Psychometric Testing of a Spiritual Well-being Scale for People with Cancer

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Panchan Thapanakulsuk
Yupapin Sirapo-ngam
Carol Estwing Ferrans
Pisamai Orathai
Tiraporn Junda


                  Spiritual well-being is crucial to the health outcomes of people with cancer and is influenced by culture, religious perspectives, and the characteristics of particular societies. There was no Thai instrument that measured this important concept, consequently, the Spiritual Well-being Scale for People with Cancer was developed by researchers and its psychometric properties were tested in this study. This instrument contains 20 items and the content validity index was .88. People with cancer aged 18 years and over, who had at least two experiences of treatment, and could communicate in the Thai language were selected to be study participants. The dimensions of spiritual well-being were identified using exploratory factor analysis (n = 190) and internal consistency testing. Four factors accounting for 58.35% of the total variance were: spiritual strengthening, spiritual suffering, spiritual uncertainty, and spiritual readiness. The confirmatory factor analysis was tested (n = 203), and the results indicated that the measurement model had a good fit with the data. The Cronbach’s alpha coefficient of the entire scale was .76. The correlation coefficient was tested with the other three instruments, and the results were between .58 and .75 (p < .001).

                   The instrument has an acceptable level of content, construct, and concurrent validity, as well as internal consistency reliability. Nurses and other healthcare profession can use this instrument to assess and evaluate intervention designs to improve the spiritual well-being of people with cancer. It is recommended that the scale be further tested with other groups of people with cancer in Thailand.

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Thapanakulsuk P, Sirapo-ngam Y, Estwing Ferrans C, Orathai P, Junda T. Psychometric Testing of a Spiritual Well-being Scale for People with Cancer. PRIJNR [Internet]. 2020 Jan. 2 [cited 2022 Nov. 29];24(1):39-53. Available from:
Original paper


1. Taylor EJ. Spiritual responses to cancer. In: Yarbro CH, Wujcik D, Gobel BH, editors. Cancer nursing: Principle & perspective. Boston: Jones and Bartlett; 2011. p. 1797-1812.

2. Chaiviboontham S, Viwatwongkasem C, Hanucharurnkul S, McCorkle R. Symptom clusters in Thais with advanced cancer. Pacific Rim Int J Nurs Res 2011; 15(4): 265-77.

3. Daniel W, Kylie O. Cancer and cancer-related fatigue and the interrelationships with depression, stress and inflammation. J Evid Based Complementary Altern Med 2017; 22(3): 502-12.

4. Margari N, Karapoulios D, Getsios I, Rizou V, Kostopoulou S, Balodimou al. Anxiety and depression in lung cancer patients. Int J Caring Sci 2016; 9 (1): 308-13.

5. Kirchhoff AC, Fowler B, Warner EL, Pannier ST, Fair D, Spraker-Perlman al. Supporting adolescents and young adults with cancer: oncology provider perceptions of adolescent and young adult unmet needs. J Adolesc Young Adult Oncol 2017; 6(4):519-23.

6. Forouzi MA, Tirgari B, Safarizadeh MH, Jahani Y. Spiritual needs and quality of life of patients with cancer. Indian J Palliat Care 2017; 23: 437-44.

7. Faeze T, Maryam R, Manighea N, Nasrin B, Azam SF, Fatemeh N. The effect of spiritual care on adolescents coping with cancer. Holist Nurs Pract 2018; 32(3):149–159.

8. Dahal A, Meheta RK. Fatigue experience and coping strategies among cancer patients receiving chemotherapy. J Nepal Health Res Counc 2018; 16 (3):285-90.

9. Rawdin B, Evans C, Rabow MW. The relationships among hope, pain, psychological, distress, and spiritual wellbeing in oncology outpatients. J Palliat Med 2013; 16(2):167-72.

10. Cha KM, Kang SY, Hyun SY, Noh JS, Shin YM, Kim NH. Mediating effect of interpersonal coping on meaning in spirituality and quality of life and the influences of depression and anxiety thereon in cancer patients. Palliat Support Care 2018; 5: 1-8.

11. Rafsanjani TH, Arab M, Ravari A, Miri S, Safarpour H. A study on the effects of spiritual group therapy on hope and the mental and spiritual health of patients with colorectal cancer. Prog Palliat Care 2017; 25(4): 171-6.

12. Hao-Zhi X, Lei G, Hong Y, Bao-Xin S. Exploring meaning in the life of Chinese breast cancer survivors. Cancer Nurs 2018; 41(2):124-130.

13. Gonzalez P, Castañeda SF, Dale J, Medeiros EA, Buelna C, Nuñez A, et al. Spiritual well-being and depressive symptoms among cancer survivors. Support Care Cancer 2014; 22: 2393-400.

14. Goyal NG, Lp EH, Salsman JM, Avis NE. Spirituality and physical health status: a longitudinal examination of reciprocal effects in breast cancer survivors. Support Care Cancer 2018; 1-7.

15. Wiriyasombat R, Pothiban L, Panuthai S, Sucamvang K, Saengthong S. Effectiveness of Buddhist doctrine practicebased programs in enhancing spiritual well-being, Coping and sleep quality of Thai elders. Pacific Rim Int J Nurs Res 2011; 15(3): 203-19.

