Multidimensional Measurement of Religiousness/Spirituality ...fetzer.org/sites/default/files/images/resources/attachment/[current... · 1999b Multidimensional Measurement of Religiousness

1999b

MultidimensionalMeasurement of

Religiousness/Spiritualityfor Use in

HealthResearch:

A Report of the Fetzer Institute/National Institute on Aging Working Group

1999b

A publication of the John E. Fetzer Institute

Fetzer Institute, National Institute on Aging Working Group: MultidimensionalMeasurement of Religiousness, Spirituality for Use in Health Research. A Report of aNational Working Group. Supported by the Fetzer Institute in Collaboration with theNational Institute on Aging. Kalamazoo, MI: Fetzer Institute, 2003 (1999).

The interpretations and conclusions contained in this publication represent the views ofthe individual working group members and do not necessarily express any official opinionor endorsement by either the National Institute on Aging, the U.S. Department of Healthand Human Services, the Fetzer Institute, its trustees, or officers.

Please contact the Fetzer Institute for additional copies of this publication, which may beused and reprinted without special permission.

1999b

October 1999Reprinted October 2003

Multidimensional Measurementof Religiousness/Spirituality

for Use inHealth Research:

A Report of the Fetzer Institute/National Institute on Aging Working Group

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This project was initially designed to bringtogether experts interested in addressingmeasurement issues around religiousness/spirituality and health from a multidimen-sional perspective. The booklet, which in-cluded the Brief Multidimensional Measureof Religiousness/Spirituality (BMMRS), waspublished as a step to encourage the exami-nation of religion/spirituality and health withsensitivity to the depth and complexity of thetopic.

The response to this effort has been muchgreater than anticipated. We continue toreceive daily requests for the booklet. To date,2,000 copies of the publication have beendistributed and another 1,200 have beendownloaded from the Internet.

In a recently completed survey of booklet usersassisted by the Kercher Center for SocialResearch at Western Michigan University,more than 80 percent of respondents believedthe booklet was useful in enabling researchersto enter, or to conduct better research in thefield of religiousness/spirituality and healthoutcomes. The most popular subscales beingused are the Religious/Spiritual Coping andthe Daily Spiritual Experiences Scales (DSES).One fourth of respondents have used the bookletin either a course that they teach, in a seminar,or in a symposium. Practitioners in clinical workare also using the booklet and the measure-ment instruments in addition to researchers.

As BMMRS and subscales are increasinglyused in research projects, the number ofpublications citing the booklet indicates thatresearch projects are beginning to be published.

The journals represented include AmericanJournal of Psychiatry, Annals of BehavioralMedicine, Gerontologist Medical Care, Journal ofHealth Psychology, Journal of the Scientific Studyof Religion, and the Journal of Adult Development.

A paper on the conceptual background to thework and the development of the BMMRS wasrecently published in the journal Research onAging: “Measuring Multiple Dimensions ofReligion and Spirituality for Health Research,”Ellen L. Idler, Marc A. Musick, ChristopherG. Ellison, Linda K. George, Neal Krause,Marcia G. Ory, Kenneth I. Pargament, LyndaH. Powell, Lynn G. Underwood, David R.Williams, 2003, 25:4.

In a joint request for applications entitledStudying Spirituality and Alcohol, sponsoredby the National Institute on Alcohol Abuseand Alcoholism of the National Institutes ofHealth and the Fetzer Institute, many of the16 funded research projects used the mea-sures from this booklet.

Please check for additional informationregarding the DSES on page 17.

We want to thank all researchers and scholarswho have provided us with thoughtful commentsand suggestions concerning their projects andthe needs of the field. We remain interestedin learning about the general disseminationof work that utilizes a multidimensionalapproach and the BMMRS, as well as learningmore about clinical uses of the booklet andBMMRS. Continue to give us feedback on theuse and development of this collection ofscales by e-mailing us at [email protected].

Prefaceadded October 2003

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Table of Contents

Page

Preface ................................................................................................ ii

Introduction ..................................................................................... 1

Daily Spiritual Experiences ............................................................ 11

Meaning ........................................................................................... 19

Values ............................................................................................... 25

Beliefs ............................................................................................... 31

Forgiveness ...................................................................................... 35

Private Religious Practices ............................................................. 39

Religious/Spiritual Coping .............................................................. 43

Religious Support ............................................................................ 57

Religious/Spiritual History ............................................................. 65

Commitment .................................................................................... 71

Organizational Religiousness ......................................................... 75

Religious Preference ........................................................................ 81

Brief Multidimensional Measure ofReligiousness/Spirituality: 1999 ..................................................... 85

Appendix A: Additional Psychometric andPopulation Distribution Data ......................................................... 89

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This publication is the product of a nationalworking group supported by the FetzerInstitute in collaboration with The NationalInstitute on Aging (NIA), part of the NationalInstitutes of Health (NIH). The workinggroup examined key dimensions of religious-ness/spirituality as they relate to physicaland mental health outcomes. The 12 papersin this report include brief literature reviews,recommended instruments, and bibliogra-phies for each identified domain. Also in-cluded is the current draft of the Brief Multi-dimensional Measure of Religiousness/Spirituality: 1999, an instrument developedby the working group, which is substantiallybased on select questions from each domain.

Core members of the working group include(in alphabetical order):

Ronald Abeles, PhD, National Institute onAging, National Institutes of Health,Bethesda, Md

Christopher Ellison, PhD, Department ofSociology, University of Texas-Austin,Austin, Texas

Linda George, PhD, Department of Sociology,Duke University Medical School,Durham, NC

Ellen Idler, PhD, Department of Sociology,Rutgers University, New Brunswick, NJ

Neal Krause, PhD, School of Public Health,University of Michigan, Ann Arbor, Mich

Jeff Levin, PhD, National Institute forHealthcare Research, Rockville, Md

Marcia Ory, PhD, National Institute onAging, National Institutes of Health,Bethesda, Md

Introduction

Kenneth Pargament, PhD, Department ofPsychology, Bowling Green StateUniversity, Bowling Green, Ohio

Lynda Powell, PhD, Department ofPreventive Medicine, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Ill

Lynn Underwood, PhD, Fetzer Institute,Kalamazoo, Mich

David Williams, PhD, Department ofSociology, University of Michigan,Ann Arbor, Mich

Background

In recent years, a growing body of literaturehas explored the implications of religion andspirituality for various mental and physicalhealth outcomes (for reviews see Koenig1994, Levin 1994). While the findings arenot univocal, mounting evidence indicatesthat various dimensions of religiousness andspirituality may enhance subjective states ofwell-being (Ellison 1991), lower levels ofdepression and psychological distress (Idler1987, Williams et al 1991), and reduce mor-bidity and mortality (for a review see Levin1996). Such findings have elicited consider-able attention from medical researchers inepidemiology, psychology, sociology, gerontol-ogy, and other fields.

Health researchers who seek to includereligious or spiritual domains in their studiestypically confront various problems. Fewhealth researchers have a scholarly back-ground in religiousness/spirituality and mostare not acquainted with the long history ofattempts to conceptualize and measuremultiple dimensions of religiousness (Krause

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Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research

1993, Williams 1994). It is becoming clearthat religious/spiritual variables cannotsimply be combined into a single scale thatexamines the effects of a single variable,“religiosity”; rather, each relevant dimensionof religiousness and spirituality should beexamined separately for its effects on physi-cal and mental health. Until recently, certainaspects of religiousness and spirituality thatare arguably most germane to the study ofhealth outcomes have received minimalempirical attention from social and behav-ioral scientists. Consequently, we currentlyhave no widely used and validated set ofstandard measures for key religious/spiritualdomains to recommend to interestedhealth researchers.

To address these issues and the growing bodyof evidence demonstrating links betweenreligious and spiritual variables and healthoutcomes, the NIA and the Fetzer Instituteconvened a panel of scholars with expertisein religiousness/spirituality and health/well-being. The initiative began with a largeconference held at the NIH in March 1995.Participants agreed that collecting abundantdata on religiousness is not feasible for manyhealth researchers because they have limitedtime in which to inquire about a wide rangeof topics germane to health outcomes. Oneprimary recommendation from the conferencewas that future studies focus on isolatingmechanisms that relate religiousness/spiritu-ality to health over a lifetime. Isolating suchmechanisms could aid researchers in select-ing specific measures that best explicate theassociation between religiousness/spiritualityand health.

Subsequent to the conference, the NIA andthe Fetzer Institute established a core work-ing group to:

• Identify those domains of religiousness/spirituality most likely to impact health;

• Suggest potential mechanisms wherebythese variables might operate; and

• Provide a short multidimensional surveyfor use in clinical research.

In their work to conceptualize andmeasure key health-relevant domains ofreligiousness/spirituality, the workinggroup identified 3 importantconsiderations.

• It became important to articulate thedistinction between religiousness andspirituality. While some may regard the2 as indistinguishable, others believereligiousness has specific behavioral,social, doctrinal, and denominationalcharacteristics because it involves asystem of worship and doctrine that isshared within a group. Spirituality isconcerned with the transcendent,addressing ultimate questions aboutlife’s meaning, with the assumption thatthere is more to life than what we see orfully understand. Spirituality can callus beyond self to concern and compas-sion for others. While religions aim tofoster and nourish the spiritual life—and spirituality is often a salient aspectof religious participation—it is possibleto adopt the outward forms of religiousworship and doctrine without having astrong relationship to the transcendent.Combining the 2 areas—religiousnessand spirituality—in 1 instrument was agoal that realized this distinction.

• Although much of the existing literatureaddresses salutary effects of religiousinvolvement on health outcomes, sometypes of religious belief and experiencemay undermine health and well-being.Thus, the group also included measuresto gauge potentially unhealthy attitudesor behaviors.

• The project’s focus was to identify andmeasure domains believed to be signifi-cant for health outcomes, not to rein-vent previous work. Many of thedomains included in this publicationhave been largely ignored in healthresearch. Furthermore, the measure-

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Introduction

Potential Mechanismsfor Health Outcomes

The working group began with the assump-tion that there are many ways religiousnessand spirituality may be connected to healthoutcomes. Behavioral, social, psychological,and even directly physiological causalpathways were considered. The net was castbroadly to link dimensions of religiousnessand spirituality to as many of these potentialmechanisms as possible.

Behavioral Mechanisms: Religiousness/spirituality may protect against diseaseindirectly by association with healthylifestyles. Certain religious denominationsadvocate healthy diets and advise againstsmoking (Cochran, Beeghley, and Bock 1988).The association between less alcohol or druguse and religiousness is relatively well-established: highly religious people areconsistently less likely to abuse drugs oralcohol than less religious people. Socialconnectedness—a concomitant of participa-tion in organized religion—and absence ofdepression have been associated withimproved information about health careresources, better compliance with health careregimens, and quicker response to acute

health crises (Umberson 1987, Doherty et al1983, Blumenthal et al 1982). While not allreligions have specific teaching regardingthese health-risk behaviors, theologians haveargued that “purity of life” is a “genericreligious value” and that most religious andspiritual traditions have beliefs about main-taining the health of mind, body, and soul.

Social Mechanisms: Religious and spiritualgroups may also provide supportive, integra-tive communities for their members. Reli-gious group membership is considered 1 ofthe major social ties, along with family,friends, and other social groups. In a numberof epidemiological studies, such ties, includ-ing religious group membership, havereduced mortality in a linear fashion as thenumber of ties increases (Berkman and Syme1979, House et al 1988). The support offeredby these social ties is often conceptualized aseither emotional (sharing feelings, sympathy,or encouragement) or instrumental (tangibleoffers to assist with tasks, materials, ormoney). Religious congregations are potentialsources of many types of support, both be-tween members who know one another andthose who may not. In 1 North Carolinastudy, frequent attendees of religious serviceshad larger social networks, and more con-tacts and social support from people withinthose networks than infrequent attendees ornonattendees; these findings have since beenreplicated in a US national sample (Bradley1995) and in a large sample of elderly resi-dents of a northeastern city (Idler andKasl 1997, Patel 1985).

Psychological Mechanisms: Religious groupsoffer members a complex set of beliefs aboutGod, ethics, human relationships, and lifeand death, beliefs which are directly relevantto health. Research in the US shows that thesubjective beneficial effects of participatingin religious services, prayer, and Bible read-ing are primarily due to their role instrengthening religious belief systems: indi-viduals who describe themselves as having astrong religious faith report being happierand more satisfied with their lives.

ment instruments were to address spiri-tuality and health in a unified orbi-dimensional framework.

The working group’s primary mission wasto develop items for assessing health-relevant domains of religiousness andspirituality as they are broadly under-stood. While many of the items have astrong Judeo-Christian focus (appropri-ately so, given the current distribution ofreligious preferences in the US), thegroup also proposed a number of itemsrelevant to the growing proportion ofAmericans who engage in spiritualactivities outside the context of churchesand synagogues.

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Religious involvement also appears to havesignificant protective effects for the emo-tional and physical well-being of individualsin crisis. Religious coping, when comparedwith other ways of coping, appears to beespecially helpful in situations, such asbereavement or serious illness, where littledirect control is possible. Additional studiesof heart surgery patients, hospitalized veter-ans, elderly women with hip fractures, menwith severe disabilities, recent widowers, andparents who have lost a child found signifi-cantly less depression among those who hadreligious resources. Whether the stressor is alife-threatening disease or disability, anenvironmental disaster, or an interpersonalconflict, the subject’s perceived support fromGod or other members of the congregationmay reduce reaction to the stressor (Seemanand McEwen 1996). Experience of a deepinner peace, often in association with medita-tion and prayer, may signal a shift fromsympathetic arousal to parasympatheticrelaxation, which is known to dampen physi-ological reactions (Seeman and McEwen1996, Benson 1975, Patel 1985).

Physiological Mechanisms: Religiousness/spirituality may provide a cushion againstboth major and minor stressors throughdirect physiological pathways. Through suchneuroendocrine messengers as catechola-mines, serotonin, and cortisol, negativeemotions have been associated with keypathogenic mechanisms including myocardialischemia (Jiang 1996), arrhythmias(Kamarck and Jennings 1991), increasedplatelet aggregation (Levine et al 1985),suppressed immune response (Stone andBovbjerg 1994), and elevations in risk factors(Brindley and Rolland 1989). Certainreligious/spiritual practices elicit the “relax-ation response,” an integrated physiologicalreaction that opposes the “stress response.”Repeated elicitation of the relaxationresponse results in reduced muscle tension,less activity of the sympathetic branch of theautonomic nervous system, less activity ofthe anterior pituitary-adrenocortical axis,lower blood pressure, lower heart rate, and

improved oxygenation, in addition to alteredbrain wave activity and function.

These potential mechanisms for healthoutcomes led the working group to focus onaspects of religiousness/spirituality that havepossible connections to areas of healthresearch in which there are knownbiobehavioral or psychosocial processes atwork. While some of the recognized pathwayshave a direct cushioning effect, it could beargued that religiousness/spirituality en-hances coping precisely in situations wherepredictability and control (concepts central tomost models of stress reduction) are limited.

Identified Domains

The working group identified the followingkey domains of religiousness/spirituality asessential for studies where some measure ofhealth serves as an outcome. In addition, thesedomains were chosen because of the strength oftheir conceptualization and theoretical orempirical connection to health outcomes.

Daily Spiritual ExperiencesMeaningValuesBeliefsForgivenessPrivate Religious PracticesReligious/Spiritual CopingReligious SupportReligious/Spiritual HistoryCommitmentOrganizational ReligiousnessReligious Preference

Additional aspects of religiousness/spiritual-ity that affect health may be identified andstudies are currently in process for some ofthem (see Current Research Efforts). Possibleadditional aspects include spiritual maturity,mystical experiences, compassion, hope,prayer, and spiritual integration, most ofwhich have never been studied in relation tohealth and await empirical documentation. Ifsuch efforts are made, the working grouprecommends beginning with a strong con-ceptualization of the relationship to health.

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Introduction

How to Use This Report

This publication was developed as a resourcethat provides an extensive listing of ques-tions relevant to religiousness/spirituality asit relates to health outcomes. It is organizedby domain. Each section identifies a domain,describes its relationship to health, recom-mends measures, discusses previous psycho-metric work, recommends uses, and discusseskey questions and concerns. The religious-ness/spirituality domains included in thisdocument are intended for use in studies thatevaluate the relationship between religious-ness/spirituality and health.

Frequently, health studies present space andtime limitations. Because of these limita-tions, we found it useful to develop a briefmeasure based substantially on select itemsfrom each of the domains. There are severalways to use the instruments included here.Researchers who wish to look merely at thedirect effects of select domains of religious-ness/spirituality on health can use therecommended measures for a specificdomain. For example, an investigatormight simply assess the interface betweenprivate religiousness/spirituality andhealth, or religious support and health, ordaily spiritual experiences and health, andso on. Such an approach is simple and easy toimplement but may overlook the fact thatthere are potentially important interrelation-ships among the different domains. Evaluat-ing these, as well as their more immediateeffects on health, is likely to lead to a moreinformed view of the health effects of reli-giousness/spirituality.

Investigators who wish to take a more com-prehensive approach can assess the interplaybetween multiple domains of religiousness/spirituality and their association with health.For example, a researcher may hypothesizethat people committed to their faith are morelikely to turn to coreligionists for socialsupport during difficult times than to indi-viduals who are less religious. Fellow parish-ioners are also more likely to recommend

religious-coping responses. Finally, thesereligious-coping responses may eliminate orresolve the stressful probe, thereby preserv-ing or improving the health of the person.Such a hypothesis suggests a model of reli-gious commitment that has both direct andindirect effects on health, with the indirecteffects operating through religious support aswell as religious coping. This researchercould, therefore, use the multidimensionalinstrument—alone in its brief form or supple-mented with long forms for specific domains,such as Religious Support and Religious/Spiritual Coping.

Current Research Efforts

The domains represented in this publicationdo not address all dimensions of religious-ness/spirituality. There are other areas thathave not yet been fully developed, either fromtheoretical or empirical perspectives. Toaddress these areas, the Fetzer Institutesupported a request for applications toencourage instrument development foradditional domains. Such projects beginwith a conceptual foundation, work througha qualitative phase, and end withquantitative measures.

Proposals from the following institutionswere selected for funding.

• Duke University Medical Center, Durham,NC: Spiritual History in Relationship toPhysical and Mental Health

• University of California-San Francisco,San Francisco, Calif: SpiritualDimensions of the Compassionate Life

• University of Missouri-St. Louis, St. Louis,Mo: Spiritual Integration and Contempla-tive Development

• Indiana University School of Medicine,Indianapolis, Ind: Assessment of PerceivedRelationship with God

• Bowling Green University, Bowling Green,Ohio: Sacred Purpose: Exploring theImplications of Spiritual Meaning forPhysical and Mental Health

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The NIA also included “Religion, Aging andHealth” as a topic of interest in its FY1997Small Grant (R03) solicitation. The SmallGrant Program provides support for pilotresearch that is likely to lead to individualresearch grants. Research projects focusingon the complex interrelationships amongreligious and spiritual variables, other psy-chosocial-mediating factors, and health andfunctioning throughout a lifetime wereencouraged. Specific topics of interest in-cluded the biopsychosocial mechanisms bywhich religion, spirituality and/or religiousaffiliations affect health; and the develop-ment of rigorous, but parsimonious scalesand indices that can be embedded in moregeneral studies of health and aging.

The following institutions are conductingresearch projects currently supported by theBehavioral and Social Science ResearchProgram at NIA.

Relationship Between Religionand Health Outcomes

• Arlene R. Gordon Research Institute, NewYork, NY: Religiousness and Spirituality inVision-Impaired Elders

• Rutgers University, New Brunswick, NJ:Religion and Spirituality in Recoveringfrom Cardiac Surgery

• University of Michigan, Ann Arbor, Mich:Religion, Stress, and Physical/MentalHealth in African-Americans

• University of Michigan, Ann Arbor, Mich:Role of Spirituality in Adjustment afterCardiac Surgery

• John W. Traphagen: Religion, Well-Being,and Aging in Japan

Measurement of Religiousness/Spirituality

• University of Florida-Gainesville,Gainesville, Fla: Refining and Testinga Spirituality Scale in the Elderly

• University of Michigan, Ann Arbor, Mich:Religion, Aging, and Health

• Eastern Virginia Medical School, Norfolk,Va: Religion, Health, and PsychologicalWell-being in the Aged

• Public Health Institute, Calif: Spiritualityand Aging in the Alameda County Study

• Bonnie Walker and Associates, Bowie, Md:Spirituality Among the Elderly in Long-term Care

• Tulane University, New Orleans, La:Religion, Health, and Aging:Quantitative Issues


Conclusion

Religiousness and spirituality are importantand vital features of many people’s lives. Theworking papers included here conclude thatthese factors play an important role in healthand health outcomes. Discussion of religious-ness, spirituality, and health in leading

Recent Developments

Since the initial publication of thisreport, the Brief MultidimensionalMeasure of Religiousness/Spirituality:1999 was embedded in the 1997-1998General Social Survey (GSS), a randomnational survey of the National DataProgram for the Social Sciences. Thebasic purpose of this survey is to gatherand disseminate data on contemporaryAmerican society in order to monitorand explain trends in attitudes andbehaviors, and to compare the UnitedStates to other societies.

The tables in Appendix A: AdditionalPsychometric and Population Distri-bution Data include the questions anddomains, percentage distributions, andpsychometric data from the GSS andreflect the efforts of the working group inanalyzing the data, the findings of whichhave been prepared as a manuscript andsubmitted for publication (Idler et al1999). The Fetzer Institute will havecopies of article reprints available uponpublication.

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journals of psychosomatic medicine, publichealth, and gerontology, as well as in generalmagazines suggests there is widespreadinterest in these issues. Therefore, theutmost conceptual and methodological clarityis critically important. This report is in-tended to encourage further research that isconceptually and methodologically sound,and should, therefore, make a lasting andsignificant contribution to the study ofreligion, spirituality, and health.

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Mauger PA, Perry J, Freeman T, Grove D,McBride A, McKinney K. The measure-ment of forgiveness: preliminary research.J Psychol Christianity. 1992;11:170-180.

McCullough M, Worthington E. Models ofinterpersonal forgiveness and theirapplications to counseling: review andcritique. Counseling Values. 1994;39:2-14.

McEwen BS, Stellar E. Stress and theindividual mechanisms leading to disease.Arch Intern Med. 1993;153:2093-2101.

Meador KG, Koenig HG, Hughes DC, BlazerDG, Turnbull J, George LK. Religiousaffiliation and major depression. HospCommunity Psychiatry. 1992;43:1204-1208.

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Pargament KI. Religious methods of coping:resources for the conservation andtransformation of significance. In:Shafranske EP, ed. Religion and theClinical Practice of Psychology.Washington, DC: American PsychologicalAssociation; 1996:215-237.

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Pargament KI, Ishler K, Dubow EF, et al.Methods of religious coping with theGulf War: cross-sectional and longitudinalanalyses. J Sci Study Religion.1994;33:347-361.

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Introduction

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Sapolsky RM. Stress, the Aging Brain, andthe Mechanisms of Neuron Death.Cambridge, Mass: The MIT Press; 1992.

Seeman TE, McEwen BS. Impact of socialenvironment characteristics onneuroendocrine regulation. PsychosomMed. 1996;58:459-471.

Stone AA, Bovbjerg DH. Stress and humoralimmunity: a review of the human studies.Adv Neuroimmunol. 1994;4:49-56.

Sweet L. Health and Medicine in the Evan-gelical Tradition. Phila, Penn: TrinityPress International; 1994.

Taylor RJ, Chatters LM. Church members asa source of informal social support. RevReligious Res. 1988;30:193-202.

Taylor RJ, Chatters LM. Nonorganizationalreligious participation among elderlyblack adults. J Gerontol: Soc Sci.1991;46:S103-S111.

Troyer H. Review of cancer among fourreligious sects: evidence that lifestyles aredistinctive sets of risk factors. Soc SciMed. 1988;26:1007-1017.


Umberson D. Family status and healthbehaviors: social control as a dimensionof social integration. J Health Soc Behav.1987;28:306-319.

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Watson PJ, Morris RJ, Hood RW. Sin andself-functioning, part I: grace, guilt, andself-consciousness. J Psychol Theology.1988;16:254-269.

