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Journal of Chinese Integrative Medicine ›› 2010, Vol. 8 ›› Issue (9): 832-841.doi: 10.3736/jcim20100906

• Original Clinical Research • Previous Articles     Next Articles

The SpREUK-SF10 questionnaire as a rapid measure of spiritual search and religious trust in patients with chronic diseases

Büssing A   

  1. Center of Integrative Medicine; Quality of Live, Spirituality and Coping; University of Witten/Herdecke, 58313 Herdecke, Germany
  • Received:2010-06-09 Accepted:2010-07-12 Online:2010-09-20 Published:2010-09-15


There is growing evidence that aspects of spirituality have an impact on health. Measures of spirituality must be adapted to the kinds of populations being studied. In order to investigate how patients with chronic diseases living in secular societies view the impact of spirituality on their health and how they cope with illness, the SpREUK questionnaire was developed.

This paper describes the background and psychometric properties of an assessment tool which might be suited for patients living in secular societies, and summarizes confirmatory findings of patients from Germany.
Design and participants

 Cross-sectional study among 496 patients (mean age 53.5±14.4 years) with chronic diseases (84% chronic pain conditions, 6% cancer, and 10% other). All subjects completed the questionnaires by themselves.
Outcome measures

We intended to develop a short form of the already established SpREUK questionnaire, and tested it with respect to its factorial structure and conceptual validity. Other measures were engagement in spiritual practices (SpREUK-P), life satisfaction (BMLSS), and interpretation of illness (IIQ).

The good psychometric properties of the contextual (disease-related) instrument which differentiates 3 factors were confirmed: (1) Trust (in Higher Guidance/Source) (alpha=0.898), (2) Search (for Support/Access to Spirituality/Religiosity) (alpha=0.844), and (3) Reflection (Positive Interpretation of Disease) (alpha=0.736). Particularly the positive interpretations of disease were moderately associated with Search and Trust, indicating their spiritual connotation.

To assess aspects of spirituality in secular societies which are not biased for or against a particular religious commitment, the SpREUK-SF10 questionnaire appears to be a good choice. Adaptations to other cultural backgrounds are encouraged.

Key words: Spirituality, Religion, Secular societies, Quality of life, Chronic disease, Questionnaire, Validity

