Development and Validation of the New Version of Spirituality Assessment Scale

Il-Sun Ko; Soyoung Choi; Jin Sook Kim

doi:10.4040/jkan.2020.50.1.132

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Ko, Choi, and Kim: Development and Validation of the New Version of Spirituality Assessment Scale

Original Article

J Korean Acad Nurs 2020;50(1):132-146.

Published online: 17 January 2020

DOI: https://doi.org/10.4040/jkan.2020.50.1.132

Development and Validation of the New Version of Spirituality Assessment Scale

Il-Sun Ko¹, Soyoung Choi², Jin Sook Kim^3,

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 E-mail: somach87@hanmail.net

Received 19 July 2019 Revised 18 November 2019 Accepted 30 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) 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.

Abstract

Purpose:

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

Methods:

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.

Results:

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).

Conclusion

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

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Figure 1.

Steps of N-SAS development.

Table 1.

Demographic Characteristics of Participants n (%) or M±SD

Characteristics	Categories	EFA (n₁=200)	CFA (n₂=211)	χ² or t, F	ρ
Gender	Male	87 (43.5)	76 (36.0)	2.10	.121
	Female	113 (56.5)	135 (64.0)
Age (yr)		42.08±16.48	43.80±15.53	2.52	.113
	19~29	66 (33.0)	54 (25.6)	4.11	.392
	30~39	32 (16.0)	37 (17.5)
	40~49	34 (17.0)	32 (15.2)
	50~59	33 (16.5)	46 (21.8)
	Over 60	35 (17.5)	42 (19.9)
Residence^†	Metropolis	165 (82.5)	161 (76.3)	2.40	.144
	Medium-sized citiies	35 (15.5)	50 (23.7)
Marital status	Married	109 (54.5)	116 (55.0)	4.87	.301
	Divorce	2 (1.0)	8 (3.8)
	Bereavement/separation	7 (3.5)	5 (2.4)/1 (0.5)
	None	82 (41.0)	81 (38.4)
Average monthly income^† (million)	<1	47 (23.5)	38 (18.0)	3.57	.467
	1~<2	35 (17.5)	44 (20.9)
	2~<3	37 (18.5)	51 (24.2)
	3~<4	26 (13.0)	27 (12.8)
	≥4	38 (19.0)	39 (18.5)
Educational level^† (graduation)	Elementary	2 (1.0)	7 (3.3)	3.34	.502
	Middle school	7 (3.5)	9 (4.3)
	High school	36 (18.0)	41 (19.4)
	Above university	116 (58.0)	118 (55.9)
	Attending university	39 (19.5)	35 (16.6)
Parenting attitude^† (multichoice answers)	Democratic	132 (66.0)	136 (64.5)	0.23	.633
	Biblical	41 (20.5)	47 (22.3)	0.15	.719
	Authoritative	35 (17.5)	31 (14.7)	0.68	.423
	Interfering	30 (15.0)	37 (17.5)	4.22	.593
	Permissive	29 (14.5)	33 (15.6)	0.08	.890
	Rejective	3 (1.5)	1 (0.5)	0.94	1.000^††
	Unknown	14 (7.0)	12 (5.7)	0.33	.566
Religion^†	Christianity	124 (62.0)	102 (48.3)	9.71	.084
	Catholic	12 (6.0)	21 (10.0)
	Buddhism	5 (2.5)	10 (4.7)
	Etc	1 (0.5)	1 (0.5)
	No	57 (28.5)	71 (33.6)
Significance of religion in life^†	(4 point scale)	3.35±.93	3.34±.92	0.04	.968
	Very much affecteed	87 (43.5)	80 (37.9)	4.35	.226
	Some affected	23 (11.5)	33 (15.6)
	A little affected	24 (12.0)	15 (7.1)
	No affected	7 (3.5)	9 (4.3)
Participating in religion ceremony^†	Weekly	101 (50.5)	107 (50.7)	2.91	.573
	2~3 times/month	12 (6.0)	11 (5.2)
	Monthly	5 (2.5)	2 (0.9)
	1~5 times/year	12 (6.0)	7 (3.3)
	No participating	12 (6.0)	10 (4.7)
Disease^†	Yes	53 (26.5)	53 (25.1)	0.04	.833
	No	143 (71.5)	150 (71.1)
Admission/operation^†	Yes	86 (43.0)	94 (44.5)	0.24	.627
	No	109 (54.5)	108 (51.2)
Self-esteem^†	10 point scale	7.75±1.83	7.64±1.83	0.64	.523
Loneliness^†	10 point scale	2.93±2.65	3.21±2.66	-1.08	.279
Depression^†	10 point scale	2.94±2.56	2.85±2.56	0.36	.716

^† Missing data excluded,

^†† Fisher’s test.

Table 2.

