The Spirituality Questionnaire: Core Dimensions of Spirituality

doi:10.4236/psych.2012.31017

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Psychology

2012. Vol.3, No.1, 116-122

Published Online January 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.31017

116

The Spirituality Questionnaire: Core Dimensions of

Spirituality

Jochen Hardt1*, Sonja Schultz1, Carola Xander2, Gerhild Becker2, Malgorzata Dragan3

1Medical Psychology and Medical Sociology, Clinic for Psychosomatic Medicine and Psychotherapy,

University Medical Center, University of Mainz, Mainz, Germany

2Psychotherapy, Univer sit y Medical Center, University of Mai nz , Mainz, Germany

3Faculty of Psychology, University of Warsaw, Warsaw, Poland

Email: *[email protected]

Received September 2nd, 2011; revised October 9th, 2011; accepte d November 18th, 2011

Various approaches are used to assess spirituality via questionnaires, ranging from one-dimensional scales

to highly multidimensional models. For the present investigation, a—in spirituality research unorthodox

—factor analytic method was chosen: principal axis analysis with oblique rotation. An item collection

was examinated and cross-validated via internet. The spirituality questionnaire contains four dimensions:

belief in God, search for meaning, mindfulness, and feeling of security. They present with high internal

consistencies. The factorial structure of the four dimensions was confirmed. Based on the better fit of this

method of extraction the authors assume that these dimensions may depict the concept of spirituality more

precisely than the previously used factor analytic methods, i.e. the principal component analysis (PCA)

with orthogonal rotation.

Keywords: Questionnaire Assessment; Religiousness; Spirituality; Mindfulness

Introduction

Psychological research on spirituality and religiousness was

strongly influenced by some of Allport’s early work. He dis-

tinguished between internal and external religiousness (IR vs.

ER), “the extrinsically motivated individual uses his religion,

whereas the intrinsically motivated lives his” (Allport & Ross,

1967). When the IR-ER concept was related to mental health, it

was found that internal religiousness was positively associated

with mental health, external religiousness negatively (James &

Wells, 2003). Examining more complex models of religious-

ness shows that various aspects of spirituality are generally

positively associated with mental health and well-being, i.e. any

form of belief seems to help patients (Mohr & Huguelet, 2004;

Mofidi, Devellis, et al., 2006; Mofidi, DeVellis, et al., 2007).

Studies on the influence of religiousness and spirituality on

physical health were mainly performed on cancer patients and

show that religiousness or spirituality is important for the vast

majority of patients (Balboni, Vanderwerker, et al., 2007). Gall

(2011) states that “religious and spiritual beliefs in relation to

one’s connection to a greater significance can aid in the

creation of life meaning and purpose. Spiritual beliefs help

individuals make sense of suffering”.

Lawler-Row and Elliott interpreted this in a way that reli-

giosity and spirituality provide an overarching interpretive

scheme for making sense of live. “Every person has the ‘will’

to seek meaning in life or to achieve purpose in life” (Ishida,

2011). Furthermore positive affected spiritual interaction has

strong influence on the patients quality of life, and existential

well-being is strongly related to all outcome health measures

(Lawler-Row & Elliott, 2009). Even the effectiveness of psy-

chotherapeutical treatment can depend on “the match or mis-

match between a client’s religious or spiritual (R/S) beliefs and

the type of psychotherapy.” (Worthington, Hook, et al., 2011)

For a patient who believes in religion or spirituality, a

psychologist discounting these issues as not important may not

be the right therapist. As Hall (2010) states “The psychologist’s

position on spirituality is not irrelevant to setting the tone of the

practice enviroment. From those who endorse spirituality to

those who reject it, there will be an impact in a myriad of ways”

(p. 49). In his study on Mestizo spirituality, Cervantes (2010)

comes to a similar conclusion, noting that “the interested

(therapeutic) practitioner (should) be familar with Mexican/

Mexican American populations and the related indigeneous

spiritual background” (p. 536).

