Introducing the South African Spirituality Scale (SASS): measuring spirituality among medical students in a heterogeneous clinical environment

ABSTRACT

The purpose was to develop a standardised scale of spirituality that can be used in clinical settings across the heterogeneous spectrum of South African cultural, religious and faith traditions. Participants (n = 445) were recruited from local health science students and Factor Analysis with promax (oblique) rotation was used to determine underlying dimensions in the data. Finally, a Factor Analysis of 32 items was conducted with six factors explaining 61% of the variance. Internal consistency for each of the scales examined using Cronbach's alpha, was adequate with all alphas > .7. All the subscales were significantly correlated with p < .0001, with only the positive correlation between “Beyond” and “Meaning” (r = .63) found to be of note. Six distinct reasonably internally consistent factors were identified to underlie the responses to the spirituality scale items, namely: “Beyond”, “Awareness”. “Meaning”, “Others”, “Journey” and “Connection”. These results can be used to further develop this local measure of spirituality.

KEYWORDS:

• Spirituality
• measure
• South Africa
• heterogeneous clinical environment

Acknowledgments

Statistical analysis: Dr Petra Gaylard, Data Management and Statistical Analysis (DMSA). Consensus discussion on initial drafting of the 35-item scale: Prof Marie Poggenpoel, Department of Nursing, University of Johannesburg and Prof Chris Myburgh, Department of Educational Psychology, University of Johannesburg.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 De Jager-Meezenbroek et al. (2012): (1) One and two-dimensional scales (4): Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp-12), Brady et al. (1999); Spirituality Subscale of the Mental, Physical and Spiritual Well-being Scale (MPS), Vella-Brodrick and Allen (1995); Self-Transcendence Scale (STS), Reed (1991); Spiritual Well-being Scale (SWB), Ellison (1983); (2) Multi-dimensional scales (6): Prague Spirituality Questionnaire (PSQ), Rican and Janosova (2005); Spirituality Assessment Scale (SAS), Howden (1992); Spiritual Involvement and Beliefs Scale Revised Version (SIBS), Hatch et al. (1998); Spiritual Transcendence Scale (STS), Piedmont (1999): Spiritual Well-Being Questionnaire (SWBQ), Gomez and Fischer (2003); WHOQOL Spirituality, Religion and Personal Beliefs (WHOQOL SRPB), O’Connell et al. (2006).

2 Austin et al. (2018): (1) Group 1. Spirituality Index of Well-Being (SIWB), FACIT-Sp, WHOQOL-SRPB, BENEFIT Scale, EORTIC QLC-SW32, SpREUK, Brief Spirituality Scale (BSS), The Spirituality Scale (SS), Ironson-Woods Spirituality/Religiosity Index (IWSRI), Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), SIBS, Brief Pictorial Instrument for Assessing Spirituality, Index of Core Spiritual Experience (INSPIRIT), Daily Spirituality Experience Scale (DSES), Spirituality Distress Assessment Tool (SDAT), Religious Belief Scale (RBS), Spirituality and Spiritual Care Rating Scale (SSCRS) and QRFPC-25; (2) Group 2. Spiritual Needs Questionnaire (SNQ), Spirituality Distress Scale (SDS), Spiritual Needs Assessment for Patients (SNAP), Spiritual Needs Inventory (SNI), Spiritual Needs Assessment Tool (SDAT) and the Advanced Cancer Patients’ Distress Scale (ACPDS).

3 De Jager-Meezenbroek et al. (2012) considered: (a) Cronbach’s a C .70; (b) factor analytic confirmation of the clustering of items into subscales; (c) moderate or strong associations (r C .30; Cohen 1988) with other spirituality measures/subscales that measure transcendental aspects are moderately or strongly associated (r C .30) with religiosity measures; other psychometric aspects (other forms of convergent validity, discriminant validity and normal distribution of scale scores).

4 De Jager-Meezenbroek et al. (2012) referred to the three Fowler (1995) criteria: (a) Items should inquire about first hand experiences and not about, for example, hypothetical behavior or about causality; (b) items include a single question, questions should, for example, not include hidden contingencies; and (c) items have to be formulated such that they have a consistent meaning; therefore, words have to be used which are generally understandable and have the same meaning for respondents.