[1] Thoresen CE . Spirituality and health: Is there a relationship?[J]. J Health Psychol, 1999,4(3):291-300
doi: 10.1177/135910539900400314
[2] McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C . Religious involvement and mortality: a meta-analytic review[J]. Health Psychol, 2000,19(3):211-222
doi: 10.1037/0278-6133.19.3.211
[3] Koenig HG, McCullough ME, Larson DB .Handbook of religion and health[M]. New York: Oxford University Press,2001:
[4] Sloan RP, Bagiella E . Claims about religious involvement and health outcomes[J]. Ann Behav Med, 2002,24(1):14-21
doi: 10.1207/S15324796ABM2401_03
[5] Powell LH, Shahabi L, Thoresen CE . Religion and spirituality. Linkages to physical health[J]. Am Psychol, 2003,58(1):36-52
doi: 10.1037/0003-066X.58.1.36 pmid: 12674817
[6] Seeman TE, Dubin LF, Seeman M . Religiosity/spirituality and health. A critical review of the evidence for biological pathways[J]. Am Psychol, 2003,58(1):53-63
doi: 10.1037/0003-066X.58.1.53 pmid: 12674818
[7] Rew L, Wong YJ . A systematic review of associations among religiosity/spirituality and adolescent health attitudes and behaviors[J]. J Adolesc Health, 2006,38(4):433-442
doi: 10.1016/j.jadohealth.2005.02.004
[8] Moreira-Almeida A, Neto FL, Koenig HG . Religiousness and mental health: a review[J]. Rev Bras Psiquiatr, 2006,28(3):242-250
doi: 10.1590/S1516-44462006000300018 pmid: 16924349
[9] Chida Y, Steptoe A, Powell LH . Religiosity/spirituality and mortality. A systematic quantitative review[J]. Psychother Psychosom, 2009,78(2):81-90
doi: 10.1159/000190791
[10] Ziebertz HG, Kay WK .Youth in Europe Ⅱ: An international empirical study about religiosity[M].Berlin: Lit Verlag, 2006
[11] Büssing A, Ostermann T, Koenig HG . Relevance of religion and spirituality in German patients with chronic diseases[J]. Int J Psychiatry Med, 2007,37(1):39-57
doi: 10.2190/60W7-1661-2623-6042 pmid: 17645197
[12] Büssing A, Füller-Mancini A, Gidley J, Heusser P .Aspects of spirituality in adolescents[J]. Int J Child Spirituality, 2010,15(1):25-44
doi: 10.1080/13644360903565524
[13] Büssing A, Ostermann T, Matthiessen PF . Search for meaningful support and the meaning of illness in German cancer patients[J]. Anticancer Res, 2005,25(2B):1449-1455
doi: 10.1902/jop.2001.72.11.1491 pmid: 15865104
[14] Büssing A, Michalsen A, Balzat HJ, Grünther RA, Ostermann T, Neugebauer EA, Matthiessen PF . Are spirituality and religiosity resources for patients with chronic pain conditions?[J]. Pain Med, 2009,10(2):327-339
doi: 10.1111/j.1526-4637.2009.00572.x pmid: 19284487
[15] Underwood LG, Teresi JA . The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data[J]. Ann Behav Med, 2002,24(1):22-33
doi: 10.1207/S15324796ABM2401_04
[16] Pargament KI. The psychology of religion and coping: theory, research, practice[M]. New York: Guilford Press,1997:
[17] Büssing A, Ostermann T. Caritas und ihre neuen dimensionen: spiritualität und krankheit. In: Patzek M. Caritas plus. Qualität hat einen Namen[M]. Kevelaer: Butzon & Bercker,2004: 110-133
[18] Ostermann T, Büssing A, Matthiessen PF . Pilot study for the development of a questionnaire for the measuring of the patients’ attitude towards spirituality and religiosity and their coping with disease(SpREUK)[J]. Forsch Komplementarmed Klass Naturheilkd, 2004,11(6):346-353
[19] Büssing A, Ostermann T, Matthiessen PF .Role of religion and spirituality in medical patients: confirmatory results with the SpREUK questionnaire[J].Health Qual Life Outcomes, 2005, 3: 10
doi: 10.1186/1477-7525-3-10
[20] Büssing A, Keller N, Michalsen A, Moebus S, Ostermann T, Matthiessen PF . Spirituality and adaptive coping styles in German patients with chronic diseases in a CAM health care setting[J]. J Compl Integr Med, 2006,3(1):1-16
[21] Büssing A, Abu-Hassan WM, Matthiessen PF, Ostermann T . Spirituality, religiosity, and dealing with illness in Arabic and German patients[J]. Saudi Med J, 2007,28(6):933-942
doi: 10.1111/j.2042-7166.2006.tb04728.x pmid: 17530114
[22] Büssing A. Befragungsergebnisse zu spirituellen/religiösen einstellungen, bedürfnissen und ausübungsformen von patienten. In: Büssing A, Ostermann T, Glöckler M, Matthiessen PF. Spiritualität, krankheit und heilung — bedeutung und ausdrucksformen der spiritualität in der medizin[M]. Frankfurt: Verlag für Akademische Schriften,2006: 69-84
