Skip to main content

Advertisement

SpringerLink
Log in

Assessing spiritual well-being in residents of nursing homes for older people using the FACIT-Sp-12: a cognitive interviewing study

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To detect any problems with completion of the Functional Assessment of Chronic Illness Therapy Spiritual Well-being Scale (FACIT-Sp-12), to analyse the causes of such problems and to propose solutions to overcome them.

Methods

We audio-recorded face-to-face interviews with 17 older people living in one of three nursing homes in London, UK, while they completed FACIT-Sp-12. We used cognitive interviewing methods to explore residents’ responses. Our analysis was based on the Framework approach to qualitative analysis. We developed the framework of themes a priori. These comprised: comprehension of the question; retrieval from memory of relevant information; decision processes; and response processes.

Results

Ten residents completed the FACIT-Sp-12 with no missing data. Most problems involved comprehension and/or selecting response options. Twelve residents had problems with comprehension of at least one question, particularly with abstract concepts (e.g. harmony, productivity), or where there were assumptions inherent in the questions (e.g. they had an illness). When residents had problems comprehending the question, they also found it difficult to select a response. Thirteen residents had difficulties selecting responses (e.g. categories did not reflect their views or were not meaningful in the context of the statement). Some chose not to respond, others responded to the question as they understood it.

Conclusions

The FACIT-Sp-12 could provide valuable insights into the spiritual concerns of nursing home residents; however, data may be neither valid nor reliable if they do not comprehend the questions as intended and respond appropriately. Providing clear and detailed instructions, including definitions of abstract concepts, may improve the validity of this measure for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nolan, S., Saltmarsh, P., & Leget, C. (2011). Spiritual care in palliative care: Working towards an EAPC Task Force. European Journal of Palliative Care, 18(2), 86–89.

    Google Scholar 

  2. Gijsberts, M. J. H. E., Echteld, M. A., Jenny, T. S., Muller, M. T., Otten, R. H. J., Ribbe, M. W., et al. (2011). Spirituality at the end of life: Conceptualization of measurable aspects—A systematic review. Journal of Palliative Medicine, 14(7), 852–863.

    Article  PubMed  Google Scholar 

  3. Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543.

    Article  CAS  PubMed  Google Scholar 

  4. Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. M. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37(4), 710–724.

    Article  Google Scholar 

  5. Koenig, H., Pargament, K., & Nielsen, J. (1998). Religious coping and health status in medically ill hospitalized older adults. Journal of Nervous and Mental Disease, 186(9), 513–521.

    Article  CAS  PubMed  Google Scholar 

  6. Haugan, G., Rannestad, T., Hammervold, R., GarÅsen, H., & Espnes, G. A. (2013). The relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients. International Journal of Older People Nursing,. doi:10.1111/opn.12018.

    PubMed  Google Scholar 

  7. Daaleman, T. P., Williams, C. S., Hamilton, V. L., & Zimmerman, S. (2008). Spiritual care at the end of life in long-term care. Medical Care, 46, 85–91.

    Article  PubMed  Google Scholar 

  8. Gijsberts, M. J., van der Steen, J. T., Muller, M. T., Hertogh, C. M., & Deliens, L. (2013). Spiritual end-of-life care in Dutch nursing homes: An ethnographic study. Journal of the American Medical Directors Association,. doi:10.1016/j.jamda.2013.04.001.

    PubMed  Google Scholar 

  9. Selman, L., Harding, R., Gysels, M., Speck, P., & Higginson, I. J. (2011). The measurement of spirituality in palliative care and the content of tools validated cross-culturally: A systematic review. Journal of Pain and Symptom Management, 41, 728–753.

    Article  PubMed  Google Scholar 

  10. Stefanek, M., McDonald, P. G., & Hess, S. A. (2005). Religion, spirituality and cancer: Current status and methodological challenges. Psycho-Oncology, 14, 450–463.

    Article  PubMed  Google Scholar 

  11. Weaver, A. J., Pargament, K. I., Flannelly, K. J., & Oppenheimer, J. E. (2006). Trends in the scientific study of religion, spirituality, and health: 1965–2000. Journal of Religion and Health, 45, 208–214.

