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Measurement of
Religiousness/
Spirituality
for Use in
Health
Research:
A Report of the Fetzer Institute/
National Institute on Aging Working Group
1999b
A publication of the John E. Fetzer Institute
The interpretations and conclusions contained in this publication represent the views of
the individual working group members and do not necessarily express any official opinion
or endorsement by either the National Institute on Aging, the U.S. Department of Health
and Human Services, the Fetzer Institute, its trustees, or officers.
Please contact the Fetzer Institute for additional copies of this publication, which may be
used and reprinted without special permission.
1999b
Multidimensional Measurement
of Religiousness/Spirituality
for Use in
Health Research:
A Report of the Fetzer Institute/
National Institute on Aging Working Group
October 1999
Reprinted October 2003
1999b i
Preface
added October 2003
This project was initially designed to bring The journals represented include American
together experts interested in addressing Journal of Psychiatry, Annals of Behavioral
measurement issues around religiousness/ Medicine, Gerontologist Medical Care, Journal of
spirituality and health from a multidimen- Health Psychology, Journal of the Scientific Study
sional perspective. The booklet, which in- of Religion, and the Journal of Adult Development.
cluded the Brief Multidimensional Measure
of Religiousness/Spirituality (BMMRS), was A paper on the conceptual background to the
published as a step to encourage the exami- work and the development of the BMMRS was
nation of religion/spirituality and health with recently published in the journal Research on
sensitivity to the depth and complexity of the Aging: “Measuring Multiple Dimensions of
topic. Religion and Spirituality for Health Research,”
Ellen L. Idler, Marc A. Musick, Christopher
The response to this effort has been much G. Ellison, Linda K. George, Neal Krause,
greater than anticipated. We continue to Marcia G. Ory, Kenneth I. Pargament, Lynda
receive daily requests for the booklet. To date, H. Powell, Lynn G. Underwood, David R.
2,000 copies of the publication have been Williams, 2003, 25:4.
distributed and another 1,200 have been
downloaded from the Internet. In a joint request for applications entitled
Studying Spirituality and Alcohol, sponsored
In a recently completed survey of booklet users by the National Institute on Alcohol Abuse
assisted by the Kercher Center for Social and Alcoholism of the National Institutes of
Research at Western Michigan University, Health and the Fetzer Institute, many of the
more than 80 percent of respondents believed 16 funded research projects used the mea-
the booklet was useful in enabling researchers sures from this booklet.
to enter, or to conduct better research in the
field of religiousness/spirituality and health Please check for additional information
outcomes. The most popular subscales being regarding the DSES on page 17.
used are the Religious/Spiritual Coping and
the Daily Spiritual Experiences Scales (DSES). We want to thank all researchers and scholars
One fourth of respondents have used the booklet who have provided us with thoughtful comments
in either a course that they teach, in a seminar, and suggestions concerning their projects and
or in a symposium. Practitioners in clinical work the needs of the field. We remain interested
are also using the booklet and the measure- in learning about the general dissemination
ment instruments in addition to researchers. of work that utilizes a multidimensional
approach and the BMMRS, as well as learning
As BMMRS and subscales are increasingly more about clinical uses of the booklet and
used in research projects, the number of BMMRS. Continue to give us feedback on the
publications citing the booklet indicates that use and development of this collection of
research projects are beginning to be published. scales by e-mailing us at info@fetzer.org.
ii 1999b
Table of Contents
Page
Preface ................................................................................................ ii
Introduction ..................................................................................... 1
Meaning ........................................................................................... 19
Values ............................................................................................... 25
Beliefs ............................................................................................... 31
Forgiveness ...................................................................................... 35
Commitment .................................................................................... 71
1999b iii
iv 1999b
Introduction
1999b 1
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
2 1999b
Introduction
1999b 3
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
4 1999b
Introduction
1999b 5
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
The NIA also included “Religion, Aging and • Eastern Virginia Medical School, Norfolk,
Health” as a topic of interest in its FY1997 Va: Religion, Health, and Psychological
Small Grant (R03) solicitation. The Small Well-being in the Aged
Grant Program provides support for pilot • Public Health Institute, Calif: Spirituality
research that is likely to lead to individual and Aging in the Alameda County Study
research grants. Research projects focusing • Bonnie Walker and Associates, Bowie, Md:
on the complex interrelationships among Spirituality Among the Elderly in Long-
religious and spiritual variables, other psy- term Care
chosocial-mediating factors, and health and • Tulane University, New Orleans, La:
functioning throughout a lifetime were Religion, Health, and Aging:
encouraged. Specific topics of interest in- Quantitative Issues
cluded the biopsychosocial mechanisms by
which religion, spirituality and/or religious Recent Developments
affiliations affect health; and the develop-
ment of rigorous, but parsimonious scales Since the initial publication of this
and indices that can be embedded in more report, the Brief Multidimensional
general studies of health and aging. Measure of Religiousness/Spirituality:
1999 was embedded in the 1997-1998
The following institutions are conducting General Social Survey (GSS), a random
research projects currently supported by the national survey of the National Data
Behavioral and Social Science Research Program for the Social Sciences. The
Program at NIA. basic purpose of this survey is to gather
and disseminate data on contemporary
Relationship Between Religion American society in order to monitor
and Health Outcomes and explain trends in attitudes and
behaviors, and to compare the United
• Arlene R. Gordon Research Institute, New States to other societies.
York, NY: Religiousness and Spirituality in
Vision-Impaired Elders The tables in Appendix A: Additional
• Rutgers University, New Brunswick, NJ: Psychometric and Population Distri-
Religion and Spirituality in Recovering bution Data include the questions and
from Cardiac Surgery domains, percentage distributions, and
• University of Michigan, Ann Arbor, Mich: psychometric data from the GSS and
Religion, Stress, and Physical/Mental reflect the efforts of the working group in
Health in African-Americans analyzing the data, the findings of which
• University of Michigan, Ann Arbor, Mich: have been prepared as a manuscript and
Role of Spirituality in Adjustment after submitted for publication (Idler et al
Cardiac Surgery 1999). The Fetzer Institute will have
• John W. Traphagen: Religion, Well-Being, copies of article reprints available upon
and Aging in Japan publication.
Measurement of Religiousness/Spirituality
Conclusion
• University of Florida-Gainesville,
Gainesville, Fla: Refining and Testing Religiousness and spirituality are important
and vital features of many people’s lives. The
a Spirituality Scale in the Elderly
working papers included here conclude that
• University of Michigan, Ann Arbor, Mich:
Religion, Aging, and Health these factors play an important role in health
and health outcomes. Discussion of religious-
ness, spirituality, and health in leading
6 1999b
Introduction
1999b 7
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
Griffith EH, Young J, Smith D. An analysis Jarvis GK, Northcott HC. Religious
of the therapeutic elements in a black differences in morbidity and mortality.
church service. Hosp Community Soc Sci Med. 1987;25:813-824.
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Gritzmacher SA, Bolton B, Dana RA. stress-induced myocardial ischemia and
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psychodynamic analysis. J Psychol factors in sudden cardiac death.
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Hadaway CK, Marler P, Chaves M. What the Kaplan B, Munroe-Blum H, Blazer D. Religion,
polls don’t show: a closer look at U.S. health, and forgiveness: traditions and
church attendance. Am Sociol Rev. challenges. In: Levin JS, ed. Religion in
1993;58:741-752. Aging and Health: Theological Founda-
Hood R. The construction and preliminary tions and Methodological Frontiers.
validation of a measure of reported Thousand Oaks, Calif: Sage
mystical experience. J Sci Study Religion. Publications; 1994.
1975;14:29-41. Kasl J, Friedman R, Leserman J,
House JS, Landis KL, Umberson D. Social Zuttermeister P, Benson H. Health out-
relationships and health. Science. comes and a new index of spiritual
1988;241:540-545. experience. J Sci Study Religion.
Howden J. Development and Psychometric 1990;30(2):203-211.
Characteristics of the Spirituality Kimble M, McFadden S, Ellor J, Seeber J,
Assessment Scale [dissertation]. Texas eds. Aging, Spirituality, and Religion.
Women’s University; 1992. Minneapolis, Minn: Fortress Press; 1995.
Iannaccone L. Why strict churches are Knekt P, Raitasaio R, Heliovaara M.
strong. Am J Sociol. Elevated lung cancer risk among persons
1994;99:1189-1211. with depressed mood. Am J Epidemiol.
Idler EL. Religion, health, and nonphysical 1996;144:1096-1103.
senses of self. Soc Forces. 1995;74:683-704. Koenig H. Construction and validation of
Idler EL. Religious involvement and the the Springfield Religiosity Schedule
health of the elderly: some hypotheses (long and short versions). In: Koenig H,
and an initial test. Soc Forces. Siley M, Gonzales JP, eds. Religion,
1987;66:226-238. Health, and Aging. Westport, Conn:
Idler EL, Kasl SV. Religion among disabled Greenwood Press; 1988.
and nondisabled elderly persons I: cross- Koenig HG. Aging and God: Spiritual Path-
sectional patterns in health practices, ways to Mental Health in Midlife and
social activities, and well-being. J Later Years. New York, NY:
Gerontol: Soc Sci. 1997;52B(6):S294-S305. Haworth; 1994.
Idler EL, Kasl SV. Religion, disability, Koenig HG, Ford SM, George LK, Blazer
depression, and the timing of death. DG, Meador KG. Religion and anxiety
Am J Sociol. 1992;97:1052-1079. disorder: an examination and compari-
Idler E, Musick M, Ellison C, George L, son of associations in young, middle-
Krause N, Levin J, Ory M, Pargament aged, and elderly adults. J Anxiety
K, Powell L, Williams D, Underwood L. Disord. 1993;7:321-342.
NIA/Fetzer Measure of Religiousness and Koenig HG, George LK, Blazer DG,
Spirituality: conceptual background and Pritchett JT, Meador KG. The relation-
findings from the 1998 General Social ship between religion and anxiety in a
Survey. In press. sample of community-dwelling older
adults. J Geriatr Psychiatry. 1993;26:65-93.
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Introduction
Koenig HG, George LK, Meador KG, Blazer Mattlin JA, Wethington E, Kessler RC.
DG, Ford SM. Religious practices and Situational determinants of coping and
alcoholism in a southern adult popula- coping effectiveness. J Health Soc Behav.
tion. Hosp Community Psychiatry. 1990;31:103-122.
1994;45:225-231. Mauger PA, Perry J, Freeman T, Grove D,
Koenig HG, Kvale JN, Ferrel C. Religion and McBride A, McKinney K. The measure-
well-being in later life. Gerontologist. ment of forgiveness: preliminary research.
