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Received: August 30, 2016
Revision Received: October 17, 2017
Accepted: November 16, 2017
OnlineFirst: January 30, 2017
Copyright © 2017 EDAM
eISSN: 2458-9675
spiritualpc.net
DOI 10.12738/spc.2017.1.0022 2017 February 2(1) 73–88
Research Article
SPIRITUAL PSYCHOLOGY AND COUNSELING
Citation: Ekşi, H., & Kardaş, S. (2017). Spiritual well-being: Scale development and validation. Spiritual Psychology and
Counseling, 2, 73–88. http://dx.doi.org/10.12738/spc.2017.1.0022
Abstract
The spiritual well-being scale was developed as a way of assessing how well adults' lives align with their values and their
understanding of ultimate meaning in personal, social, environmental, and transcendental terms. The items on the scale
were selected based on existing literature and essays addressing spirituality. The scale was then shown to 17 specialists in
spirituality and edited in response to their comments to produce the last version of each item. The scale, composed of 49
items, was then administered to 865 adults (498 women, 57.6%; 367 men, 42.4%). Based on the results, the item set was
then resolved to a 29-item scale, and Exploratory Factor Analysis revealed three significant dimensions of spirituality, which
are transcendence, harmony with nature, and anomie. Construct validity and reliability were empirically ascertained and
the goodness of fit was determined for the proposed model of spiritual well-being. (KMO: 951, when eigenvalue is 2; total
item explanation variance: 58.337 %). The ensemble of the model's coefficients are x²/sd = 4.11, RMESEA = .06, SRMR =
.50, NFI = .90, CFI = .92. The results show that the Spiritual Well-Being Scale has the ability to measure adults' spiritual
well-being in a valid and reliable manner.
Keywords
Spirituality • Spiritual well-being • Scale • Scale development • Reliability • Validity
Halil Ekşi1
Marmara University
Selami Kardaş2
Marmara University
Spiritual Well-Being:
Scale Development and Validation*
* This paper is based on the doctoral thesis of the second author supported by Marmara University BAPKO (numbered as
EGT-C-DRP-130116-0022).
1 Department of Educational Sciences, Marmara University, Istanbul, Turkey. Email: halileksi@marmara.edu.tr
2 Correspondence to: Selami Kardaş, Department of Educational Sciences, Marmara University, Goztepe Campus, Kadikoy
34722, Istanbul, Turkey. Email: selamikardas@gmail.com
Spiritüel İyi Oluş: Ölçek Geliştirme ve Geçerliği
Öz
İnsanın değer ve nihai anlamları doğrultusunda kişisel, toplumsal, çevresel ve trasandantal (aşkın) yönleriyle hayatlarını
anlama ve yaşama sürecini belirlemek amacıyla yetişkinlere yönelik geliştirilmiş bir ölçektir. Ölçeğin maddeleri ilgili
literatür ile diğer ölçeklerden yararlanılarak ve konuyla ilgili olan kişilere yazdırılmış kompozisyonlardan elde edilmiştir.
Konuyla ilgili çalışmaları olan 17 uzmanın görüşleri alınmış bunlar dikkate alınarak maddelere son hali verilmiştir. Son
aşamada toplam 49 maddeden oluşan çalışma 865 yetişkine (498 kadın, %57,6; 367 erkek, %42,4) uygulanmıştır. Yapılan
doğrulayıcı faktör analizi sonucunda 29 maddelik; aşkınlık, doğayla uyum ve anomi adlı 3 faktörlü bir yapı ortaya çıkmıştır.
Yapılan analizle birlikte ölçeğin yapı geçerliği ve güvenirliği bilimsel olarak ortaya çıkarılmış ve amaçlanan spiritüel iyi oluş
modeline uygun bir yapı ortaya çıkmıştır. (KMO: 951, Eigen değeri 2 olarak alındığında toplam madde açıklama varyansı
% 58,337). Modelin uyum indeksleri (x²/sd = 4.11, RMESEA = .06, SRMR = .50, NFI = .90, CFI = .92) şeklindedir. Spiritüel
İyi Oluş Ölçeği'nin geçerlik ve güvenirlik çalışmaları, ölçeğin yetişkinlerin spiritüel iyi olma hallerini geçerli ve güvenilir
olarak ölçme yeteneğine sahip olduğunu göstermektedir.
Anahtar Kelimeler
Spiritüellik • Spiritüel iyi oluş • Ölçek • Ölçek geliştirme • Geçerlik • Güvenirlik
SPIRITUAL PSYCHOLOGY AND COUNSELING
74
Morrison-Orton (2004) stated that, historically, there is no distinction between
religion and spirituality, and that, as a result, the growth of western secularism and
disillusionment with religiosity has led to the perception that science is the only
source of information for the psychological, social and physical diseases of society.
Hill and Pargament (2003) argued that developments in the elds of religiosity and
spirituality have demonstrated that these two concepts have a functional relation
with physical and mental health. Scheck-Varner (2009) asserted that spirituality, in
the widest sense, comprises numerous structures such as religiosity, participation
in religious communities, religious and spiritual practices, religious coping, and
spiritual well-being.
