Brief Multidimensional Measure of Religiousness/Spirituality

1. Abstract

The Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) is a seminal psychometric instrument developed through an interdisciplinary collaboration sponsored by the Fetzer Institute and the National Institute on Aging (NIA) Working Group in 1999 and updated in 2003. Created to standardize empirical investigations into the nexus of religion, spirituality, physical health, and psychological well-being, the BMMRS operationalizes religiousness and spirituality not as a single, monolithic entity, but as a nuanced, multidimensional domain encompassing behavioral, cognitive, emotional, social, and existential facets. The standard brief battery consists of 38 primary core items distributed across distinct domains, including Daily Spiritual Experiences, Values, Forgiveness, Private Religious Practices, Religious and Spiritual Coping, Religious Support, Religious/Spiritual History, Commitment, Organizational Religiousness, Religious Preference, and Overall Self-Ranking, alongside optional exploratory probes regarding Meaning and Purpose.

Psychometrically, the instrument exhibits robust measurement integrity across diverse epidemiological, clinical, and community cohorts, including landmark samples such as the General Social Survey (GSS) and the Health and Retirement Study (HRS). Subscale internal consistency estimates generally demonstrate acceptable to high reliability, with Cronbach’s alpha coefficients spanning from .65 to .91 across domains such as Daily Spiritual Experiences (α ≥ .88) and Positive Religious Coping (α ≥ .81). Confirmatory and exploratory factor analyses substantiate the multidimensional architecture of the scale, verifying that distinct factors predict discrete health trajectories, such as cardiovascular recovery, depressive symptom remission, immunological function, and all-cause mortality. Because the BMMRS employs heterogeneous response formats tailored to the cognitive and behavioral nature of each specific domain (e.g., frequency ratings, Likert agreement scales, counts, and categorical inquiries), it affords investigators a granular, psychometrically sound diagnostic profile of an individual’s spiritual and religious life without imposing excessive respondent burden.

2. Keywords

Brief Multidimensional Measure of Religiousness/Spirituality, BMMRS, Fetzer Institute, National Institute on Aging, Daily Spiritual Experiences, Religious Coping, Spiritual Well-Being, Psychometrics, Health Psychology, Behavioral Medicine

3. Authors

The Brief Multidimensional Measure of Religiousness/Spirituality was conceptualized, designed, and psychometrically validated by an interdisciplinary panel of leading behavioral scientists, epidemiologists, psychometricians, and theologians convened under the auspices of the Fetzer Institute and National Institute on Aging Working Group (1999, 2003). Key contributing scientists and domain experts included:

• Lynn G. Underwood, Ph.D. — Originator and developer of the Daily Spiritual Experiences domain; affiliated with the Fetzer Institute and the University of North Carolina, Chapel Hill.
• Kenneth I. Pargament, Ph.D. — Pioneer of the theoretical frameworks and measurement paradigms of religious and spiritual coping (RCOPE); Department of Psychology, Bowling Green State University.
• Neal Krause, Ph.D. — Expert in religious social support and health outcomes in late life; School of Public Health, University of Michigan.
• David B. Larson, M.D., M.S.P.H. (Late) — Founder and former president of the International Institute for Healthcare Research and senior researcher in epidemiological psychiatry.
• Peter C. Hill, Ph.D. — Specialist in psychological measurement of religiousness and spirituality; Rosemead School of Psychology, Biola University.
• Harold G. Koenig, M.D. — Director of the Center for Spirituality, Theology and Health; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
• Linda M. Chatters, Ph.D. and Robert Joseph Taylor, Ph.D. — Experts in social support networks, religious participation, and health disparities; School of Social Work and School of Public Health, University of Michigan.
• Jeff Levin, Ph.D., M.P.H. — Epidemiologist of religion and aging; Institute for Studies of Religion, Baylor University.

