Spiritual Health and Life-Orientation Measure: Psychometric properties of the Brazilian Portuguese version

Abstract

This study aimed to translate into Brazilian Portuguese and evaluate the main psychometric properties from Spiritual Health and Life-Orientation Measure in a sample of 487 students aged 9–15 years in Southern Brazil. Spiritual Health and Life-Orientation Measure is divided into Ideals and Lived Experience sections and showed high internal consistency reliability (Cronbach’s α = 0.94). Comparison of mean values between age showed a tendency to decrease spirituality scores with increasing age. Discriminate validity of mean scores between groups of atheists, “spiritual, but not religious,” and religious was significant in all domains (0.026 < p < 0.001). Spiritual Health and Life-Orientation Measure presents adequate psychometric properties and may contribute to study spirituality in children and adolescents.

Keywords

adolescents children religiosity scale spirituality

Introduction

Studies on the relationship between spirituality and mental health have increased in recent decades (Damiano et al., 2016; Gonçalves et al., 2017). Overall, researches demonstrate that religious/spiritual persons report higher levels of subjective well-being (Hackney and Sanders, 2003; Koenig and Larson, 2001), better physical and mental health, and higher levels of quality of life (QoL; Diener et al., 2011; Moreira-Almeida et al., 2014) when compared to non-religious/spiritual persons. However, assessments in spirituality are not an easy task due to the diversity of concepts of spirituality and religiosity, as well as cultural and developmental differences among populations.

Although many researchers consider religiosity and spirituality (R/S) as connected but separable constructs (Holder et al., 2010), there is still a lack of consensus on the separate meanings of the two terms. According to Koenig et al. (2012), religion is an organized system of beliefs, practices, rituals, and symbols related to sacred or transcendent, while spirituality is a personal search for answers to questions related to meaning of life, sacred or transcendent that may be or not be connected to religious rituals. De Jager Meezenbroek et al. (2012) defines spirituality as “one’s striving for an experience of connection with oneself, connectedness with others and nature, and connectedness with the transcendent” (p. 338). In this sense, it is important to produce indicators to reflect how people experience spirituality in their own lives and not just categorize them according to indicators of “religiosity” (i.e. religious affiliation and the frequency of religious service).

Guidelines for the study of R/S in mental health point to the need for multidimensional assessments for better description and evaluation of health outcomes (Kendler et al., 2003; Pargament and Lomax, 2013). In 1975, the National Interfaith Coalition on Aging’s (NICA) defined spiritual well-being (SWB), as “the affirmation of life in a relationship with God, self, community, and environment that nurtures and celebrates wholeness.” In this sense, Spiritual Health and Life-Orientation Measure (SHALOM) was developed to measure spiritual health, understood as a dynamic state of being, shown by the extent to which people live in harmony within relationships in up to four domains of SWB (personal, communal, environmental, and transcendental), identified in Fisher’s model (2010a, 2010b, 2011, 2013, 2016).

An adequate differentiation and measurement of these dimensions of spirituality seem relevant because may have different repercussions on measures of physical and psychological well-being. (Harris et al., 2008; Mata-McMahon, 2016). Investigating different dimensions of spirituality can lead us to understand what dimension(s) of spirituality are associated with better health outcomes. Despite the several instruments for measuring SWB or a spiritual dimension of health (Monod et al., 2011; O’Connell and Skevington, 2005), there is a shortage of scales to measure these constructs in Brazilian Portuguese. Furthermore, there is a lack of studies assessing the psychometric properties of this instruments performed on non-clinical samples aged under 12.

Moore et al. (2016) affirmed that children over 7 years have the ability to think about abstract spiritual concepts and to perceive the transcendent as having supernatural qualities that go beyond time and space. They were also able to respond to items on the measure, which were related to the idea of having a body that is separate from a spirit or a soul.

The advantages of SHALOM include its shortness, ease of application, and an accurate study provided about dimensions of spirituality. SHALOM has been used in several studies worldwide, with secondary students, including a sample of children aged 8–12 years in Canada, in which it reported its effectiveness to study SWB and happiness (Holder et al., 2010), and it was translated into 29 languages (Fisher, 2016), including Portuguese of Portugal (Gouveia et al., 2009).