Spirituality and religiosity occupy an important place in human life as motivating
and harmonizing forces. Religion and spirituality are not concepts that enter one's
life only under certain conditions or at certain times; rather, they are ways of life
that challenge us to consistently seek, experience, strengthen, and preserve (Hill &
Pargament, 2003). Patneaude (2006) noted that spirituality is a multidimensional
structure and has been utilized in various contexts such as spirituality, spiritual
goodness and spiritual well-being. She summarizes the denitions of spirituality by
stating that there is a widespread conviction that spirituality is a universal experience,
that it consists of meaning, purpose, values and beliefs, that it has a relational nature
in which oneself, others and a higher being are involved, and that it contains a
transcendental element. According to the results of a study conducted by Zinnbauer
et al. (1997), spirituality and religiosity are concepts with different denitions. While
religiosity is associated with higher-level authoritarianism, religious orthodoxy, inner
religiosity, religious participation of one's parents, self-righteousness, and church
participation, spirituality is associated with mystic experiences, New Age beliefs and
practices, higher income and the experience of frustration with traditional religious
structures.
The status of spiritual health as an important part of general health was
acknowledged ofcially by the World Health Organization in 1998 (Robert, 2003).
Paloutzian and Ellison (1982) had already developed a scale to measure spiritual
well-being that included two subscales: religious and existential well-being. Unruh
(1997) observed that spirituality is dened in the health literature in one of seven
ways: (1) a relationship to God, spiritual well-being or a higher power, and a belief in
a reality greater than the self; (2) an understanding or sensation that spirituality comes
not from within the self but from outside of the self; (3) a state of transcendence or
connectedness that is indispensably related to belief in a higher being or power; (4)
an existential qualication of life that is not from the material world; (5) a sense of
meaning and purpose in life; (6) life power or integrating power of the person; and
(7) the sum of the above.
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
75
According to Chandler, Holden, and Kolander (1992), spirituality is related to the
innate capacity or tendency to seek and move beyond the individual's current location
of centeredness, reaching for a transcendence that involves increased knowledge and
love. Every experience that moves beyond an individual's old reference frame and
results in greater knowledge and love is a spiritual experience. A state of spiritual
wellness consists of the active pursuit of spiritual development or a balanced
openness to spiritual development. By adopting a holistic and theoretical approach
to personality, therapists are able to help and guide the whole person rather than
simply addressing one aspect of the person's life. Furthermore, spiritual wellness
involves psychological wellness and requires the adoption of a transcendental rather
than humanistic view. Spiritual psychotherapy seeks answers from a transcendent
God. Spiritual wellness integrates all dimension of life, including spirituality, with
each other (Baldwin, 2003).
As noted by Moberg and Brusek (1978), spiritual well-being is comprised of two
dimensions, the rst involving the relationship of a person with a higher power within
a certain system of religious beliefs, and the second involving the sense of meaning
and purpose in life. According to this denition, meaning and purpose in life can be
independent from a certain religious structure.
The National Interfaith Coalition on Aging (NICA, 1975) dened spiritual well-
being as the afrmation of wholeness which is blessed and fostered in relationship of
life with God, self, society, and environment. Ellison (1983) stated that researchers
had emphasized the signicance of the need to discover the qualities of well-being.
The above denition by NICA (1975) treats spiritual well-being as a two-dimensional
concept, i.e., religious and psychosocial. Ellison (1983) regards these dimensions
as horizontal and vertical dimensions of spiritual well-being. While the vertical
dimension expresses God or a higher power, the horizontal dimension expresses
purpose in and satisfaction with life.
Opatz (1986) dened spiritual well-being as willingness to seek the meaning and
purpose of human existence, a habit of questioning everything, and the comprehension
of abstract things that cannot be explained or understood easily. A spiritually good
person seeks harmony between the forces inside and outside himself. Paloutzian and
Ellison (1982) drew attention to public (religion) and private (existential harmony)
interpretations of spiritual practices and suggest that spiritual well-being can be better
understood if it is examined through these two dimensions. Kamya (2000) stated
that spiritual well-being is a powerful predictor of self-esteem and ability to cope
effectively with challenges and distresses, and examines spiritual well-being in two
dimensions, demonstrating a positive relationship between belief in a higher being
and feelings of meaning and purpose in life. Chapman (1987) points out that spiritual
well-being is linked to the ability to reach one's full potential, to explore purpose
SPIRITUAL PSYCHOLOGY AND COUNSELING
76
in life, to express oneself, and to take action. He also states that spiritual wellness
fosters growth in love, fun, and peace through the pursuit of a satisfactory life and
contribution to others to aid them improve their own spiritual health.
According to Seaward (1991), spiritual well-being incorporated concepts from
many disciplines such as psychology, sociology, philosophy, and theology which
collaboratively create an integrated characteristic network and are expressed as
emotions and behaviors within the spiritual paradigm. Spiritual well-being is a
complicated concept inuenced by a wide range of factors. As Emmons (1999) stated,
spiritual efforts bring about better health and well-being. Perseverance in the pursuit
of transcendental purposes provides a sense of empowerment, stability, support and
direction in critical times. It also acts as a unifying force on the personality even
under social and cultural conditions that would otherwise force the personality to
splinter, and offers not only goals in life but also methods of reaching them.
No previous studies on spiritual well-being have been conducted in Turkey, and
most studies on spirituality have been based on studies developed in other cultures.
It is certain, however, that literature on spirituality cannot be disengaged from the
cultural milieu in which it was produced. Therefore it is essential to be able to
measure spiritual well-being with a scale developed for the culture under study. We
have developed the Spiritual Well-Being Scale (SWBS) with the aim of measuring
the spiritual well-being of adults in Turkey.
