One potential criticism of this multidimensional scale that

One potential criticism of this multidimensional scale that measures perceptions of child spiritual health is that it BMI-1 inhibitor is operationally very similar to other psychological constructs. The latter include measures of well-being, life satisfaction, and emotional health. These constructs too have some emphasis on connections and relationships, and hence would correlate with this multidimensional measure of adolescent perceptions of spiritual health. Analyses of such correlations may be problematic due to these conceptual overlaps. Further, our measures of perceptions of spiritual health attempt to get at inner experiences and feelings (subjective perceptions of importance) vs. reports of actual spiritual health practices. Such perceptions are clearly not identical to the lived experience of spiritual health. Further study, both qualitative and quantitative, about such lived experiences would be a positive contribution to this area of research. Finally, the 8-item version of the spiritual health module used admittedly represents only a skeletal view of this construct and its four domains. It was not possible to include the full 20-item Fisher׳s Spiritual Well-being scale for secondary students (Gomez & Fisher, 2003) due to questionnaire response burden in our general health survey context. While extensive efforts were made to validate the abbreviated version and most psychometrics associated with its use were satisfactory, our confirmatory analysis suggests that use of the 8-item version is not optimal, and future work should revert, where possible, to use of the 20-item scale.
Implications The highly gendered patterns in these self-reported perceptions of the importance of spiritual health, which generally favour girls over boys, suggest that gender-specific curricula and approaches to the promotion of spiritual health may be warranted. In addition, wide variations in the perceived importance of spiritual health exist by domain, and the strong declines observed with age for some key domains suggest a need for a more outward focus to be stressed during adolescence. For example, if spirituality enhances health by increasing personal meaning, strategies aimed at enhancing personal meaning in children׳s lives require promotion. Approaches could include such simple things as encouraging young people to keep journals (Sinats et al., 2005) or to participate in volunteer activities (Holder et al., 2008; Post, 2005). While evidence surrounding their effects is mixed, meditation programs such as mindfulness also appear to be efficacious. Provision of opportunities for young people to not only care for, but also to learn to know and love the natural world, may also be important. In order for such interventions to be fully informed, there is a need for more in-depth explorations of the mechanisms that lay behind the observed patterns. There is a further need for conceptual work on differences between religiosity and spirituality (as begun by Benson et al. (2012) and Scales et al. (2014)) and a stronger conceptualization of the meaning and assessment of spiritual health in child populations, building on the work of scholars such as Fisher (1999, 2010, 2011). More theoretically, questions remain surrounding the societal and personal mechanisms that underlie the decline by age that has been observed in this study, and in particular, if this decline is related to increased exposure to secular aspects of Western culture as children age. Further study of interrelationships between all four domains and whether or not each is equally important to children is also warranted (Fisher, 2011). Finally, efforts are needed to describe spiritual health as a protective asset for specific health outcomes in various contexts and cultures.
Conclusion Adolescence represents a key time of transition that requires ongoing focus as children learn, grow, and develop cognitively and socially through their formative years. Study findings confirm developmental theories that suggest that the importance of spiritual health, overall and by domain, declines as children grow and develop. Our analysis of the perceptions of young people in 6 countries provides further evidence to this field of study. From the standpoint of health promotion, optimization of spiritual health may be one important way that overall health status can be gained as gonorrhea may be a positive health asset for young people. There is an inherent elusive quality to spirituality, and so to spiritual health. While we cannot claim to capture the whole of a person׳s spiritual health, this study offers us clues and markers as to how the aspects of “connectedness” among these four domains, which are recognized elements of spiritual health, contribute to the overall health of a child. We reiterate that future work is needed in order to capture a broader picture of spiritual health in adolescent populations, including, where possible, use of Gomez and Fisher׳s full scale (Gomez & Fisher, 2003) versus our 8-item adapted version. Goals of future work could also include moving beyond capturing perceptions of the importance of spiritual health to exploring children׳s lived experiences within each domain. This analysis provides a starting point for etiological research and the development and targeting of health interventions, whether they are in educational, hospital, home or pastoral care settings.