WHOQOL Spirituality, Religiousness and Personal Beliefs (SRPB)

Abstract

The WHOQOL Spirituality, Religiousness and Personal Beliefs (SRPB) module is a cross-culturally validated instrument developed by the World Health Organization (WHO) as an optional supplement to the core WHOQOL instruments (WHOQOL-100 and WHOQOL-BREF). Its primary function is to measure the extent to which Spirituality, Religiousness, and Personal Beliefs contribute to an individual’s overall perception of Quality of Life (QOL). The SRPB module was created following extensive international field testing which identified that spiritual, religious, and existential dimensions were crucial, culturally relevant components of QOL not adequately captured by the initial four domains (Physical Health, Psychological, Social Relations, and Environment).

Keywords

WHOQOL, SRPB, Quality of Life, Spirituality, Religiousness, Personal Beliefs, Psychological Assessment, Cross-cultural validation, Health Psychology

Authors

The WHOQOL Group (A collaborative project involving numerous international centers and researchers)

Purpose

The central purpose of the WHOQOL-SRPB module is to provide a standardized, yet culturally sensitive, method for assessing the spiritual, religious, and existential facets of Quality of Life across diverse populations. While the core WHOQOL instruments cover broad domains of functioning, the SRPB module addresses deeper, often subjective, sources of well-being, coping, and meaning that are particularly relevant in contexts of health, illness, and aging.

The scale allows researchers and clinicians to understand how factors such as inner peace, hope, faith, and meaning in life function as psychological resources or, conversely, as sources of distress. The WHO intended for this module to be applicable globally, irrespective of specific religious affiliations, focusing instead on universal existential concerns and spiritual well-being.

Construct

The WHOQOL-SRPB defines the domain of Spirituality, Religiousness, and Personal Beliefs (SRPB) broadly, encompassing both formal religious practices and individual, non-institutionalized spiritual or existential beliefs. The construct is broken down into eight distinct facets, which together capture the multidimensional nature of this domain as it relates to psychological well-being and QOL.

These eight facets move beyond simple measures of religious attendance to include deep personal experiences, cognitive coherence, and emotional states derived from one’s belief system. The facets are designed to measure the impact of these beliefs on coping with stress, finding purpose, and achieving personal harmony.

Validity

The WHOQOL-SRPB module has demonstrated robust cross-cultural validity during its development phase, involving data collection from over 18 international centers. This rigorous process ensured that the items were meaningful and relevant across vastly different cultural and religious contexts, avoiding biases toward any single belief system. Construct validity is supported by the module’s ability to differentiate between individuals reporting high and low levels of spiritual well-being, and its moderate correlation with other QOL domains, suggesting it measures a related yet distinct construct.

Furthermore, the SRPB module exhibits good discriminant validity, showing that while it relates to psychological well-being (e.g., positive feelings), it is not redundant with measures of physical or environmental QOL. The field testing indicated that the SRPB domain significantly contributes to the prediction of overall QOL beyond the contribution of the original four domains of the WHOQOL-BREF.

Reliability

The internal consistency of the SRPB module, measured using Cronbach’s alpha, is generally reported to be high across international samples, often exceeding 0.90 for the overall scale score, indicating excellent reliability. This suggests that the 32 items within the module consistently measure the underlying SRPB construct.

Reliability studies confirm that the individual facets within the SRPB domain also show acceptable to high internal consistency, ranging typically from 0.70 to 0.90. This high reliability is crucial for an instrument intended for use in diverse clinical and research settings where measurement precision is paramount.

Factor Analysis

Initial exploratory and confirmatory Factor Analysis conducted by the WHOQOL Group during development supported the conceptual framework of the SRPB module, leading to the establishment of eight distinct, yet correlated, facets. Although the number of factors identified can vary slightly based on cultural context, the core eight facets consistently emerge as key components of the SRPB domain. These eight facets are:

• Spiritual Connection
• Meaning & Purpose In Life
• Experiences of Awe & Wonder
• Wholeness & Integration (Mind, Body, Soul balance)
• Spiritual Strength
• Inner Peace
• Hope & Optimism
• Faith

This multi-faceted structure allows for detailed scoring and profile generation, enabling researchers to identify which specific aspects of spirituality or belief systems are most influential on an individual’s overall well-being.

Instrument

Test Type: Self-report questionnaire / Quality of Life Assessment Supplement

Format: 32 items, typically administered using a 5-point Likert scale (varying descriptors, e.g., extent, frequency, satisfaction, or intensity).

Language Available: Available in numerous languages due to the WHO’s extensive translation and validation protocol.

Population Group: General population, clinical populations, and specific groups (e.g., palliative care patients, elderly).

Age Group: Adults (typically 18 years and older)

Population Details: Utilized globally in cross-cultural psychological assessment and epidemiological studies.

Test Methodology: Items are scored based on the specific response scale used (A-H). Higher scores generally indicate a higher level of QOL or a stronger presence of the measured spiritual/existential resource.