Methods
Study Group
All data used in developing the SWBS was collected from adults. As the scale is
intended to measure the spiritual well-being of adults of all kinds, adulthood was the
only criterion required for participation. The ages of participants ranged from 16 to
54. The scale was administered to 498 females (57.6% of participants) and 367 males
(42.4% of participants). The participants took preliminary versions of the SWBS
through a website called Survey Monkey that collects data via the Internet.
Analysis Method
As the rst step in our Scale Development Study, we reviewed the literature
about spiritual well-being and analyzed other scales developed previously to
assess spiritual well-being or similar qualities. We then asked 57 adults interested
in spiritual well-being to write compositions about the subject including clear and
instructive denitions of it. Working within the framework of the data thus collected,
we generated 170 items. We attempted to include sensual, cognitive, and behavioral
items as Katz and Stotland (1959) recommended. Next, they were evaluated by three
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
77
experts in the eld and the number of items was decreased to 74 through the removal
of some items and the addition of others in response to their suggestions. The resulting
74-item draft of our scale was then shown to 15 other experts. In this process, each
expert response was coded as one of three Likert types (1 = Item is suitable, 2 = Item
should be revised, 3 = Item should be removed) on a questionnaire form that we
provided to them. Experts were invited to make corrections if necessary, and blanks
were left opposite the items for this purpose. Subsequently, the number of items was
decreased to 51 through the removal of some items according to content validity rate
as proposed by Veneziano and Hooper (1997). In addition, 18 items were edited again
according to the experts' suggestions. Finally, in response to the feedback received
in a pilot study, two more items were removed from the draft so that the draft nally
consisted of 49 items. Answers to the items are to be given in a ve-point rating scale
(1 = Not applicable to me at all, 2 = Not applicable to me, 3 = Somewhat applicable
to me, 4 = Quite applicable to me, 5 = Completely applicable to me).
After the pilot study, the instructions accompanying the scale were also edited.
The scale in its nal form was then administered to actual subjects: 897 adults in
total. When all results were examined, 32 response forms were found to have been
lled out incorrectly or were incomplete and were accordingly removed from the
evaluation. Thus useable data were acquired from 865 subjects in total and scale
development analyses were begun.
Statistical Analysis
Two statistics programs were used for data analysis. Exploratory factor analysis
was performed on the data in order to assess the SWBS's validity. The suitability
of the data for factor analysis was examined by means of the Kaiser-Meyer-Olkin
(KMO) parameter and the Bartlett sphericity test. In exploratory factor analysis,
the Principal Component Technique (Kleinbaum, Kupper & Muller, 1987; Zeller
& Karmines, 1978) was used. After exploratory factor analysis, conrmatory factor
analysis was performed on the same data set to analyze the relations between factors.
In order to assess the scale's reliability, Cronbach's alpha coefcient was calculated.
Findings
Reliability Analyses
Reliability that indicates the consistency of a range of measurements according
to Cronbach (1990), is related to how correctly a test or measurement tool measures
as well as to the consistency of the results obtained in different measurements
(Thompson, 2003). There are certain statistical methods for measuring the reliability
of Likert–type scales and for assessing the internal consistency of scales and their
subdimensions (Tavakol & Dennick, 2011).
SPIRITUAL PSYCHOLOGY AND COUNSELING
78
Validity Analyses
Item analyses are conducted to determine whether the items of a measurement
scale result in generating meaningful data, both together and within sub dimensions
of the scale. As part of our scale's validity study, we performed factor analysis, a
structural validity study that is used to determine how accurately the structure of the
target characteristic is measured using this scale that aims to determine the scale's
structure with regard to this feature (Tabachnick & Fidell, 2007). Factor analysis
has been used frequently in the elds of education, psychology, and health sciences
in recent years. One of its benets is that when complex statistical procedures are
incorporated, the process enables us to compare similar data across many studies and
experiments (Williams, Onsman, & Brown, 2010).
Two types of factor analyses exist. The rst is the examination type, in which
the researcher seeks information about the nature of the factors measured with the
measurement tool rather than simply testing a certain hypothesis while remaining
uninformed about the number of factors that the measurement tool measures.
Exploratory factor analysis is another name for this type. The second type, which
is used in experiments testing a hypothesis developed by a researcher in accordance
with a theory, is conrmatory factor analysis (DeCoster, 1998). Both types of factor
analyses were used in this scale's development. For validity procedures, factor
analysis was performed rst to determine groupings (factor) between items. Later on,
KMO and Bartlett's Test Values were determined, analysis of basic components was
conducted and, nally, varimax rotation procedures were carried out.
The suitability of our data for factor analysis was analyzed by means of the Kaiser-
Mayer-Olkin (KMO) coefcient and Bartlett's Sphericity test. The KMO coefcient
indicates whether a data matrix is suitable for factor analysis and whether the data
structure is suitable for factor extraction. For factorability, KMO should be higher
than 0.60. Bartlett's test examines whether there is a relation between variables within
the context of partial correlations. We also evaluated whether our research data were
suitable for factor analysis by examining the KMO and Barlett's Test results and
analyzing them as shown in Table 1 below in sequence.
Table 1
KMO vs Bartlett's Test Value
.950
Chi Square Value 15443.420
Bartlett's Test of Sphericity Degree of freedom 406
P .000
The KMO test is important for testing both whether the range is sufcient and
whether partial correlations are small or large. A good KMO score is close to 1 and
an unacceptable score is lower than .50. In the present study, the KMO value for the
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
79
SWBS was found to be excellent (.95). The Barlett's test result was 15443.420 ( <
.00), indicating that the values are meaningful and that the data used has a multivariate
normal distribution.