[23] Büssing A, Matthiessen PF, Ostermann T .Engagement of patients in religious and spiritual practices: confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life research[J].Health Qual Life Outcomes, 2005, 3: 53
doi: 10.1186/1477-7525-3-53
[24] Lipowski ZJ . Physical illness, the individual and the coping processes[J]. Psychiatry Med, 1970,1(2):91-102
doi: 10.2190/19Q3-9QL8-XYV1-8XC2 pmid: 4257952
[25] Lipowski ZJ . Psychosocial reactions to physical illness[J]. Can Med Assoc J, 1983,128(9):1069-1072
doi: 10.1007/978-1-4613-2509-3_8 pmid: 6839255
[26] Büssing A, Fischer J . Interpretation of illness in cancer survivors is associated with health-related variables and adaptive coping styles[J]. BMC Womens Health, 2009,9(1):2-12
doi: 10.1186/1472-6874-9-2
[27] Büssing A, Fischer J, Haller A, Ostermann T, Matthiessen PF . Validation of the Brief Multidimensional Life Satisfaction Scale in patients with chronic diseases[J]. Eur J Med Res, 2009,14(4):171-177
doi: 10.1186/2047-783X-14-4-171
[28] Huebner ES, Suldo S, Valois RF, Drane JW, Zullig K . Brief multidimensional students’ life satisfaction scale: sex, race, and grade effects for a high school sample[J]. Psychol Rep, 2004,94(1):351-356
doi: 10.2466/pr0.94.1.351-356
[29] Zullig KJ, Huebner ES, Gilman R, Patton JM, Murray KA . Validation of the brief multidimensional students’ life satisfaction scale among college students[J]. Am J Health Behav, 2005,29(3):206-214
doi: 10.5993/AJHB.29.3.2
[30] Büssing A, Ostermann T, Matthiessen PF . Wer kontrolliert die Gesundheit?[J]. Dtsch Z Onkol, 2008,40(4):150-156
doi: 10.1055/s-0028-1082647
[31] Batson CD, Schoenrade PA . Measuring religion as Quest: 1) Validity concerns[J]. J Sci Study Relig, 1991,30(4):416-429
doi: 10.2307/1387277
[32] Batson CD, Schoenrade PA, Ventis WL. Religion and the individual: a social-psychological perspective[M]. New York: Oxford University Press,1993:
[33] Martsolf DS, Mickley JR . The concept of spirituality in nursing theories: differing world-views and extent of focus[J]. J Adv Nurs, 1998,27(2):294-303
doi: 10.1046/j.1365-2648.1998.00519.x pmid: 9515639
[34] Dezutter J, Luyckx K, Schaap-Jonker H, Büssing A, Corveleyn J, Hutsebaut D . God image and happiness in chronic pain patients: the mediating role of disease interpretation[J]. Pain Med, 2010,11(5):765-773
doi: 10.1111/j.1526-4637.2010.00827.x pmid: 20353410
[35] Büssing A, Fischer J, Ostermann T, Matthiessen PF . Reliance on God’s help as a measure of intrinsic religiosity in healthy elderly and patients with chronic diseases. Correlations with health-related quality of life?[J]. Appl Res Qual Life, 2009,4(1):77-90
doi: 10.1007/s11482-009-9068-8
[36] Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D . Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy — Spiritual Well-being Scale(FACIT-Sp[J]. Ann Behav Med, 2002,24(1):49-58
doi: 10.1207/S15324796ABM2401_06
[37] Canada AL, Murphy PE, Fitchett G, Peterman AH, Schover LR . Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy — Spiritual Well-being Scale(FACIT-Sp[J]. Psychooncology, 2008,17(9):908-916
doi: 10.1002/pon.1307 pmid: 18095260
[38] Levine EG, Aviv C, Yoo G, Ewing C, Au A . The benefits of prayer on mood and well-being of breast cancer survivors[J]. Support Care Cancer, 2009,17(3):295-306
doi: 10.1007/s00520-008-0482-5 pmid: 3494290
[39] Büssing A, Fischer J, Ostermann T, Matthiessen PF . Reliance on God’s help, depression and fatigue in female cancer patients[J]. Int J Psychiatry Med, 2008,38(3):357-372
doi: 10.2190/PM.38.3.j pmid: 19069578
[40] Thune-Boyle IC, Stygall JA, Keshtgar MR, Newman SP . Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature[J]. Soc Sci Med, 2006,63(1):151-164
doi: 10.1016/j.socscimed.2005.11.055
[41] Balboni TA, Vanderwerker LC, Block SD, Paulk ME, Lathan CS, Peteet JR, Prigerson HG . Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life[J]. J Clin Oncol, 2007,25(5):555-560
doi: 10.1200/JCO.2006.07.9046
[42] Büssing A, Balzat HJ, Heusser P . Spiritual needs of patients with chronic pain diseases and cancer — validation of the spiritual needs questionnaire[J]. Eur J Med Res, 2010,15(6):266-273
doi: 10.1186/2047-783X-15-6-266
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