Today, with the increasing secularisation in many western

countries, the authors see the focus in society moving away

from religiousness towards spirituality. In spite of an ancient

tradition connecting science, medicine and religiousness, there

is not much doubt that modern western medicine has not con-

centrated much on the religious and spiritual needs of patients

but has widely left this field to alternative medicine (Koenig,

McCullough, et al., 2001). However, there recently are some

large studies concerning the impact of spirituality and relig-

iousness on physical health. As Nicholson et al. state in an in-

ternational comparative study “There are extensive data linking

religious involvement with better health” (p. 1). Using multi-

level logistic regression models, Nicholson et al. depicted reli-

gious participation as an indicator for the individual medical

condition (Nicholson, Rose, et al., 2010). Apart form spiritual-

ity, at least a tendency is visible in medicine that for some spe-

cial patient groups it becomes realized that a mechanical model

alone does not suffice to explain the patients complaints (e.g.

chronic fatigue: Van Houdenhove & Luyten, 2011), others have

shown that the coherence of the meaning system in mind is

*Correspo n ding author.

J. HARDT ET AL.

lower in psychiatry patients than in psychotherapists (Löffler,

Knappe, et al., 2010).

Apart from Allport’s concept of the IR-ER religious orienta-

tion, a variety of questionnaires has been developed to measure

spirituality and/or religiousness (Monod, Brennan, et al, 2011).

Some consider it a one-dimensional construct (Koenig, Park-

erson, et al., 1997) while others use a multidimensional ap-

proach. Considering the widely individual character of spiritu-

ality, the authors think that a multidimensional approach is

necessary to capture the various aspects of spirituality ade-

quately. Büssing (2006), for example, identified 24 dimensions

in religiousness and spirituality. Among others, the latter com-

prises “asking for the meaning of life”, “transcendence”,

“search for insight and wisdom”, “prayer”, “trust in God”.

However, it must be stated, that there is not much congruence

between the various approaches. One possible explanation

would be in the statistical method used. The vast majority of

researchers relied on factor analysis to develop the dimensions.

In doing so, research on religiousness and spirituality has al-

most totally applied principal component analysis (PCA) with

orthogonal rotation. It has been shown that PCA is not ideal for

extraction, i.e. it overestimates the item loadings and results in

unstable models (Gorsuch, 1997). Orthogonal rotation means

that the factors are forced to be uncorrelated. With respect to

the dimensions of spirituality this assumption maybe question-

able (Heszen-Niejodek, 2003). It would be more realistic to

assume some positively correlated factors.

Hence, the aim of the present paper was to develop a multi-

dimensional questionnaire on spirituality using a different fac-

tor analytic method that maybe more suitable for a model de-

scribing spirituality, i.e. principal axis factoring with oblique

rotation. Here, the communality of each item is first estimated

by the highest correlation to any other item. The extracted fac-

tors are later rotated without any fixed angles between them so

that the assumption of independent factors is no longer neces-

sary.

For this purpose, the items of the Kwestionariusz Samoopisu

(Heszen-Niejodek, 2003) were translated from Polish into

German by a native German speaker and supplemented by

other items reflecting various aspects of spirituality. The sup-

plemented item set was then translated back into Polish by a

native Polish speaker. Those items originally formulated in

German were translated back into German again by the native

German speaker. The back translations were checked by JH and

MD and modified to become identical in both languages and

comprehensive for our understanding of spirituality. The thus

developed item pool comprises items about belief in God,

search for meaning, mindfulness and consciousness and feeling

of security.

A pilot study was performed on medical students. Although

the pilot questionnaire was long (61 items), it was well ac-

cepted. Feedback from the students was largely positive, it was

said that it was interesting to fill out. Hence, all 61 items were

applied to sample 1 via internet. Factor analysis resulted in four

dimensions: 1) belief in God; 2) search for meaning; 3) mind-

fulness and 4) feeling of security, comprising 27 of the 61

original items. No other scale could be constructed out of the

item pool that contained at least five items. For the 27 items,

the questionnaire was cross-checked again to ensure that every

item was clearly phrased in a modern everyday language and

that it focused on one single topic only. This was done to dis-

cover precisely which aspects of spirituality constitute our di-

mensions. If necessary, minor reformulations of the items were

performed again. The questionnaire was then shortened to 20

items, retaining only those 5 items for each dimension that were

most specific. All scales were to be answered on a five-point

Likert scale with the categories “not true at all”, “hardly true”,

“don’t know” “rather true” and “absolutely true”. This new

questionnaire was then cross-validated in a new sample of 500

participants via internet again. It can be viewed at http://www.

screening4you.de

Method

Samples

Subjects were asked via Internet to fill out a questionnaire

containing about 280 items. They were registered participants

at a company that mainly performs marketing research. The

ethic commissions of the University of Düsseldorf and for

Rheinland-Pfalz approved the project (Nr. 3063 and 6281).

