December 2010 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.
Kapuscinski, A. N. and Masters, K. S. "The current status of measures of spirituality: a critical review of scale development" Psychology of Religion and Spirituality 2, no. 4 (November 2010): 191–205.
[Editor's Note: A supplemental table to this month's article is available freely online as a Zip file via http://dx.doi.org/10.1037/a0020498.supp. The Zip file format may trigger anti-virus software, but since it comes from the American Psychological Association it should present no real virus threat.]
SUMMARY and COMMENT: Spirituality has become an ascendant concept (vis-à-vis religion) in the health care literature in recent years, but its measurement remains a challenge for research. This month's article looks at nineteen instruments produced after 1999 (when a similar survey of measures was published by MacDonald, D. A., et al. [--see Related Items of Interest, below, §I]), plus five "older measures that have received significant use and remain influential" [p. 194]. The authors' objectives are: "1) provide readers with an overview of scale development practices and psychometric properties of existing spirituality measures, 2) discuss strengths and weaknesses in these areas, 3) discuss the general limitations of quantitative measurement of spirituality, and 4) make recommendations for future scale development practices as well as for use of scales in research" [p. 193]. This task is undertaken from the perspective of psychology.
A table -- not included in the printed article but is available online (http://dx.doi.org/10.1037/a0020498.supp) -- "provides a summary of information for each measure, including the authors' conceptualization of the construct, development strategy, number of items, response format, subscales, use of traditional religious language (e.g., 'God,' 'church' etc.), sample characteristics, and reliability and validity evidence" [p. 194]. The 24 measures are:
After an introduction addressing the basic problem of measurement in this area and trends in the conceptualization of spirituality [pp. 191-193], Kapuscinski and Masters review and critique specific issues of conceptualization, item generation, scale format/structure, sampling, and psychometrics/validity for the selected instruments. This is a rich article, with much to consider, but chaplains may be especially interested in these points:
- Beliefs and Values Scale -- (King et al. (2006)
- Daily Spiritual Experience Scale -- Underwood & Teresi (2002)
- Expressions of Spirituality Scale -- MacDonald (2000)
- FACIT-Sp -- Peterman et al. (2002)
- Index of Core Spiritual Experiences -- Kass et al. (1991)
- Intrinsic Spirituality Scale -- Hodge (2003)
- Miller Measure of Spirituality -- Miller (2004)
- NIA/Fetzer Short Form -- Idler et al. (2003)
- Personal Meanings of Spirituality -- Graci et al. (2003)
- Royal Free Interview: Spiritual Scale -- King, Speck & Thomas (2001)
- Spiritual and Religious Dimensions Scale -- Nasel & Haynes (2005)
- Spiritual Assessment Inventory-R -- Hall & Edwards (1996, 2002)
- Spiritual Index of Well-Being -- Daaleman et al. (2002); Daaleman & Frey (2004)
- Spiritual Involvement and Beliefs Scale -- Hatch et al. (1998)
- Spiritual Meaning Scale -- Mascaro et al. (2003)
- Spiritual Orientation Inventory -- Elkins et al. (1988)
- Spiritual Transcendence Index -- Seidlitz et al. (2002)
- Spiritual Transcendence Scale -- Piedmont (1999)
- Spiritual Transformation Scale -- Cole et al. (2008)
- Spiritual Well-Being Questionnaire -- Gomez & Fisher (2002)
- Spiritual Well-Being Scale (SWBS) -- Paloutzian & Ellison (1982)
- Spirituality Scale -- Jagers & Smith (1996)
- Spirituality Self-Rating Scale -- Galanter et al. (2007)
- Theistic Spiritual Outcome Survey -- Richards et al. (2005)
The authors conclude by recommending four measures in particular that use "high-quality development practices and are likely to be valuable in exploring a variety of research objectives" [p. 202]: the Daily Spiritual Experiences Scale (Underwood & Teresi, 2002), the Spiritual Transcendence Scale (Piedmont, 1999), the Theistic Spiritual Outcome Survey (Richards et al., 2005), and the FACIT-Sp (Peterman et al., 2002).
- The task of measurement remains beset by "1) disagreement regarding the relationship of religion to spirituality; and even more basic, 2) difficulty defining spirituality" [p. 192]. Moreover, spirituality and religion "continue to be both used and separated with little consensus on meaning" [p. 193].
