Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research is a report, originally published in 1999, by a Fetzer Institute / National Institute on Aging working group on the measurement of religion and spirituality. A revised version with a new preface was published in 2003. The book presents a series of 12 self-report questionnaire measures, each focused on a particular aspect of religiousness or spirituality, along with reviews of underlying theory and supporting research. The book's purpose is to provide validated measures of spiritual and religious factors in health research. The book includes the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), a practical measure with selected items from the 12 previous chapters.
The book has been widely cited in health and behavioral science research, and several subsequent publications have been partially or entirely dedicated to evaluating and critiquing the measures.<ref name=koenig08/><ref name=idler03/><ref name=traphagan05/><ref name=neff06/><ref name=stewart06/><ref name=masters09/><ref name=harris08/><ref name=johnstonejrh09/><ref name=piedmont06/>
Topics covered Both editions contain an introduction, followed by 12 chapters, each on the measurement of a particular aspect ("domain") of religion or spirituality. Combining all these questions gives the Multidimensional Measure of Religiousness/Spirituality. (MMRS). Concluding pages of each edition select items for a briefer 38-item version of the questionnaire (BMMRS), along with data from a US national survey that incorporated many of its items.
Background and purpose. The Introduction states the book is responding to "a growing body of literature.... indicat[ing] that various dimensions of religiousness and spirituality may enhance subjective states of well-being... lower levels of depression and psychological distress... and reduce morbidity and mortality.... elicit[ing] considerable attention from medical researchers in epidemiology, psychology, sociology, gerontology, and other fields" (p. 1). However, Health researchers who seek to include religious or spiritual domains in their studies typically confront various problems. Few health researchers have a scholarly background in religiousness/spirituality and most are not acquainted with the long history of attempts to conceptualize and measure multiple dimensions of religiousness... [and] we currently have no widely used and validated set of standard measures for key religious/spiritual domains to recommend to interested health researchers (pp. 1-2)
Domain-Focused Chapters:Multidimensional Measurement of Religiousness /Spirituality for use in Health ResearchDomain / Chapter TitleSample ItemDaily Spiritual Experiences (Lynn G. Underwood)I find strength and comfortin my religion.*Meaning (Kenneth I. Pargament)My spirituality helps definethe goals I set for myself.Values (Ellen Idler)My whole approach to lifeis based on my religion.Beliefs (Ellen Idler)Do you believe there isa life after death?*Forgiveness (Ellen Idler)I have forgiven those whohurt me.Private Religious Practices (Jeff Levin)How often do you prayprivately in places other thanat church or synagogue?*Religious/Spiritual Coping (Kenneth I. Pargament)I think about how my life is partof a larger spiritual force.*Religious Support (Neal Krause)If you were ill, how muchwould the people in yourcongregation help you out?*Religious/Spiritual History (Linda K. George)Did you ever have a religiousor spiritual experience thatchanged your life?*Commitment (David R. Williams)I try hard to carry my religiousbeliefs over into all my otherdealings in life.*Organizational Religiousness (Ellen Idler)How often do you go toreligious services?*Religious Preference (Christopher Ellison)What is your current religiouspreference?**These items also appeared in the BMMRS
Thus, "the NIA and the Fetzer Institute established a core working group to: Identify those domains of religiousness/spirituality most likely to impact health Suggest potential mechanisms whereby these variables might operate; and Provide a short multidimensional survey for use in clinical research." (p. 2)
Plausibility of health effects. The Introduction described a variety of "potential mechanisms" by which religiou/spirituality might affect health. These include "behavioral mechanisms" (e.g., less drug abuse), "social mechanisms" (e.g., community ties), "psychological mechanisms" (e.g., emotional support or religious coping), and physiological mechanisms" (e.g., prayer or meditation that elicits a "relaxation response") (pp. 3–4).
Cultural orientation. The Introduction also noted that "While many of the items have a strong Judeo-Christian focus... the group also proposed a number of items relevant to the growing proportion of Americans who engage in spiritual activities outside the content of churches and synagogues" (p. 3).
Domain-focused chapters. The titles of the 12 domain-focused chapters, each written by one of the committee members, are shown in the adjacent table. A sample question from each chapter's questionnaire measure is also shown in the table.
