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In secular cultures, such as Denmark, tools to measure spiritual needs are warranted to guide existential and spiritual care. We examined the clinimetric properties of the Danish version of the Spiritual Needs Questionnaire (DA-SpNQ-20) based on a digital survey in a test-retest setup. A convenience sample was reached via social media and student platforms. A total of 325 (148 for retest) respondents were included in the analysis. The sample was randomly split into two groups (A and B) and used for exploratory (EFA) and confirmatory factor analysis (CFA) by structural equation modeling, respectively. SpNQ dimensions had an internal consistency with Cronbach's alpha between 0.73 and 0.93. The four factors of the SpNQ were supported by both EFA and CFA as follows: religious needs, existential needs, inner peace needs, and generativity needs. The instrument showed good internal consistency, good test-retest reliability, and acceptable structural validity in the sample of relatively young and healthy persons., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association., Methods: Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists., Results: We found 11 eligible surveys from 8 countries (n = 3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48-0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists., Conclusions: We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

To provide spiritual care, an assessment and documentation of patients´ spiritual struggles and/or their spiritual needs is required to initiate appropriate support planning processes. For that purpose, the Spiritual Needs Questionnaire (SpNQ) was developed in 2009 as an easy to apply standardized measure. The tool has so far been translated into numerous languages and is widely used as a valid and reliable instrument to assess a wide range of spiritual needs of patients with chronic diseases, elderly, adolescents, and healthy persons. Its four main factors address Religious needs, Existential needs, Inner Peace needs, and Giving/Generativity needs. Here, the main findings are summarized and discussed., (© 2021. The Author(s).)

Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had "some" influence on their patients' health (CI95%) (81.8%-84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%-95.5%). Across all samples 649 (16%; 14.9%-17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%-25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Kørup A et al.)

In Adventists (n = 603) 45% were less effective and 55% more effective in coping with phases of spiritual dryness, particularly those with leading roles in the church. Strategies such as devotion/trust in God, private prayer/meditation/scripture reading, openness, talks with close others, and self-care were most often utilized. Their ability to cope was predicted best by low Acedia, Living from the Faith, low emotional exhaustion, well-being and having a duty in the church (R 2  = .24). When these phases were overcome, several perceived spiritual depth and were able to help others all the more. Helpful strategies should be made available to support persons struggling with spiritual dryness.

In a cross-sectional survey among 626 Adventists, we investigated their perception of spiritual dryness, and its association with indicators of Acedia, well-being and emotional exhaustion. Women, younger persons and those without a specific duty within the church had significantly higher spiritual dryness scores. Spiritual dryness was predicted best by perceived Excessive Spiritual Demands (indicating spiritual exhaustion) and low perception of the sacred. Further predictors are Acedia's Difficulties in Prayer Life, reduced well-being and emotional exhaustion. The underlying causes might be complex and thus to support persons experiencing these phases, a thorough differentiation of the underlying 'spirits' is required.

The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.

Background: During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected 'extra time' there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic., Methods: An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ)., Results: Within the number of respondents (n = 1277), women were predominating (67.5%). Participants' mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: (1) Nature/Silence/Contemplation (Cronbach's alpha = .87), (2) Spirituality (Cronbach's alpha = .83), (3) Relationships (Cronbach's alpha = .80), (4) Reflection on life (Cronbach's alpha = .74), (5) Digital media usage (Cronbach's alpha = .74). Strongest changes were observed for Relationships and Nature/Silence/Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person's perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants' wellbeing was explained best by low perceived burden and high life satisfaction (R 2  = .46). Awe/gratitude, perceived changes in terms of Nature/Silence/Contemplation and low Reflections of live are further variables that would predict a person's wellbeing among the COVID-19 pandemic., Conclusions: During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons' wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples' life.

