By Austine Duru
The concept of spiritual well-being is not new to health literature and research. In fact, this concept has shown remarkable resilience and has resurfaced in research literature as well as in popular culture, but not without lingering problems related to its complexity and measurement limitations.
David Moberg, a sociologist, was perhaps one of the earliest individuals to attempt to measure spiritual well-being as a subject of sociological study. His “Spiritual Well-Being: Background and Issues” in 1971 introduced a 96-item questionnaire for evaluating spiritual well-being and opened the door for further research. However, it was not until 1982 that Raymond F. Paloutzian and Craig W. Ellison developed a more refined and streamlined 20-item spiritual well-being scale to explore both the subjective and objective aspects of the quality of life (Paloutzian & Ellison, 1991).
In 2002, the Functional Assessment of Chronic Illness Therapy Spiritual Well-being (FACIT-Sp) was introduced to the research community by Amy Peterman et al. This 12-item instrument is perhaps the best-known tool for measuring spiritual well-being from a broader perspective with a more inclusive set of criteria and language. It has been validated and tested in 15 languages and used in several studies that investigate the correlation of spiritual well-being, health and illness. The FACIT-Sp instrument measures two subscales: a measure of the sense of meaning and peace, and a measure of the role of faith in illness. The initial study, “Measuring Spiritual Well-being in People with Cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale” tested this instrument and was published in 2002. (The article is available in the Annals of Behavioral Medicine, for a fee.)
Another article that helped test and validate the FACIT-Sp instrument soon after it was published was Michael J. Fisch et al (2003), “Assessment of Quality of Life in Outpatients with Advanced Cancer: The Accuracy of Clinician Estimations and the Relevance of Spiritual Well-Being – A Hoosier Oncology Group Study.” This study explored the correlation between quality-of-life impairments and spiritual well-being among patients. For a fairly thorough review of both articles by Peterman et al. and Fisch et al. please see the ACPE Research Network by John Ehman.
Peterman, et al, also developed “The expanded version of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-Ex): Initial report of the psychometric properties.” This expanded instrument included 11 additional items that explore questions about forgiveness, appreciation, and connectedness.
These earlier investigations and measurement tools laid the groundwork to explore spiritual well-being in the context of illness and disease. This field has grown to include various disciplines, such as healthcare, entertainment, education, social work, human resources, economics and management studies, leadership studies, agriculture, fashion, television, major businesses, politics, political policy and citizenship. The more researchers learn about the connection between spirituality and overall wellness, the more interest it generates among the general public and within the academic community. Certainly this is driving integrative medicine, which is gaining significant traction in the medical community; so also is psychoneuroimmunology or immunopsychiatry, a concept with deep roots in spirituality, psychology, bioscience and neuroscience.
One recent creative application of well-being measure by a chaplain was the team well-being measure developed by chaplain Nancy Cook. Although this is not an investigative research work, Cook lays out a unique four-step process for raising employee well-being within a healthcare organization. Cook draws from the human and development models and the writings of Bernard Lonergan. The protocol is best suited for teams, but can also be adapted for individual use. To read more about Cook’s work, click here.
Subsequent scholarship has continued to build on the robust background of research in spiritual well-being and wellness. A key movement in this area, as evidenced by available literature, is a push toward community health, or healthier communities. Inspired by new regulations and incentive structures, organizations are looking at ways to impact the health of the broader community, not just individual members of the community. This has significant impact for healthcare organization, chaplains, communities, policy development and advocacy. Below, we offer abstracts of a few relevant and more recent investigations.
Austine Duru, BCC, is regional director of mission, ethics, and pastoral care at SSM Wisconsin.
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Meditation Awareness Training (MAT) for improved psychological well-being: a qualitative examination of participant experiences. Journal of religion and health, 53(3), 849-863.
Abstract: Mindfulness-based interventions are reported as being efficacious treatments for a variety of psychological and somatic conditions. However, concerns have arisen relating to how mindfulness is operationalized in mindfulness-based interventions and whether its ‘spiritual essence’ and full potential treatment efficacy have remained intact. This qualitative study used interpretative phenomenological analysis to examine participant experiences regarding the acceptability and effectiveness of a newly designed secularized intervention called meditation awareness training (MAT) that follows a more traditional Buddhist approach to meditation. Participants (with issues of stress and low mood) reported experiencing improvements in psychological well-being due to receiving MAT. The wider implications are discussed. This article can be accessed in full for a small fee: link.springer.com/article/10.1007/s10943-013-9679-0 .
Mohd Yusof, J., & Mohamad, M. (2014). The Influence of Spiritual Leadership on Spiritual Well-Being and Job Satisfaction: A Conceptual Framework. International Review of Management and Business Research, 3(4), 1868-1877.
Abstract: This study offers a conceptual framework which relates the influence of spiritual leadership on employees spiritual well-being and job satisfaction. Spiritual leadership is a relatively new concept in leadership literature. It aims to intrinsically motivate the leaders and the followers for their spiritual well-being. Job satisfaction is a critical concept with various antecedents and consequences. The situational and dispositional factors or the combination of both factors determine the level of satisfaction of the employees toward their job. How the leaders spiritual leadership influences employees’ spiritual well-being; and its relationship with the employees’ job satisfaction are discussed. The framework suggests that spiritual leadership is directly influences employees spiritual well-being and job satisfaction. It is also hypothesized that spiritual well-being is also directly influences job satisfaction and mediates the influence of spiritual leadership on job satisfaction. A full version of this article is publicly available at no cost: www.irmbrjournal.com/papers/1418117947.pdf
Lamis, D. A., Wilson, C. K., Tarantino, N., Lansford, J. E., & Kaslow, N. J. (2014). Neighborhood disorder, spiritual well-being, and parenting stress in African American women. Journal of Family Psychology, 28(6), 769.
