The National Institutes of Health measure of Healing Experience of All Life Stressors (NIH-HEALS): Factor analysis and validation

Rezvan Ameli, Ninet Sinaii, María José Luna, Julia Cheringal, Brunilde Gril, Ann Berger, Rezvan Ameli, Ninet Sinaii, María José Luna, Julia Cheringal, Brunilde Gril, Ann Berger

Abstract

Two hundred patients with severe and/or life-threatening disease were recruited form the NIH Clinical Center and participated in the validation of the NIH-HEALS, which included exploratory factor analysis, principal component analysis, reliability, convergent validity, and divergent validity analyses. Item-reducing principal components analysis and internal consistency and split-half reliability demonstrated excellent internal consistency and split-half reliability (Cronbach's alpha = 0.89, split-half reliability = 0.95). Exploratory factor analysis revealed a three-factor structure, namely Connection (including religious, spiritual, and interpersonal), Reflection & Introspection, and Trust & Acceptance. Seven items were not retained. Convergent and divergent validity of 35-item NIH-HEALS against other validated measures of healing and spirituality provided strong evidence for its validity. As predicted, the Healed factor of the Self-Integration Scale (SIS), and Meaning, Peace, and Faith factors of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12 Scale (FACIT-SP12) were all positively and significantly correlated with the NIH-HEALS and its three factors. Divergent validity was also confirmed by the significant negative correlation between the NIH-HEALS and the Codependent factor on the SIS. Confirmatory Factor Analyses revealed good model fit by GFI (0.96), adjusted GFI (0.95), SRMR (0.077), and RMSEA (0.065), supporting the use of the NIH-HEALS with 35 items.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Three factor, 35-item NIH-HEALS measure.
Fig 1. Three factor, 35-item NIH-HEALS measure.
The three factors accounted for 43.4% of the total variability with excellent reliability (Cronbach’s alpha = 0.89, split-half reliability = 0.95). Retained items for each factor are listed along with their individual loadings (in parenthesis) from the exploratory factor analysis. Items 6, 23, 28, and 34 are reversed scored.
Fig 2. Path diagram of the three-factor,…
Fig 2. Path diagram of the three-factor, 35-item NIH-HEALS measure.
Data are standardized coefficients from mean and covariance structure model of confirmatory factor analysis. The numbers in the ovals represent the NIH-HEALS items. Data in parenthesis following items are standardized error coefficients. **p

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