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Domain of Measurement

This domain is intended to measure theindividual’s perception of the transcendent(God, the divine) in daily life and the percep-tion of interaction with, or involvement of,the transcendent in life. The items attempt tomeasure experience rather than cognitiveconstructions. Although a variety of thedomains in the more complete Brief Multidi-mensional Measure of Religiousness/Spiritu-ality: 1999 address spirituality, this domainmakes spirituality its central focus and canbe used effectively across many religiousboundaries.

Description of Measures

This domain attempts to capture thoseaspects of life that represent day-to-dayspiritual experience particularly well. Thedomain was designed to be a more directmeasure of the impact of religion and spiritu-ality on daily life. The items assess aspects ofday-to-day spiritual experience for an ordi-nary person, and should not be confused withmeasures of extraordinary experiences (suchas near-death or out-of-body experiences),which may tap something quite different andhave a different relationship to health out-comes. The experiences reflected in thisdomain may be evoked by a religious contextor by daily life. They may also reflect theindividual’s religious history and/or religiousor spiritual beliefs.

Cognitive interviews conducted with thisinstrument across a variety of cultural,religious, and educational groups haveencouraged the use of the word “God” to

Daily Spiritual ExperiencesLynn G. Underwood, PhD

Vice President-Health ResearchFetzer Institute

Kalamazoo, Michigan

describe the transcendent. Even the fewpeople for whom the word “God” is not theusual descriptor of the transcendent seemcapable of connecting the term with theirexperience. Although this instrument as-sumes a predominantly Judeo-Christianresearch population, the items have shownpromise in preliminary evaluations for usewith other groups and may require onlyminor modifications for such application.

This complete domain has not been sepa-rately addressed in any published, testedinstrument. In developing this instrument,the author drew on in-depth interviews andfocus groups conducted over a number ofyears, exploring in an open-ended way theexperiences of a wide variety of individualsfrom many religious perspectives. Thesereports of individual experience, plus areview of features of the spiritual life ashighlighted in theological, spiritual andreligious writings (Buber 1937, van Kaam1991, Merton 1969, Hanh 1994, Underhill1927, De Wit 1991), were used to developthis instrument. A review of current scalesthat attempt to measure some aspect ofspiritual experience was also conducted(Hood 1975, Elkins et al 1988, Idler and Kasl1992). Some of the most helpful insightscame from reading works by those who havea deep understanding of the spiritual as anintegral aspect of life, and seeing manysimilar issues emerge in the open-endedinterviews. Cognitive interviews on earlierdrafts of the instrument led to further refine-ments, and efforts were repeatedly made toground the questions in daily experience.

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The interviews revealed that connection wasan important concept. Western spiritualityemphasizes a more personal connection withGod and other people, while Eastern spiritu-ality places more emphasis on connectionwith all of life, and connection in unity. Manypeople have frequent interaction with thetranscendent on a daily basis, looking to Godfor strength, asking for help, and feelingguidance in specific circumstances. Emo-tional support from the transcendent ismanifested in feelings of being loved andcomforted. A concept that emerges frequentlyin the spiritual literature of both Eastern andWestern traditions is the concept of spiritualintegration, with a resulting sense of innerharmony or wholeness.

Another concept that emerged was the sensethat one can have an existence that does notsolely depend on physical or mental aspectsof self or social definitions: that one is con-nected to something beyond self or deeperwithin self. The ability to transcend thelimits of one’s present situation frequentlycomes from a spiritual and religious context.van Kamm (1986) suggests that awe is thecentral quality of the spiritual life and allother aspects flow from that. Awe comes froma realization that one is not the center of theuniverse, and from a sense of wonder ormystery that the universe itself speaks of thetranscendent and can frame one’s approach.David Steindal-Rast (1984) describes howgratefulness can provide a resting place formuch of the rest of spiritual life. An attitudeof gratefulness suggests that life is a giftrather than a right.

Compassion is a central component to manyspiritual traditions (Smith 1991) and itscapacity to benefit the one who is compas-sionate might be profitably explored in thesetting of health. Forgiveness, while devel-oped as its own domain in the larger instru-ment, is linked with the concept of mercy,which is employed in this scale. Giving othersthe benefit of the doubt, dealing with others’faults in light of one’s own, and being gener-ous are possible ways in which the spiritualis evident in everyday life.

In developing this instrument, the notionthat one might not have a connection withthe transcendent, but that one might long forsuch a connection was discussed. Longing forconnections with God, or the divine, is anaspect of the spiritual life that crops up inthe mystical literature of many traditionsand can easily be considered an element ofdaily spiritual experience of ordinary people.Such yearning is also manifested in a senseof wanting to be closer to God, or to mergewith the divine.

In developing this domain, 9 key dimensionswere identified: connection with the tran-scendent, sense of support from the transcen-dent, wholeness, transcendent sense of self,awe, gratitude, compassion, mercy, andlonging for the transcendent. The responsecategories, except for question 16, relate tofrequency, and make use of the followingscale: many times a day, every day, mostdays, some days, once in a while, never oralmost never.

Connection with the Transcendent1. I feel God’s presence.2. I experience a connection to all of life.

As in our relationships with each other, thisquality of intimacy can be very important.These questions were developed to addressboth people whose experience of relationshipwith the transcendent is one of personalintimacy and those who describe a moregeneral sense of unity as their connectionwith the transcendent.

Sense of Support from the TranscendentA sense of support is expressed in 3 ways:strength and comfort, perceived love, andinspiration/discernment.

Strength and Comfort4. I find strength in my religion or spirituality.5. I find comfort in my religion or spirituality.

This dimension has been described as “socialsupport from God.” The Index of Religiositymeasure—“I obtain strength and comfort

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Daily Spiritual Experiences

from my religion” (Idler and Kasl 1992)—was broken into 2 parts, based on cognitiveinterviews that revealed a perception thatstrength and comfort were distinct. Theitems intend to measure a direct sense ofsupport and comfort from the transcendent.They may prove highly correlated and maybe combined as this instrument undergoesfurther testing.

Perceived Love9. I feel God’s love for me directly.

10. I feel God’s love for me through others.

Individuals can believe that God is lovingwithout feeling loved themselves. The emo-tional support of feeling loved may proveimportant in the relationship of religious/spiritual issues to health outcomes. Thequality of love imputed to God has potentialdifferences from the love humans give eachother, and there is a kind of love from otherswhich many attribute to God. God’s love canbe experienced as affirming, and can contrib-ute to self-confidence and a sense of self-worth independent of actions.

Inspiration/Discernment7. I ask for God’s help in the midst of

daily activities.8. I feel guided by God in the midst of

daily activities.

These items address the expectation of divineintervention or inspiration and a sense that adivine force has intervened or inspired. The“guidance” item was most often deemedsimilar to a “nudge” from God and morerarely as a more dramatic action.

Sense of Wholeness, Internal Integration6. I feel deep inner peace or harmony.

This item attempts to move beyond merepsychological well-being. In the cognitiveinterviews, individuals were asked repeat-edly whether a person could experience asense of wholeness while feeling over-whelmed, stressed, or depressed. Thoseinterviewed generally felt that a sense of

wholeness would be harder to experienceunder adverse circumstances, but that suchinternal integration was still possible. Theword “deep” allows people to consider factorsother than psychological ease.

Transcendent Sense of Self3. During worship, or at other times when

connecting with God, I feel intense joywhich lifts me out of my daily concerns.

This item attempts to identify the experienceof a lively worship service where one’s day-to-day concerns can dissolve in the midst ofworship. Transcending the difficulties ofpresent physical ills or psychological situa-tions may also be possible through an aware-ness that life consists of more than the physi-cal and psychological. For further explorationof this concept, see Underwood 1998. Thiswas a particularly difficult dimension totranslate from metaphysical terms into morepractical lay language.

Sense of Awe11. I am spiritually touched by the beauty of

creation.

This dimension attempts to capture the waysin which people experience the transcendent.A sense of awe can be provoked by exposureto nature, human beings, or the night sky,and has an ability to elicit experience of thespiritual that crosses religious boundariesand affects people with no religious connec-tions (van Kaam 1986).

Sense of Gratitude12. I feel thankful for my blessings.

This aspect of spirituality is consideredcentral by many people and has potentialconnection to psychologically positive ways ofviewing life. Because of the potential connec-tions between gratitude and circumstances oflife, external stressors may modify a respon-dent’s feelings of thankfulness. It is impor-tant to note, however, that some people findblessings even in the most dire circumstances.

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Sense of Compassion13. I feel a selfless caring for others.

This item was preferred to “I care for otherswithout expecting anything in return,” whichcan reflect negative connotations aboutexpectations of others. “Selfless caring,” aseemingly unwieldy term, was easily under-stood by diverse individuals. Compassion isvalued in Buddhist, Christian, and Jewishtraditions, and may be a useful measurebeyond these traditions.

Sense of Mercy14. I accept others even when they do things

I think are wrong.

This item addresses the felt sense of mercy,rather than the mere cognitive awarenessthat mercy is a good quality. As demonstratedin the cognitive interviews, this measure wassuccessful in presenting mercy as a neutral,easily understood concept. Mercy, as pre-sented in this item, is closely linked to for-giveness, yet is a deeper experience thanisolated acts of forgiveness.

Longing for the Transcendent15. I desire to be closer to God or in union

with Him.

This item should always be paired withquestion 16 to fully evaluate the concept oflonging. There are 2 opposed ways ofresponding to this item: some people feel theyare so close to God that it is not possible toget closer; others have no desire to becomecloser. To clarify a respondent’s view, item 16has been added.

16. In general, how close to God do you feel?

Item 15 was included to evaluate experiencesof being drawn to the spiritual, to assessdesire or longing. Question 16 assesses theindividual’s current degree of intimacy orconnection with God.

These dimensions form a starting point andwill likely be expanded as this work

progresses. We hope that a number of thedimensions will be strongly correlated. Thewide variety of items seeks to elucidate a fewcommon elements.

Previous Psychometric Work

The instrument has been incorporated into 3large studies of physical health outcomes,including the Chicago site of a multicentermenopause study, an Ohio University painstudy, and a study at Loyola University ofChicago. In addition, the instrument hasbeen incorporated into 3 ongoing healthstudies as well as a qualitative and quantita-tive evaluation on a non-Judeo-ChristianAsian population at the University of Califor-nia, San Francisco.

Reliability and exploratory factor analysisfrom the different samples support the use ofthe instrument to measure daily spiritualexperiences. The scale is highly internallyconsistent, with alphas ranging from .91 to.95 across samples. Preliminary constructvalidity was established by examination ofthe mean scale scores across sociodemographicsubgroups, and preliminary exploratoryfactor analyses support a unidimensional set.The analysis has been included in an articlesubmitted for publication (Underwood andTeresi 1999).

A shortened version of the instrument wasembedded in the 1997-1998 wave of theGeneral Social Survey. A summary of thatpsychometric data is included inAppendix A of this report.

Association with Health

While existing scales for mystical or spiritualexperience attempt to capture aspects of thisdomain associated with psychological well-being, little empirical work links the spiritualexperiences of daily life with health out-comes. However, one of the items moststrongly predictive of positive health outcomein the Oxman study of cardiovascular disease(Oxman et al 1995) was incorporated intothis scale: “I obtain strength and comfortfrom my religion.”


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The emotional and physical feelings describedby these items may buffer individuals frompsychological stress, which has been exten-sively linked to health through specific physi-ologic effects (Cohen et al 1995). Positive emo-tional experiences have also been connectedwith positive effects on the immune system,independent of the negative effects of stress(Stone 1994). Likewise, positive expectationsfor outcomes have been linked to positiveimmune effects (Flood et al 1993, Roberts et al1995). There may also be overlap betweenendorsing a “sense of deep peace” and thecondition that leads to or emanates from directneurologic and endocrine effects similar tothose identified during meditation (Benson 1975).

The inclusion of this domain in health stud-ies has great potential for establishing apathway by which religiousness and spiritu-ality might influence health, providing apossible link between certain religious/spiritualpractices and/or cognition and health outcomes.This domain also provides an opportunity toassess direct effects of daily spiritual experi-ences on physical and mental health.

Estimated Completion Time

Less than 2 min.

Other Considerations

We are hoping to tap into a trait. However,since this domain measures perceptions andfeelings, scores may vary according to exter-nal stressors and emotional state. Ideally,psychosocial variables (such as emotionalstates, traits, and levels of stressors) wouldbe addressed in concurrently administeredmeasures, allowing researchers to account forconfounding by these factors.

Please note: When introducing the DailySpiritual Experience items to subjects, pleaseinform them, “The list that follows includesitems you may or may not experience. Pleaseconsider if and how often you have theseexperiences, and try to disregard whether youfeel you should or should not have them. Inaddition, a number of items use the word‘God.’ If this word is not a comfortable one,

please substitute another idea that calls tomind the divine or holy for you.”

Proposed Items

DAILY SPIRITUAL EXPERIENCES-LONG FORM

You may experience the following in yourdaily life. If so, how often?

1. I feel God’s presence.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

2. I experience a connection to all of life.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

3. During worship, or at other times whenconnecting with God, I feel joy whichlifts me out of my daily concerns.

1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

4. I find strength in my religion or spirituality.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

5. I find comfort in my religion or spirituality.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never


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6. I feel deep inner peace or harmony.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

7. I ask for God’s help in the midst ofdaily activities.


8. I feel guided by God in the midst ofdaily activities.


9. I feel God’s love for me, directly.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

10. I feel God’s love for me, through others.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

11. I am spiritually touched by thebeauty of creation.


12. I feel thankful for my blessings.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

13. I feel a selfless caring for others.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

14. I accept others even when they do thingsI think are wrong.


The following 2 items are scored differently.

15. I desire to be closer to God or in unionwith Him.

1 - Not at all close2 - Somewhat close3 - Very close4 - As close as possible

16. In general, how close do you feel to God?1 - Not at all close2 - Somewhat close3 - Very close4 - As close as possible

DAILY SPIRITUAL EXPERIENCES-SHORT FORM

None provided.

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Additional information regardingDSES Survey:

The Daily Spiritual Experience Scale (DSES)has been included in a number of researchstudies, including the alcohol studiesmentioned in the preface as well as projectsfunded from the Fetzer Institute request forproposals, Scientific Research on AltruisticLove and Compassionate Love. We found thatmany investigators without current self-reportmeasures directly addressing compassionatelove included two items from the DSES intheir study as a measure of compassion andmercy. These items are DSES #13, “I feel aselfless caring for others,” and DSES #14,“I accept others even when they do things Ithink are wrong.”

These same two items were also placed in thelatest 2002 wave of the General Social Sur-vey in a National Study of Altruism, (Na-tional Opinion Research Center/University ofChicago). The results are as follows:

Including the DSES as measurement of aspiritual component along with more organi-zational religious measures may present animportant method to examine religiousness/spirituality in health studies.

I accept othersI 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

A copy of the article, “The Daily SpiritualExperience Scale: Development, TheoreticalDescription, Reliability, Exploratory FactorAnalysis, and Preliminary Construct ValidityUsing Health-Related Data” by Underwoodand Teresi, Annals of Behavioral Medicine2002, 24(1): 22-33, can be found atwww.fetzer.org or by contacting [email protected].

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Bibliography

Benson H. The Relaxation Response. NewYork, NY: Avon; 1975.

Buber M. I and Thou. New York, NY:Charles Scribners & Sons; 1970.

Cohen S, Kessler R, Underwood-Gordon L.Measuring Stress: A Guide for Healthand Social Scientists. New York, NY:Oxford Press; 1995.

De Wit HF. Contemplative Psychology. Pitts-burgh, Penn: Duquesne Press; 1991.

Elkins DN, Hedstrom LJ, Hughes LL, LeafJA, Saunders C. Toward a humanistic-

phenomenological spirituality: defini-tion, description, and measurement.

J Humanistic Psychol. 1988;28(4):5-18.Flood AB, Lorence DP, Ding J, et al. The role

of expectations in patients’ reports ofpost-operative outcomes and improve-

ment following therapy. Med Care.1993;31(11):1043-1056.Hanh TN. A Joyful Path: Community,

Transformation and Peace. Berkeley,Calif: Parallax Press; 1994.

Hood R. The construction and preliminaryvalidation of a measure of reported

mystical experience. J Sci Study Reli-gion. 1975;22:353-365.Howden J. Development and PsychometricCharacteristics of the Spirituality

Assessment Scale [dissertation]. TexasWomen’s University; 1992.

Idler EL. Religiousness involvement andhealth of the elderly: some hypotheses

and an initial test. Soc Forces.1987;66:226-238.

Idler EL, Kasl S. Religion, disability,depression and the timing of death.Am J Sociol. 1992;97(4):1052-1079.

Koenig HG, Smiley M, Gonzales J. Religion,Health, and Aging. Westport, Conn:Greenwood Press; 1988.

Merton, T. Life & Holiness. New York, NY:Doubleday; 1969.


Roberts AH, Kewman DG, et al. The powerof nonspecific effects in healing:implications for psychosocial andbiological treatments. Clin Psychol Rev.1995;13:375-391.

Smith H. The World’s Religions: Our GreatWisdom Traditions. Rev ed. SanFrancisco, Calif: Harper; 1991.

Steindal-Rast D. Gratefulness, the Heart ofPrayer: An Approach to Life in Fullness.New York, NY: Paulist Press; 1984.

Stone AA, Bovbjerg DH. Stress and humoralimmunity: a review of the human studies.Adv Neuroimmunol. 1994;4:49-56.

Underhill E. Practical Mysticism. UnitedKingdom: Shaw Publications; 1927.

Underwood LG. A working model of health:spirituality and religiousness asresources: applications to persons with

disability. J Religion Disability Rehabil.In press.Underwood L., Teresi J. Development,

theoretical description, reliabilityand exploratory factor of the daily spiritualexperience (DSE) scale. In press.

van Kaam A. Formation of the Human Heart.In: Formative Spirituality Series.Vol 3. New York, NY: Crossroads; 1991.

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Constructing meaning from life’s events is anessentially human endeavor. Less clear is themeans for measuring a person’s search formeaning (the process) and the success orfailure of that search (the outcome). Althoughmany items pertaining to meaning arepresent in a variety of scales, none could becalled definitive.


Attempts to measure the construct of mean-ing grow largely out of the theoretical work ofViktor Frankl, who asserted that the “will tomeaning” is an essential human characteris-tic, one that can lead to physical and mentalsymptomatology if blocked or unfulfilled(Frankl 1963). Others have also spoken of theimportance of meaning or purpose in life aspart of a sense of coherence (Antonovsky1979), an essential function of coping withmajor life stresses (Park and Folkman inpress), or an element of psychological well-being (Ryff 1989).

The search for meaning has also been definedas one of the critical functions of religion.Frankl himself viewed meaning in religiousterms. Meaning as he saw it was somethingto be “discovered rather than created,” thatis, every individual was said to have aunique, externally given purpose in life.Other theorists have also defined religion asthat individual and social force concernedwith existential questions and their solutions(Batson, Schoenrade, and Ventis 1993; Geertz1966).

MeaningKenneth I. Pargament, PhD

Bowling Green State UniversityDepartment of Psychology

Bowling Green, Ohio

In support of the “religion-meaning” connec-tion, several studies have demonstratedsignificant relationships between measuresof religiousness (particularly conservativereligiousness) and a sense of purpose in life(Dufton and Perlman 1986, Paloutzian 1981).


Current Scales for Assessing Meaning:Several scales have been developed to meas-ure aspects of meaning or purpose in life.These include:• The Purpose-in-Life scale (PIL), which

assesses the degree to which the individualexperiences a sense of meaning or purpose(Crumbaugh 1968);

• The Seeking of Noetic Goals scale (SONG),which measures the strength of motivationto find meaning in life (Crumbaugh 1977);

• The Life Regard Index (LRI), whichassesses whether the individual has aframework from which meaning can bederived and the degree to which theselife goals are being fulfilled (Battista andAlmond 1973);

• The Life Attitude Profile (LAP), whichcontains items from the PIL and SONG, aswell as other items (Reker 1992);

• The Sense of Coherence scale (SOC), whichassesses the degree to which the world andlife events are perceived as comprehensible,manageable, and meaningful (Antonovsky1979, 1987); and

• Ryff ’s Purpose-in-Life subscale, whichassesses the degree to which the individualhas goals in life, holds beliefs that give lifepurpose, and perceives meaning in thepresent and past (Ryff and Keyes 1995).

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Measures of meaning have been criticized.First, the scales appear to be multidimen-sional. For example, factor analyses of thePIL test (one of the most heavily used meaningmeasures) reveal several factors which varyfrom study to study (Dufton and Perlman1986, Chamberlain and Zika 1988). Duftonand Perlman (1986) in working with collegestudents created a two-factor solution (lifesatisfaction and life purpose) and another setof items that did not use either of thesefactors. Chamberlain and Zika (1988), work-ing with a sample of community women,found a four-factor solution (meaning inlife through goal commitment, contentednesswith life, being in control, enthusiasm withlife). They did, however, find a higher ordergeneral factor. Other rationally derivedmeaning scales include a number ofsubscales that seem to be related, tangen-tially at best, to the core construct of mean-ing. For example, an early form of the LAPconsisted of 7 subscales: goal seeking, futuremeaning, existential vacuum, death accep-tance, life purpose, life control, and will tomeaning (Reker and Peacock 1981). The PILsubscale by Ryff (1989) appears to measurean active goal orientation (“I enjoy makingplans for the future and working to makethem a reality”), as well as the sense ofmeaning and purpose.

Criticisms can also be made of the confound-ing of meaning with other health-relatedconstructs, such as depression. The PIL scale,for instance, correlates -.65 with the Minne-sota Multiphasic Personality Inventorydepression scale and -.58 with the BeckDepression Inventory (Dyck 1987). Thecorrelation is understandable; several itemson the PIL include responses about suicidalideation, emptiness and despair, and painfuland boring experiences.

It would be useful to distinguish the searchfor meaning (a process) from the success orfailure of the search (the outcome). In fact,some of the factor-analytic results suggestthis split (Dufton and Perlman 1986). Thescales seem to do a better job of measuring

the outcome than the process. Stated anotherway, more measures evaluate whether theindividual has found meaning than whetherthe individual is searching for meaning. Theoutcome-oriented approach to measurementis apparently more vulnerable to confound-ing; the attainment of a sense of meaningand purpose in life seems difficult to separatefrom life satisfaction or low levels of depres-sion. The process-oriented approach seems tobe less vulnerable to confounding; whetherpeople who are engaged in a search for mean-ing are more likely to report better healthstatus is an interesting question. In this vein,Emmons has conducted a number of studiesthat indicate significant relationshipsbetween various personal strivings (efforts toattain a variety of goals in daily life) andindices of mental and physical health(Emmons 1986, Emmons in press).

The Religious Aspects of Meaning: A key question for researchers is whethermeaning is inherently religious or spiritual.This question cuts to the heart of what itmeans to be religious. From the functionaltradition of religious definition, the search formeaning could be (and has been) definedas inherently religious (Pargament 1997).Anyone who searches for answers to ques-tions of meaning from this point of viewwould be defined as religious, regardless ofthe nature of that search. The person whoseeks meaning through science, drugs, power,etc., would be considered as religious as theperson who seeks meaning through transcen-dental means. From the substantive traditionof religious definition, the search for meaningbecomes religious only when it involves someconnection with the sacred.

Meaning has traditionally been measuredfrom the functional tradition. Most items onmeaning scales do not explicitly referenceGod, higher powers, or spiritual matters. Toassess meaning from the perspective of thistradition, researchers could select the PILtest by Crumbaugh (the most widely usedinstrument), the Purpose and Coherencesubscales from the LAP by Reker (conceptually

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Meaning

sharper), or the PIL subscale from Ryff (linkedto a larger theory of psychological well-being).It is also important to note that these scalesgenerally focus more on the attainment ofmeaning (the outcome) than the search formeaning (the process). Reker’s subscales,however, do recognize this distinction.