Purpose: The study addresses the spiritual dimension of care of non-terminally ill cancer patients by measuring their spiritual needs in association with indicators of quality of life (i.e., happiness, satisfaction with life, pain intensity, functional capacity) and personal and illness characteristics., Method: A descriptive, cross-sectional survey included 227 patients with cancer. All patients that underwent treatment at a nursing and supportive treatment unit were interviewed face-to-face between January and November 2018. Regression models were used to control for gender, education, religiosity, pain intensity, functional capacity, life satisfaction and happiness., Results: The non-terminally ill cancer patients experienced the exceptional importance of Inner Peace and Giving/Generativity and Forgiveness, while Religious and Existential needs were scored marginally lower, but nevertheless much higher as compared to patients with cancer from West-Europe. Correlation analysis revealed strong positive and in one case moderate interconnections among each of four spiritual needs, with the strongest association between Existential needs and the other three domains. Unmet Religious needs were positively associated with pain intensity and reduced physical capacity of patients, but less with life satisfaction. Pain intensity was the strongest predictor of cancer patients' Existential, Inner Peace and Giving/Generativity and Forgiveness needs., Conclusion: This study provides the first empirical evidence about the spiritual needs of cancer patients' care in Lithuania. Findings will serve as the basis for specific strategies to enhance the holistic well-being of these patients. The insights into oncology patients' unmet spiritual needs may be relevant to other Eastern European and former Soviet Union countries with similar developmental histories., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Spirituality is part of the basic needs of all humans, yet often undervalued by health professionals. Less is known about the spiritual needs of mothers of preterm or sick new born children., Aim: Identify unmet psychosocial and spiritual needs of these mothers, and to relate these needs to their perceived stress and impairments of life concerns., Methods: Anonymous cross-sectional survey with standardized instruments (e.g., Spiritual Needs Questionnaire) among 125 mothers of two paediatric departments in Germany., Findings: Mothers felt supported by their partner and hospital staff, and hospital staff assured 82% of them that they must not worry about their child's prognosis. They nevertheless did have specific unmet spiritual needs. Religious Needs and Existentialistic Needs scored lowest, while Giving/Generativity Needs were of moderate and Inner Peace Needs of strongest relevance. With respect to the expected diagnosis and prognosis of their child, there were no significant differences for their secular spiritual needs scores, but significant differences for Religious Needs which scored highest in mothers with children having an unclear prognosis (F=8.6; p=.004). Particularly Inner Peace Needs correlated with their stress perception (r=.34), impairments of life concerns (r=.25) and grief (r=.23)., Discussion: Mothers of sick born/premature children felt supported by the hospital team and their partner, but nevertheless experienced stress and daily life impairments, and particularly have unmet Inner Peace Needs., Conclusions: Addressing mothers' specific needs may help support them in their struggle with their difficult situation avoiding fears and insecurity and thus facilitating positive bonding to their child., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

In a cross-sectional survey among 213 patients with multiple sclerosis, we intended to analyze their resources of hope, orientation, and inspiration in life, and how these resources are related to health-associated variables, adaptive coping strategies, and life satisfaction. Resources were categorized as Faith (10 %), Family (22 %), Other sources (16 %), and No answer (53 %). These non-respondents were predominantly neither religious nor spiritual (70 % R-S-). Although R-S- persons are a heterogeneous group with varying existential interest, they did not significantly differ from their spiritual/religious counterparts with respect to physical and mental health or life satisfaction, but for an adaptive Reappraisal strategy and Gratitude/Awe.

In an anonym cross-sectional survey (using standardized questionnaires) among 1092 German soldiers, we found that 21 % regard their faith as a "strong hold in difficult times." Only a few had specific religious needs. Rather, a consistent theme from the participants was the need to communicate their own fears, worries and desire to attain states of inner peace. "Soldiers" stress perception and posttraumatic stress disorder symptoms were associated particularly with existential and Inner Peace Needs. Structural equation modeling indicated that stress perception has a negative influence on soldiers' life satisfaction, which in turn gives rise to specific unmet spiritual needs. These specific needs may indicate psycho-emotional problems which could be supported very early to prevent health affections and service failure.

We aimed to analyse stress perception, psychosomatic health and life satisfaction in pastoral professionals, paying particular attention to their individual and shared resources. Enrolling 8574 German pastoral professionals (48% priests, 22% parish expert workers, 18% pastoral assistants, 12% deacons), we found that pastoral professionals' stress perception is associated with psychosomatic health impairment. General self-efficacy was a beneficial resource to protect against stress perceptions, while perception of the transcendent had a further yet weakly positive influence for stress-related impairment of health. External stressors (i.e. team size, duration of work per week and size of pastoral unit) were only of marginal independent relevance.

In a cross-sectional survey using standardized questionnaires such as the Spiritual Needs Questionnaire (SpNQ), we analyze unmet spiritual needs of 275 patients with chronic diseases from Catholic Poland. The factorial structure of SpNQ's Polish version is similar to the primary version and has good internal consistency (Cronbach's α = 0.89). Here, not only Inner Peace needs and Giving/Generativity needs were of relevance, but also Religious Needs and Existential Needs. These needs were not significantly associated with life satisfaction, but with interpretations of illness. To address such unmet needs, multi-professional teams should care for patients' multifaceted needs.

We intended to analyze whether patients with chronic diseases believe in guardian angels (GdA) as a coping resource. In a cross-sectional survey, we analyzed data from 576 German patients with chronic diseases (mean age 51.3 ± 15.4 years). We found that 56 % of the patients often or even regularly believed in GdA, with significantly more women than men believing. Particularly interesting was the fact that 38 % of patients who were identified as neither religious nor spiritual (R-S-) believed in GdAs. This belief may indicate that patients are interested in bridging the gap between the concrete struggle to manage illness and non-rational/transcendent realms.

