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Understanding spirituality and religiosity among very old people: measurements and experiences
Umeå University, Faculty of Medicine, Department of Nursing. (Umeå 85+/GERDA)ORCID iD: 0000-0001-7710-4367
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Spirituality is a multifaceted concept. In this thesis, spirituality is understood as an overarching term and a core of a person´s being. Religiosity is seen as one of many expressions of spirituality. Very old people are a vulnerable population, with an increased risk to be exposed to negative life events. Spirituality is suggested to have an impact on the possibility to adapt to life circumstances and manage age-related challenges.

Aim: The overall aim of this thesis was to assess psychometric properties of instruments and to gain understanding about associations and experiences in relation to spirituality and religiosity among very old people.

Method: The thesis has been conducted in the population based Umeå 85+/GERDA study. Half of those aged 85, all 90 year old, and all aged 95 and older in Umeå, Västerbotten, northern Sweden and in Ostrobothnia in Western Finland were invited to participate (cf. Näsman et al, 2017). Questionnaires used to measure religiosity versus spirituality were the Religious Orientations Scale (SROS) and the Self-Transcendence Scale (STS). None of these has previously been validated among very old people in a Swedish context. Factors associated and correlating with STS score are presented. How very old people express and perceive spirituality is also studied. 

Result: The participants in study I scored high on both subscales, indicating that they were religious in both an intrinsic and extrinsic manner. The SROS ability to distinguish between intrinsic and extrinsic items was tested. The cluster analysis revealed three clusters interpreted as intrinsic, extrinsic-personal, and extrinsic-social religious orientation, with no cross-loadings. The revised version of STS, (study II) with 10 items, had satisfactory psycho­metric properties (α .83). A factor analysis resulted in a two-factor solution (α .78 & .73). Test-retest reliability and concurrent criterion validity were supported. In study III STS showed a positive association with psychological well-being, self-rated health, having someone to talk with, and being able to go outdoors indepen­dently. A negative association was found between STS and diagnosis of depression, dementia disease, osteoporosis, living in a geriatric care institution, and feeling lonely. An accumulation of negative life events was associated with a larger decline of STS score over five years. Findings in study IV showed that spirituality was perceived as a connectedness to God, and other people. Telling about spiritual experiences was described as un­common in conversation due to the private nature of the subject area and because of a fear of being considered as dubious. The findings also showed that experiences of spirituality were connected to a view of life where participants were transcending life’s circumstances, and experiencing mysteries.

Conclusion: The results propose that the Swedish version of SROS and STS, aimed to measure religious orientation versus self-transcendence have satisfactory psychometric properties and are feasible to use among very old people. Furthermore, self-transcendence was positively and significantly, associated and correlated, to a number of factors known to enhance well-being. Spirituality was understood as including religiosity, a belief in God, connectedness to other people and conviction about a spiritual reality. The very old expressed a desire to share personal beliefs and experiences of spirituality, but they found it difficult due to a fear of not being taken serious. Hence spiritual needs can be unnoticed within the health care context, health care professionals need knowledge in order to recognize expressions of spirituality, and skills to support patients in a need of spiritual care. 

 

Abstract [sv]

Denna avhandling omfattar fyra delstudier. Det övergripande syftet var att testa skattningsskalor med avseende på dess psykometriska egenskaper och få en ökad förståelse för faktorer relaterade till, samt erfarenheter av andlighet och religiositet bland de allra äldsta. Att vara mycket gammal, det vill säga över 85 år och äldre, kan innebära en ökat risk för sårbarhet. Andlighet har i tidigare studier visat sig ha betydelse för välbefinnande, mening och mål i livet, upplevelse av tröst, coping och en hjälp att anpassa sig till de ändrade livsvillkor som åldrandet kan innebära. Det finns ingen enhetlig definition av begreppet andlighet. Andlighet kan förstås som en djup form av religiositet men andlighet kan också förstås som ett övergripande begrepp som kan innefatta religion. En ytterligare förståelse av begreppet är att andlighet innefattar mening och mål i livet vilket kan utryckas på olika sätt genom exempelvis, musik, konst, litteratur, meditation, naturupplevelse, gemenskap och bön. Tidigare studier visar att äldre personer sammankopplar andlighet med religiositet och personlig tro.

Samtliga studier i den här avhandlingen bygger på data insamlat inom Umeå 85+/GERDA. Umeå 85+/GERDA är en populationsbaserad studie där varannan 85-åring, varje 90-åring och samtliga 95 år och äldre inbjudits att delta. Datainsamlingen startade år 2000 och har därefter upprepats vart femte år.

Delstudie I, II och III är tvärsnittsstudier som bygger på självskattningsskalor, mätningar och uppgifter från medicinska journaler. Delstudie IV är en intervjustudie, där deltagarna har ombetts att berätta om hur de uppfattar andlighet.