According to previous researches in adult samples, individuals who have more R/S have less psychiatric disorders as depression and anxiety and experience better QoL (Moreira-Almeida et al., 2014). Investigating spirituality among children and adolescents, how it develops and changes with age, could bring more information about the implications of this construct in health outcomes in this population. To conduct these studies, it is important to have reliable measurement tools to measure spirituality and clear conceptualization and operationalization of the construct (James and Miller, 2017).

In this sense, the objective of this study was to report the process of translation and cultural adaptation of the SHALOM for Brazilian children and adolescents (aged 9–15 years), as well as to evaluate the main psychometric properties of the instrument.

Methods

Participants

We submitted the Brazilian version of SHALOM to a study whereby 487 healthy students (aged 9–15 years) were selected at random and recruited from two schools (one public and one private) in the catchment area of the Basic Health Unit link to the UFRGS/HCPA, in the same district of the city of Porto Alegre, Southern Brazil. We excluded three participants due to missing data. The research instruments were applied within the classroom, by trained research assistants (medical students) under the supervision of a Senior Psychologist, with the presence of a school teacher. Information regarding subjective happiness, religiosity, depressive symptoms, QoL, economic values, and spirituality was collected from March to July 2015. Students of both genders (50.7% male) and educational levels ranging from third grade to ninth grade were included.

The procedures of this study followed the Helsinki Declaration of 1975, as revised in 1983 (ethics committee approval number: 14-0575 GPPG/HCPA). Permission was obtained from the school districts, school principals, and teachers. Before the start of the survey, children were asked for their informed assent and parent informed dissent according to the ethical committee’s requirement. Individuals with cognitive deficits clinically diagnosed were not included in the study. The translation and adaptation of the scale to Brazilian Portuguese followed the methodology proposed by Guillemin et al. (1993).

Measures

SHALOM

The SHALOM utilizes the same 20 items as the Spiritual Well-Being Questionnaire (SWBQ) that was developed from an initial selection of 60 items derived from the four domains model of, spiritual health, and was reduced to the 20-item SHALOM using exploratory factor analysis (Fisher, 2010b). The five items in each of four dimensions of spirituality were scored using a Likert scale, responses ranging from 1 = very low to 5 = very high.

The scale contains two sections. The first section comprises the ideals for spiritual health held by respondents, and the participants rate the 20 items considering: (1) How important do you think (each item) is for optimum spiritual health. The second section reflects the lived experience of spirituality in the participant’s lives, and they rate the same 20 items based on (2) How do you feel (this item) reflects your personal experience most of the time. The difference between respondents’ “ideals” and “lived experience” is used to investigate the level of spiritual harmony/dissonance (Fisher, 2016).

The Lived Experience section (i.e. the original SWBQ) can be viewed as a measure of spirituality because spirituality is by nature an individual experience (Kapuscinski and Masters, 2010), and the term “Transcendent” lessens its religious affiliation and allows it to act as a measure of spirituality/spiritual health across a variety of worldviews (Fisher, 2013). This is supported by research that successfully utilized items from the SWBQ as a measure of global spirituality (Holder et al., 2010; Koss and Holder, 2015).

SHALOM was developed in the belief that an instrument should have appropriate language and conceptual clarity for studies of Spiritual Health within general populations and individuals. The scale measures four dimensions of spirituality (Figure 1), according to a largely known theoretical model of spirituality (De Jager Meezenbroek et al., 2012; Gomez and Fisher, 2003).

Figure 1.

Items comprising four dimensions of spiritual well-being in SHALOM (Fisher, 2010b).

Children Depression Inventory

We used the Children Depression Inventory (CDI) (Kovács, 1983) to measure depression symptoms. CDI is composed of 20 items, related to the last 2 weeks, with values ranging 0–2 points. Each item has three options, one refers to normal, another to mild symptoms, and the other to a higher intensity. The sum of the score values of the responses represents the presence and severity of depression symptoms with a cut point of 17 points for depression. The instrument was adapted and standardized by Gouveia et al. (1995) and shows good psychometric parameters and level of internal consistency, and it was validated to Brazilian samples (Coutinho et al., 2014).

Brief Multidimensional Measure of Religiousness/Spirituality

In 1999, Fetzer Institute and the US National Institute of Aging (FI/NIA) worked to develop a comprehensive and multidimensional tool on spirituality and religiosity suitable for use in health-related researches.