The rst factor analysis was performed on our 49 items. In the rst analysis, when
there is no rotation and the eigenvalue is set to 1, an eight-factor structure occurs.
The eight factors that emerge explain 59.26% of the total variance. Our analyzes
show that the factors with eigenvalues of 2 and over explain 47.15% of the total
variance. In the social sciences, explanation of between 40 and 60% of variance
is considered adequate. Thus the eigenvalue for our analyzes was set to 2, and the
remaining analyzes were continued in this way. When the eigenvalue was set to 2, a
three–factor structure emerged.
After this procedure, the analysis was continued using the Varimax rotation
technique to determine whether the factors were independent of one another. This
revealed that some items did not have the desired load values while others received
a common load from multiple factors. Items scoring below ( < .60) were thus
eliminated. The analysis was continuously repeated as items 8, 41, 10, 29, 31, 2, 7,
49, 35, 29, 15, 19, 1, 42, 22, 46, 36, 16, 37, and 6 were removed from the scale one by
one; thus the scale took on its nal form. The resulting 29-item scale assesses three
sub dimensions of spiritual well-being in its nal form. When the items in each sub
dimension are examined, the sub dimensions correlate reasonably.
Component Number
2928272625242322212019181716151413121110 987654321
Eigenvalue
12
10
8
6
4
2
0
Figure 1. Scree plot.
SPIRITUAL PSYCHOLOGY AND COUNSELING
80
As shown in Figure 1, the point where the graphical curve shows a rapid decline is
after the third factor. Subsequently, the curve moves in the same direction. Given this,
it is thought that the number of factors examined by the scale should be no more than
three. Eigenvalues and cumulative variance percentages for the three factors found
are shown in Table 2.
As can be seen from Figure 1 and Table 2, three factors emerge when the eigenvalue
is set at 2 and continuous analysis is applied. The total variance of these three factors
is 58.79%. The rst factor was observed to explain 31.38% of variance, the second
factor to explain 14.17%, and the third factor to explain 13.23%.
Table 2
Total Variance
Factors
Initial Eigenvalue Totals Total Factor Loads Rotated Totals of Factor Loads
Total Variance
%
Cumulative
%Total Variance
%
Cumulative
%Total Variance
%
Cumulative
%
1 10.425 35.947 35.947 10.425 35.947 35.947 9.101 31.383 31.383
2 3.723 12.837 48.785 3.723 12.837 48.785 4.110 14.173 45.556
3 2.901 10.004 58.789 2.901 10.004 58.789 3.838 13.233 58.789
4 .936 3.226 62.015
5 .845 2.913 64.928
6 .791 2.728 67.657
7 .707 2.438 70.094
8 .650 2.240 72.334
9 .631 2.176 74.510
10 .588 2.027 76.537
11 .555 1.914 78.451
12 .515 1.777 80.228
13 .492 1.695 81.923
14 .464 1.600 83.524
15 .460 1.586 85.110
16 .452 1.559 86.669
17 .436 1.503 88.172
18 .397 1.370 89.542
19 .373 1.285 90.827
20 .350 1.205 92.033
The nal states of item status and loads are presented in Table 3:
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
81
Table 3
SWBS's Item-Factor Structure
Items
Factors
Transcendence Harmony with Nature Anomie
Item 27 .881
Item 48 .873
Item 44 .862
Item 11 .852
Item 45 .824
Item 21 .818
Item 47 .797
Item 39 .758
Item 3 .727
Item 14 .695
Item 5 .693
Item 25 .693
Item 10 .669
Item 33 .644
Item 13 .638
Item 26 .785
Item 20 .761
Item 12 .736
Item 43 .725
Item 4 .702
Item 38 .699
Item 32 .643
Item 23 .819
Item 30 .778
Item 9 .744
Item 24 .705
Item 34 .701
Item 28 .665
Item 17 .643
When the eigenvalue is set to 2 and processed, it is seen that the scale consists of
three factors and that the items in each factor have high values (the lowest item load
value was .638 and the highest item load value was .881). There are no high-value
common loads affecting all three of the factors.
As a next step, reliability analysis of each sub-factor is performed. The Cronbach
Alpha values calculated on the basis of each factor are given in Table 4:
SPIRITUAL PSYCHOLOGY AND COUNSELING
82
Table 4
Cronbach's Alpha Value
Factors Cronbach's Alpha Value
1 (Transcendence) .953
2 (Harmony with Nature) .864
3 (Anomie) .853
Total .886
As shown in Table 4, our statistical analysis of the reliability of the scale found
that the the total reliability coefcients were sufciently high to be acceptable in
the social sciences. As for the reliability coefcients of the sub-dimensions, the
Cronbach's Alpha value of the transcendence sub-factor is α = .953, while that of the
harmony with nature sub-factor is .864 and that of the anomie sub-factor is .853. The
total Cronbach's Alpha value was calculated as α = .886. These results suggest that
the scale has high values at the point of internal consistency.
Table 5
Correlative Relations Between Sub-Factors
Factors Transcendence Harmony with Nature Anomie
Total .885** .585** .230**
Transcendence 1 .425** -.162**
Harmony with Nature 1 -.159**
Anomie 1
**p < .001
As shown in Table 5, the sub-factors have a meaningful relationship with each
other and with the total score in the positive direction as Pearson Correlation Analyses
were conducted to determine whether there was a signicant relationship between the
factors determined on the scale. The correlation of the Transcendence sub-factor to
the total score is (r = .885; p < .001), the correlation of the Harmony with Nature
sub-factor to the total score is (r = .585; p < .001) and the correlation of the Anomie
sub-factor to the total score is (r = .230; p < .001). This indicates that the sub-factors
are strongly correlated to the scale. These results are important to show that all factors
are within the same structure.