Objective: Research has shown that several patients report unmet psychosocial and spiritual needs. While most studies focus on patients with advanced stages of disease, we intended to identify unmet spiritual needs in patients with chronic pain diseases and cancer living in a secular society., Methods: In an anonymous cross-sectional study, standardized questionnaires were provided to German patients with chronic pain diseases (and cancer), i.e., Spiritual Needs Questionnaire (SpNQ), Spirituality/Religiosity and Coping (SpREUK-15), Spiritual Well-being (FACIT-Sp), Brief Multidimensional Life Satisfaction Scale, Interpretation of Illness Questionnaire, and Escape from Illness (Escape)., Results: We enrolled 392 patients (67% women, mean age 56.3 ± 13.6 years; 61% Christian denomination) with chronic pain diseases (86%) and cancer (14%). Religious Needs (mean score 0.5 ± 0.8 on the scale) and Existential Needs (0.8 ± 0.8 on the scale) were low, while needs for Inner Peace (1.5 ± 0.9 on the scale) and Giving/Generativity were scored high (1.3 ± 1.0 on the scale). Regression analyses indicated that Religious Needs can be predicted best by (religious) "Trust," the illness interpretation "call for help," and living with a partner; Existential Needs can be predicted by "call for help" and to a weaker extent by (religious) "Trust." Existential Needs are influenced negatively by the illness interpretation "challenge." Needs for Inner Peace were predicted only in trend by the illness interpretation "threat," and there were no significant predictors for the Giving/Generativity needs in the respective regression model., Conclusions: Patients with chronic pain diseases predominantly report needs related to inner peace and generative relatedness on a personal level, whereas needs related to transcendent relatedness were of minor relevance. Nevertheless, even religious "skeptics" can express specific religious needs, and these should be recognized. Addressing patients' specific needs and also supporting them in their struggle with chronic illness remain a challenging task for the modern health care system., (Wiley Periodicals, Inc.)

Objective: Even in secular societies, a small portion of patients find their spirituality to help cope with illness. But for the majority of patients, psychosocial and spiritual needs are neither addressed nor even considered a relevant factor by health care professionals. To measure such specific needs, the Spiritual Needs Questionnaire (SpNQ) was developed. The aim of this study was to validate the Chinese version of the SpNQ (SpNQ-Ch) and thus to measure psychosocial and spiritual needs of Chinese patients., Methods: This was a cross-sectional study among 168 patients with chronic diseases who were recruited in the Changhai Hospital of Traditional Chinese Medicine, Shanghai, China using standardized questionnaires. We performed reliability and factor analyses, as well as analyses of variance, first order correlations and regression analyses., Results: The 17-item SpNQ-Ch had a similar factorial structure as the original version with two main and three minor factors which accounted for 64% of variance, and internal consistency estimates (Cronbach's α) ranging from 0.51 to 0.81. Included were the 4-item scale Inner Peace Needs, the 5-item scale Giving/Generativity Needs, the 5-item scale Religious Needs (with 2 sub-constructs, Praying and Sources), and a 3-item scale Reflection/Release Needs. In Chinese patients with cancer (63%), pain affections (10%), or other chronic conditions (23%), the needs for Giving/Generativity (which refer to categories of Connectedness and Meaning) and Inner Peace Needs scored highest, while Religious Needs and the Reflection/Release Needs scored lower., Conclusion: The SpNQ-Ch is congruent with its primary version, and can be used in future studies with the mostly nonreligious patients from China. First findings indicate specific psychosocial and spiritual needs which should be addressed by health care professionals to support patients in their struggle with chronic illness in terms of psycho-emotional stabilization, finding hope and meaning, and thus achieving peaceful states of mind despite chronic illness.