No scales measure meaning from a substan-tive religious perspective. The developmentof a more explicit religious and/or spiritualmeaning scale would be a useful addition tothe literature. Because religious/spiritualmeaning lies at the core of meaning itself,according to some theorists, an explicitlyreligious/spiritual meaning may add power tothe study of meaning (for example, a spiri-tual meaning measure may predict healthabove and beyond the effects of traditionalmeaning measures). An explicitly theisticmeaning scale would consist of items such as:“The events in my life unfold according to adivine plan”; and “Without God, my lifewould be meaningless.” A spiritual meaningscale would consist of items such as: “Myspirituality gives meaning to my life’s joysand sorrows”; and “What gives meaning tomy life is the knowledge that I am a part ofsomething larger than myself.” These illus-trative items are also better indicators of theattainment of religious/spiritual meaning(the outcome) than the search for religious/spiritual meaning (the process).

Studies of the search for religious/spiritualmeaning are also needed. Batson’s “quest”scale provides 1 useful tool for assessing thedegree to which the individual is engaged inefforts to answer fundamental existentialquestions (Batson, Schoenrade, and Ventis1993). Emmons’ research on personalstrivings could also be extended to includestudies of religious and spiritual strivings, orthe degree to which personal strivings aresanctified (Emmons in press).


A number of studies have found significantrelationships between the sense of meaning

in life and indices of health, particularlymental health (Crumbaugh 1968, Zika andChamberlain 1987, Padelford 1974, Ryff1989).

Proposed Items

MEANING-LONG FORM

Instructions: Please circle how much youagree or disagree with the following state-ments on the scale below.

1 - Strongly disagree2 - Disagree3 - Neutral4 - Agree5 - Strongly agree

1. My spiritual beliefs give meaning to mylife’s joys and sorrows.


2. The goals of my life grow out of my under-standing of God.


3. Without a sense of spirituality, my dailylife would be meaningless.


4. The meaning in my life comes from feel-ing connected to other living things.


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5. My religious beliefs help me find a pur-pose in even the most painful and confus-ing events in my life.


6. When I lose touch with God, I have aharder time feeling that there ispurpose and meaning in life.


7. My spiritual beliefs give my life a sense ofsignificance and purpose.


8. My mission in life is guided/shaped by myfaith in God.


9. When I am disconnected from thespiritual dimension of my life, I losemy sense of purpose.


10. My relationship with God helps me findmeaning in the ups and downs of life.


11. My life is significant because I am part ofGod’s plan.


12. What I try to do in my day-to-day life isimportant to me from a spiritualpoint of view.


13. I am trying to fulfill my God-givenpurpose in life.


14. Knowing that I am a part of somethinggreater than myself gives meaningto my life.


15. Looking at the most troubling orconfusing events from a spiritualperspective adds meaning to my life.


16. My purpose in life reflects what I believeGod wants for me.



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17. Without my religious foundation, my lifewould be meaningless.


18. My feelings of spirituality add meaning tothe events in my life.


19. God plays a role in how I choose mypath in life.


20. My spirituality helps define the goals Iset for myself.


MEANING-SHORT FORM

None provided. See Brief MultidimensionalMeasure of Religiousness/Spirituality: 1999,Appendix.

Bibliography

Antonovsky A. Health, Stress, and Coping.San Francisco, Calif: Jossey-Bass; 1979.

Antonovsky A. Unraveling the Mystery ofHealth. San Francisco, Calif:Jossey-Bass; 1987.

Batson CD, Schoenrade P, Ventis WL.Religion and the Individual: A Social-Psychological Perspective. New York, NY:Oxford; 1993.

Battista J, Almond R. The development ofmeaning in life. Psychiatry.1973;36:409-427.

Chamberlain K, Zika S. Measuring meaningin life: an examination of three scales.Pers Individual Differences. 1988;9:589-596.

Crumbaugh JC. Cross-validation of Purposein Life Test based on Frankl’s concepts.J Individual Psychol. 1968;24:74-81.

Crumbaugh JC. The Seeking of Noetic GoalsTest (SONG): a complementary scaleto the Purpose in Life Test (PIL). J ClinPsychol. 1977;33:900-907.

Dufton BD, Perlman D. The associationbetween religiosity and the Purpose-in-Life test: does it reflect purpose orsatisfaction. J Psychol Theology.1986;14:42-48.

Dyck MJ. Assessing logotherapeutic con-structs: conceptual and psychometricstatus of the Purpose in Life and Seekingof Noetic Goals tests. Clin Psychol Rev.1987;7:439-447.

Emmons RE. Assessing spirituality throughpersonal goals: implications for researchon religion and subjective well-being. SocIndicators Res. In press.

Emmons RE. Personal strivings: an approachto personality and subjective well-being.J Pers Soc Psychol. 1986;51:1058-1068.

Frankl V. Man’s Search for Meaning. NewYork, NY: Washington SquarePress; 1963.

Geertz C. Religion as a cultural system. In:Banton M, ed. AnthropologicalApproaches to the Study of Religion.London: Tavistock; 1966:1-46.

Padelford BL. Relationship between druginvolvement and purpose in life. J ClinPsychol. 1974;30:303-305.

Paloutzian RF. Purpose in life and valuechanges following conversion. J PersSoc Psychol. 1981;41:1153-1160.

Pargament KI. The Psychology of Religionand Coping: Theory, Research, Practice.New York, NY: GuilfordPublications; 1997.

Meaning

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Pargament KI, Mahoney AM. SacredPurpose: Exploring the Implications ofSpiritual Meaning for Physical andMental Health. Unpublished manuscript.

Park CL, Folkman S. Meaning in the contextof stress and coping. Gen Psychol Rev.In press.

Reker GT. The Life Attitude Profile-Revised(LAP-R). Peterborough, Ont: StudentPsychologists Press; 1992.

Reker GT, Peacock EJ. The Life AttitudeProfile (LAP): a multidimensionalinstrument for assessing attitudes towardlife. Can J Behav Sci. 1981;13:264-273.

Ryff CD. Happiness is everything, or is it?Explorations on the meaning ofpsychological well-being. J Pers SocPsychol. 1989;57:1069-1081.

Ryff CD, Keyes CLM. The structure ofpsychological well-being revisited.J Pers Soc Psychol. 1995;69:719-727.

Zika S, Chamberlain K. Relation of hasslesand personality to subjective well-being.J Pers Soc Psychol. 1987;53:155-162.


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This domain is intended to measure dimen-sions distinct from the value the individualplaces on religion itself (“How important isreligion in your life?”), which is currentlycovered under the domain entitled “Commit-ment.” This domain is not about the sheerpresence or absence of values per se;presumably everybody values something.Instead, this domain is based on the approachof Merton (1968), who described values asgoals, and norms as the means to those goals.Other theorists viewed values as criteriapeople use to select and justify actions (Wil-liams 1968, Kluckhohn 1951). This domainattempts to assess the extent to which anindividual’s behavior reflects a normativeexpression of his/her faith or religion as theultimate value.


The Short Form for this domain directlyassesses the influence of faith on everydaylife. Three items have been proposed, 1 fromBenson (1988) and 2 from the Intrinsic/Extrinsic (I/E) Revised Scale (Gorsuch andMcPherson, 1989). One of the 3 items isphrased negatively and 1 includes amoral dimension.

The Long Form assesses the importance of awide range of possible values, placing reli-gious values in a more general context ofcompeting values. The advantage of thisapproach is that it minimizes the knownsocial desirability problems of the I/E Scale(Leak and Fish 1989). The best known workin the comprehensive measurement of values

ValuesEllen Idler, PhD

Rutgers UniversityDepartment of Sociology

Institute for Health, Health Care Policy, and Aging ResearchNew Brunswick, New Jersey

is that of Rokeach (1973). His Value Surveyasks respondents to rank 18 terminal (goal)values and 18 instrumental (process) values.Rokeach’s research reflects a strong interestin the relationship between values andreligiousness (Rokeach 1969a, 1969b) andreveals some differences between AmericanChristians and American Jews. It also dem-onstrates differences by religiousness: thevalues of salvation and forgiving are moresalient for those who attend church/syna-gogue more often and say religion is moreimportant to them. An important feature ofthe Rokeach scale is that respondents areasked to rank their values, necessitating thatsome be placed ahead of others.

More recently, Schwartz (Schwartz andBilsky 1987, Schwartz 1992, Schwartz andHuismans 1995) has developed and tested anexpanded and modified version of the Rokeachscale. Respondents are asked to rate each of56 values in terms of their importance asguiding principles in their life on a scalevarying from “opposed to my principles” (-1)through “not important” (0) to “of supremeimportance” (7). Schwartz’s original workused the same ranking technique as Rokeach,but the later work added more values andshifted to a rated scoring system. The rank-ing tasks can be time-consuming. Schwartz’swork demonstrated that the 56 values can becategorized into a smaller number of domains,and that results from a survey organized inthis manner can be replicated across popula-tions as diverse as German students, Israeliteachers, Greek Orthodox, Dutch Protestants,and Spanish Catholics. He also found thatreligiousness among respondents correlates

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negatively with the “individualist” valuedomains of hedonism, stimulation, achieve-ment, and self-direction, and positively withthe “collectivist” domains of tradition, con-formity, benevolence, and security. Somevalue domains, such as power and universal-ism, show little association with religion.

According to Schwartz and Huismans:

Theological analyses suggest thatmost and possibly all major contempo-rary religions promote transcendenceof material concerns. Religionsencourage people to seek meaningbeyond everyday existence, linkingthemselves to a “ground of being”through belief and worship. Mostfoster attitudes of awe, respect, andhumility by emphasizing the place ofthe human being in a vast, unfathom-able universe, and exhort people topursue causes greater than theirpersonal desires. The opposed orienta-tion, self-indulgent materialism, seekshappiness in the pursuit and con-sumption of material goods. In thisview, the primary function of religionis to temper self-indulgent tendenciesand to foster transcendental concernsand beliefs. Religions seek to do thisby promulgating religious creeds,moral prescriptions, and ritualrequirements. If greater religiositysignifies acceptance of these priorities,we would expect religiosity to corre-late positively with values thatemphasize reaching toward andsubmitting to forces beyond the selfand negatively with values thatemphasize gratification of materialdesires. (1995:91).

Other researchers have also identified theprosocial orientation of religious respondents.Ellison (1992), Pollner (1989), and othersargue along these lines: modeling humanrelationships after divine ones provides“godlike” models for behavior; there are

direct teachings in many faiths on the subjectof love and concern for others; feelings ofdivine protection may encourage feelings ofsecurity and friendliness to strangers. Ellisonfound that religious people were generallykind, as judged by the interviewers for theNational Survey of Black Americans (1992).


For the Short Form, the I/E Scale is thesingle most frequently used measure in thesocial scientific study of religion (Allport andRoss 1967). One of the items from the I/EScale was determined to be the highestloading item on the I/E Scale, and Gorsuchand MacPherson (1989) suggest it can beused as a single item if the survey sample islarge enough.

The Long Form comes from Schwartz, whohas tested his instrument for reliability andvalidity in numerous international samples(Schwartz 1992, Schwartz and Bilsky 1987,Schwartz and Huismans 1995).


There is no obvious, direct connection betweenvalues and health, and virtually no researchhas been done in this area. The link wouldhave to be through behaviors that are pro-moted by the value or criteria of faith.Schwartz and Huismans (1995) found thatreligious people consistently show a morecollectivist orientation and place less valueon self-indulgence or sensation-seeking.

A collectivist orientation that places littlevalue on self-stimulation, pleasure, andexcitement might cause a person to avoidrisky behaviors, such as heavy drinking, fastdriving, and/or promiscuous sex. Such acollectivist orientation may also be reflectedin larger or more supportive social networks.Ellison and George (1994) and Bradley (1995)found that religiously active people reportlarger social networks, especially of friends,which would provide another link to health.

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Values

Another effect of the value of concern forothers, especially those less fortunate thanoneself, may be the facilitation of socialcomparisons. In health research, “downwardcomparisons,” or the tendency of people tocompare themselves with others who areworse off, is commonly shown to enhancefeelings of well-being and reduce depression(Wood, Taylor, and Lichtman 1985; Gibbons1986; Affleck and Tennen 1991). Volunteeringtime to others in the community is said toproduce an altruistic “helper’s high” (Luks1993). If religiously motivated values causepeople to expose themselves to the physicalor social needs of others, and perhaps to helpothers in some way, feelings of relative well-being may be an unintentional but neverthe-less real benefit.

Suggested Administration

The Short Form items are easily self-admin-istered or administered by phone or in-person.The Long Form items must be self-administered.

Time Referent

Both scales refer to the present only.


Short Form: 15-20 sec.Long Form: approximately 10 min.

Proposed Items

VALUES-LONG FORM

Instructions: Please rate the following values“AS A GUIDING PRINCIPLE IN MY LIFE.”Begin by reading the first column (1-30).Then, from that column only, choose and ratethe most important value and the leastimportant value. Next read the second col-umn (31-56), and select the most importantvalue and the least important value in thatcolumn. Finally, rate each value in bothcolumns using the following scale.

First Column1. ___ Equality (equal opportunity for all)2. ___ Inner harmony (at peace with myself)3. ___ Social power (control over others,

dominance)4. ___ Pleasure (gratification of desires)5. ___ Freedom (freedom of action

and thought)6. ___ A spiritual life (emphasis on spiritual

not material matters)7. ___ Sense of belonging (feeling that

others care about me)8. ___ Social order (stability of society)9. ___ An exciting life (stimulating

experiences)10. ___ Meaning in life (a purpose in life)11. ___ Politeness (courtesy, good manners)12. ___ Wealth (material possessions, money)13. ___ National security (protection of my

nation from enemies)14. ___ Self-respect (belief in one’s

own worth)15. ___ Reciprocation of favors (avoidance of

indebtedness)16. ___ Creativity (uniqueness, imagination)17. ___ A world at peace (free of war

and conflict)18. ___ Respect for tradition (preservation of

time-honored customs)19. ___ Mature love (deep emotional and

spiritual intimacy)20. ___ Self-discipline (self-restraint,

resistance to temptation)21. ___ Detachment (from worldly concerns)22. ___ Family security (safety for loved ones)23. ___ Social recognition (respect, approval

by others)24. ___ Unity with nature (fitting into nature)25. ___ A varied life (filled with challenge,

novelty, and change)26. ___ Wisdom (a mature understanding

of life)27. ___ Authority (the right to lead or

command)28. ___ True friendship (close, supportive

friends)29. ___ A world of beauty (beauty of nature

and the arts)30. ___ Social justice (correcting injustice,

care for the weak)

-1Opposedto

0Notimportant

1 2 3Important

4 5 6Veryimportant

7Of supremeimportance

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Second Column31. ___ Independent (self-reliant,

self-sufficient)32. ___ Moderate (avoiding extremes of

feeling and action)33. ___ Loyal (faithful to my friends, group)34. ___ Ambitious (hardworking, aspiring)35. ___ Broad-minded (tolerant of different

ideas and beliefs)36. ___ Humble (modest, self-effacing)37. ___ Daring (seeking adventure, risk)38. ___ Protecting the environment

(preserving nature)39. ___ Influential (having an impact on

people and events)40. ___ Honoring of parents and elders

(showing respect)41. ___ Choosing own goals (selecting own

purposes)42. ___ Healthy (not being sick physically

or mentally)43. ___ Capable (competent, effective,

efficient)44. ___ Accepting my portion in life

(submitting to life’s circumstances)45. ___ Honest (genuine, sincere)46. ___ Preserving my public image

(protecting my “face”)47. ___ Obedient (dutiful, meeting obligations)48. ___ Intelligent (logical, thinking)49. ___ Helpful (working for the welfare

of others)50. ___ Enjoying life (enjoying food, sex,

leisure, etc.)51. ___ Devout (holding to religious faith

and belief)52. ___ Responsible (dependable, reliable)53. ___ Curious (interested in everything,

exploring)54. ___ Forgiving (willing to pardon others)55. ___ Successful (achieving goals)56. ___ Clean (neat, tidy)

VALUES-SHORT FORM

1. My whole approach to life is based on myreligion. (I/E Scale)

1 - Strongly agree2 - Agree3 - Not sure4 - Disagree5 - Strongly disagree

2. Although I believe in my religion, manyother things are more important in life.(I/E Scale)


3. My faith helps me know right fromwrong. (Benson)


Schwartz SH. Adv Exp Soc Psychol.1992;25:60-62.

Bibliography

Affleck G, Tennen H. Social comparison andcoping with major medical problems. In:Suls J, Wills T, eds. Social Comparison:Contemporary Theory and Research.Hillsdale, NJ: Lawrence Erlbaum;1991:369-393.

Allport G, Ross J. Personal religiousorientation and prejudice. J Pers SocPsychol. 1967;5:432-443.

Benson P. Effective Christian Education: ANational Study of Protestant Congrega-tions. Minneapolis, Minn: SearchInstitute; 1988.

Bradley DE. Religious involvement and socialresources: evidence from the data set“Americans’ Changing Lives.” J Sci StudyReligion. 1995;34:259-267.


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Ellison CG. Are religious people nice people?Evidence from the National Survey ofBlack Americans. Soc Forces.1992;71:411-430.

Ellison CG, George L. Religious involvement,social ties, and social support in a south-eastern community. J Sci Study Religion.1994;33:46-61.

Gibbons F. Social comparison and depression:company’s effect on misery. J Pers SocPsychol. 1986;51:140-148.

Gorsuch RL, McPherson SE. Intrinsic/extrinsicmeasurement: I/E-revised and single-item scales. J Sci Study Religion.1989;28:348-354.

Kluckhohn C. Values and value-orientationsin the theory of action: an exploration indefinition and classification. In: ParsonsT, Shils E, eds. Toward a General Theoryof Action. Cambridge, Mass: HarvardUniversity Press; 1951:388-433.

Leak GK, Fish S. Religious orientation,impression management, and self-decep-tion: toward a clarification of the linkbetween 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 SocialStructure. New York, NY: FreePress; 1968.

Pollner M. Divine relations, social relations,and well-being. J Health Soc Behav.1989;30:92-104.

Rokeach M. Religious values and socialcompassion. 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 ofReligious Res. 1969b;11:3-23.

Schwartz SH. Universals in the content andstructure of values: theoretical advancesand empirical tests in 20 countries. AdvExp Soc Psychol. 1992;25:1-65.

Schwartz SH, Bilsky W. Toward a universalpsychological structure of human values.J Pers Soc Psychol. 1987;53:550-562.

Schwartz SH, Huismans S. Value prioritiesand religiosity in four western religions.Soc Psychol Q. 1995;58:88-107.

Williams RM. Values. In: Shils E, ed.International Encyclopedia of the SocialSciences. New York, NY: Macmillan; 1968.

Wood J, Taylor S, Lichtman R. Socialcomparison in adjustment to breastcancer. J Pers Soc Psychol.1985;49:1169-1183.

Values

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The central feature of religiousness is thecognitive dimension of belief; members ofreligious groups are identified as “believers.”However, members of the same religiousgroup vary in the strength of their belief andmay also disagree about what their beliefsshould be. By definition, beliefs differ fromreligion to religion, so finding a set of beliefscommon to all religions, not to mentionfinding beliefs that religions might have incommon with spirituality, is by definitionimpossible. Stark, Rodney, and Glock (1968),for example, approach the measurement ofbelief with an orthodoxy index, and find greatvariation even within a restricted range ofProtestant denominations. Nevertheless, it isessential to measure this cognitive dimensionof religiousness/spirituality.

Beliefs can be central to health and healingas well. The placebo effect, a change in apatient’s condition attributable to the sym-bolic import of a treatment rather than to aspecific pharmacological or physiologicalintervention, has long been acknowledged(Beecher 1955). Recent work (reviewed inTurner et al 1994) suggests that placeboresponse rates may actually be higher thantraditionally thought. Herbert Benson’s work(1996) argues that religious faith mobilizesplacebo effects by enhancing the memory ofrepeated, familiar, positive therapeutic states.

Moreover, religious/spiritual beliefs offerindividuals cognitive resources beyond therelatively simple or naive expectations of

BeliefsEllen Idler, PhD



positive outcomes. Beliefs about the mean-ing of suffering and death are in some waycentral to all religions (Bowker 1970, 1991);they create webs of meaning and compre-hensibility that may comfort and sustainbelievers, even in the midst of acute trag-edy or long-term suffering.

The measurement of beliefs for this domainshould be limited to beliefs that are rel-evant to health by:

• Promoting expectations of positive out-comes, and/or

• Providing frameworks for the interpreta-tion of human suffering.


The first item that pertains to both criteriais the “strength and comfort” item, with itsreference to the 23rd Psalm (Idler and Kasl1992; Oxman, Freeman, and Manheimer1995). Already used in several healthoutcome studies, this item is included inboth Long and Short Forms, if only for thesake of comparison with other studies.The second item on the Short Form is thestandard “life after death” question, takenfrom the General Social Survey (1990).

The Long Form includes 5 additional itemsfrom National Opinion Research polling(McCready and Greeley 1976), which aredescribed as “statements about the deepermeaning of life and the ultimate purposeof living.”

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Little psychometric work exists for the 2items on the Short Form, although theyexhibit strong face validity. The additionalitems for the Long Form all have loadings of.45 or better on a factor called “faith” byMcCready and Greeley (1976).


The first Short Form item has been associ-ated, alone or in combination with otheritems, with higher rates of survival followingcardiac surgery (Oxman, Freeman, andManheimer 1995), lower levels of depressionamong men with functional disability (Idlerand Kasl 1992), lower levels of depressionand better ambulation among hip fracturepatients (Pressman et al 1990), and lowerrisk of mortality among elderly respondentsin poor health (Zuckerman, Kasl, and Ostfeld1984). To date, no research has made use ofthe “life after death” item or the “ultimatepurpose of living” scale as related tohealth outcomes.


Both the Long and Short Forms are simpleand can be self-administered or administeredby phone or in-person.

Time Referent

These items assess only current behavior andattitudes.


Short Form: 10 sec.Long Form: 1.5 min.

Proposed Items

BELIEFS-LONG FORM

1. How much is religion a source of strengthand comfort to you? (Yale Health andAging Project)

1 - None2 - A little3 - A great deal

2. Do you believe there is a life after death?(General Social Survey)

1 - Yes2 - No3 - Undecided

3. God’s goodness and love are greater thanwe can possibly imagine.

1 - Agree strongly2 - Agree somewhat3 - Can’t decide4 - Disagree somewhat5 - Disagree strongly

4. Despite all the things that go wrong, theworld is still moved by love.


5. When faced with a tragic event I try toremember that God still loves me andthat there is hope for the future.


6. I feel that it is important for my childrento believe in God.


7. I think that everything that happens hasa purpose.


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Beliefs

BELIEFS-SHORT FORM

1. How much is religion a source of strengthand comfort to you? (Yale Health andAging Project)

1 - None2 - A little3 - A great deal

2. Do you believe there is a life after death?(General Social Survey)

1 - Yes2 - No3 - Undecided

Bibliography

Beecher H. The powerful placebo. JAMA.1955;159:1602-1682.

Benson H. Timeless Healing: The Power andBiology of Belief. New York, NY: Simonand Schuster; 1996.

Bowker J. The Meanings of Death.Cambridge: Cambridge UniversityPress; 1991.

Bowker J. Problems of Suffering in theReligions 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 UltimateValues of the American Population.Beverly Hills, Calif: SagePublications; 1976.

National Opinion Research Center. GeneralSocial Surveys, 1972-1990: CumulativeCodebook. Chicago, Ill: University ofChicago; 1990.


Pressman P, Lyons JS, Larson DB, Strain JJ.Religious belief, depression, andambulation status in elderly women withbroken hips. Am J Psychiatry.1990;147:758-760.

Stark R, Glock CY. American Piety: TheNature of Religious Commitment.Berkeley, Calif: University of CaliforniaPress; 1968.

Turner J, Deyo RA, Loesser JD, Von Korff M,Fordyce WE. The importance of placeboeffects in pain treatment and research.JAMA. 1994; 271:1609-1614.

Zuckerman DM, Kasl SV, Ostfeld A. Psycho-social predictors of mortality among theelderly poor. Am J Epidemiol.1984;119:410-423.

