Journal List > J Korean Acad Nurs > v.50(1) > 1143165

J Korean Acad Nurs. 2020 Feb;50(1):132-146. Korean.
Published online Feb 28, 2020.
© 2020 Korean Society of Nursing Science
Development and Validation of the New Version of Spirituality Assessment Scale
Il-Sun Ko,1 Soyoung Choi,2 and Jin Sook Kim3
1College of Nursing, Yonsei University, Seoul, Korea.
2College of Nursing, The Pennsylvania State University, University Park, PA, USA.
3Department of Nursing, Woosong University, Daejeon, Korea.

Address reprint requests to: Kim, Jin Sook. Department of Nursing, Woosong University, 171 Dongdaejeon-ro, Dong-gu, Daejeon 34606, Korea. Tel: +82-42-630-9294, Fax: +82-42-630-9299, Email:
Received Jul 19, 2019; Revised Nov 18, 2019; Accepted Jan 30, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. ( If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.



The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity.


The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity.


The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001).


Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

Keywords: Spirituality; Factor Analysis, Statistical; Reliability and Validity


Figure 1
Steps of N-SAS development.
Click for larger image


Table 1
Demographic Characteristics of Participants n (%) or M±SD
Click for larger image

Table 2
Items Analysis, Factor Loading, and Validity in Exploratory Factor Analysis and Confirmatory Factor Analysis
Click for larger image

Table 3
Discriminant Validity of Average Variance Extracted and 95% Confidence Interval in Confirmatory Factor Analysis (N=211)
Click for larger image

Table 4
Correlation between New Version of Spirituality Assessment Scale (N-SAS) and Spiritual Assessment Scale (SAS)
Click for larger image


This study was supported by the Research Grant of College of Nursing, Yonsei University in 2014, 2015 (NO: 6-2014-0183, 6-2015-0183).

CONFLICTS OF INTEREST:The authors declared no conflict of interest.


  • Conceptualization or/and Methodology: Ko IS & Kim JS.

  • Data curation or/and Analysis: Kim JS.

  • Funding acquisition: Ko IS.

  • Investigation: Choi S & Kim JS.

  • Project administration or/and Supervision: Ko IS.

  • Resources or and Software: Kim JS.

  • Validation: Ko IS & Kim JS.

  • Visualization: Ko IS & Kim JS.

  • Writing original draft or/and Review & editing: Ko IS & Choi S & Kim JS.


1. Ramezani M, Ahmadi F, Mohammadi E, Kazemnejad A. Spiritual care in nursing: A concept analysis. International Nursing Review 2014;61(2):211–219. [doi: 10.1111/inr.12099]
2. Callister LC, Bond AE, Matsumura G, Mangum S. Threading spirituality throughout nursing education. Holistic Nursing Practice 2004;18(3):160–166. [doi: 10.1097/00004650-200405000-00008]
3. Burkhart L, Hogan N. An experiential theory of spiritual care in nursing practice. Qualitative Health Research 2008;18(7):928–938. [doi: 10.1177/1049732308318027]
4. Timmins F, Caldeira S. Understanding spirituality and spiritual care in nursing. Nursing Standard 2017;31(22):50–57. [doi: 10.7748/ns.2017.e10311]
5. Ko IS, Choi SY, Kim JS. Evolutionary concept analysis of spirituality. Journal of Korean Academy of Nursing 2017;47(2):242–256. [doi: 10.4040/jkan.2017.47.2.242]
6. Gall TL, Malette J, Guirguis-Younger M. Spirituality and religiousness: A diversity of definitions. Journal of Spirituality in Mental Health 2011;13(3):158–181. [doi: 10.1080/19349637.2011.593404]
7. Oh PJ, Kang KA. Spirituality: Concept analysis. Journal of Korean Academy of Nursing 2000;30(5):1145–1155. [doi: 10.4040/jkan.2000.30.5.1145]
8. Park HJ. Spirituality of measuring tool development and the spirituality of catholic social welfare workers. Journal of Woori Theology 2003;2:196–223.
9. Kim SG. Religion, spirituality and health. Journal of Religion and Culture 2010;15:45–79.
10. Ellison CW. Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology 1983;11(4):330–338. [doi: 10.1177/009164718301100406]
11. Sessanna L, Finnell D, Jezewski MA. Spirituality in nursing and health-related literature: A concept analysis. Journal of Holistic Nursing 2007;25(4):252–262. [doi: 10.1177/0898010107303890]
12. Howden JW. In: Development and psychometric characteristics of the spirituality assessment scale [dissertation]. Denton (TX): Texas Woman's University; 1992. pp. 1-310.
13. Villagomeza LR. Spiritual distress in adult cancer patients: Toward conceptual clarity. Holistic Nursing Practice 2005;19(6):285–294. [doi: 10.1097/00004650-200511000-00010]
14. Rodgers BL. Concept analysis: An evolutionary view. In: Rodgers BL, Knafl KA, editors. Concept Development in Nursing: Foundations, Techniques, and Applications. 2nd ed. Philadelphia (PA): Saunders; 2000. pp. 77-102.
15. 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). Annals of Behavioral Medicine 2002;24(1):49–58. [doi: 10.1207/S15324796ABM2401_06]
16. Delaney C. The spirituality scale: Development and psychometric testing of a holistic instrument to assess the human spiritual dimension. Journal of Holistic Nursing 2005;23(2):145–167. [doi: 10.1177/0898010105276180]
17. King M, Jones L, Barnes K, Low J, Walker C, Wilkinson S, et al. Measuring spiritual belief: Development and standardization of a beliefs and values scale. Psychological Medicine 2006;36(3):417–425. [doi: 10.1017/S003329170500629X]
18. 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(3):257–264. [doi: 10.1016/j.jsat.2006.06.014]
19. Cho SB, Kim SH. Development of a spirituality scale for university students. Korean Journal of Counseling 2012;13(2):877–890. [doi: 10.15703/kjc.13.2.201204.877]
20. Lee KY, Kim CH, Kim DW. Development of the spirituality scale. The Korean Journal of Counseling and Psychotherapy 2003;15(4):711–728.
21. Yong JS, Kim J, Han SS, Puchalski CM. Development and validation of a scale assessing spiritual needs for Korean patients with cancer. Journal of Palliative Care 2008;24(4):240–246. [doi: 10.1177/082585970802400403]
22. Comrey AL, Lee HB. In: A first course in factor analysis. 2nd ed. New York: Psychology Press; 2013. pp. 217.
23. Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods 1998;1(1):104–121.
24. Oh PJ, Chun HS, So WS. Spiritual assessment scale: Psychometric evaluation of the Korean version. Asian Oncology Nursing 2001;1(2):168–179.
25. Groves RM, Fowler FJ, Couper MP, Lepkowski JM, Singer E, Tourangeau R. In: Survey Methodology. 2nd ed. New York: John Wiley & Sons; 2011. pp. 263-265.
26. Lee CY. In: Advanced nurising statistics. Paju: Soomunsa; 2016. pp. 231-264.
27. O'Connor BP. SPSS and SAS programs for determining the number of components using parallel analysis and Velicer's MAP test. Behavior Research Methods, Instruments, & Computers 2000;32(3):396–402.
28. Yu JP. In: Model concept and understanding of structural equation. Seoul: Hannarae Publishing Co.; 2012. pp. 150-372.
29. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health. 2007;30(4):459–467. [doi: 10.1002/nur.20199]