Cultural adaptation and validation of the Sinhala version of the Spiritual Needs Assessment for Patients (S-SNAP) questionnaire

Abstract

Background Spiritual support for patients and caregivers of critically ill patients is associated with improved quality of life. This aspect, however, is not incorporated into the current care pathways in Sri Lanka. The Spiritual Needs Assessment for Patients (SNAP) questionnaire, comprised of 3 domains: psychosocial, spiritual and religious, gives a platform for clinicians to assess the spiritual needs of those patients. This study presents the results of validation of the Sinhala version of the SNAP (S-SNAP) questionnaire. Methods The SNAP was translated from English to Sinhala using the standard forward and backward translation process. After verifying the content validity, unambiguity and clarity of items in a focused group discussion, and a pilot study, the pre-final version was tested among 267 volunteers with cancer selected from three state-run cancer care institutions. Data were analysed for internal consistency and item-total correlations. Factor analysis was done using Varimax rotation with Kaiser normalization. A Scree plot was also made to determine the number of factors. Results The mean (SD) age of subjects was 63.2 (11.4) years. The total S-SNAP score ranged from 22–88 (maximum 88). The overall Cronbach’s alpha was 0.94 while item-total correlations varied from 0.26–0.87. Total SNAP score showed inverse correlations with age, Charleson Comorbidity index and Barthel index while a positive correlation was seen with the Karnofsky performance status scale (p < 0.05). Kaiser-Meyer-Olkein value of 0.92 (P = < 0.001) for Bartlett’s test indicated adequate sampling and non-linearity of factors. The scree plot showed a four-factor structure explaining 76% variation. Meaning of life and relationship with a supernatural being and religious rituals are loaded as 2 different factors. Worries, fears and forgiveness are grouped as the third factor while relaxation, coping and sharing feelings are loaded separately. Conclusions The S-SNAP is a reliable and valid tool to assess spiritual suffering among patients with cancers conversant in the Sinhala language.