title: The "Spirit 8" successfully captured spiritual well-being in African palliative care: factor and Rasch analysis.
abstract: 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.
  
  
  METHODS
  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 α=0.73; Well-being factor α=0.69, Transcendence factor α=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, UK. Lucy.selman@kcl.ac.uk
authors.forename: Lucy
authors.initials: L
authors.lastname: Selman
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Siegert
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Godfrey
authors.initials: G
authors.lastname: Agupio
authors.forename: Natalya
authors.initials: N
authors.lastname: Dinat
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Liz
authors.initials: L
authors.lastname: Gwyther
authors.forename: Thandi
authors.initials: T
authors.lastname: Mashao
authors.forename: Keletso
authors.initials: K
authors.lastname: Mmoledi
authors.forename: Tony
authors.initials: T
authors.lastname: Moll
authors.forename: Lydia Mpanga
authors.initials: LM
authors.lastname: Sebuyira
authors.forename: Barbara
authors.initials: B
authors.lastname: Ikin
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044383:Black People; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000592:standards; D011471:Prostatic Neoplasms / Q000523:psychology; D011594:Psychometrics; D011788:Quality of Life; D012107:Research Design; D012514:Sarcoma, Kaposi / Q000523:psychology; D013019:South Africa / Q000453:epidemiology; D029181:Spirituality; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000523:psychology