The dimensions of spirituality and religiousness included in this instrument are intended for use in studies that evaluate the relationship between religiosity, spirituality, and health. The Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) has 38 items and measures 11 dimensions which can be analyzed in general or separately: (1) daily spiritual experiences; (2) values/beliefs; (3) forgiveness; (4) private religious practices; (5) religious/spiritual coping; (6) religious support; (7) religious/spiritual history; (8) commitment; (9) organizational religiosity; (10) religious preference; and (11) overall self-ranking. The response options are arranged on a Likert scale, which in some items range from 1 to 8 options and in others from 1 to 6 response options.

It was translated and validated on a Brazilian sample by Curcio et al. (2015). This instrument has been used in several worldwide studies and has been validated across developmental periods (e.g. adolescence and adulthood; Bodling et al., 2013; Harris et al., 2008).

Procedures

First, the instrument developer, John Fisher, was contacted to ask for permission to use and translate the instrument. The second step was to conduct two independent forward translations of the instrument involving a two-person English–Brazilian Portuguese translation team. In the reconciliation step, we discussed about discrepancies between the original independent translations and seek agreement between individual speech habits and preferences processes and a discussion group (composed of a team of psychiatrist expert in QoL questionnaires and their applications, a senior psychologist, and an English and Portuguese teacher) responsible for reaching full consensus regarding lexical and cultural equivalence and a reconciliation step after that. The fourth step was the back-translation to English original version conducted by two-person and a review with the instrument developer and compare with the Portuguese version from Portugal. The original author’s approval of the resulting merged version (back-translation) suggests that the methodology employed was adequate. A debriefing was performed with 10 children (aged 9–12 years), which represents the focus group regarding age and school year, and no items were considered to be problematic by these subjects.

Statistical analysis

Descriptive and basic statistical analyses were performed using SPSS 21.0. The normality distribution of the variables was evaluated by the Kolmogorov–Smirnov test. We applied a square root transformation to the variables with asymmetric distribution (CDI score). To determine internal consistency, Cronbach’s alpha coefficients were calculated with a cutoff of 0.70 (Nunnally, 1967). We used t-test for independent samples to compare spiritual dimensions mean scores between sex. Participants who reported not having a religion but believed in something beyond human nature (God, Higher Power) were classified as spiritual, but not religious. We used an analysis of variance (ANOVA) and a post hoc Tukey comparisons to determine discriminate between groups of atheists, “spiritual, but not religious,” and religious. For discriminate validity, it was expected that the SHALOM scores would be different between religious, atheists, and “spiritual, but not religious” groups. Convergent validity was assessed using Pearson correlations with three domains of BMMRS (daily spiritual experiences, values/belief, and overall self-ranking), and CDI. For convergent validity, it was expected that the measures of BMMRS domains spirituality would be positively correlated with the SHALOM’s dimensions and CDI scores would be a negative relationship. A p-value of 0.05 or less was used to define statistical significance.

Results

Demographics

The sample of 487 children and adolescents, aged 9–15 years were recruited from a private (65.1%) and a public school (34.9%) of Porto Alegre, Southern Brazil. The mean age was 11.4 years (standard deviation (SD), 1.94), and 50.4 percent were male. Ethnic composition of the sample (n = 484) was as follows: Caucasian n = 373 (77.1%), African Brazilian n = 83 (17.1%), Indigenous n = 21 (4.3%), and other n = 7 (1.4%). Approximately 93 percent (n = 456) reported family incomes variance range from $5000/year to $30,000/year. And, 62 percent of parents/guardians had a graduate education.

Religious/spiritual characteristics

Religious affiliations of subjects were classified as Catholic (39.5%), “Spiritual, but not religious” (31.2%), Evangelic (10.3%), Kardecist (8%), Atheist (6.8%), Afroreligions (2.1%), and Others (2.1%).

Internal consistency

Table 1 presents the internal consistency for each section (Ideals and Lived Experience) to each SHALOM domain. In the section Ideals, all the four dimensions Cronbach’s alpha was ranging from 0.77 to 0.91, and the total was 0.92. In the Lived Experience section, Cronbach’s alpha to personal domain was 0.82; the communal domain was 0.81; the environmental domain was 0.85; and the transcendental domain was 0.91. The total Cronbach’s alpha for the Lived Experience section was 0.94.

Table 1.

Summary statistics and reliability coefficients (Cronbach’s alpha) for each item/domain of the two sections of SHALOM in children and adolescents.

