Development and psychometric evaluation of the Spiritual Health Questionnaire among Iranian Muslim adults

Background: Spiritual health (SH) has received great attention from nurses and other health-care providers in recent years. The existing instruments for SH measurement measure either some aspects of SH or SH-related concepts, and there is no specific SH measurement instrument, particularly for Muslim adults in Iran. Objective: This study aimed at the development and psychometric evaluation of the Spiritual Health Questionnaire (SHQ). Methods: This exploratory sequential mixed methods study was conducted in a qualitative and a quantitative phase in 2014–2016. In the qualitative phase, a concept analysis was conducted using the hybrid model and its results were used to develop the primary SHQ. In the quantitative phase, the face, content, and construct validity and reliability of SHQ were assessed. Exploratory factor analysis and concurrent validity assessment were performed for construct validity assessment. Test–retest stability and internal consistency were also assessed for reliability assessment. Results: The qualitative phase of the study showed that the concept of SH had six main components. In the quantitative phase, the number of primary SHQ items was reduced from 88 to 59 after face and content validity assessments. In construct validity assessment, 12 more items were excluded and the remaining 47 items were loaded on six factors which explained 45.2% of the total variance. The Cronbach’s alpha values of the questionnaire and its six dimensions were 0.778 and 0.752–0.788, respectively. Convergent validity assessment showed that the mean scores of SHQ and the Spiritual Well-Being Index had a significant correlation with each other (r = 0.35; P = 0.032). Conclusion: The 47-item SHQ is a specific instrument for SH assessment with acceptable validity and reliability.