THE ROYAL FREE INTERVIEW FOR RELIGIOUS AND SPIRITUAL BELIEFS

Abstract

The Royal Free Interview for Religious and Spiritual Beliefs is a psychological instrument developed to empirically measure the extent of spiritual, religious, or philosophical beliefs, particularly among patients admitted to a hospital with an acute physical illness. The ultimate goal of the scale is to determine if these beliefs influence the outcome of the illness. Developed by King, Speck, and Thomas (1995), this interview was designed to move beyond measures focused solely on North American Christianity, instead adopting a broader and more inclusive understanding of these constructs.

The instrument is structured into three main sections: Section A collects demographic data, Section B involves a physician’s assessment of the patient’s condition, and Section C contains the main body of the survey concerning beliefs. Section C employs a complex branching format, allowing the interviewer to tailor the path based on the subject’s responses. Quantitative responses are recorded using an 11-point scale (ranging from 0 to 10). The survey yields two primary derived scales: a Spiritual Belief scale and a Philosophical Belief scale.

Keywords

Royal Free Interview, Religious Beliefs, Spiritual Beliefs, Philosophical Beliefs, Acute Illness, Psychometrics, Health Psychology, Standardization, London

Authors

Michael King, Penny Speck, Ann Thomas

Purpose

The primary purpose of the Royal Free Interview for Religious and Spiritual Beliefs is twofold. First, it aims to establish a reliable and valid method for the empirical measurement of spiritual, religious, and philosophical beliefs in a clinical setting, specifically among patients suffering from an acute physical illness. Second, it seeks to investigate whether these belief systems have a measurable influence on the prognosis or outcome of the patient’s illness.

A key objective in the scale’s development was to create an instrument that was not limited by assumptions based predominantly on North American Christianity. The authors sought a measure applicable across diverse cultural and religious frameworks, thus providing a tool for assessing beliefs rooted in a broader understanding of human spirituality and meaning-making.

Construct

The scale measures three distinct, yet related, psychological constructs: Religion, Spiritual, and Philosophical Beliefs. The definitions employed within the survey are explicit:

• Religion: Defined as the practice of and/or the framework for a system encompassing specific beliefs, codes of conduct, rituals, and values.

• Spiritual: Taken in its broad sense, this refers to an individual’s belief in a power or entity that is extraneous to him or herself.

• Philosophical Belief: This construct captures an individual’s search for meaning in life but specifically without reference to an external or transcendent power.

The scale structure allows for the derivation of two key quantitative measures: (1) a Spiritual Belief scale (sum of answers to questions 3, 9, 10, 11, and 12), and (2) a Philosophical Belief scale (sum of answers to questions 3, 15, 16, and 17).

Validity

Concurrent validity for the Royal Free Interview remains unknown, as no comparisons were made with other established measures of religious or spiritual belief during the initial standardization phase. However, Criterion Validity was assessed using two distinct methods.

The first method assessed the association between spiritual belief (as measured by the Spiritual Scale score) and the frequency of religious observance. A Pearson correlation coefficient of 0.41 (p < .0005) was found, indicating a significant linear relationship between the frequency of religious observance and the self-reported strength of belief.

The second method involved comparing the Spiritual Scale scores of a highly religious reference group (Group 3, composed of chaplains, ministers, nuns, etc.) against the combined scores of the other two reference populations (Royal Free Hospital staff and General Practice patients). As hypothesized, the mean spiritual scale score of the highly religious group (37.1) was significantly higher than the combined score of the RFH and GP groups (27.6), t(228) = 4.06, p < .0005. These results provide evidence supporting the criterion validity of the Spiritual scale.

Reliability

Both internal consistency and test-retest reliability were evaluated for the derived Spiritual and Philosophical scales.

Internal reliability was measured using the alpha coefficient: the Spiritual scale demonstrated strong internal consistency with an alpha coefficient of 0.81. The Philosophical scale showed a moderate level of consistency with an alpha coefficient of 0.60.

Test-retest reliability was assessed by re-interviewing 103 hospital staff subjects one week after the initial administration. The correlation coefficients for individual questions scored on the 11-point quantitative scale were consistently high, ranging from 0.76 to 0.93. Specifically, five correlations exceeded 0.90, four were above 0.85, and four were below 0.85. Kappa coefficients for the categorical questions (4, 5, 8, 13, 14) also indicated high agreement, ranging from 0.67 to 1.0. For the derived composite scores, the test-retest reliability coefficients were exceptionally high: 0.95 for the Spiritual scale and 0.91 for the Philosophical scale.

Factor Analysis

The provided source material describes the derivation of two scales (Spiritual and Philosophical) based on the summation of specific item scores. However, a formal exploratory or confirmatory factor analysis detailing the underlying dimensionality of the entire instrument was not reported in the source material used for standardization.

Instrument

Test Type: Structured Interview/Survey

Format: The instrument uses a complex branching format based on initial responses. It includes categorical questions (Yes/No/Refuse to Answer) and quantitative questions requiring subjects to respond on an 11-point scale (0 to 10) indicating the strength of a particular belief.

Language Available: English (used exclusively during standardization)

Population Group: Primarily patients admitted to a hospital with acute physical illness, though Section C is applicable to non-hospitalized individuals.

Age Group: Adults (implied by the use of hospital staff and general practice patients)

Population Details: Standardization utilized three distinct groups from London: (a) a convenience sample of Royal Free Hospital staff (n=153); (b) a consecutive series of non-acutely ill general practice patients (n=123); and (c) a validation sample of individuals strongly associated with a religious faith (n=29).

Test Methodology: Interviewer-administered questionnaire. Scoring requires simple summation of quantitative scale scores, with the exception of Question 2, which requires the administrator to categorize the subject’s open response into religious, spiritual (without observance), or philosophical (without religious/spiritual) understanding.

Keywords

Psychological Measurement, Religious Beliefs, Spiritual Assessment, Criterion Validity, Test-Retest Reliability, Acute Care, Pearson Correlation

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Not provided in source material.

Correspondence Address: Not provided in source material.

Permissions & Fee and Test Year

Test Year: The refined version of the interview was published and standardized in 1995.

Permissions and Fee: Information regarding current permissions or licensing fees for using the scale is not provided in the original source material. Researchers should contact the corresponding author, Michael King, for access and usage rights.

Reference’s

King, M., Speck, P., & Thomas, A. (1995). The Royal Free Interview for Religious and Spiritual Beliefs: Development and standardization. Psychological Medicine, 25, 1125-1134.

King, M., Speck, P., & Thomas, A. (1994). Spiritual and religious beliefs in acute illness: Is this a feasible area for study? Social Science and Medicine, 38, 631-636.

Items of the THE ROYAL FREE INTERVIEW FOR RELIGIOUS AND SPIRITUAL BELIEFS

The full text of the interview items is not provided in the source content. However, the structure includes:

• Section A: Demographic data.

• Section B: Physician’s assessment of the patient’s condition.

• Section C: Main body of the religious survey, following a branching format, including questions about the nature of the subject’s spiritual, religious, and philosophical understanding.

• Quantitative Items: Questions requiring responses on an 11-point scale (0-10).

• Illness Association Items: Six specific questions dealing with the subject’s understanding of any association between their illness and their religious beliefs.

• Items forming the Spiritual Scale: Questions 3, 9, 10, 11, and 12.

• Items forming the Philosophical Scale: Questions 3, 15, 16, and 17.