Journal of Religion and Health

, Volume 51, Issue 4, pp 1239–1260 | Cite as

Multidimensional Assessment of Spirituality/Religion in Patients with HIV: Conceptual Framework and Empirical Refinement

  • Magdalena Szaflarski
  • Ian Kudel
  • Sian Cotton
  • Anthony C. Leonard
  • Joel Tsevat
  • P. Neal Ritchey
Original Paper

Abstract

A decade ago, an expert panel developed a framework for measuring spirituality/religion in health research (Brief Multidimensional Measure of Religiousness/Spirituality), but empirical testing of this framework has been limited. The purpose of this study was to determine whether responses to items across multiple measures assessing spirituality/religion by 450 patients with HIV replicate this model. We hypothesized a six-factor model underlying a collective of 56 items, but results of confirmatory factor analyses suggested eight dimensions: Meaning/Peace, Tangible Connection to the Divine, Positive Religious Coping, Love/Appreciation, Negative Religious Coping, Positive Congregational Support, Negative Congregational Support, and Cultural Practices. This study corroborates parts of the factor structure underlying the Brief Multidimensional Measure of Religiousness/Spirituality and some recent refinements of the original framework.

Keywords

Spirituality Religion HIV Brief Multidimensional Measure of Religiousness/Spirituality 