1988;28:18-28. J Psychol Christianity. 1992;11:170-180.
Koenig HG, Moberg DO, Kvale JN. Religious McCullough M, Worthington E. Models of
activities and attitudes of older adults in interpersonal forgiveness and their
a geriatric assessment clinic. J Am applications to counseling: review and
Geriatr Soc. 1988;36:362-374. critique. Counseling Values. 1994;39:2-14.
Krause N. Measuring religiosity in later life. McEwen BS, Stellar E. Stress and the
Res Aging. 1993;15:170-197. individual mechanisms leading to disease.
Krause N. Social support, stress, and well- Arch Intern Med. 1993;153:2093-2101.
being among older adults. J Gerontol. Meador KG, Koenig HG, Hughes DC, Blazer
1986;41:512-519. DG, Turnbull J, George LK. Religious
Levine SP, Towell BL, Suarez AM. Platelet affiliation and major depression. Hosp
activation and secretion associated with Community Psychiatry. 1992;43:1204-1208.
emotional stress. Circulation. Oxman TE, Freeman DH, Manheimer ED.
1985;71:1129-1134. Lack of social participation or religious
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Patel CH, Marmot MM, Terry DJ, et al. Umberson D. Family status and health
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10 1999b
Daily Spiritual Experiences
Lynn G. Underwood, PhD
Vice President-Health Research
Fetzer Institute
Kalamazoo, Michigan
1999b 11
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
The interviews revealed that connection was In developing this instrument, the notion
an important concept. Western spirituality that one might not have a connection with
emphasizes a more personal connection with the transcendent, but that one might long for
God and other people, while Eastern spiritu- such a connection was discussed. Longing for
ality places more emphasis on connection connections with God, or the divine, is an
with all of life, and connection in unity. Many aspect of the spiritual life that crops up in
people have frequent interaction with the the mystical literature of many traditions
transcendent on a daily basis, looking to God and can easily be considered an element of
for strength, asking for help, and feeling daily spiritual experience of ordinary people.
guidance in specific circumstances. Emo- Such yearning is also manifested in a sense
tional support from the transcendent is of wanting to be closer to God, or to merge
manifested in feelings of being loved and with the divine.
comforted. A concept that emerges frequently
in the spiritual literature of both Eastern and In developing this domain, 9 key dimensions
Western traditions is the concept of spiritual were identified: connection with the tran-
integration, with a resulting sense of inner scendent, sense of support from the transcen-
harmony or wholeness. dent, wholeness, transcendent sense of self,
awe, gratitude, compassion, mercy, and
Another concept that emerged was the sense longing for the transcendent. The response
that one can have an existence that does not categories, except for question 16, relate to
solely depend on physical or mental aspects frequency, and make use of the following
of self or social definitions: that one is con- scale: many times a day, every day, most
nected to something beyond self or deeper days, some days, once in a while, never or
within self. The ability to transcend the almost never.
limits of one’s present situation frequently
comes from a spiritual and religious context. Connection with the Transcendent
van Kamm (1986) suggests that awe is the 1. I feel God’s presence.
central quality of the spiritual life and all 2. I experience a connection to all of life.
other aspects flow from that. Awe comes from
a realization that one is not the center of the As in our relationships with each other, this
universe, and from a sense of wonder or quality of intimacy can be very important.
mystery that the universe itself speaks of the These questions were developed to address
transcendent and can frame one’s approach. both people whose experience of relationship
David Steindal-Rast (1984) describes how with the transcendent is one of personal
gratefulness can provide a resting place for intimacy and those who describe a more
much of the rest of spiritual life. An attitude general sense of unity as their connection
of gratefulness suggests that life is a gift with the transcendent.
rather than a right.
Sense of Support from the Transcendent
Compassion is a central component to many A sense of support is expressed in 3 ways:
spiritual traditions (Smith 1991) and its strength and comfort, perceived love, and
capacity to benefit the one who is compas- inspiration/discernment.
sionate might be profitably explored in the
setting of health. Forgiveness, while devel- Strength and Comfort
oped as its own domain in the larger instru- 4. I find strength in my religion or spirituality.
ment, is linked with the concept of mercy, 5. I find comfort in my religion or spirituality.
which is employed in this scale. Giving others
the benefit of the doubt, dealing with others’ This dimension has been described as “social
faults in light of one’s own, and being gener- support from God.” The Index of Religiosity
ous are possible ways in which the spiritual measure—“I obtain strength and comfort
is evident in everyday life.
12 1999b
Daily Spiritual Experiences
from my religion” (Idler and Kasl 1992)— wholeness would be harder to experience
was broken into 2 parts, based on cognitive under adverse circumstances, but that such
interviews that revealed a perception that internal integration was still possible. The
strength and comfort were distinct. The word “deep” allows people to consider factors
items intend to measure a direct sense of other than psychological ease.
support and comfort from the transcendent.
They may prove highly correlated and may Transcendent Sense of Self
be combined as this instrument undergoes 3. During worship, or at other times when
further testing. connecting with God, I feel intense joy
which lifts me out of my daily concerns.
Perceived Love
9. I feel God’s love for me directly. This item attempts to identify the experience
10. I feel God’s love for me through others. of a lively worship service where one’s day-to-
day concerns can dissolve in the midst of
Individuals can believe that God is loving worship. Transcending the difficulties of
without feeling loved themselves. The emo- present physical ills or psychological situa-
tional support of feeling loved may prove tions may also be possible through an aware-
important in the relationship of religious/ ness that life consists of more than the physi-
spiritual issues to health outcomes. The cal and psychological. For further exploration
quality of love imputed to God has potential of this concept, see Underwood 1998. This
differences from the love humans give each was a particularly difficult dimension to
other, and there is a kind of love from others translate from metaphysical terms into more
which many attribute to God. God’s love can practical lay language.
be experienced as affirming, and can contrib-
ute to self-confidence and a sense of self- Sense of Awe
worth independent of actions. 11. I am spiritually touched by the beauty of
creation.
Inspiration/Discernment
7. I ask for God’s help in the midst of This dimension attempts to capture the ways
daily activities. in which people experience the transcendent.
8. I feel guided by God in the midst of A sense of awe can be provoked by exposure
daily activities. to nature, human beings, or the night sky,
and has an ability to elicit experience of the
These items address the expectation of divine spiritual that crosses religious boundaries
intervention or inspiration and a sense that a and affects people with no religious connec-
divine force has intervened or inspired. The tions (van Kaam 1986).
“guidance” item was most often deemed
similar to a “nudge” from God and more Sense of Gratitude
rarely as a more dramatic action. 12. I feel thankful for my blessings.
1999b 13
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
The emotional and physical feelings described please substitute another idea that calls to
by these items may buffer individuals from mind the divine or holy for you.”
psychological stress, which has been exten-
sively linked to health through specific physi- Proposed Items
ologic effects (Cohen et al 1995). Positive emo-
tional experiences have also been connected
DAILY SPIRITUAL EXPERIENCES-
with positive effects on the immune system, LONG FORM
independent of the negative effects of stress You may experience the following in your
(Stone 1994). Likewise, positive expectations daily life. If so, how often?
for outcomes have been linked to positive
immune effects (Flood et al 1993, Roberts et al 1. I feel God’s presence.
1995). There may also be overlap between 1 - Many times a day
endorsing a “sense of deep peace” and the 2 - Every day
condition that leads to or emanates from direct 3 - Most days
neurologic and endocrine effects similar to 4 - Some days
those identified during meditation (Benson 1975). 5 - Once in a while
6 - Never or almost never
The inclusion of this domain in health stud-
ies has great potential for establishing a 2. I experience a connection to all of life.
pathway by which religiousness and spiritu- 1 - Many times a day
ality might influence health, providing a 2 - Every day
possible link between certain religious/spiritual 3 - Most days
practices and/or cognition and health outcomes. 4 - Some days
This domain also provides an opportunity to 5 - Once in a while
assess direct effects of daily spiritual experi- 6 - Never or almost never
ences on physical and mental health.
3. During worship, or at other times when
Estimated Completion Time connecting with God, I feel joy which
Less than 2 min. lifts me out of my daily concerns.
1 - Many times a day
2 - Every day
Other Considerations
3 - Most days
We are hoping to tap into a trait. However, 4 - Some days
since this domain measures perceptions and 5 - Once in a while
feelings, scores may vary according to exter- 6 - Never or almost never
nal stressors and emotional state. Ideally,
psychosocial variables (such as emotional 4. I find strength in my religion or spirituality.
states, traits, and levels of stressors) would 1 - Many times a day
be addressed in concurrently administered 2 - Every day
measures, allowing researchers to account for 3 - Most days
confounding by these factors. 4 - Some days
5 - Once in a while
Please note: When introducing the Daily 6 - Never or almost never
Spiritual Experience items to subjects, please
inform them, “The list that follows includes 5. I find comfort in my religion or spirituality.
items you may or may not experience. Please 1 - Many times a day
consider if and how often you have these 2 - Every day
experiences, and try to disregard whether you 3 - Most days
feel you should or should not have them. In 4 - Some days
addition, a number of items use the word 5 - Once in a while
‘God.’ If this word is not a comfortable one, 6 - Never or almost never
1999b 15
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
6. I feel deep inner peace or harmony. 12. I feel thankful for my blessings.
1 - Many times a day 1 - Many times a day
2 - Every day 2 - Every day
3 - Most days 3 - Most days
4 - Some days 4 - Some days
5 - Once in a while 5 - Once in a while
6 - Never or almost never 6 - Never or almost never
7. I ask for God’s help in the midst of 13. I feel a selfless caring for others.
daily activities. 1 - Many times a day
1 - Many times a day 2 - Every day
2 - Every day 3 - Most days
3 - Most days 4 - Some days
4 - Some days 5 - Once in a while
5 - Once in a while 6 - Never or almost never
6 - Never or almost never
14. I accept others even when they do things
8. I feel guided by God in the midst of I think are wrong.
daily activities. 1 - Many times a day
1 - Many times a day 2 - Every day
2 - Every day 3 - Most days
3 - Most days 4 - Some days
4 - Some days 5 - Once in a while
5 - Once in a while 6 - Never or almost never
6 - Never or almost never
The following 2 items are scored differently.
9. I feel God’s love for me, directly.
1 - Many times a day 15. I desire to be closer to God or in union
2 - Every day with Him.