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ForgivenessEllen Idler, PhD




This domain includes 5 dimensions of forgive-ness: confession, feeling forgiven by God,feeling forgiven by others, forgiving others,and forgiving oneself. The Short Form con-tains single items for forgiveness of self,forgiveness of others, and forgiveness by God.The Long Form contains multiple items foreach dimension.


The concept of forgiveness is central to theJudeo-Christian tradition. It is the focus of amajor Jewish holiday (Yom Kippur) and atheme in much of Jewish scripture. It is alsothe core belief of the Christian faith, cel-ebrated in Easter, the most important Chris-tian holiday. Jews and Christians haveconcepts of both divine and interpersonalforgiveness, the latter being modeled on theformer. Kaplan, Munroe-Blum and Blazer(1993) and Enright, Gassin, and Wu (1992)discuss definitions of forgiveness. Enright etal use a definition adapted from North:

Forgiveness is overcoming of negativeaffect and judgment toward theoffender, not by denying ourselves theright to such affect and judgment, butby endeavoring to view the offenderwith compassion, benevolence, andlove while recognizing that he or shehas abandoned the right to them(1992:101).

Kaplan et al (1993) and Enright et al (1992)note the existence of the concept of forgive-ness, but little more, in Zen Buddhism,

Confucianism, and Islam. Kaplan notes thatwe need cross-cultural studies of forgiveness.

Weiner and his colleagues at the Universityof California at Los Angeles (1991) conducteda series of experiments on the effects ofpublic confession of wrongdoing. Confessionassumes both personal responsibility andpersonal blame; it implies the shared recogni-tion that a norm has been violated andreaffirms that the transgressor values thatrule. Confession can repair the perception ofthe transgressor as a moral person, reducefeelings of guilt, and restore the collectivity.Their research examined whether confessionsactually result in forgiveness. In 5 experi-ments they found that “. . . confession gener-ally does result in perceived changes inpersonality traits, causal attributions, affec-tive reactions, expectancies, forgiveness,and judgments of behavior toward the confes-sor” (Weiner et al 1992:296). Weiner’s work isentirely secular in its language and concepts,and presents as examples Jimmy Swaggart(who confessed) and Jim Bakker (who didnot). Without intending to, these researchersmake the case for the power of forgivenessbecause their research demonstrates theeffectiveness of ritualized public confession.

There is a growing body of literature regard-ing forgiveness, most of it from the years1992 to 1997. Mauger et al (1992) note that aPsycLIT search for 1984 to 1992 failed toproduce a single research paper on the sub-ject. Enright and his colleagues in theHuman Development Study Group at theUniversity of Wisconsin have run a 5-yearseminar about the process of forgiveness,

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likening it to Kohlberg’s stages of moraldevelopment. The stages demonstrate theparallel development of cognitive and moralreasoning: as individuals develop cognitively,they can take the perspectives of others,empathize with others’ weaknesses, andvalue them despite their faults. The Enrightmodel of this developmental process andseveral other models are compared inMcCullough and Worthington (1994).


Many citations from recent literature are todissertations, which means that the currentscales have questionable validity and reliabil-ity, but also that forgiveness is an area ofhigh and continuing interest. Mauger et al(1992) developed scales measuring forgive-ness of others and forgiveness of self,with demonstrated reliability and validity.However, these scales do not explore forgive-ness by God or by others.


Enright et al (1992) cite other researchers’experimental studies that demonstratecorrelations between high levels of forgive-ness and lower blood pressure and fewernegative emotions; other nonexperimentalstudies associated forgiveness with lessdepression and anxiety, and higher levelsof self-esteem. Mauger et al (1992) found thatlower scores for forgiving oneself or forgivingothers correlated with higher psychopathol-ogy scores on the Minnesota MultiphasicPersonality Inventory. In much of the thera-peutic literature, healing, in the spiritualsense, is linked with forgiveness. Clearly,research about forgiveness has hardly begun.


The items can be self-administered or admin-istered by phone or in-person.

Time Referent

These items assess only current behaviorand attitudes.


Short Form: 15-20 sec.Long Form: <1 min.

Proposed Items

FORGIVENESS-LONG FORM

Confession1. It is easy for me to admit that I am

wrong. (Mauger et al)1 - Always or almost always2 - Often3 - Seldom4 - Never

2. If I hear a sermon, I usually think aboutthings that I have done wrong.(Mauger et al)

1 - Always or almost always2 - Often3 - Seldom4 - Never

Forgiveness by God3. I believe that God has forgiven me for

things I have done wrong.1 - Always or almost always2 - Often3 - Seldom4 - Never

4. I believe that there are times when Godhas punished me.


Forgiveness by Others5. I believe that when people say they

forgive me for something I did they reallymean it. (Mauger et al)


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Forgiveness

6. I often feel that no matter what I do now Iwill never make up for the mistakes Ihave made in the past. (Mauger et al)


Forgiveness of Others7. I am able to make up pretty easily with

friends who have hurt me in some way.(Mauger et al)


8. I have grudges which I have held onto formonths or years. (Mauger et al)


Forgiveness of Oneself9. I find it hard to forgive myself for some

things that I have done. (Mauger et al)1 - Always or almost always2 - Often3 - Seldom4 - Never

10. I often feel like I have failed to live theright kind of life. (Mauger et al)


FORGIVENESS-SHORT FORM

1. I have forgiven myself for things that Ihave done wrong.


2. I have forgiven those who hurt me.1 - Always or almost always2 - Often3 - Seldom4 - Never

3. I know that God forgives me.1 - Always or almost always2 - Often3 - Seldom4 - Never

Bibliography

Enright RD, Gassin E, Wu C-R.Forgiveness: a developmental view.J Moral Educ. 1992;21:99-114.

Hargrave T, Sells J. The development of aforgiveness scale. J Marital Fam Ther.1997;23:41-62.

Kaplan B, Munroe-Blum H, Blazer D.Religion, health, and forgiveness:traditions and challenges. In: Levin JS,ed. Religion in Aging and Health.Thousand Oaks, Calif: SagePublications; 1993.

Mauger PA, Perry J, Freeman T, Grove D,McBridge A, McKinney K. The measure-ment of forgiveness: preliminaryresearch. J Psychol Christianity.1992;11:170-180.

McCullough M, Worthington E. Models ofinterpersonal forgiveness and theirapplications to counseling: review andcritique. Counseling and Values.1994;39:2-14.

Weiner B, Graham S, Peter O, Zmuidinas M.Public confession and forgiveness. J Pers.1991;59:281-312.

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Private Religious PracticesJeff Levin, PhD, MPH

Senior Research FellowNational Institute for Healthcare Research

Rockville, Maryland


These items are designed to assess privatereligious and spiritual practices, a conceptualdomain or dimension of religious involvementoften characterized by terms such asnonorganizational, informal, and non-institutional religiosity.


Private religious practices represent a subsetof behaviors constituting the larger constructof religious involvement. The domain ofprivate religious practices is distinct from thedomain of public (ie, organizational, formal,institutional) religious behavior. Privatepractices are nonorganizational in that theyoccur outside the context of organized reli-gion. They are informal in that they may notalways occur at fixed times or in fixed places,or necessarily involve fixed liturgical formu-lae. Finally, they are noninstitutional in thatthey are private behaviors that occur athome—individually or in a family setting—rather than as collective experiences in aformal place of worship.

The items were modified from existing meas-ures and were selected in part because theyrepresent the most commonly used itemsfrom other scales or survey instruments. Theitems were selected to be cross-religiouslyapplicable whenever possible, at least withrespect to the US population. A review of 7well-known scales or survey instrumentsrevealed 45 items assessing private religiouspractices. In most instances, these items arenot listed separately in these inventoriesunder a “private religious practices” heading,

but constitute a subset within a larger,undifferentiated collection of religiousinvolvement items.

The National Opinion Research Center(NORC) General Social Survey (GSS) formany years has included several itemsassessing private religious practices. Theseinclude ordinal items about prayer frequencyand home Bible study, a binary item aboutsaying grace, and items about financialcontributions and watching religious televi-sion, with coding schemes specifying exactdollar amounts and numbers of hours, re-spectively. The National Survey of BlackAmericans (NSBA) also asks about prayerfrequency and watching religious television,but includes listening to the radio in thelatter question, and also asks about readingreligious books or materials and requestingprayer from others. A significant improve-ment of the NSBA over the GSS questions isthe use of a common 5-category ordinalresponse scheme. This feature better enablesthe construction of a scale based onthese items.

In the 1960s and 1970s, sociologists of reli-gion proposed numerous multidimensionalinventories of religiosity. The most influentialand widely used were measures developed byGlock and Stark, Faulkner and DeJong, andKing and Hunt (Robinson and Shaver 1969).The first 2 sets of measures include itemsabout praying privately, saying grace, andreading the Bible or other religious litera-ture, each with unique coding schemes,whose metrics are not comparable and thusdo not easily permit scaling. The King

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and Hunt measures include items aboutpraying privately, reading religious litera-ture, and reading the Bible. These items usea common coding scheme (regularly, fairlyfrequently, occasionally, seldom or never),which is imprecise.

Based on this prior work, as well as a reviewof a few other measures (Himmelfarb 1975,Paloma and Gallup 1991), and taking intoaccount certain psychometric principles, theworking group concluded that any newmeasure of private religious practices should1) be widely applicable, 2) assess the mostprevalent behaviors, 3) use a common metric,and 4) include at least 4 items.

First, a scale of private religious practices foruse in national surveys and clinical studiesshould assess behaviors that occur across thespectrum of common US religious traditions.To develop a brief instrument that coversall facets of private religious practice for allreligions or denominations would be impos-sible, naturally. Yet every item should beinterpretable, meaningful, and important tomost Catholics, Protestants, and Jews, asthey represent the 3 largest religious groupsin America.

Second, a handful of important practicescommonly appear in inventories of privatereligious practices and should be includedhere. These include praying, watching reli-gious television programs or listening toreligious radio programs, reading the Bible orother religious literature, saying grace, andcontributing to religious institutions. Thislast behavior could also be construed as anindicator of religious commitment, so it maynot be essential in a short-form privatereligious practices scale. This list does notexhaust all possible private religious prac-tices. Rather, it includes the most prevalentor frequently practiced behaviors, thusensuring reasonable response distributions.

Third, a common coding scheme applied to allor nearly all items would provide a moreuniversal metric, and thus more easily

enable development and validation of aunidimensional scale. The best ordinal scalewould specify quantified amounts of eachbehavior, ranging from “never” to multipletimes per day. This would ensure capture ofthe full range of possible frequencies ofeach practice.

Fourth, inclusion of at least 4 items is highlydesirable for psychometric reasons (seeSuggested Administration). Three or feweritems may be detrimental in terms of scalereliability and also less than ideal forvalidating a scale’s measurement properties.


The proposed scale has not been psychometri-cally confirmed or validated. However, varia-tions on the constituent items have appearedin other validated scales or have been scaledand subsequently confirmed in secondaryanalyses. For example, items regardingfrequency of prayer, reading religious mate-rial, and watching or listening to religioustelevision or radio constituted three-fourthsof a well-fitting measurement model ofnonorganizational religiosity confirmed in anational probability sample of African Ameri-cans, for use both among older adults (Chat-ters, Levin, and Taylor 1992) and across thelife course (Levin, Taylor, and Chatters1995). Similar items regarding frequency ofprayer, reading religious material, andsaying grace also formed part of an internallyconsistent, reliable measure of nonorgan-izational religiosity in 4 successive age cohortswithin a multiracial national probabilitysample (Levin 1993).


A review of gerontological research on reli-gion through the late 1980s concluded thatthe domain of nonorganizational religiousinvolvement was significantly associatedwith physical health status and psychologicalwell-being (Levin 1989). Such an associationhas been examined in several gerontologicalstudies since 1980 (Markides 1983; Idler1987; Markides, Levin, and Ray 1987;

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Private Religious Practices

Koenig, Moberg, and Kvale 1988; Alexanderand Duff 1991,1992; Taylor and Chatters1991; Ainlay, Singleton, and Swigert 1992;Levin, Chatters, and Taylor 1995). Thisrelationship, usually manifested in olderadults and in prevalence surveys, is some-what complex and merits explanation.Nonorganizational religiosity and health orwell-being may be inversely associated incross-sectional analyses, possibly reflecting anincrease in private religious practices amongolder adults disengaging from organizationalreligious behavior for reasons of ill health ordisability. Therefore, longitudinal designs arenecessary to accurately characterize theeffects of private religious practices on healthand well-being.


Because only 4 items appear on the proposedscale, no suggested Short Form is provided. Ifprior psychometric research can serve as aguide, these items constitute a reliable,unidimensional measure that is applicableacross the US adult population. Items aresimple enough that they may be either self-administered or administered in a personalor telephone interview, although amultimethod comparison analysis would beinstructive. As noted earlier, the use of atleast 4 items is highly desirable from apsychometric standpoint, as this is believedto enhance reliability and is known to enablethe use of powerful confirmatory procedures,such as those based on covariance-structuremodeling. For a unidimensional latentconstruct, such as private religious practices,a minimum of 4 items is required to over-identify parameters for purposes of estima-tion, a necessary condition for testing overallmodel fit (Bollen 1989, Chou and Bentler1995).

Time Referent

These items refer to current religious behaviorand are written in the present tense.


60 sec.

Proposed Items

PRIVATE RELIGIOUS PRACTICES-LONG FORM

Please choose the most accurate response tothe following questions.

1. How often do you pray privately in placesother than at church or synagogue?

1 - Several times a day2 - Once a day3 - A few times a week4 - Once a week5 - A few times a month6 - Once a month7 - Less than once a month8 - Never

2. How often do you watch or listen toreligious programs on TV or radio?


3. How often do you read the Bible or otherreligious literature?


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4. How often are prayers or grace saidbefore or after meals in your home?1 - At all meals2 - Once a day3 - At least once a week4 - Only on special occasions5 - Never

PRIVATE RELIGIOUS PRACTICES-SHORT FORM

None provided. See Suggested Administra-tion for this domain.

Bibliography

Ainlay SC, Singleton R, Swigert VL. Agingand religious participation: reconsideringthe effects of health. J Sci StudyReligion. 1992;31:175-188.

Alexander F, Duff RW. Influence of religiosityand alcohol use on personal well-being.J Religious Gerontol. 1991;8(2):11-25.

Alexander F, Duff RW. Religion and drinkingin the retirement community. J ReligiousGerontol. 1992;8(4):27-44.

Bollen KA. Structural Equations with LatentVariables. New York, NY: John Wiley &Sons; 1989:256-257.

Chatters LM, Levin JS, Taylor RJ. Antecedentsand dimensions of religious involvementamong older black adults. J Gerontol: SocSci. 1992;47:S269-S278.

Chou CP, Bentler PM. Estimates and tests instructural equation modeling. In: HoyleRH, 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 thehealth of the elderly: some hypothesesand an initial test. Soc Forces.1987;66:226-238.

Koenig HG, Moberg DO, Kvale JN. Religiousactivities and attitudes of older adults ina geriatric assessment clinic. J AmGeriatr Soc. 1988;36:362-374.

Levin JS. Age differences in mystical experi-ence. Gerontologist. 1993;33:507-513.

Levin JS. Religious factors in aging, adjust-ment, and health: a theoretical overview.In: Clements WM, ed. Religion, Aging andHealth: A Global Perspective. New York,NY: The Haworth Press and World HealthOrganization; 1989:133-146.

Levin JS, Chatters LM, Taylor RJ. Religiouseffects on health status and life satisfac-tion among black Americans. J Gerontol:Soc Sci. 1995;50B:S154-S163.

Levin JS, Taylor RJ, Chatters LM. A multidi-mensional measure of religious involve-ment for African Americans.” Sociol Q.1995;36:157-173.

Markides KS. Aging, religiosity, and adjust-ment: a longitudinal analysis. JGerontol. 1983;38:621-625.

Markides KS, Levin JS, Ray LA. Religion,aging, and life satisfaction: an eight-year,three-wave longitudinal study.Gerontologist. 1987;27:660-665.

Paloma MM, Gallup GH. Varieties of Prayer:A Survey Report. Phila, Penn: TrinityPress Int; 1991:19-42.

Robinson JP, Shaver PR. Measures of SocialPsychological Attitudes. Ann Arbor, Mich:Institute for Social Research;1969:543-622.

Taylor RJ, Chatters LM. Nonorganizationalreligious participation among elderlyblack adults. J Gerontol: Soc Sci.1991;46:S103-S111.


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These items assess 2 patterns of religious/spiritual coping with stressful life events:positive religious/spiritual coping reflective ofbenevolent religious methods of understand-ing and dealing with life stressors; andnegative religious/spiritual coping reflectiveof religious struggle in coping.


Empirical studies have shown a clear connec-tion between stressful life events and variousforms of religious/spiritual involvement(Bearon and Koenig 1990, Bjorck and Cohen1993, Ellison and Taylor 1996, Lindenthal etal 1970). Why should this be the case? Majorlife events can threaten or harm many ob-jects of significance—the sense of meaning,intimacy with others, personal control,physical health, the sense of personal com-fort, etc. Religion (defined broadly as thesearch for significance in ways related to thesacred) offers a variety of coping methods forconserving these objects of significance intimes of stress or, if that is no longer possible,transforming these objects of significance(Pargament 1997).

There is a large body of empirical evidencethat religious/spiritual methods of coping canaffect the psychological, social, physical, andspiritual adjustment of people to crisis, forbetter or worse (Koenig et al 1992; Oxman etal 1995; Pargament et al 1994; Wright, Pratt,and Schmall 1985). Research also indicatesthat methods of religious/spiritual coping donot duplicate those of nonreligious coping;religious/spiritual coping measures continue

Religious/Spiritual CopingKenneth I. Pargament, PhD

Bowling Green State UniversityDepartment of Psychology

Bowling Green, Ohio

to predict significant portions of variance inoutcomes to life stressors after removing theeffects of nonreligious coping measures(Pargament and Koenig 1997). Furthermore,methods of religious/spiritual coping are notredundant with global religious measures,such as intrinsic religiousness, averagechurch attendance, average frequency ofprayer, and self-rated religiousness. Severalstudies have shown that measures of specificmethods of religious/spiritual coping continueto predict outcomes to life stressors signifi-cantly, even after removing the effects ofglobal religious measures (Pargament 1997).The reverse is not typically the case; that is,global religious measures do not predictadjustment to life crises with much powerafter the effects of religious coping methodsare removed. These findings suggest a modelin which religious/spiritual coping methodsmediate the relationship between globalvariables (eg, intrinsic religiousness, fre-quency of prayer, denomination, frequency ofchurch attendance) and the outcomes ofstressful life events. In plainer language,in times of crisis people translate their gen-eral religious orientation into specific meth-ods of religious/spiritual coping. The specificmethods of coping have the more immediateand most proximal implications for health.

Five approaches have been used to measurereligious/spiritual coping: the indicatorsapproach, the overall approach, the generalcoping approach, the specific religious copingmethods approach, and the patterns of reli-gious coping approach.

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The Indicators Approach to Measurement:This approach uses global religious items (eg,frequency of prayer or frequency of churchattendance) as indicators of religious/spiri-tual coping. Using indicators is frequently anefficient way to collect survey data aboutreligion. However, even when significantcorrelations emerge between the indicatorand the measures, questions remain. Has theindividual actually applied that religiouspractice or belief to the critical situation?This can be a problem when the religious/spiritual indicator is phrased in terms ofaverage frequency of prayer or attendance,rather than frequency of prayer or attendanceas a way of dealing with a problem. We arealso left with questions about the underlyingfunctional mechanism that connects theindicator of religious/spiritual coping tooutcomes. A relationship between frequencyof prayer or attendance and health can beexplained by several theoretical frameworks.In addition, as noted earlier, there is evi-dence that measures of religious/spiritualcoping methods predict outcomes morestrongly than do religious indicators.

The Overall Approach to Measurement:This approach assesses the overall degree ofreligious/spiritual involvement in coping. Agood example is Koenig and colleagues’(1992) Religious Coping Index. A strength ofthis 3-item index is its use of multiple meth-odologies: 1 item is an open-ended questionabout how the individual coped with a stres-sor (religious coping is coded); another iteminvolves the interviewer’s rating of the extentto which the individual relied on religion tocope; the third item uses a visual analoguescale in which the individual rates howhelpful he/she found religious beliefs oractivities in coping with the situation. Thestrength of this approach is also a weakness;as is, the scale could not be used in largesurveys. In addition, if religious/spiritualcoping is defined in terms of attempts orefforts to understand and deal with problemsthrough religion, then the item in which theindividual rates the helpfulness of religious/spiritual coping is more reflective of “religious

coping efficacy” or religious outcome thanreligious/spiritual coping per se. Care isneeded to avoid confounding outcomeswith coping.

Pargament et al (1990) used a single item totap into the overall degree of religious/spiri-tual involvement in coping: “To what extentwas your religion involved in understandingor dealing with THIS EVENT in any way?(By religion, we mean your religious beliefs,practices, relationship with God, and rela-tionships with members and clergy in yourchurch.)” This item is answered on a 5-pointLikert scale ranging from “not at all” to“considerably.” On the positive side, con-founding of coping process with outcome maybe less of a problem with this item. In unpub-lished analyses, the item has been associatedwith more specific religious/spiritual copingmethods. Yet this overall item does notpredict outcomes to life stressors as well asthe more specific religious/spiritual copingmethods. In addition, as with the indicatorsapproach described earlier, the overallapproach leaves unanswered the question,“What is it about religion that makes thedifference in health?”

General Coping Approach to Measurement:In this approach, items reflecting a few usesof religion in the process of coping with a lifestressor are included in general copinginstruments (Keefe 1992, Lazarus andFolkman 1984). For example, Lazarus andFolkman’s (1984) Ways of Coping Scaleincludes 2 explicitly religious items: “foundnew faith” and “I prayed.” However, thespecial contribution religion may make tocoping tends to be obscured in this approach,because the small number of religious itemsare typically embedded in broader factor-analytically derived dimensions. In the caseof the Ways of Coping Scale, the 2 religiousitems become part of a larger “PositiveReappraisal” factor.

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Religious/Spiritual Coping

The Specific Religious Coping MethodsApproach to Measurement:If we assume that religion offers a variety ofmethods for coping with life’s problems (eg,confession, seeking spiritual support, rites ofpassage, conversion), then it should be pos-sible to assess these different methods indetail. Several approaches have been takento measure specific methods of religious/spiritual coping.

Styles of Religious Problem Solving:Pargament et al (1988) measured 3 religiousstyles of attaining control in the problem-solving process. In the deferring style, controlis sought from God; the individual places theresponsibility for coping on God. In thecollaborative style, control is sought withGod; the individual and God share theresponsibility for coping. In the self-directingstyle, control rests within the individual; theindividual takes the responsibility for copinghim/herself. We developed three 12-itemscales to measure these problem-solvingstyles (the Religious Problem Solving scalesor RPS). The items cover various domains ofthe problem-solving process: problem defini-tion, generation of alternative solutions,selection of a solution, implementation of thesolution, conclusion and redefinition of theproblem. A Short Form of the scale madeup of three 6-item scales is also available.The scales have been used in several studies(Pargament 1997). Factor analyses yield astrong 3-factor solution, which has beenreplicated in a few studies. The scales arehighly consistent internally and stable. Theyhave demonstrated evidence of discriminantand criterion-related validity with respect tomeasures of depression, anxiety, mood, guilt,physical symptoms, and psychosocial compe-tence. Although the RPS scales are phrasedand measured in terms of how the individualgenerally copes with problems, a situation-specific version of the scale has also beenpublished (Schaefer and Gorsuch 1993).

Religious Coping Activities: Pargament et al(1990) took a less theory-based, more induc-tive approach by attempting to measure a

wider range of religious/spiritual copingmethods. The items were developed througha literature review and through interviewswith clergy and adults who were dealing withvarious crises. The items were factor ana-lyzed in a sample of more than 500 membersof mainline Protestant and Roman Catholicchurches, with respondents facing a varietyof life crises. The resulting factors were:spiritually-based coping (through the rela-tionship with God, problems are reframed,limits of control are accepted, and guidanceand reassurance are sought), good deeds(efforts to live a better, more religiouslyintegrated life), discontent (expressions ofanger, mistrust, and distance to God and thecongregation), religious support (attempts toobtain help from the clergy or congregationmembers), pleading (attempts to bargainwith God or obtain a miracle), and religiousavoidance (religious activities to distract theindividual from problems). In several studies,the Religious Coping Activities (RCA) scaleshave emerged as predictors of mood, depres-sion, anxiety, and religious outcomes amongpeople facing various crises (Pargament1997). The scales are not redundant withnonreligious coping measures and are notredundant with global religious measures.

