Chan, CLY

Fok, SSY

Gui, SX

Leung, DYP

Lou, VWQ

Shek, DTL

Tsui, AKM

HKU Scholars Hub

Title Conceptualizing and assessing spirituality among Chineseelders: towards evidence-based practiceAuthor(s) Lou, VWQ; Chan, CLY; Leung, DYP; Fok, SSY; Tsui, AKM; Gui,SX; Shek, DTLCitation Generations Review, 2012, v. 22 n. 1, p. 15-16Issued Date 2012URL http://hdl.handle.net/10722/159844Rights Creative Commons: Attribution 3.0 Hong Kong LicenseThe World at Large Page 15 Conceptualizing and Assessing Spirituality among Chinese Elders: Towards Evidence-based Practice Vivian W. Q. Lou The University of Hong Kong Catherine L. Y. Chan Tung Wah Group of Hospitals, Hong Kong Doris Y. P. Leung The Chinese University of Hong Kong Shirley. S. Y. Fok Tung Wah Group of Hospitals, Hong Kong Amy K. M. Tsui Tung Wah Group of Hospitals, Hong Kong  S. X. Gui East China Normal University Daniel T. L. Shek The Polytechnic University of Hong Kong    Background  Spiritual care is one of the essential but often ignored elements of the holistic care model. Despite its importance in human behaviour and to the Chinese culture, scientific studies of the importance of spirituality have been very limited in Chinese communities.  How can spirituality contribute to the holistic well-being of Chinese elders? Inspired by curiosity and a passion for enhanc-ing the quality of life of elders among us, we have experienced a rich and rewarding journey, together with elders and their family members, as well as health care professionals and workers, to discover the meaning of spirituality among Chi-nese elders.   Research Process  The research project was started in November 2009 and went through three phases. Phase one was qualitative research that involved adopting focus groups and conducting in-depth inter-views to elicit the underlying meaning of spirituality from the perspective of Chinese elders and those having close relation-ships with them. Altogether, eight focus groups were held, four in Hong Kong and four in Shanghai. In both cities, we invited elders and their caregivers to participate. Focus group participants included: (1) residential home-dwelling elders, (2) community-dwelling elders, (3) family caregivers of elders, and (4) staff members of social services for elders. In addition, three in-depth interviews with elders were conducted in Hong Kong. Phase two was a Delphi study aiming to reach expertise con-sensus on the meaning of spirituality among Chinese elders. Two rounds of Delphi exercises were carried out between May 2010 and July 2010, with an expert panel consisting of 16 mem-bers from three Chinese communities, including Mainland China, Taiwan, and Hong Kong. Panel members were asked to rate the degree of relevance of each item and to provide their comments and suggestions relating to the Chinese conceptuali-sation of spirituality. Two rounds of expertise meetings were also organised to further discuss the rating items. The first draft of a Spirituality Scale for Chinese Elders (SSCE) was then developed, which led to further validation.  Phase three consisted of quantitative research aiming to vali-date the Spirituality Scale for Chinese Elders (SSCE). To-gether with other standardised measures, including the World Health Organization Quality of Life measures (WHOQoL), Purpose in Life (PIL), and Positive and Negative Affect Scale (PANAS), the 44-item, 5-point Likert SSCE draft was admin-istered to 825 elders in Hong Kong and Shanghai. Face and content validity of SSCE were established through a Delphi process. Internal consistency, construct validity, and criterion validity of the SSCE were examined by Cronbach‟s alpha con-firmatory factor analysis (CFA) and correlations with PANAS, Purpose in Life, and psychological well-being in WHOQoL respectively.  Key Findings  Seven key components of spirituality, including spiritual well-being, meaning of life, transcendence, and relationships with self, family, people other than family members, and environ-ment were generated from the Delphi study in Phase two. Con-firmatory factor analyses revealed that measurement models for the seven SSCE components, with spiritual well-being and relationships with people other than family members having two subscales and the other five having one scale, were all well fit, as indicated by the model fit indices. Cronbach‟s al-pha values for all the subscales were higher than or close to 0.6 (Table 1). Correlations of SSCE components with PANAS, PIL, and four subscales in WHOQoL were moderate, signifi-cant (p<0.001), and in the expected direction, except that be-tween transcendence and WHOQoL environment subscale (p=0.10) (Table 2). Results of the present study showed that the conceptualization of spirituality in the Chinese context should be understood in regard with relationship orientation and interdependent self-construct of Chinese people. Along this line, SSCE was a reliable and valid measure that assesses spirituality among the Chinese older population in which the social-cultural context is featured by nonreligious, relationship-oriented and interdependent self-construct. Emphasis on help-ing elders to expand harmonious relationships with different systems can improve their spirituality as part of holistic care. Volume 22 , Number 1         January 2012 Page 16 Generations Review  Future Directions  As the first scale purposefully developed for measuring spiri-tuality among Chinese elders, the research team has been working on developing intervention protocols that aim to en-hance spirituality among Chinese elders.  Acknowledgement: The Study on Assessing and Enhancing Spirituality Among Elders in Hong Kong and Shanghai is initi-ated and fully supported by Tung Wah Group of Hospitals of Hong Kong. For more information contact: wbu@hku.hk Component # item R-χ2 (df) SRMR R-CFI R-RMSEA (90% CI) Alpha Spiritual well-being   68.7 (19) .048 .924 .056 (.042-.071)     Positive 5         .74   Negative 3         .68 Meaning of life 5 31.4 (5) .040 .959 .080 (.055-.108) .76 Transcendence 6 38.6 (9) .036 .953 .063 (.044-.084) .70 Relationship with self 4 2.7 (2) .015 .998 .021 (.00-.076) .71 Relationship with family 8 64.0 (19) .029 .969 .054 (.039-.068) .89 Relationship with people other than family   36.1 (13) .042 .950 .047 (.029-.065)      Friends 4         .60    Others 3         .59 Relationship with environment 6 66.5 (9) .064 .905 .088 (.069-.108) .70 Table 1. Confirmatory factor analysis of measurement models of SSCE components SSCE component PANAS Purpose of Life QoL Physio Q o L Psych Q o L Social QoL Env Positive spiritual well-being .52 .48 .44 .59 .41 .48 Negative spiritual well-being -.50 -.39 -.32 -.48 -.28 -.29 Meaning of life .47 .53 .30 .46 .31 .27 Transcendence .47 .35 .19 .35 .18 .06# Relationship with self .24 .29 .22 .35 .24 .29 Relationship with family .35 .33 .18 .42 .36 .31 Relationship with friends .40 .36 .27 .38 .48 .23 Relationship with others .31 .30 .22 .40 .40 .30 Relationship with environment .26 .30 .29 .42 .30 .50 Table 2. Correlations of SSCE components with PANAS, Purpose of Life, and WHOQoL measures Note. All p-values < 0.001 except the correlation with #. 

Conceptualizing and assessing spirituality among Chinese elders: towards evidence-based practice

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Conceptualizing and assessing spirituality among Chinese elders: towards evidence-based practice

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