Criterion Validity
In order to determine the criterion validity for the SWBS, we tested it against the
Spiritual Orientation Scale developed by Kasapoğlu (2015) for the Transcendence
sub-factor, against the Self-denial sub-factor of the Nature Loyalty Scale adapted
to Turkish by Çakır, Karaarslan, Şahin, and Ertepınar (2015) for the Harmony with
Nature sub-factor and against the Social Wellness Scale adapted to Turkish by Akın,
Demirci, Çitemel, Sarıçam, and Ocakçı (2013) for the Anomie sub-factor. Each
sub-factor of the SWBS and the corresponding other scale or sub dimension were
administered to 72 students. Pearson Correlation Analysis was performed to test the
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
83
criterion validity by determining correlative relationships between scales or sub-
factors.
There is a signicant positive relationship between the Transcendence Sub-factor
of the SWBS and the Spiritual Orientation Scale (r = .94; p < .001), between the
Harmony with Nature Sub-factor of the SWBS and the Self-denial sub-factor of the
Nature Loyalty Scale (r = .74; p < .001) and between the Anomie Sub-factor of the
SWBS and the Social Wellness Scale (r = .34; p < .003). Thus statistically signicant
correlations were found between all subscales of the SWBS and other measurement
instruments assessing the same values according to our criterion validity analysis,
and the criterion validity of the SWBS is conrmed.
Conrmatory Factor Analysis
Figure 2. Conrmatory factor analysis.
The conrmatory factor analysis of SWBS and the values between factors are
shown in Figure 2. The goodness-of-t indices of the scale are given in Table 6.
Conrmatory factor analysis was performed on the same study group.
SPIRITUAL PSYCHOLOGY AND COUNSELING
84
Table 6
Fit Indices
Scale x²/sd RMSA S-RMR NFI CFI
4.11 .060 .050 .90 .92
Note: RMSEA: Root-Mean-Square Error Approximation; S-RMR: Standardized
Root Mean Square Residual; NFI: Normed Fit Index; CFI: Comparative Fit Index
Fit indices dene how compatible the analysis is with the trial data (McDonald
& Ho, 2002). Our analysis showed that the data were in compliance with the model.
Conclusion and Discussion
Descriptive factor analysis revealed the existence of three factors in the context of
continuous analysis with an eigenvalue of 2. The total variance explained by these
three factors is 58.79%. The scale items related to each factor were examined and the
sub-factors were named. The rst factor was called the "Transcendence" sub-factor,
the second was called the "Harmony with Nature" sub-factor and the third was called
the "Anomie" sub-factor.
Conrmatory factor analysis was performed in the last step, but rst, the ratio of
the chi-square value to the degree of freedom was checked. The chi-square value is
the traditional measure used to assess a model's overall t; it evaluates the magnitude
of the discrepancy between data and covariance matrices (Hu & Bentler, 1999).
There are certain limitations of the chi-square value when it is used as a t index
in analysis. The most important of these is its sensitivity to sample size. Chi-square
value is sensitive to sample size because it is essentially a statistical signicance
test, and it almost always rejects the model when large samples are used (Bentler &
Bonnet, 1980; Jöreskog & Sörbom, 1993). Given this, in this study which has a large
sample size (865 individuals), it is acceptable that the ratio of chi-square to degrees
of freedom is somewhat high (χ 2 /sd = 4.11) relative to the range of acceptable
values (2–5) (Tabachnick & Fidel, 2007). For this reason, other adjustment indices
should be taken into consideration. The next index, RMSA (Root Mean-Square Error
Approximation), indicates how well the unknown but optimally chosen coefcient
estimates t the model's data covariance matrix (Byrne, 1998). Though there are
various opinions on the value of RMSA, a score between .08 and .10 is generally
believed to indicate a moderate t and a score below .08 to indicate a good t
(MacCallum, Browne, & Sugawara, 1996). In our working model, as seen in Table
6, the RMSA value is .060 and corresponds to a good t. In another index, SRMR
(Standardized Root Mean Square Residual), a score below .08 corresponds to a good
t and a score below .10 corresponds to a moderate t (Brown, 2006; Hu & Bentler,
1999). For the NFI (Normed Fit Index), Bentler and Bonnet (1980) and Byrne (1994)
hd stated that a score of .90 or above corresponds to a good t; the .90 NFI value
Ekşi, Kardaş / Spiritual Well-Being: Scale Development and Validation
85
in our model thus indicates a good t. The next index, the CFI (Comparative Fit
Index), is included in all Structural Equation Model programs and is one of the most
commonly used t indices since it is one of the measures least affected by sample size
(Fan, Thompson, & Wang, 1999). CFI values exceeding .95 indicate a perfect t (Hu
& Bentler, 1999), while values over .85 indicate an acceptable t (Bollen, 1989). The
CFI value in the working model (.92) indicates a good t.
As a result of this validity and reliability analysis, the SWBS is shown to measure
the spiritual well-being of adults in a reliable and valid manner. It should be noted
that this scale has not been tested for validity and reliability in children.