With respect to the working group’s task, thereligious/spiritual support scale is redundantwith Krause’s religious support items. Thepleading scale might also be conceptualizedas a fourth religious problem-solving style,one in which control is sought indirectlythrough God.

The Turning to Religion Subscale of the COPE:Carver, Scheier, and Weintraub (1989) devel-oped a 4-item religious/spiritual copingsubscale in their larger measure of coping.There is a situational and dispositionalversion of the scale. Individuals respond tothe items in terms of what they generally dowhen they face stressors or what they dowhen they face a particular stressor. Thesubscale seems to tap into an emotion-focused, spiritually-based coping method. The4 items are: “I seek God’s help. I put my trust

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in God. I try to find comfort in religion. I praymore than usual.” The subscale is internallyconsistent and stable. It has been associatedwith optimism and a monitoring informationprocessing style.

The RCOPE: Most recently, Koenig andPargament have been working on a compre-hensive measure of religious/spiritual copingcalled RCOPE (Koenig, Pargament, andNielsen in press; Pargament and Koenig1997). This measure is designed to be theo-retically based, comprehensive, and open tothe negative as well as the positive side ofreligious/spiritual coping. There are 5-itemand 3-item versions that assess 17 religious/spiritual coping methods. Examples of themeasures include: benevolent religiousappraisals, religious forgiving, spiritualdiscontent, religious helping, the search forspiritual connection, and anger at God. Thesecoping methods are targeted variously tothe search for meaning, intimacy, self-devel-opment, comfort, and spirituality. Prelimi-nary factor analytic results with collegestudents and medically ill patients are prom-ising. The scales also correlate with avariety of measures of stress-related out-comes, including physical health, mentalhealth, and spiritual outcomes.

On the positive side, the specific religious/spiritual coping methods approach appears toyield stronger relationships with outcomesthan the global approach to religious meas-urement. Moreover, by using these measures,it is easier to understand how religion mayaffect health because the function of religionis, to some extent, “built into” the items.Unfortunately, this approach is lengthy.Thus, unless the researcher chooses to focuson one particular type or set of religious/spiritual coping methods, this approach isnot feasible for use in large, generalpurpose surveys.

The Patterns of Religious CopingApproach to Measurement:People do not appear to use methods ofreligious/spiritual coping singly. Moderate

intercorrelations among the religious/spiri-tual coping scales suggest that methods ofreligious/spiritual coping are applied incombinations or patterns. Rather than meas-ure the variety of religious/spiritual copingmethods in detail, then, it is possible toassess a broad range of religious/spiritualcoping activities more economically. Twogroups have examined patterns of religious/spiritual coping.

Ways of Religious Coping Scale (WORCS):Boudreaux et al (1995) created a 40-itemscale that taps into a variety of religious/spiritual methods of coping with stress (eg,saying prayers, confessing, obtaining helpfrom clergy, thinking about Jesus as myfriend, trying to be less sinful). Factor analy-sis revealed 2 interpretable factors: an inter-nal/private factor of personal/cognitive reli-gious coping methods and an external/socialfactor of religious behaviors and social activi-ties. The scales are easy to read and relatedifferentially to the Religious Coping Activi-ties scales. No data are available on therelationships of these scales to measures ofhealth status. The scales also lack a theoreti-cal underpinning.

Brief RCOPE: Pargament, Smith, Koenig andPerez (1998) developed a subscale by select-ing 21 items from the RCOPE dimensionsdiscussed earlier. The items were adminis-tered to a community sample of family,friends, and acquaintances of victims of theOklahoma City bombing. The factor analysisyielded 2 factors: a positive religious/spiritualcoping factor that reflects benevolent reli-gious involvement in the search for signifi-cance (12 items), and a negative factor thatreflects religious struggle in coping (9 items).The subscales were internally consistent andevidence was found of discriminant andcriterion-related validity using measures ofstress-related growth, post-traumatic stressdisorder symptoms, callousness to others,and religious outcomes.

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As noted earlier, the overall religious/spiri-tual coping item has been associated withspecific methods of religious/spiritual coping(Pargament et al 1990) and with the out-comes of major life stressors, though theassociation is less strong than with measuresof specific religious coping methods. Thesubset of items drawn from the Brief RCOPEfor use here (see p 48 and 49) has not beentested directly. However, the Brief RCOPEhas shown evidence of internal consistency,discriminant, and criterion-related validity.Moreover, similar items have been used inother measures and studies of religious/spiritual coping and demonstrated concur-rent and predictive validity (Pargament1997). The RCOPE has received factor ana-lytic support. It has also shown evidence ofinternal consistency, criterion-related valid-ity, and incremental validity in 2 diversesamples.


Measures of religious/spiritual coping havebeen associated with indicators of physicalhealth, mental health, and spiritual out-comes. Theorists have suggested severalfunctional mechanisms to explain the connec-tion between religious/spiritual coping andhealth and well-being. Methods of religious/spiritual coping may serve as antidotes toanxiety, as a check on human impulses(Freud 1927/1961), as sources of meaning inthe world (Geertz 1966), as stimuli for per-sonal growth and development (Fromm1950), and as bases of social cohesiveness(Durkheim 1915). The motivation to find andexperience the sacred may also have intrinsichealth benefits that cannot be “reduced” toother psychosocial mechanisms.


In large surveys with limited space, theoverall approach and the patterns approachto the measurement of religious/spiritualcoping appear to be the most appropriate.The overall religious/spiritual coping question

from Pargament et al (1990) provides asummary evaluation of the degree to whichthe individual involves religion/spiritualityin coping (see the Brief RCOPE Items andOverall Religious/Spiritual Coping Items onp 48 and 49).

The Brief RCOPE Items (p 48, 49) can also beadapted for the purposes of a larger survey(Pargament, Smith, Koenig and Perez 1998).The 3 items that load highest on the positive(items 1-3 on p 52) and negative (items 1-3 onp 52, 53) religious/spiritual coping factors,respectively, were selected to create a ShortForm of the Brief RCOPE 1. A longer form ofthe Brief RCOPE, consisting of the 5 itemsthat load highest on the positive and nega-tive religious/spiritual coping factors, respec-tively, is also presented (p 48, 49). The specificreligious/spiritual coping methods assessedby each item of the Brief RCOPE are noted inparentheses. The items can be rated in termsof how the individual copes with a particularstressor, or with life stressors in general, ifcoping is measured dispositionally. Whetherto use situational or dispositional forms ofthe religious/spiritual coping measuresdepends on the purpose of the survey. If thefocus is on a group facing a particular lifestressor, then the situation-specific form ismost appropriate. If the focus is on healthstatus more generally, the dispositional formmakes more sense.

The 2 subscales of the Brief RCOPE allow forexamination of both the potentially positiveand negative effects of religion/spirituality.The items also have some theoretical connec-tion and suggest how religion/spiritualitymay affect health. Analyses of specific itemson the subscales could also point to areas forfurther, more detailed investigation using thespecific religious coping methods approachto measurement.

For studies in which space limitations areless of an issue, the RCOPE appears to be themost appropriate measure (see the LongForm starting on p 48). Theoretically-based,comprehensive, and open to the negative as


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well as the positive, this instrument providesan intensive analysis of religious/spiritualcoping methods and could serve as a basis forthe development of psychoreligiousinterventions.

Time Referent

When coping is measured dispositionally (asin the Brief RCOPE Short Form), no timeframe is specified. When coping is measuredsituationally (as in the RCOPE Long Form),the items refer to the time frame of thespecific life crisis.


Short Form (Brief RCOPE): 90 sec.-2 min.Long Form (RCOPE): 30 min.

Proposed Items

RELIGIOUS/SPIRITUAL COPING-LONG FORM

*Indicates item is on the 3-item version ofthe given subscale.

Brief RCOPE Items

Instructions (Dispositional): Think about howyou try to understand and deal with majorproblems in your life. To what extent is eachinvolved in the way you cope?

Positive Religious/Spiritual Coping Subscale(factor loadings> .60)

1. I think about how my life is part of alarger spiritual force (Search for SpiritualConnection).*

1 - A great deal2 - Quite a bit3 - Somewhat4 - Not at all

2. I work together with God as partners toget through hard times (CollaborativeReligious Coping).*


3. I look to God for strength, support, andguidance in crises (Seeking SpiritualSupport).*


4. I try to find the lesson from God in crises(Benevolent Religious Appraisal).


5. I confess my sins and ask for God’sforgiveness (Ritual Purification).


Negative Religious/Spiritual Coping Subscale(factor loadings> .53)

1. I feel that stressful situations are God’sway of punishing me for my sins or lack ofspirituality (Punishing God Reappraisal).*


2. I wonder whether God has abandoned me(Spiritual Discontent).*


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3. I try to make sense of the situation anddecide what to do without relying on God(Self-Directed Religious Coping).*


4. I question whether God really exists(Religious Doubts).


5. I express anger at God for letting terriblethings happen (Anger at God).


Overall Religious/Spiritual Coping Item

To what extent is your religion involved inunderstanding or dealing with stressfulsituations in any way?*

1 - Very involved2 - Somewhat involved3 - Not very involved4 - Not involved at all

RCOPE Subscales and Items and Definitionsof Religious/Spiritual Coping Methods 1

Religious/Spiritual Methods of Copingto Find Meaning

Instructions (Situational Form): The follow-ing items deal with ways you coped with thenegative event in your life. There are manyways to try to deal with problems. Theseitems ask what you did to cope with thisnegative event. Obviously different peopledeal with things in different ways, but weare interested in how you tried to deal withit. Each item says something about a particu-lar way of coping. We want to know to whatextent you did what the item says. How muchor how frequently? Don’t answer on the basis

of what worked or not—just whether or notyou did it. Use these raceway choices. Try torate each item separately in your mind fromthe others. Make your answers as true FORYOU as you can. Circle the answer that bestapplies to you.

1 - Not at all2 - Somewhat3 - Quite a bit4 - A great deal

Benevolent Religious Reappraisal—redefining thestressor through religion as benevolent andpotentially beneficial*1. Saw my situation as part of God’s plan.*2. Tried to find a lesson from God in

the event.*3. Tried to see how God might be trying to

strengthen me in this situation. 4. Thought that the event might bring me

closer to God.

Punishing God Reappraisal—redefining thestressor as a punishment from God for theindividual’s sins*1. Wondered what I did for God to punish me.*2. Decided that God was punishing me for

my sins.*3. Felt punished by God for my lack

of devotion. 4. Wondered if God allowed this event to

happen to me because of my sins. 5. Wondered whether God was punishing

me because of my lack of faith.

Demonic Reappraisal—redefining the stressoras the act of the Devil*1. Believed the Devil was responsible for

my situation.*2. Felt the situation was the work of

the Devil. 3. Felt the Devil was trying to turn me away

from God.*4. Decided the Devil made this happen. 5. Wondered if the Devil had anything to

do with this situation.


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Reappraisal of God’s Powers—redefining God’spower to influence the stressful situation*1. Questioned the power of God.*2. Thought that some things are beyond

God’s control.*3. Realized that God cannot answer all of

my prayers. 4. Realized that there were some things that

even God could not change. 5. Felt that even God has limits.

Religious/Spiritual Methods of Copingto Gain Control

Collaborative Religious Coping—seeking controlthrough a partnership with God in problemsolving*1. Tried to put my plans into action together

with God.*2. Worked together with God as partners.*3. Tried to make sense of the situation

with God. 4. Felt that God was working right along

with me. 5. Worked together with God to relieve my

worries.

Active Religious Surrender—an active giving upof control to God in coping*1. Did my best and then turned the

situation over to God.*2. Did what I could and put the rest in

God’s hands.*3. Took control over what I could, and gave

the rest up to God. 4. Tried to do the best I could and let God do

the rest. 5. Turned the situation over to God after

doing all that I could.

Passive Religious Deferral—passive waiting forGod to control the situation*1. Didn’t do much, just expected God to

solve my problems for me.*2. Didn’t try much of anything; simply

expected God to take control.*3. Didn’t try to cope; only expected God to

take my worries away. 4. Knew that I couldn’t handle the situation,

so I just expected God to take control. 5. Didn’t try to do much; just assumed God

would handle it.

Pleading For Direct Intercession—seeking controlindirectly by pleading to God for a miracle ordivine intercession*1. Pleaded with God to make things

turn out okay.*2. Prayed for a miracle.*3. Bargained with God to make

things better. 4. Made a deal with God so that he would

make things better. 5. Pleaded with God to make everything

work out.

Self-Directing Religious Coping—seeking controldirectly through individual initiative ratherthan help from God*1. Tried to deal with my feelings without

God’s help.*2. Tried to make sense of the situation

without relying on God.*3. Made decisions about what to do without

God’s help. 4. Depended on my own strength without

support from God. 5. Tried to deal with the situation on my

own without God’s help.


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Religious/Spiritual Methods of Coping to GainComfort and Closeness to God

Seeking Spiritual Support—searching for com-fort and reassurance through God’s loveand care*1. Sought God’s love and care.*2. Trusted that God would be by my side.*3. Looked to God for strength, support

and guidance. 4. Trusted that God was with me. 5. Sought comfort from God.

Religious Distraction—engaging in religious/spiritual activities to avoid focusing onthe stressor*1. Prayed to get my mind off of my problems.*2. Thought about spiritual matters to stop

thinking about my problems.*3. Focused on religion to stop worrying

about my problems. 4. Went to church to stop thinking about

this situation. 5. Tried to get my mind off my problems by

focusing on God.

Religious Purification—searching for spiritualcleansing through religious actions*1. Confessed my sins.*2. Asked forgiveness for my sins.*3. Tried to be less sinful. 4. Searched for forgiveness from God. 5. Asked for God to help me be less sinful.

Spiritual Connection—experiencing a sense ofconnectedness with forces that transcend 1. Looked for a stronger connection

with God.*2. Sought a stronger spiritual connection

with other people.*3. Thought about how my life is part of a

larger spiritual force. 4. Tried to build a strong relationship with a

higher power. 5. Tried to experience a stronger feeling of

spirituality.

Spiritual Discontent—expressing confusion anddissatisfaction with God’s relationship to theindividual in the stressful situation*1. Wondered whether God had

abandoned me.*2. Voiced anger that God didn’t answer

my prayers.*3. Questioned God’s love for me. 4. Wondered if God really cares. 5. Felt angry that God was not there for me.

Marking Religious Boundaries—clearly demarcat-ing acceptable from unacceptable religiousbehavior and remaining withinreligious boundaries*1. Avoided people who weren’t of my faith.*2. Stuck to the teachings and practices of

my religion.*3. Ignored advice that was inconsistent with

my faith. 4. Tried to stick with others of my own faith. 5. Stayed away from false religious teachings.

Religious/Spiritual Methods of Coping to GainIntimacy with Others and Closeness to God

Seeking Support from Clergy or Members—search-ing for comfort and reassurance through thelove and care of congregation membersand clergy*1. Looked for spiritual support from clergy.*2. Asked others to pray for me.*3. Looked for love and concern from the

members of my church. 4. Sought support from members of

my congregation. 5. Asked clergy to remember me in

their prayers.

Religious Helping—attempting to providespiritual support and comfort to others*1. Prayed for the well-being of others.*2. Offered spiritual support to family

or friends.*3. Tried to give spiritual strength to others. 4. Tried to comfort others through prayer. 5. Tried to provide others with spiritual

comfort.


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Interpersonal Religious Discontent—expressingconfusion and dissatisfaction with the rela-tionship of clergy or members to the indi-vidual in the stressful situation*1. Disagreed with what the church wanted

me to do or believe.*2. Felt dissatisfaction with the clergy.*3. Wondered whether my church had

abandoned me. 4. Felt my church seemed to be rejecting or

ignoring me. 5. Wondered whether my clergy was really

there for me.

Religious/Spiritual Methods of Coping toAchieve a Life Transformation

Seeking Religious Direction—looking to religionfor assistance in finding a new direction forliving when the old one may no longerbe viable*1. Asked God to help me find a new purpose

in life.*2. Prayed to find a new reason to live.*3. Prayed to discover my purpose in living. 4. Sought new purpose in life from God. 5. Looked to God for a new direction in life.

Religious Conversion—looking to religion for aradical change in life*1. Tried to find a completely new life

through religion.*2. Looked for a total spiritual reawakening.*3. Prayed for a complete transformation of

my life. 4. Tried to change my whole way of life and

follow a new path—God’s path. 5. Hoped for a spiritual rebirth.

Religious Forgiving—looking to religion for helpin shifting from anger, hurt, and fear associ-ated with an offense to peace*1. Sought help from God in letting go of

my anger.*2. Asked God to help me overcome

my bitterness.*3. Sought God’s help in trying to

forgive others. 4. Asked God to help me be more forgiving. 5. Sought spiritual help to give up

my resentments.

RELIGIOUS/SPIRITUAL COPING-SHORT FORM

Brief RCOPE Items

Instructions (Dispositional): Think about howyou try to understand and deal with majorproblems in your life. To what extent is eachinvolved in the way you cope?

Positive Religious/Spiritual Coping Subscale(factor loadings> .60)

1. I think about how my life is part of alarger spiritual force (Search forSpiritual Connection).


2. I work together with God as partners toget through hard times (CollaborativeReligious Coping).


3. I look to God for strength, support,and guidance in crises (SeekingSpiritual Support).


Negative Religious/Spiritual Coping Subscale(factor loadings> .53)

1. I feel that stressful situations are God’sway of punishing me for my sins or lack ofspirituality (Punishing God Reappraisal).



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2. I wonder whether God has abandoned me(Spiritual Discontent).


3. I try to make sense of the situation anddecide what to do without relying on God(Self-Directed Religious Coping).


Overall Religious/Spiritual Coping Item

To what extent is your religion involved inunderstanding or dealing with stressfulsituations in any way?


RCOPE Subscales and Items and Definitionsof Religious/Spiritual Coping Methods 1

Religious/Spiritual Methods of Copingto Find Meaning

Instructions (Situational Form): The follow-ing items deal with ways you coped with thenegative event in your life. There are manyways to try to deal with problems. Theseitems ask what you did to cope with thisnegative event. Obviously different peopledeal with things in different ways, but weare interested in how you tried to deal withit. Each item says something about a particu-lar way of coping. We want to know to whatextent you did what the item says. How muchor how frequently? Don’t answer on the basisof what worked or not—just whether or notyou did it. Use these raceway choices. Try torate each item separately in your mind from

the others. Make your answers as true FORYOU as you can. Circle the answer that bestapplies to you.

1 - Not at all2 - Somewhat3 - Quite a bit4 - A great deal

Benevolent Religious Reappraisal—redefining thestressor through religion as benevolent andpotentially beneficial1. Saw my situation as part of God’s plan.2. Tried to find a lesson from God in

the event.3. Tried to see how God might be trying to

strengthen me in this situation.

Punishing God Reappraisal—Redefining thestressor as a punishment from God for theindividual’s sins1. Wondered what I did for God to punish me.2. Decided that God was punishing me for

my sins.3. Felt punished by God for my lack

of devotion.

Demonic Reappraisal—redefining the stressoras the act of the Devil1. Believed the Devil was responsible for

my situation.2. Felt the situation was the work of

the Devil.3. Decided the Devil made this happen.

Reappraisal of God’s Powers—redefining God’spower to influence the stressful situation1. Questioned the power of God.2. Thought that some things are beyond

God’s control.3. Realized that God cannot answer all of

my prayers.


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Religious/Spiritual Methods of Copingto Gain Control

Collaborative Religious Coping—seeking controlthrough a partnership with God inproblem solving1. Tried to put my plans into action together

with God.2. Worked together with God as partners.3. Tried to make sense of the situation

with God.

Active Religious Surrender—an active giving upof control to God in coping1. Did my best and then turned the

situation over to God.2. Did what I could and put the rest in

God’s hands.3. Took control over what I could, and gave

the rest up to God.

Passive Religious Deferral—passive waiting forGod to control the situation1. Didn’t do much, just expected God to

solve my problems for me.2. Didn’t try much of anything; simply

expected God to take control.3. Didn’t try to cope; only expected God to

take my worries away.

Pleading For Direct Intercession—seeking controlindirectly by pleading to God for a miracle ordivine intercession1. Pleaded with God to make things

turn out okay.2. Prayed for a miracle.3. Bargained with God to make things better.

Self-Directing Religious Coping—seeking controldirectly through individual initiative ratherthan help from God1. Tried to deal with my feelings without

God’s help.2. Tried to make sense of the situation

without relying on God.3. Made decisions about what to do without

God’s help.

Religious/Spiritual Methods of Coping to GainComfort and Closeness to God

Seeking Spiritual Support—searching for comfortand reassurance through God’s love and care1. Sought God’s love and care.2. Trusted that God would be by my side.3. Looked to God for strength, support and

guidance.

Religious Distraction—engaging in religious/spiritual activities to avoid focusing onthe stressor1. Prayed to get my mind off of my problems.2. Thought about spiritual matters to stop

thinking about my problems.3. Focused on religion to stop worrying

about my problems.

Religious Purification—searching for spiritualcleansing through religious actions1. Confessed my sins.2. Asked forgiveness for my sins.3. Tried to be less sinful.

Spiritual Connection—experiencing a sense ofconnectedness with forces that transcend1. Looked for a stronger connection

with God.2. Sought a stronger spiritual connection

with other people.3. Thought about how my life is part of a

larger spiritual force.

Spiritual Discontent—expressing confusion anddissatisfaction with God’s relationship to theindividual in the stressful situation1. Wondered whether God had

abandoned me.2. Voiced anger that God didn’t answer

my prayers.3. Questioned God’s love for me.


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Marking Religious Boundaries—clearly demar-cating acceptable from unacceptable religiousbehavior and remaining withinreligious boundaries1. Avoided people who weren’t of my faith.2. Stuck to the teachings and practices of

my religion.3. Ignored advice that was inconsistent with

my faith.

Religious/Spiritual Methods of Coping to GainIntimacy with Others and Closeness to God

Seeking Support from Clergy or Members—search-ing for comfort and reassurance through thelove and care of congregation membersand clergy1. Looked for spiritual support from clergy.2. Asked others to pray for me.3. Looked for love and concern from the

members of my church.

Religious Helping—attempting to providespiritual support and comfort to others1. Prayed for the well-being of others.2. Offered spiritual support to family

or friends.3. Tried to give spiritual strength to others.

Interpersonal Religious Discontent—expressingconfusion and dissatisfaction with the rela-tionship of clergy or members to the indi-vidual in the stressful situation1. Disagreed with what the church wanted

me to do or believe.2. Felt dissatisfaction with the clergy.3. Wondered whether my church had

abandoned me.

Religious/Spiritual Methods of Copingto Achieve a Life Transformation

Seeking Religious Direction—looking to religionfor assistance in finding a new direction forliving when the old one may no longerbe viable1. Asked God to help me find a new purpose

in life.2. Prayed to find a new reason to live.3. Prayed to discover my purpose in living.

Religious Conversion—looking to religion for aradical change in life1. Tried to find a completely new life

through religion.2. Looked for a total spiritual reawakening.3. Prayed for a complete transformation of

my life.

Religious Forgiving—looking to religion for helpin shifting from anger, hurt, and fear associ-ated with an offense to peace1. Sought help from God in letting go of

my anger.2. Asked God to help me overcome

my bitterness.3. Sought God’s help in trying to

forgive others.


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Bibliography

Bearon LB, Koenig HG. Religious cognitionand use of prayer in health andillness. Gerontologist. 1990;30:249-253.

Bjorck JP, Cohen LH. Coping with threats,losses, and challenges. J Soc ClinPsychol. 1993;12:36-72.

Boudreaux E, et al. The ways of religiouscoping scale: reliability, validity, and scaledevelopment. Assessment. 1995;2:233-244.