3 - Most days 1 - Not at all close
4 - Some days 2 - Somewhat close
5 - Once in a while 3 - Very close
6 - Never or almost never 4 - As close as possible
10. I feel God’s love for me, through others. 16. In general, how close do you feel to God?
1 - Many times a day 1 - Not at all close
2 - Every day 2 - Somewhat close
3 - Most days 3 - Very close
4 - Some days 4 - As close as possible
5 - Once in a while
6 - Never or almost never DAILY SPIRITUAL EXPERIENCES-
SHORT FORM
11. I am spiritually touched by the
beauty of creation. None provided.
1 - Many times a day
2 - Every day
3 - Most days
4 - Some days
5 - Once in a while
6 - Never or almost never
16 1999b
Daily Spiritual Experiences
The Daily Spiritual Experience Scale (DSES) A copy of the article, “The Daily Spiritual
has been included in a number of research Experience Scale: Development, Theoretical
studies, including the alcohol studies Description, Reliability, Exploratory Factor
mentioned in the preface as well as projects Analysis, and Preliminary Construct Validity
funded from the Fetzer Institute request for Using Health-Related Data” by Underwood
proposals, Scientific Research on Altruistic and Teresi, Annals of Behavioral Medicine
Love and Compassionate Love. We found that 2002, 24(1): 22-33, can be found at
many investigators without current self-report www.fetzer.org or by contacting info@fetzer.org.
measures directly addressing compassionate
love included two items from the DSES in
their study as a measure of compassion and
mercy. These items are DSES #13, “I feel a
selfless caring for others,” and DSES #14,
“I accept others even when they do things I
think are wrong.”
I accept others
I feel a even when they
selfless caring do things I
for others think are wrong
Many times
a day 9.8 9.4
Every day 13.2 15.5
Most days 20.3 32.4
Some days 24.0 23.0
Once in
a while 22.3 14.8
Never or
almost never 10.4 4.9
1999b 17
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
18 1999b
Meaning
Kenneth I. Pargament, PhD
Bowling Green State University
Department of Psychology
Bowling Green, Ohio
1999b 19
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
Measures of meaning have been criticized. the outcome than the process. Stated another
First, the scales appear to be multidimen- way, more measures evaluate whether the
sional. For example, factor analyses of the individual has found meaning than whether
PIL test (one of the most heavily used meaning the individual is searching for meaning. The
measures) reveal several factors which vary outcome-oriented approach to measurement
from study to study (Dufton and Perlman is apparently more vulnerable to confound-
1986, Chamberlain and Zika 1988). Dufton ing; the attainment of a sense of meaning
and Perlman (1986) in working with college and purpose in life seems difficult to separate
students created a two-factor solution (life from life satisfaction or low levels of depres-
satisfaction and life purpose) and another set sion. The process-oriented approach seems to
of items that did not use either of these be less vulnerable to confounding; whether
factors. Chamberlain and Zika (1988), work- people who are engaged in a search for mean-
ing with a sample of community women, ing are more likely to report better health
found a four-factor solution (meaning in status is an interesting question. In this vein,
life through goal commitment, contentedness Emmons has conducted a number of studies
with life, being in control, enthusiasm with that indicate significant relationships
life). They did, however, find a higher order between various personal strivings (efforts to
general factor. Other rationally derived attain a variety of goals in daily life) and
meaning scales include a number of indices of mental and physical health
subscales that seem to be related, tangen- (Emmons 1986, Emmons in press).
tially at best, to the core construct of mean-
ing. For example, an early form of the LAP The Religious Aspects of Meaning:
consisted of 7 subscales: goal seeking, future A key question for researchers is whether
meaning, existential vacuum, death accep- meaning is inherently religious or spiritual.
tance, life purpose, life control, and will to This question cuts to the heart of what it
meaning (Reker and Peacock 1981). The PIL means to be religious. From the functional
subscale by Ryff (1989) appears to measure tradition of religious definition, the search for
an active goal orientation (“I enjoy making meaning could be (and has been) defined
plans for the future and working to make as inherently religious (Pargament 1997).
them a reality”), as well as the sense of Anyone who searches for answers to ques-
meaning and purpose. tions of meaning from this point of view
would be defined as religious, regardless of
Criticisms can also be made of the confound- the nature of that search. The person who
ing of meaning with other health-related seeks meaning through science, drugs, power,
constructs, such as depression. The PIL scale, etc., would be considered as religious as the
for instance, correlates -.65 with the Minne- person who seeks meaning through transcen-
sota Multiphasic Personality Inventory dental means. From the substantive tradition
depression scale and -.58 with the Beck of religious definition, the search for meaning
Depression Inventory (Dyck 1987). The becomes religious only when it involves some
correlation is understandable; several items connection with the sacred.
on the PIL include responses about suicidal
ideation, emptiness and despair, and painful Meaning has traditionally been measured
and boring experiences. from the functional tradition. Most items on
meaning scales do not explicitly reference
It would be useful to distinguish the search God, higher powers, or spiritual matters. To
for meaning (a process) from the success or assess meaning from the perspective of this
failure of the search (the outcome). In fact, tradition, researchers could select the PIL
some of the factor-analytic results suggest test by Crumbaugh (the most widely used
this split (Dufton and Perlman 1986). The instrument), the Purpose and Coherence
scales seem to do a better job of measuring subscales from the LAP by Reker (conceptually
20 1999b
Meaning
sharper), or the PIL subscale from Ryff (linked in life and indices of health, particularly
to a larger theory of psychological well-being). mental health (Crumbaugh 1968, Zika and
It is also important to note that these scales Chamberlain 1987, Padelford 1974, Ryff
generally focus more on the attainment of 1989).
meaning (the outcome) than the search for
meaning (the process). Reker’s subscales, Proposed Items
however, do recognize this distinction.
MEANING-LONG FORM
No scales measure meaning from a substan- Instructions: Please circle how much you
tive religious perspective. The development agree or disagree with the following state-
of a more explicit religious and/or spiritual ments on the scale below.
meaning scale would be a useful addition to 1 - Strongly disagree
the literature. Because religious/spiritual 2 - Disagree
meaning lies at the core of meaning itself, 3 - Neutral
according to some theorists, an explicitly 4 - Agree
religious/spiritual meaning may add power to 5 - Strongly agree
the study of meaning (for example, a spiri-
tual meaning measure may predict health 1. My spiritual beliefs give meaning to my
above and beyond the effects of traditional life’s joys and sorrows.
meaning measures). An explicitly theistic 1 - Strongly disagree
meaning scale would consist of items such as: 2 - Disagree
“The events in my life unfold according to a 3 - Neutral
divine plan”; and “Without God, my life 4 - Agree
would be meaningless.” A spiritual meaning 5 - Strongly agree
scale would consist of items such as: “My
spirituality gives meaning to my life’s joys 2. The goals of my life grow out of my under-
and sorrows”; and “What gives meaning to standing of God.
my life is the knowledge that I am a part of 1 - Strongly disagree
something larger than myself.” These illus- 2 - Disagree
trative items are also better indicators of the 3 - Neutral
attainment of religious/spiritual meaning 4 - Agree
(the outcome) than the search for religious/ 5 - Strongly agree
spiritual meaning (the process).
3. Without a sense of spirituality, my daily
Studies of the search for religious/spiritual life would be meaningless.
meaning are also needed. Batson’s “quest” 1 - Strongly disagree
scale provides 1 useful tool for assessing the 2 - Disagree
degree to which the individual is engaged in 3 - Neutral
efforts to answer fundamental existential 4 - Agree
questions (Batson, Schoenrade, and Ventis 5 - Strongly agree
1993). Emmons’ research on personal
strivings could also be extended to include 4. The meaning in my life comes from feel-
studies of religious and spiritual strivings, or ing connected to other living things.
the degree to which personal strivings are 1 - Strongly disagree
sanctified (Emmons in press). 2 - Disagree
3 - Neutral
Association with Health 4 - Agree
5 - Strongly agree
A number of studies have found significant
relationships between the sense of meaning
1999b 21
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
5. My religious beliefs help me find a pur- 11. My life is significant because I am part of
pose in even the most painful and confus- God’s plan.
ing events in my life. 1 - Strongly disagree
1 - Strongly disagree 2 - Disagree
2 - Disagree 3 - Neutral
3 - Neutral 4 - Agree
4 - Agree 5 - Strongly agree
5 - Strongly agree
12. What I try to do in my day-to-day life is
6. When I lose touch with God, I have a important to me from a spiritual
harder time feeling that there is point of view.
purpose and meaning in life. 1 - Strongly disagree
1 - Strongly disagree 2 - Disagree
2 - Disagree 3 - Neutral
3 - Neutral 4 - Agree
4 - Agree 5 - Strongly agree
5 - Strongly agree
13. I am trying to fulfill my God-given
7. My spiritual beliefs give my life a sense of purpose in life.
significance and purpose. 1 - Strongly disagree
1 - Strongly disagree 2 - Disagree
2 - Disagree 3 - Neutral
3 - Neutral 4 - Agree
4 - Agree 5 - Strongly agree
5 - Strongly agree
14. Knowing that I am a part of something
8. My mission in life is guided/shaped by my greater than myself gives meaning
faith in God. to my life.
1 - Strongly disagree 1 - Strongly disagree
2 - Disagree 2 - Disagree
3 - Neutral 3 - Neutral
4 - Agree 4 - Agree
5 - Strongly agree 5 - Strongly agree
10. My relationship with God helps me find 16. My purpose in life reflects what I believe
meaning in the ups and downs of life. God wants for me.
1 - Strongly disagree 1 - Strongly disagree
2 - Disagree 2 - Disagree
3 - Neutral 3 - Neutral
4 - Agree 4 - Agree
5 - Strongly agree 5 - Strongly agree
22 1999b
Meaning
1999b 23
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
24 1999b
Values
Ellen Idler, PhD
Rutgers University
Department of Sociology
Institute for Health, Health Care Policy, and Aging Research
New Brunswick, New Jersey
1999b 25
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
negatively with the “individualist” value direct teachings in many faiths on the subject
domains of hedonism, stimulation, achieve- of love and concern for others; feelings of
ment, and self-direction, and positively with divine protection may encourage feelings of
the “collectivist” domains of tradition, con- security and friendliness to strangers. Ellison
formity, benevolence, and security. Some found that religious people were generally
value domains, such as power and universal- kind, as judged by the interviewers for the
ism, show little association with religion. National Survey of Black Americans (1992).
26 1999b
Values
1999b 27
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
28 1999b
Values
Ellison CG. Are religious people nice people? Schwartz SH, Huismans S. Value priorities
Evidence from the National Survey of and religiosity in four western religions.