Domain—items	SHALOM—Ideals^a				SHALOM—Liv_Exp^b
Domain—items	N	Mean ± SD	Median (minimum–maximum)	α	N	Mean ± SD	Median (minimum–maximum)	α
SpPersonal	478; 98.2%	21.3 ± 3.43	22 (5–25)	0.776	479; 98.4%	20.2 ± 3.90	21 (5–25)	0.818
5	482; 99.0%	4.01 ± 1.01	4 (1–5)		480; 98.6%	3.85 ± 1.03	4 (1–5)
9	483; 99.2%	4.39 ± 0.84	5 (1–5)		480; 98.6%	4.20 ± 0.88	4 (1–5)
14	483; 99.2%	4.60 ± 0.78	5 (1–5)		481; 98.8%	4.30 ± 0.95	5 (1–5)
16	481; 98.8%	4.19 ± 1.04	5 (1–5)		481; 98.8%	3.88 ± 1.15	4 (1–5)
18	481; 98.8%	4.10 ± 1.06	4 (1–5)		481; 98.8%	3.96 ± 1.12	4 (1–5)
SpCommunal	481; 98.8%	21.2 ± 3.56	22 (5–25)	0.813	478; 98.2%	20.4 ± 3.63	21 (5–25)	0.817
1	483; 99.2%	4.26 ± 0.91	5 (1–5)		480; 98.6%	4.12 ± 0.93	4 (1–5)
3	482; 99.0%	4.15 ± 0.99	4 (1–5)		482; 99.0%	3.91 ± 1.02	4 (1–5)
8	483; 99.2%	3.94 ± 1.03	4 (1–5)		481; 98.8%	3.80 ± 1.06	4 (1–5)
17	483; 99.2%	4.47 ± 0.88	5 (1–5)		480; 98.6%	4.30 ± 0.86	5 (1–5)
19	482; 99.0%	4.38 ± 0.88	5 (1–5)		481; 98.8%	4.28 ± 0.89	4 (1–5)
SpEnvironmental	480; 98.6%	19.6 ± 4.31	20 (5–25)	0.853	477; 97.9%	18.6 ± 5.07	20 (5–25)	0.898
4	483; 99.2%	4.07 ± 1.04	4 (1–5)		480; 98.6%	3.73 ± 1.19	4 (1–5)
7	481; 98.8%	3.84 ± 1.06	4 (1–5)		480; 98.6%	3.90 ± 1.11	4 (1–5)
10	483; 99.2%	4.04 ± 1.09	4 (1–5)		480; 98.6%	3.77 ± 1.19	4 (1–5)
12	483; 99.2%	4.06 ± 0.97	4 (1–5)		481; 98.8%	3.81 ± 1.13	4 (1–5)
20	482; 99.0%	3.53 ± 1.27	4 (1–5)		481; 98.8%	3.37 ± 1.38	4 (1–5)
SpTranscendental	483; 99.2%	17.6 ± 5.54	18 (5–25)	0.909	477; 97.9%	16.2 ± 6.19	17 (5–25)	0.40
2	483; 99.2%	3.49 ± 1.26	4 (1–5)		480; 98.6%	3.22 ± 1.32	3 (1–5)
6	483; 99.2%	3.46 ± 1.30	4 (1–5)		480; 98.6%	3.29 ± 1.38	3 (1–5)
11	483; 99.2%	3.52 ± 1.31	4 (1–5)		480; 98.6%	3.26 ± 1.41	3 (1–5)
13	483; 99.2%	3.80 ± 1.25	4 (1–5)		480; 98.6%	3.43 ± 1.39	4 (1–5)
15	483; 99.2%	3.29 ± 1.35	3 (1–5)		481; 98.8%	2.95 ± 1.40	3 (1–5)
Total	475; 97.5%	79.8 ± 13.5	82 (26–100)	0.922	472; 96.9%	75.2 ± 15.8	77 (20–100)	0.940

SHALOM: Spiritual Health and Life-Orientation Measure; SD: standard deviation.

Section Ideals: what participants rate about how important they think each item is for optimum spiritual health.

Section Lived Experience: what participants rate about how they feel that each item reflect your personal experience most of the time.

Discriminate validity

In the comparison of the dimensions between genders, there was no difference on mean values of both sections of the scale, as shown in Table 2. Moreover, in the comparison between age, the scale showed a tendency to lower spirituality mean scores with the increase in the age.

Table 2.

Comparison of SHALOM between genders and age groups in 484 children and adolescents.

