Spirituality Perspective Scale (SPS)

1. Abstract

The Spirituality Perspective Scale (SPS), originally conceived and operationalized by Pamela G. Reed (1986a, 1986b, 1987) with roots in earlier sociological and religious measurement research by King and Hunt (1975), is a widely utilized 10-item psychometric instrument designed to evaluate the extent to which individuals hold spiritual perspectives and engage in spiritually-related practices within their daily lives. Developed within the context of nursing science, developmental psychology, and behavioral medicine, the SPS captures both overt behavioral manifestations of spirituality—such as engagement in private prayer, contemplation, reading spiritual literature, and discussing existential matters—and intrinsic cognitive-affective orientations, including seeking spiritual guidance, valuing forgiveness, and finding foundational meaning in existence. The instrument utilizes a dual-format 6-point Likert rating system: Items 1 through 4 assess behavioral frequency ranging from 1 (“Not at all”) to 6 (“About once a day”), while Items 5 through 10 evaluate degree of agreement with spiritual self-orientations ranging from 1 (“Strongly Disagree”) to 6 (“Strongly Agree”). Scoring is typically calculated via an unweighted mean across all 10 items, yielding an overall composite score between 1.0 and 6.0, with higher scores reflecting a more pronounced spiritual perspective. Extensively validated across diverse populations, including healthy adults, terminally ill patients, older adults, clinical nurses, palliative care recipients, and family caregivers across multiple global cultures, the SPS consistently demonstrates robust psychometric properties. Internal consistency reliability coefficients (Cronbach’s alpha) typically range from .86 to .95 across independent investigations. Exploratory and confirmatory factor analyses overwhelmingly support an essentially unidimensional latent structure measuring overall spiritual perspective, while occasionally revealing two correlated second-order facets corresponding to spiritual behaviors and spiritual beliefs. Strong construct, convergent, and discriminant validities have been established through significant correlations with psychological well-being, self-transcendence, adaptive coping, lower depressive symptomatology, and resilience in facing existential crises.

2. Keywords

Spirituality Perspective Scale, SPS, Pamela G. Reed, Self-Transcendence Theory, Nursing Psychometrics, Spiritual Well-Being, Religiosity Measurement, Existential Meaning, Palliative Care Assessment, Health Psychology

3. Authors

The primary developer and intellectual architect of the Spirituality Perspective Scale is Pamela G. Reed, PhD, RN, FAAN. Dr. Reed is a distinguished Professor of Nursing at the University of Arizona College of Nursing in Tucson, Arizona, United States. Renowned internationally for her groundbreaking contributions to nursing philosophy and middle-range nursing theory, Dr. Reed developed the landmark Theory of Self-Transcendence, within which spirituality serves as a vital developmental resource that fosters human flourishing and mental health, particularly during life crises, serious illness, and end-of-life transitions.

The historical psychometric foundation of the scale traces its origins in part to the sociological instrument development work of Morton B. King and Richard A. Hunt (1975) at Southern Methodist University, whose multidimensional investigations into the measurement of religious variables provided empirical paradigms for assessing behavioral religious involvement and cognitive belief orientations. Dr. Reed refined, adapted, and conceptually transformed these operational indicators in the mid-1980s (Reed, 1986a, 1986b, 1987) to establish an inclusive, non-sectarian measure focused broadly on personal spirituality rather than strict institutional or dogmatic adherence.

4. Purpose

The primary purpose of the Spirituality Perspective Scale (SPS) is to systematically evaluate the salient role that spiritual views, beliefs, and practices play in an individual’s worldview, decision-making, and coping mechanisms. In clinical and empirical disciplines such as health psychology, nursing science, psycho-oncology, and gerontology, understanding an individual’s spiritual perspective is essential because spiritual beliefs frequently serve as fundamental psychological buffers against distress, morbidity, and existential despair.

From a theoretical standpoint, the SPS was designed to operationalize spirituality as an intrinsic developmental resource. Unlike traditional measures of religiosity that focus heavily on formal institutional affiliations, church attendance frequencies, denominational orthodoxy, or adherence to specific theological dogmas, the SPS was engineered to bridge institutional and personal dimensions of human spirituality. It captures how spirituality permeates everyday cognitive appraisals, interpersonal relationships, emotional regulation, and private contemplative practices. Dr. Reed recognized that individuals confronting terminal diagnoses, functional decline, or profound developmental crises often experience an acute activation of existential questioning; measuring this dimension reliably enables researchers and clinicians to track changes in spiritual perspectives across the lifespan and during therapeutic interventions.

