Running head: SYSTEMATIC REVIEW OF SPIRITUAL WELL-BEING SCALES SYSTEMATIC REVIEW OF SPIRITUAL WELL-BEING SCALES

Het concept van welbevinden is door de jaren heen een belangrijk aandachtspunt geweest in de wetenschappelijke wereld waardoor verschillende instrumenten zijn ontwikkeld die hun waarde hebben bewezen in termen van betrouwbaarheid en validiteit. Het welbevinden wordt in de wetenschappelijke literatuur vaak omschreven als een combinatie van het emotioneel, psychologisch en sociaal welbevinden. Echter, naast deze aspecten van welbevinden duiden verschillende onderzoeken op het bewijs van spiritualiteit als een aspect van het welbevinden. Dus om het welbevinden te kunnen verhogen, is het belangrijk om dit begrip zo compleet mogelijk te meten. Om die reden zijn in dit onderzoek de meest gebruikte spiritueel welbevinden instrumenten op een systematische wijze geïdentificeerd en beoordeeld op hun psychometrische kwaliteiten. De twee meest voorkomende instrumenten zijn uiteindelijk beoordeeld; de Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) en de Spiritual Well-Being Scale (SWBS). Voor elk instrument is een kernartikel geselecteerd aan de hand waarvan de methodologie is beoordeeld om conclusies te kunnen trekken met betrekking tot de psychometrische kwaliteiten in termen van inhoudsvaliditeit en hypotheses toetsen (onderdeel van constructvaliditeit). Het is beoordeeld aan de hand van de COSMIN checklist en het ‘slechtste score telt’ principe. De uitkomst is een slechte beoordeling van de methodologie van de kernartikelen. Dit houdt in dat op basis van de kernartikelen de psychometrische kwaliteiten van de instrumenten onvoldoende zijn geëvalueerd en dat er (een gedeelte van) informatie mist over de manier waarop de inhoudsen constructvaliditeit in de betreffende artikelen tot stand is gekomen. Ook kwam in dit onderzoek naar voren dat eerder onderzoek op het gebied van spiritueel welbevinden meestal plaatsvond in de klinische context. Tot slot duiden de resultaten van dit onderzoek erop dat alternatieven voor de COSMIN checklist en ‘slechtste score telt’ principe wellicht kunnen bijdragen aan een minder strenge en beter passende conclusie met betrekking tot de manier waarop de kwaliteit van de methodologie wordt geëvalueerd. Voor toekomstig onderzoek kunnen mogelijk ook de spiritueel welbevinden instrumenten die minder vaak in de literatuur worden genoemd belangrijke inzichten verschaffen in de bruikbaarheid van alternatieve spiritueel welbevinden instrumenten en verdienen om deze redenen meer aandacht. Kernwoorden: welbevinden, spiritualiteit, beoordeling, psychometrisch, instrument SYSTEMATIC REVIEW OF SPIRITUAL WELL-BEING SCALES 3 Abstract Throughout the years the concept of well-being has been an important focus in the scientific world and various instruments were developed that measured this concept and proved their worth in terms of reliability and validity. In scientific literature well-being is often described as a combination of the emotional, psychological and social well-being. However, beside these aspects of well-being various studies indicate that the aspect of spirituality is equally important in the assessment of well-being. Therefore, in order to improve well-being, we should be able to accurately measure this construct, including aspect of spirituality. In this study the most frequently used spiritual well-being scales were systematically identified and reviewed on their psychometric properties. The two most frequently used scales were selected for review; the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) and the Spiritual Well-Being Scale (SWBS). Subsequently, for each scale key articles were selected in order to review the methodology of these articles and consequently draw conclusions regarding their psychometric properties in terms of content validity and hypotheses testing (or construct validity). The methodology of the key articles was reviewed using the COSMIN checklist and “worst score counts” principle. The results implied a poor rating of the methodology, which means that on the basis of the key articles the psychometric qualities of the instruments have not been sufficiently evaluated. This means that a (part of) information is missing about the way in which the content and construct validity has been developed in the key articles. This present study also contributed to the knowledge that earlier research in the field of spiritual well-being usually took place in the clinical context. Finally, the results of this study indicate that alternatives for the COSMIN checklist and “worst score counts” principle may contribute to a more appropriate conclusion regarding the review of the methodology. For future research it may also be useful to pay more attention to the less frequently used spiritual well-Throughout the years the concept of well-being has been an important focus in the scientific world and various instruments were developed that measured this concept and proved their worth in terms of reliability and validity. In scientific literature well-being is often described as a combination of the emotional, psychological and social well-being. However, beside these aspects of well-being various studies indicate that the aspect of spirituality is equally important in the assessment of well-being. Therefore, in order to improve well-being, we should be able to accurately measure this construct, including aspect of spirituality. In this study the most frequently used spiritual well-being scales were systematically identified and reviewed on their psychometric properties. The two most frequently used scales were selected for review; the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) and the Spiritual Well-Being Scale (SWBS). Subsequently, for each scale key articles were selected in order to review the methodology of these articles and consequently draw conclusions regarding their psychometric properties in terms of content validity and hypotheses testing (or construct validity). The methodology of the key articles was reviewed using the COSMIN checklist and “worst score counts” principle. The results implied a poor rating of the methodology, which means that on the basis of the key articles the psychometric qualities of the instruments have not been sufficiently evaluated. This means that a (part of) information is missing about the way in which the content and construct validity has been developed in the key articles. This present study also contributed to the knowledge that earlier research in the field of spiritual well-being usually took place in the clinical context. Finally, the results of this study indicate that alternatives for the COSMIN checklist and “worst score counts” principle may contribute to a more appropriate conclusion regarding the review of the methodology. For future research it may also be useful to pay more attention to the less frequently used spiritual wellbeing scales, which may provide important insights in the usefulness of the less frequently used scales.