Data collections were performed in January and October 2008

by a professional marketing institute (http://www.linequest.de).

Participants were about 40 (sample 1) to 45 (sample 2) years

old on average, and about 50% female (see Table 1). The ma-

jority of participants of both samples were living in a partner-

ship. About 48% in the first sample and 61% in the second

sample were members of one of the German Christian churches.

The differences between sample 1 and 2 are likely to be largely

an effect of age.

Procedure

The spirituality questionnaire was located in the middle of

the item set. Participants registered at a commercial company to

fill out online questionnaires, mostly for marketing research.

They were informed that the present questionnaire served re-

search purposes and that the authors were interested in mental

health in combination with various life circumstances. During

data collection, information was put onto the homepage of the

University of Mainz to enable participants to verify the scien-

tific background of the study. Participants received a compen-

sation of about € 4.30 for filling out the questionnaire. Even if

the questionnaire was long, some individual feedback was

rather positive, it was told that it was interesting to fill out the

questionnaire. Particularly the questions about spirituality and

about childhood received posi tive evaluation .

Statistical Analysis

The items of the spirituality questionnaire were coded from

zero to four. Sub score scales of the spirituality questionnaire

were calculated as the mean of their respective items. There

were no missing items in the internet surveys, because the pro-

gramme prompted the respondents for an answer when an item

was left open.

The first step of the analysis was to compare convergent and

discriminant item correlations in both samples (for a detailed

description of the methods, see Hardt, Petrak, et al., 2003). In a

second step, item and sub score means between samples 1 and 2

were compared via t-tests. Finally, correlations between the

subscales were computed. The alpha level for all statistical tests

was set to .01 (two-tailed). Hence, effect sizes for mean com-

parisons (Cohen, 1988) of d < .15 were non-significant in the

present sample. This alpha levelalance statistical was set to b

J. HARDT ET AL.

118

Table 1.

Sample description.

Sample 1 Sample 2

N 500 500 Test for differences

Gender (% fe male) 55.4 50.0 2

(1)

= 2.93, p = .087

Age:

(sd) 39.3 (11.2) 44.8 (16.1) t998 = 6.27, p < .001

Confession (%)

Christian 48.2 60.8

Other 2.8 1.6

None 49.0 37.6

(4)

= 16.42, p < .001

Nationality (%)

German 94.2 97.4

Other 5.8 2.6

(2)

= 6.36, p = .012

Living in Partnershi p (%) 84.0 70.0 2

(2)

= 27.67, p < .001

Job (%)

High grade professional 7.4 4.2

Lower grade professional 17.8 30.2

Skilled non-manual employee 38.4 33.0

Skilled manual employee 3.4 5.2

Partly skilled worker 20.0 10.8

Unskilled labourer 6.0 6.2

Housewife/ housemen 7.0 10.4 2

(6)

= 41.46, p < .001

Mean Differences

and clinical significance. Even if d < .15 is not a common stan-

dard, the authors think it made sense to set the significance at

this level in the present study. It means, that in a two group

comparison about 10% of the variance are different (Cohen,

1988: p. 20). Trends were not interpreted. Calculations were

performed using ITAMIS (Kohr, 1978), SPSS 14.0 (SPSS) and

STATA 11.0 (StataCorp, 2009).

The means of the scales “belief in God”, “search for mean-

ing” and “mindfulness” did not differ significantly between the

two samples. However, in the scale “belief in God”, two items

had significantly lower means in sample 2 (item 12 “My belief

in God helps me to get along with difficult situations in life”, t

= 4.42, p = .001; item 3 “I turn to God”, t = 3.46, p = .001. In

item 3 the significance of the difference is attributable to the

shortening of the item). Likewise, in the scale “search for

meaning”, two items had significantly lower means in sample 2

(item 7 “My life is a constant searching and questioning”, t =

6.83, p < .001; item 13 “I try to expand my soul”, t = 4.65, p

< .001), another item had a significantly higher mean (item 9 “I

look for insight and coherence in life”, t = 4.33, p < .001).

Likewise, in the scale “mindfulness”, one item had a significant

lower mean in sample 2 (item 16 “I try to help others”, t = 6.23,

p < .001). The scale “feeling of security” had a significantly

higher mean in sample 2 (t = 4.09, p < .001), with an effect size

of d = .25. On this scale, all but one items showed significantly

higher values in sample 2 (items 6, 5, 8, 19; see Table 3).

