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December 2013 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.


Hammer, J. H., Cragun, R. T. and Hwang, K. "Measuring spiritual fitness: atheist military personnel, veterans, and civilians." Military Psychology 25, no. 5 (September 2013): 438-451.


SUMMARY and COMMENT: In the still-developing field of spirituality & health research, new measures are continually coming to light along side of a relatively small number of established instruments, but where there may be especially strong potential for advancement of the field overall is in the reconsideration of those instruments that have already been well-used to gather data. Examples that the Network has noted in the past include the FACIT-Sp (reassessed in terms of a three-factor model --see the Fall 2008 Newsletter) and the Brief RCOPE (changed significantly for Jewish patients --see our July 2009 Article-of-the-Month). The process of revisiting these instruments allows for building upon the conceptual work that lies behind them, and this can be instructive for the general debate of what form and language may be optimal for spiritual measures.

This month's featured article reexamines a "spiritual fitness" measure that is part of the US Army's Global Assessment Tool (GAT) used in its Comprehensive Soldier Fitness (CSF) program [--see Items of Related Interest, §I, below]. The authors scrutinize certain "transcendent phrasing" that is employed in the self-report survey, and they thereby implicitly pose larger concerns relevant to chaplains about how such language may play into pastoral research and clinical care with diverse populations that include non-theists. Also, the concept of "spiritual fitness" itself may be of interest to chaplains beyond the military, inasmuch as it is here broadly defined as "the capacity to (a) identify one’s core self and what provides a sense of purpose and direction; (b) access resources that facilitate the realization of the core self and strivings, especially in times of struggle; and (c) experience a sense of connectedness with diverse people and the world" [p. 438].

The specific aim of the study was "to determine the potential impact of transcendent item phrasing (i.e., phrasing that assumes the respondent believes in certain sacred or supernatural concepts) on the validity of the U.S. Army’s Comprehensive Soldier Fitness Program’s spiritual fitness scale for atheist military personnel, veterans, and civilians" [p. 448]. The authors created a Revised version of the five items that comprise the spiritual domain of the GAT and tested three hypotheses by comparing results from samples of atheists and Christians: namely that 1) "the inclusion of transcendent item phrasing would lead to reduced concurrent and predictive validity for the spiritual fitness scale when administered to atheists" [p. 447], 2) "the inclusion of transcendent phrasing would engender underestimation of atheists’ but not Christians’ spiritual fitness" [p. 448], and 3) "the removal of transcendent phrasing would lead to decreased concurrent validity for Christian respondents" [p. 447].

The items may be summarized as follows [--from pp. 442 and 444-445]:

1. "I am a spiritual person." "I have a core of beliefs, ethics, and values that give my life a sense of meaning and purpose."
2. "My life has lasting meaning." "I’ve been able to find a sense of meaning in my life."
3. "I believe that in some ways my life is closely connected to all humanity and all the world." "I feel a sense of connection to the rest of humanity and the natural world."
4. "The job I am doing in the military has lasting meaning." "The work I am doing in the military is meaningful to me." [or "…at my place of work/school" for civilians]
5. "I believe there is a purpose for my life." "I live life with a clear sense of purpose."

The reasoning by Hammer, Cragun and Hwang for their revisions is worth close attention in a first-hand reading of the article [--see pp. 439-440, 442 and 444-445], but they focus on the word spiritual as "not have[ing] consistent meaning across individuals" [p. 439], on the word lasting as suggesting the idea of an afterlife, on the phrase "closely connected" as here hinting at something "akin to a supernatural bond" [p. 439], and on the wording of "I believe there is a purpose…" as connoting an "externally determined or deity-bestowed purpose" [p. 440]. Overall, the researchers steer the items toward the concept of "'meaningfulness'—a subjective felt-sense of meaning and purpose in life" [p. 439].