Carver CS, Scheier MF, Weintraub JK.Assessing coping strategies: atheoretically based approach. J Pers SocPsychol. 1989;56:267-283.

Durkheim E. The Elementary Forms of theReligious Life. New York, NY: FreePress; 1915.

Ellison CG, Taylor RJ. Turning to prayer:social and situational antecedentsof religious coping among AfricanAmericans. Rev Religious Res.1996;38:61-81.

Freud S. The Future of an Illusion. New York,NY: Norton; 1927/1961.

Fromm E. Psychoanalysis and Religion. NewHaven, Conn: Yale University Press; 1950.

Geertz C. Religion as a cultural system. In:Banton M, ed. AnthropologicalApproaches to the Study of Religion.London: Tavistock; 1966:1-46.

Keefe FJ. The Coping Strategies Questionnaire.1992. Unpublished manuscript. DukeUniversity Medical Center, Pain Manage-ment Program, Durham, NC.

Koenig HG, et al. Religious coping anddepression among elderly hospitalizedmedically ill men. Am J Psychiatry.1992;149:1693-1700.

Koenig HG, Pargament KI, Nielsen J. Reli-gious coping and health status inmedically ill hospitalized older adults. JNerv Ment Dis. In press.

Lazarus RS, Folkman S. Stress, Appraisaland Coping. New York, NY:Springer; 1984.

Lindenthal JJ, Myers JK, Pepper MS, SteinMR. Mental status and religious behavior.J Sci Study Religion. 1970;9:143-149.


Pargament KI. The Psychology of Religionand Coping: Theory, Research, Practice.New York, NY: Guilford Press; 1997.

Pargament KI, Ishler K, Dubown E, et al.Methods of religious coping with the GulfWar: cross-sectional and longitudinalanalyses. J Sci Study Religion.1994;33:347-361.

Pargament KI, Koenig HG. A comprehensivemeasure of religious coping. Developmentand initial validation of the RCOPE.Report presented at: Retirement ResearchFoundation; 1997; Chicago, Ill.

Pargament KI, Smith BW, Koenig HG, PerezL. Patterns of positive and negativereligious coping with major life stressors.J Sci Study Religion. 1998;37:711-725.

Pargament KI, et al. God help me (I):religious coping efforts as predictorsof the outcomes to significant negative lifeevents. Am J Community Psychol.1990;1g:793-824.

Pargament KI, et al. Religion and theproblem-solving process: three stylesof coping. J Sci Study Religion.1988;27:90-104.

Schaefer CA, Gorsuch RL. Situational andpersonal variations in religious coping.J Sci Study Religion. 1993;32:136-147.

Wright S, Pratt C, Schmall V. Spiritualsupport for caregivers of dementiapatients. J Religion Health.1985;24:31-38.


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These items are designed to measure selectaspects of the social relationships betweenstudy participants and others in their sharedplace of worship.


The literature to date contains numeroustheoretical discussions about the interfacebetween religion and social support. Even so,efforts to measure social support within thecontext of religion have not kept pace withthis conceptual work. The lag is unfortunatebecause the wider literature on social supportmeasurement is now well developed, andsophisticated multidimensional scales thatassess social support outside the context ofreligion are readily available. Moreover,these scales have sound psychometric proper-ties. Rather than avail themselves of thisextensive work, most researchers interestedin social support and religion have insteadturned to 1 of 2 less desirable measurementapproaches: some merely ask about socialsupport generally, without any explicit refer-ence to religion, while others rely on the fewsocial support items that can be gleaned fromlarger religious coping batteries. Either tacticfails to do justice to the complex nature of thesocial support process.

Given this unsatisfactory state of affairs, thebest strategy is to devise new measures thatfocus explicitly on social support and religion.However, instead of ignoring all previouswork, it makes more sense to use secularscales of social support (ie, support that takesplace outside the context of religion) as a

Religious SupportNeal Krause, PhD

University of MichiganDepartment of Health Behavior and Health Education

School of Public HealthAnn Arbor, Michigan

template. While this strategy provides auseful point of departure, developing a prac-tical measure of religious support calls formore than just a straightforward extrapola-tion of previous work. In particular, impor-tant decisions must be made about itemcontent. One of 2 major approaches may betaken. The first involves modifying existingsecular support items by specifying thatassistance comes from a fellow parishioner.The only change involves specifying that thesource of support is a coreligionist. In con-trast, the second approach focuses on assis-tance that is specifically religious in nature.Such an approach involves much moresubstantial change because there is a funda-mental shift in the nature or kind of helpbeing given. In this instance, the itemswould assess the provision of uniquelyreligious support.

The first strategy—modifying secular supportitems to specify the source of support—isperhaps best illustrated by an example. Onewidely used secular support item asks re-spondents how often people in their informalsocial network listen to them talk about theirprivate problems and concerns. This indica-tor may be altered by asking how often fellowparishioners listen to them talk about theirprivate problems and concerns. The advan-tage in pursuing this option is that much isknown about the psychometric properties ofthe secular support items used to createthese indicators. As a result, the odds ofdeveloping equally good religious supportitems seem promising, particularly if thechange is simply adding an additional clausespecifying the source of support as another

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religious person. But there is another,perhaps even more important benefit inusing this approach. Decades of researchwith secular support items have now estab-lished clear links between these measuresand health. If the intent of a study is toassess religious support and health, it wouldappear that researchers can capitalize onprevious work by maintaining the content ofthe support question, while only modifyingthe source of assistance.

As noted earlier, the second way to constructreligious social support items requires inves-tigators to begin almost from scratch, devisingindicators that focus on assistance that isexplicitly religious in nature. For example,an investigator might ask how often fellowparishioners give an elder spiritual strength.There are, however, 3 drawbacks associatedwith this strategy. First, since the items mustbe developed de novo, we have no sense oftheir psychometric properties. Second, wehave no way of knowing whether the newmeasures will be related to health. Finally,there are likely to be many ways in whichpeople of different religions provide religioussupport. Given these drawbacks, the range ofpotential measures will be quite broad and itwill be especially difficult to determinewhether the domain has been specified andsampled adequately.

Therefore, it would appear that the beststrategy is the first approach, that is, modifysecular social support items to reflect the factthat we are interested only in assistance thatcomes from a coreligionist. However, as notedearlier, the literature on general social sup-port measures is vast and investigators havedevised a plethora of scales to assess a rangeof dimensions or types of help. Consequently,the next task is to determine which dimen-sions should be covered and which scalesused. A fairly extensive battery, covering thefull spectrum of social support dimensions,would be ideal, though impractical. As aresult, the subset of social support dimen-sions likely to provide the greatest payoffwas considered.

A necessary first step for our working groupwas to briefly critique the range of secularsupport measures available in the literature.Barrera (1986) provides a succinct summaryof the options, arguing that there are 3broad categories of social support measures:

• Measures of social embeddedness (thefrequency of contact with others);

• Received or enacted support (the amount oftangible help actually provided by others);and

• Measures of perceived support (subjectiveevaluations of supportive exchanges, suchas satisfaction with support).

Clearly, measures of enacted and perceivedsupport are more highly correlated withhealth than measures of social embedded-ness. Given these findings, it makes the mostsense to focus the religious support measureson these 2 key dimensions.

The term “enacted support” does not refer toa single type of assistance. Instead, it encom-passes a fairly diverse range of specifichelping behaviors. Although there are manyways to classify specific types of enactedsupport, one useful schema divides thisconceptual domain into 3 broad types ofhelping: emotional, tangible, and informa-tional support. Extensive research indicatesthese dimensions of enacted support arehighly correlated, and the most crucialappears to be emotional support (House andKahn 1985). Consequently, indicators ofemotional support provided by others areincluded in the battery of religious supportitems proposed here.

Although it is important to focus on theamount of help provided by others, a smallbut intriguing cluster of studies suggests thatgiving support to others may have beneficialeffects as well (Krause 1986). This view issupported by a rich theoretical tradition inthe social sciences, specifying that socialrelations are based on reciprocity, and thatnetworks function best when individuals giveas well as receive. This seems to be an

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Religious Support

especially salient issue for the study of reli-gious support, because sacred texts of manyfaiths make numerous references to theimportance of helping others. As a result,measures of emotional support provided toothers are also included in the batteryproposed here.

There are also a number of different ways toconceptualize the measure of perceived socialsupport. Two are included in the batteryprovided at the end of this section: the firstassesses negative interaction, whereas thesecond deals with anticipated support. Inves-tigators working in the social support fieldoften overlook the fact that relations withothers are not always positive, and encoun-ters with social network members are some-times marred by conflict and strife. Moreover,compelling evidence provided by Rook (1984)and others suggests that negative interactionmay exert a greater effect on health and well-being than the positive or beneficial thingsthat significant others do for us. Even so,apparently no scales of religious supportinclude measures of negative interaction.This is somewhat surprising, since evencasual observations suggest that churchesmay at times be rife with conflict. Given thisfact, we decided to include indicators ofnegative interaction in the religious supportmeasure proposed here.

The final dimension of perceived support tobe included in our religious support measuresis anticipated support, defined as the beliefthat others are willing to provide help in thefuture should the need arise. Several recentstudies reveal that anticipated support mayexert a more beneficial effect on health andwell-being than the actual amount of assis-tance provided by others (Krause in press).There are several reasons for this. First,some investigators suspect that anticipatedsupport acts as a social safety net that en-courages risk-taking and individual resolu-tion of problems. This means that people willbe more likely to resolve difficulties on theirown if they believe that others will be thereto help out, should the individually based

coping strategies turn out to be ineffective.Second, anticipated support may reducesocial network burden and promote thesmooth functioning of social relationships.This benefit may arise because the individualcoping efforts that it promotes tend to reducethe demands made on others for assistance.Finally, anticipated support may be especiallyimportant within the context of religion,because membership in a formal religiousorganization carries the implicit promise thatmembers of the religious community willprovide help in the future if necessary.


After reviewing current scales, the workinggroup included the following dimensions ofsocial support in this religious support scale.

• Emotional support received fromfellow parishioners;

• Emotional support given to others inone’s congregation;

• Negative interaction with coreligionists;and

• Anticipated support.

The measures of emotional support receivedand emotional support provided to otherswere adapted from the work of Krause andMarkides (1990). The indicators of negativeinteraction as well as anticipated support aremodified versions of the items devised byLiang (1990) and evaluated in a nationwidesurvey of older adults by Krause (1995, 1997).

The items in these scales have not beentested directly. However, they representrelatively minor modifications of indicatorsthat have been tested extensively with anationwide probability sample of older adultsin the US (Krause 1995, 1997), as well as inJapan (Liang 1990). The minor modificationstook the following form. As discussed previ-ously, the items assessing emotional supportreceived from others were modified to refer tocoreligionists only. Similarly, the original1-year time frame was switched to thepresent tense.

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A number of researchers suspect thatinvolvement in religion improves a person’shealth and psychological well-being. Althoughthere are many ways to explain these rela-tionships, some investigators believe thatassistance exchanged among those whoworship together accounts for at least part ofthe healthful effect. This postulate is sup-ported by a vast literature linking socialsupport to health and well-being outside thecontext of religion. There are 2 ways thatreligious support may enhance health andwell-being. First, assistance fromcoreligionists may help to offset the noxiouseffects of stressful life events (the death of aloved one, financial loss). Second, irrespectiveof this stress-buffering function, religioussupport may be an important determinant ofhealth in its own right (a direct effectsmodel). This second function is based on thehypothesis that health and well-being arebolstered simply by being embedded in anactive and integrated social network. Pre-sumably, these benefits arise because beingpart of a tightly knit group increases self-esteem, bolsters feelings of control and,in some instances, promotes the adaptationof desirable health behaviors. For example,some religious groups encourage their mem-bers to avoid alcohol and tobacco. There isalso some evidence that social support im-proves health by bolstering immune function.


Two issues should be kept in mind whenusing these measures. First, a Short Formand a Long Form are provided. We stronglyrecommend using the Long Form, becausedoing so will improve the psychometricproperties of the measures (by increasing theinternal consistency reliability estimates)and facilitate the use of more advanced dataanalytic techniques (such as latent variablemodeling). Second, if the intent of the studyis to see whether religious support offsets thedeleterious effects of stressful life events,then the items assessing emotional supportreceived from others, emotional support

provided to others, and negative interactionshould be modified. When researchers studystress, they are typically concerned withevents that have arisen 6 months to a yearbefore the interview. Consequently, the timeframe used for the social support itemsshould match the time frame used to gatherinformation on stress. This means, forexample, that if a study focuses on stressfulevents in the past year, then the social sup-port questions should refer to the past yearas well.

Time Referent

No time frame is specified; items are writtenin the present tense.


Short Form: 90 sec.

Proposed Items

RELIGIOUS SUPPORT-LONG FORM

Emotional Support Received from OthersThe following questions deal with the rela-tionships you’ve had with the people in yourcongregation.

1. How often do the people in your congre-gation make you feel loved and cared for?

1 - Very often2 - Fairly often3 - Once in a while4 - Never

2. How often do the people in your congre-gation listen to you talk about yourprivate problems and concerns?



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3. How often do the people in your congre-gation express interest and concern inyour well-being?


Emotional Support Provided to OthersThe following questions deal with things youmay do for the people you worship with.

4. How often do you make the people inyour congregation feel loved andcared for?


5. How often do you listen to the people inyour congregation talk about theirprivate problems and concerns?


6. How often do you express interest andconcern in the well-being of peopleyou worship with?


Negative InteractionSometimes the contact we have with others isnot always pleasant.

7. How often do the people in your congre-gation make too many demands on you?


8. How often are the people in your congre-gation critical of you and the thingsyou do?


9. How often do the people in your congre-gation try to take advantage of you?


Anticipated SupportThese questions are designed to find out howmuch help the people in your congregationwould be willing to provide if you need it inthe future.

10. If you were ill, how much would thepeople in your congregation be willing tohelp out?

1 - A great deal2 - Some3 - A little4 - None

11. If you had a problem or were faced with adifficult situation, how much comfortwould the people in your congregation bewilling to give you?


12. If you needed to know where to go to gethelp with a problem you were having,how much would the people in yourcongregation be willing to help out?


Religious Support

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RELIGIOUS SUPPORT-SHORT FORM

Emotional Support Received from OthersThe following questions deal with the rela-tionships you’ve had with the people inyour congregation.

1. How often do the people in your congrega-tion make you feel loved and cared for?


2. How often do the people in your congrega-tion listen to you talk about your privateproblems and concerns?


Emotional Support Provided to OthersThe following questions deal with things youmay do for the people you worship with.

3. How often do you make the people in yourcongregation feel loved and cared for?


4. How often do you listen to the people inyour congregation talk about their privateproblems and concerns?


Negative InteractionSometimes the contact we have with others isnot always pleasant.

5. How often do the people in your congrega-tion make too many demands on you?




Anticipated SupportThese questions are designed to find out howmuch help the people in your congregationwould be willing to provide if you need it inthe future.

7. If you were ill, how much would thepeople in your congregation be willing tohelp out?




Scoring: Score these responses in the follow-ing manner (points in parentheses): Veryoften (4); Fairly often (3); Once in a while (2);Never (1). Score these responses in thefollowing manner (points in parentheses):A great deal (4); Some (3); A little (2); None (1).


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Bibliography

Barrera M. Distinctions between socialsupport concepts, measures and models.Am J Community Psychol. 1986;14:413-445.

House JS, Kahn RL. Measures and conceptsof social support. In: Cohen S, Syme SL,eds. Social Support and Health. NewYork, NY: Academic Press; 1985:83-108.

Krause N. Anticipated support, receivedsupport, and economic stress amongolder adults. J Gerontol: Psychol Sci.In press.

Krause N. Negative interaction and satisfac-tion with social support among olderadults. 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 socialsupport among older adults. Int JAging Hum Dev. 1990;30:37-53.

Liang J. The National Survey of JapaneseElderly. Ann Arbor, Mich: Institute ofGerontology; 1990.

Rook KS. The negative side of social interac-tion: impact on psychological well-being.J Pers Soc Psychol. 1984;46:1097-1108.

Religious Support

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Religious/Spiritual HistoryLinda K. George, PhD

Duke University Medical SchoolDepartment of Sociology

Durham, N. Carolina


Measures in this domain are intended toassess the individual’s religious/spiritualhistory. As compared to measures of currentreligious/spiritual participation, these itemsprovide a brief assessment of religious/spiritual participation over the life course.


There have been few attempts to developscales that measure religious or spiritualhistory. Thus, options for this domain areseverely limited. Three or 4 current measurestap religious/spiritual history, yet they varywidely in levels of detail.

Religious Biography: Benson has developedthe most comprehensive measure of religioushistory published to date (Benson 1991). Aspart of a larger survey of religiousness, hecreated a 100-item section focused on reli-gious history. The major contents of thismeasure can be summarized as follows:• 30 items reported retrospectively for 2 time

periods: ages 5 to 12 years and ages 13 to18 years. Items cover a wide range, includ-ing public religious participation, privatepractices, degree to which religion wasemphasized at home, etc.

• 22 items reported for 4 time periods (asapplicable): ages 20 to 29 years, ages 30 to39 years, ages 40 to 49 years, and ages 50to 64 years. Again, items cover a wide range.

• 2 items about history of participation incurrent church.

• 2 items about education in church-related schools.

• 3 items about religious commitments ofsignificant others.

• 22 items about life events, only one ofwhich involves religion. (Thus, thissubsection is largely irrelevant to spiritualhistory.)

• 1 item about the age at which any signifi-cant loss of faith occurred.

• 1 item about the age at which any signifi-cant growth in faith occurred.

• 1 item, containing 30 response categories,about religious role models.

• 16 items about religious participationduring the past 2 to 3 years. All items tappublic participation and privatereligious practices.

Benson has not yet developed specificsubscales or indexes from this pool of items.His approach to analyzing data based onthese items has been to compare age groupswith respect to specific facets of religious-ness, for example, religious importance,frequency of private prayer, frequency ofBible reading, and/or church involvement.

Benson’s work provides an excellent startingpoint for future efforts in developing mean-ingful, but briefer, measures of religioushistory. Unfortunately, it provides no evidenceabout especially salient aspects of religious orspiritual biography that may be relatedto health.

Religious/Spiritual History Questionnaire:Kehoe, a clinical psychologist in full-timepractice at Cambridge Hospital, Mass.,developed a 36-item questionnaire (unpub-lished), including 11 items about religious

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practices in the family of origin, 6 itemsabout religion during early childhood, 8 itemsabout religion during the “school years,” 8items about religion during adolescence/young adulthood, and 3 items about currentreligious practices. All questions are open-ended; Kehoe has not developed response orcoding categories and has used this measureexclusively for clinical purposes, never ad-ministering it outside of the treatment con-text. Kehoe is convinced, on the basis ofclinical experience, that there is a linkbetween religious/spiritual history and mentalhealth, and that assessing current religiouspractices is not sufficient for understandingthe impact of religion on health status. Inaddition, with the exception that Kehoe iscareful to specify interest in spirituality aswell as religion, all of these measures areincluded (in somewhat different form,of course) in Benson’s items aboutreligious history.

Life-Changing Religious/Spiritual Experience:Several studies have included measures (2 or3 items) regarding the respondent’s experi-ence of a life-changing religious or spiritualevent. The origin of these items is unclear. Anaffirmative response leads to a follow-upquestion about the age at which that experi-ence occurred. Researchers disagree aboutwhat these items measure. Some researchersrefer to them as a measure of intense reli-gious experience. Yet with the focus on age,these items are perhaps better viewed ascomponents of religious history. Given theresults of previous research and the fewitems involved, further research regardingthe lifetime experience of life-changingreligious/spiritual events is highlyrecommended.

Spiritual Maturity: Measures of spiritualmaturity are intended to focus on the sub-stance of religious or spiritual beliefs. Thereis an assumed hierarchy, which ranges frompurely extrinsic religiousness to religiousautonomy, the highest level of spiritualmaturity.

James Fowler (1981) is the father of thetheoretical concept of spiritual maturity,although he uses the term “faith develop-ment” instead of “spiritual maturity.” Fowlertakes a developmental perspective, similar instructure and approach to the theories ofErickson, Piaget, and, especially, Kohlberg.Fowler has also developed an interview guideto assess faith development. The revisedinterview includes 34 questions in 4 majorareas: 4 life review questions, 7 questionsabout life-shaping experiences and relation-ships, 14 questions about present values andcommitments, and 9 questions about religion.All of the questions are open-ended. Stan-dardized response or coding categories arenot available. The interview usually requires2 hours for completion and seems highlyunsuitable for survey research or large-scaleclinical studies.

Benson and colleagues (Benson 1991, Bensonand Elkin 1990) developed the 38-item FaithMaturity Index for their national study of 5Protestant denominations. The 38 items tap2 dimensions of faith, which are labeled“vertical religion,” focused on the relationshipbetween the respondent and God; and “hori-zontal religion,” focused on social service andsocial justice. Responses can be scored in 2ways. First, responses to all 38 items can beaveraged to yield a mean score that rangesfrom 1 to 7. Benson and colleagues suggestthat higher scores represent higher levels ofspiritual maturity. When this scoring methodis used cross-sectionally, faith maturityincreases, modestly but significantly, withincreasing age. The second method of scoringthe Faith Maturity Index is to cross-classifyindividuals’ scores on the vertical and hori-zontal measures of religiousness, yielding atypology of 4 discrete groups, or, as Bensoncalls them, faith types:• Undeveloped Faith (low vertical,

low horizontal)• Vertical Faith (high vertical, low horizontal)• Horizontal Faith (low vertical,

high horizontal)• Integrated Faith (high vertical,

high horizontal).


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Benson views integrated faith as the apex ofspiritual maturity. In his sample, as withmean index scores, the proportion of personswith integrated faith increased linearly asage increased.

The Faith Maturity Index has significantproblems on conceptual grounds. For thedevelopmental perspective of faith maturityto have value, subjects must respond to itemsthat represent the full range of maturity.That is, items would assess purely extrinsicreligiousness, religious autonomy, and soforth. Scores would then be summed todetermine the “state” of faith maturity mostrepresentative of the individual. This is, infact, how measures of Piaget-based cognitivedevelopment and Kohlberg-based moraldevelopment are constructed. Yet Benson andcolleagues give equal weight to all items,with no attempt to determine what stage ofmaturity the items represent. They simplyaverage agreement with all the items. Theitems also appear to represent a variety ofstages of faith maturity as defined byFowler and others.

Finally, spiritual maturity (or faith develop-ment) has never been studied in relation tohealth. A relationship may exist, but if so, itawaits empirical documentation. If suchefforts are made, it would be useful to con-ceptualize the role of spiritual maturity inhealth. For example, does spiritual maturityhelp to prevent or minimize illness as manycognitive resources do? Does spiritual matu-rity also affect illness course and outcome byboosting coping abilities? Because consider-able empirical work remains, we cannot ingood faith recommend inclusion of any briefset of items tapping spiritual maturity.


Tests of reliability and validity on Benson’sReligious History Scale are not available andmay not have been performed. Nor has Kehoedone psychometric tests on her scales. It isdifficult to assess single-item measures, suchas life-changing religious/spiritual history,

psychometrically. Using longitudinal datafrom the 3 major studies mentioned previ-ously, investigators have only been able toexamine stability of reports over time. Theevidence on this point is very reassuring.Even over a 7-year interval, less than 1% ofthe people who reported a life-changingexperience at 1 point in time denied havingsuch an experience at a later interview.


There is little evidence that religious/spiri-tual history correlates with physical ormental health. Benson did not examine therelationship between religious history andhealth. Kehoe has done so as a clinician, buthas no empirical evidence. The exception tothis uncertainty is the measure of life-chang-ing religious/spiritual experience. Strongrelationships have been found between thismeasure and depressive disorders and symp-toms (Koenig et al 1994a, Meador et al 1992,Ellison and George 1994), anxiety disordersand symptoms (Koenig et al 1993; Koenig,Ford et al 1993), and alcohol abuse anddependence (Koenig et al 1994b). Currentunpublished data from these studies indicatethat this item is significantly related to self-rated health. These findings come from 3major studies—2 population-based epidemio-logical studies (1 age-heterogeneous, 1 basedon persons age 65 years and older), and alarge clinical study of depression amongmedically ill older adults. At least this aspectof religious history seems to have robustassociations with health, especially mentalhealth. These findings also suggest thepotential importance of further efforts todevelop psychometrically sound measuresof religious/spiritual history.

