Journal of Religion and Health

, Volume 53, Issue 4, pp 1025–1035 | Cite as

Psychometric Properties of the Persian Spiritual Coping Strategies Scale in Hemodialysis Patients

  • Mohsen Saffari
  • Harold G. Koenig
  • Ghader Ghanizadeh
  • Amir H. Pakpour
  • Donia R. Baldacchino
Original Paper


Spiritual strategies may provide an effective way of coping with disease. This study sought to investigate the validity and reliability of the Persian version of the spiritual coping strategies (SCS) scale among Iranian hemodialysis patients. A convenience sample of 204 hemodialysis patients was recruited to participate in the study. A forward–backward translation method was used to produce the Persian version of the scale. Internal consistency was assessed by Cronbach’s alpha and item–total score correlation. Two-week test–retest reliability was also assessed. The convergent and divergent validity of the scale was evaluated using the Duke University Religion Index and a visual analogue scale for health status. Exploratory and confirmatory factor analyses were used to assess the factor structure. Participants consisted of 113 males and 91 females (mean age 57.2 [SD = 9.7]). Cronbach’s alpha was acceptable (0.87). We found two underlying factors similar to the original scale. The correlations between the study scales confirmed the convergent and divergent validity of the SCS. Confirmatory factor analysis showed a good fit to the data (GFI = 0.923, CFI = 0.948 and RMSEA = 0.068). The Persian version of the SCS has sound psychometric properties in Iranian hemodialysis patients. Future research should consider applying the scale to populations with other religious/cultural backgrounds.


Spirituality Coping Hemodialysis Validity Reliability 



The authors thank Baqiyatallah University of Medical Sciences for support to conduct the study. Also, we are grateful to Mr. Ali Karami and Mrs. Maryam Naderi for their valuable help to data collection.