Black Americans. Soc Forces. Soc Psychol Q. 1995;58:88-107.
1992;71:411-430. Williams RM. Values. In: Shils E, ed.
Ellison CG, George L. Religious involvement, International Encyclopedia of the Social
social ties, and social support in a south- Sciences. New York, NY: Macmillan; 1968.
eastern community. J Sci Study Religion. Wood J, Taylor S, Lichtman R. Social
1994;33:46-61. comparison in adjustment to breast
Gibbons F. Social comparison and depression: cancer. J Pers Soc Psychol.
company’s effect on misery. J Pers Soc 1985;49:1169-1183.
Psychol. 1986;51:140-148.
Gorsuch RL, McPherson SE. Intrinsic/extrinsic
measurement: I/E-revised and single-
item scales. J Sci Study Religion.
1989;28:348-354.
Kluckhohn C. Values and value-orientations
in the theory of action: an exploration in
definition and classification. In: Parsons
T, Shils E, eds. Toward a General Theory
of Action. Cambridge, Mass: Harvard
University Press; 1951:388-433.
Leak GK, Fish S. Religious orientation,
impression management, and self-decep-
tion: toward a clarification of the link
between religiosity and social desirability.
J Sci Study Religion. 1989;28:355-359.
Luks A. The Healing Power of Doing Good.
New York, NY: Ballantine; 1993.
Merton RK. Social Theory and Social
Structure. New York, NY: Free
Press; 1968.
Pollner M. Divine relations, social relations,
and well-being. J Health Soc Behav.
1989;30:92-104.
Rokeach M. Religious values and social
compassion. Rev of Religious Res.
1969a;11:24-39.
Rokeach M. The Nature of Human Values.
New York, NY: Free Press; 1973.
Rokeach M. Value systems in religion. Rev of
Religious Res. 1969b;11:3-23.
Schwartz SH. Universals in the content and
structure of values: theoretical advances
and empirical tests in 20 countries. Adv
Exp Soc Psychol. 1992;25:1-65.
Schwartz SH, Bilsky W. Toward a universal
psychological structure of human values.
J Pers Soc Psychol. 1987;53:550-562.
1999b 29
30 1999b
Beliefs
Ellen Idler, PhD
Rutgers University
Department of Sociology
Institute for Health, Health Care Policy, and Aging Research
New Brunswick, New Jersey
1999b 31
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
32 1999b
Beliefs
Bibliography
Beecher H. The powerful placebo. JAMA.
1955;159:1602-1682.
Benson H. Timeless Healing: The Power and
Biology of Belief. New York, NY: Simon
and Schuster; 1996.
Bowker J. The Meanings of Death.
Cambridge: Cambridge University
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Bowker J. Problems of Suffering in the
Religions of the World. Cambridge:
Cambridge University Press; 1970.
Idler EL, Kasl S. Religion, disability,
depression, and the timing of death.
Am J Sociol. 1992;97:1052-1079.
McCready WC, Greeley AM. The Ultimate
Values of the American Population.
Beverly Hills, Calif: Sage
Publications; 1976.
National Opinion Research Center. General
Social Surveys, 1972-1990: Cumulative
Codebook. Chicago, Ill: University of
Chicago; 1990.
Oxman TE, Freeman DH, Manheimer ED.
Lack of social participation or religious
strength and comfort as risk factors for
death after cardiac surgery in the elderly.
Psychosom Med. 1995;57:5-15.
Pressman P, Lyons JS, Larson DB, Strain JJ.
Religious belief, depression, and
ambulation status in elderly women with
broken hips. Am J Psychiatry.
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1999b 33
34 1999b
Forgiveness
Ellen Idler, PhD
Rutgers University
Department of Sociology
Institute for Health, Health Care Policy, and Aging Research
New Brunswick, New Jersey
1999b 35
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
36 1999b
Forgiveness
6. I often feel that no matter what I do now I 2. I have forgiven those who hurt me.
will never make up for the mistakes I 1 - Always or almost always
have made in the past. (Mauger et al) 2 - Often
1 - Always or almost always 3 - Seldom
2 - Often 4 - Never
3 - Seldom
4 - Never 3. I know that God forgives me.
1 - Always or almost always
Forgiveness of Others 2 - Often
7. I am able to make up pretty easily with 3 - Seldom
friends who have hurt me in some way. 4 - Never
(Mauger et al)
1 - Always or almost always Bibliography
2 - Often
Enright RD, Gassin E, Wu C-R.
3 - Seldom
Forgiveness: a developmental view.
4 - Never
J Moral Educ. 1992;21:99-114.
Hargrave T, Sells J. The development of a
8. I have grudges which I have held onto for
forgiveness scale. J Marital Fam Ther.
months or years. (Mauger et al)
1997;23:41-62.
1 - Always or almost always
Kaplan B, Munroe-Blum H, Blazer D.
2 - Often
Religion, health, and forgiveness:
3 - Seldom
traditions and challenges. In: Levin JS,
4 - Never
ed. Religion in Aging and Health.
Thousand Oaks, Calif: Sage
Forgiveness of Oneself
Publications; 1993.
9. I find it hard to forgive myself for some
Mauger PA, Perry J, Freeman T, Grove D,
things that I have done. (Mauger et al)
McBridge A, McKinney K. The measure-
1 - Always or almost always
ment of forgiveness: preliminary
2 - Often
research. J Psychol Christianity.
3 - Seldom
1992;11:170-180.
4 - Never
McCullough M, Worthington E. Models of
interpersonal forgiveness and their
10. I often feel like I have failed to live the
applications to counseling: review and
right kind of life. (Mauger et al)
critique. Counseling and Values.
1 - Always or almost always
1994;39:2-14.
2 - Often
Weiner B, Graham S, Peter O, Zmuidinas M.
3 - Seldom
Public confession and forgiveness. J Pers.
4 - Never
1991;59:281-312.
FORGIVENESS-SHORT FORM
1. I have forgiven myself for things that I
have done wrong.
1 - Always or almost always
2 - Often
3 - Seldom
4 - Never
1999b 37
38 1999b
Private Religious Practices
Jeff Levin, PhD, MPH
Senior Research Fellow
National Institute for Healthcare Research
Rockville, Maryland
The items were modified from existing meas- In the 1960s and 1970s, sociologists of reli-
ures and were selected in part because they gion proposed numerous multidimensional
represent the most commonly used items inventories of religiosity. The most influential
from other scales or survey instruments. The and widely used were measures developed by
items were selected to be cross-religiously Glock and Stark, Faulkner and DeJong, and
applicable whenever possible, at least with King and Hunt (Robinson and Shaver 1969).
respect to the US population. A review of 7 The first 2 sets of measures include items
well-known scales or survey instruments about praying privately, saying grace, and
revealed 45 items assessing private religious reading the Bible or other religious litera-
practices. In most instances, these items are ture, each with unique coding schemes,
not listed separately in these inventories whose metrics are not comparable and thus
under a “private religious practices” heading, do not easily permit scaling. The King
1999b 39
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
and Hunt measures include items about enable development and validation of a
praying privately, reading religious litera- unidimensional scale. The best ordinal scale
ture, and reading the Bible. These items use would specify quantified amounts of each
a common coding scheme (regularly, fairly behavior, ranging from “never” to multiple
frequently, occasionally, seldom or never), times per day. This would ensure capture of
which is imprecise. the full range of possible frequencies of
each practice.
Based on this prior work, as well as a review
of a few other measures (Himmelfarb 1975, Fourth, inclusion of at least 4 items is highly
Paloma and Gallup 1991), and taking into desirable for psychometric reasons (see
account certain psychometric principles, the Suggested Administration). Three or fewer
working group concluded that any new items may be detrimental in terms of scale
measure of private religious practices should reliability and also less than ideal for
1) be widely applicable, 2) assess the most validating a scale’s measurement properties.
prevalent behaviors, 3) use a common metric,
and 4) include at least 4 items. Previous Psychometric Work
The proposed scale has not been psychometri-
First, a scale of private religious practices for
cally confirmed or validated. However, varia-
use in national surveys and clinical studies
tions on the constituent items have appeared
should assess behaviors that occur across the
in other validated scales or have been scaled
spectrum of common US religious traditions.
and subsequently confirmed in secondary
To develop a brief instrument that covers
analyses. For example, items regarding
all facets of private religious practice for all
frequency of prayer, reading religious mate-
religions or denominations would be impos-
rial, and watching or listening to religious
sible, naturally. Yet every item should be
television or radio constituted three-fourths
interpretable, meaningful, and important to
of a well-fitting measurement model of
most Catholics, Protestants, and Jews, as
nonorganizational religiosity confirmed in a
they represent the 3 largest religious groups
national probability sample of African Ameri-
in America.
cans, for use both among older adults (Chat-
ters, Levin, and Taylor 1992) and across the
Second, a handful of important practices
life course (Levin, Taylor, and Chatters
commonly appear in inventories of private
1995). Similar items regarding frequency of
religious practices and should be included
prayer, reading religious material, and
here. These include praying, watching reli-
saying grace also formed part of an internally
gious television programs or listening to
consistent, reliable measure of nonorgan-
religious radio programs, reading the Bible or
izational religiosity in 4 successive age cohorts
other religious literature, saying grace, and
within a multiracial national probability
contributing to religious institutions. This
sample (Levin 1993).
last behavior could also be construed as an
indicator of religious commitment, so it may
not be essential in a short-form private
Association with Health
religious practices scale. This list does not A review of gerontological research on reli-
exhaust all possible private religious prac- gion through the late 1980s concluded that
tices. Rather, it includes the most prevalent the domain of nonorganizational religious
or frequently practiced behaviors, thus involvement was significantly associated
ensuring reasonable response distributions. with physical health status and psychological
well-being (Levin 1989). Such an association
Third, a common coding scheme applied to all has been examined in several gerontological
or nearly all items would provide a more studies since 1980 (Markides 1983; Idler
universal metric, and thus more easily 1987; Markides, Levin, and Ray 1987;
40 1999b
Private Religious Practices
Time Referent
These items refer to current religious behavior
and are written in the present tense.
1999b 41
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
4. How often are prayers or grace said Levin JS. Age differences in mystical experi-
before or after meals in your home? ence. Gerontologist. 1993;33:507-513.
1 - At all meals Levin JS. Religious factors in aging, adjust-
2 - Once a day ment, and health: a theoretical overview.
3 - At least once a week In: Clements WM, ed. Religion, Aging and
4 - Only on special occasions Health: A Global Perspective. New York,
5 - Never NY: The Haworth Press and World Health
Organization; 1989:133-146.