Religious/Spiritual History

Note: the author, as coinvestigator, isconducting a study supported by the FetzerInstitute that examines spiritual lifehistory trajectories and their associationwith health status. The investigators arecurrently analyzing the extensive data inorder to further develop the spiritualhistory scale.

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Although we strongly recommend includ-ing the “life-changing experience” item,there are 2 forms from which to choose. Thechoice of form depends on the nature of thepopulation to which the item is adminis-tered. We also recommend, but with lessconfidence, a few other items extractedprimarily from Benson’s Religious HistoryMeasure. This recommendation is notbased on evidence of psychometric adequacyor demonstrated relationship to health. It isbased, instead, on the assumption that wewill never understand the relationshipbetween religious/spiritual history andhealth unless we study it.


Regardless of form, the “life-changing experi-ence” items require less than 1 minute toadminister. Estimated time to administer theother items is approximately 5 minutes.

Proposed Items

RELIGIOUS/SPIRITUAL HISTORY-LONG FORM

Are you a born again Christian?YesNo

IF YES: How old were you when this occurred?

IF NO: Have you had a religious or spiritualexperience that changed your life?

NoYes


Brief Religious History

Were you raised in a religious tradition?NoYes

IF YES: Answer next 5 items.

1. When you were a young child, how oftendid you attend religious services?

2. When you were a young child, how oftendid you participate in religious practicesat home, either by yourself or withyour family?

3. When you were a teenager, how often didyou attend religious services?

4. When you were a teenager, how often didyou participate in religious practices athome—either by yourself or withyour family?

5. Do you currently practice the samereligion in which you were raised?

No, no longer practice any religionNo, I’ve changed religious affiliationsYes

Now let’s turn to your religious participationas an adult. For each of the following ageperiods, please rate your religious involvement.

20-29 30-39 40-49 50-64 65+

Involvement in religious services

Low Low Low Low LowMedium Medium Medium Medium MediumHigh High High High HighDoes not Does not Does not Does not Does notapply apply apply apply apply

Involvement in private religious practicessuch as prayer, meditation, and study ofreligious materials


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The strength of your religious orspiritual faith


Note: Age categories are those used byBenson with the exception of adding a cat-egory for 65 years and older.

RELIGIOUS/SPIRITUAL HISTORY-SHORT FORM

History of Life-Changing Religious/SpiritualExperience

Did you ever have a religious or spiritualexperience that changed your life?

NoYes

IF YES: How old were you when thisexperience occurred?

Bibliography

Benson PL. Patterns of religious developmentin adolescence and adulthood. Invited address at: American PsychologicalAssociation Meeting; 1990;San Francisco, Calif.

Benson PL, Elkin CH. Effective ChristianEducation: A National Study of ProtestantCongregations. Washington, DC: SearchInstitute; 1990.

Benson PL, Williams DL. Religion on CapitolHill: Myths and Realities. Oxford: OxfordUniversity 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 ofHuman Development and the Quest forMeaning. New York, NY: Harper &Row; 1981.

Koenig HG, Ford SM, George LK, Blazer DG,Meador KG. Religion and anxiety disorder:an examination and comparison of asso-ciations in young, middle-aged, andelderly adults. J Anxiety Disord.1993;7:321-342.

Koenig HG, George LK, Blazer DG, PritchettJT, Meador KG. The relationship betweenreligion and anxiety in a sample of com-munity-dwelling older adults. J GeriatricPsychiatry. 1993;26:65-93.

Koenig HG, George LK, Meador KG, BlazerDG, Dyke P. Religious affiliation andpsychiatric disorders among Protestantbaby boomers. Hosp CommunityPsychiatry. 1994a;45:586-596.

Koenig HG, George LK, Meador KG, BlazerDG, Ford SM. The relationship betweenreligion and alcoholism in a sample ofcommunity-dwelling adults. HospCommunity Psychiatry. 1994b;45:225-231.

Meador KG, Koenig HG, Hughes DC, BlazerDG, Turnbull J, George LK. Religiousaffiliation and major depression. HospCommunity Psychiatry.1992;43:1204-1208.

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These items were designed to measure theimportance of and commitment to one’sreligious/spiritual beliefs.


Currently there is no extensive literature onreligious/spiritual commitment and health,nor is there consensus regarding whichaspects of religious/spiritual involvementindicate religious commitment. In fact, someof the measures included in other domains(for example, the measure of religious atten-dance) could also be conceptualized as ameasure of religious commitment. However,most researchers agree that religious com-mitment is multidimensional and the meas-ures proposed here attempt to capture themore important dimensions relevant tohealth status. These measures are bestthought of as individual dimensions of aconstruct, rather than as a cohesive, mul-tiple-item scale. The proposed Short Formincludes items about contributions of timeand money, and a single-item indicator ofintrinsic religion.

Traditional measures of religious commit-ment include the reported importance ofattending religious services or the salience offaith. They include: “How religious would yousay you are?” (Chatters et al 1992); and “Howimportant is attending church or synagogueto you?” (Futterman and Koenig 1995). Someevidence suggests that behaviorally oriented“hard” measures of religious commitment aremore strongly linked to health status thanattitudinally oriented “soft” ones (Gartner,

CommitmentDavid R. Williams, PhDUniversity of Michigan

Department of SociologyInstitute for Social Research

Ann Arbor, Michigan

Larson, and Allen 1991). Accordingly, reli-gious measures that capture commitments oftime and money to religious organizations orcauses probably tap important dimensions ofreligious commitment (Ainlay and Smith1984, Williams 1994). The King and Huntscale (Hilty et al 1984; King and Hunt 1972,1975) and the General Social Survey, amongothers, have included measures of financialcontributions to religious organizations. TheDetroit Area Study (1995) used this question:“During the last year about how much wasthe average monthly contribution of yourfamily to your church (or place of worship)?”Combined with annual income, this itemquantifies commitment in financial terms.Commitment of time could be assessed by thefollowing question: “In an average week, howmany hours do you spend in activities onbehalf of your congregation or activities thatyou do for religious or spiritual reasons?”

Intrinsic religiousness is a measure of religiousmotivation that has a long and distinguishedhistory in the study of religion. Although it isprimarily used as a measure of religiousmotivation, it captures the pervasiveness ofreligious influence in daily life. Becauseintrinsic religiousness captures a generalorientation to all aspects of life and socialrelationships, it can be regarded as a measureof religious commitment. Allport’s ReligiousOrientation Scale and its adaptations are themost widely used measure of intrinsic andextrinsic religiousness in the empirical studyof religion (Kirkpatrick 1989). Allport’s Scalehas proven to be empirically robust and theo-retically enlightening in the study of prejudiceand other social phenomena (Donahue 1985).

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Hoge (1972) has proposed a 10-item shortform for measuring intrinsic religious moti-vation. The items are:

1. My faith involves all of my life.2. One should seek God’s guidance when

making every important decision.3. In my life I experience the presence of

the Divine.4. My faith sometimes restricts my actions.5. Nothing is as important to me as serving

God as best I know how.6. I try hard to carry my religion over into

all my other dealings in life.7. My religious beliefs are what really lie

behind my whole approach to life.8. It doesn’t matter so much what I believe

as long as I lead a moral life.9. Although I am a religious person, I refuse

to let religious considerations influencemy everyday affairs.

10. Although I believe in my religion, I feelthat there are many more importantthings in life.

Hoge’s scale is useful and appropriate forresearchers interested in a longer form thanthe 3-item Short Form proposed here.

There are several critiques of the IntrinsicReligion Scale (Kirkpatrick 1989, Kirkpatrickand Hood 1990, Stark and Glock 1968), andefforts have been made to develop shortversions (Gorsuch and McPherson 1989).Three items from the Benson and Elkin(1990) Mature Faith (Vertical Dimension)Scale appear to be conceptually similar to theintrinsic dimension of religion. They addressthe extent to which faith informs daily deci-sions, and dictates moral principles. Theseitems appear to have face validity as amultiple-item short version of intrinsicreligious motivation.

1. My faith shapes how I think and act eachand every day;

2. My faith helps me know right fromwrong; and

3. I talk with other people about my faith.

Another potential alternative to the IntrinsicReligion Scale is a measure of religiousimportance. The following single-item meas-ure has been used in some research studies.

1. In general, how important are religious orspiritual beliefs in your day-to-day life?Would you say very important, fairlyimportant, not too important, or not atall important?

Sociologists (Raden 1985) and psychologists(Abelson 1988) have also been developingattitudinal items that capture the presenceor strength of a respondent’s conviction.Their approach could be used successfully toassess religious commitment and may beespecially useful in assessing the salienceof religious beliefs and attitudes. Researchersstudying conviction attempt to distinguishattitudes that are consequential or centralfrom those that are inconsequential.Abelson’s (1988) work has identified 3 dimen-sions of conviction important in capturing thestrength of attitudes toward God, nuclearpower, divestment, abortion, welfare, starwars, Nicaragua, and AIDS. To my knowl-edge, these measures have not been appliedin any study of religious involvement, butthey are another potentially promisingdirection for research. The cognitive-elabora-tion items may be less relevant to assessingthe strength of religious or spiritual attitudesin terms of health. The highest-loading itemsunder each of Abelson’s (1988) “conviction”clusters are:

A. Emotional Commitment1. My beliefs about X express the real me.2. I can’t imagine ever changing my mind

about X.

B. Ego Preoccupation1. I think about X often.2. I hold my views very strongly.3. My belief is important to me.

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Commitment

C. Cognitive Elaboration1. I’ve held my views a long time compared

to most people.2. Several other issues could come up in

a conversation about it.

Another dimension of religious commitmentis how religious an individual is comparedwith others in the same religious group. Thismeasure partially captures the “social con-trol” dimensions of religion (Umberson 1987).Stark (1984) emphasizes that religion shapesindividual behavior, not only throughinternalized religious beliefs, but also as anaspect of groups. Levin and Vanderpool(1987) have recommended this item: “Com-pared to most people in your place of worshipare you more religiously involved and com-mitted, just about the same as everyone else,or less religiously involved and committed?”


Most of the suggested items have been usedin prior studies, but no psychometric data areavailable for the scale as proposed. Forresearchers interested in the longer versionof the Intrinsic Religion Scale, ampleinformation is available on its psychometricproperties (Kirkpatrick 1989, Kirkpatrickand Hood 1990, Gorsuch and McPherson1989, Hoge 1972).


Measures of intrinsic religion have beenrelated to a broad range of social and psycho-logical phenomena (Donahue 1985), but theirassociation with health has generated fewempirical studies. Small studies of religiousindividuals suggest that intrinsic religion ispositively related to mental health (Payne etal 1991), but this association needs to beexamined in broad-based epidemiologicstudies. Similarly, there is little empiricalsupport for the notion that indicators of thecommitment of time and means are related tohealth status. However, it is likely that thesemeasures account, at least in part, for thewell-established association betweenreligious attendance and health. By refining

and broadening the domain of religiousinvolvement, these measures may alsoenhance our ability to identify the extent towhich religiousness is related to health(Williams 1994).

Time Referent

No time frame is specified; items are writtenin the present tense.


Less than 1 min.

Proposed Items

COMMITMENT-LONG FORM

None provided. See Description of Measuresfor this domain.

COMMITMENT-SHORT FORM

1. I try hard to carry my religious beliefsover into all my other dealings in life.

1 - Strongly agree2 - Agree3 - Disagree4 - Strongly disagree

2. During the last year about how much wasthe average monthly contribution of yourhousehold to your congregation or toreligious causes?

$________________ OR $________________Contribution Contribution

per year per month

3. In an average week, how many hours doyou spend in activities on behalf of yourcongregation or activities that you do forreligious or spiritual reasons?

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Bibliography

Abelson RP. Conviction. Am Psychol.1988;43:267-275.

Ainlay SC, Smith RG. Aging and religiousparticipation. J Gerontol. 1984;39:357-363.

Benson PL, Elkin CH. Effective ChristianEducation: A National Study of ProtestantCongregations. Minneapolis, Minn:Search Institute; 1990.

Chatters LM, Levin JS, Taylor RJ. Antece-dents and dimensions of religious involve-ment among older black adults. JGerontol. 1992;47:S269-S278.

Detroit Area Study. Health and Social Issues.Ann Arbor, Mich: Survey ResearchCenter, University of Michigan; 1995.

Donahue MJ. Intrinsic and extrinsicreligiousness: review and meta-analysis.J Pers Soc Psychol. 1985;48:400-409.

Futterman A, Koenig H. Measuring Religiosityin Later Life. Unpublished paper. 1995.

Gartner J, Larson DB, Allen GD. Religiouscommitment and mental health: areview of the empirical literature.J Psychol Theology. 1991;19:6-25.

Gorsuch RL, McPherson SE. Intrinsic/extrinsic measurement: I/E-revised andsingle-item scales. J Sci Study Religion.1989;28:348-354.

Hilty DM, Morgan RL, Burns JE. King andHunt revisited: dimensions of religiousinvolvement. J Sci Study Religion.1984;23:252-266.

Hoge DR. A validated intrinsic religiousmotivation scale. J Sci Study Religion.1972;11:369-376.

King MB, Hunt RA. Measuring the religiousvariable: replication. J Sci StudyReligion. 1972;6:173-185.

King MB, Hunt RA. Measuring the religiousvariable: a national replication.J Sci Study Religion. 1975;14:13-22.

Kirkpatrick LA. A psychometric analysis ofthe Allport-Robs and Feagin measures ofintrinsic-extrinsic religious orientation.Res Soc Sci Study Religion. 1989;1:1-31.

Kirkpatrick LA, Hood RW. Intrinsic-extrinsicreligious orientation: the boon or bane ofcontemporary psychology of religion. J SciStudy Religion. 1990;29:442-462.

Levin JS, Vanderpool HY. Is frequent religiousattendance really conducive to betterhealth?: toward an epidemiology of reli-gion. Soc Sci Med. 1987;24:589-600.

Payne IR, Bergin AE, Bielma KA, et al.Review of religion and mental health:prevention and the enhancement ofpsychosocial functioning. Prev Hum Serv.1991;9:11-40.

Raden D. Strength-related attitude dimen-sions. Soc Psychol Q. 1985;48:312-330.

Stark R. Religion and conformity: reaffirminga sociology of religion. Sociol Analysis.1984;45:273-282.

Stark R, Glock CY. American Piety. Berkeley,Calif: University of California Press;1968.

Williams D. The measurement of religion inepidemiological studies: problems andprospects. In: Levin J, ed. Religion inAging and Health: TheoreticalFoundations and Methodological Frontiers.Thousand Oaks, Calif: Sage Press;1994:125-148.

Umberson D. Family status and healthbehaviors: social control as a dimension ofsocial integration. J Health Soc Behavior.1987;28:306-319.

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This domain assesses the involvement of therespondent with a formal public religiousinstitution: a church, synagogue, temple,mosque, ashram, etc. It can include bothbehavioral and attitudinal dimensions.


Most surveys that measure religiousnessinclude a measure of attendance at religiousservices. As an alternative, some surveys usemembership in a congregation. Activitiesother than worship, such as choir practice,youth groups, and volunteer activities,should also be included. In addition to thesebehavioral indicators, a measure of how wellthe individual “fits” into the religious congre-gation of which he or she is a member repre-sents an evaluation of involvement. Finally,this domain can include a measure of aspectsof the experience of public religious worshipthat are both behavioral and attitudinal,including the importance of prayer, music,reading texts, ritual, architecture, etc.


As a set, these items have not been tested forreliability and validity; however, it is doubt-ful that one would want to use them as asingle scale in any case. Attendance at reli-gious services is a reliable item and has beenused for 50 years in the Gallup Poll (Wingroveand Alston 1974), though a recent studyshows apparent overstatement of attendancerates (Hadaway, Marler, and Chaves 1993).Some have argued for using the “member-ship” item as a means of reducing this bias

Organizational ReligiousnessEllen Idler, PhD



(Stolzenberg, Blair-Loy, and Waite, 1995), butthe long history of using the “attendance”item, and its demonstrated association withhealth, argue for retaining it.

The item that includes “other activities”(choir practice, youth groups, etc.) has beenused and tested in the Alameda CountyStudy (Strawbridge et al 1997), together withthe “attendance” item, as an index of organi-zational religiousness.

The single “fit” item was developed andtested by Pargament, Tyler, and Steele(1979). The 4 “fit” items were developed byBenson et al (1988), but no psychometric dataare available.

The “experience of worship” items are newand have not yet been tested, so their validityand reliability are unassessed.


Studies of the association between religious-ness and morbidity or mortality have, withfew exceptions, employed the single item of“attendance” at services as a measure oforganizational religiousness. Often, this isthe only measure of religious involvement(aside from “affiliation”) available in thedata. Cross-sectional and longitudinal stud-ies (reviewed in Koenig and Futterman 1995,Levin 1994) consistently find significantassociations between religious attendanceand physical health-status indicators,including specific conditions such as hyper-tension, general measures of functionaldisability, and overall mortality. Findings

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from cross-sectional study designs are prob-lematic, because of the impact illness is likelyto have on attendance; the significant asso-ciation would be due to selection and notcausation. The strong existing evidencecomes from longitudinal studies.

From a theoretical perspective, there aremany reasons to believe that organizationalreligiousness would show a positive relation-ship with health and longevity (Idler andKasl 1997a, Idler and Kasl 1997b). Fre-quency of attendance at services may indi-cate the frequency with which heightenedstates of religious consciousness or the expe-rience of the sacred is achieved throughprayer, music, architecture, or rituals(Benson 1996; Bygren, Konlaan, Johansson1996; Williams 1994); regular attendancemay indicate behavioral conformity to reli-gious beliefs regarding alcohol use, smoking,dietary practices, or sexual intercourse(Gorsuch 1995); frequent contact with thesocial network of the congregation may makespiritual, emotional, or instrumental socialsupport more readily available (Ellisonand George 1994); or the constant reinforcingof beliefs may provide understanding andcomfort in times of crisis (Pressman et al1990). The effectiveness of most of thesemechanisms varies directly with the fre-quency of attendance and may be a simple,global indicator for a complex set of processes.


The items are simple and can be self-admin-istered or administered by phone or in-person. Because the “experience of worship”items have not been tested before, they arenot recommended for the Short Form. The“membership” and “fit” items should also beused only for the Long Form.

Time Referent

These items assess only current behavior andattitudes.


Short Form (items 1 and 2 only): 15 sec.Long Form: 1 to 1-1/2 min.

Proposed Items

ORGANIZATIONAL RELIGIOUSNESS-LONG FORM

Attendance (General Social Survey)1. How often do you attend religious services?

1 - Never2 - Less than once a year3 - About once or twice a year4 - Several times a year5 - About once a month6 - 2-3 times a month7 - Nearly every week8 - Every week9 - Several times a week

2. Besides religious services, how often doyou take part in other activities at a placeof worship?


Fit (Pargament, Tyler, and Steele 1979;Benson 1988)

3. We all differ according to our generalinterests, attitudes, beliefs, andvalues. Your church/synagogue, in turn,has its own unique identity as demon-strated through its religious, educational,organizational, and social activities.

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Organizational Religiousness

Church/synagogue members may differsomewhat according to how well they, asindividuals, fit in their church/synagogue.How well do you feel that you fit in yourchurch/synagogue?

1 - Fit extremely well2 - Fit very well3 - Fit slightly4 - Do not fit very well5 - Do not fit at all

4. If I had to change churches/synagogues, Iwould feel a great sense of loss.


5. I feel at home in this church/synagogue.1 - Strongly agree2 - Agree3 - Not sure4 - Disagree5 - Strongly disagree

6. I would change my church/synagogueif it developed major leadership orfinancial problems.


7. The church/synagogue I attend matters agreat deal to me.


Worship Experience (Idler)8. Following is a list of things people

commonly experience in religious worshipservices. Please state how often you dothese things when attending services andhow important they are to you.

a. Listening to others perform music.1 - More than once per service

1 - Extremely important2 - One per service

2 - Very important3 - Regularly but not every service

3 - Somewhat important4 - Occasionally

4 - Of slight importance5 - Never

5 - Not important at all

b. Singing or performing music yourself.1 - More than once per service






c. Praying.1 - More than once per service






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d. Reading or listening to Scripture or Torah.1 - More than once per service






e. Listening to the sermon or drasha.1 - More than once per service






f. Participating in rituals or sacraments,such as communion, baptism, or lightingthe Sabbath candles.1 - More than once per service






g. Thinking about the beauty of the building.1 - More than once per service






h. Sitting in silence.1 - More than once per service






i. Being part of a healing ritual, like thelaying on of hands.1 - More than once per service






j. Receiving gifts of the spirit, like speakingin tongues.1 - More than once per service







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ORGANIZATIONAL RELIGIOUSNESS-SHORT FORM

Attendance (General Social Survey)1. How often do you attend religious services?




Bibliography

Benson H. Timeless Healing: The Power andBiology of Belief. New York, NY: Simonand Schuster; 1996.

Benson P, et al. Effective Christian Education:A National Study of Protestant Congrega-tions. Minneapolis, Minn: SearchInstitute; 1988.

Bygren LO, Konlaan BB, Johansson S-E.Attendance at cultural events, readingbooks or periodicals, and making music orsinging in a choir as determinantsfor survival: Swedish Interview Survey ofLiving Conditions. BMJ.1996;313:1577-1580.

Ellison C, George L. Religious involvement,social ties, and social support in a south-eastern community. J Sci Study Religion.1994;33:46-61.

Gorsuch RL. Religious aspects of substanceabuse and recovery. J Soc Issues.1995;51:65-83.

Hadaway C, Kirk PM, Chaves M. What thepolls don’t show: a closer look at U.S.church attendance. Am Sociol Rev.1993;58:741-752.

Idler E, Kasl S. Religion among disabled andnondisabled persons II: cross-sectionalpatterns in health practices, social activi-ties, and well-being. J Gerontol: Soc Sci.1997a;52B(6):S294-S305.

Idler E, Kasl S. Religion among disabled andnondisabled persons I: attendance atreligious services as a predictor of thecourse of disability. J Gerontol: Soc Sci.1997b;52B(6):S306-S316.

Koenig H, Futterman A. Religion and HealthOutcomes: A Review and Synthesis of theLiterature. Paper presented at: Method-ological Approaches to the Study ofReligion, Aging, and Health; 1995;Washington, DC.

Levin JS. Religion and health: is there anassociation, is it valid, and is it causal?Soc Sci Med. 1994;38:1475-1482.

Pargament K, Tyler FB, Steele RE. Is fit it?The relationship between church/syna-gogue member fit and the psychosocialcompetence of the member. J CommunityPsychol. 1979;7:243-252.

Pressman P, Lyons JS, Larson DB, Strain JJ.Religious belief, depression, andambulation status in elderly women withbroken hips. Am J Psychiatry.1990;147:758-760.

Stolzenberg RM, Blair-Loy M, Waite LJ.Religious participation in early adult-hood: age and family life cycle effects onchurch membership. Am SociolRev. 1995;60:84-103.

Strawbridge WJ, Cohen RD, Shema SJ,Kaplan GA. Frequent attendance atreligious services and mortality over 28years. Am J Public Health. 1997.

Williams D. The measurement of religion inepidemiologic studies: problems andprospects. In: Levin JS, ed. Religion inAging and Health. ThousandOaks, Calif: Sage; 1994.

Wingrove CR, Alston JP. Cohort analysis ofchurch attendance, 1939-69. Soc Forces.1974;53:324-331.


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This item is designed to ascertain the religioustradition or denomination with which anindividual identifies.


Items about religion or religious preferencegenerally tap identification with, or closenessto, a given religious community or tradition.Thus, an expression of religious preferencemay or may not indicate current churchmembership or current participation in agiven group.

Previous Work

Items about religious preference have becomestandard in many major large-scale surveys(eg, General Social Surveys, National Surveyof Families and Households [NSFH], Na-tional Survey of Black Americans [NSBA],Americans’ Changing Lives Survey). Most ofthese surveys assess religious preference ina single question about a respondent’s reli-gious preference, along with a brief probeasking Protestant respondents to specify adenomination. Some surveys record specificdenominations with the aid of a partialchecklist (8 to 12 of the largest denomina-tions), while others use only an open-endeditem, with responses coded on apost-hoc basis.