Variables	SpPersonal (mean ± SD)	SpCommunal (mean ± SD)	SpEnvironmental (mean ± SD)	SpTranscendental (mean ± SD)
SHALOM—Ideals
Gender
Male	21.0 ± 3.6	20.8 ± 3.8	19.6 ± 4.3	17.5 ± 5.8
Female	21.6 ± 3.2	21.7 ± 3.1	19.5 ± 4.3	17.6 ± 5.3
T	−1.812	−2.799	0.428	0.147
P	0.070	0.005	0.668	0.883
Age
8/9	22.0 ± 3.2^b	21.8 ± 3.5^{a b c}	21.8 ± 3.6^d	19.9 ± 4.7^b
10	21.9 ± 3.4^{a b}	22.0 ± 3.4^{b c}	20.8 ± 3.6^{c d}	20.3 ± 4.7^b
11	21.8 ± 3.9^{a b}	22.3 ± 3.0^c	20.4 ± 4.4^{b c d}	18.9 ± 4.7^b
12	20.7 ± 3.4^a	20.1 ± 3.9^a	18.8 ± 4.0^abc	161 ± 5.6^a
13	20.9 ± 3.5^{a b}	20.5 ± 3.7^{a b}	18.7 ± 4.1^{a b}	16.1 ± 5.7^a
14	20.9 ± 2.7^{a b}	21.2 ± 3.2^{a b c}	18.1 ± 4.5^a	16.2 ± 5.3^a
15/16	20.7 ± 3.6^{a b}	20.5 ± 3.7^{a b}	17.6 ± 4.7^a	14.4 ± 5.4^a
P	0.043	<0.001	<0.001	<0.001
SHALOM—Liv_Exp
Sex
Male	20.1 ± 4.0	20.1 ± 3.9	18.6 ± 5.2	16.3 ± 6.4
Female	20.3 ± 3.8	20.7 ± 3.3	18.5 ± 5.0	16.0 ± 6.0
T	−0.625	−1.884	0.202	0.691
P	0.532	0.060	0.840	0.490
Age
8/9	21.6 ± 3.8^c	21.6 ± 3.6^b	21.3 ± 4.4^c	19.9 ± 4.6^d
10	21.7 ± 3.0^c	21.8 ± 2.7^b	20.5 ± 4.0^c	19.3 ± 5.4^d
11	21.2 ± 4.0^{b c}	21.6 ± 3.4^b	19.9 ± 4.6^{b c}	17.5 ± 5.2^{c d}
12	19.4 ± 4.0^{a b}	19.7 ± 3.2^a	17.4 ± 4.9^{a b}	15.0 ± 5.5^{b c}
13	19.2 ± 4.1^a	19.2 ± 4.0^a	17.3 ± 4.9^a	13.6 ± 6.2^{a b}
14	19.0 ± 3.6^a	19.8 ± 3.6^a	16.9 ± 5.2^a	14.3 ± 6.4^{a b}
15/16	18.6 ± 3.6^a	18.7 ± 3.5^a	15.9 ± 5.1^a	12.0 ± 5.9^a
P	<0.001	<0.001	<0.001	<0.001

SHALOM: Spiritual Health and Life-Orientation Measure; SD: standard deviation.

a,b,c,d

ANOVA equal letters do not differ on Tukey post hoc comparisons at 5 percent of significance.

df = n − 1 (=483).

Table 3 presents the mean values and SDs of the two sections of SHALOM among atheists, “spiritual, but not religious,” and religious groups. The post hoc Tukey Test comparisons showed that there was a difference between groups in all dimensions of the two sections of the scale.

Table 3.

Comparison of SHALOM domain mean values across atheists, spiritual, but not religious, and religious groups of 484 children and adolescents.

Domain—items	Atheists (mean ± SD)	Spiritual, but not religious (mean ± SD)	Religious (mean ± SD)	F *	p
SpPersonal
SHALOM—Ideals	19.5 ± 4.3^a	21.4 ± 3.2^b	21.4 ± 3.4^b	2.183	0.007
SHALOM—Liv_Exp	18.2 ± 4.7^a	19.6 ± 4.1^{a b}	20.5 ± 3.7^b	6.732	0.001
SpCommunal
SHALOM—Ideals	19.6 ± 4.5^a	21.2 ± 3.1^b	21.4 ± 3.6^b	4.279	0.026
SHALOM—Liv_Exp	18.3 ± 4.5^a	20.0 ± 3.2^b	20.7 ± 3.6^b	6.958	0.001
SpEnvironmental
SHALOM—Ideals	16.9 ± 5.2^a	20.1 ± 4.1^b	19.6 ± 4.2^b	9.421	0.001
SHALOM—Liv_Exp	14.9 ± 5.5^a	18.7 ± 5.2^b	18.9 ± 4.9^b	9.600	<0.001
SpTranscendental
SHALOM—Ideals	9.5 ± 4.9^a	15.9 ± 5.4^b	18.9 ± 4.8^c	12.678	<0.001
SHALOM—Liv_Exp	7.1 ± 4.3^a	14.4 ± 6.0^b	17.6 ± 5.5^c	57.017	<0.001