In clinical practice, the SPS serves as an efficient, low-burden screening and assessment tool. Healthcare providers, particularly palliative care clinicians, clinical nurse specialists, hospice chaplains, and medical social workers, utilize the instrument to:

• Identify patients’ spiritual coping resources and potential existential needs upon admission or diagnosis.
• Facilitate holistic, patient-centered care planning that acknowledges the profound influence of spiritual beliefs on medical treatment choices, advance directives, and end-of-life decision-making.
• Assess the psychosocial vulnerabilities of family caregivers who face chronic caregiving burden, exhaustion, and moral injury.
• Evaluate the longitudinal outcomes of integrative health interventions, such as mindfulness programs, spiritual counseling, narrative therapy, and palliative supportive care models.

In academic research, the SPS provides an empirically rigorous, cross-culturally validated measure that can be correlated with physiological biomarkers, psychological resilience scales, indices of depressive affect, quality of life inventories, and Dr. Reed’s sister instrument, the Self-Transcendence Scale (STS). It allows scholars to disentangle the nuanced relationships between inner existential meaning and health-related quality of life.

5. Psychological Construct

The Spirituality Perspective Scale measures a multidimensional yet highly integrated psychological and existential construct defined by Dr. Pamela Reed as an awareness of honor, reverence, or connection to that which is beyond the self, which permeates life and provides meaning and purpose. This construct is manifested through two primary interacting dimensions: behavioral externalizations (Spiritual Practices and Interactions) and internal cognitive-affective evaluations (Spiritual Beliefs and Worldview).

Spiritual Behaviors and Interpersonal Practices

The first dimension of the construct encompasses observable actions, communicative behaviors, and private disciplines through which an individual actively expresses and nurtures their spiritual perspective. This behavioral component acknowledges that spirituality is not merely a passive or abstract philosophical posture, but a lived, operationalized engagement with reality. Within the SPS, this dimension is captured through:

• Interpersonal Spiritual Communication: Engaging with family members, friends, and social networks regarding spiritual matters, as well as sharing the experiential joys, conflicts, and challenges associated with living in congruence with one’s core spiritual principles. This reflects an externalized, relational manifestation of spirituality that fosters communal bonding and shared meaning.
• Intellectual and Reflective Engagement: Actively seeking out spiritually-oriented literature, texts, sacred writings, or philosophical materials. This reflects a deliberate cognitive commitment to ongoing existential learning, conceptual exploration, and intellectual enrichment.
• Private Contemplative Practices: Regular participation in solitary prayer, meditation, quiet reflection, or contemplative mindfulness. This internal practice serves as an emotional self-regulation mechanism, enabling individuals to recalibrate attention, process existential vulnerability, and experience communion with the transcendent.

Spiritual Beliefs, Meaning-Making, and Values

The second dimension addresses the subjective, internal cognitive architecture through which an individual interprets life events, moral dilemmas, and their ultimate purpose within the universe. This cognitive-affective facet reflects how deeply spiritual views are integrated into personality and identity:

• Ethical Values and Forgiveness: The recognition of forgiveness as an indispensable, non-negotiable component of spiritual maturity and emotional equilibrium. Forgiveness in this context represents a transcending of interpersonal grievance, facilitating emotional release and interpersonal reconciliation.
• Existential Guidance and Decision-Making: Relying on spiritual values, intuitive discernment, or transcendent connection as an operative compass when navigating complex daily decisions, ethical quandaries, and major life crises.
• Centrality and Salience of Spirituality: The degree to which spirituality represents a central organizing axis of personal identity and daily living, rather than a peripheral or situational interest.
• Transcendent Connection: Experiencing a profound sense of relational proximity, unity, or intimacy with God, a higher power, or a sacred reality during private prayer, collective worship, nature immersion, or critical life milestones.
• Existential Meaning and Teleological Understanding: The degree to which one’s spiritual perspective provides satisfying answers to fundamental existential questions regarding suffering, purpose, identity, and death. Spirituality serves as a foundational cognitive framework that transforms arbitrary or painful life experiences into coherent, meaningful developmental tasks.