Correspondence regarding the original monographs and historical working group proceedings is archived through the Fetzer Institute, 9292 West KL Avenue, Kalamazoo, Michigan 49009, USA.

4. Purpose

The historical landscape of epidemiological, behavioral, and clinical health research was long impeded by the oversimplification of religion and spirituality. Prior to the late 1990s, the vast majority of social science and biomedical surveys measured these complex human constructs using crude, unidimensional proxy indicators, most notably denominational affiliation or nominal church attendance frequency. While these basic demographic variables occasionally demonstrated positive correlations with physical longevity and psychological resilience, they obscured the underlying cognitive, emotional, behavioral, and interpersonal mechanisms that accounted for such associations. Moreover, they conflated formal participation in institutional, organizational religious bodies with personal, existential, and non-institutional spiritual experiences.

Recognizing this critical methodological limitation, the Fetzer Institute and the National Institute on Aging convened a distinguished working group of methodologists, clinicians, and social scientists in 1995 to build a unified, multidimensional, psychometrically validated measurement battery. The explicit purpose of the resulting Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) was threefold:

1. To delineate and standardize discrete domains of religiousness and spirituality that possess theoretical and empirical plausibility as determinants of physical, mental, and functional health outcomes.
2. To provide clinical, epidemiological, and demographic researchers with a concise, modular psychometric tool capable of being seamlessly incorporated into large-scale population health surveys without imposing prohibitive respondent burden or survey attrition.
3. To disentangle positive, salutogenic religious and spiritual factors (such as benevolent divine attribution, forgiveness, and congregational social support) from dysfunctional or distressing manifestations (such as negative religious coping, feelings of divine abandonment, congregational conflict, and punitive theological beliefs).

In clinical contexts, the BMMRS serves as a comprehensive diagnostic screening instrument for behavioral medicine specialists, palliative care teams, psychiatric clinicians, and hospital chaplains. By identifying patients who rely on active spiritual coping strategies or, conversely, those experiencing severe spiritual struggle, clinicians can tailor biopsychosocial-spiritual treatment plans, anticipate adherence patterns, and mitigate risk factors for treatment-resistant clinical depression, chronic anxiety, and existential distress. In population research, the BMMRS provides the standard metric for elucidating causal pathways across longitudinal cohorts, shedding light on the neuroendocrine, cardiovascular, behavioral, and social pathways linking human transcendence to morbidity and mortality.

5. Psychological Construct

The BMMRS conceptualizes religiousness and spirituality as distinct yet overlapping multidimensional constructs situated within a biopsychosocial framework. Religiousness denotes an individual’s adherence to the codified beliefs, doctrines, institutional practices, rituals, and communal structures of an established religious tradition. Conversely, spirituality signifies an experiential, personal search for the sacred, transcendent meaning, ultimate reality, and deep connectedness with nature, humanity, or a higher power, which may unfold entirely outside institutional frameworks. The BMMRS articulates this multifaceted paradigm across eleven core psychological and behavioral dimensions:

Daily Spiritual Experiences (DSE)

Formulated primarily by Lynn G. Underwood, this dimension captures the respondent’s ordinary, day-to-day emotional and perceptual awareness of the transcendent or divine in everyday life. Rather than assessing institutional beliefs or religious behaviors, DSE evaluates visceral, affective experiences such as feeling God’s presence, deriving comfort from the sacred, experiencing inner harmony, and being touched by aesthetic or natural beauty. It measures the degree to which spirituality permeates daily psychological awareness, serving as a primary affective buffer against life stressors.

Values

This subscale assesses the cognitive assimilation of deeply held ethical, moral, and metaphysical worldviews. It measures whether the individual subscribes to a providential worldview (e.g., believing in a benevolent God who watches over them) and internalizes an altruistic, pro-social imperative (e.g., feeling a personal responsibility to diminish human suffering globally). These values orient the individual’s executive decision-making and ethical priorities.

