This research sought to define and measure spirituality in a sample of individuals with chronic illness. Firstly, a review of the conceptual literature led to the development of a conceptual framework of spirituality consisting of three dimensions: connectedness, transcendence, and meaning in life. A review of the empirical literature identified only one instrument that measures the three dimensions together. Yet, recent appraisals of this instrument highlighted a lack of rigour in its development and limited evidence of reliability and validity.
Aim:Thus, the aim of this research was to develop a theoretically-grounded instrument to measure spirituality – the Spirituality Instrument 27 (SpI-27©). A secondary objectives was to psychometrically evaluate the instrument in a sample of individuals with chronic illness.
Methods: A two-phase design was adopted. Phase one consisted of the development of the SpI-27© based on item generation from a concept analysis, a review of theoretical and empirical literature, and an appraisal of instruments measuring spirituality. The second phaseestablished the psychometric properties of the instrument. This phase included a qualitative descriptive design using focus groups to establish content validity, a pilot study to evaluate the online mode of administration, and a descriptive correlational design to assess the reliability and validity of the instrument. Data were collected from 249 participants and analysed using SPSS (Version 18).
Results:Results of exploratory factor analysis concluded a final five-factor solution with 27 items. These five factors were labelled: Connectedness with Others, Self-Transcendence, Self-Cognisance, Conservationism, and Connectedness with a Higher Power. Cronbach’s alpha coefficients ranged from 0.823 to 0.911 for the five factors, and 0.904 for the overall scale, indicating high internal consistency. Paired-sample t-tests, intra-class correlations, and weighted kappa values supported the temporal stability of the instrument over a time-period of 2 weeks. A significant and positive correlation was found between the SpI-27© and the Spirituality Index of Well-Being, providing preliminary evidence for convergent validity.
Conclusion:Spirituality is a concept that is increasingly securing the interest of researchers and clinicians in nursing and many other disciplines. Some researchers claim that the study of spirituality is fragmented and in the early stages. The progress of spirituality research has been challenged by a lack of consensus on definitions and measures. This research addresses a call within the literature for a theoretically-grounded instrument to measure spirituality. The newly developed instrument is founded upon a conceptual framework of spirituality. Furthermore, a rigorous, mixed-methods approach was used to develop the instrument.
The study has many implications for clinical practice, research and education. In terms of clinical practice, the conceptual framework can be used to guide spiritual assessment and the delivery of spiritual care. With regard to research, the SpI-27© can be used to measure spirituality in other cohorts and investigate relationships with other variables. From a nursing education perspective, the study can assist in educating nurses about spirituality and it's impact on individuals with chronic illness.
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