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Learning Objective 1: Identify the internal consistency reliability of Ellison's Spiritual Well-Being Scale in patients with heart failure.
Learning Objective 2: Identify the need for evaluating spiritual well-being in patients with heart failure.
Methods: Data from a subset of patients with heart failure who were participating in a clinical trial were used in this psychometric study. Patients (n = 48; 25% female; 13% minority, 42% New York Heart Association class III or IV, mean age 63 ± 13 years) were recruited from an academic medical center in Kentucky. Patients were recruited who had a confirmed diagnosis of heart failure from systolic or diastolic dysfunction, and whose medical therapy was optimized. All patients completed Ellison’s Spiritual Well-Being Scale (ESWBS) and the Beck Depression Inventory-II (BDI) at baseline. The ESWBS consists of a total scale score and a religious well-being subscale and an existential well-being subscale score. Internal consistency reliability was assessed using Cronbach’s alpha. Principle component factor analysis was used to examine construct validity with construction of a scree plot. Finally, in order to provide further evidence of construct validity, we determined the relationship between spiritual well-being (using ESWBS) and depression (using the Beck Depression Inventory-II) using Spearman’s rho correlation.
Findings: Internal consistency reliability was demonstrated in this sample by a Cronbach’s alpha of 0.94 for the total scale score, 0.87 for the religious well-being subscale, and 0.87 for the existential well-being subscale. Factor analysis supported the identification of the two subscales found in previous research. However, there were four factors with eigenvalues above 1.0 (9.5, 2.4, 1.4, and 1.2). These data distinguished between the two subscales in the instrument development; however, two principle components were extrapolated from each of the two subscales. A Spearman’s rho correlation coefficient between ESWS and the depression instrument was 0.30, p < 0.05. Greater depression was associated with higher levels of spiritual well-being.
Discussion: The results of this project demonstrate good reliability of ESWS. There are, however, problems with the validity. The factor analysis suggests more dimensions in heart failure patients than demonstrated by the developers and other users. The failure of our study to support construct validity using a known hypothesis suggests a lack of validity of the ESWS in heart failure. We will await a final conclusion about the instrument’s use in heart failure until more patients are recruited for further evaluation.
Research completed: This is a preliminary analysis of these data. More participants are needed to adequately evaluate the instrument.