Forgiveness

The Forgiveness dimension evaluates a pivotal psychological coping mechanism grounded in moral cognition and emotional regulation. It delineates three distinct vectors of forgiveness: forgiving oneself for transgressions and moral failures, extending forgiveness to interpersonal offenders, and experiencing perceived absolution from a higher power. Psychometrically, this subscale captures the reduction of chronic hostility, rumination, and guilt, which are well-documented neurobiological contributors to cardiovascular and immune dysfunction.

Private Religious Practices

This behavioral domain operationalizes non-organizational, self-directed religious behaviors enacted within personal or domestic spaces. It quantifies the frequency of private prayer, contemplative meditation within one’s tradition, consumption of religious media (broadcasts, literature, Scripture), and domestic rituals such as praying or saying grace before meals. These behaviors represent non-socially coerced investments of personal time and cognitive focus into sacred activities.

Religious and Spiritual Coping

Anchored in Kenneth I. Pargament’s transactional model of religious coping, this domain evaluates how individuals utilize their faith to understand, appraise, and navigate severe life stressors, bereavement, and medical illnesses. Crucially, the BMMRS captures both Positive Religious Coping (partnering with God, seeking divine strength, framing suffering within a benevolent cosmic framework) and Negative Religious Coping or spiritual struggle (attributing illness to divine punishment, fearing divine abandonment, or experiencing acute spiritual estrangement). Negative coping is consistently linked in the psychometric literature to compromised immune profiles and elevated psychiatric vulnerability.

Religious Support

Grounded in social network theory and aging research, this domain operationalizes the multi-directional social exchanges occurring within faith-based congregations. It bifurcates into positive emotional and instrumental support (expectations that congregational peers will assist during severe illness or personal crises) and negative religious interaction (perceptions that fellow congregants are excessively demanding, judgmental, or critical). This captures the dual-edged nature of religious social environments.

Religious/Spiritual History

This chronological dimension records major life-course inflection points, religious conversions, paradigm shifts, and critical losses in faith. By recording whether and at what developmental age individuals underwent transformative spiritual awakenings, profound augmentations of belief, or precipitous declines in faith, the BMMRS establishes a developmental trajectory of faith across the lifespan.

Commitment

The Commitment domain quantifies the tangible sacrifice, temporal investment, and behavioral fidelity dedicated to one’s worldview. It operationalizes intrinsic religious commitment (striving to integrate faith into all professional and social affairs) as well as concrete behavioral expenditures, including annual financial contributions to religious causes and weekly hours spent volunteering on behalf of faith organizations.

Organizational Religiousness

This subscale measures formal public participation in institutional religious environments. It quantifies the frequency of attending formal worship services as well as involvement in ancillary congregational meetings, educational classes, and committee functions. It captures exposure to the institutional doctrines, social capital, and health-promoting lifestyle proscriptions characteristic of organized faith communities.

Religious Preference and Overall Self-Ranking

The instrument concludes with demographic identification of religious tradition (and specific denomination) alongside two distinct single-item global self-appraisals: the degree to which respondents consider themselves “religious” and “spiritual.” By differentiating these two subjective identity markers, the BMMRS allows researchers to identify distinct phenomenological groups (e.g., “spiritual but not religious” vs. “religious and spiritual”).

6. Theoretical Framework

The conceptual architecture of the BMMRS is rooted in the synthesis of several major psychological paradigms, including Lazarus and Folkman’s transactional model of stress and coping, Pargament’s theory of religious coping, Bandura’s social cognitive theory, and the broader field of biopsychosocial medicine.