Background: Epidemiological data show psychosocial health risks of pastors. This study should therefore identify psychosocial risk factors and health resources including religiosity and spirituality in profession related behaviour and experience of pastors. Methods Pastors of two protestant denominations were surveyed with three standard instruments (AVEM, SF-12, BMMRS)., Results: Only a small fraction of pastors presented a healthy behaviour and experience pattern (13.9% SDA; 10.1% FEG). A burnout-related risk pattern was found in 28.3% of SDA and 37.2% of FEG pastors. Pastors with a healthy pattern scored higher in physical and mental health and selected scales of religiosity/spirituality than those with a pattern in risk for burnout., Conclusions: The results show distinct psychosocial strain patterns of pastors. Religiosity and spirituality may be an important resource., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: We studied whether or not spirituality/religiosity is a relevant resource for patients with chronic pain conditions, and to analyze interrelations between spirituality/religiosity (SpREUK Questionnaire; SpREUK is an acronym of the German translation of "Spiritual and Religious Attitudes in Dealing with Illness"), adaptive coping styles that refer to the concept of locus of disease control (AKU Questionnaire; AKU is an acronym of the German translation of "Adaptive Coping with Disease"), life satisfaction, and appraisal dimensions., Patients: In a multicenter cross-sectional study, 580 patients with chronic pain conditions were enrolled., Results: We found that the patients relied on both external powerful sources of disease control and on internal powers and virtues, while Trust in Higher Source (intrinsic religiosity) or Illness as Chance (reappraisal) were valued moderately; Search for Meaningful Support/Access (spiritual quest orientation) was of minor relevance. Stepwise regression analyses revealed that the internal sources of disease control, such as Conscious and Healthy Way of Living and Positive Attitudes, were (apart from the religious denomination) the strongest predictors of patients' reliance on spirituality/religiosity. Both behavioral styles were rated significantly lower in patients who regarded themselves as neither religious nor spiritual. Positive disease interpretations such as Challenge and Value were clearly associated with a spiritual quest orientation and intrinsic religiosity., Conclusion: The associations between spirituality/religiosity, positive appraisals. and internal adaptive coping strategies indicate that the utilization of spirituality/religiosity goes far beyond fatalistic acceptance, but can be regarded as an active coping process. The findings support the need for further research concerning the contributions of spiritual coping in adjustment to chronic pain.

Objective: We intended to develop a brief and compact scale which measures the beneficial effects of spirituality/religiosity (SpR) on several dimensions of patients' life concerns, to be used in health outcome studies., Method: To attain a short measure valid for spiritual and religious dimensions, we designed a scale based on tested items of an independent item pool of the already established SpREUK inventory, which measures SpR attitudes and convictions and holds an independent data pool addressing the support of life concerns through SpR. To validate the intended BENEFIT scale, reliability and factor analyses were performed utilizing 371 individuals with different chronic diseases recruited in various medical centers in Germany (exploratory analysis), while for the confirmatory analyses we used an independent pool of 229 patients with chronic pain conditions., Results: Six items addressed the beneficial effects of SpR of the patients' concerns, and thus were chosen for the BENEFIT scale. These items had a good internal reliability (Cronbach's alpha = 0.922). Primary factor analysis pointed to a 1-factor solution, which explained 72% of variance. Correlation analyses revealed that the BENEFIT scale correlated with both uniquely religious and spiritual attitudes., Conclusions: The data demonstrate the reliability and validity of the 6-item BENEFIT scale that captures a unique aspect of SpR that can be used in epidemiological studies and clinical trials for those who wish to assess both the external and internal dimensions of SpR. This brief instrument can be easily incorporated into almost any study of mental health, physical health, or quality of life.

Objective: Many American patients depend on religion to cope, but less is known about the spiritual/religious (SpR) characteristics of medical patients in Europe, a more secular environment. We examined self-categorizations of SpR (spiritual, religious, both, neither), patients' search for meaningful support, trust in higher source, positive interpretation of disease, and support in relations of life through SpR, as measured with the SpREUK questionnaire, in German medical patients., Method: We analyzed data on 710 West-German patients with a mean age of 54. Forty-two percent had chronic pain diseases, 25% cancer, 10% multiple sclerosis, 21% other chronic diseases, and 3% acute diseases., Results: The general interest in search for meaningful support was moderate. Trust in a higher source and support in life through SpR were rated higher, while almost all patients had a positive interpretation of their diseases, i.e, hint to change life. The interest in SpR issues was highest in cancer patients and lowest in patients with multiple sclerosis. Univariate analyses confirmed that the SpR self-categorization was the strongest predictor of all four factors, while trust in a higher source was also affected by religious affiliation and age. Positive interpretations of disease correlated well with search for meaningful support., Conclusions: Patients with chronic diseases differ with respect to their SpR self-categorizations and may thus utilize different aspects of SpR. Cancer patients, in particular, often depend on their trust in a higher power and in conventional religious activities to help them to cope with their illness.