6. Theoretical Framework

The Spirituality Perspective Scale is primarily grounded in Pamela G. Reed’s Theory of Self-Transcendence (Reed, 1991, 2008, 2014), a renowned middle-range nursing theory rooted in developmental psychology, life-span developmental models (e.g., Erik Erikson, Robert Kegan), and existential philosophy. In Reed’s conceptual model, human development is characterized by an innate, continuous capacity to expand personal boundaries multidimensionally across the entire life span, especially when confronted with life-limiting illness, traumatic loss, or end-of-life confrontation.

According to Self-Transcendence Theory, human beings navigate life through three interconnected core conceptual components:

1. Vulnerability: The contextual awareness of one’s mortality, physical frailty, moral limitations, or existential crisis. Vulnerability naturally increases during severe illness, aging, loss, and radical life disruption.
2. Self-Transcendence: The developmental capacity to expand self-boundaries intrapersonally (through self-acceptance and inward reflection), interpersonally (through empathic connection with others and community), transpersonally (through connecting with unseen dimensions, a higher power, nature, or God), and temporally (through integrating past experiences and future hopes into a cohesive present).
3. Well-Being: The subjective sense of wholeness, mental health, and life fulfillment that emerges as an individual successfully navigates developmental crises through self-transcendent and spiritual mechanisms.

Within this framework, spirituality is conceptualized not as a fixed static trait or a rigid set of dogmatic institutional requirements, but as a vital personal resource and developmental asset. Reed posited that when individuals face high vulnerability—such as terminal disease or severe caregiver strain—spiritual perspectives become intensified, functioning as a vital conduit through which transpersonal and intrapersonal self-transcendence occurs. In turn, this heightened spiritual perspective buffers the psychological impact of vulnerability, mitigating depressive symptoms, anxiety, and demoralization, while facilitating a profound sense of inner well-being.

Furthermore, the historical construction of the SPS reflects the conceptual rigor of Morton King and Richard Hunt’s (1975) empirical research into the measurement of religiosity. King and Hunt sought to move social science beyond simplistic unidimensional classifications (such as church membership alone) toward multidimensional operationalizations encompassing cognitive beliefs, personal practices, and social interactions. Reed synthesized these empirical insights with nursing’s holistic perspective, purposefully refining the phrasing to make the instrument accessible to individuals holding diverse theological, non-theistic, or individualistic spiritual worldviews.

7. Validity

The Spirituality Perspective Scale has undergone extensive empirical evaluation across four decades, establishing robust psychometric validity across varied clinical, developmental, and cultural contexts.

Construct Validity

Construct validity was initially demonstrated by Reed (1986b, 1987) using contrasting-groups and developmental hypothesis-testing methodologies. In her landmark 1986 study examining religiousness and spirituality among terminally ill hospitalized adults, non-terminally ill hospitalized adults, and healthy non-hospitalized adults, Reed demonstrated that individuals facing life-threatening conditions exhibited significantly higher spiritual perspective scores compared to healthy control counterparts, supporting the theoretical premise that awareness of mortality activates spiritual perspectives as a self-transcendent coping resource. Subsequent studies by Suk-Sun Kim (2008) in South Korea and the United States further confirmed construct validity by demonstrating that spiritual perspective serves as a mediating variable between family caregiving stress and psychological well-being among Korean elders and their primary caregivers.

Convergent Validity

Convergent validity has been repeatedly established through significant, theoretically expected correlations with validated instruments measuring related existential and psychological constructs:

• Self-Transcendence: Strong positive correlations have been consistently documented between the SPS and Reed’s Self-Transcendence Scale (STS), with Pearson correlation coefficients typically ranging between r = .50 and r = .72 (p < .001).
• Spiritual Well-Being: Demonstrates high positive correlations with the Spiritual Well-Being Scale (SWBS) developed by Paloutzian and Ellison, specifically the Religious Well-Being subscale (r = .68 to .81) and the Existential Well-Being subscale (r = .54 to .67).
• Purpose in Life and Hope: Moderate to high positive correlations have been observed with the Purpose in Life Test (PIL; r = .45 to .60) and the Herth Hope Index (HHI; r = .48 to .63), confirming that elevated spiritual perspective aligns with heightened existential purpose and optimism.