    Article  Google Scholar 

  12. Cotton, S. P., Levine, E. G., Fitzpatrick, C. M., Dold, K. H., & Targ, E. (1999). Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncology, 8(5), 429–438.

    Article  CAS  PubMed  Google Scholar 

  13. Bredle, J. M., Salsman, J. M., Debb, S. M., Arnold, B. J., & Cella, D. (2011). Spiritual well-being as a component of health-related quality of life: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Religions, 2, 77–94.

    Article  Google Scholar 

  14. Whitford, H. S., Olver, I. N., & Peterson, M. J. (2008). Spirituality as a core domain in the assessment of quality of life in oncology. Psycho-Oncology, 17(11), 1121–1128.

    Article  PubMed  Google Scholar 

  15. Heyland, D. K., Cook, D. J., Rocker, G. M., Dodek, P. M., Demetrios, J., et al. (2010). Defining priorities for improving end-of-life care in Canada. Canadian Medical Association Journal, 182(16), E747–E752.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Cobb, M., Dowrick, C., & Lloyd-Williams, M. (2012). What can we learn about the spiritual needs of palliative care patients from the research literature? Journal of Pain and Symptom Management, 43, 1105–1119.

    Article  PubMed  Google Scholar 

  17. Edwards, A., Pang, N., Shiu, V., & Chan, C. (2010). Review: The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: A meta-study of qualitative research. Palliative Medicine, 24, 753–770.

    Article  CAS  PubMed  Google Scholar 

  18. Lunder, U., Furlan, M., & Simonic, A. (2011). Spiritual needs assessments and measurements. Current Opinion in Supportive and Palliative Care, 5, 273–278.

    Article  PubMed  Google Scholar 

  19. MacKinlay, E. (2006). Spiritual growth and care in the fourth age of life. London: Jessica Kingsley.

    Google Scholar 

  20. Baltes, P. B., & Smith, J. (2003). New frontiers in the future of aging: From successful aging of the young old to dilemmas of the fourth age. Gerontology, 49, 123–135.

    Article  PubMed  Google Scholar 

  21. Albers, G., Echteld, M. A., de Vet, H. C. W., Onwuteaka-Philipsen, B. D., van der Linden, M. H. M., & Deliens, L. (2010). Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: A review. Journal of Pain and Symptom Management, 40, 290–300.

    Article  PubMed  Google Scholar 

  22. Vivat, B. (2008). Members of the quality of life group of the European Organisation for Research and Treatment of Cancer. Measures of spiritual issues for palliative care patients: A literature review. Palliative Medicine, 22, 859–868.

    Article  CAS  PubMed  Google Scholar 

  23. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy Spiritual Well-being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 49–58.

    Article  PubMed  Google Scholar 

  24. Cella, D., Tulsky, D., Gray, G., Sarafian, B., Linn, E., & Bonami, P. (1993). The functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. Journal of Clinical Oncology, 11, 570–579.

    CAS  PubMed  Google Scholar 

  25. Canada, A. L., Murphy, P. E., Fitchett, G., Peterman, A. H., & Schover, L. R. (2008). A 3-factor model for the FACIT-Sp. Psycho-Oncology, 17, 908–916.

    Article  PubMed  Google Scholar 

  26. Tanur, J. M. (1992). Questions about questions. Inquiries into the cognitive bases of surveys. New York: Russell Sage.

    Google Scholar 

  27. Bergh, I., Kvalem, I. L., Aass, N., & Hjermstad, M. J. (2011). What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton symptom assessment system. Palliative Medicine, 25, 716–724.

    Article  PubMed  Google Scholar 

  28. Mallinson, S. (2002). Listening to respondents: A qualitative assessment of the Short-Form 36 Health Status Questionnaire. Social Science and Medicine, 54, 11–21.

    Article  PubMed  Google Scholar 

  29. Paterson, C. (2012). Seeking the patient’s perspective: A qualitative assessment of EuroQoL, COOP–WONCA charts and MYMOP. Quality of Life Research, 13, 871–881.

    Article  Google Scholar 

  30. Willis, G. B. (2005). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage.

    Google Scholar 

  31. Frank, L., Flynn, J., & Rothman, M. (2001). Use of a self-report constipation questionnaire with older adults in long-term care. Gerontologist, 41, 778–786.