Keywords

Existential well-being, Spiritual health, Psychological assessment, Health outcomes, WHO, Palliative care, Measurement scale, Inner peace

Authors

Author ORCID Identifier: Not applicable (Developed by a collaborative group)

Affiliation Email addresses: Contact information generally managed through the WHO Quality of Life Programme.

Correspondence Address: World Health Organization (WHO), Geneva, Switzerland

Permissions & Fee and Test Year

The WHOQOL instruments, including the SRPB module, are typically available for use by non-profit institutions and academic researchers following an application process and formal agreement with the World Health Organization. While the instruments themselves are often provided free of charge for non-commercial research, formal permissions are required. The SRPB module was finalized and published for use around 2002, following development work initiated in the mid-1990s as an extension of the original WHOQOL-100 and WHOQOL-BREF projects.

The original PDF detailing the WHOQOL instruments and methodologies can be downloaded here: http://apps.who.int/iris/bitstream/10665/77778/1/WHO_MSD_MER_Rev.2012.05_eng.pdf?ua=1

Reference’s

• WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a quality of life assessment instrument (WHOQOL). Qual Life Res‚ 2:153–159.
• WHOQOL Group. (1994).The development of the World Health Organization quality of life assessment instrument (the WHOQOL). In: Orley J‚ Kuyken W‚ eds. Quality of life assessment: international perspectives. Berlin: Springer-Verlag‚ 1994:41–57.
• WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med‚ 28:551–558.
• Bonomi‚ A.E.‚ Patrick‚ D.L.‚ Bushnell‚ D.M.‚ et al. (2000). Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol 2000;53:1–12.
• McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS.

Items of the WHOQOL Spirituality‚ Religiousness and Personal Beliefs (SRPB)

WHOQOL Spirituality‚ Religiousness and Personal Beliefs (SRPB) Items (32 Items)

1. To what extent does any connection to a spiritual being help you to get through hard times? (A)
2. To what extent does any connection to a spiritual being help you to tolerate stress? (A)
3. To what extent does any connection to a spiritual being help you to understand others? (A)
4. To what extent does any connection to a spiritual being provide you with comfort /reassurance? (A)
5. To what extent do you find meaning in life? (A)
6. To what extent does taking care of other people provide meaning of life for you? (A)
7. To what extent do you feel your life has a purpose? (A)
8. To what extent do you feel you are here for a reason? (A)
9. To what extent do you feel inner spiritual strength? (A)
10. To what extent can you find spiritual strength in difficult times? (A)
11. To what extent does faith contribute to your well-being? (A)
12. To what extent does faith give you comfort in daily life? (A)
13. To what extent does faith give you strength in daily life? (A)
14. To what extent do you feel spiritually touched by beauty? (B)
15. To what extent do you have feelings of inspiration / excitement in your life? (B)
16. To what extent are you grateful for the things in nature that you can enjoy? (B)
17. How hopeful do you feel? (B)
18. To what extent are you hopeful about your life? (B)
19. To what extent are you able to experience awe from your surroundings? (e.g. nature‚ art‚ music) (D)
20. To what extent do you feel any connection between your mind‚ body and soul? (D)
21. To what extent do you feel the way you live is consistent with what you feel and think? (D)
22. How much do your beliefs help you to cr‎eate coherence between what you do‚ think and feel? (D)
23. How much does spiritual strength help you to live better? (D)
24. To what extent does your spiritual strength help you to feel happy in life? (D)
25. To what extent do you feel peaceful within yourself? (D)
26. To what extent do you have inner peace? (D)
27. How much are you able to feel peaceful when you need to? (D)
28. To what extent do you feel a sense of harmony in your life? (D)
29. To what extent does being optimistic improve your quality of life? (D)
30. How able are you to remain optimistic in times of uncertainty? (D)
31. To what extent does faith help you to enjoy life? (D)
32. How satisfied are you that you have a balance between mind‚ body and soul? (E)

SRPB Facets (as identified in source):

• S1 *Spiritual Connection
• S2 *Meaning & Purpose In Life
• S3 *Experiences of Awe & Wonder
• S4 *Wholeness & Integration
• S5 *Spiritual Strength
• S6 *Inner Peace
• S7 *Hope & Optimism
• S8 *Faith

Response Scales:

• A. 1 Not at all; 2 A little; 3 A moderate amount; 4 Very much; 5 An extreme amount
• B. 1 Not at all; 2 Slightly; 3 Moderately; 4 Very; 5 Extremely
• C. 1 Not at all; 2 Slightly; 3 Moderately; 4 Very well; 5 Extremely
• D. 1 Not at all; 2 A little; 3 Moderately; 4 Mostly; 5 Completely
• E. 1 Very dissatisfied; 2 Dissatisfied; 3 Neither satisfied nor dissatisfied; 4 Satisfied; 5 very satisfied
• F. 1 Very unhappy; 2 Unhappy; 3 Neither happy nor unhappy; 4 Happy; 5 Very happy
• G. 1 Very poor; 2 Poor; 3 Neither poor nor good; 4 Good; 5 Very good
• H. 1 Never; 2 Seldom; 3 Quite often; 4 Very often; 5 Always