- "...[M]ost definitions of spirituality emphasiz[e] the cognitive or affective components, rather than behavioral elements..." Yet, "…excluding observable behavior seems unjustifiable from both psychological and theological perspectives" "...[S]piritual experience must have
its 'expressions.'" ..."The inclusion of behavioral components in future conceptualizations of spirituality is recommended because it will assist in creating a more balanced scientific knowledge base, and will also reflect more complete theological and philosophical perspectives of the phenomenon." [p. 195]
- It is important to include in the conceptualization of spirituality "the sacred or transcendent as central to spirituality." "...[O]ne may wonder what 'transcendentless spirituality' brings to the psychological table. If spirituality is limited to constructs such as congruent life scheme, self-efficacy...or quality of life...that may be found in better established areas of psychology, then it seems that the significance of spirituality is notably diminished." ..."Spirituality need not incorporate a traditionally religious understanding
of the sacred, but inclusion of belief in some transcendent power as central to spirituality provides a conceptual formulation not found in other psychological constructs." [p. 195]
- "Given the pervasive conceptualization difficulties discussed throughout this review, the limited amount of qualitative research investigating spirituality is surprising and troubling. ...The qualitative approach is recommended both for informing the process of scale development, as well as on its own to capture data regarding the experience of spirituality that may be valuable in applied contexts. Additionally, more studies using focus groups to explore individuals’ evaluation of scale items would be beneficial." [p. 201]
- Regarding "the dominant use of expert opinion to evaluate scale items": ..."Though the practice contributes to increasing researchers’ confidence in the content validity of the instruments, one should also consider the extent that notions of spirituality from the perspective of theological or psychological experts differ from common usage and understanding." [p. 197] Such differences also suggest the potential importance for face validity testing. [See pp. 200 and 201.]
- Regarding sampling used in scale development: "…[A]s the United States becomes more religiously and spiritually heterogeneous, and/or if religious minorities are specifically being studied, scale development must be inclusive of nonChristians." [p. 199]
This is a valuable update on the state of measures of spirituality, with good practical advice for researchers in choosing instruments as well as for those developing them. For instance, chaplain researchers looking for a measure among the many published would be well served to follow the exhortation to "scrutinize what conceptualization of spirituality is guiding their own thinking and research objectives" [p. 201].
The following specific questions are pertinent: How are spirituality and religion related? Will scale items using religious language adequately assess the construct of interest? Is it important that behavioral elements of spirituality be addressed?
Chaplains new to instrument selection may find most helpful the introductory section on Trends in Conceptualization of Spirituality [pp. 192-193]. (However, this reader found somewhat ironic that our authors based what they call "important conclusions regarding the public's understanding of the constructs" [p. 192] largely on a now-thirteen-year-old study by Zinbauer, et al., "Religion and spirituality: unfuzzing the fuzzy" [--see Related Items of interest, below, §II], when an underlying tenant of present article is that understandings of spirituality are in flux.] For more experienced chaplains, the section on Psychometric Properties [pp. 199-200] may be quite instructive and challenging on the issue of types of validity. For all chaplains serious about research, our featured article this month warrants a close reading.
Suggestions for the Use of the Article for Discussion in CPE:
CPE students seem generally to find it hard to engage the subject of measures, and so this month's article may be best suited to those already familiar with -- and interested in -- quantitative methodology. However, it is very clearly written and should be accessible to any student. The opening pages [pp. 191-193] set out well the fact that spirituality is a term that is used often but with little consensus. Students should discuss their own conceptualization of spirituality and how it relates to that of religion. Can even a small CPE peer group come to some consensus? How might the group go about "pinning down" the idea so that it can be described, compared, and tracked [--which are goals of research]? The Review and Critique of Conceptualization section [pp. 194-195] may be intriguing after such a preliminary discussion, especially regarding the role of transcendence and of behavioral expressions of spirituality. Also, what does it mean for concepts like spirituality to be defined by "experts" when such definitions may differ markedly from a general public understanding? For advanced research students, the section on Psychometric Properties [pp. 199-200] deserves special attention, with discussion of the different types of validity testing.
Related Items of Interest:
I. Kapuscinski and Masters indicate that their article is effectively a follow-up to a two-part survey of instruments by Douglas A. MacDonald and colleagues from 1999 --a publication that had followed a 1995 review by that author. Note that MacDonald emphasizes the term transpersonal construct in his work.
MacDonald, D. A., Friedman, H. L. and Kuentzel, J. G.
"A survey of measures of spiritual and transpersonal constructs: part one--research update." Journal of Transpersonal Psychology 31, no. 2 (1999): 137-154. [(Abstract:) Provides the results of the authors' ongoing literature searches with 2 specific aims in mind, namely to (1) advocate the increased use of psychometric instruments in transpersonal and spiritual research to further scientific development in the field and (2) aid in bringing some order to the growing body of empirical literature by providing information on studies that have utilized a number of the more promising standardized instruments of spiritual and transpersonal constructs. This article provides a summary of information on empirical research that used any of the 20 instruments described at length in the prior test survey completed by D. A. MacDonald et al (1995). Literature searches were completed between 1995–1999. Findings indicate that topics such as non-ordinary states of consciousness (e.g., meditative, hypnotic, and dissociative), coping, health and wellness, and the implications of spiritual and transpersonal phenomena for the therapeutic interventions represent the majority of literature uncovered. Further, the Mystical Experiences Scale, the Phenomenology of Consciousness Inventory, and the Spiritual Well-Being Scale are the assessment tools which were the most employed in the reviewed research.]