References
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Appendix
Spiritual Well-Being Scale
Ltfen aşağıdaki ifadeleri okuduktan sonra kendinizi değerlendirip sizin için
en uygun seçeneğin numarasını işaretleyiniz. Numaraların anlamları:
(1) Bana Hiç Uygun Değil
(2) Bana Uygun Değil
(3) Bana Biraz Uygun
(4) Bana Oldukça Uygun
(5) Bana Tamamen Uygun
Ltfen her ifadeye mutlaka TEK yanıt veriniz ve kesinlikle BOŞ
bırakmayınız. En uygun yanıtları vereceğinizi mit eder katkılarınız için
teşekkr ederiz.
Bana hiç uygun değil
Bana uygun değil
Bana biraz uygun
Bana oldukça uygun
Bana tamamen uygun
1. İlahi bir gce bağlı olmak bana gven verir. (1) (2) (3) (4) (5)
2. Doğaya saygı duyulması gerektiğini dşnrm. (1) (2) (3) (4) (5)
3. Hayata dair bir hoşnutsuzluk duygusu hissederim. (1) (2) (3) (4) (5)
4. Bir problemle karşılaştığımda Allah'ın yardımını hissederim. (1) (2) (3) (4) (5)
5. Allah'ın gizli ve açık tm duygu ve dşncelerimi bildiğine inanırım. (1) (2) (3) (4) (5)
6. Btn canlıların saygıyı hak ettiğini dşnrm. (1) (2) (3) (4) (5)
7. Hayatımda byk bir boşluk var. (1) (2) (3) (4) (5)
8. Gnlk hayatta Allah'ın kudretine şahit olurum. (1) (2) (3) (4) (5)
9. Allah'ın beni sevdiğine ve önemsediğine inanırım. (1) (2) (3) (4) (5)
10. Yeryzndeki tm canlılara iyi davranırım. (1) (2) (3) (4) (5)
11. Hayattan zevk almam. (1) (2) (3) (4) (5)
12. Hayatımın her anında Allah'ın varlığını hissederim. (1) (2) (3) (4) (5)
13. Daha gçl bir varlığa sığınma duygusu beni rahatlatır. (1) (2) (3) (4) (5)
14. Kendimi doğanın bir parçası olarak görrm. (1) (2) (3) (4) (5)
15. Hayatımın amacını halen bulabilmiş değilim. (1) (2) (3) (4) (5)
16. Yaşadığım her olayda bir hayır olduğuna inanırım. (1) (2) (3) (4) (5)
17. İnancım, nasıl bir hayat sreceğime dair bana yol gösterir. (1) (2) (3) (4) (5)
18. Yeryzndeki btn canlıların hakları benim için önemlidir. (1) (2) (3) (4) (5)
19. Sorunlarımı çözmeye nereden başlayacağımı bilemem. (1) (2) (3) (4) (5)
20. Yalnız kaldığımda Allah'ı ve yarattıklarını dşnrm (tefekkr ederim). (1) (2) (3) (4) (5)
21. İnanç ve değerlerim, zorluklar karşısında dayanabilme gcm arttırır. (1) (2) (3) (4) (5)
22. Doğayla uyum içinde yaşarım. (1) (2) (3) (4) (5)
23. Zorluklar yaşadığımda bunalmış hissederim. (1) (2) (3) (4) (5)
24. İnancım, yaşadığım sıkıntılarda dahi olumlu taraarın olabileceğini
görmemi sağlar. (1) (2) (3) (4) (5)
25. Hayatta hiçbir şey sebepsiz değildir. (1) (2) (3) (4) (5)
26. Hayatın beni mutsuz eden olaylardan ibaret olduğunu dşnrm. (1) (2) (3) (4) (5)
27. Her şeyin elimde olmadığını bilmek zldğm olaylar karşısında bir teselli
kaynağıdır. (1) (2) (3) (4) (5)
28. Yeryzndeki her doğal varlığın eşsiz olduğuna inanırım. (1) (2) (3) (4) (5)
29. Dnya hayatının geçici olduğuna inanmak beni hırslarımdan arındırır. (1) (2) (3) (4) (5)
... The Three-Factor Spiritual Well-Being Scale was developed and introduced to the literature by Ekşi and Kardaş [17], and it aims to assess how well adults' lives are compatible with their values and understanding of the ultimate meaning in terms of personal, environmental, and social aspects. During the development process of the scale, 17 experts were consulted, and the scale was given its final form. ...
... The scale is in the form of a 5-point Likert-type scale. The scale is scored ranging from 1= "Not applicable to me at all" to 5= "Completely applicable to me." Items "1, 4,5,8,9,12,13,16,17,20,21,24,25,27 and 29" of the scale constitute the transcendency dimension, items "2, 6, 10, 14, 18, 22 and 28" form the dimension of harmony with nature, and items "3, 7, 11, 15, 19, 23 and 26" make up the dimension of anomie. While scoring the scale, the anomie dimension is inversely scored. ...
... As a result of analyses, the construct validity and reliability of the scale were empirically determined, and a scale with the goodness of fit for the spiritual well-being model was produced (KMO:951, when eigenvalue is taken as 2, the item explanation of total variance is 58.337%). The Cronbach's alpha coefficient of the scale was found to be 0.86, and the Cronbach's alpha coefficients of the subscales of transcendency (i), harmony with nature (ii), and anomie (iii) were determined as 0.95 (i), 0.86 (ii) and 0.85 (iii) [17]. In our study, the Cronbach's alpha coefficient of the scale was identified as 0.93, and for the subscales, they were 0.91 (i), 0.82 (ii), and 0.89 (iii). ...