Background: Quality of life is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. In order to examine how patients with severe diseases view the impact of spirituality and religiosity on their health and how they cope with illness, we have developed the SpREUK questionnaire. We deliberately avoided the intermingling of attitudes, convictions and practices, and thus addressed the distinct forms and frequencies of spiritual/religious practices in an additional manual, the SpREUK-P questionnaire., Methods: The SpREUK-P was designed to differentiate spiritual, religious, existentialistic and philosophical practices. It was tested in a sample of 354 German subjects (71% women; 49.0 +/- 12.5 years). Half of them were healthy controls, while among the patients cancer was diagnosed in 54%, multiple sclerosis in 22%, and other chronic diseases in 23%. Reliability and factor analysis of the inventory were performed according to the standard procedures., Results: We confirmed the structure and consistency of the previously described 18-item SpREUK-P manual and improved the quality of the current construct by adding several new items. The new 25-item SpREUK-P 1.1 (Cronbach's alpha = 0.8517) has the following scales: (1) conventional religious practice (CRP), (2) existentialistic practice (ExP), (3) unconventional spiritual practice (USP), (4) nature/environment-oriented practice (NoP), and (5) humanistic practice (HuP). Among the tested individuals, the highest engagement scores were found for HuP and NoP, while the lowest were found for the USP. Women had significantly higher scores for ExP than male patients. With respect to age, the engagement in CRP increases with increasing age, while the engagement in a HuP decreased. Individuals with a Christian orientation and with a religious and spiritual attitude had the highest engagement scores for CRP, while the engagement in an USP was high with respect to a spiritual attitude. Variance analyses confirmed that the SpR attitude and religious affiliation are the main relevant covariates for CRP and ExP, while for the USP the SpR attitude and the educational level are of significance, but not religious affiliation. Patients with multiple sclerosis overall had the lowest engagement scores for all five forms of SpR practice, while it is remarkable that cancer patients had lower scores for HuP and USP than healthy subjects., Conclusion: The current re-evaluation of the SpREUK-P questionnaire (Version 1.1) indicates that it is a reliable, valid measure of five distinct forms of spiritual, religious and philosophical practice that may be especially useful for assessing the role of spirituality and religiosity in health related research. An advantage of our instruments is the clear-cut differentiation between convictions and attitudes on the one hand, and the expression of these attitudes in a concrete engagement on the other hand.

Background: Spiritual needs are an essential component of holistic health care. Several studies have shown that religious involvement and spirituality are associated with better health outcome, coping skills and health-related quality of life., Patients and Methods: Using the newly developed SpREUK inventory, we examined how German cancer patients (n=115) by themselves view the impact of spirituality and religiosity (SpR) on their health and how they cope with illness., Results: Cancer patients with both a religious and spiritual attitude had significantly higher values in the search for meaningful support and in addressing the stabilizing effects of SpR than patients without such attitudes. Patients with non-spiritual religious attitudes had a lower perception of the beneficial effects of their SpR and significantly lower needs for meaningful support. Female cancer patients were convinced that finding access to a spiritual source has a positive influence on their illness, that illness has meaning, regard illness as a chance for their own development and as a hint to change life., Conclusion: Knowledge of a patient's spirituality can help service providers predict aspects of psychosocial needs and to respond sensitively and appropriately. The SpREUK questionnaire is a useful tool to define patients who are more in need of spiritual support than others.

Background: Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire., Methods: In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 +/- 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%)., Results: As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level., Conclusions: The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases.

A cross-sectional survey among religious brothers and sisters (n = 250) with their specific lifestyle and related spiritual practices stated moments of awe perceptions. They responded to both the Awe/Gratitude scale and to free text fields to substantiate their quantitative responses. Qualitative content analysis of their free text responses resulted in six main categories of awe triggers: (1) Nature, (2) Special Moments, (3) Transcendence Perceptions, (4) Religious practices, (5) Distinct People, and (6) Aesthetics, Art and Culture. Awe perceptions can be an immediate feeling and the outcome of a process of reflection in response to admiration, inspiration, and elevation. As these perceptions are related to psychological well-being and prosocial behaviors, their training can generate positive effects on quality of life. [ABSTRACT FROM AUTHOR]

The importance of spirituality in the treatment of mental illness is increasingly acknowledged, but mental healthcare professionals often feel they lack specific competence. An instrument is missing to quantify the spiritual care competence of mental healthcare professionals in the Netherlands. The aim of this study was thus to translate the Spiritual Care Competence Questionnaire (SCCQ) into Dutch and validate it for use in mental healthcare. After translation, the SCCQ-NL was distributed in a cross-sectional design among 3497 healthcare professionals in two mental healthcare institutions (MHIs) in the Netherlands. In the sample of 730 completed questionnaires, exploratory factor analysis revealed seven factors: perception of spiritual needs competencies, team spirit, spiritual self-awareness, documentation competencies, empowerment and proactive opening competencies, knowledge about other religions, and conversation competencies. One item was deleted during the process. Internal consistency for the 25-item SCCQ-NL subscales is sufficient with Cronbach's alpha ranging from 0.64 to 0.81. Conversation competencies and perception of spiritual needs scored highest in the sample, next to knowledge about other religions and empowerment competencies, while spiritual self-awareness, team spirit and documentation competencies scored the lowest. Small but significant differences in several subscale scores were found for profession, identifying oneself as a believer, practicing prayer and/or meditation, age and working years. The SCCQ-NL can be used for the assessment of spiritual care competencies and for the planning and evaluation of training and improvement strategies. [ABSTRACT FROM AUTHOR]