SHALOM: Spiritual Health and Life-Orientation Measure; SD: standard deviation.

Section Ideals: what participants rate about how important they think each item is for optimum spiritual health.

Section Lived Experience: what participants rate about how they feel that each item reflect your personal experience most of the time.

a,b,c

ANOVA equal letters do not differ on Tukey Test at 5 percent of significance.

df = n − 1 (=483).

Convergent validity

Correlations between the SHALOM dimensions and measures of the three domains of BMMRS, and depressive symptoms were all significant (p < 0.001) as shown in Table 4. Positive correlations were found between BMMRS domains and the each dimensions of both sections of SHALOM: SpPersonal: daily spiritual experiences (0.36 < r < 0.48; p < 0.001); values/beliefs (0.33 < r < 0.38; p < 0.001); overall self-ranking (0.26 < r < 0.31; p < 0.001); SpCommunal: daily spiritual experiences (0.36 < r < 0.42; p < 0.001); values/beliefs (0.37 < r < 0.42; p < 0.001); overall self-ranking (0.27 < r < 0.38; p < 0.001); SpEnvironmental: daily spiritual experiences (0.39 < r < 0.43; p < 0.001); values/beliefs (0.34 < r < 0.33; p < 0.001); overall self-ranking (0.29 < r < 0.32; p < 0.001). Depressive symptoms had inverse correlations—SpPersonal: (−0.27 < r < 0.42; p < 0.001); SpCommunal: (−0.25 r < −0.372; p < 0.001); SpEnvironmental: (−0.20 < r < −0.27; p < 0.001); SpTranscendental: (−0.29 < r < −0.36; p < 0.001). We found strongest correlations between the transcendental dimension of SHALOM and BMMRS domains (daily spiritual experiences 0.65 < r < 0.72; belief r = 0.55; overall self-ranking 0.52 < r < 0.56; ps < 0.001).

Table 4.

Correlations between the two sections of SHALOM dimensions, BMMRS domains, and CDI scores—Pearson coefficient.

Scales	SpPersonal	SpCommunal	SpEnvironmental	SpTranscendental
BMMRS
Daily spiritual experiences
SHALOM—Ideals	0.360*	0.367*	0.390*	0.652*
SHALOM—Liv_Exp	0.489*	0.462*	0.430*	0.717*
Values and beliefs
SHALOM—Ideals	0.331*	0.375*	0.345*	0.557*
SHALOM—Liv_Exp	0.385*	0.422*	0.333*	0.551*
Overall self-ranking
SHALOM—Ideals	0.263*	0.274*	0.290*	0.518*
SHALOM—Liv_Exp	0.315*	0.338*	0.320*	0.558*
CDI
SHALOM—Ideals	−0.277*	−0.256*	−0.200*	−0.291*
SHALOM—Liv_Exp	−0.429*	−0.376*	−0.272*	−0.362*

SHALOM: Spiritual Health and Life-Orientation Measure; BMMRS: Brief Multidimensional Measure of Religiousness/Spirituality; CDI: Children Depression Inventory.

Section Ideals: what participants rate about how important they think each item is for optimum spiritual health.

Section Lived Experience: what participants rate about how they feel that each item reflect your personal experience most of the time.

p < 0.001.

Discussion

This is the first study to assess spirituality/spiritual health in children and adolescents aged 9 years and above in Brazil. The findings describe acceptable psychometric properties of the SHALOM; regarding internal consistency; discriminate validity between atheists, “spiritual, but not religious,” religious, and age groups; and convergent validity.

Children as young as 7 years old can report abstract constructs like satisfaction with their lives and their emotions, as well as think about the meaning of life, goals for the future, and values (James et al., 2012). However, it is important to consider the cognitive developmental process and the ability to abstract in this population, which grows with age.