16. Taylor EJ. Spirituality, culture, and cancer care. Semin Oncol Nurs 2001; 17(3): 197-205.

17. Taylor EJ, Davenport F. Spiritual quality of life. In: King CR, Hinds PS. editors. Quality of life: from nursing and patient perspectives. Massachusetts: Jones & Bartlett; 2012. p. 83-104.

18. Khumsaen N. Relationships between teaching role in spiritual nursing of nursing instructors, spiritual wellbeing, and spiritual care behaviors of students as reported by students, nursing colleges under the Jurisdiction of Praboromrajchanok Institute, The Ministry of Public Health. [master’s thesis]. Bangkok, Thailand: Chulalongkorn Univ.; 1997.[in Thai].

19. Noipiang T. Perceived severity of illness, social support, and spiritual well-being among breast cancer patients. [master’ Thesis]. Chiang Mai, Thailand: Chiang Mai Univ.; 2002 [in Thai].

20. Ketkong S, Hanuchareonkul S, McCorkle R Viwatwongkasem C, Junda T, Ittichaikulthol W. Symptom Experience, palliative care and spiritual well-being among Thais with advanced cancer. Pacific Rim Int J Nurs Res 2010; 14(3), 219-34.

21. Unsanit P, Sunsern R, Kunsongkeit W, O’Brien ME, McMullen P. Development and evaluation of the Thai spiritual well-being assessment tool for elders with a chronic illness. Pacific Rim Int J Nurs Res 2012; 16(1): 13-28.

22. Promkaewngam S, Pothiban L, Srisuphan W, Sucamvang K. Development of the spiritual well-being scale for Thai Buddhist adults with chronic illness. Pacific Rim Int J Nurs Res 2014; 18(4): 320-32.

23. Johnson ME, Piderman KM, Sloan JA, Huschka M, Atherton PJ, Hanson JM. Measuring spiritual quality of life in patients with cancer. J Support Oncol 2007; 5:437-42.

24. Pokpalagon P, Hanucharurnkul S, McCorkle R, Tongprateep T, Patoomwan A, Viwatwongkasem C.
Comparison of care strategies and quality of life of advanced cancer patients from four different palliative care settings. Pacific Rim Int J Nurs Res 2012; 16(4): 326-42.

25. Hungelmann JA, Kenkel-Rossi E, Klassen L, Stollenwerk RM. Focus on spiritual well-being: harmonious interconnectedness of mind-body-spirit use of the JAREL spiritual well-being scale. Geriatr Nurs 1996; 17(6): 262-66.

26. O’Brien ME. Conceptual models of parish nursing practice: a middle-range theory of spiritual well-being in illness. In: O’Brien ME. editor. Parish nursing healthcare ministry within the church. Massachusetts: Jones and Bartlett; 2003. p. 99-115.

27. O’Brien ME. Spirituality in nursing: standing on holy ground. 3rd ed. Burlington (MA): Jones and Bartlett; 2014.

28. Chaiviboontham S, Viwatwongkasem C, Hanucharurnkul S, McCorkle R. Symptom Clusters in Thais with advanced cancer. Pacific Rim Int J Nurs Res 2011; 15(4): 265-77.

29. Saengsiri A, Hacker ED. Conducting quality of life research in people with coronary artery disease in non- Englishspeaking countries: Conceptual and operationalization issues. J Cardiovasc Nurs 2015; 30(1): 74-84.

30. Wanawarodom P, Lampavaj J, Sanyan A Baupul P, Saejing P, Boonnuch C. Spiritual needs of cancer patients and spiritual support needs from nurses. Annual Seminars, Siriraj Hospital 2009; 420-34.

31. Ferrans CE, Powers MJ. Ferrans and Powers: Quality of life index cancer version III [Internet].1994&1998 [cited2016 Jan 24]. Available from: pdf/cancer version III/cancerenglish.pdf.

32. Ferrans CE, Powers MJ. Psychometric assessment of the Quality of Life Index. Res Nurs Health 1992; 15(1): 29-38

33. Tabachnick BG, Fidell LS. Principle components and factor analysis. In Barbara TG, & Fidell LS, editors. Using multivariate statistics. 5th ed. Boston: Pearson Education; 2007. p.607-75.

34. Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate data analysis. 5th ed. London: Prentice Hall; 1998.

35. Satorra A, Bentler PM. Ensuring positiveness of the scaled difference chi-square test statistic, Psychometrika 2010; 75(2): 243-48.

36. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. London: Pearson; 2010.

37. Netemeyer RG, Bearden WO, Sharma S. Scaling procedures: issues and applications. California: Sage; 2003.

38. Peterson RA. Meta-Analysis of variance accounted for and factor loadings in exploratory factor analysis. Mark Lett 2000; 11(3):261-75.

39. Mills AC, Wong-Anuchit C, Poogpan J. A concept analysis of Thum-jai: A Thai coping strategy. Pacific Rim Int J Nurs Res 2017; 21(3) : 234-43.