Items Analysis, Factor Loading, and Validity in Exploratory Factor Analysis and Confirmatory Factor Analysis

Item No	Item contents	Item analysis				EFA (n=200)				CFA (n=211)
		M±SD	ITC	Alpha if item deleted	Com-mu-nality	Factor loading				Factor loadding		r			AVE	CR
		M±SD	ITC	Alpha if item deleted	Com-mu-nality	1	2	3	4	SRW	SE	1 (RG)	2 (ML)	3 (ST)	AVE	CR
6	I seek God’s support to solve the problems in	2.86±1.11	.79	.97	.82	.89	.11	.09	.07	.94	.39	1		.72	.98
	my life.
3	I accept that God is involved in my life.	2.81±1.23	.79	.97	.82	.89	.12	.08	.06	.92	.34
9	I make my decisions based on my faith in	2.61±1.23	.85	.97	.86	.89	.22	.12	.07	.92	.25
	God.
11	I try to keep the peace based on my faith in	2.85±1.13	.79	.97	.80	.88	.10	.11	.10	.90	.20
	God.
16	I pray to God.	2.91±1.08	.76	.97	.79	.88	.02	.11	.12	.89	.31
7	I try to form my identity through my faith in	2.61±1.23	.85	.97	.85	.87	.23	.15	.09	.94	.48
	God.
4	I get love, strength, and support from God.	2.76±1.26	.81	.97	.81	.87	.18	.10	.12	.90	.26
19	I participate the activity with others who have	2.50±1.16	.84	.97	.82	.86	.12	.23	.14	.89	.59
	the same faith as me.
12	I try to reflect myself or mediate regularly to	2.66±1.06	.83	.97	.82	.86	.08	.22	.18	.88	.22
	live in faith.
10	I want God’s forgiveness for evil intentions or	2.84±1.13	.76	.97	.76	.85	.05	.12	.12	.91	.24
	feelings.
8	I have the power to overcome my sufferings	2.70±1.23	.82	.97	.80	.85	.18	.15	.16	.92	.28
	and difficulties based on my faith in God.
14	I am the being who is loved by God.	2.83±1.26	.81	.97	.79	.84	.26	.11	.04	.88	.24
5	I feel my faith in God is more strengthened.	2.61±1.26	.79	.97	.76	.84	.17	.13	.09	.88	.32
17	I read some related books to live in faith.	2.45±1.10	.83	.97	.79	.83	.15	.24	.12	.84	.22
15	I share with others about my faith in God.	2.48±1.16	.84	.97	.79	.83	.23	.21	.10	.87	.37
2	I have an intimate relationship with God.	2.58±1.25	.82	.97	.76	.82	.19	.21	.10	.87	.31
18	I listen to some related music to live in my	2.47±1.11	.79	.97	.75	.82	.10	.25	.09	.87	.31
	faith.
1	I believe in the existence of God.	3.05±1.24	.73	.97	.67	.79	.11	.19	.05	.77	.28
13	I think of the blessings I have received.	2.96±0.99	.75	.97	.63	.71	.15	.30	.12	.76	.17
41	I think I am a decent person.	2.92±0.88	.33	.97	.61	-.02	.77	.12	.03	.51	.59	.37	1	.47	.88
42	I feel myself harmonious.	2.56±1.03	.47	.97	.51	.21	.65	.21	-.01	.61	.70
46	I lead a productive life.	2.84±0.85	.41	.97	.47	.11	.65	.13	.15	.72	.55
40	I have an inner strength that can solve my	2.96±0.98	.55	.97	.58	.18	.64	.29	.23	.57	.53
	difficulties and sufferings.
43	I feel that life given to me is wonderful.	2.69±0.98	.57	.97	.55	.31	.63	.20	.13	.73	.56
47	I try to develop myself better than my current	2.99±0.71	.30	.97	.52	-.01	.63	.02	.36	.66	.72
	status.
33	My life is filled with joy.	2.62±1.02	.58	.97	.47	.33	.54	.23	.16	.68	.51
44	I do what I like.	2.90±0.89	.45	.97	.55	.12	.52	.34	.14	.54	.37
39	I do not avoid new things arisen in my life.	3.04±0.79	.55	.97	.47	.25	.52	.36	.14	.50	.58
32	I know the reason that I exist.	2.79±1.08	.63	.97	.51	.38	.51	.26	.17	.68	.51
28	I accept the advice of others.	3.09±0.62	.45	.97	.65	.08	.16	.74	.28	.57	.45	.51	.87 1	.44	.88
25	I am not obsessed with ambition, failure, and	2.79±0.86	.50	.97	.57	.26	.03	.69	.15	.48	.27
	distress.
20	I accept my weaknesses and limitations as	3.02±0.75	.45	.97	.52	.18	.08	.68	.10	.49	.61
	they are.
21	I know who I am.	2.99±0.90	.47	.97	.61	.07	.42	.65	.05	.57	.51
27	I honestly concede my mistake.	3.13±0.66	.50	.97	.59	.11	.34	.65	.20	.55	.25
26	I try to live a life that is consistent with what I	3.04±0.77	.62	.97	.60	.30	.34	.62	.10	.59	.55
	believe.
23	I know what to do with the difficulties and	2.92±0.96	.55	.97	.53	.29	.31	.59	-.04	.63	.31
	sufferings of my life.
24	I try to be a mature person.	3.25±0.58	.53	.97	.51	.18	.35	.54	.25	.62	.27
34	I seek a worthwhile life even when faced with	2.93±0.84	.56	.97	.47	.26	.32	.51	.20	.74	.42
	difficulties and hardships.
37	I get the valuable meaning in my life while	2.86±0.90	.54	.97	.44	.24	.39	.44	.17	.60	.45
	taking care of others.
48	I am intimate with others and my	3.00±0.63	.45	.97	.69	.18	.36	.03	.73	.57	.34	.21	.64 .65	.68	.91
	neighborhoods.
49	I collaborate with others to develop the	3.07±0.64	.46	.97	.65	.17	.24	.21	.72	.60	.32
	community.
50	I listen to others’ stories.	3.19±0.59	.42	.97	.61	.13	.25	.17	.71	.80	.10
51	I respect others and my neighbors as they are.	3.10±0.63	.39	.97	.48	.15	.10	.27	.62	.68	.18
56	I value living creatures.	3.30±0.55	.37	.97	.45	.13	.03	.38	.54	.70	.14
	Eigen value					19.34	5.48	1.85	1.69			Model fit index:
	Explained variance (%)					43.9	12.4	4.2	3.8	Chi-square=2301(χ²/df=2.57, p<.001)					),
	Accumulative variance (%)					43.9	56.4	60.6	64.4	GFI=.67, CFI=.83, TLI=.83, RMSEA=.086,
	Number of items					19	10	10	5	PNF	I=.72
	Kaiser-Meyer-Olkin (KMO)						.94
	Bartlett’s test of sphericity		χ²=8277.90			df=9	46	p<.0	01
	Reliability: Cronbach’s α			Total .97	.98	.88	.89	.80	Total .96	.98	.86	.83	.79