MacDonald, D. A., Kuentzel, J. G. and Friedman, H. L. "A survey of measures of spiritual and transpersonal constructs: part two--additional instruments." Journal of Transpersonal Psychology 31, no. 2 (1999): 155-177 [(Abstract:) Provides information on measures of spiritual and transpersonal constructs. 10 different instruments described are the Ego Permissiveness Inventory; the Expressions of Spirituality Inventory; the Feelings, Reactions, and Beliefs Survey; the Immanence Scale; the Mental, Physical, and Spiritual Well Being Scale; the Psychomatrix Spirituality Inventory; the Religious Experiences Episodes Measure; the Royal Interview for Religious and Spiritual Beliefs; the Spiritual Assessment Inventory; and the Spiritual Well-Being Questionnaire. Four of these tests were initially mentioned in D. A. MacDonald et al (1995) and the remaining 6 measures were obtained through both computerized database searches completed between 1995–1999 as well as through informal means. These 10 measures were selected for discussion based on the authors' appraisal of their potential to contribute to new lines of research.]
MacDonald, D. A., LeClair, L., Holland, J., Alter, A. and Friedman, H. L. "A survey of measures of transpersonal constructs." Journal of Transpersonal Psychology 27, no. 2 (1995): 171-235. [(Abstract:) Describes 20 standardized assessment instruments useful for research in transpersonal psychology. The general benefits and limitations of such measures are considered. 54 additional measures of relevance to transpersonal research, with bibliographic references, are listed.]
II. Kapuscinski and Masters cite nine times an important 1997 study by Brian J. Zinnbauer and colleagues, and seven times a subsequent overview from 1999. These remain solid background readings in the field.
Zinnbauer, B. J., Pargament, K. I., Cole, B., Rye, M. S., Butter, E. M., Belavich, T. G. and Kadar, J. L. "Religion and spirituality: unfuzzing the fuzzy." Journal for the Scientific Study of Religion 36, no. 4 (December 1997): 549-564. [(Abstract:) The present study attempts to measure how individuals define the terms religiousness and spirituality, to measure how individuals define their own religiousness and spirituality, and to examine whether these definitions are associated with different demographic, religio/spiritual, and psychosocial variables. The complete sample of 346 individuals was composed of 11 groups of participants drawn from a wide range of religious backgrounds. Analyses were conducted to compare participants' self-rated religiousness and spirituality, to correlate self-rated religiousness and spirituality with the predictor variables, and to use the predictor variables to distinguish between participants who described themselves as "spiritual and religious" from those who identified themselves as "spiritual but not religious." A content analysis of participants' definitions of religiousness and spirituality was also performed. The results suggest several points of convergence and divergence between the constructs religiousness and spirituality. The theoretical, empirical, and practical implications of these results for the scientific study of religion are discussed.]
Zinnbauer, B. J., Pargament, K. I. and Scott, A. B.
"The emerging meanings of religiousness and spirituality: problems as prospects." Journal of Personality 67, no. 6 (December 1999): 889-919. [(Abstract:) This article examines traditional and modern psychological characterizations of religiousness and spirituality. Three ways in which religiousness and spirituality are polarized by contemporary theorists are examined: organized religion versus personal spirituality; substantive religion versus functional spirituality; and negative religiousness versus positive spirituality. An alternative approach to understanding religiousness and spirituality is presented that integrates rather than polarizes these constructs, and sets boundaries to the discipline while acknowledging the diversity of religious and spiritual expressions. Directions for future investigations of these two constructs are presented.]
III. This month's article appears in Psychology of Religion and Spirituality, the journal of the Psychology of Religion (Division 36) of the American Psychological Association. Among other recent articles of interest is a survey of APA leaders that asked their thoughts on the inauguration of the journal:
McMinn, M. R., Hathaway, W. L., Woods, S. W. and Snow, K. N. "What American Psychological Association leaders have to say about psychology of religion and spirituality." Psychology of Religion and Spirituality 1, no. 1 (2009):1-13. [(From the abstract:) A survey was sent to 204 current APA council representatives and divisional residents, yielding 63 completed questionnaires (31% response rate). Respondents generally affirmed the importance of religion and spirituality as topics of inquiry in psychology. Although not highly religious themselves, respondents recognize religion and spirituality as important aspects of human diversity. In considering the new journal, current APA leaders who responded to the survey are particularly interested in articles relating religion and spirituality to health and coping and articles considering cross-cultural and interfaith issues.]
While the journal is available by subscription, the Division also produces a quarterly Newsletter is that available freely online and that sometimes holds articles of general interest (in addition to Division/APA business). Browsing through past issues may turn up material useful to chaplains.
III. The psychology of religion/spirituality is an important constituent field in the general study of religion/spirituality & health, especially inasmuch as the field has worked at the application of empirical methodology. Chaplains may be interested in the latest edition of one of the major texts in the field: The Psychology of Religion: An Empirical Approach, 4th edition (2009), by Ralph W. Hood, Jr., Peter C. Hill, and Bernard Spilka. The book is massive, but the second chapter on "Foundations for an Empirical Psychology of Religion" [pp. 21-53] is a good overview of issues of the application of empirical methodology to spirituality/religion, addressing such things as the problem of reductionism --which is a prevalent concern of chaplains. (Note that one of the co-authors of this book, Peter C. Hill, is also a co-author of 1999 book, Measures of Religiosity, an analytical collection of 126 instruments from the psychology of religion.)