Discriminant and Predictive Validity

Discriminant validity is supported by weak or negligible correlations with social desirability scales, as well as distinct divergence from measures of general intelligence, physical functional independence (e.g., Katz Index of ADLs), and socioeconomic status. In predictive validity analyses, multiple regression and structural equation models demonstrate that higher SPS scores predict lower scores on depressive symptom measures (such as the Center for Epidemiologic Studies Depression Scale [CES-D] and the Beck Depression Inventory [BDI]) among chronically ill patients, older adults, and family caregivers, even after controlling for baseline physical health severity and demographic covariates.

8. Reliability

The Spirituality Perspective Scale consistently displays high internal consistency reliability across diverse participant cohorts, translation initiatives, and geographic regions.

Internal Consistency

Across Dr. Reed’s foundational studies, Cronbach’s alpha coefficients for the 10-item scale consistently surpassed the standard psychometric benchmarks for clinical and academic research:

• In Reed’s (1986a) longitudinal study of developmental resources and depression in older adults, Cronbach’s alpha was documented at .90.
• In terminally ill and hospitalized adult populations (Reed, 1986b, 1987), internal consistency ranged from .93 to .95.
• In cross-cultural adaptations, such as the Korean translation evaluated by Suk-Sun Kim (2008), the SPS yielded an alpha of .89 among older adult recipients of care and .88 among family caregivers.
• In oncology and palliative nursing populations, alpha coefficients consistently fall within the narrow, highly dependable band of .88 to .94, with item-total correlation values typically exceeding .55 across all items.

Test-Retest Reliability and Stability

Evaluation of temporal stability has shown commendable test-retest reliability across intervals ranging from one to four weeks among stable community-dwelling adult populations, with test-retest correlation coefficients (Pearson r and Intraclass Correlation Coefficients [ICC]) ranging between .82 and .89. When stability was assessed across extended longitudinal intervals (e.g., six months to one year) in the absence of severe health status changes, spiritual perspective scores demonstrated stable baseline properties while remaining sensitive to profound developmental shifts and acute existential transitions.

9. Factor Analysis

The structural dimensionality of the Spirituality Perspective Scale has been investigated using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across various cultural and clinical cohorts.

Exploratory Factor Analysis (EFA)

Principal Axis Factoring and Principal Components Analysis with both orthogonal (Varimax) and oblique (Promax) rotations generally yield either a single dominant general factor or two highly correlated sub-dimensions that mirror the scale’s response format structure:

• Unidimensional Solution: In many clinical cohorts, a single-factor solution accounts for between 55% and 68% of the total scale variance. In this unrotated solution, all 10 items demonstrate strong factor loadings exceeding .60, with several items (notably Items 6, 7, 8, and 9) loading above .80. This robust first factor provides strong psychometric justification for summing or averaging all 10 items into a single composite score.
• Two-Factor Correlated Structure: When a two-factor solution is extracted, the items divide cleanly according to behavioral frequency versus cognitive-affective agreement:
• Factor 1: Spiritual Beliefs and Values (Items 5 to 10), accounting for approximately 42%–48% of the variance, with loadings ranging from .65 to .88.
• Factor 2: Spiritual Behaviors and Practices (Items 1 to 4), accounting for approximately 12%–16% of the variance, with loadings ranging from .58 to .84.

The inter-factor correlation between these two dimensions is typically substantial (r > .60 to .72), confirming that while behaviors and cognitive beliefs are structurally distinct facets, they reflect a unified underlying construct.

Confirmatory Factor Analysis (CFA)

Contemporary structural equation modeling studies testing the factor structure of the SPS demonstrate satisfactory goodness-of-fit indices for both the unidimensional model (with correlated measurement error between adjacent behavioral items) and the second-order hierarchical model. Typical fit indices reported in the literature include:

• Comparative Fit Index (CFI): .94 to .98
• Tucker-Lewis Index (TLI): .92 to .97
• Root Mean Square Error of Approximation (RMSEA): .045 to .068 (90% CI [.030, .082])
• Standardized Root Mean Square Residual (SRMR): .032 to .051

These fit metrics substantiate the scale’s cross-sample structural invariant properties across genders, age demographics, and clinical versus community-based populations.