The Transactional Model and Religious Coping

Central to the BMMRS is Richard Lazarus and Susan Folkman’s cognitive-phenomenological stress theory, which posits that an individual’s psychological and somatic response to adversity is mediated by cognitive appraisal processes (primary appraisal of threat or loss, and secondary appraisal of coping resources). Kenneth I. Pargament extended this framework into the sacred realm, demonstrating that religion often serves as the “operating system” through which primary and secondary appraisals occur. In the BMMRS, religious coping items assess whether stressful life events are framed as divine challenges, opportunities for spiritual growth, punitive acts of God, or signs of cosmic abandonment. Positive religious coping fosters an external locus of spiritual collaboration (“working together with God as partners”), which sustains perceived control, mitigates subjective helplessness, and blunts sympathetic nervous system hyperactivation.

Social Cognitive and Self-Regulation Theories

Albert Bandura’s social cognitive framework elucidates how religious systems instill self-regulatory behaviors and collective efficacy. The Organizational Religiousness and Commitment domains measure exposure to normative social structures that reinforce positive health behaviors (such as abstinence from substance abuse, dietary moderation, and marital stability). Furthermore, public and private rituals (e.g., communal liturgy, personal prayer, and meditation) activate cognitive self-soothing scripts, down-regulating amygdala reactivity and eliciting the parasympathetic relaxation response, as characterized in mind-body medicine by Herbert Benson.

Psychoneuroimmunology and Biopsychosocial Integration

The Working Group constructed the BMMRS under the foundational premise that psychological, existential, and social constructs exert direct, measurable biological effects via neuroendocrine and immune pathways. For example, unresolved anger and interpersonal bitterness activate sustained hypothalamic-pituitary-adrenal (HPA) axis secretion of cortisol and sympathetic catecholamines. By incorporating the Forgiveness and Daily Spiritual Experiences subscales, the BMMRS directly tests the hypothesis that spiritual constructs buffer individuals against chronic allostatic load. The theoretical model posited by the NIA and Fetzer panel assumes that religion/spirituality operates through multiple intersecting pathways: behavioral lifestyles, social capital and interpersonal support, cognitive framing and coping strategies, and direct psychophysiological modulation.

7. Validity

Extensive psychometric investigations have affirmed the construct, criterion, convergent, and discriminant validity of the BMMRS across general population cohorts, geriatric populations, cancer survivors, and individuals with cardiovascular pathology.

Construct and Structural Validity

The structural validity of the BMMRS has been verified across various national and clinical samples. In large-scale epidemiological investigations, such as analyses of the General Social Survey (GSS) and the Health and Retirement Study (HRS), multi-group confirmatory factor analyses demonstrated that the distinct domains of the BMMRS cannot be collapsed into a single general factor without substantial loss of model fit. Each subscale exhibits high item-to-subscale correlations (typically exceeding .60) and satisfies standard thresholds for factorial uniqueness, confirming that constructs like Daily Spiritual Experiences, Private Religious Practices, and Religious Coping represent statistically independent dimensions of human experience.

Convergent and Discriminant Validity

Convergent validity is evidenced by robust correlations with alternative established psychological instruments. The Daily Spiritual Experiences subscale correlates strongly with the Spiritual Well-Being Scale (SWBS; r = .70 to .82) and the Intrinsic Religious Motivation Scale (r = .68). The Positive and Negative Religious Coping subscales demonstrate expected convergence with the full 105-item RCOPE, yielding correlations above .85 with their parent subscales. Discriminant validity has been demonstrated against primary personality traits assessed by the NEO Personality Inventory-Revised (NEO-PI-R); while religiousness shares modest positive variance with Agreeableness and Conscientiousness (r = .15 to .30), it demonstrates negligible overlap with Neuroticism, Extraversion, or Openness to Experience, establishing that the BMMRS does not merely capture generalized temperament.