References

  1. Belcher, A. E., Dettmore, D., & Holzemer, S. P. (1989). Spirituality and sense of well-being in persons with AIDS. Holistic Nursing Practice, 3(4), 16–25.PubMedGoogle Scholar
  2. Bernstein, K., Lyon, M. E., & D’Angelo, L. J. (2009). “Will you pray with me?” Do HIV-infected adolescents want their care providers involved in their religious or spiritual lives? Journal of Adolescent Health, 44(2), S25.CrossRefGoogle Scholar
  3. Bormann, J. E., Gifford, A. L., Shively, M., Smith, T. L., Redwine, L., Kelly, A., et al. (2006). Effects of spiritual mantram repetition on HIV outcomes: A randomized controlled trial. Journal of Behavioral Medicine, 29(4), 359–376.PubMedCrossRefGoogle Scholar
  4. Braxton, N. D., Lang, D. L., Sales, J. M., Wingood, G. M., & DiClemente, R. J. (2007). The role of spirituality in sustaining the psychological well-being of HIV-positive black women. Women and Health, 46(2–3), 113–129.Google Scholar
  5. Canada, A. L., Murphy, P. E., Fitchett, G., Peterman, A. H., & Schover, L. R. (2008). A 3-factor model for the FACIT-Sp. Psychooncology, 17(9), 908–916.PubMedCrossRefGoogle Scholar
  6. Cotton, S., McGrady, M. E., & Rosenthal, S. L. (2010). Measurement of religiosity/spirituality in adolescent health outcomes research: Trends and recommendations. Journal of religion and health, Feb 2. [Epub ahead of print].Google Scholar
  7. Cotton, S., Puchalski, C. M., Sherman, S. N., Mrus, J. M., Peterman, A. H., Feinberg, J., et al. (2006). Spirituality and religion in patients with HIV/AIDS. Journal of General Internal Medicine, 21(5), S5–S13.PubMedCrossRefGoogle Scholar
  8. Dalmida, S. G. (2006). Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: Integrating spirituality into mental health care. Issues in Mental Health Nursing, 27(2), 185–198.PubMedCrossRefGoogle Scholar
  9. DeVellis, R. F. (1991). Scale development: Theory and applications (Vol. 26). Newbury Park, CA: SAGE.Google Scholar
  10. Ellison, C. G., & Levin, J. S. (1998). The religion-health connection: Evidence, theory, and future directions. Health Education and Behavior, 25(6), 700–720.PubMedCrossRefGoogle Scholar
  11. FACIT. (2007). Functional Assessment of Chronic Illness Therapy. Welcome. Available at: http://www.facit/org/about/welcome.aspx. Accessed 26, February, 2010.
  12. Fetzer Institute and National Institute on Aging Working Group. (1999; reprinted 2003). Multidimensional measurement of religiousness/spirituality for use in health research: A report of a national working group. Kalamazoo, MI: Fetzer Institute.Google Scholar
  13. Garber, M., Hanusa, B. H., Switzer, G. E., Mellors, J., & Arnold, R. M. (2007). HIV-infected African Americans are willing to participate in HIV treatment trials. Journal of General Internal Medicine, 22(1), 17–42.PubMedCrossRefGoogle Scholar
  14. Guillory, J. A., Sowell, R., Moneyham, L., & Seals, B. (1997). An exploration of the meaning and use of spirituality among women with HIV/AIDS. Alternative Therapies in Health and Medicine, 3(5), 55–60.PubMedGoogle Scholar
  15. Hall, D. E., Koenig, H. G., & Meador, K. G. (2009). Episcopal measure of faith tradition: A context-specific approach to measuring religiousness. Journal of Religion and Health, 49(2), 164–178.PubMedCrossRefGoogle Scholar
  16. Hall, D. E., Meador, K. G., & Koenig, H. G. (2008). Measuring religiousness in health research: Review and critique. Journal of Religion and Health, 47(2), 134–163.PubMedCrossRefGoogle Scholar
  17. Harris, S. K., Sherritt, L. R., Holder, D. W., Kulig, J., Shrier, L. A., & Knight, J. R. (2008). Reliability and validity of the Brief Multidimensional Measure of Religiousness/Spirituality among adolescents. Journal of Religious Health, 47(4), 438–457.CrossRefGoogle Scholar
  18. Hill, P. C., & Hood, R. W. (1999). Measures of religiosity. Birmingham, Ala: Religious Education Press.Google Scholar
  19. Idler, E. L., Musick, M. A., Ellison, C. G., George, L. K., Krause, N., Ory, M. G., et al. (2003). Measuring multiple dimensions of religion and spirituality for health research: Conceptual background and findings from the 1998 General Social Survey. Research on Aging, 25(4), 327–365.CrossRefGoogle Scholar
  20. Ironson, G., & Kremer, H. (2009). Spiritual transformation, psychological well-being, health, and survival in people with HIV. International Journal of Psychiatry in Medicine, 39(3), 263–281.PubMedCrossRefGoogle Scholar
  21. Ironson, G., Kremer, H., & Ironson, D. (2006a). Spirituality, spiritual experiences, and spiritual transformations in the face of HIV. In J. D. Koss & P. Hefner (Eds.), Spiritual transformation and healing: Anthropological, theological, neuroscientific, and clinical perspectives (pp. 241–262). Lanham, MD: AltaMira Press.Google Scholar
  22. Ironson, G., Solomon, G. F., Balbin, E. G., O’Cleirigh, C., George, A., Kumar, M., et al. (2002). The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Annals of Behavioral Medicine, 24(1), 34–48.PubMedCrossRefGoogle Scholar
  23. Ironson, G., Stuetzle, R., & Fletcher, M. A. (2006b). An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. Journal of General Internal Medicine, 21(5), S62–S68.PubMedCrossRefGoogle Scholar
  24. Jenkins, R. A. (1995). Religion and HIV: Implications for research and intervention. Journal of Social Issues, 51, 131–144.CrossRefGoogle Scholar
  25. Johnstone, B., Yoon, D. P., Franklin, K. L., Schopp, L., & Hinkebein, J. (2009). Re-conceptualizing the factor structure of the Brief Multidimensional Measure of Religiousness/Spirituality. Journal of Religion and Health, 48(2), 146–163.PubMedCrossRefGoogle Scholar
  26. Jöreskog, K. G., & Sörbom, D. (2006). LISREL 8.8 for Windows [Computer software]. Lincolnwood, IL: Scientific Software International, Inc.,Google Scholar
  27. Kendler, K. S., Liu, X. Q., Gardner, C. O., McCullough, M. E., Larson, D., & Prescott, C. A. (2003). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. The American Journal of Psychiatry, 160(3), 496–503.PubMedCrossRefGoogle Scholar
  28. Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York: Guilford Press.Google Scholar
  29. Koenig, H. G. (2008a). Concerns about measuring “spirituality” in research. The Journal of Nervous and Mental Disease, 196(5), 349–355.PubMedCrossRefGoogle Scholar