PRIVATE RELIGIOUS PRACTICES- Levin JS, Chatters LM, Taylor RJ. Religious
SHORT FORM effects on health status and life satisfac-
tion among black Americans. J Gerontol:
None provided. See Suggested Administra- Soc Sci. 1995;50B:S154-S163.
tion for this domain. Levin JS, Taylor RJ, Chatters LM. A multidi-
mensional measure of religious involve-
Bibliography ment for African Americans.” Sociol Q.
Ainlay SC, Singleton R, Swigert VL. Aging 1995;36:157-173.
and religious participation: reconsidering Markides KS. Aging, religiosity, and adjust-
the effects of health. J Sci Study ment: a longitudinal analysis. J
Religion. 1992;31:175-188. Gerontol. 1983;38:621-625.
Alexander F, Duff RW. Influence of religiosity Markides KS, Levin JS, Ray LA. Religion,
and alcohol use on personal well-being. aging, and life satisfaction: an eight-year,
J Religious Gerontol. 1991;8(2):11-25. three-wave longitudinal study.
Alexander F, Duff RW. Religion and drinking Gerontologist. 1987;27:660-665.
in the retirement community. J Religious Paloma MM, Gallup GH. Varieties of Prayer:
Gerontol. 1992;8(4):27-44. A Survey Report. Phila, Penn: Trinity
Bollen KA. Structural Equations with Latent Press Int; 1991:19-42.
Variables. New York, NY: John Wiley & Robinson JP, Shaver PR. Measures of Social
Sons; 1989:256-257. Psychological Attitudes. Ann Arbor, Mich:
Chatters LM, Levin JS, Taylor RJ. Antecedents Institute for Social Research;
and dimensions of religious involvement 1969:543-622.
among older black adults. J Gerontol: Soc Taylor RJ, Chatters LM. Nonorganizational
Sci. 1992;47:S269-S278. religious participation among elderly
Chou CP, Bentler PM. Estimates and tests in black adults. J Gerontol: Soc Sci.
structural equation modeling. In: Hoyle 1991;46:S103-S111.
RH, ed. Structural Equation Modeling:
Concepts, Issues, and Applications.
Thousand Oaks, Calif: Sage Publications;
1995:37-55.
Himmelfarb HS. Measuring religious involve-
ment. Soc Forces. 1975;53:606-618.
Idler EL. Religious involvement and the
health of the elderly: some hypotheses
and an initial test. Soc Forces.
1987;66:226-238.
Koenig HG, Moberg DO, Kvale JN. Religious
activities and attitudes of older adults in
a geriatric assessment clinic. J Am
Geriatr Soc. 1988;36:362-374.
42 1999b
Religious/Spiritual Coping
Kenneth I. Pargament, PhD
Bowling Green State University
Department of Psychology
Bowling Green, Ohio
1999b 43
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
44 1999b
Religious/Spiritual Coping
1999b 45
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
in God. I try to find comfort in religion. I pray intercorrelations among the religious/spiri-
more than usual.” The subscale is internally tual coping scales suggest that methods of
consistent and stable. It has been associated religious/spiritual coping are applied in
with optimism and a monitoring information combinations or patterns. Rather than meas-
processing style. ure the variety of religious/spiritual coping
methods in detail, then, it is possible to
The RCOPE: Most recently, Koenig and assess a broad range of religious/spiritual
Pargament have been working on a compre- coping activities more economically. Two
hensive measure of religious/spiritual coping groups have examined patterns of religious/
called RCOPE (Koenig, Pargament, and spiritual coping.
Nielsen in press; Pargament and Koenig
1997). This measure is designed to be theo- Ways of Religious Coping Scale (WORCS):
retically based, comprehensive, and open to Boudreaux et al (1995) created a 40-item
the negative as well as the positive side of scale that taps into a variety of religious/
religious/spiritual coping. There are 5-item spiritual methods of coping with stress (eg,
and 3-item versions that assess 17 religious/ saying prayers, confessing, obtaining help
spiritual coping methods. Examples of the from clergy, thinking about Jesus as my
measures include: benevolent religious friend, trying to be less sinful). Factor analy-
appraisals, religious forgiving, spiritual sis revealed 2 interpretable factors: an inter-
discontent, religious helping, the search for nal/private factor of personal/cognitive reli-
spiritual connection, and anger at God. These gious coping methods and an external/social
coping methods are targeted variously to factor of religious behaviors and social activi-
the search for meaning, intimacy, self-devel- ties. The scales are easy to read and relate
opment, comfort, and spirituality. Prelimi- differentially to the Religious Coping Activi-
nary factor analytic results with college ties scales. No data are available on the
students and medically ill patients are prom- relationships of these scales to measures of
ising. The scales also correlate with a health status. The scales also lack a theoreti-
variety of measures of stress-related out- cal underpinning.
comes, including physical health, mental
health, and spiritual outcomes. Brief RCOPE: Pargament, Smith, Koenig and
Perez (1998) developed a subscale by select-
On the positive side, the specific religious/ ing 21 items from the RCOPE dimensions
spiritual coping methods approach appears to discussed earlier. The items were adminis-
yield stronger relationships with outcomes tered to a community sample of family,
than the global approach to religious meas- friends, and acquaintances of victims of the
urement. Moreover, by using these measures, Oklahoma City bombing. The factor analysis
it is easier to understand how religion may yielded 2 factors: a positive religious/spiritual
affect health because the function of religion coping factor that reflects benevolent reli-
is, to some extent, “built into” the items. gious involvement in the search for signifi-
Unfortunately, this approach is lengthy. cance (12 items), and a negative factor that
Thus, unless the researcher chooses to focus reflects religious struggle in coping (9 items).
on one particular type or set of religious/ The subscales were internally consistent and
spiritual coping methods, this approach is evidence was found of discriminant and
not feasible for use in large, general criterion-related validity using measures of
purpose surveys. stress-related growth, post-traumatic stress
disorder symptoms, callousness to others,
The Patterns of Religious Coping and religious outcomes.
Approach to Measurement:
People do not appear to use methods of
religious/spiritual coping singly. Moderate
46 1999b
Religious/Spiritual Coping
1999b 47
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
well as the positive, this instrument provides 2. I work together with God as partners to
an intensive analysis of religious/spiritual get through hard times (Collaborative
coping methods and could serve as a basis for Religious Coping).*
the development of psychoreligious 1 - A great deal
interventions. 2 - Quite a bit
3 - Somewhat
Time Referent 4 - Not at all
When coping is measured dispositionally (as
3. I look to God for strength, support, and
in the Brief RCOPE Short Form), no time
guidance in crises (Seeking Spiritual
frame is specified. When coping is measured
Support).*
situationally (as in the RCOPE Long Form),
1 - A great deal
the items refer to the time frame of the
2 - Quite a bit
specific life crisis.
3 - Somewhat
4 - Not at all
Estimated Completion Time
Short Form (Brief RCOPE): 90 sec.-2 min. 4. I try to find the lesson from God in crises
Long Form (RCOPE): 30 min. (Benevolent Religious Appraisal).
1 - A great deal
Proposed Items 2 - Quite a bit
3 - Somewhat
RELIGIOUS/SPIRITUAL COPING- 4 - Not at all
LONG FORM
*Indicates item is on the 3-item version of 5. I confess my sins and ask for God’s
the given subscale. forgiveness (Ritual Purification).
1 - A great deal
Brief RCOPE Items 2 - Quite a bit
3 - Somewhat
Instructions (Dispositional): Think about how 4 - Not at all
you try to understand and deal with major
problems in your life. To what extent is each Negative Religious/Spiritual Coping Subscale
involved in the way you cope? (factor loadings> .53)
Positive Religious/Spiritual Coping Subscale 1. I feel that stressful situations are God’s
(factor loadings> .60) way of punishing me for my sins or lack of
spirituality (Punishing God Reappraisal).*
1. I think about how my life is part of a 1 - A great deal
larger spiritual force (Search for Spiritual 2 - Quite a bit
Connection).* 3 - Somewhat
1 - A great deal 4 - Not at all
2 - Quite a bit
3 - Somewhat 2. I wonder whether God has abandoned me
4 - Not at all (Spiritual Discontent).*
1 - A great deal
2 - Quite a bit
3 - Somewhat
4 - Not at all
48 1999b
Religious/Spiritual Coping
3. I try to make sense of the situation and of what worked or not—just whether or not
decide what to do without relying on God you did it. Use these raceway choices. Try to
(Self-Directed Religious Coping).* rate each item separately in your mind from
1 - A great deal the others. Make your answers as true FOR
2 - Quite a bit YOU as you can. Circle the answer that best
3 - Somewhat applies to you.
4 - Not at all 1 - Not at all
2 - Somewhat
4. I question whether God really exists 3 - Quite a bit
(Religious Doubts). 4 - A great deal
1 - A great deal
2 - Quite a bit Benevolent Religious Reappraisal—redefining the
3 - Somewhat stressor through religion as benevolent and
4 - Not at all potentially beneficial
*1. Saw my situation as part of God’s plan.
5. I express anger at God for letting terrible *2. Tried to find a lesson from God in
things happen (Anger at God). the event.
1 - A great deal *3. Tried to see how God might be trying to
2 - Quite a bit strengthen me in this situation.
3 - Somewhat 4. Thought that the event might bring me
4 - Not at all closer to God.
1999b 49
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
50 1999b
Religious/Spiritual Coping
1999b 51
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
2. I wonder whether God has abandoned me the others. Make your answers as true FOR
(Spiritual Discontent). YOU as you can. Circle the answer that best
1 - A great deal applies to you.
2 - Quite a bit 1 - Not at all
3 - Somewhat 2 - Somewhat
4 - Not at all 3 - Quite a bit
4 - A great deal
3. I try to make sense of the situation and
decide what to do without relying on God Benevolent Religious Reappraisal—redefining the
(Self-Directed Religious Coping). stressor through religion as benevolent and
1 - A great deal potentially beneficial
2 - Quite a bit 1. Saw my situation as part of God’s plan.
3 - Somewhat 2. Tried to find a lesson from God in
4 - Not at all the event.
3. Tried to see how God might be trying to
Overall Religious/Spiritual Coping Item strengthen me in this situation.