Abstract: Using a culturally informed risk-protective framework, the purpose of this study was to examine spiritual well-being (existential, religious) as a moderator (protective factor) in the relation between neighborhood disorder (risk factor) and parenting stress in a high-risk sample of low-socioeconomic status (SES) African American women (N = 144). These women, who were primary caregivers of children between 8 and 12 years old, reported on disorder in their existential and religious well-being, neighborhoods, and 3 types of parenting stress. Women who perceived more disorder in their neighborhood had more parenting stress, and women who reported more existential and religious well-being had less parenting stress. Existential (characterized by a sense of purpose in life), but not religious (characterized by a sense of life in relation with God) well-being moderated the relation between neighborhood disorder and all types of parenting stress, such that women with medium or high levels of existential well-being had low levels of parenting stress at low levels of neighborhood disorder, but higher levels of parenting stress at higher levels of neighborhood disorder. No moderation effects were found at low levels of existential well-being. Results are framed in a context that emphasizes their relevance to incorporating family interventions that bolster culturally relevant resilience factors, such as spirituality, pertinent to low-SES African American families. The full text of this article is available for a fee: psycnet.apa.org/journals/fam/28/6/769/
Haugan, G., Rannestad, T., Hammervold, R., Garåsen, H., & Espnes, G. A. (2014). The relationships between self‐transcendence and spiritual well‐being in cognitively intact nursing home patients. International journal of older people nursing, 9(1), 65-78.
Abstract: Self-transcendence is considered a developmental process of personal maturity and a vital resource of well-being in later adulthood. Measurement of the associations between self-transcendence and spiritual well-being in cognitively intact nursing home patients has not been previously published. The aim of this study was to identify the relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients. A cross-sectional design using the self-transcendence scale and the FACIT-Sp spiritual well-being questionnaire was adopted. A sample of 202 cognitively intact nursing home patients in mid-Norway was selected to respond to the questionnaires in 2008 and 2009. Statistical analyses were conducted using lisrel 8.8 (Scientific Software International, Chicago, IL, USA) and structural equation modelling. A hypothesised structural equation model comprising a two-factor construct of self-transcendence and a three-factor construct of spiritual well-being demonstrated significant direct relationships between self-transcendence and spiritual well-being and total effects of self-transcendence on spiritual well-being. Implications for practice: Facilitating patients’ self-transcendence, both interpersonally and intrapersonally, might increase spiritual well-being among cognitively intact nursing home patients, which is seen to be of great importance to nursing home patients’ overall satisfaction and satisfaction with staff. The two-factor construct of self-transcendence and the three-factor construct of FACIT-Sp allow a more complex examination of the associations between the constructs and prove more specific guidelines for nursing interventions promoting well-being in nursing home patients. A full text of this article can be rented or purchased: onlinelibrary.wiley.com/doi/10.1111/opn.12018/full
West, Colin P., et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA internal medicine 174.4 (2014): 527-533.
Abstract: Objective: To test the hypothesis that an intervention involving a facilitated physician small-group curriculum would result in improvement in well-being. Design, Setting, and Participants: Randomized clinical trial of 74 practicing physicians in the Department of Medicine at the Mayo Clinic in Rochester, Minnesota, conducted between September 2010 and June 2012. Additional data were collected on 350 nontrial participants responding to annual surveys timed to coincide with the trial surveys… Results: Empowerment and engagement at work increased by 5.3 points in the intervention arm vs a 0.5-point decline in the control arm by 3 months after the study (P = .04), an improvement sustained at 12 months (+5.5 vs +1.3 points; P = .03). Rates of high depersonalization at 3 months had decreased by 15.5% in the intervention arm vs a 0.8% increase in the control arm (P = .004). This difference was also sustained at 12 months (9.6% vs 1.5% decrease; P = .02). No statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction were seen. In additional comparisons including the nontrial physician cohort, the proportion of participants strongly agreeing that their work was meaningful increased 6.3% in the study intervention arm but decreased 6.3% in the study control arm and 13.4% in the nonstudy cohort (P = .04). Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the trial intervention arm, decreased slightly in the trial control arm, and increased in the nontrial cohort (P = .03, .007, and .002 for each outcome, respectively). Conclusions and Relevance: An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months after the study. A full text of this articles is available for free in the JAMA Network, registration is required: archinte.jamanetwork.com/article.aspx?articleid=1828744
Merriam, S. B., & Kee, Y. (2014). Promoting community wellbeing: The case for lifelong learning for older adults. Adult Education Quarterly, 64(2), 128-144.
Abstract: Community wellbeing is a function of many factors working in concert to promote an optimal quality of life for all members of a community. It is argued here that the promotion of lifelong learning among older adults can significantly contribute to community wellbeing. The aging society is a worldwide phenomenon presenting both opportunities and challenges to community wellbeing. Research suggests that the more active, healthier, and educated older adults are, the less drain they are on family and community resources and services. At the same time, active and healthy elders contribute to community wellbeing through their accumulated life experience, expertise, and service. The relationship between lifelong learning and community wellbeing is argued from a social capital perspective. This framework contends that formal, nonformal, and informal learning activities of older adults promote an active and engaged lifestyle that helps create and preserve community. Issues of access and opportunity are also addressed. This article is available in full for a fee: aeq.sagepub.com/content/64/2/128.short