The first step to evaluate spiritual health as an essential component of multidimensional patient care is using a valid scale. This study aimed to provide a psychometric evaluation of the Spiritual Dryness Scale. This cross-sectional study was conducted on 136 patients with cancer in Arak city, Iran. Face and content validity, and confirmatory factor analysis were used to assess the validity and construct validity respectively, and Cronbach's alpha, and test-retest were calculated to measure internal consistency. The results indicated that the scale had appropriate face validity and the total mean score was 1.514 ±.74. All items had suitable CVR and CVI higher than.8. The ICC of the scale was.999, and Cronbach's alpha was.899 in the test– retest. The fit index was satisfactory (χ2 /df = 1.187). This scale had appropriate validity and reliability after translation into Farsi and was convenient, accessible, inexpensive, and easy-to-use. [ABSTRACT FROM AUTHOR]

We conducted three studies to validate the Polish version of the GrAw-7. Our objectives are as follows: first, to explore the dimensional structure of the scale and to determine the internal consistency (study 1: N = 635); second, to verify the stability of the GraW-7 (study 2: N = 27); and third, to determine the validity of the GrAw-7 (study 3: N = 385). To explore the dimensional structure of the scale, we tested a one-factor model proposed by Büssing (2018). To determine the validity of the GrAw-7, we analysed correlations among Awe/Gratitude and gratitude as an affective trait, resilience, health behaviours, transcendence and openness to spirituality. Based upon the presented data, it can be concluded that the Polish version of GrAw-7 has good psychometric qualities that are similar to those of the original version. The CFA results confirmed that the univariate solution is well adjusted to the data. The internal compatibility assessment is good. The absolute stability (test-retest) was estimated to be high. Based upon the results obtained, the questionnaire was demonstrated to be convergently valid as the overall GrAw-7 scores correlated positively with dispositional gratitude, resilience, transcendence proper, spiritual openness, and health-related behaviours. [ABSTRACT FROM AUTHOR]

Background: Spiritual struggles affect the wellbeing of religious people. Among them are strugglers with God which is perceived as non-responsive and distant. These perceptions were so far analyzed predominantly in Western societies with a Christian background, but not in Muslims from Iran. The aim of this study was to determine the predictors of spiritual dryness among cancer patients in Iran during the COVID-19 pandemic. Methods: Cross-sectional study with standardized questionnaires (i.e., Spiritual Dryness Scale, WHO-5, BMLSS-10, Awe/Gratitude Scale) among 490 cancer patients (mean age 49.50 ± 14.92 years) referring to the selected educational hospitals in Tehran (the capital of Iran), who were selected through convenience sampling and based on the inclusion criteria, enrolled between December 2020-May 2021. Data analysis was done using SPSS software version 26 and the statistical methods including calculating the mean and the standard deviation, correlation coefficients, as well as regression analysis. Results: The overall experience of spiritual dryness was perceived regularly in 10.2% of Iranian cancer patients, sometimes in 22.9%, rarely in 22.9%, and never in 43.3%. The mean ± SD was 25.66 ± 5.04, and the scores ranged from 10 to 55. A higher score means greater spiritual dryness. The strongest predictors of spiritual dryness were praying activities Furthermore, the perception of burden due to the pandemic was positively correlated with spiritual dryness. Moreover, each 1 unit increase in its score changed the spiritual dryness score by 0.2 units. The regression of spirituality-related indicators, demographic-clinical variables, and health-related behaviors accounted for 21, 6, and 4% of the total SDS variance, respectively. These findings show that with an increase in praying, performing daily prayers, and the indicators related to spirituality, spiritual dryness will decrease. Most patients were able to cope with these phases often or even regularly, while 31.1% were never or rarely only able to cope. Conclusion: The results of this study showed that in times of crisis, cancer patients' faith and confidence in God could be challenged. It is not the disease itself which seems to be associated with this form of crisis, but their religious practices. Therefore, it is necessary to support these patients during their struggle, especially as spirituality is one of the best approaches to cope with the disease. [ABSTRACT FROM AUTHOR]