Predictive and Criterion Validity

The BMMRS exhibits exceptional predictive validity across psychological, functional, and physical health criteria:

• Mental Health Outcomes: High baseline scores on Daily Spiritual Experiences and Forgiveness prospectively predict reduced incidence of major depressive episodes, lower anxiety scores on the Beck Anxiety Inventory, and greater overall life satisfaction. Conversely, elevated scores on Negative Religious Coping (e.g., believing God is punishing or abandoning the individual) strongly predict worsening depressive symptoms, demoralization, and elevated suicide risk in chronically ill cohorts.
• Physical Health and Physiological Biomarkers: Longitudinal analyses from the NIA-supported cohorts show that frequent organizational attendance and private religious practices predict reduced levels of systemic inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6). In cardiac rehabilitation cohorts, higher positive spiritual coping at hospital discharge predicted significantly fewer secondary cardiovascular events over a 3-year follow-up period.
• Mortality: Studies utilizing the BMMRS items embedded within the National Health and Nutrition Examination Survey (NHANES) and GSS have repeatedly demonstrated that regular organizational attendance and daily spiritual experiences confer a significant protective hazard ratio against all-cause mortality, even after rigorous multivariate statistical adjustment for baseline health status, socioeconomic position, and health-risk behaviors.

8. Reliability

The Brief Multidimensional Measure of Religiousness/Spirituality has demonstrated acceptable to excellent internal consistency, split-half reliability, and temporal stability across diverse age groups, ethnicities, and clinical populations.

Internal Consistency

The internal consistency of the BMMRS subscales varies systematically based on item count, conceptual homogeneity, and the nature of the construct. Representative Cronbach’s alpha (α) coefficients documented across landmark validation studies (including Idler et al., 2003; Fetzer/NIA, 1999; and Johnstone et al., 2009) include:

• Daily Spiritual Experiences (6 items): α = .88 – .92 (demonstrating outstanding scale homogeneity).
• Positive Religious Coping (3 items): α = .81 – .88 (high internal consistency).
• Negative Religious Coping (3 items): α = .65 – .74 (acceptable internal consistency for an abbreviated 3-item subscale capturing distinct facets of spiritual distress).
• Forgiveness (3 items): α = .66 – .75 (acceptable reliability across self, other, and divine domains).
• Private Religious Practices (5 items): α = .72 – .78 (moderate-to-high reliability for diverse home practices).
• Religious Support (Positive Support, 2 items): α = .75 – .82; (Negative Support, 2 items): α = .62 – .70.
• Organizational Religiousness (2 items): α = .80 – .85 (robust inter-item correlation between service attendance and church activity participation).

Test-Retest Reliability

Investigations examining the longitudinal stability of the BMMRS over intervals ranging from 6 weeks to 12 months show high test-retest reliability. Intraclass correlation coefficients (ICCs) for structural traits such as Values, Organizational Religiousness, and Commitment consistently exceed .80. More state-sensitive dimensions, such as Daily Spiritual Experiences and Religious Coping, exhibit test-retest coefficients between .70 and .79 across six-month intervals, indicating both the temporal stability of core beliefs and the instrument’s sensitivity to situational fluctuations during acute medical or personal crises.

9. Factor Analysis

The latent dimensionality of the BMMRS has been rigorously scrutinized using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across numerous heterogeneous samples.

Exploratory Factor Analysis (EFA)

Initial exploratory factor analyses conducted by the Fetzer/NIA Working Group and subsequent independent psychometric teams (e.g., Idler et al., 2003) utilized principal axis factoring with promax (oblique) and varimax (orthogonal) rotations. Analyses typically reveal a robust multi-factor architecture accounting for 55% to 68% of the total item variance. The Daily Spiritual Experiences items consistently load on a single dominant factor with factor loadings ranging from .72 to .86. Items measuring positive and negative religious coping split into two distinct, inversely or weakly correlated factors, confirming Pargament’s theoretical premise that positive coping and spiritual struggle are not polar opposites on a single continuum, but rather orthogonal dimensions. Private practices, organizational participation, forgiveness, and congregational support similarly resolve into clear, unifactorial components with minimal cross-loadings (< .30).

Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent confirmatory factor analyses performed on large national datasets (e.g., the 1998 General Social Survey, N = 1,445) systematically tested competing structural models: a single-factor unidimensional model, a two-factor model (broad “Religiousness” vs. “Spirituality”), and the hypothesized multi-factor hierarchical model corresponding to the discrete BMMRS domains. The single-factor and two-factor models yielded wholly unacceptable fit indices (e.g., Comparative Fit Index [CFI] < .80; Root Mean Square Error of Approximation [RMSEA] > .11).

In contrast, the multidimensional first-order model, incorporating the distinct latent domains (Daily Spiritual Experiences, Values/Forgiveness, Private Practices, Positive Coping, Negative Coping, Religious Support, and Organizational Participation), demonstrated excellent fit to empirical data. Standard fit indices reported in structural validation studies include:

• Chi-Square / Degrees of Freedom Ratio (χ²/df): ≤ 2.45
• Comparative Fit Index (CFI): .94 – .97
• Tucker-Lewis Index (TLI): .93 – .96
• Root Mean Square Error of Approximation (RMSEA): .042 – .055 (90% CI: .038 – .059)
• Standardized Root Mean Square Residual (SRMR): .041 – .049

Item factor loadings within designated latent variables are strong, with Daily Spiritual Experiences exhibiting standardized loadings between .75 and .89, Positive Coping between .71 and .84, and Negative Coping between .58 and .76. These empirical findings provide decisive psychometric justification for computing discrete subscale scores rather than relying on an undifferentiated total composite score.

10. Instrument / Measurement Tool

The Brief Multidimensional Measure of Religiousness/Spirituality is a modular, structured assessment tool designed for self-administration, computer-assisted personal interviewing (CAPI), or clinician/researcher administration. It comprises 38 primary core items organized across 11 distinct domains, alongside 2 optional developmental items assessing life-meaning:

• Instrument Structure: Modular multidimensional battery (38 core items + 2 optional meaning items).
• Format & Administration: Paper-and-pencil questionnaire, online assessment platform, or structured clinical/epidemiological interview. Average completion time ranges between 10 and 15 minutes.
• Domains & Item Allocation:
  • Daily Spiritual Experiences: 6 items (Items 1–6)
  • Values-Long Form: 2 items (Items 7–8)
  • Forgiveness: 3 items (Items 9–11)
  • Private Religious Practices: 5 items (Items 12–16)
  • Religious and Spiritual Coping: 7 items (Positive Coping: Items 17, 18, 19; Negative Coping: Items 20, 21, 22; Overall Involvement: Item 23)
  • Religious Support: 4 items (Positive Support: Items 24, 25; Negative Interaction: Items 26, 27)
  • Religious/Spiritual History: 3 items with branching age follow-ups (Items 28–30)
  • Commitment: 3 items (Items 31–33; combining Likert rating, financial quantification, and time commitment)
  • Organizational Religiousness: 2 items (Items 34–35)
  • Religious Preference: 1 open/categorical demographic item with branching denomination inquiries (Item 36)
  • Overall Self-Ranking: 2 items (Items 37–38)
  • Meaning (Optional Short-Form Considerations): 2 items
• Response Scales:
  • Daily Spiritual Experiences (Items 1–6): 6-point frequency scale (1 = Many times a day; 2 = Every day; 3 = Most days; 4 = Some days; 5 = Once in a while; 6 = Never or almost never). Note: Item 4 source material presents 5 categorical increments.
  • Values & Commitment Likert (Items 7–8, 31): 4-point agreement scale (1 = Strongly agree; 2 = Agree; 3 = Disagree; 4 = Strongly disagree).
  • Forgiveness (Items 9–11): 4-point frequency scale (1 = Always or almost always; 2 = Often; 3 = Seldom; 4 = Never).
  • Private Practices (Items 12–15): 8-point frequency scale (1 = More than once a day to 8 = Never); Item 16: 5-point frequency scale (1 = At all meals to 5 = Never).
  • Coping (Items 17–22): 4-point involvement scale (1 = A great deal; 2 = Quite a bit; 3 = Somewhat; 4 = Not at all); Item 23: 4-point involvement scale (1 = Very involved to 4 = Not involved at all).
  • Religious Support (Items 24–25): 4-point assistance scale (1 = A great deal to 4 = None); Items 26–27: 4-point frequency scale (1 = Very often to 4 = Never).
  • History (Items 28–30): Dichotomous (No / Yes) with numerical age of occurrence entry.
  • Commitment Quantifiers (Items 32–33): Open-ended continuous metric (dollar contribution and weekly hours).
  • Organizational Religiousness (Items 34–35): 6-point attendance scale (1 = More than once a week to 6 = Never).
  • Overall Self-Ranking (Items 37–38): 4-point appraisal scale (1 = Very to 4 = Not at all).
• Scoring and Transformation Rules: In the original Fetzer/NIA instrumentation, lower numerical values designate higher levels of religiousness or spiritual experience (e.g., 1 = “Many times a day” or “Strongly agree”). In modern epidemiological and psychometric practice, items are routinely reverse-coded prior to composite aggregation so that higher numerical values reflect greater spiritual experience, higher religious involvement, or more intense coping. Subscale scores are computed by summing or averaging the items within that specific domain. It is strongly recommended by psychometric consensus not to combine all 38 items into a single grand total score, as the BMMRS is inherently multidimensional.

