The "Spirit 8" successfully captured spiritual well-being in African palliative care: factor and Rasch analysis

Lucy Selman, Richard J. Siegert, Irene J. Higginson, Godfrey Agupio, Natalya Dinat, Julia Downing, Liz Gwyther, Thandi Mashao, Keletso Mmoledi, Tony Moll, Lydia Mpanga Sebuyira, Barbara Ikin, Richard Harding

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29 Citations (Scopus)


Objective: To describe the dimensionality of a measure of spiritual well-being (SWB) (the "Spirit 8") in palliative care (PC) patients in South Africa and Uganda, and to determine SWB in this population.

Study Design and Setting: A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI). Translated questionnaires were administered to consecutively recruited patients. Factor analysis and Rasch analysis were used to examine the dimensionality of eight items from the Well-being and Transcendent subscales. The resulting measure (the "Spirit 8") was used to determine levels of SWB.

Results: Two hundred eighty-five patients recruited; mean age 40.1; 197 (69.1%) female; primary diagnosis HIV (80.7%), cancer (17.9%). Internal consistency of the eight-item scale was alpha = 0.73; Well-being factor alpha = 0.69, Transcendence factor alpha = 0.68. Rasch analysis suggested unidimensionality. Mean SWB score was 26.01 (standard deviation 5.68). Spiritual distress was present in 21.4-57.9%. Attending the Ugandan service, HIV and younger age were associated with poorer SWB scores.

Conclusion: The Spirit 8 is a brief, psychometrically robust, unidimensional measure of SWB for use in South African and Ugandan PC research. Further research testing the Spirit 8 and examining the SWB of PC patients in South Africa and Uganda is needed to improve spiritual care.
Original languageEnglish
Article numberN/A
Pages (from-to)434 - 443
Number of pages10
JournalJournal of Clinical Epidemiology
Issue number4
Publication statusPublished - Apr 2012


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