Many people relied on their faith as one resource in order to cope during the COVID-19 pandemic. In Germany, between the eighteen months from June 2020 to November 2021, different participants at different times were assessed during different phases of the COVID-19 pandemic. The total sample of this continuous cross-sectional survey consisted of 4,693 participants. Analyses revealed that with the 2nd wave of the infection and its 2nd lockdown, trust in a Higher Source, along with praying and meditation decreased. Also, the sharp increase in corona-related stressors was associated with a decline of wellbeing and a continuing loss of faith. These developments were observed in both Catholics and Protestants, and in both younger and older persons. In addition, the long phases of insecurity and social isolation lacking the significant support usually given by religious communities may have likewise challenged the religious-coping capacities of religious/spiritual people themselves. [ABSTRACT FROM AUTHOR]

We aimed to validate the Spanish version of the Spiritual Care Competence Questionnaire (SCCQ) in a sample of 791 health care professionals from Spanish speaking countries coming principally from Argentina, Colombia, Mexico and Spain. Exploratory factor analysis pointed to six factors with good internal consistency (Cronbach's alpha ranging from 0.71 to 0.90), which are in line with the factors of the primary version of the SCCQ. Conversation competences and Perception of spiritual needs competences scored highest, and Documentation competences and Team spirit the lowest, Empowerment competences and Spiritual self-awareness competences in-between. The Spanish Version of the SCCQ can be used for assessment of spiritual care competencies, planning of educational activities and for comparisons as well as monitoring/follow-up after implementation of improvement strategies. [ABSTRACT FROM AUTHOR]

Background: Spirituality is a multidimensional construct which includes religious, existentialistic, and relational issues and has different layers such as faith as the core, related attitudes and conviction, and subsequent behaviors and practices. The perceptive aspects of spirituality such as wondering awe are of relevance for both, religious and non-religious persons. These perceptions were related to perceiving the Sacred in life, mindful awareness of nature, others and self, to compassion, meaning in life, and emotional wellbeing. As awe perceptions are foremost a matter of state, it was the aim (1) to empirically analyze the frequency of wondering awe perceptions (i.e., with respect to gender, age cohorts, religious or non-religious persons) and (2) to qualitatively analyze a range of triggers of awe perceptions. Methods: Data from 7,928 participants were analyzed with respect to the frequency of Awe/Gratitude perceptions (GrAw-7 scale), while for the second part of the study responses of a heterogeneous group of 82 persons what caused them to perceive moments of wondering awe were analyzed with qualitative content analysis techniques. Results: Persons who experience Awe/Gratitude to a low extend were the youngest and had lowest wellbeing and lowest meditation/praying engagement, while those with high GrAw-7 scores were the oldest, had the highest wellbeing, and were more often meditating or praying (p <0.001). Gender had a significant effect on these perceptions, too (Cohen's d =0.32). In the qualitative part, the triggers can be attributed to four main categories, Nature , Persons , Unique Moments , and Aesthetics , Beauty , and Devotion. Some of these triggers and related perceptions might be more a matter of admiration than wondering awe, while other perceptions could have more profound effects and may thus result in changes of a person's attitudes and behaviors. Conclusion: Emotionally touching experiences of wondering awe may result in feelings of interconnectedness, prosocial behavior, mindful awareness, and contribute to a person's meaning in life and wellbeing and can also be a health-relevant resource. These perceptions can be seen as a perceptive aspect of spirituality, which is not exclusively experienced by religious people but also by non-religious persons. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, people reported about fears, depressive states, and phases of loneliness. However, there have also been positively experienced changes in terms of awareness of nature, reflection of life, more intensive relationships, meaningful digital media usage to connect with others, and interest in spirituality. We were interested in the dynamics of these indicators directly after the first lockdown, the summer months and during the second wave of the pandemic with its second lockdown, and how they relate to the perceived restrictions, fears, and worries. Method: Survey with standardized questionnaires, i.e., Perceived Changes Questionnaire, WHO-Five Well-being Index, Brief Multidimensional Life Satisfaction Scale, Awe/Gratitude scale. Participants were categorized as cohort 1 (June 2020; n = 1,333), cohort 2 (July to September 2020, n = 823), and cohort three (October 2020 to January 2021, n = 625). Results: Participants perceived changes in specific attitudes and behaviors, which have impacted their well-being and life satisfaction. Compared to their experiences directly after the first wave of the pandemic (cohort 1), well-being (Hedge's g = 0.83) and life satisfaction (g = 0.63) decreased during the second wave (cohort 3) and participants' stressors increased (g = −0.94). At the same time, positive perceptions such as Nature/Silence/Contemplation (g = 0.67), Spirituality (g = 0.62), Relationships (g = 0.55), and Digital media usage declined (g = 0.31), but not Reflections on life (g = −0.03). In cohort 3, the proportion of persons relying on their faith as a strong hold was declining also in nominally religious persons. Awe/Gratitude was among the best predictors of perceived positive changes, indicating a resource which is nevertheless declining during the second wave of the pandemic (g = 0.60). Conclusions: Several perceptions, attitudes, and behaviors have changed, particularly during the second wave of the pandemic, which had a strong influence on psychological health. Although Awe/Gratitude was confirmed as the best predictor of perceived positive changes, this resource may not buffer against the negative outcomes of the pandemic but helps to recognize the still positive aspects in life. There is a need for new and not yet defined public health communities that could focus on persons which are affected in their physical, mental, social, and spiritual health and well-being due to the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and "praying five times a day" was the highest scoring item. Gender (p =.04), age (p =.01), and duration of being diagnosed with cancer (p =.01) were associated with spiritual needs. Female gender (p =.005) and older age (p <.001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients' need to pray five times a day during hospitalization, thus help them manage and endure the illness. [ABSTRACT FROM AUTHOR]