Results

Scale Structure

As a result, the four subscales were confirmed as originally

designed: 1) belief in God, 2) search for meaning, 3) mindful-

ness, 4) feeling of security. The subscales presented with good

reliabilities (.78  Cronbachs   .97) and medium positive

intercorrelations (.26  r  .52). All items except two had

higher convergent than discriminant correlations. Item 13 (“I

try to expand my soul”) had one marginally higher value on a

foreign scale in sample 2 (see Table 2). Differences between

the two samples on the structural level were minimal. Except

for the scale “belief in God”, the convergent correlations as

well as Cronbach’s alpha were smaller in sample 2. The scale

“search for meaning” had a Cronbach’s alpha of about .78 in

sample 2, which was considerably lower than in sample 1. The

other scales represented with good to excellent internal consis-

tencies in both samples.

Age- and Gender Effects

Computing a regression analysis, for the subscale “belief in

God”, an age effect was found ( = 0.12; t = 3.71; p < .001;

Table 3), indicating that older persons have a stronger belief in

J. HARDT ET AL.

Table 2.

Item parameter.

Sample 1 Sample 2

Item Abbreviation God SfM Min Sec God SfM Min Sec

Belief in God .97 .96

15 I trust in God .90 .35 .25 .27 .93 .47 .23 .41

12 My faith help s to cope w. problems .93 .41 .24 .28 .92 .47 .26 .42

18 I trust in my faith for decisions .90 .43 .25 .31 .81 .50 .25 .48

14 I feel the love of God .93 .46 .23 .38 .89 .53 .26 .47

2 I feel that God is my friend .90 .44 .27 . 44 .88 .46 .23 .41

Search for meaning .93 .78

7 My life means searching and asking .32 .73 .28 .24 .11 .39 .19 –.05

9 I look for insight and co herence .33 .79 .31 .31 .22 .55 .46 .30

10 I try to open my mind .36 .81 .34 .46 .35 .63 .36 .43

13 I try to expan d my soul .46 .87 .35 .4 0 .64 .61 .36 .43

3 I search for the spiri t .47 .86 .33 .43 .51 .62 .35 .31

Mindulfness

.89

.83

17 I try to deal consciously with others .25 .22 .71 .34 .20 .34 .72 .20

1 I deal consc i o usly with environment .26 .32 .74 .39 .17 .30 .51 .17

16 I try to help others .18 .29 .74 .32 .27 .42 .67 .27

11 I try to be patient and tolerant .24 .28 .75 .42 .16 .32 .60 .16

4 I try to be empathetic with others .17 .40 .71 .44 .21 .40 .65 .21

Feeling of Security .88 .83

6 I feel peace deep inside me .42 .42 .49 .74 .33 .25 .26 .66

7 My life is peace and joy .29 .22 .42 .71 .27 .24 .30 .71

8 I fe el one with the world .40 .37 .37 .69 .38 .39 .30 .64

19 I see a friendly world around me .17 .30 .26 .70 .29 .19 .32 .56

20 I feel there is a lot of love in the world .19 .42 .36 .73 .52 .41 .37 .55

God than younger ones. For the subscale “search for meaning”,

an age effect was also found ( = 0.09; t = 2.77, p = .006).

Though small, it also indicates higher values on this scale for

older persons. Additionally, a sample effect was found ( =

0.11; t = 3.35, p = .001), demonstrating higher values on this

scale in the first sample. Age also affected the values of the

subscale “mindfulness” significantly ( = 0.11; t = 3.35, p

= .001), again older persons exhibited higher values. For the

subscale “feeling of security”, two factors have significant in-

fluence: age ( = .22; t = 7.18, p < .001), indicating higher val-

ues for older persons and sample ( = 0.08; t = 2.62, p = .009),

demonstrating higher values for people of the sample 2. Mem-

bership of a Christian Church is highly associated with belief in

God, but marginally with the other scales (Table 4).

Discussion

In general, the spirituality questionnaire shows similar item

characteristics in both samples. Convergent item-test score

correlations were good for all items but two, and discriminant

correlati ons were considerably lower for almost all items. From

a test-statistical view, the questionnaire demonstrates good

qualities. The first two scales of the spirituality questionnaire,

“belief in God” and “search for meaning” can be regarded as

core dimensions of spirituality, as understood by most re-

searchers. The scale “belief in God” represents the traditional

western concept of spirituality. The phrasing of the items of the

scale “belief in God” in this questionnaire has the advantage of

not specifying which God the participant believes in, i.e. fol-

lowers of all religions that incorporate deism are included.