    Article  CAS  PubMed  Google Scholar 

  32. Housen, P., Shannon, G. R., Simon, B., Edelen, M. O., Cadogan, M. P., Sohn, L., et al. (2008). What the resident meant to say: Use of cognitive interviewing techniques to develop questionnaires for nursing home residents. Gerontologist, 48(2), 158–169.

    Article  PubMed  Google Scholar 

  33. Ritchie, J., & Spencer, L. (1993). Qualitative data analysis for applied policy and research. In A. Bryman & R. Burgess (Eds.), Researching social life. London: Routledge.

    Google Scholar 

  34. Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R., & Schimmel, H. (1983). Validation of a short Orientation–Memory–Concentration Test of cognitive impairment. American Journal of Psychiatry, 140, 734–739.

    CAS  PubMed  Google Scholar 

  35. O’Toole, D. M., & Golden, A. M. (1991). Evaluating cancer patients for rehabilitation potential. Western Journal of Medicine, 155, 384–387.

    PubMed Central  PubMed  Google Scholar 

  36. Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel index. Maryland State Medical Journal, 14, 61–65.

    CAS  PubMed  Google Scholar 

  37. Tourangeau, R. (1984). Cognitive sciences and survey methods. In T. B. Jabine, M. L. Straf, J. M. Tanur, & R. Tourangeau (Eds.), Cognitive aspects of survey methodology: Building a bridge between disciplines (pp. 73–101). Washington, DC: National Academy Press.

    Google Scholar 

  38. Murtagh, F. E. M., Addington-Hall, J. M., & Higginson, I. J. (2007). The value of cognitive interviewing techniques in palliative care research. Palliative Medicine, 21, 87–93.

    Article  PubMed  Google Scholar 

  39. Hulme, C., Long, A. F., Kneafsey, R., & Reid, G. (2004). Using the EQ-5D to assess health-related quality of life in older people. Age and Ageing, 33, 504–507.

    Article  PubMed  Google Scholar 

  40. Magsi, H., & Malloy, T. (2005). Under recognition of cognitive impairment in assisted living facilities. Journal of the American Geriatrics Society, 53(2), 295–298.

    Article  PubMed  Google Scholar 

  41. Magaziner, J., German, P., Zimmerman, S., et al. (2000). The prevalence of dementia in a state wide sample of new nursing home admissions aged 65 and older: Diagnosis by expert panel. Gerontologist, 40, 663–672.

    Article  CAS  PubMed  Google Scholar 

  42. Sørensen, L., Foldspang, A., Gulmann, N. C., et al. (2001). Under recognition of cognitive impairment in assisted living facilities. International Journal of Geriatric Psychiatry, 16, 615–621.

    Article  PubMed  Google Scholar 

  43. Hales, S., Gagliese, L., Nissim, R., Zimmermann, C., & Rodin, G. (2012). Understanding bereaved caregiver evaluations of the quality of dying and death: An application of cognitive interviewing methodology to the Quality of Dying and Death Questionnaire. Journal of Pain and Symptom Management, 43, 195–204.

    Article  PubMed  Google Scholar 

  44. Bradshaw, S. A., Playford, E. D., & Riazi, A. (2012). Living well in care homes: A systematic review of qualitative studies. Age and Ageing, 41, 429–440.

    Article  PubMed  Google Scholar 

  45. Orchard, H., & Clark, D. (2012). Tending the soul as well as the body: Spiritual care in nursing and residential homes. International Journal of Palliative Nursing, 7(11), 541–546.

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful to the nursing home staff for their help, to the residents who took part in this study, and to Diana Opio, Cassie Goddard and Sreeparna Chattopadhyay for conducting the interviews. This work was supported by Cicely Saunders International, from a grant from the Dunhill Medical Trust. Our financial sponsors played no role in the design, execution, analysis and interpretation of data, or writing of the study.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. King’s College London, Department of Palliative Care Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK

    Sue Hall & Sharon Beatty

Authors
  1. Sue Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sharon Beatty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sue Hall.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hall, S., Beatty, S. Assessing spiritual well-being in residents of nursing homes for older people using the FACIT-Sp-12: a cognitive interviewing study. Qual Life Res 23, 1701–1711 (2014). https://doi.org/10.1007/s11136-014-0627-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-014-0627-6

Keywords

Search

Navigation