CB 7595, Manning Drive, Chapel Hill, NC 27599-7595. E-mail: tim_daaleman@med.unc.edu.

To submit a letter to the editor on this topic, click here: jfp@fammed.uc.edu.

Internal reliabilities for the subscales (6 items each) and the SIWB scale (12 items total) were calculated. A maximum likelihood factor analysis with Varimax rotation also was conducted to verify that a 2-factor solution remained for the reduced 12-item scale.

Validity testing. Well-being is conceptually subsumed within the psychological domain of quality of life measures and is comprised of the dimensions of positive affect (affective) and subjective perceptions of general health and life satisfaction (cognitive).¹² As a result, we determined concurrent construct validity by correlating the 2 6-item subscale scores and the total SIWB score with summed scores from the fear of death items from the DAP-R, the GDS, YOHL, the Physical Functioning Index from the SF-36, and the EuroQol. We anticipated positive correlations of the SIWB with physical functioning (SF-36) and quality of life (EuroQol) and inverse correlations with fear of death (DAP-R), depression (GDS), and self-reported poor health status (YOHL). Discriminant validity was examined by correlating the SIWB subscale and total scores with the religiosity measure. All analyses were performed with the Statistical Package for the Social Sciences version 9.0 (SPSS, Chicago, IL, 1996).

Results

Study population

Two hundred seventy-seven patients were in the final cohort and participated in the study Table 1. The mean age of the study population was 74 years, with a range of 65 to 90 years. Most participants (66%) were 75 years or younger, and the population was evenly distributed between males and females. Participants were predominantly white (78%), reported a wide range of education levels, and had a mean physical function score (SF-36) of 62.92 and a mean health status score (EuroQol) of 0.77.

Internal consistency and factor analysis

Twelve items, 6 each from the self-efficacy and life scheme subscales, remained from the original 40 items after item reduction; initial reliability testing and factor analysis were performed. This 12-item measure of the SIWB produced a coefficient α of .87, indicating good internal consistency. The 6-item subscales also demonstrated good reliability: .83 for self-efficacy and .80 for life scheme.

Results of factor analysis with individual items and item loadings for the final SIWB scale are presented in Table 2. A confirmatory approach anticipated 2 factors, which was based on our conceptual framework. Factor analysis found that 2 factors, reasonably named self-efficacy and life scheme, accounted for a substantial proportion of the variance in responses. The eigenvalue for the self-efficacy factor was 2.88, accounting for 24.04% of the total variance. The eigenvalue for the life scheme factor was 2.35, accounting for 19.57% of the total variance. A Pearson chi-square goodness of fit test of the difference between the actual and reproduced correlation patterns was not significant (51.72; df = 43; P = .17), which suggested that a 2-factor solution was reasonable. Table 3 contains the descriptive statistics for the SIWB scale and its subscales.

Validity testing

To provide a more consistent and intuitive interpretation of scores and correlations, SIWB total and subscale scores were produced by reverse scoring and summing items. As a result, higher SIWB scores indicated a greater degree of spirituality or its components. Correlations between the summed SIWB and subscale scores and other health-related measures of well-being are presented in Table 4. The SIWB and its subscales had significant and expected correlations in direction and magnitude with other measures related to subjective well-being. Fear of death and depression (GDS) had the highest inverse correlations with the SIWB and its subscales. Subjective perceptions of general health and life satisfaction, as measured by self-reports of poor health status (YOHL), functional quality of life (EuroQol), and physical functioning (SF-36) had significant correlations with the SIWB.

Although the life scheme subscale did have a significant but small correlation with a previously validated measure of religiosity, the total SIWB scale and self-efficacy subscale did not have a significant correlation with religiosity.

Discussion

The purpose of this study was to evaluate a brief research instrument designed to measure the effect of spirituality on subjective well-being in a patient population. Instruments that are developed to measure health-related quality of life are evaluated according to several criteria, most notably their degree of validity and reliability.²⁸ The SIWB demonstrated very good reliability with good internal consistency for the total and subscales as assessed by α coefficient in a geriatric patient population.

The construct spirituality has multiple dimensions and connotations in health-related settings,²⁹ which challenge the validity testing of any spirituality instrument. We chose a qualitative approach, rather than the use of experts or preexisting measures in health services research, pastoral theology and chaplaincy, and the social sciences, to conceptualize how patients understand and define spirituality, in particular as if affects their well-being. This approach also provided stimulus material for SIWB item selection and scale construction.