A second scale of the spirituality questionnaire is the quest

for meaning and sense in life as comprised by the scale “search

for meaning”. The search for meaning is an essential question

for self-reflecting individuals (Fromm, 1950). In psychotherapy,

it was Frankl (1964) who emphasised the importance of

searching for meaning. He described the “noetic” dimension as

the “spiritual” core of man’s personality. Within this dimension,

human beings find their quest for a meaningful existence, and

the ability to overcome existential suffering. In the field of

spirituality research, the quest approach was established by

J. HARDT ET AL.

Table 3.

Means of the subscales and items.

Sample 1 Sample 2

Scale and items

sd t998 p

Belief in God 1.35 1.31 1.20 1.21 1.88 p = .060

I trust in God 1.43 1.43 1.13 1.35 3.46 p = .001

My faith help s me to cope w. problems 1.48 1.46 1.18 1.33 3.42 p = .001

I trust in my faith for decisions 1.22 1.34 1.09 1.24 1.62 p = .106

I feel the love of God 1.29 1.33 1.15 1.26 1.73 p = .084

I feel that God is my friend 1.30 1.40 1.43 1.35 1.47 p = .141

Search for meaning 2.12 1.08 1.99 0.84 2.15 p = .032

My life means searchin g and asking 2.40 1.18 1.89 1.17 6.83 p < .001

I look for insight and co herence 2.34 1.22 2.64 0.97 4.33 p < .001

I try to open my mind 2.13 1.22 2.22 1.13 1.24 p = .215

I try to expand my soul 1.91 1.26 1.54 1.23 4.65 p < .001

I search for the spiri t 1.84 1.22 1.66 1.22 2.29 p = .022

Mindfulness 2.98 0.68 2.95 0.63 0.80 p = .424

I try to deal consciously with others 2.90 0.79 2.98 0.81 1.66 p = .097

I deal consciously with environment 2.96 0.76 2.96 0.76 0.04 p = .967

I try to help others 3.19 0.72 2.87 0.90 6.23 p < .001

I try to be patient and tolerant 2.94 0.88 3.02 0.78 1.48 p = .140

I try to be empathetic with others 2.94 0.93 2.93 0.84 0.18 p = .858

Feeling of security 1.71 0.93 1.93 0.81 4.09 p < .001

I feel peace deep inside me 1 .73 1.17 2.01 1.01 4.03 p < .001

My life is pe ace and joy 1.98 1.15 2.25 0.98 4.09 p < .001

I feel one with the world 1.40 1.11 1.77 1.02 5.41 p < .001

I see a friendly world around me 1.22 1.34 1.09 1.24 4.14 p < .001

I feel there is a lot of love in t he world 1.74 1.09 1.65 1.15 1.19 p = .236

Table 4.

Pearson-Correlati ons among the subscales and b et w e en the subsc a les and gender, age an d m embership of a Christian Church.

Sample 1 Sample 2

God SfM Min Sec God SfM Min Sec

Meaning .44 .51

Mindfulness .67 .39 .26 .46

Security .36 .42 .45 .47 .39 .40

Age .03 .06 .09 .25 .18 .12 .05 .22

Gender .10 .06 .09 –.17 -.01 .00 .16 .05

Church .48 .21 .01 –.05 .47 .14 .06 .13

r > .12 is significant at p < .01.

120

J. HARDT ET AL.

Batson and Ventis (1985) to assess to what degree a religious

person incorporates an open-ended responsive dialogue with

existential questions raised by the contradictions and tragedies

of life.