The Revised version of the scale was tested using three sample groups: "448...current active military personnel..., Reserve or National Guard...and veterans...who self-identified as atheists and who also did not endorse a belief in God"; "789...self-identified atheist civilians who did not endorse a belief in God"; and "293...Christian civilians attending a large, Midwestern university" [pp. 441-442]. Participants were given the Original and Revised scales "combined into one instrument and presented in a random, intermixed order" [p. 446], along with measures of purpose in life, sense of coherence, self-concept clarity, life satisfaction, and depression/anxiety/stress, and functional health status. Members of the two atheist samples were asked to retake the measures a second time after six months.

Results are presented in good detail in the text and a table [--see pp. 443-444 and 447-448]. Regarding the three hypotheses:

...[T]he results provide partial support for our first hypothesis: The inclusion of transcendent phrasing reduced concurrent validity (predictive validity was not impacted) for the spiritual fitness scale when administered to atheist military personnel and veterans, and reduced concurrent and predictive validity when administered to atheist civilians. [p. 447]

...[R]esults support our second hypothesis: The inclusion of transcendent phrasing led to the underestimation of atheists’ but not Christians’ spiritual fitness. Furthermore, appears that this underestimation may be of considerable practical significance. Also, Christians’ scores across the two scales were identical, suggesting that the removal of the transcendent phrasing from the items is unlikely to result in a different spiritual fitness score for Christian respondents. [p. 448]

...[T]he results did not support our third hypothesis: The removal of transcendent phrasing did not lead to decreased concurrent validity for Christian respondents. To the contrary, it appeared to lead to an increase in concurrent validity. [p. 448]

The authors conclude: "Taken together, these findings suggest the Revised scale, which is composed of items that do not rely on transcendent phrasing, produces better psychometric outcomes for both atheist and Christian respondents" [p. 448]. They appropriately address limitations and propose avenues for further study [--see p. 339] and go on to speak about implications for the use of the measure in the US Army. However, for chaplain researchers, these early findings seem to indicate that avoiding transcendent language and concentrating on meaningfulness may not only serve the goal of inclusion of non-theists in spirituality research but serve even better -- in some sense – as one measure for (at least) Christian individuals.

For this reader, aware of a drive within health care for a spirituality measure that may indicate coping and resilience through crises by diverse patients, the five Original and Revised Spiritual Fitness items are intriguing. The Revised items especially recommend a meaningfulness measure, without involving the idea of transcendence. Nevertheless, whether an assessment that revolves around the concept of the "human spirit" [p. 442, italics added] and one that works out of concepts rooted in religious culture can properly both share the designation of spiritual assessments remains open to debate. A measure like the one(s) presented here may be getting us closer to the heart of a practical sense of spirituality or may be stretching the conceptualization of spirituality too far. As healthcare chaplains continue to discuss this, we should be aware that the US military is developing its own line of thought on the subject and is already putting instruments in action.


Suggestions for the Use of the Article for Student Discussion: 

The methodology and analysis involved in this month's article require some familiarity with research for easy reading, and so the piece may be suited especially for advanced students. Newer students may be guided to concentrate on the opening sections (pp. 438-440), the Revised scale item description (pp. 442, 444, and the top of 445), and the Discussion section (p. 448-449). Topics for the group's discussion could include the very idea of spiritual fitness, how a meaningfulness measure may be a spirituality indicator, and the authors' speculation about the unexpected finding that the Revised scale seemed to be a better measure for Christians than the Original. This would be an excellent opportunity to engage students in discussion of how theistic chaplains see themselves working with non-theist patients and the role of spiritual assessment in those circumstances. If there is not a non-theist student in the CPE group, then a guest could be invited, preferably one who is sensitive to transcendent language. Discussion could be rich, even if the article itself remained largely in the background. Finally, for students interested in research, the methodology could be explored. This is a good article for thinking about instrument validity.


