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.

In our conceptual framework, spirituality within a health context is a state that is comprised primarily of the domains of life scheme and self-efficacy. Patients who report high self-efficacy beliefs regarding their functioning and who view their lives as purposeful and meaningful should score higher on measures of subjective well-being than those who do not hold such beliefs or attitudes. The use of concurrent construct validity testing allowed us to test this assumption through the correlation of SIWB scores with other established proxies of subjective well-being. Face validity may suggest that the SIWB is a measure of affective or cognitive states (eg, depression) or a proxy for self-efficacy and alienation rather than spirituality. Concurrent construct validity testing provided a means to determine the independence of the SIWB from an accepted measure of depression, the GDS.

Although the pilot version of the SIWB consisted of 40 items with positive and negative statements regarding life scheme and personal self-efficacy, only negative items remained after validity and reliability testing. One explanation for the exclusion of positive statements from the SIWB may involve the predominance of a specific component of subjective well-being in older persons, a low level of negative affect. There are several additional components of subjective well-being (eg, positive affect, satisfaction with work or other domains, and life satisfaction),³⁰ that may not be as salient or as operational in an older population.

However, the SIWB consistently had significant and expected correlations in direction and magnitude with other established measures related to subjective well-being. Spirituality had the highest inverse correlations with fear of death, depression, and perceived health status, which are supportive of affective and cognitive dimensions of subjective well-being in our instrument. A modest correlation with the GDS also suggested that the SIWB is a measure that is independent of depression.

Discriminant validity testing was used to differentiate the SIWB from religiosity. The total SIWB scale did not have a significant correlation with a measure of religiosity that has been used in a geriatric population,²⁷ although the life scheme subscale did have a significant but small (r = .18) correlation. The distinction between conceptualizations of religiosity and spirituality is a major consideration in measurement development,³¹ and there are other measures of spirituality that have been used in clinical and research settings. Virtually all are contaminated by the inclusion of items that assess religiosity.⁹ For example, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale contains items that measure the comfort and strength derived from religious faith, in addition to a sense of meaning, purpose, and peace in life.³² The Systems of Belief Inventory, which was designed for use in quality of life and psychosocial research examining illness adjustment, measures religious and spiritual beliefs and practices and the social support that accompanies those beliefs and practices.³³

The Spiritual Well-Being Scale has been used widely in health care settings and consists of 2 subscales: a religious well-being subscale and an existential well-being subscale.³⁴ Religious well-being is conceptualized as the quality of one’s relationship with God, whereas existential well-being includes characteristics such as life purpose, life satisfaction, and positive and negative life experiences. Scores from the Spiritual Well-Being Scale have been inversely correlated with measures of psychological well-being.

However, much of this unpublished research has been compromised by ceiling effects or an inability to detect differences in those who score high on the scale, particularly in religious populations³⁵ and by a lack of peer review.³⁶

Our study has several limitations. Our conceptualization of spirituality is a new construct based on qualitative research, and the study purpose was to evaluate the psychometric properties of a new instrument to measure this construct. As a result, we did not analyze or report normative data about the SIWB. Spirituality may have conceptual overlap with existing constructs, such as self-efficacy and alienation, and we did not evaluate the independence of our scale against these constructs. The SIWB was embedded in the final cohort of a longitudinal study, and we were unable to perform test-retest reliability to determine the stability and the responsiveness or sensitivity of the instrument over time. Due to subject burden, the parent study limited the inclusion of additional measures and the quality-of-life instruments were selected a priori.

Our cross-sectional design also did not allow us to draw any definitive conclusions about the causal relations of the variables. The study population consisted primarily of predominantly white, older patients with some functional limitations, and the generalizability of our findings to other populations is uncertain. However, good theory development and item construction from prior qualitative studies, a high α coefficient, and factor analysis support the validity and reliability of our measure.