11. Permissions & Fee and Test Year

The Brief Multidimensional Measure of Religiousness/Spirituality was originally finalized and published in 1999 as part of the official working group monograph titled Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A Report of the Fetzer Institute/National Institute on Aging Working Group, with an expanded edition released in 2003.

Through the philanthropic sponsorship of the Fetzer Institute and federal funding from the National Institute on Aging, the instrument was placed into the public domain to stimulate empirical research in health, behavioral medicine, and social science. Consequently, no licensing fees or royal commercial permissions are required for non-profit academic research, scientific investigations, public health surveillance, or clinical assessment. Investigators using the instrument are expected to cite the original 1999/2003 working group report and acknowledge the specific authorial contributions of subscale developers (such as Lynn G. Underwood for Daily Spiritual Experiences and Kenneth I. Pargament for Coping domains). Commercial publishers wishing to repackage the battery into proprietary commercial software suites should consult the Fetzer Institute.

12. References

Fetzer Institute, & National Institute on Aging Working Group. (1999). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group. John E. Fetzer Institute. https://fetzer.org/resources/multidimensional-measurement-religiousnessspirituality-use-health-research

Fetzer Institute, & National Institute on Aging Working Group. (2003). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group (Revised ed.). John E. Fetzer Institute.

Idler, E. L., Musick, M. A., Ellison, C. G., George, L. K., Krause, N., Ory, M. G., Pargament, K. I., Powell, L. H., Underwood, L. G., & Williams, D. R. (2003). Measuring multiple dimensions of religion and spirituality for health research: Conceptual background and findings from the 1998 General Social Survey. Research on Aging, 25(4), 327–365. https://doi.org/10.1177/0164027503252749

Johnstone, B., Yoon, D. P., Cohen, D., Schopp, L. H., McCormack, G., Campbell, J., & Smith, M. (2009). Relationships among religiousness, spirituality, and health for individuals with significant disabilities. Journal of Clinical Psychology in Medical Settings, 16(2), 152–162. https://doi.org/10.1007/s10880-009-9152-4

Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195335958.001.0001

Krause, N. (2008). Aging in the church: How social relationships affect health. Templeton Foundation Press.

Masters, K. S., & Spielmans, G. I. (2007). Prayer and health: Review, meta-analysis, and research agenda. Journal of Behavioral Medicine, 30(4), 329–338. https://doi.org/10.1007/s10865-007-9106-4

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. https://doi.org/10.1207/S15324796ABM2401_04

13. Items of the Scale (Questionnaire)