1999b 53
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
54 1999b
Religious/Spiritual Coping
1999b 55
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
56 1999b
Religious Support
Neal Krause, PhD
University of Michigan
Department of Health Behavior and Health Education
School of Public Health
Ann Arbor, Michigan
1999b 57
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
religious person. But there is another, A necessary first step for our working group
perhaps even more important benefit in was to briefly critique the range of secular
using this approach. Decades of research support measures available in the literature.
with secular support items have now estab- Barrera (1986) provides a succinct summary
lished clear links between these measures of the options, arguing that there are 3
and health. If the intent of a study is to broad categories of social support measures:
assess religious support and health, it would
appear that researchers can capitalize on • Measures of social embeddedness (the
previous work by maintaining the content of frequency of contact with others);
the support question, while only modifying • Received or enacted support (the amount of
the source of assistance. tangible help actually provided by others);
and
As noted earlier, the second way to construct • Measures of perceived support (subjective
religious social support items requires inves- evaluations of supportive exchanges, such
tigators to begin almost from scratch, devising as satisfaction with support).
indicators that focus on assistance that is
explicitly religious in nature. For example, Clearly, measures of enacted and perceived
an investigator might ask how often fellow support are more highly correlated with
parishioners give an elder spiritual strength. health than measures of social embedded-
There are, however, 3 drawbacks associated ness. Given these findings, it makes the most
with this strategy. First, since the items must sense to focus the religious support measures
be developed de novo, we have no sense of on these 2 key dimensions.
their psychometric properties. Second, we
have no way of knowing whether the new The term “enacted support” does not refer to
measures will be related to health. Finally, a single type of assistance. Instead, it encom-
there are likely to be many ways in which passes a fairly diverse range of specific
people of different religions provide religious helping behaviors. Although there are many
support. Given these drawbacks, the range of ways to classify specific types of enacted
potential measures will be quite broad and it support, one useful schema divides this
will be especially difficult to determine conceptual domain into 3 broad types of
whether the domain has been specified and helping: emotional, tangible, and informa-
sampled adequately. tional support. Extensive research indicates
these dimensions of enacted support are
Therefore, it would appear that the best highly correlated, and the most crucial
strategy is the first approach, that is, modify appears to be emotional support (House and
secular social support items to reflect the fact Kahn 1985). Consequently, indicators of
that we are interested only in assistance that emotional support provided by others are
comes from a coreligionist. However, as noted included in the battery of religious support
earlier, the literature on general social sup- items proposed here.
port measures is vast and investigators have
devised a plethora of scales to assess a range Although it is important to focus on the
of dimensions or types of help. Consequently, amount of help provided by others, a small
the next task is to determine which dimen- but intriguing cluster of studies suggests that
sions should be covered and which scales giving support to others may have beneficial
used. A fairly extensive battery, covering the effects as well (Krause 1986). This view is
full spectrum of social support dimensions, supported by a rich theoretical tradition in
would be ideal, though impractical. As a the social sciences, specifying that social
result, the subset of social support dimen- relations are based on reciprocity, and that
sions likely to provide the greatest payoff networks function best when individuals give
was considered. as well as receive. This seems to be an
58 1999b
Religious Support
especially salient issue for the study of reli- coping strategies turn out to be ineffective.
gious support, because sacred texts of many Second, anticipated support may reduce
faiths make numerous references to the social network burden and promote the
importance of helping others. As a result, smooth functioning of social relationships.
measures of emotional support provided to This benefit may arise because the individual
others are also included in the battery coping efforts that it promotes tend to reduce
proposed here. the demands made on others for assistance.
Finally, anticipated support may be especially
There are also a number of different ways to important within the context of religion,
conceptualize the measure of perceived social because membership in a formal religious
support. Two are included in the battery organization carries the implicit promise that
provided at the end of this section: the first members of the religious community will
assesses negative interaction, whereas the provide help in the future if necessary.
second deals with anticipated support. Inves-
tigators working in the social support field Previous Psychometric Work
often overlook the fact that relations with
After reviewing current scales, the working
others are not always positive, and encoun-
group included the following dimensions of
ters with social network members are some-
social support in this religious support scale.
times marred by conflict and strife. Moreover,
compelling evidence provided by Rook (1984)
• Emotional support received from
and others suggests that negative interaction
fellow parishioners;
may exert a greater effect on health and well-
• Emotional support given to others in
being than the positive or beneficial things
one’s congregation;
that significant others do for us. Even so,
• Negative interaction with coreligionists;
apparently no scales of religious support
and
include measures of negative interaction.
• Anticipated support.
This is somewhat surprising, since even
casual observations suggest that churches
The measures of emotional support received
may at times be rife with conflict. Given this
and emotional support provided to others
fact, we decided to include indicators of
were adapted from the work of Krause and
negative interaction in the religious support
Markides (1990). The indicators of negative
measure proposed here.
interaction as well as anticipated support are
modified versions of the items devised by
The final dimension of perceived support to
Liang (1990) and evaluated in a nationwide
be included in our religious support measures
survey of older adults by Krause (1995, 1997).
is anticipated support, defined as the belief
that others are willing to provide help in the
The items in these scales have not been
future should the need arise. Several recent
tested directly. However, they represent
studies reveal that anticipated support may
relatively minor modifications of indicators
exert a more beneficial effect on health and
that have been tested extensively with a
well-being than the actual amount of assis-
nationwide probability sample of older adults
tance provided by others (Krause in press).
in the US (Krause 1995, 1997), as well as in
There are several reasons for this. First,
Japan (Liang 1990). The minor modifications
some investigators suspect that anticipated
took the following form. As discussed previ-
support acts as a social safety net that en-
ously, the items assessing emotional support
courages risk-taking and individual resolu-
received from others were modified to refer to
tion of problems. This means that people will
coreligionists only. Similarly, the original
be more likely to resolve difficulties on their
1-year time frame was switched to the
own if they believe that others will be there
present tense.
to help out, should the individually based
1999b 59
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
60 1999b
Religious Support
3. How often do the people in your congre- 8. How often are the people in your congre-
gation express interest and concern in gation critical of you and the things
your well-being? you do?
1 - Very often 1 - Very often
2 - Fairly often 2 - Fairly often
3 - Once in a while 3 - Once in a while
4 - Never 4 - Never
Emotional Support Provided to Others 9. How often do the people in your congre-
The following questions deal with things you gation try to take advantage of you?
may do for the people you worship with. 1 - Very often
2 - Fairly often
4. How often do you make the people in 3 - Once in a while
your congregation feel loved and 4 - Never
cared for?
1 - Very often Anticipated Support
2 - Fairly often These questions are designed to find out how
3 - Once in a while much help the people in your congregation
4 - Never would be willing to provide if you need it in
the future.
5. How often do you listen to the people in
your congregation talk about their 10. If you were ill, how much would the
private problems and concerns? people in your congregation be willing to
1 - Very often help out?
2 - Fairly often 1 - A great deal
3 - Once in a while 2 - Some
4 - Never 3 - A little
4 - None
6. How often do you express interest and
concern in the well-being of people 11. If you had a problem or were faced with a
you worship with? difficult situation, how much comfort
1 - Very often would the people in your congregation be
2 - Fairly often willing to give you?
3 - Once in a while 1 - A great deal
4 - Never 2 - Some
3 - A little
Negative Interaction 4 - None
Sometimes the contact we have with others is
not always pleasant. 12. If you needed to know where to go to get
help with a problem you were having,
7. How often do the people in your congre- how much would the people in your
gation make too many demands on you? congregation be willing to help out?
1 - Very often 1 - A great deal
2 - Fairly often 2 - Some
3 - Once in a while 3 - A little
4 - Never 4 - None
1999b 61
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
62 1999b
Religious Support
Bibliography
Barrera M. Distinctions between social
support concepts, measures and models.
Am J Community Psychol. 1986;14:413-445.
House JS, Kahn RL. Measures and concepts
of social support. In: Cohen S, Syme SL,
eds. Social Support and Health. New
York, NY: Academic Press; 1985:83-108.
Krause N. Anticipated support, received
support, and economic stress among
older adults. J Gerontol: Psychol Sci.
In press.
Krause N. Negative interaction and satisfac-
tion with social support among older
adults. J Gerontol: Psychol Sci.
1995;50B:P59-P73.
Krause N. Social support, stress, and well-
being among older adults. J Gerontol.
1986;41:512-519.
Krause N, Markides K. Measuring social
support among older adults. Int J
Aging Hum Dev. 1990;30:37-53.
Liang J. The National Survey of Japanese
Elderly. Ann Arbor, Mich: Institute of
Gerontology; 1990.
Rook KS. The negative side of social interac-
tion: impact on psychological well-being.
J Pers Soc Psychol. 1984;46:1097-1108.
1999b 63
64 1999b
Religious/Spiritual History
Linda K. George, PhD
Duke University Medical School
Department of Sociology
Durham, N. Carolina
Religious Biography: Benson has developed Benson has not yet developed specific
the most comprehensive measure of religious subscales or indexes from this pool of items.
history published to date (Benson 1991). As His approach to analyzing data based on
part of a larger survey of religiousness, he these items has been to compare age groups
created a 100-item section focused on reli- with respect to specific facets of religious-
gious history. The major contents of this ness, for example, religious importance,
measure can be summarized as follows: frequency of private prayer, frequency of
• 30 items reported retrospectively for 2 time Bible reading, and/or church involvement.
periods: ages 5 to 12 years and ages 13 to
18 years. Items cover a wide range, includ- Benson’s work provides an excellent starting
ing public religious participation, private point for future efforts in developing mean-
practices, degree to which religion was ingful, but briefer, measures of religious
emphasized at home, etc. history. Unfortunately, it provides no evidence
• 22 items reported for 4 time periods (as about especially salient aspects of religious or
applicable): ages 20 to 29 years, ages 30 to spiritual biography that may be related
39 years, ages 40 to 49 years, and ages 50 to health.
to 64 years. Again, items cover a wide range.
