Skip to main content
Log in

Instruments Measuring Spirituality in Clinical Research: A Systematic Review

  • Reviews
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. New York, NY: Oxford University Press; 2001.

    Google Scholar 

  2. Koenig HG, Larson DB. Religion and mental health: Evidence for an association. Int Rev Psychiatry 2001;13:67–78.

    Article  Google Scholar 

  3. Shuman J, Meador K. Heal Thyself. Spirituality, Medicine, and the Distortion of Christianity. New York,NY: Oxford University Press; 2003.

    Google Scholar 

  4. Chandler CK, Holden JM, Kolander CA. Counseling for spiritual wellness: Theory and practice. Journal of Counseling & Development 1992;71:168–175.

    Google Scholar 

  5. Moberg DO. Assessing and measuring spirituality: Confronting dilemmas of universal and particular evaluative criteria. Journal of Adult Development 2002;9:47–60.

    Article  Google Scholar 

  6. Miller WR, Thoresen CE. Spirituality, religion, and health: An emerging research field. Am Psychol 2003;58:24–35.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 2002;42 3:24–33.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Sinclair S, Pereira J, Raffin S. A thematic review of the spirituality literature within palliative care. J Palliat Med 2006;9:464–479.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Vivat B. Measures of spiritual issues for palliative care patients: a literature review. Palliat Med 2008;22:859–868.

    Article  PubMed  CAS  Google Scholar 

  17. Stefanek M, McDonald PG, Hess SA. Religion, spirituality and cancer: current status and methodological challenges. Psychooncology 2005;14:450–463.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. Allport GW, Ross JM. Personal religious orientation and prejudice. Journal of Personality & Social Psychology 1967;5:432–443.

    Article  CAS  Google Scholar 

  21. Koenig H, Parkerson GR, Jr., Meador KG. Religion index for psychiatric research. Am J Psychiatry 1997;154:885–886.

    PubMed  CAS  Google Scholar 

  22. Ellison CW. Spiritual well-being: Conceptualization and measurement. J Psychol Theol 1983;11(4):330–340.

    Google Scholar 

  23. Moberg DO. Spiritual well-being: background and issues. Review of Religious Research 1984;25.

  24. 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

    Google Scholar 

  25. Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med 2006;119:166–16.

    Article  PubMed  Google Scholar 

  26. 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.

  27. 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.

    Article  Google Scholar 

  28. MacDonald D. Spirituality: Description, Measurement, and Relation to the Five Factor Model of Personality. J Pers 2000;68:153–197.

    PubMed  CAS  Google Scholar 

  29. 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.

    Article  CAS  Google Scholar 

  30. 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.

    Article  PubMed  CAS  Google Scholar 

  31. Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971;76:378–382.

    Article  Google Scholar 

  32. Herth K. Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs 1992;17(10):1251–1259.

    Article  PubMed  CAS  Google Scholar 

  33. Warner SC, Williams JI. The Meaning in Life Scale: determining the reliability and validity of a measure. J Chron Dis 1987;40:503–512.

    Article  PubMed  CAS  Google Scholar 

  34. Roberts KT, Aspy CB. Development of the Serenity Scale. J Nurs Meas 1993;1:145–164.

    PubMed  CAS  Google Scholar 

  35. 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.

    Article  Google Scholar 

  36. 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.

    Article  Google Scholar 

  37. Reed PG. Religiousness among terminally ill and healthy adults. Res Nurs Health 1986;9:35–41.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. Howden JW. Development and psychometric characteristics of the Spirituality Assessment Scale. Unpublished doctoral dissertation. Texas Women’s University;1992

  40. 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.

  41. 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.

    Article  Google Scholar 

  42. 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.

    Article  Google Scholar 

  43. 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.

    PubMed  CAS  Google Scholar 

  44. 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.

    Article  Google Scholar 

  45. Piedmont RL. Does spirituality represent the sixth factor of personality? Spiritual transcendence and the Five-Factor Model. J Pers 1999;67:985–1013.

    Article  Google Scholar 

  46. Veach TL, Chappel JN. Measuring spiritual health: a preliminary study. Substance Abuse 1992;13(3):139–147.

    Google Scholar 

  47. 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.

    Article  Google Scholar 

  48. King M, Speck P, Thomas A. The Royal Free interview for religious and spiritual beliefs: development and standardization. Psychol Med 1995;25:1125–1134.

    Article  PubMed  CAS  Google Scholar 

  49. 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.

    Article  PubMed  CAS  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  CAS  Google Scholar 

  52. 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.

    Article  PubMed  Google Scholar 

  53. 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.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. 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.

    PubMed  Google Scholar 

  56. 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.

    Google Scholar 

  57. 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.

    Article  Google Scholar 

  58. 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.

    Article  PubMed  CAS  Google Scholar 

  59. 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.

    Google Scholar 

  60. Genia V. The Spiritual Experience Index: Revision and reformulation. Review of Religious Research 1997;38:344–361.

    Article  Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. 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.

    Article  Google Scholar 

  64. 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.

    Article  Google Scholar 

  65. 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.

    Article  PubMed  Google Scholar 

  66. 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.

    Article  Google Scholar 

  67. 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

    Google Scholar 

  68. 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.

    PubMed  Google Scholar 

  69. 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.

    Article  PubMed  Google Scholar 

  70. 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.

    Article  PubMed  CAS  Google Scholar 

  71. 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.

    Article  PubMed  Google Scholar 

  72. 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.

    Article  PubMed  Google Scholar 

  73. Hermann C. Development and testing of the spiritual needs inventory for patients near the end of life. Oncol Nurs Forum 2006;33:737–744.

    Article  PubMed  Google Scholar 

  74. Taylor EJ. Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncol Nurs Forum 2006;33:729–735.

    Article  PubMed  Google Scholar 

  75. 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.

    PubMed  Google Scholar 

  76. 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.

    PubMed  Google Scholar 

  77. 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.

    Article  PubMed  Google Scholar 

  78. 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.

    Article  PubMed  Google Scholar 

  79. 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.

    Article  PubMed  Google Scholar 

  80. 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.

    Article  PubMed  Google Scholar 

  81. 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.

    Article  PubMed  Google Scholar 

  82. Brennan M, Heiser D. Introduction: Spiritual assessment and intervention: Current directions and applications. Journal of Religion, Spirituality and Aging 2004;17:1–20.

    Article  Google Scholar 

Download references

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stéfanie Monod MD.

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

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-011-1769-7

KEY WORDS

Navigation