10. Instrument / Measurement Tool

• Instrument Name: Spirituality Perspective Scale (SPS)
• Alternative Titles: Reed’s Spirituality Perspective Scale, Spiritual Perspective Scale
• Developer: Pamela G. Reed, PhD, RN, FAAN (with historical adaptation from King & Hunt, 1975)
• Target Population: Adults (18 years and older), including healthy adults, older adults, chronically or terminally ill patients, healthcare professionals, and family caregivers.
• Administration Format: Self-administered paper-and-pencil questionnaire, clinician-administered structured interview (for individuals with visual or physical impairments), or secure digital/electronic survey.
• Completion Time: Approximately 3 to 5 minutes.
• Total Item Count: 10 standardized quantitative items, accompanied by an optional qualitative prompt for respondent elaboration.
• Response Scale Architecture: A dual 6-point ordinal response format:
• Items 1 to 4 (Spiritual Behaviors): Measured along a 6-point frequency scale:
  
  1 = Not at all
  
  2 = Less than once a year
  
  3 = About once a year
  
  4 = About once a month
  
  5 = About once a week
  
  6 = About once a day
• Items 5 to 10 (Spiritual Beliefs and Perspectives): Measured along a 6-point agreement scale:
  
  1 = Strongly Disagree
  
  2 = Disagree
  
  3 = Disagree more than agree
  
  4 = Agree more than disagree
  
  5 = Agree
  
  6 = Strongly Agree
• Scoring Methodology:
• All 10 items are positively keyed; no reverse coding is required.
• The overall composite score is computed by calculating the arithmetic mean of all 10 items (Sum of item scores divided by 10), resulting in a possible score range of 1.00 to 6.00. Alternatively, a total sum score can be computed ranging from 10 to 60.
• Subscale scores may optionally be reported: Spiritual Behaviors Subscale (Mean of Items 1–4; range 1.00–6.00) and Spiritual Beliefs Subscale (Mean of Items 5–10; range 1.00–6.00).
• Higher scores represent a higher degree of spiritual perspective, frequency of spiritual practices, and existential integration.
• Qualitative Component: An open-ended prompt follows the 10 items: “If possible, please describe how you define spirituality on the back of this page, or provide any other comments you feel are important for the researcher to know about.” This allows rich narrative content analysis regarding individual subjective meanings of spirituality.

11. Permissions & Fee and Test Year

The Spirituality Perspective Scale was formally formulated and validated in peer-reviewed scientific literature by Dr. Pamela G. Reed between 1986 and 1987 (Reed, 1986a, 1986b, 1987). The scale is protected under academic copyright by Dr. Pamela G. Reed.

For non-commercial academic research, nursing scholarship, dissertation research, and direct clinical evaluation, Dr. Reed has traditionally granted permission for use upon receipt of a formal request. Scholars and clinicians wishing to utilize, translate, or digitally reproduce the SPS are advised to contact Dr. Pamela G. Reed through the University of Arizona College of Nursing (Tucson, Arizona, USA) to obtain explicit written authorization and request the official instrument documentation, scoring guidelines, and user manual. Commercial utilization, integration into proprietary healthcare software platforms, or fee-generating clinical screening tools requires explicit licensing agreements. No fee is typically assessed for non-funded academic or graduate student research projects.

12. References

• Kim, S.-S. (2008). Interdependence of spirituality and well-being among Korean elders and family caregivers (Doctoral dissertation). The University of Arizona. Available online: https://www.nursing.arizona.edu/Library/081_Kim_Suk-Sun.pdf
• King, M. B., & Hunt, R. A. (1975). Measuring the religious variable: National replication. Journal for the Scientific Study of Religion, 14(1), 13–22. https://doi.org/10.2307/1384504
• Reed, P. G. (1986a). Developmental resources and depression in the elderly: A longitudinal study. Nursing Research, 35(2), 368–374. https://doi.org/10.1097/00006199-198611000-00014
• Reed, P. G. (1986b). Religiousness among terminally ill and healthy adults. Research in Nursing & Health, 9(1), 35–41. https://doi.org/10.1002/nur.4770090107
• Reed, P. G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Research in Nursing & Health, 10(5), 335–344. https://doi.org/10.1002/nur.4770100508
• Reed, P. G. (1991). Toward a nursing theory of self-transcendence: Deductive reformulation using developmental theories. Advances in Nursing Science, 13(4), 64–77. https://doi.org/10.1097/00012272-199106000-00008
• Reed, P. G. (2008). Theory of self-transcendence. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (2nd ed., pp. 105–129). Springer Publishing Company.
• Reed, P. G. (2014). Theory of self-transcendence. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (3rd ed., pp. 109–139). Springer Publishing Company.

13. Items of the Scale