  1. Aghighi, M., Mahdavi-Mazdeh, M., Zamyadi, M., Heidary Rouchi, A., Rajolani, H., & Nourozi, S. (2009). Changing epidemiology of end-stage renal disease in last 10 years in Iran. Iranian Journal of Kidney Diseases, 3(4), 192–196.PubMedGoogle Scholar
  2. Amoah, C. F. (2011). The central importance of spirituality in palliative care. International Journal of Palliative Nursing, 17(7), 353–358.PubMedCrossRefGoogle Scholar
  3. Baldacchino, D. R., & Buhagiar, A. (2003). Psychometric evaluation of the Spiritual Coping Strategies scale in English, Maltese, back-translation and bilingual versions. Journal of Advanced Nursing, 42(6), 558–570.PubMedCrossRefGoogle Scholar
  4. Battistello, M. (2012). Management of depression in hemodialysis patients. Canadian Association of Nephrology Nurses and Technicians Journal 22(3), 29–34; quiz 35–26.Google Scholar
  5. Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191.PubMedCrossRefGoogle Scholar
  6. Bugarski, V., Sakac, V., Vodopivec, S., & Slankamenac, P. (2010). Relation between personality dimensions and depressive symptoms in patients on hemodialysis. Medicinski Pregled, 63(5–6), 305–312.PubMedCrossRefGoogle Scholar
  7. Burker, E. J., Evon, D. M., Sedway, J. A., & Egan, T. (2005). Religious and non-religious coping in lung transplant candidates: Does adding God to the picture tell us more? Journal of Behavioral Medicine, 28(6), 513–526.PubMedCrossRefGoogle Scholar
  8. Burrai, F., Scalorbi, S., Sebastiani, S., & Cenerelli, D. (2009). Psychometric analysis of the principal components of the Spiritual Coping Strategies. Scenario, 26, 13–20.Google Scholar
  9. Charzynska, E. (2012). Development of a questionnaire measuring spiritual coping. Psychology and Health, 27, 177–178.Google Scholar
  10. Davison, S. N., & Jhangri, G. S. (2010). Existential and supportive care needs among patients with chronic kidney disease. Journal of Pain and Symptom Management, 40(6), 838–843.PubMedCrossRefGoogle Scholar
  11. Eli Friedman. (2012). A Comparison of ESRD Therapy in the United States and Overseas (An Editorial). Retrieved 2013-01-13, from The American Association of Kidney Patients (AAKP):
  12. Fustos, K. (2011). The Global Muslim Population. Retrieved 2013-01-10, from Population Reference Bureau:
  13. Gill, C. S., Minton, C. A. B., & Myers, J. E. (2010). Spirituality and religiosity: Factors affecting wellness among low-income, rural women. Journal of Counseling and Development, 88(3), 293–302.CrossRefGoogle Scholar
  14. Hair, J. F. (2010). Multivariate data analysis (7th ed.). Upper Saddle River, NJ: Prentice Hall.Google Scholar
  15. Haque, A. (2004). Religion and mental health: The case of American Muslims. Journal of Religion and Health, 43(1), 45–58.CrossRefGoogle Scholar
  16. Hawthorne, D., Youngblut, J. M., & Brooten, D. (2011). Psychometric evaluation of the Spanish and English versions of the spiritual coping strategies scale. Journal of Nursing Measurement, 19(1), 46–54.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Hunglemann, J. A., Kenkel-Rossi, E., Klassen, L., & Stollenwerk, R. M. (1985). Spiritual well-being in older adults: Harmonious interconnectedness. Journal of Religion and Health, 24(2), 147–153.CrossRefGoogle Scholar
  18. Hutch, R. A. (2011). Health and Healing: Spiritual, Pharmaceutical, and Mechanical Medicine. Journal of Religion Health.Google Scholar
  19. Ichikawa, M., & Konishi, S. (2008). Constructing second-order accurate confidence intervals for communalities in factor analysis. British Journal of Mathematical and Statistical Psychology, 61, 361–378.PubMedCrossRefGoogle Scholar
  20. Jeremy J. (2009). Confirmatory Factor Analysis using Amos, LISREL, Mplus, SAS/STAT CALIS. Retrieved 2013-01-5, from Indiana University:
  21. Kalish, N. (2012). Evidence-based spiritual care: A literature review. Current Opinion in Supportive and Palliative Care, 6(2), 242–246.PubMedCrossRefGoogle Scholar
  22. Kao, T. W., Chen, P. C., Hsieh, C. J., Chiang, H. W., Tsang, L. Y., Yang, I. F., et al. (2009). Correlations between spiritual beliefs and health-related quality of life of chronic hemodialysis patients in Taiwan. Artificial Organs, 33(7), 576–579.PubMedCrossRefGoogle Scholar
  23. Kimura, T., Hayashida, K., Araki, Y., Morita, T., Yamaguchi, N., & Eboshida, A. (2008). How valid is the self-administered visual analogue scale for assessing the health status of elderly people? Hiroshima Journal of Medical Sciences, 57(3–4), 85–92.PubMedGoogle Scholar
  24. Koenig, H., Parkerson, G. R, Jr, & Meador, K. G. (1997). Religion index for psychiatric research. American Journal of Psychiatry, 154(6), 885–886.PubMedGoogle Scholar
  25. Modi, G. K., & Jha, V. (2006). The incidence of end-stage renal disease in India: A population-based study. Kidney International, 70(12), 2131–2133.PubMedGoogle Scholar
  26. NIDDK. (2012). Kidney Disease Statistics for the United States. Retrieved 2013-01-16, from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
  27. Pakpour, A. H., Saffari, M., Yekaninejad, M. S., Panahi, D., Harrison, A. P., & Molsted, S. (2010). Health-related quality of life in a sample of Iranian patients on hemodialysis. Iranian Journal of Kidney Diseases, 4(1), 50–59.PubMedGoogle Scholar
  28. Pakpour, A. H., Yekaninejad, M., Molsted, S., Harrison, A. P., Hashemi, F., & Saffari, M. (2011). Translation, cultural adaptation assessment, and both validity and reliability testing of the kidney disease quality of life—short form version 1.3 for use with Iranian patients. Nephrology, 16(1), 106–112.PubMedCrossRefGoogle Scholar
  29. Parkin, D., Rice, N., Jacoby, A., & Doughty, J. (2004). Use of a visual analogue scale in a daily patient diary: modelling cross-sectional time-series data on health-related quality of life. Social Science and Medicine, 59(2), 351–360.PubMedCrossRefGoogle Scholar
  30. Ptacek, J. T., Pierce, G. R., & Ptacek, J. J. (2007). Coping, distress, and marital adjustment in couples with cancer: an examination of the personal and social context. Journal of Psychosocial Oncology, 25(2), 37–58.PubMedCrossRefGoogle Scholar
  31. Ramirez, S. P., Macedo, D. S., Sales, P. M. G., Figueiredo, S. M., Daher, E. F., Araujo, S. M., et al. (2012). The relationship between religious coping, psychological distress and quality of life in hemodialysis patients. Journal of Psychosomatic Research, 72(2), 129–135.PubMedCrossRefGoogle Scholar
  32. Renty, J., & Roeyers, H. (2007). Individual and marital adaptation in men with autism spectrum disorder and their spouses: The role of social support and coping strategies. Journal of Autism and Developmental Disorders, 37(7), 1247–1255.PubMedCrossRefGoogle Scholar
  33. Saffari, M., Zeidi, I. M., Pakpour, A. H., & Koenig, H. G. (2012). Psychometric Properties of the Persian Version of the Duke University Religion Index (DUREL): A Study on Muslims. J Relig Health.Google Scholar
  34. Seidl, L. G. (1993). The value of spiritual health. Health Programme, 74(7), 48–50.Google Scholar
  35. Tanyi, R. A., & Werner, J. S. (2003). Adjustment, spirituality, and health in women on hemodialysis. Clinical Nursing Research, 12(3), 229–245.PubMedCrossRefGoogle Scholar
  36. Thune-Boyle, I. C., Stygall, J., Keshtgar, M. R., Davidson, T. I., & Newman, S. P. (2012). Religious/spiritual coping resources and their relationship with adjustment in patients newly diagnosed with breast cancer in the UK. Psychooncology.Google Scholar
  37. Weisbord, S. D., Fried, L. F., Arnold, R. M., Rotondi, A. J., Fine, M. J., Levenson, D. J., et al. (2004). Development of a symptom assessment instrument for chronic hemodialysis patients: The dialysis symptom index. Journal of Pain and Symptom Management, 27(3), 226–240.PubMedCrossRefGoogle Scholar
  38. WHO. (2012). How can we achieve global equity in provision of renal replacement therapy? Retrieved 2013-01-14, from World Health Organization:

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mohsen Saffari
    • 1
    • 2
  • Harold G. Koenig
    • 3
    • 4
  • Ghader Ghanizadeh
    • 5
  • Amir H. Pakpour
    • 6
  • Donia R. Baldacchino
    • 7
  1. 1.Religion and Medicine Research CenterBaqiyatallah University of Medical SciencesTehranIran
  2. 2.Health Education Department, School of HealthBaqiyatallah University of Medical SciencesTehranIran
  3. 3.Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  4. 4.King Abdulaziz UniversityJeddahSaudi Arabia
  5. 5.Department of Environmental Health, School of HealthBaqiyatallah University of Medical SciencesTehranIran
  6. 6.Qazvin Research Center for Social Determinants of HealthQazvin University of Medical SciencesQazvinIran
  7. 7.Faculty of Health SciencesUniversity of MaltaMsidaMalta

Personalised recommendations