• 2 items about history of participation in Religious/Spiritual History Questionnaire:
current church. Kehoe, a clinical psychologist in full-time
• 2 items about education in church- practice at Cambridge Hospital, Mass.,
related schools. developed a 36-item questionnaire (unpub-
lished), including 11 items about religious
1999b 65
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
practices in the family of origin, 6 items James Fowler (1981) is the father of the
about religion during early childhood, 8 items theoretical concept of spiritual maturity,
about religion during the “school years,” 8 although he uses the term “faith develop-
items about religion during adolescence/ ment” instead of “spiritual maturity.” Fowler
young adulthood, and 3 items about current takes a developmental perspective, similar in
religious practices. All questions are open- structure and approach to the theories of
ended; Kehoe has not developed response or Erickson, Piaget, and, especially, Kohlberg.
coding categories and has used this measure Fowler has also developed an interview guide
exclusively for clinical purposes, never ad- to assess faith development. The revised
ministering it outside of the treatment con- interview includes 34 questions in 4 major
text. Kehoe is convinced, on the basis of areas: 4 life review questions, 7 questions
clinical experience, that there is a link about life-shaping experiences and relation-
between religious/spiritual history and mental ships, 14 questions about present values and
health, and that assessing current religious commitments, and 9 questions about religion.
practices is not sufficient for understanding All of the questions are open-ended. Stan-
the impact of religion on health status. In dardized response or coding categories are
addition, with the exception that Kehoe is not available. The interview usually requires
careful to specify interest in spirituality as 2 hours for completion and seems highly
well as religion, all of these measures are unsuitable for survey research or large-scale
included (in somewhat different form, clinical studies.
of course) in Benson’s items about
religious history. Benson and colleagues (Benson 1991, Benson
and Elkin 1990) developed the 38-item Faith
Life-Changing Religious/Spiritual Experience: Maturity Index for their national study of 5
Several studies have included measures (2 or Protestant denominations. The 38 items tap
3 items) regarding the respondent’s experi- 2 dimensions of faith, which are labeled
ence of a life-changing religious or spiritual “vertical religion,” focused on the relationship
event. The origin of these items is unclear. An between the respondent and God; and “hori-
affirmative response leads to a follow-up zontal religion,” focused on social service and
question about the age at which that experi- social justice. Responses can be scored in 2
ence occurred. Researchers disagree about ways. First, responses to all 38 items can be
what these items measure. Some researchers averaged to yield a mean score that ranges
refer to them as a measure of intense reli- from 1 to 7. Benson and colleagues suggest
gious experience. Yet with the focus on age, that higher scores represent higher levels of
these items are perhaps better viewed as spiritual maturity. When this scoring method
components of religious history. Given the is used cross-sectionally, faith maturity
results of previous research and the few increases, modestly but significantly, with
items involved, further research regarding increasing age. The second method of scoring
the lifetime experience of life-changing the Faith Maturity Index is to cross-classify
religious/spiritual events is highly individuals’ scores on the vertical and hori-
recommended. zontal measures of religiousness, yielding a
typology of 4 discrete groups, or, as Benson
Spiritual Maturity: Measures of spiritual calls them, faith types:
maturity are intended to focus on the sub- • Undeveloped Faith (low vertical,
stance of religious or spiritual beliefs. There low horizontal)
is an assumed hierarchy, which ranges from • Vertical Faith (high vertical, low horizontal)
purely extrinsic religiousness to religious • Horizontal Faith (low vertical,
autonomy, the highest level of spiritual high horizontal)
maturity. • Integrated Faith (high vertical,
high horizontal).
66 1999b
Religious/Spiritual History
Benson views integrated faith as the apex of psychometrically. Using longitudinal data
spiritual maturity. In his sample, as with from the 3 major studies mentioned previ-
mean index scores, the proportion of persons ously, investigators have only been able to
with integrated faith increased linearly as examine stability of reports over time. The
age increased. evidence on this point is very reassuring.
Even over a 7-year interval, less than 1% of
The Faith Maturity Index has significant the people who reported a life-changing
problems on conceptual grounds. For the experience at 1 point in time denied having
developmental perspective of faith maturity such an experience at a later interview.
to have value, subjects must respond to items
that represent the full range of maturity. Association with Health
That is, items would assess purely extrinsic
There is little evidence that religious/spiri-
religiousness, religious autonomy, and so
tual history correlates with physical or
forth. Scores would then be summed to
mental health. Benson did not examine the
determine the “state” of faith maturity most
relationship between religious history and
representative of the individual. This is, in
health. Kehoe has done so as a clinician, but
fact, how measures of Piaget-based cognitive
has no empirical evidence. The exception to
development and Kohlberg-based moral
this uncertainty is the measure of life-chang-
development are constructed. Yet Benson and
ing religious/spiritual experience. Strong
colleagues give equal weight to all items,
relationships have been found between this
with no attempt to determine what stage of
measure and depressive disorders and symp-
maturity the items represent. They simply
toms (Koenig et al 1994a, Meador et al 1992,
average agreement with all the items. The
Ellison and George 1994), anxiety disorders
items also appear to represent a variety of
and symptoms (Koenig et al 1993; Koenig,
stages of faith maturity as defined by
Ford et al 1993), and alcohol abuse and
Fowler and others.
dependence (Koenig et al 1994b). Current
unpublished data from these studies indicate
Finally, spiritual maturity (or faith develop-
that this item is significantly related to self-
ment) has never been studied in relation to
rated health. These findings come from 3
health. A relationship may exist, but if so, it
major studies—2 population-based epidemio-
awaits empirical documentation. If such
logical studies (1 age-heterogeneous, 1 based
efforts are made, it would be useful to con-
on persons age 65 years and older), and a
ceptualize the role of spiritual maturity in
large clinical study of depression among
health. For example, does spiritual maturity
medically ill older adults. At least this aspect
help to prevent or minimize illness as many
of religious history seems to have robust
cognitive resources do? Does spiritual matu-
associations with health, especially mental
rity also affect illness course and outcome by
health. These findings also suggest the
boosting coping abilities? Because consider-
potential importance of further efforts to
able empirical work remains, we cannot in
develop psychometrically sound measures
good faith recommend inclusion of any brief
of religious/spiritual history.
set of items tapping spiritual maturity.
1999b 67
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
68 1999b
Religious/Spiritual History
The strength of your religious or Koenig HG, Ford SM, George LK, Blazer DG,
spiritual faith Meador KG. Religion and anxiety disorder:
an examination and comparison of asso-
Low Low Low Low Low ciations in young, middle-aged, and
Medium Medium Medium Medium Medium elderly adults. J Anxiety Disord.
High High High High High
1993;7:321-342.
Does not Does not Does not Does not Does not
apply apply apply apply apply Koenig HG, George LK, Blazer DG, Pritchett
JT, Meador KG. The relationship between
Note: Age categories are those used by religion and anxiety in a sample of com-
Benson with the exception of adding a cat- munity-dwelling older adults. J Geriatric
egory for 65 years and older. Psychiatry. 1993;26:65-93.
Koenig HG, George LK, Meador KG, Blazer
RELIGIOUS/SPIRITUAL HISTORY- DG, Dyke P. Religious affiliation and
SHORT FORM psychiatric disorders among Protestant
baby boomers. Hosp Community
History of Life-Changing Religious/Spiritual Psychiatry. 1994a;45:586-596.
Experience Koenig HG, George LK, Meador KG, Blazer
DG, Ford SM. The relationship between
Did you ever have a religious or spiritual religion and alcoholism in a sample of
experience that changed your life? community-dwelling adults. Hosp
No Community Psychiatry. 1994b;45:225-231.
Yes Meador KG, Koenig HG, Hughes DC, Blazer
DG, Turnbull J, George LK. Religious
IF YES: How old were you when this affiliation and major depression. Hosp
experience occurred? Community Psychiatry.1992;43:1204-1208.
Bibliography
Benson PL. Patterns of religious development
in adolescence and adulthood. Invited
address at: American Psychological
Association Meeting; 1990;
San Francisco, Calif.
Benson PL, Elkin CH. Effective Christian
Education: A National Study of Protestant
Congregations. Washington, DC: Search
Institute; 1990.
Benson PL, Williams DL. Religion on Capitol
Hill: Myths and Realities. Oxford: Oxford
University Press; 1986.
Ellison CG, George LK. Religious involvement,
social ties, and social support in a south-
eastern community. J Sci Study Religion.
1994;33:46-61.
Fowler JW. Stages of Faith: The Psychology of
Human Development and the Quest for
Meaning. New York, NY: Harper &
Row; 1981.
1999b 69
70 1999b
Commitment
David R. Williams, PhD
University of Michigan
Department of Sociology
Institute for Social Research
Ann Arbor, Michigan
1999b 71
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
Hoge (1972) has proposed a 10-item short Another potential alternative to the Intrinsic
form for measuring intrinsic religious moti- Religion Scale is a measure of religious
vation. The items are: importance. The following single-item meas-
ure has been used in some research studies.
1. My faith involves all of my life.
2. One should seek God’s guidance when 1. In general, how important are religious or
making every important decision. spiritual beliefs in your day-to-day life?
3. In my life I experience the presence of Would you say very important, fairly
the Divine. important, not too important, or not at
4. My faith sometimes restricts my actions. all important?
5. Nothing is as important to me as serving
God as best I know how. Sociologists (Raden 1985) and psychologists
6. I try hard to carry my religion over into (Abelson 1988) have also been developing
all my other dealings in life. attitudinal items that capture the presence
7. My religious beliefs are what really lie or strength of a respondent’s conviction.
behind my whole approach to life. Their approach could be used successfully to
8. It doesn’t matter so much what I believe assess religious commitment and may be
as long as I lead a moral life. especially useful in assessing the salience
9. Although I am a religious person, I refuse of religious beliefs and attitudes. Researchers
to let religious considerations influence studying conviction attempt to distinguish
my everyday affairs. attitudes that are consequential or central
10. Although I believe in my religion, I feel from those that are inconsequential.
that there are many more important Abelson’s (1988) work has identified 3 dimen-
things in life. sions of conviction important in capturing the
strength of attitudes toward God, nuclear
Hoge’s scale is useful and appropriate for power, divestment, abortion, welfare, star
researchers interested in a longer form than wars, Nicaragua, and AIDS. To my knowl-
the 3-item Short Form proposed here. edge, these measures have not been applied
in any study of religious involvement, but
There are several critiques of the Intrinsic they are another potentially promising
Religion Scale (Kirkpatrick 1989, Kirkpatrick direction for research. The cognitive-elabora-
and Hood 1990, Stark and Glock 1968), and tion items may be less relevant to assessing
efforts have been made to develop short the strength of religious or spiritual attitudes
versions (Gorsuch and McPherson 1989). in terms of health. The highest-loading items
Three items from the Benson and Elkin under each of Abelson’s (1988) “conviction”
(1990) Mature Faith (Vertical Dimension) clusters are:
Scale appear to be conceptually similar to the
intrinsic dimension of religion. They address A. Emotional Commitment
the extent to which faith informs daily deci- 1. My beliefs about X express the real me.
sions, and dictates moral principles. These 2. I can’t imagine ever changing my mind
items appear to have face validity as a about X.
multiple-item short version of intrinsic
religious motivation. B. Ego Preoccupation
1. I think about X often.
1. My faith shapes how I think and act each 2. I hold my views very strongly.
and every day; 3. My belief is important to me.