Delstudie I innefattade 43 personer. Bland dessa var 37 kvinnor och 6 män, medelåldern var 92 år och samtliga bekände sig som kristna. I denna delstudie besvarade samtliga en skala som mäter religiös orientering, det vill säga drivkraften/motivationen för religiositet. Syftet var att undersöka om skalan går att använda bland mycket gamla personer samt om den kan skilja mellan inre och yttre motivation till religiositet. Resultatet visade att skalan är tillförlitlig och att inre och yttre motivation till religiositet går att åtskilja genom att de påståenden som mäter inre respektive yttre motivation till religiositet fördelade sig i olika kluster.

I delstudie II ingick två urvalsgrupper. Grupp 1 innefattade 198 personer. Bland dessa var 126 kvinnor och 72 män, medelåldern var 88, 9 år. Grupp 2 innefattade 60 personer. Bland dessa var 26 kvinnor och 34 män med en medelålder på 39, 2 år. Samtliga besvarade Självtranscendens Skalan (STS). Efter att fem påståenden exkluderats fördelades de återstående påståendena i två faktorer som bedömdes motsvara intrapersonell självtranscendens och interpersonell självtranscendens. Resultatet visade på god trovärdighet och tillförlitlighet av den svenska versionen.

Delstudie III innefattade 190 personer, 123 kvinnor och 67 män med en medelålder på 88, 8 år. Samtliga besvarade Självtranscendens Skalan (STS). Av dessa besvarade 55 personer skalan vid två tillfällen med 5 års mellanrum. Syftet med studien var att beskriva samband mellan självtranscendens och fysiskt och psykologiskt välbefinnande samt att undersöka samband mellan självtranscendens och negativa livshändelser samt om självtranscendens påverkar livslängd. Resultatet visade ett signifikant positivt samband mellan självtranscendens och välbefinnande, självskattad hälsa, att ha någon att samtala med och att kunna vistas utomhus. Resultatet visade även ett signifikant negativt samband mellan självtranscendens och depression, demenssjukdom, osteoporos, att bo på äldreboende och att uppleva känslor av ensamhet. Vidare visar resultatet att en alltför stor belastning av negativa livshändelser signifikant minskar självtranscendens och därigenom förmåga att transcendera. Självtranscendens påverkade dock inte livslängd/överlevnad.

Delstudie IV innefattade 12 personer, 10 kvinnor och 2 män med en medelålder på 89,7 år. Studien bygger på intervjuer där deltagarna har berättat om sina tankar om andlighet. Resultatet visar att andlighet för dessa personer var nära sammankopplat med religiositet och en personlig tro på något större/Gud som de litade på. Deltagarna beskrev andlighet som en djup kontakt med Gud och viktiga personer som funnits och finns i deras närhet. Deltagarna utryckte en önskan om att få tala om sin tro men samtal om andlighet och tro är inte ett vanligt samtalsämne. Dels för att det är svårt att sätta ord på sin tro men även på grund av en rädsla att inte bli tagen på allvar. Vidare visade resultatet att andlighet handlar om att transcendera livets svårigheter och livsvillkor. Deltagarna berättade om svåra erfarenheter i livet och om den förestående döden på ett naturligt sätt och uttryckte tacksamhet över att få leva. Resultatet visade också att andlighet handlar om att leva i en medvetenhet om att det finns något mera än den synliga världen. Deltagarna uttryckte en stor förundran men uttryckte även frågor om Guds egenskaper.

Sammanfattningsvis visar avhandlingen att skalor som mäter religiös orientering (SROS) och självtranscens (STS) är tillförlitliga och användbara vid forskning bland mycket gamla personer. Avhandlingens resultat visar på ett statistiskt säkerställt samband mellan självtranscendens och hälso- och ohälsorelaterade faktorer. Avhandlingen kan bidra med en ökad kunskap om hur andlighet kan uttryckas. Vårdpersonal behöver både teoretiskt och praktiskt kunnande för att kunna förstå andliga behov och ge andlig omvårdnad.

