Designation and psychometric assessment of a comprehensive spiritual health questionnaire for Iranian populations

  • Parisa Amiri مرکز تحقیقات تعیین‌کننده‌های اجتماعی سلامت غدد درون‌ریز و مرکز تحقیقات پیشگیری و درمان چاقی، پژوهشکده علوم غدد درون ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.
  • Mahmoud Abbasi مرکز تحقیقات اخلاق و حقوق پزشکی، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.
  • Safura Gharibzadeh گروه آمار زیستی و اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران و مرکز تحقیقات غدد درون ریز و متابولیسم، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.
  • Mohammad Asghari Gharib abadi مرکز تحقیقات پیشگیری از مصدومیت‌هاي ترافيكي جاده‌ای، دانشگاه علوم پزشکی تبریز، آذربایجان شرقی، ایران.
  • Najmeh Hamzavi Zarghani مرکز تحقیقات تعیین‌کننده‌های اجتماعی سلامت غدد درون ریز و مرکز تحقیقات پیشگیری و درمان چاقی، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.
  • Fereydoon Azizi مرکز تحقیقات غدد درون‌ریز و متابولیسم، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران. (نویسنده مسؤول)
Keywords: Spiritual Health, Questionnaire, Validity, Reliability, Muslims, Iran


Introduction: Despite the considerable research documented regarding spiritual health through the last decades, there is still the lack of a comprehensive and acceptable definition for the term. Measuring spiritual health in Iranian populations initially requires a definition of spiritual health that meets the cultural, social and religious norms of our society. Hence designation and evaluation of an appropriate questionnaire to measure its conceptual constructs is essential. As one of the first efforts, this study aimed to explore the concept of spiritual health and to design and assess a comprehensive spiritual health questionnaire in an Iranian population.

Methods: In this  methodological cross-sectional study, a spiritual health questionnaire was developed based on  three constructs,  including “insight”, “tendency” and “behaviors” based on a review of Islamic literature approved by the spiritual health department of academy of medical sciences Islamic republic of Iran. Overall 506 individuals (64% females), aged ≥ 20 years, participated in the psychometric assessment process, were recruited from among residents of district 13 of Tehran. Test-retest reliability and internal consistency were used to assess reliability. Face, content and construct validity were examined.

Results: Forty-eight items were perceived as essential, relevant and comprehendible by both the experts and the community. Content validity was confirmed by a panel of experts. Exploratory factor analysis suggested a six-factor model in the structure of developed items, which was optimized in a two factor model that encompassed 1- cognitive/emotional and 2- behavioral constructs. The results of the confirmatory factor analysis indicated acceptable fits for the proposed models. The internal consistency, as measured by Cronbach’s alpha coefficients, exceeded the minimum reliability standard of 0.70 for all scales and subscales, all of which demonstrated satisfactory test-retest reliability over two weeks.

Conclusion: Our results provide initial evidence that the much needed questionnaire developed is a valid and reliable instrument for measuring spiritual health in this urban Iranian population. Further research is suggested for different populations and regions in Iran.


Abbasi, M., Shamsi G. E., et al. (2013). Introduction to spritual health. First edition, Hoghooghi Pub., Tehran.

Berntson, G. G., Norman, G. J., et al. (2008). Spirituality and autonomic cardiac control. Ann Behav Med, 35(2), 198-208.

Bruce, M. A., Sims, M., et al. (2007). One size fits all? Race, gender and body mass index among US adults. JNMA, 99(10), 1152.

Buck, A. C., Williams, D. R., et al. (2009). An examination of the relationship between multiple dimensions of religiosity, blood pressure, and hypertension. Soc Sci Med, 68(2), 314-322.

Burazeri, G., Goda, A., et al. (2008). Religious observance and acute coronary syndrome in predominantly Muslim Albania: a population-based case-control study in Tirana. Ann epidemiol, 18(12), 937-945.

Dhar, N., Chaturvedi, S., et al. (2011). Spiritual health scale 2011: defining and measuring 4 dimension of health. Indian J Community Med, 36(4), 275-282.

