Umeå University's logo

Aims: To present the validation process of WHOQOL-SRPB andWHOQOL-SRPB BREF in Sweden, one of the most secular countriesin the world though multi-religious, thus emphasising the need forprerequisite adjustments for cultural validation of the spirituality,religiousness and personal beliefs facets [SRPB].

Methods: Theprocess adopted here follows WHO guidelines for translation andadaptation of instruments: Forward and Back translation, Pre-testing,Cognitive Interviewing, and Final version. Four bilingually and biculturally experienced researchers worked in two groups, comprisingexperience of either the Swedish translation of WHOQOL-100, -Brefand -OLD, or research into existential public health. Based on initialindependent translations from each, a final version was then developed through consensus translation, which was then back-translated.A pre-testing phase was conducted with individuals representingdifferent religious and non-religious worldviews. The final Swedishversion was completed by 170 persons, aging between 21 and 89(m = 46.6), with 105 women, and comprising both ‘‘healthy’’ individuals and individuals with mental health or somatic issues.

Results:It was found that the instruction and particularly SRPB items thatused religious terminology needed adjustment. For example, ‘‘Spiritual being’’ was replaced with ‘‘Spiritual dimension’’, ‘‘Belief’’ with‘‘Your belief/idea’’, and ‘‘higher and more powerful’’ (instructiontext) was translated to ‘‘force/power/dimension’’. The pre- test resultswere useful in this process, especially qualitative information fromindividuals representing secular existential worldviews includingdifferent philosophical and political traditions. The internal consistency reliability of the overall SRPB-module was high (alpha = .97)as well as for the 8 facets (alpha ranging .80–.97). Test- retest(n = 19) showed r = .83 (p\.01). There were strong correlationsbetween all facets, the overall SRPB-module, and the overall qualityof life general health perceptions. No difference was found betweenwomen and men in the overall SRPB-module but in the ‘‘Connect’’facet, women scored higher (p = .02) whereas in ‘‘Peace’’ menscored higher (p = .04).

Conclusions: The significance found throughusing existing translation/adaption guidelines, confirms that not onlyis it possible, but also relevant to include culturally validated existential aspects in studies of HRQL even in contexts that are largelysecular.