... It has three sub-scales. Items 1,3,5,6,9,10,13,18,25,27 assess the severe pain fear, items 2,4,7,12,19,22,23,24,28,30 assess the minor pain fear and items 8,11,14,15,16,17,20,21,26,29 assess the medical pain fear. The higher scale score indicates the higher fear. ...
... For the analysis of sampling adequacy, the KMO index for 150 samples was found as 0.88 to be close to perfect for factor analysis. In the literature, it was reported to be >0.50 (26)(27)(28)(29). Also for the suitability of the data set the Barlett's test of sphericity showed the sample was coming from a multivariate normal scatter and was found significant with values of (χ2=807.616, ...
... It is also important to test the range sufficiency and partial correlations whether they are small or large. These parameters showed the sampling was appropriate to conduct factor analysis (25,26,29). ...
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![Seher Ünver]()
- Fatma Nesrin Turan
Aim:There is a need to assess the pain fear levels of surgical patients simply and appropriately before the surgery. This study aimed to develop and test the psychometrics of an instrument to evaluate the fear of postoperative pain.Methods:This methodological study was conducted at four surgical clinics including general surgery, orthopedics and traumatology, neurosurgery, heart and vessel surgery of a university hospital between 28 March and 19 October 2018. Totally, 150 patients who were scheduled for elective surgery and at their preoperative day were included. This scale contained 10 items related to the postoperative pain sources and aimed to identify the pain fear of patients preoperatively. To measure the sampling adequacy, Kaiser-Meyer-Olkin index and Bartlett's test of sphericity was used. Explanatory and confirmatory factor analyses were conducted to evaluate the construct validity. The internal consistency of the scale was evaluated by Cronbach's alpha calculation. All hypotheses were tested in two directions.Results:The total variance explained 55.5% of the variance for one factor structure consisting of 10 items. The model fit index values through the confirmatory factor analysis were found to support this structure.Conclusion:The scale is appropriate to be used in clinical settings to quickly evaluate the elective surgical patients' fear level of postoperative pain preoperatively.
... A person's spiritual health guides their spiritual feelings in decisions and is an important factor in terms of establishing a balance between one's beliefs and values and their relationships with themselves and their environment (Hall, 2013). Spiritual health has been shown to correspond to a high level of spiritual well-being (Carey et al., 2011;Ekşi and Kardaş, 2017;Phenwan et al., 2019), which suggests that the relationship between spiritual health and physical health affects the self-esteem of individuals and enables individuals to have a positive outlook on life through the positive relationships they are able to establish with those around them (Chirico, 2016;Phenwan et al., 2019). Therefore, individuals who are spiritually healthy are able to establish a strong positive connection with other people and their environment, derive meaning from their lives through their devotion to a divine power and have self-awareness about any negative feelings and thoughts they have about life experiences (Chirico, 2016;Ekşi and Kardaş, 2017). ...
... Spiritual health has been shown to correspond to a high level of spiritual well-being (Carey et al., 2011;Ekşi and Kardaş, 2017;Phenwan et al., 2019), which suggests that the relationship between spiritual health and physical health affects the self-esteem of individuals and enables individuals to have a positive outlook on life through the positive relationships they are able to establish with those around them (Chirico, 2016;Phenwan et al., 2019). Therefore, individuals who are spiritually healthy are able to establish a strong positive connection with other people and their environment, derive meaning from their lives through their devotion to a divine power and have self-awareness about any negative feelings and thoughts they have about life experiences (Chirico, 2016;Ekşi and Kardaş, 2017). Studies conducted with different groups, such as palliative care patients, patients scheduled to undergo open heart surgery, and cancer patients, have found that individuals with high spiritual wellbeing have high levels of coping skills (Nakagawa et al., 2018;Sun et al., 2016;Paiva et al., 2015;Phenwan et al., 2019). ...
... This scale, developed by Ekşi and Kardaş, (2017), is a 5-point Likert-type, with response options ranging from 1 = Does not suit me at all to 5 = Completely suitable for me. The scale includes three sub-dimensions, "Transcendence", "Harmony with nature" and "Anomie". ...
The aim of the study is to determine how Islamic belief and spiritual well-being affect the attitudes of individuals towards organ donation. The study was designed as a descriptive-relational study and included the participation of 402 adults in the eastern Mediterranean region of Turkey. For data collection, a personal information form, the Organ Donation Attitude Scale, and the Spiritual Well-being Scale were used. A statistically significant relationship was observed between the acceptance of organ donation according to Islamic beliefs and organ donation attitude. A negative relationship was found between organ donation attitude and the scores on the anomie sub-dimension of the Spiritual Well-being Scale, while a positive relationship was found between organ donation attitude and the scores on the transcendence and harmony with nature sub-dimensions. It was concluded from the results that Islamic belief and spiritual well-being have an effect on the organ donation attitudes of individuals.
... The scale is a 5-point Likert-type self-assessment scale that was developed by Ekşi and Kardaş (2017) to measure spiritual well-being. The scale consists of 29 items. ...
... The scores of the items in the sub-factors are obtained by the sum of points of the answers given to the items of that sub-factor; the total spiritual well-being score is obtained by the sum of the sub-factor scores, and it ranges between 29 and 145 points. Higher scores indicate higher general spiritual well-being (Ekşi & Kardaş, 2017). The original Cronbach's alpha internal consistency coefficient of the scale is 0.82. ...