Mindfulness, the third subscale, assesses the conscious per-

cepti on of others and th e environment . The concept is re flected

in various eastern reliagions, particularly in Buddhism (Suzuki,

Fromm, et al., 1972). In recent time, it has found some entrance

into psychotherapy research (Kabat-Zinn, 1990; Lakey, Camp-

bell, et al., 2007). In brief, it describes the development of

equanimity (one of the four divine states in buddhism), over-

coming emotional reactivity and developing friendliness, toler-

ance, gentleness, placidity, acceptance and (Grossmann and

Grossmann, 2007). Mindfulness also includes conscious and

attentive contact with others. Various questionnaires exist to

assess mindfulness, i.e. the Kentucky Inventory of Mindfulness

Skills (KIMS: Baer, Smith, et al., 2004), the Freiburger Frage-

bogen zur Achtsamkeit (FFA: Walach, 2006) and the Mindful

Attention and Awareness Scale (MAAS: Brown, 2003). There

is some evidence that mindfulness is linked with physical as

well as mental health. Carlson and Brown (2005) found nega-

tive correlations of the MAAS with mood disturbances and

stress. In a study of Carmody and colleagues (2008), increases

in mindfulness and spirituality were associated with decreases

in psychological distress and reported medical symptoms. Fur-

thermore, programmes on mindfulness based stress reduction

aim to improve chronic disorders like pain, cancer, depression,

anxiety and overall quality of life in patients as well as in

non-clinical groups (Grossman, Niemann, et al., 2004; Flugel,

Colle, Vincent, et al., 2010). However, further research assess-

ing long-term outcomes are needed. Kohls (2009) identified

two mechanisms that are mainly imortant for the positive ef-

fects: equanimity and overcoming emotional reactivity.

Finally, the fourth subscale, “feeling of security”, chara-

cterises a feeling of safety and trust in the world, a feeling of

being at home in the world. In developmental psychology,

Erikson (1995) drew a parallel to our scale with his concept of

“sense of basic trust”. Due to Erikson, a child develops this

“sense of basic trust” within the first few years of life as a

foundation for further development of personality. With “feel-

ing of security”, a dimension found entrance into the question-

naire that seems to be conceptually underdeveloped in western

culture.

The authors observed small but consistent age-effects; the

older the respondent was, the higher the reported spirituality.

Effects were relatively strong for the feeling of security (.22  r

 .25), but considerably smaller for most other dimensions (see

table 4). These results are consistent with earlier studies (e.g.:

Idler, Musick, et al., 2003; Flannelly & Galek, 2006). They

point to the likelihood that spirituality tends to increase during

later adulthood (Moberg, 2005).

Gender effects were also small, and furthermore inconsistent.

The latter was surprising because previous studies have sug-

gested that, regardless of a person’s religious identification,

women tend to be more religious and spiritual than men (Flan-

nelly & Galek, 2006). However, our findings appear to pro-

vide a challenge to this often accepted notion of gender differ-

ences, as others recently have (Büssing, 2006).

The present study has several limitations. 1) The four ex-

tracted dimensions by no means represent the huge variety of

aspects contributing to the concept spirituality. They are fac-

tor-analytically derived, and an old critique of factor analysis

already states: “In factor analysis you only get out what you put

in before” (Eysenck 1985, cited after Schumann, 2009). This

means that although items describing many facets of spirituality

were included, it is possible that some aspects were not repre-

sented by at least five items and did not constitute a separate

factor. Adding more questions about these aspects to the data

set would probably have led to an additional factor. Despite our

endeavour to apply techniques that correspond with the subject

(PAF with oblique rotation), the item selection remained sub-

jective. Indeed, the authors were surprised that only four factors

could be retained from our relatively large item pool. 2) The

present data were collected via internet. Sample 1 was not rep-

resentative while sample 2 was representative concerning age

and gender. It is still not known how Internet users differ from

the general population. This may have caused a bias in the re-

sults. 3) The attempt to assess spirituality utilising a question-

naire may be regarded dubiously by other researchers. It can be

argued that this field is intrinsically idiosyncratic and may not

be subject to quantitative research. On the other hand, the pre-

sent data demonstrate that there is considerable congruence

between different subject groups, otherwise such a clear factor

structure would not have emerged.

With the limitations given above, the authors believe that the

spirituality questionnaire represents a valid instrument to assess

four core dimensions of spirituality. Even in the event of weak

loadings, which was not the case in the present investigation,

the sample sizes were large enough to give valid results. All

scales present with good reliability and a clear structure almost

identical in the two samples. The questionnaire is easy to apply,

and respondents usually have no problems filling it out. Items

are clearly worded and the answering categories seem adequate.

The authors hope that the spirituality questionnaire will en-

courage others to do research in a field which is important for

many patients but has been almost overlooked in medical re-

search.

Acknowledgement

This work was supported in part by the Heigl-Stiftung

Düsseldorf and by the Köhler Stiftung Essen.

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