Ellison, C. (1983). Spritual well- being: conceptualization and measurment. J Psychol Theol, 11(4), 330-340

Fisher, J. (2010). Development and application of a spiritual well-being questionnaire called SHALOM. Religions, 1(1), 105-121.

Fisher, J.W., Francis, L.J., et al. (2000). Assessing spiritual health via four domains of spiritual wellbeing: The SH4DI. Pastoral Psychol, 49(2), 133-145.

Fitchett, G., Powell, L. H. (2009). Daily spiritual experiences, systolic blood pressure, and hypertension among midlife women in SWAN. Ann Behav Med, 37(3), 257-267.

Gillum, R. F., Ingram, D. D. (2006). Frequency of attendance at religious services, hypertension, and blood pressure: the third national health and nutrition examination survey. Psychosom Med, 68(3), 382-385.

Gomez, R., Fisher, J. W. (2003). Domains of spiritual well-being and development and validation of the Spiritual Well-Being Questionnaire. J Individ Differ, 35(8), 1975-1991.

Group, W.S. (2006). A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Soc Sci Med, 62(6), 1486-1497.

Hill, P. C., Pargament, K. I. (2003). Advences in the conceptualization and measurment of religion and spirituality. AM.Psychol, 58, 64-74.

Horne, B. D., May, H. T., et al. (2008). Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol, 102(7), 814-819. e811.

Hungelmann, J., Kenkel-Rossi, E., et al. (1985). Spiritual well-being in older adults: Harmonious interconnectedness. J relig Health, 24(2), 147-153.

Idler, E. L., Musick, M. A., et al. (2003). Measuring multiple dimensions of religion and spirituality for health research conceptual background and findings from the 1998 General Social Survey. Res Aging, 25(4), 327-365.

MacDonald, D. A. (2000). Spirituality: Description, measurement, and relation to the five factor model of personality. J Pers, 68(1), 153-197.

Macleod, J., Smith, G. D., et al. (2002). Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men. BMJ, 324(7348), 1247.

Maselko, J., Kubzansky, L. D. (2006). Gender differences in religious practices, spiritual experiences and health: Results from the US General Social Survey. Soc Sci Med, 62(11), 2848-2860.

Maselko, J., Kubzansky, L., et al. (2007). Religious service attendance and allostatic load among high-functioning elderly. Psychosom Med, 69(5), 464-472.

McCullough, M. E., Hoyt, W. T., et al. (2000). Religious involvement and mortality: a meta-analytic review. Health psychol, 19(3), 211.

Mesbah, M. (2013). Islamic approach to spiritual health. First edition, Hoghooghi Pub., Tehran.

Moberg, D. O. (2002). Assessing and measuring spirituality: Confronting dilemmas of universal and particular evaluative criteria. J Adult Dev, 9(1), 47-60.

Monod, S. f., Brennan, M., et al. (2011). Instruments measuring spirituality in clinical research: a systematic review. J Gen Intern Med, 26(11), 1345-1357.

National Interfaith Coalition on Aging. (1975). Spiritual wellbeing: a definition. Athens, GA: Author.

Peterman, A. H., Fitchett, G., et al. (2002). Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med, 24(1), 49-58.

Schnall, E., Wassertheil-Smoller, S., et al. (2010). The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women's Health Initiative Observational Study. Psychol Health, 25(2), 249-263.

Strawbridge, W. J., Shema, S. J., et al. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Ann Behav Med, 23(1), 68-74.

Thoresen, C. E., Harris, A. H. (2002). Spirituality and health: What’s the evidence and what’s needed? Ann Behav Med, 24(1), 3-13.

Vader, J. P. (2006). Spiritual health: the next frontier. Eur J Public Health, 16(5), 457-457.

Yeager, D. M., Glei, D. A., et al. (2006). Religious involvement and health outcomes among older persons in Taiwan. Soc Sci Med, 63(8), 2228-2241.

Young, E. W. (1984). Spiritual health—an essential element in optimum health. J Am College Health, 32(6), 273-276.

Original/Research Article