Place, publisher, year, edition, pages
Umeå: Department of Nursing, Umeå University , 2018. , p. 51
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1942
Keywords [en]
Aged 80 and older, Sweden, spirituality, self-transcendence, Self-transcendence Scale, Religious Orientation Scale, religiosity, psychometrics, experiences, Umeå 85+/GERDA
National Category
Nursing
Research subject
caring sciences in social sciences
Identifiers
URN: urn:nbn:se:umu:diva-143793ISBN: 978-91-7601-819-4 (print)OAI: oai:DiVA.org:umu-143793DiVA, id: diva2:1172586
Public defence
2018-02-02, Forum Hörsal M, Campus Skellefteå., 931 87, Skellefteå, 09:00 (Swedish)
Opponent
Supervisors
Projects
Umeå 85+/GERDAAvailable from: 2018-01-12 Created: 2018-01-10 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Intrinsic and Extrinsic Religious Orientation Among the Very Old
Open this publication in new window or tab >>Intrinsic and Extrinsic Religious Orientation Among the Very Old
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2012 (English)In: Journal of Religion, Spirituality & Aging, ISSN 1552-8030, Vol. 24, no 4, p. 314-324Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to test a shortened version of the Swedish Religious Orientation Scale's (SROS) appropriateness, feasibility, and ability to distinguish between intrinsic and extrinsic religious orientation among very old people. The participants (n = 43) were Lutheran believers aged ≥85 years. They scored high on both the intrinsic and extrinsic sub-scales and a cluster analysis revealed three clusters of items, one measuring intrinsic religious orientation and two measuring extrinsic religious orientation. The shortened version of the SROS appears appropriate for distinguishing between intrinsic and extrinsic religious orientation among very old people.

Place, publisher, year, edition, pages
Taylor & Francis, 2012
Keywords
Religious orientation, Swedish Religious Orientation Scale, SROS, psychometric test, very old people, Umeå 85+ study.
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-61552 (URN)10.1080/15528030.2012.714336 (DOI)
Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2018-06-08Bibliographically approved
2. Psychometric properties of the Swedish version of the Self-Transcendence Scale among very old people
Open this publication in new window or tab >>Psychometric properties of the Swedish version of the Self-Transcendence Scale among very old people
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2015 (English)In: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, Vol. 23, no 1, p. 96-111Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: This study tested the psychometric properties of a Swedish version of the Self-Transcendence Scale (STS).

METHODS: Cohen's weighted kappa, agreement, absolute reliability, relative reliability, and internal consistency were calculated, and the underlying structure of the STS was established by exploratory factor analysis. There were 2 samples available: 1 including 194 people aged 85-103 years and a convenience sample of 60 people aged 21-69 years.

RESULTS: Weighted kappa values ranged from .40 to .89. The intraclass correlation coefficient for the original STS was .763, and the least significant change between repeated tests was 6.25 points.

CONCLUSION: The revised STS was found to have satisfactory psychometric properties, and 2 of the 4 underlying dimensions in Reed's self-transcendence theory were supported.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Reed, Self-transcendence, psychometrics, validation studies
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-105510 (URN)10.1891/1061-3749.23.1.96 (DOI)25985498 (PubMedID)
Available from: 2015-06-25 Created: 2015-06-24 Last updated: 2018-06-07Bibliographically approved
3. Self-transcendence (ST) among very old people: its associations to social and medical factors and development over five years
Open this publication in new window or tab >>Self-transcendence (ST) among very old people: its associations to social and medical factors and development over five years
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2015 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 61, no 2, p. 247-253Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: The aims of this study were to describe the associations between ST and psychological and physical wellbeing among oldest old people and to test the influence of negative life events on ST, and the predictive value of the self-transcendence scale (STS) for mortality.

BACKGROUND: ST has been identified as a valuable resource for transcending psychological and physical suffering and has been related to psychological wellbeing and higher quality of life.

DESIGN: The study design was correlational, prospective, and longitudinal.

SETTINGS: The participants were recruited from a medium-sized town and from an adjacent rural area in northern Sweden.

METHOD: The sample consisted of 190 participants (123 women and 67 men) who completed the STS. At a 5-year follow-up, 55 people (29.5%) were alive and able to complete the assessments again.

RESULTS: ST was positively associated with psychological wellbeing, self-rated health, having someone to talk with and being able to go outdoors independently. Diagnoses of depression, dementia disease, and osteoporosis were associated with lower STS scores as were living in a residential care facility, and feeling lonely. There was a significant relationship between the index of negative life events and ST between baseline and follow-up. More negative life events were associated with a larger decline in STS scores over five years.

CONCLUSION: ST is an important source for wellbeing among the oldest old, and the accumulation of negative life events might threaten the ability to transcend setbacks.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Depression, Negative life-events, Oldest old, Self-transcendence
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:umu:diva-104211 (URN)10.1016/j.archger.2015.04.003 (DOI)000365586100019 ()26043959 (PubMedID)
Available from: 2015-06-08 Created: 2015-06-08 Last updated: 2018-06-07Bibliographically approved
4. Spirituality as it is perceived and expressed by the very old people
Open this publication in new window or tab >>Spirituality as it is perceived and expressed by the very old people
(English)Manuscript (preprint) (Other academic)
Keywords
Aged 80 and older, Sweden, spirituality, religiosity, experiences, qualitative content analysis, Umeå 85+/GERDA
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-143804 (URN)
Projects
Umeå 85+/GERDA
Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-06-09

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