The coefficients of internal consistency were similar to those reported in reliability analyses of the SHALOM in a sample of 341 adults in Israel, which the internal consistency was found to be high for both sections of the scale: Ideals, α = 0.89 and Experience, α = 0.90. Alpha values for the four dimensions of Experience and Ideals sections ranged from adequate to ideal (0.72 < α < 0.96) (Elhai et al., 2016). In the Portuguese version of the SWBQ, the evaluation of the psychometric properties showed that the variation of Cronbach’s α for all dimensions ranging 0.72 <α< 0.88 (Gouveia et al., 2009).

Regarding children and adolescent’s samples, Fisher (2013), in a study with 460 students, aged 12–18 years, from four different types of secondary schools (State, Catholic, Christian Community and other independent schools) in Victoria Australia demonstrated good levels of internal consistency (alpha value personal = 0.83; transcendental = 0.92; environmental = 0.87; and communal = 0.78). The internal consistency of the SHALOM was sufficiently high and fairly similar to the four dimensions.

The analysis of the convergent and discriminate validation criteria with BMMRS and CDI were satisfactory. Our results showed a higher level of convergence in the transcendental domain and BMMRS domains, most of the daily spiritual experiences, and this is the first evaluation of these properties in healthy children and adolescent sample. James and Miller (2017) found evidences that spirituality mediates, in different ways, the relationship between religious behaviors and health behaviors (for depression outcomes and emotional regulation suppression strategies). Future studies are necessary to investigate the dynamic qualities of R/S, the processes of growing and transforming of faith and spiritual beliefs, and the role in health outcomes.

In the analysis of discriminate validity between atheist groups, “spiritual but not religious,” and religious groups, we observe a presence of an ascending gradient. The group of atheists had the lowest scores, followed by the spiritual group, but not religious, and religious group, which was expected according to the scale construct. Analysis regarding psychometric properties of the original SWBQ using item response theory (IRT), in a sample comprising 4462 participants, from mainly secondary schools and universities, showed that the discrimination parameters for all items in the four scales were moderate to large (Gomez and Fisher, 2005a).

Regarding the convergent validity, it was performed with three domains of BMMRS and CDI, and both presented results in the expected directions and offered support to the external validity of the measure. We found positive correlations of SHALOM and the BMMRS domains: daily spiritual experiences, values and beliefs, and overall self-ranking, which measure similar constructs. The negative correlation between spirituality domains of SHALOM and CDI suggests that more spirituality people also tend to present lower depressive symptoms.

In the comparative analysis between genders, the results showed no significant difference. Results from measurement of the structural equivalencies and latent mean differences across gender in the SWBQ found support for the invariance in factor loadings and mean values across males and females (Gomez and Fisher, 2005b).

Concerning to age, the finding that as people progress in age, from childhood to adolescence, the score in all dimensions decreases agrees with some current research. In a cohort of twins from 14 to 25 years, religiousness and religious service attendance were evaluated, and the results demonstrate a slight, but significant, decrease in the mean level of religiousness especially during the transition from 14 to 20 years (Koenig et al., 2008).

Limitations

SHALOM is a multidimensional scale, and future studies should execute analysis of IRT to evaluate the performance of the items, tests to assess unidimensionality (Rasch analysis) to increase the validity of the scale.

Although we evaluated a sample of healthy children and adolescents from urban context with high and low socioeconomic levels, more studies are needed in different settings, due to the cultural and religious diversity in Brazil.

Conclusion

Since there are very few multidimensional R/S instruments in Brazil Portuguese, and as far as we know, none that measure spirituality in children samples, SHALOM could become a reference tool for studies about religiousness and spirituality. Also, SHALOM embraces four dimensions (personal, communal, environmental, and transcendental), and two different sections (Ideals and Lived Experience) that could be analyzed separately. The “lived experience” section of SHALOM can be used as a measure of spirituality, in a broad definition that includes personal, communal, environmental, and the transcendent dimensions. In this sense, as a growing number of studies are reporting their findings using SHALOM, it is becoming increasingly useful as a database upon which to compare other studies using different measures.

The SHALOM adapted to Brazilian culture has produced results that indicate satisfactory equivalence to the original version and suggest that it is a reliable, user-friendly option for evaluation of spiritual health/spirituality among Brazilian children and adolescents aged 9 years and above.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) grant number 462338/2014-2 from Ministry of Education in Brazil.

ORCID iD

Lucianne J Valdivia

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