|By Prof. Dr., Arndt Büssing, MD
Zentrum für Integrative Medizin, Universität Witten/Herdecke, Germany
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Published data on the associations between spirituality/religiosity (SpR) and health are mainly from the USA and hence draw on a particular cultural background only. One may doubt that the results on the health promoting effects of SpR can easily be transferred to the more secular countries of Northern Europe. Moreover, one has to recognize different concepts of spirituality and different attitudes towards its utilization in the medical systems. As a consequence, there are several attempts to measure the `un-measurable´ with standardized questionnaires.
Generally, one may differentiate generic instruments which address common aspects of SpR, and unique instruments which address specific features of SpR in the context of chronic illness. Due to fact that a large proportion of individuals in Northern Europe do not regard themselves as religious or spiritual (up to 40% in our samples), we have designed and tested specific questionnaires to measure aspects of SpR:
- Spiritual/Religious Attitudes and Coping with Disease questionnaire (SpREUK; 16 items; Cronbach´s alpha = .93) avoids exclusive terms such as God, Jesus, church etc., and differentiates (1) Search for Meaningful Support/Access because of illness, (2) Trust in Higher Guidance, and (3) Positive Interpretation of Disease (reflection and hint to change life).
- SpR practices manual (SpREUK-P; 25 items; alpha = .90) is a generic instrument which measures the frequency of engagement in (1) Conventional religious practices, (2) Spiritual practices, (3) Existentialistic practices, (4) Humanistic practices, and (5) Gratitude/Reverence.
- Reliance on God´s Help scale (5 items; alpha = .92) from the AKU questionnaire which was used as a measure of intrinsic religiosity in response to illness as an internal adaptive coping strategy.
- BENEFIT scale (6 items; alpha = .92) addressing perceived support of life concerns through SpR.
- Spiritual needs questionnaire (SpNQ; 21 items; alpha = .92) differentiates (1) Religious Needs/Praying, (2) Existentialistic Needs, (3) Search Attention/Connection/Relief, (4) Search for Inner Peace, and (5) Actively Connecting / Giving.
- Aspects of Spirituality questionnaire (ASP; 25-items; alpha = .94) is a generic instrument which differentiates in its condensed form (1) Religious orientation (Prayer/Trust in God), (2) Search for Insight/Wisdom, (3) Conscious interactions (with others, self, environment), and (4) Transcendence conviction.
- Perception of God images (PGI, 10 items) is a generic instrument referring either to negative perceptions associated with God (alpha = 0.89) or to positive perceptions (alpha = 0.94), and Disinterest.
Data of 5,248 individuals indicate that, although about half of them had a strong belief that God will help and prayed to become healthy again, the Reliance on God’s Help was not generally associated with better physical or mental health-related quality of life. In patients with chronic pain conditions, there was just a moderate interest in SpR. However, positive disease interpretations such as Challenge and Value were clearly associated with Search for Meaningful Support/Access and Trust in Higher Guidance. In a sample of 1,229 individuals, we found that the ASP factors Search for Insight/Wisdom and Conscious interactions were highly expressed, while Religious orientation and esoteric Transcendence convictions were of lower relevance.
In conclusion, secular humanism and existentialism were of higher relevance in healthy individuals, while intrinsic religiosity was utilized particularly by patients with higher age and cancer. SpR should be regarded as a resource of meaning-focused coping rather than an independent contributor to health-related quality of life. The obvious inter-correlations between SpR and appraisal dimensions may have relevance for patients’ coping with illness and decision making. The tested instruments were found to be valid and reliable, and useful to address relevant aspects of Northern Europe´s spirituality.