Related Items of Interest:

I. For more on the idea of Spiritual Fitness and the Global Assessment Tool used in the US Army's Comprehensive Soldier Fitness (CSF) program, see the January 2011 theme issue of American Psychologist, especially:

Pargament, K. I. and Sweeney, P. J. "Building spiritual fitness in the Army: an innovative approach to a vital aspect of human development." American Psychologist 66, no. 1 (January 2011): 58-64. [(Abstract:) This article describes the development of the spiritual fitness component of the Army's Comprehensive Soldier Fitness (CSF) program. Spirituality is defined in the human sense as the journey people take to discover and realize their essential selves and higher order aspirations. Several theoretically and empirically based reasons are articulated for why spirituality is a necessary component of the CSF program: Human spirituality is a significant motivating force, spirituality is a vital resource for human development, and spirituality is a source of struggle that can lead to growth or decline. A conceptual model developed by Sweeney, Hannah, and Snider (2007) is used to identify several psychological structures and processes that facilitate the development of the human spirit. From this model, an educational, computer-based program has been developed to promote spiritual resilience. This program consists of three tiers: (a) building awareness of the self and the human spirit, (b) building awareness of resources to cultivate the human spirit, and (c) building awareness of the human spirit of others. Further research will be needed to evaluate the effectiveness of this innovative and potentially important program.]

Peterson, C., Park, N. and Castro, C. A. "Assessment for the U.S. Army Comprehensive Soldier Fitness program: the Global Assessment Tool." American Psychologist 66, no. 1 (January 2011): 10-18. [(Abstract:) Psychology and the U.S. military have a long history of collaboration. The U.S. Army Comprehensive Soldier Fitness (CSF) program aims to measure the psychosocial strengths and assets of soldiers as well as their problems, to identify those in need of basic training in a given domain as well as those who would benefit from advanced training, and then to provide that training. The goals of the CSF program include the promotion of well-being as well as the prevention of problems. Assessment is the linchpin of the CSF program, and the Global Assessment Tool (GAT) is a self-report survey that measures psychosocial fitness in emotional, social, family, and spiritual domains. We review the history of psychological assessment in the military and the lessons taught by this history. Then we describe the process by which the GAT was developed and evaluated. We conclude with a discussion of pending next steps in the development and use of the GAT.]


II. For a broader and background view of Spiritual Fitness in the US military, see the special August 2010 Supplement issue of Military Medicine, especially:

Hufford, D. J., Fritts, M. J. and Rhodes, J. E. "Spiritual Fitness." Military Medicine 175, Supplement to no. 8 (August 2010): 73-87. [Spirituality, as distinct from psychological and other variables, is now recognized as a crucial element in the total force fitness of service members. There is substantial literature available for the development of evidence-based policies and programs for spiritual support and the treatment of spiritual distress and moral injury. These developments should be integrated within existing programs, and this will require that commanders be proactive. Chaplains provide a primary resource and should be enabled to operate within integrated teams of support personnel. This has not been the case historically, and only the leadership of commanders can bring this about. Programs should utilize existing instruments for monitoring purposes, but should also include proactive plans for service members before deployment and whenever events such as large-scale civilian casualties increase the overall risk of spiritual distress. Behavioral science experts should be utilized in a collaborative role with chaplains in developing spiritual support. Leaders should receive elementary training in cultural competence and spiritual diversity to provide the needed support for spiritual fitness program development.] [This article is available online from the Samueli Institute.]


III. The Rand Corporation's October 3, 2013 report, Spiritual Fitness and Resilience: A Review of Relevant Constructs, Measures, and Links to Well-Being, by Yeung, D. and Martin, M. T. (Santa Monica, CA: Rand Corporation, 2013), was noted in the Fall 2013 Research Network Newsletter --see §2.


IV. Since this month's article considers the needs and views of atheists, readers may be interested in the recent Pew Research Center's report, "'Nones on the Rise," which includes a good deal of demographic/survey information about those who so self-identify. The report is noted in our Fall 2012 Research Network Newsletter --see §1. A word of caution about the report, though: atheists and agnostics tend to be grouped together in the findings.


NOTE: The assessment of Spiritual Fitness considered here is distinct from that of the the Spiritual Fitness Assessment presented in Kassab, V. A and MacDonald, D. A., "Examination of the psychometric properties of the Spiritual Fitness Assessment," Journal of Religion & Health 50, no. 4 (December 2011): 975-985.



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