Brief measure. The final chapter contains a "short form" (BMMRS) with 36 items mostly drawn from the longer measures that appear in the previous 12 chapters (see table). Two additional items elicit a respondent's overall self-ranking (e.g., "To what extent to you consider yourself a spiritual person?", with a similar question about being a "religious person").Responses are 1) very spiritual, 2) moderately spiritual, 3) slightly spiritual, or 4) not spiritual at all. The other question asks "To what extent do you consider yourself a religious person?" (p. 88). This chapter is entitled: Brief Multidimensional Measure of Religiousness/Spirituality: 1999
Survey data. The appendix contains results from administering the BMMRS to a US nationally representative sample, through the General Social Survey, in 1998. For example, it was found that 24.4 percent of US adults reported engaging in private prayer "more than once a day", and 9.0 percent reported engaging in meditation "more than once a day" (p. 92). The appendix is entitled: Appendix A: Additional Psychometric and Population Distribution Data
Response and influence By 2010, the book had been cited more than 350 times in scientific publications.In the PsycINFO database (accessed 25 May 2010), a search for publications that cited "Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research" revealed citations by 303 peer-reviewed journal articles, 13 books, and 40 chapters/essays that appeared from 2000 to 2010. Critiques and evaluations of the MMRS or BMMRS have appeared in the Journal of Nervous and Mental Disease, Research on Aging,<ref name=traphagan05></ref> the Journal for the Scientific Study of Religion,<ref name=neff06></ref> the International Journal for the Psychology of Religion,<ref name=stewart06></ref> Journal of Religion and Health,<ref name=johnstonejrh09></ref> Research in the Social Scientific Study of Religion, and elsewhere.
In the Journal of Nervous and Mental Disease, Harold G. Koenig wrote that The Fetzer Institute’s Multidimensional Measure of Religiousness/Spirituality is rapidly becoming the standard measure of religiousness/spirituality in the spirituality and health field overall, given its comprehensive nature... There also exist national norms for the short version of this instrument (p. 352). However, he expressed concern that some items for some of the domains of the BMMRS might be "contaminated": "Among its spirituality subscales are meaning, values, and forgiveness subscales [containing] items such as... 'Knowing that I am a part of something greater than myself gives meaning to my life'... [and] 'It is easy for me to admit that I am wrong,' ... these positive traits could very well be the outcome or the results of spirituality. However, should they be part of the definition itself?... completely secular persons and atheists may experience these things as frequently or more frequently than so called 'spiritual persons" (p. 352). Others have empirically tested this issue for the BMMRSs Daily Spiritual Experiences Scale finding that it is composed of two factors - theism and civility — with many people who eschew religion and spirituality scoring highly on civility.Schuurmans-Stekhoven, J. B. (2013). "As a shepherd divideth his sheep from the goats": Does the Daily Spiritual Experiences Scale encapsulate separable theistic and civility components? Social Indicators Research, 110(1), 131-146.doi:10.1007/s11205-011-9920-8
In Research on Aging, Idler and other working group members reported results of in-depth analyses of data from administering the BMMRS in the 1998 General Social Survey. The various BMMRS questions "had the expected relationships with other measures of [religious] concepts. Overall, the instrument has the appropriate characteristics of reliability and validity to be used in further research." (p. 356). Another analysis of the same data suggested that the BMMRS "is useful for multiethnic research," and that the daily spirituality and values/beliefs scales could benefit by being combined (p. 446).
Several researchers evaluated how well the BMMRS appeared to work when given to different populations. One study concluded that "most BMMRS measures are reliable and valid for use among adolescents" (p. 439). Another found that the "BMMRS is a viable multifactor measure of [religion/spirituality] for use with young adults" when the "wording on some items was slightly altered to be more inclusive of various religious traditions" (pp. 106, 110). A third reported that in a sample of midwestern US college students, "despite having a collection of items from 12 different domains, these items really constitute two major areas of interest: one relating to spiritual experiences and the other to religious involvements" (p. 194). In a population of patients undergoing rehabilitation, it appears that "the BMMRS assesses distinct positive and negative aspects of religiousness and spirituality that may be best conceptualized... as... (a) Spiritual Experiences... (b) Religious Practices... (c) Congregational Support; and (d) Forgiveness" (p. 146). Findings from Southern US adults suggested that the MMRS appears best at measuring "3 primary factors (Meaning, Spirituality, Religious Practices and Organized Religiousness) and 2 secondary factors (Guilt vs. God’s Grace, and Loving/Forgiving God)" (p. 181).
John Traphagan, in Research on Aging, examined how the book can "raise questions about the extent to which basic ideas associated with the study of Judeo-Christian religions are meaningful in contexts such as Japan" and other Asian countries (p. 387). He argued that questions suggested for many of the 12 domains are irrelevant to understanding religiousness/spirituality in Japan.For example, "questions such as 'If I hear a sermon, I usually think about things that I have done wrong' (Fetzer Report 1999:36) are unlikely to be useful in Japan, because there is no tradition of confession and no sense of a need to confess one’s transgressions in order to achieve salvation. Sermons are not an important part of most religious gatherings, and when they do occur, they are not generally focused on moral behavior" (p. 404). However, a few MMRS domains held promise. For example, with regard to religious coping, he stated that "certain kinds of ritual performance in Japan can be understood in terms of coping mechanisms, and this is an area identified in the Fetzer report that holds promise for cross-cultural research (at least in relation to Japan)" (p. 405).