The purpose of this study was to explore the relationship between pregnant women's fear of coronavirus (COVID-19), depression, and spiritual well-being. This cross-sectional research was carried out with 336 pregnant women living in a city in the Eastern Anatolia region of Turkey between the 1st of March and 30th of March 2021. For data collection, the scales of the Fear of COVID-19, the Beck Depression Inventory, and the Spiritual Well-being were administered to the participants. The pregnant women's fear of COVID-19 was found to be at a moderate level, their depression was at a mild level, and their spiritual well-being was above the moderate level. It was found that there was a significant negative correlation between the spiritual well-being levels of pregnant women and their fear of COVID-19 and depression. Moreover, it was also found that there was a significant positive correlation between pregnant women's levels of fear of COVID-19 and depression (p < 0.001). It is recommended that relevant spiritual care practices can be disseminated and implemented effectively to reduce pregnant women's fear and depression during the pandemic. In addition, when providing care to pregnant women, health professionals can adopt a holistic approach to increase pregnant women's spiritual well-being.
... Spiritual Well-Being Scale (SWBS). This scale was developed by Eksi and Kardas [40] in order to understand how people live and understand life in personal, social, environmental, and faith terms. In the Turkish validity and reliability study of the scale, the Cronbach's alpha coefficient was determined as 0.88. ...
Objectives The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic. Design This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI). Results Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers' mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05). Conclusion In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.
... The score range is 0-20. The feeling of falling in personal accomplishment consists of 8 items (4,7,9,12,17,18,19,21) that define the feelings of competence and success in people working with people, it contains positive expressions and is reverse-coded, so the higher scores to be obtained show a decrease in personal accomplishment. The scale consists of 22 items and is a five-point Likert-type scale (scoring from 0 to 4). ...
This study was conducted as a descriptive study to determine the relationship between quality of work life, burnout and spiritual well-being in intensive care nurses. The research has been carried out on 211 nurses who work in the intensive care units in three public hospitals located in Turkey's Eastern Anatolia Region. In data collection, a form containing questions about the socio-demographic characteristics of individuals (age, gender, education level, marital status, economic status and receiving spiritual care education), "Spiritual Well-being Scale", "Nursing Work Life Scale" and "Maslach Burnout Scale" were used. T test was used for independent variables in the analysis of the data. In addition, the effect of independent variables on the dependent variable in numerical data was made using multiple regression analysis. In this study, it was determined that the spiritual well-being and emotional exhaustion levels of the nurses were above the middle level, and the mean scores of the nurses' quality of life, depersonalization and personal accomplishment were below the middle level. As a result, it was found that as the spiritual well-being levels of nurses working in intensive care increased, their burnout levels decreased and their work life quality increased. In addition, it was found that nurses who received spiritual care training had higher work life quality and lower burnout levels than nurses who did not receive training.
- Tuğba Aydın Yıldırım
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![Duygu Kes]()
The aim of this study was to investigate the relationship between coping with pain in individuals with chronic pain and their levels of spiritual wellbeing. The research was conducted as a cross-sectional study. It was conducted with 148 participants who were experiencing chronic pain. Data were collected using Sociodemographic Questionnaire, Pain Coping Questionnaire (PCQ) and Spiritual Well-Being Scale (SWBS). Data were analyzed using Kolmogorov-Smirnov/Shapiro-Wilk's test, skewness, kurtosis, Cronbach's α, mean, standard deviation, mean rank and binary logistic regression analysis. According to the data obtained, it was concluded that participants' levels of spiritual wellbeing were high, and spiritual wellbeing could be used as an effective mechanism for coping with pain. It is therefore recommended that training sessions and information meetings be organized to create awareness in health care and social work professionals and in those living with chronic pain and their families.
- Yüksel CAN ÖZ
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![Songül Duran]()
Spiritual well-being is among the factors that affect subjective recovery. This study aimed to explore the relationship between subjective recovery and spiritual well-being among psychiatric patients and to identify the factors that affected their subjective recovery. A descriptive, cross-sectional study was conducted with 96 patients admitted to the psychiatry clinic of a hospital. It was found that the patients had high subjective recovery assessment levels and medium levels of spiritual well-being. There was a positive association between the patients' subjective recovery assessments and their spiritual well-being, and spiritual well-being was a significant predictor of the subjective recovery level. It is recommended that mental health professionals focus on serving patients through a holistic healthcare approach and enhancing patients' subjective recovery levels through applications that will strengthen the spiritual dimension.
- Brian Luke Seaward
The following article presents a theoretical model based upon a synthesis of psychological theories regarding components of the human spirit, development of spiritual wellbeing and the manifestation of self-reliance. These components include an insightful relationship with both oneself and others, a strong personal value system, and a meaningful purpose in one's life. Based on this model, health education programs can incorporate exercises to remove existing roadblocks into existing classes or newly designed courses to promote development of these components of human spirit as part of the wellness paradigm.
- Anita M. Unruh
Spirituality is a key dimension in occupational therapy models of practice, but definitions of spirituality and its relationship to occupation have eluded us. Nevertheless, if the writings of people who are deeply involved in their occupations are examined, we discover that spirituality can be expressed through our engagement in occupations with personal meaning in our lives. In these reflections, the author examines spirituality as it is expressed by gardeners in their garden musings, and suggests that this occupation has the capacity to enrich spirituality in everyday life. Further study of the relationship between specific occupations and spirituality may illuminate the construct of spirituality and demonstrate the ways in which occupation can be used to facilitate a richer spiritual life for individuals and communities.
Source: https://www.researchgate.net/publication/315910160_Spiritual_Well-Being_Scale_Development_and_Validation
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