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be "spellbound at the moment" and to become "quiet and devout," indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor. Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020. Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a "stronghold in difficult times" (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R 2 = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = −0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of β = 0.15 (p < 0.001) and an indirect effect of β = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is β = 0.18 (p < 0.001), and the indirect effect is β = 0.11 (p < 0.001). Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply "touch" a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the Working Group "Prevention and Integrative Oncology" (PRIO) in the German Cancer Society has initiated flash interviews and surveys. One of these stated increasing rates of fears and mental stress of tumor patients. Now we aimed to analyze whether tumor patients did perceive changes in their attitudes and behaviors related to their relationships, awareness of nature and quietness, interest in spiritual issues, or feelings of worries and isolation. A further point of interest was how these perceived changes could be predicted, either by meaning in life, spirituality as a resource to cope, perceived fears and worries, or particularly by their wellbeing. Materials and Methods: Online survey with standardized questionnaires (i.e., WHO-Five Well-being Index (WHO5), Meaning in Life Questionnaire (MLQ), Spiritual and Religious Attitudes to cope with illness (SpREUK-15), Gratitude/Awe scale (GrAw-7)) among 292 tumor patients (72% men; mean age 66.7 ± 10.8 years; 25% < 60 years, 33% 60-70 years, 41% > 70 years) from Germany between May 6 to June 10, 2020. Results: Patients´ wellbeing (WHO5) scores were in the lower range (14.7 ± 6.0); 35% scored < 13, indicating depressive states. Wellbeing was significantly higher in older persons and lower in younger ones (F=11.1, p<.0001). Most were irritated by different statements about the danger and the course of the corona infection in the public media (60%), and 57% were worrying to be infected and to have a complicated course of disease. Because of the restrictions, patients noticed changes in their attitudes and behaviors (measured with the 12-item Perceptions of Change Scale): 1) Perception of nature and silence (Cronbach´s alpha =.82), 2) Worrying reflections and loneliness (Cronbach´s alpha =.80), 3) Interest in spirituality (Cronbach´s alpha =.91), 4) Intense relationships (Cronbach´s alpha =.64). These perceptions of change were similar in women and men, age groups and also with respect to tumor stages. Regression analyses revealed that the factor Perception of nature and silence was predicted best by patients´ ability to value and experience the 'wonder' of the present moment (in terms of wondering awe and gratitude) and by patients´ search for meaning in life. The factor Worrying reflections and loneliness was predicted best by their search for meaning in life and by feelings of being under pressure because of the Corona pandemic. Interest in spirituality was predicted best by search for an access to a spiritual source and by frequency of praying. Intense relationships were explained with weak predictive power by patients´ ability to reflect life concerns. Patients´ wellbeing during the Corona pandemic was predicted (R2 =.57) by a mix of disease and pandemic related stressor, and by available resources (meaning in life and religious trust). Conclusion: In this study among tumor patients from a secular society the topics meaning in life, having (religious) trust, stable relationships, mindful encounter with nature, and times of reflection were found to be of importance. To overcome tumor patients´ feelings of isolation, depressive states, and insecurity about future perspectives, further support is needed, particularly in their socio-spatial surrounding. These are the domains of psychotherapy and spiritual care. The planned integration of structured access to spiritual care seems to be important, not only for the field of cancer care. As the findings refer to patients´ self-perceptions, longitudinal studies are required to substantiate these perceived changes. [ABSTRACT FROM AUTHOR]

In light of the COVID-19 pandemic, the emotional, spiritual, and social well-being of 1,036 German Seventh-day Adventists were analyzed; usage of the Church’s digital media resources was also analyzed. This study found that older peoples’ well-being was particularly high, and this group also benefited from digital media resources. The findings presented in this article may encourage Christian and non-Christian communities alike to further expand their digital media resources to provide helpful resources during the successive waves of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]