Numerous studies have reported religiousgroup differences in a wide range of mentaland physical health outcomes and mortality(Jarvis and Northcott 1987; Troyer 1988;

Religious PreferenceChristopher Ellison, PhD

University of Texas-AustinDepartment of Sociology

Austin, Texas

Dwyer, Clarke, and Miller 1990; Ellison 1991;Idler and Kasl 1992). There are severalgeneral reasons to anticipate denominationalvariations in such outcomes. Some religiouscommunities discourage unhealthful lifestylesand/or promote positive health behaviors. Forinstance, certain denominations (Mormons,evangelical and fundamentalist Protestants)prohibit or discourage the consumption ofalcoholic beverages (Cochran, Beeghley, andBock 1988), and some also frown on tobaccouse. A few groups (Adventists) embracespecific dietary practices that may behealthful. The values of many conservativeand sectarian groups may also reduce thelikelihood of risky sexual practices. In addi-tion, specific religious traditions may havewell-articulated philosophical perspectives onpersonal well-being (Ott 1991, Sweet 1994).

In a more speculative vein, some have sug-gested that a range of denomination-specificbeliefs or ritual practices may influencemental or physical health. While these issuesremain under studied, a few examples includebeliefs about sin and divine grace (Watson,Morris, and Hood 1988), specific beliefs aboutthe death and the afterlife (Wuthnow,Christiano, and Kuzlowski 1980), and cathar-tic worship styles (Gritzmacher, Bolton, andDana 1988), among other possibilities. De-pending on the study design and the specifichealth outcome under consideration, someassociations between religious preference andhealth may be accounted for by the inclusionof direct measures of health behaviors,coping, religious experience, and otherintervening constructs.

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Although the proposed item and relatedprobe are relatively straightforward, severalconsiderations are germane when using thisitem. It seems important to collect as muchinformation as feasible. This permits investi-gators to categorize religious preferenceslater, in ways appropriate to the particularpopulations and research questions at hand.Although generic schemes for classifyingdenominations (into fundamentalist, moder-ate, and liberal, or variants thereof) arewidely used by social scientists (Smith 1986,1990; Roof and McKinney 1987), suchapproaches may not be well-suited to theneeds and objectives of health researchers.

An open-ended item may offer the best strat-egy for maximizing information and flexibility,allowing isolation of particular groups withdistinctive health behaviors or beliefs. How-ever, some researchers might wish to use theappended listing of religious preferencecategories simply for guidance, or as a pos-sible checklist for a self-administered item.This listing is not intended to be complete.Although it includes virtually all majorreligions in the US, including predominantlyAfrican American denominations, this listfocuses heavily on Christian and Jewishgroups. Therefore, it may be less helpful forresearchers studying Asian Americans andsome other immigrant populations in the US.

Researchers should understand that broaddenominational labels like “Lutheran” and“Baptist” can mask considerable heterogeneityin terms of theology, structure, organiza-tional culture, and so on. A good example isprovided by the wide gulf that separatesmembers of the Evangelical Lutheran Churchof America from Missouri Synod Lutherans.Investigators should be attentive to suchdifferences when using the denominationalprobe. Similarities in denominational namesoften result in confusion as well, since theycan conceal major intergroup differences. Agood example: several very distinct groupsuse the label “Church of Christ.” These

groups range from theologically liberal(United Church of Christ) to fundamentalistProtestant (Church of Christ) in aspects oftheir theology and culture. Thus, investiga-tors should be alert to the potential forconfusion. When classifying the manysmaller religious groups or those with whichthey may be unfamiliar, investigators mayfind it helpful to consult leading referenceguides on religious groups in the US, includ-ing works by Melton (1989) and Mead andHill (1990).

Finally, it is important to mention the geo-graphical clustering of many religious groupsin the US. This issue may be especiallygermane to studies conducted within a singlecommunity, or those focusing on a smallnumber of research sites. In the case of somereligious traditions (eg, Lutheran, DutchReformed), patterns of regional concentrationreflect the historic link between religion andethnicity in the US. A plethora of tinydenominations and sectarian groups in theUS can only be found in a few areas of thecountry. Researchers seeking further infor-mation on the distribution of diverse faithcommunities across the US may wish toconsult the Glenmary Research Institute’sChurches and Church Membership in theUnited States: 1990 (Bradley et al 1992). Thisvaluable resource presents detailed member-ship and adherence statistics for numerousreligious groups at regional, state, andcounty levels. These figures, along withestimates for some undercounted groups, arebased primarily on data compiled by theNational Council of Churches and severalother major religious bodies.

Time Referent

The proposed item is designed to measurecurrent religious preference at the time of theinterview. However, many previous surveyshave also used similarly structured items togauge religious preference at earlier times(eg, at age 16, or while the respondent wasgrowing up).

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Religious Preference


Under 1 min.

Proposed Items

RELIGIOUS PREFERENCE

At the present time, what is yourreligious preference?

IF PROTESTANT ASK: Whichspecific denomination?

Religious Preference Categories(for advisory purposes only)

No religion (includes atheist, agnostic)

Roman CatholicOrthodox (Eastern, Greek, Russian,

Serbian, Ukrainian)Non-Chalcedonian Orthodox (Armenian,

Syrian, Coptic, Ethiopian)

Jewish, ReformJewish, ConservativeJewish, ReconstructionistJewish, Orthodox

Episcopal, Anglican

Lutheran, ELCALutheran, Missouri SynodLutheran, otherLutheran, don’t know which

Methodist, United MethodistAfrican Methodist Episcopal

(AME, AME Zion)Methodist, otherMethodist, don’t know whichWesleyan Methodist

Presbyterian, PCUSAPresbyterian, otherPresbyterian, don’t know which

United Church of Christ (Congregational)

Christian Church (includes Disciples ofChrist, Christian-Disciples, any modifiersuch as First, Eastside, Community, etc.NOT including “just a Christian” or“Christian-no denomination”)

Reformed (Reformed Church in America,Christian Reformed)

Baptist, Southern Baptist ConventionBaptist, IndependentBaptist, other fundamentalist (Primitive,

Free Will, Missionary)Baptist, African American bodies (National

Baptist Convention of America)Baptist, AmericanBaptist, otherBaptist, don’t know which

Christian and Missionary AllianceChurches of Christ (NOT including United

Church of Christ [above], or InternationalChurches of Christ)

Evangelical Free ChurchSalvation ArmyFull Gospel FellowshipFoursquare GospelNazarene

Bible ChurchChurches of God (if possible, specify which)Other fundamentalist or evangelical

Protestant (if possible, specify which)

MennoniteFriends, QuakerBrethrenHutteritesAmish

Assemblies of GodChurch of God in ChristPentecostal (includes anything with

Pentecostal in the name)HolinessApostolicSanctified, SanctificationOther charismatic (if possible, specify which)

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AdventistMormon (includes all Latter Day Saints

groups)Jehovah’s Witness

Christian ScientistMetropolitan Community ChurchSpiritualistUnityOther community churchNon-denominational church (other than

charismatic)

Protestant, no further informationChristian, no further information

Baha’iIslamic/Muslim (if possible, specify which)HinduBuddhist (if possible, specify which)ShintoTaoistWiccan, other ritual magic

Other religion not mentioned here(if possible, specify which)

Bibliography

Bradley MB, Green NM, Jones DE, Lynn M,McNeil L. Churches and Church Member-ship in the United States: 1990. Atlanta,Ga: Glenmary Research Institute; 1992.

Cochran JK, Beeghley L, Bock EW. Religiosityand alcohol behavior: an exploration ofreference group theory. Sociol Forum.1988;3:256-276.

Dwyer JW, Clarke LL, Miller MK. The effectof religious concentration and affiliationon county cancer mortality rates. JHealth Soc Behav. 1990;31:195-202.

Ellison CG. Religious involvement andsubjective well-being. J Health SocBehav. 1991;32:80-99.

Gritzmacher SA, Bolton B, Dana RA. Psycho-logical characteristics of Pentecostals: aliterature review and psychodynamicanalysis. J Psychol Theology.1988;16:233-245.

Idler EL, Kasl SV. Religion, disability,depression, and the timing of death. Am JSociol. 1992;97:1052-1079.

Jarvis GK, Northcott HC. Religious differencesin morbidity and mortality. Soc Sci Med.1987;25:813-824.

Mead F, Hill SS. Handbook of Denominations.9th ed. Nashville, Tenn: AbingdonPress; 1990.

Melton JG. Encyclopedia of American Religion.3rd ed. Detroit: Gale Research; 1989.

Ott PW. John Wesley on health and whole-ness. J Religion Health. 1991;30:43-58.

Roof WC, McKinney W. American MainlineReligion. New Brunswick, NJ: RutgersUniversity Press; 1987.

Smith TW. Classifying Protestant Denomina-tions. GSS Technical Report No. 67.Chicago, Ill: National Opinion ResearchCenter; 1986.

Smith TW. Classifying Protestant denomina-tions. Rev Religious Res. 1990;31:225-246(short version).

Sweet L. Health and Medicine in the Evan-gelical Tradition. Phila, Penn: TrinityPress International; 1994.

Troyer H. Review of cancer among fourreligious sects: evidence that lifestyles aredistinctive sets of risk factors. Soc SciMed. 1988;26:1007-1017.

Watson PJ, Morris RJ, Hood RW. Sin andself-functioning, part 1: grace, guilt, andself-consciousness. J Psychol Theology.1988;16:254-269.

Wutnow R, Christiano K, Kuzlowski J. Reli-gion and bereavement: a conceptualframework. J Sci Study Religion.1980;19:408-422.


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Brief Multidimensional Measure ofReligiousness/Spirituality: 1999


The following questions deal with possiblespiritual experiences. To what extent can yousay you experience the following:

1. I feel God’s presence.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

2. I find strength and comfort in my religion.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

3. I feel deep inner peace or harmony.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

4. I desire to be closer to or in union with God.1 - Many times a day2 - Every day3 - Most days4 - Some days5 - Once in a while6 - Never or almost never

5. I feel God’s love for me, directly orthrough others.


6. I am spiritually touched by thebeauty of creation.


Meaning

See Appendix at the end of this section.

Values/Beliefs

7. I believe in a God who watches over me.1 - Strongly agree2 - Agree3 - Disagree4 - Strongly disagree

8. I feel a deep sense of responsibility forreducing pain and suffering in the world.


For more information about this measure, see Introduction: How to Use This Report.

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Forgiveness

Because of my religious or spiritual beliefs:

9. I have forgiven myself for things that Ihave done wrong.


10. I have forgiven those who hurt me.1 - Always or almost always2 - Often3 - Seldom4 - Never

11. I know that God forgives me.1 - Always or almost always2 - Often3 - Seldom4 - Never

Private Religious Practices

12. How often do you pray privately in placesother than at church or synagogue?

1 - More than once a day2 - Once a day3 - A few times a week4 - Once a week5 - A few times a month6 - Once a month7 - Less than once a month8 - Never

13. Within your religious or spiritualtradition, how often do you meditate?


14. How often do you watch or listen toreligious programs on TV or radio?


15. How often do you read the Bible or otherreligious literature?


16. How often are prayers or grace saidbefore or after meals in your home?

1 - At all meals2 - Once a day3 - At least once a week4 - Only on special occasions5 - Never

Religious and Spiritual Coping

Think about how you try to understand anddeal with major problems in your life. Towhat extent is each of the following involvedin the way you cope?

17. I think about how my life is part of alarger spiritual force.


18. I work together with God as partners.1 - A great deal2 - Quite a bit3 - Somewhat4 - Not at all

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Brief Multidimensional Measure of Religiousness/Spirituality: 1999

19. I look to God for strength, support,and guidance.


20. I feel God is punishing me for my sins orlack of spirituality.


21. I wonder whether God has abandoned me.1 - A great deal2 - Quite a bit3 - Somewhat4 - Not at all

22. I try to make sense of the situation anddecide what to do without relying on God.


23. To what extent is your religion involved inunderstanding or dealing with stressfulsituations in any way?


Religious Support

These questions are designed to find out howmuch help the people in your congregationwould provide if you need it in the future.

24. If you were ill, how much would thepeople in your congregation help you out?




Sometimes the contact we have with others isnot always pleasant.

26. How often do the people in your congrega-tion make too many demands on you?





28. Did you ever have a religious or spiritualexperience that changed your life?

NoYes

IF YES: How old were you when thisexperience occurred?

29. Have you ever had a significant gain inyour faith?

NoYes


30. Have you ever had a significant loss inyour faith?

NoYes


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Commitment

31. I try hard to carry my religious beliefsover into all my other dealings in life.


32. During the last year about how much wasthe average monthly contribution of yourhousehold to your congregation or toreligious causes?

$________________ OR $________________Contribution Contribution

per year per month

33. In an average week, how many hours doyou spend in activities on behalf of yourchurch or activities that you do forreligious or spiritual reasons?

_______________________


34. How often do you go to religious services?1 - More than once a week2 - Every week or more often3 - Once or twice a month4 - Every month or so5 - Once or twice a year6 - Never


1 - More than once a week2 - Every week or more often3 - Once or twice a month4 - Every month or so5 - Once or twice a year6 - Never

Religious Preference

36. What is your current religious preference?

______________________

IF PROTESTANT ASK:Which specific denomination is that?

_______________________

(List of religious preference categoriesattached for advisory purposes. See ReligiousPreference section.)

Overall Self-Ranking

37. To what extent do you consider yourself areligious person?

1 - Very religious2 - Moderately religious3 - Slightly religious4 - Not religious at all

38. To what extent do you consider yourself aspiritual person?

1 - Very spiritual2 - Moderately spiritual3 - Slightly spiritual4 - Not spiritual at all

Appendix-Meaning

The working group did not feel it was appro-priate at this time to include any “religiousmeaning” items in this measure, as no finaldecisions have been made regarding thisdomain. The following items are being con-sidered for a Short Form.

1. The events in my life unfold according toa divine or greater plan.


2. I have a sense of mission or calling in myown life.


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The Brief Multidimensional Measure ofReligiousness/Spirituality: 1999 was embeddedin the 1997-1998 General Social Survey (GSS),a random national survey of the National DataProgram for the Social Sciences. The basicpurpose of this survey is to gather and dissemi-nate data on contemporary American society inorder to monitor and explain trends in atti-tudes and behaviors, and to compare theUnited States to other societies.

Several factors went into deciding to add thequestions from the measure to the GSS. First,The Brief Multidimensional Measure ofReligiousness/Spirituality: 1999 contains awide variety of demographic measures andincludes the detail necessary for such asurvey and its required coding. Also, with theCensus barred from measuring religiousaffiliation and with many large governmentsurveys limited to ascertaining affiliation, theGSS may be the most widely used source tostudy religion’s role in contemporary society.The 1998 version of the GSS also included atopical module on religion. Thus, the NIA/Fetzer measurement instrument benefitedfrom a unique opportunity to examine how itsmeasures relate to other measures of religionboth in the GSS core as well as in this one-time topical module. Finally, the GSS data areof the highest quality. In terms of samplingprocedure, response rate, validation proce-dures, data cleaning, and quality control,the GSS meets the most demanding standardsof contemporary survey research.

One disadvantage in utilizing the GSS wasthat slight wording changes were required insome questions and several questions werenot included in the survey.

The following tables include the questions anddomains, percentage distributions, andpsychometric data from the GSS and reflectthe efforts of the working group in analyzingthe data, the findings of which have beenprepared as a manuscript and submitted forpublication (Idler et al 1999). The FetzerInstitute will have copies of article reprintsavailable upon publication. The findingssupport the multidimensional approach out-lined in this publication and indicate that thedomains were endorsed by substantial num-bers of respondents, that the items formedreliable indices within the domain, and that theindices were moderately but not highly corre-lated with each other (Idler et al 1999). Whilesome minor regroupings are reflected in thedata presented, we cannot finally determinewhether there is need for regrouping theinstrument’s domains without collecting fur-ther health-related data. A limitation to thisanalysis is the small number of items for eachdomain.

The results to date support the theoreticalbasis of the measure and indicate it has theappropriate reliability and validity to facilitatefurther research that will help us betterunderstand the complex relationship ofreligion, spirituality, and health.

Bibliography

Idler E, Musick M, Ellison C, George L,Krause N, Levin J, Ory M, Pargament K,Powell L, Williams D, Underwood L. NIA/Fetzer Measure of Religiousness andSpirituality: conceptual background andfindings from the 1998 General SocialSurvey. In press.

Appendix A:Additional Psychometric andPopulation Distribution Data

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Table 1: NIA/Fetzer Short Form, Domains and Instrument - GSS* Results

Domain Testable relevance to health 1998 GSS item wording

Affiliation

History

PublicPractices

PrivatePractices

What is your religious preference? Is itProtestant, Catholic, Jewish, some otherreligion, or no religion?

(If Protestant: What specific denominationis that?)

Did you ever have a religious or spiritualexperience that changed your life?

How often do you attend religious services?How often to you take part in the activities

or organizations of a church or place ofworship other than attending services?

How often do you pray privately in placesother than at church or synagogue?

Within your religious or spiritual tradition,how often do you meditate?

How often have you read the Bible in thelast year?

If you were ill, how much would the peoplein your congregation help you out?

If you had a problem or were faced with adifficult situation, how much comfortwould the people in your congregationbe willing to give you?

How often do the people in yourcongregation make too many demandson you?

How often are the people in yourcongregation critical of you and thethings you do?

Denomination-specificproscriptions for lifestyle riskfactors: alcohol, diet, smoking

Life-changing experiencefostering behavior change

Exposure to psychophysicalreligious/spiritual states


Conformity to risk-reducingbehaviors

Exposure to social networksand sources of support


Support Access to instrumentalassistance and expression ofcaring

Reduction of stress throughresolution of conflict

Encouragement of compliancewith medical treatments

Reduction of health riskbehaviors

Access to medical care andhealth information throughreferral networks

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Appendix A

Coping

Beliefs andValues

Commitment

Forgiveness

SpiritualExperience

ReligiousIntensity

Table 1: NIA/Fetzer Short Form, Domains and Instrument - GSS* Results (continued)

Domain Testable relevance to health 1998 GSS item wording

Think about how you try to understand anddeal with major problems in your life. To whatextent is each of the following involved in theway 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.

I believe in a God who watches over me.I feel a deep sense of responsibility for

reducing pain and suffering in the world.Do you believe there is life after death?I try hard to carry my religious beliefs

over into all my other dealings in life.

During the last year how much money did youand 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?

Because of my religious or spiritual beliefs:I have forgiven myself for things that

I have done wrong.I have forgiven those who hurt me.I know that God forgives me.

The following questions deal with possiblespiritual experiences. To what extent canyou say you experience the following:I feel God’s presence.I find strength and comfort in my religion.I feel deep inner peace or harmony.I desire to be closer to or in union with God.I feel God’s love for me, directly or through

others.I am spiritually touched by the beauty

of creation.

Reduction of negative impactof stressful life events

Opportunities for social compari-son promote personal well-being

Reduction of stress through provi-sion of hope

Reduction of stress through resolu-tion of conflict


Indicator of feelings of self-worth

Enhancement of well-beingthrough concern for others

To what extent do you consider yourselfa religious person?

To what extent do you consider yourselfa spiritual person?

*1998 General Social Survey, National Opinion Research Center, University of Chicago**R = respondent

91

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Tabl

e 2:

Per

cent

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trib

utio

n w

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IA/F

etze

r R

elig

ious

ness

and

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ritu

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omai

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GS

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Res

ults

92

1999b

Appendix A

Rel

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8 G

ener

al S

ocia

l S

urv

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ter,

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iver

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icag

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R =

res

pon

den

t

Tabl

e 2:

Per

cent

age

Dis

trib

utio

n w

ithin

NIA

/Fet

zer

Rel

igio

usne

ss a

nd S

piri

tual

ity D

omai

ns -

GS

S*

Res

ults

(co

ntin

ued)

93

1999b


Range Mean SD Female Male p:Mean Mean µ f = µm

Public ActivityService attendance 0 - 8 3.63 2.77 3.91 3.28 •••Other public activities 1 - 11 3.43 2.71 3.60 3.22 •Private ActivityPrivate prayer 1 - 8 5.49 2.50 5.98 4.90 •••Meditation 1 - 8 3.39 2.72 3.53 3.23 •Bible reading 1 - 6 2.22 1.42 2.37 2.03 •••Congreation SupportHelp with illness 1 - 4 3.17 .94 3.20 3.13Help with problem 1 - 4 3.32 .88 3.24 3.29Makes too many demands 1 - 4 3.50 .73 3.53 3.46Critical of R** 1 - 4 3.67 .67 3.72 3.59 ••CopingLife is part of larger force 1 - 4 2.36 1.05 2.50 2.21 •••Work with God 1 - 4 2.48 1.04 2.65 2.27 •••Look to God for strength 1 - 4 2.94 1.09 3.14 2.71 •••Feel God is punishing 1 - 4 3.69 .64 3.71 3.67Wonder if abandoned 1 - 4 3.83 .49 3.84 3.83Make sense without God 1 - 4 2.97 1.02 3.11 2.80 •••IntensityReligious strength 1 - 4 2.65 .95 2.75 2.52 •••Spiritual strength 1 - 4 2.72 .94 2.83 2.59 •••ForgivenessForgiven self 1 - 4 3.19 .88 3.28 3.08 •••Forgiven others 1 - 4 3.29 .81 3.34 3.23 ••Know that God forgives 1 - 4 3.61 .77 3.69 3.52 •••Spiritual ExperienceFeel God’s presence 1 - 6 3.77 1.67 3.99 3.52 •••Find comfort in religion 1 - 6 3.77 1.66 4.02 3.47 •••Feel inner peace 1 - 6 3.74 1.40 3.89 3.55 •••Desire to be closer to God 1 - 6 3.86 1.62 4.07 3.60 •••Feel God’s love 1 - 6 3.89 1.59 4.09 3.64 •••Touched by creation 1 - 6 4.29 1.51 4.47 4.08 •••Beliefs and ValuesCarry over beliefs 1 - 4 2.93 .88 3.04 2.79 •••God watches over 1 - 4 3.44 .78 3.56 3.30 •••Desire to reduce pain 1 - 4 2.72 .82 2.78 2.66 ••Belief in afterlife 1 - 3 2.55 .76 2.57 2.51CommitmentGiving amount in ($1000s) 0 - 60 .88 3.72 .77 1.02Giving ratio 0 - 0.10 .01 .03 .01 .01HistoryReligious experience 0 - 1 .39 .49 .38 .40

*1998 General Social Survey, National Opinion Research Center, University of Chicago**R = respondent

Table 3: Descriptive Statistics for NIA/Fetzer Religiousness and Spirituality Items- GSS* Results

94

1999b

Appendix A

Alpha rof items

Alpha r withinIndex for domain Items domain

Public Religious Activities .82 Religious service attendance .70Other public religious activities .70

Private Religious Activities .72 Private prayer .55Meditation .51Bible reading .56

Congregation Benefits .86 Congregation helps with illness .76Congregation helps with problems .76

Congregation Problems .64 Congregation makes too many demands .47Congregation is critical .47

Positive Religious Coping .81 Life is part of a larger force .58Work with God as a partner .75Look to God for support .65

Negative Religious Coping .54 Feel that God is punishing .37Wonder if God has abandoned .37

Religious Intensity .77 Religious person .63Spiritual person .63

Forgiveness .66 Forgiven self .47Forgiven others .50Know that God forgives .43

Daily Spiritual Experiences .91 Feel God’s presence .77Find comfort in religion .81Feel deep inner peace .70Desire to be closer to God .79Feel God’s love .82Touched by beauty of creation .63

Beliefs and Values .64 God watches over me .51Responsibility to reduce pain and .34

sufferingLife after death .30Carry beliefs to other areas of life .56

*1998 General Social Survey, National Opinion Research Center, University of Chicago

Table 4: Reliability Tests (r) for NIA/Fetzer Indices - GGS* Results

95

1999b96

1999b

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