2. My faith helps me know right from
wrong; and
3. I talk with other people about my faith.
72 1999b
Commitment
1999b 73
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
74 1999b
Organizational Religiousness
Ellen Idler, PhD
Rutgers University
Department of Sociology
Institute for Health, Health Care Policy, and Aging Research
New Brunswick, New Jersey
1999b 75
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
76 1999b
Organizational Religiousness
1999b 77
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
e. Listening to the sermon or drasha. i. Being part of a healing ritual, like the
1 - More than once per service laying on of hands.
1 - Extremely important 1 - More than once per service
2 - One per service 1 - Extremely important
2 - Very important 2 - One per service
3 - Regularly but not every service 2 - Very important
3 - Somewhat important 3 - Regularly but not every service
4 - Occasionally 3 - Somewhat important
4 - Of slight importance 4 - Occasionally
5 - Never 4 - Of slight importance
5 - Not important at all 5 - Never
5 - Not important at all
f. Participating in rituals or sacraments,
such as communion, baptism, or lighting j. Receiving gifts of the spirit, like speaking
the Sabbath candles. in tongues.
1 - More than once per service 1 - More than once per service
1 - Extremely important 1 - Extremely important
2 - One per service 2 - One per service
2 - Very important 2 - Very important
3 - Regularly but not every service 3 - Regularly but not every service
3 - Somewhat important 3 - Somewhat important
4 - Occasionally 4 - Occasionally
4 - Of slight importance 4 - Of slight importance
5 - Never 5 - Never
5 - Not important at all 5 - Not important at all
78 1999b
Organizational Religiousness
1999b 79
80 1999b
Religious Preference
Christopher Ellison, PhD
University of Texas-Austin
Department of Sociology
Austin, Texas
1999b 81
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
82 1999b
Religious Preference
1999b 83
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
84 1999b
Brief Multidimensional Measure of
Religiousness/Spirituality: 1999
For more information about this measure, see Introduction: How to Use This Report.
1999b 85
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
86 1999b
Brief Multidimensional Measure of Religiousness/Spirituality: 1999
19. I look to God for strength, support, 25. If you had a problem or were faced with a
and guidance. difficult situation, how much comfort
1 - A great deal would the people in your congregation be
2 - Quite a bit willing to give you?
3 - Somewhat 1 - A great deal
4 - Not at all 2 - Some
3 - A little
20. I feel God is punishing me for my sins or 4 - None
lack of spirituality.
1 - A great deal Sometimes the contact we have with others is
2 - Quite a bit not always pleasant.
3 - Somewhat
4 - Not at all 26. How often do the people in your congrega-
tion make too many demands on you?
21. I wonder whether God has abandoned me. 1 - Very often
1 - A great deal 2 - Fairly often
2 - Quite a bit 3 - Once in a while
3 - Somewhat 4 - Never
4 - Not at all
27. How often are the people in your congre-
22. I try to make sense of the situation and gation critical of you and the things
decide what to do without relying on God. you do?
1 - A great deal 1 - Very often
2 - Quite a bit 2 - Fairly often
3 - Somewhat 3 - Once in a while
4 - Not at all 4 - Never
1999b 87
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
33. In an average week, how many hours do 38. To what extent do you consider yourself a
you spend in activities on behalf of your spiritual person?
church or activities that you do for 1 - Very spiritual
religious or spiritual reasons? 2 - Moderately spiritual
3 - Slightly spiritual
_______________________ 4 - Not spiritual at all
______________________
88 1999b
Appendix A:
Additional Psychometric and
Population Distribution Data
The Brief Multidimensional Measure of The following tables include the questions and
Religiousness/Spirituality: 1999 was embedded domains, percentage distributions, and
in the 1997-1998 General Social Survey (GSS), psychometric data from the GSS and reflect
a random national survey of the National Data the efforts of the working group in analyzing
Program for the Social Sciences. The basic the data, the findings of which have been
purpose of this survey is to gather and dissemi- prepared as a manuscript and submitted for
nate data on contemporary American society in publication (Idler et al 1999). The Fetzer
order to monitor and explain trends in atti- Institute will have copies of article reprints
tudes and behaviors, and to compare the available upon publication. The findings
United States to other societies. support the multidimensional approach out-
lined in this publication and indicate that the
Several factors went into deciding to add the domains were endorsed by substantial num-
questions from the measure to the GSS. First, bers of respondents, that the items formed
The Brief Multidimensional Measure of reliable indices within the domain, and that the
Religiousness/Spirituality: 1999 contains a indices were moderately but not highly corre-
wide variety of demographic measures and lated with each other (Idler et al 1999). While
includes the detail necessary for such a some minor regroupings are reflected in the
survey and its required coding. Also, with the data presented, we cannot finally determine
Census barred from measuring religious whether there is need for regrouping the
affiliation and with many large government instrument’s domains without collecting fur-
surveys limited to ascertaining affiliation, the ther health-related data. A limitation to this
GSS may be the most widely used source to analysis is the small number of items for each
study religion’s role in contemporary society. domain.
The 1998 version of the GSS also included a
topical module on religion. Thus, the NIA/ The results to date support the theoretical
Fetzer measurement instrument benefited basis of the measure and indicate it has the
from a unique opportunity to examine how its appropriate reliability and validity to facilitate
measures relate to other measures of religion further research that will help us better
both in the GSS core as well as in this one- understand the complex relationship of
time topical module. Finally, the GSS data are religion, spirituality, and health.
of the highest quality. In terms of sampling
procedure, response rate, validation proce- Bibliography
dures, data cleaning, and quality control,
Idler E, Musick M, Ellison C, George L,
the GSS meets the most demanding standards
Krause N, Levin J, Ory M, Pargament K,
of contemporary survey research.
Powell L, Williams D, Underwood L. NIA/
Fetzer Measure of Religiousness and
One disadvantage in utilizing the GSS was
Spirituality: conceptual background and
that slight wording changes were required in
findings from the 1998 General Social
some questions and several questions were
Survey. In press.
not included in the survey.
1999b 89
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
Support Access to instrumental If you were ill, how much would the people
assistance and expression of in your congregation help you out?
caring If you had a problem or were faced with a
Reduction of stress through difficult situation, how much comfort
resolution of conflict would the people in your congregation
be willing to give you?
Encouragement of compliance How often do the people in your
with medical treatments congregation make too many demands
Reduction of health risk on you?
behaviors How often are the people in your
congregation critical of you and the
Access to medical care and things you do?
health information through
referral networks
90 1999b
Appendix A
Table 1: NIA/Fetzer Short Form, Domains and Instrument - GSS* Results (continued)
Domain Testable relevance to health 1998 GSS item wording
Coping Reduction of negative impact Think about how you try to understand and
of stressful life events deal with major problems in your life. To what
extent is each of the following involved in the
way you cope:
I think about how my life is part of a larger
spiritual force.
I work together with God as partners.
I look to God for strength, support, guidance.
I feel that God is punishing me for my sins
or lack of spirituality.
I wonder whether God has abandoned me.
I try to make sense of the situation and
decide what to do without relying on God.
Beliefs and Opportunities for social compari- I believe in a God who watches over me.
Values son promote personal well-being I feel a deep sense of responsibility for
Reduction of stress through provi- reducing pain and suffering in the world.
sion of hope Do you believe there is life after death?
I try hard to carry my religious beliefs
over into all my other dealings in life.
Commitment Enhancement of well-being During the last year how much money did you
through concern for others and the other family members in your house-
hold contribute to each of the following:
Your local congregation?
Other religious organizations, programs,
causes?
Nonreligious charities, organizations, causes?
Were any of your contributions involved in
the arts, culture, or humanities?
Forgiveness Reduction of stress through resolu- Because of my religious or spiritual beliefs:
tion of conflict I have forgiven myself for things that
I have done wrong.
I have forgiven those who hurt me.
I know that God forgives me.
*1998 General Social Survey, National Opinion Research Center, University of Chicago
**R = respondent
1999b 91
92
Table 2: Percentage Distribution within NIA/Fetzer Religiousness and Spirituality Domains - GSS* Results
Daily Spiritual Never/ Once in a Some days Most days Every day Many times
Experiences Almost while a day
never
Feel God’s presence 11.9 17.0 13.8 13.9 25.8 17.5
Find strength in religion 13.8 12.8 13.8 17.4 25.9 16.2
Feel inner peace 6.4 14.6 20.2 28.0 19.2 11.6
Closer to God 11.4 13.1 14.7 16.4 27.9 16.6
Feel God’s love 10.3 13.1 15.1 17.7 26.8 17.1
Touched by creation 6.1 9.6 12.6 17.5 28.6 25.5
Private Religious Never Less than Once a A few times Once a A few times Once a More
Practices once a month a month week a week day than once
month a day
Private prayer 13.2 9.2 2.3 5.5 4.9 13.9 26.5 24.4
Meditation 48.2 6.9 3.4 4.4 5.0 9.5 13.7 9.0
Never Less than Once a week Several Once a day Several
once a week times a times a day
week
Reading the Bible 41.9 28.3 9.2 10.0 8.1 2.6
1999b
Table 2: Percentage Distribution within NIA/Fetzer Religiousness and Spirituality Domains - GSS* Results (continued)
1999b
Religious Support None A little Some A great
deal
Help out with illness 7.8 13.6 32.4 46.2
Help out with problems 6.0 10.2 29.8 54.0
Never Once in a Fairly Very often
` while often
Make too many demands 61.9 28.9 6.5 2.6
Critical of R** 75.2 19.0 3.1 2.7
Religious/Spiritual No Yes
History
Life-changing experience 60.9 39.1
Organizational Never Less than Once or Several Once a 2-3 times a Nearly Every Several
Religiousness once a twice a times a month month every week times a
year year year week week
Service attendance 19.5 10.7 10.8 11.0 8.1 7.9 6.6 17.2 8.2
Once a Several
day times a
day
Other public activities 38.1 11.9 10.9 10.6 5.2 5.3 4.4 7.1 5.3 0.6 0.6
Religious preference Protestant Catholic Jewish Other None N
Religious preference 54.2 25.7 1.8 4.2 13.8 1,437
*1998 General Social Survey, National Opinion Research Center, University of Chicago
**R = respondent
93
Appendix A
Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research
*1998 General Social Survey, National Opinion Research Center, University of Chicago
**R = respondent
94 1999b
Appendix A
*1998 General Social Survey, National Opinion Research Center, University of Chicago
1999b 95
96 1999b
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1999b