  30. Koenig, H. G. (2008b). Medicine, religion, and health: Where science & spirituality meet. West Conshohocken, Pa: Templeton Foundation Press.Google Scholar
  31. Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford University Press.CrossRefGoogle Scholar
  32. Koenig, H., Parkerson, G. R., Jr., & Meador, K. G. (1997). Religion index for psychiatric research. The American Journal of Psychiatry, 154(6), 885–886.PubMedGoogle Scholar
  33. Kremer, H., & Ironson, G. (2009). Everything changed: Spiritual transformation in people with HIV. International Journal of Psychiatry in Medicine, 39(3), 243–262.PubMedCrossRefGoogle Scholar
  34. Miller, W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health. An emerging research field. The American Psychologist, 58(1), 24–35.PubMedCrossRefGoogle Scholar
  35. Mokuau, N., Hishinuma, E., & Nishimura, S. (2003). Validating a measure of religiousness/spirituality for Native Hawaiians. Pacific Health Dialog, 8(2), 407–416.Google Scholar
  36. Mrus, J. M., Leonard, A. C., Yi, M. S., Sherman, S. N., Fultz, S. L., Justice, A. C., et al. (2006). Health-related quality of life in veterans and nonveterans with HIV/AIDS. Journal of General Internal Medicine, 21(5), S39–S47.PubMedCrossRefGoogle Scholar
  37. Neff, J. A. (2006). Exploring the dimensionality of “religiosity” and “spirituality” in the Fetzer Multidimensional Measure. Journal for the Scientific Study of Religion, 45(3), 449–459.CrossRefGoogle Scholar
  38. Pargament, K. I. (1999; reprinted 2003). Religious/spiritual coping. In Fetzer Institute, National Institute on Aging Working Group. Multidimensional measurement of religiousness/spirituality for use in health research: A report of a national working group (pp. 43-56). Kalamazoo, MI: Fetzer Institute.Google Scholar
  39. Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543.PubMedCrossRefGoogle Scholar
  40. Pargament, K. I., McCarthy, S., Shah, P., Ano, G., Tarakeshwar, N., Wachholtz, A., et al. (2004). Religion and HIV: A review of the literature and clinical implications. The Southern Medical Journal, 97(12), 1201–1209.CrossRefGoogle Scholar
  41. Peterman, A. H., Brady, M. J., Fitchett, G., & Cella, D. (2000). Spirituality and quality of life among cancer and HIV/AIDS patients: the role of ethnicity. Savannah, GA: Paper presented at the Annual Meeting of the American Psychosomatic Society.Google Scholar
  42. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49–58.PubMedCrossRefGoogle Scholar
  43. Piedmont, R. L., Mapa, A. T., & Williams, J. E. G. (2007). A factor analysis of the Fetzer/NIA Brief Multidimensional Measure of Religiousness/Spirituality. Research in the Social Scientific Study of Religion, 17, 177–196.Google Scholar
  44. Ridge, D., Williams, I., Anderson, J., & Elford, J. (2008). Like a prayer: The role of spirituality and religion for people living with HIV in the UK. Sociology of Health & Illness, 30(3), 413–428.CrossRefGoogle Scholar
  45. SAS Institute Inc. (2002–2003). SAS 9.1 for Windows [Computer software]. Cary, NC, USA: SAS Institute Inc.Google Scholar
  46. Siegel, K., & Schrimshaw, E. W. (2002). The perceived benefits of religious and spiritual coping among older adults living with HIV/AIDS. Journal for the Scientific Study of Religion, 41, 91–102.CrossRefGoogle Scholar
  47. Sowell, R., Moneyham, L., Hennessy, M., Guillory, J., Demi, A., & Seals, B. (2000). Spiritual activities as a resistance resource for women with human immunodeficiency virus. Nursing Research, 49(2), 73–82.PubMedCrossRefGoogle Scholar
  48. Stewart, R. P., & Koeske, G. F. (2006). Religion, spirituality, and medicine. Lancet, 353, 664–667.Google Scholar
  49. Szaflarski, M., Ritchey, P. N., Leonard, A. C., Mrus, J. M., Peterman, A. H., Ellison, C. G., et al. (2006). Modeling the effects of spirituality/religion on patients’ perceptions of living with HIV/AIDS. Journal of General Internal Medicine, 21(5), S28–S38.PubMedCrossRefGoogle Scholar
  50. Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V., & Prigerson, H. G. (2006). Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine, 9(3), 646–657.PubMedCrossRefGoogle Scholar
  51. Trevino, K. M., Pargament, K. I., Cotton, S., Leonard, A. C., Hahn, J., Caprini-Faigin, C. A., et al. (2007). Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: Cross-sectional and longitudinal findings. AIDS and Behavior, 14(2), 379–389.PubMedCrossRefGoogle Scholar
  52. Tsevat, J., Leonard, A. C., Szaflarski, M., Sherman, S. N., Cotton, S., Mrus, J. M., et al. (2009). Change in quality of life after being diagnosed with HIV: A multicenter longitudinal study. AIDS Patient Care STDS, 23(11), 931–937.PubMedCrossRefGoogle Scholar
  53. Tuck, I., & Thinganjana, W. (2007). An exploration of the meaning of spirituality voiced by persons living with HIV disease and healthy adults. Issues in Mental Health Nursing, 28(2), 151–166.PubMedCrossRefGoogle Scholar
  54. Underwood, L. G., & Teresi, J. A. (2002). The Daily Spiritual Experience Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Annals of Behavioral Medicine, 24(1), 22–33.PubMedCrossRefGoogle Scholar
  55. Woods, T. E., Antoni, M. H., Ironson, G. H., & Kling, D. W. (1999). Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men. Journal of Psychosomatic Research, 46(2), 165–176.PubMedCrossRefGoogle Scholar
  56. Yoon, D. P., & Lee, E. K. (2007). The impact of religiousness, spirituality, and social support on psychological well-being among older adults in rural areas. Journal of Gerontological Social Work, 48(3–4), 281–298.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Magdalena Szaflarski
    • 1
    • 2
  • Ian Kudel
    • 3
    • 4
  • Sian Cotton
    • 2
  • Anthony C. Leonard
    • 1
  • Joel Tsevat
    • 3
    • 4
  • P. Neal Ritchey
    • 5
  1. 1.Department of Public Health Sciences, College of MedicineUniversity of CincinnatiCincinnatiUSA
  2. 2.Department of Family and Community MedicineCollege of Medicine, University of CincinnatiCincinnatiUSA
  3. 3.Department of Internal MedicineUniversity of Cincinnati, College of MedicineCincinnatiUSA
  4. 4.Veterans Healthcare System of Ohio (VISN 10)CincinnatiUSA
  5. 5.Department of SociologyUniversity of Cincinnati, McMicken College of Arts and SciencesCincinnatiUSA

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