M=Mean; SD=Standardized deviation; ITC=Corrected item to total correlation; alpha if item deleted=Cronbach’s alpha if the item was deleted; SRW=Standardized regression weight; SE=Standard error; RG=Related with God; ML=Meaning of life and self-integration; ST=Self-transcendence; AVE=Average variance extracted; CR=Construct reliability; GFI=Goodness fit index; CFI=Comparative fit index; TLI=Tucker-Lewis index; RMSEA=Root mean square error of approximation; PNFI=Parsimonious normed fit index.

Table 3.

Discriminant Validity of Average Variance Extracted and 95% Confidence Interval in Confirmatory Factor Analysis (N=211)

Factor name	Φ²				AVE
Factor name	RG	ML	ST	RO	AVE
Relation with God	1			.72
Meaning of life and self-	.37	1		.47
integration
Self-transcendence	.51	.76	1	.44
Relation with others,	.21	.40	.42	1 .68
neighborhoods, and nature
Criteria		AVE>Φ²
Factor A↔Factor B	Φ	SE Φ-2×SE	Φ+2×SE
RG↔ML	.37	.05 0.	.27 0.47
RG↔ST	.51	.06 0.	.39 0.63
RG↔RO	.21	.03 0.	.14 0.28
ML↔ST	.87	.05 0.	.77 0.97
ML↔RO	.63	.03 0.	.27 0.69
ST↔RO	.65	.03
Criteria	whether [Φ±2×SE] includes 1.0

SE=Standard error; Φ²=Squared correlation; Φ=Correlation; AVE= Average variance extracted; RG=Relation with God; ML=Meaning of life and self-integration; ST=Self-transcendence; RO=Relation with others, neighborhoods, and nature.

Table 4.

Correlation between New Version of Spirituality Assessment Scale (N-SAS) and Spiritual Assessment Scale (SAS) (N=211)

	r (p)
	N-SAS_RG	N-SAS_ST	N-SAS_ML	N-SAS_RO	N-SAS_Total
SAS_R	.51 (<.001)	.61 (<.001)	.58 (<.001)	.55 (<.001)	.68 (<.001)
SAS_T	.60 (<.001)	.60 (<.001)	.60 (<.001)	.29 (<.001)	.72 (<.001)
SAS_RS	.75 (<.001)	.62 (<.001)	.66 (<.001)	.38 (<.001)	.84 (<.001)
SAS_M	.43 (<.001)	.61 (<.001)	.72 (<.001)	.45 (<.001)	.63 (<.001)
SAS_Total	.66 (<.001)	.67 (<.001)	.69 (<.001)	.44 (<.001)	.81 (<.001)

SAS_R=SAS_relation; SAS_T=SAS_transcendence; SAS_RS=SAS_resource; SAS_M=SAS_meaning; N-SAS_RG=N-SAS_relation with God; N-SAS_ST=N-SAS_self transcendence; N-SAS_ML=N-SAS_meaning of life and self-integration; N-SAS_RO=N-SAS_relation with others, neighborhoods, and nature.

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