Conference PaperPDF Available

BAS International Conference 2018: An investigation of the feasibility of spirituality assessment and intervention in aphasia: exploring the use of SHALOM and WELLHEAD

Authors:
Katharyn Mumby at New Pathways Independent Therapy
Katharyn Mumby
  • New Pathways Independent Therapy
Download full-text PDF
Read full-text
Download citation

Abstract

An overview of ground-breaking work into aphasia and spirituality using WELLHEAD (resources developed by Mumby with people with aphasia) and SHALOM (Fisher 2010) providing quantitative and qualitative findings.
Content uploaded by Katharyn Mumby
Author content
All content in this area was uploaded by Katharyn Mumby on Nov 29, 2018
Content may be subject to copyright.
1
An investigation of the feasibility of spirituality assessment and
intervention in aphasia: exploring the use of SHALOM and WELLHEAD.
Conference presentation abstract: BAS International Conference 14th-16th November 2018
University of Sheffield, The Edge. The full conference programme can be found here:
BAS_Conference_Programme_2018
Lead Investigator: Dr Katharyn Mumby kath@new-pathways.co.uk
Primary Collaborator: Dr Hazel Roddam
Background
Spiritual aspects of aphasia rehabilitation are poorly understood (1), though identified within
adjustment (2). Existing spiritual health assessments have not been used with people with aphasia,
and no structured program to facilitate intervention has been documented, despite
acknowledgements that spirituality is important in health and wellbeing (3,4,5) and distinct from
quality of life (6).
Method
A PPI Steering Group comprising five people with aphasia shaped the research cyclically, agreeing a
spirituality definition comprising: ‘Meaning and purpose’. The feasibility study used mixed methods
to investigate the accessibility and acceptability of a spiritual health assessment chosen by them,
SHALOM (7) and WELLHEAD, a spirituality toolkit originated by Mumby (8). WELLHEAD evolved in
collaboration with the Steering Group and Hospital Chaplain, incorporating an interview framework
with word and picture resources, visual analogue patient reported outcome measures, and goal
setting for spiritual growth.
A convenience sample of 10 people with aphasia discharged from speech and language therapy was
recruited with NHS ethical approval, including diverse aetiologies, aphasia severity, ages and
religious backgrounds. They completed a two-hour session using SHALOM, the WELLHEAD toolkit
and a feedback questionnaire within video-recorded interviews. Quantitative results from all three
components were integrated with a qualitative thematic analysis in NVivo 11 including numerical
and descriptive summaries verified by the participants, feedback interview transcripts and field
notes with reflections. The thematic analysis was systematically verified by an independent
collaborator to improve rigour. Feedback from participants was further verified by incorporating
their comments from reviewing the overall findings.
Results
Quantitative and qualitative feedback evaluated the materials positively. Thematic analysis
supported the linguistic and cognitive accessibility of SHALOM and WELLHEAD, and their
acceptability from diverse religious perspectives. There was also widely reported impact including
perceived benefit with life changes being initiated. Modifications to the materials and procedures
were identified by participants and incorporated.
Further in-depth quantitative and qualitative analysis of the WELLHEAD interviews constituted a
case series, exploring themes from the neutral terms of ‘WIDE, LONG HIGH and DEEP’ and detailed
2
scores from SHALOM. ‘Belief’ ‘Faith’ and Religion’ were disambiguated. Initial insights emerged for
understanding how people with aphasia experienced spirituality.
Discussion
Establishing the psychometric properties of SHALOM and WELLHEAD requires a larger sample. A
pilot intervention study with additional measures would investigate potential impact. There is clear
potential for wider application of WELLHEAD in diverse settings and populations.
Conclusions
This preliminary work lays foundations for spiritual assessment and intervention in aphasia.
References
1. Mathisen, B., Carey, L.B., Carey-Sargeant, C.L. et al. (2015). Religion, Spirituality and
Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care. J Relig
Health, 54: 2309–2323.
2. Mumby, K., & Whitworth, A. (2013). Adjustment processes in chronic aphasia after stroke:
Exploring multiple perspectives in the context of a community based intervention.
Aphasiology, 27 (4): 462-489.
3. McSherry W. and Ross L. (eds.) (2010). Spiritual Assessment in Healthcare Practice. M & K
Publishing
4. de Jager Meezenbroek,E., Garssen, B. ,van der Berg, M. ,van Dierendonck, D. , Visser, A.,
Schaufeli, W.B. (2012). Measuring Spirituality as a Universal Human Experience: A Review of
Spirituality Questionnaires. J Religious Health, 51: 336-354
5. Monod, S., Brennen, M., Rochat, E., Martin, E., Rochat, S. and Büla, C. J. (2011). Instruments
Measuring Spirituality in Clinical Research: A Systematic Review. J Gen Intern Med, 26(11):
1345–57
6. Sawatsky, R., Ratner, P.A. and Chiu L. (2005). A Meta-Analysis of the relationship between
Spirituality and Quality of Life. Social Indicators Research, 72 (2): 153-188
7. Fisher, J. (2010) Development and application of a spiritual well-being questionnaire called
SHALOM. Religions, 1: 105-121.
8. Mumby, K., & Hobbs, E. Q. (2017). The Shape of Discipleship. The Reader, 117 (1): 16-17.
... Following completion of the feasibility study ongoing discussions between the SLT and the chaplain distilled further reflections about the research process. The specific positive findings about the accessibility and acceptability of WELLHEAD are being reported elsewhere (Mumby & Roddam [in preparation]; Mumby & Roddam 2018), but the work described above illustrates the value of collaboration in chaplaincy work. The design of WELLHEAD means that it has real potential to be applied as part of future collaborations between chaplaincy staff and other AHPs or trained volunteers as part of spiritual health assessment and intervention. ...
WELLHEAD: a Collaborative Approach to Spiritual Assessment and Intervention, Developed with People with Aphasia
Article
Full-text available
  • Feb 2020
Spirituality is a neglected aspect of healthcare and rehabilitation for those with acquired communication difficulties such as aphasia (language impairment) as a consequence of stroke, neurological disease and dementia. Collaborative working between health professionals and chaplaincy services in promoting spiritual health is desirable and necessary in the context of barriers to the delivery of spiritual care, which are explored from a hospital speech and language therapy perspective. Terminological and institutional barriers, restricted care provision, lack of knowledge and awareness, and lack of resources appropriate in communication impairment, gave rise to "WELLHEAD", a novel approach to spiritual health assessment, intervention and outcomes measurement originated by Dr Katharyn Mumby. The article describes the theoretical framework and content of WELLHEAD. Reflections are outlined about the positive collaboration between speech and language therapy, chaplaincy services and people with aphasia in feasibility work with WELLHEAD, an approach offering tools for further application and development.
View
... A feasibility study of the WELLHEAD spirituality toolkit using a case series of 10 people with aphasia was conducted in a health service outpatient setting in accordance with health research authority ethical approval (Study reference: IRAS id 216 799 https://www.hra.nhs.uk/planning-andimproving-research/application-summaries/research-summaries/aphasia-and-spirituality-toolkitpilot-study-version-1/). The overarching findings are being reported in detail elsewhere, (Mumby and Roddam, in preparation; see also Mumby and Roddam 2018) with the focus here upon in-depth dialogue with a participant with TBI. Prior to the study, a steering group of people with aphasia collaborated with the researcher to select the spiritual health assessment, Spiritual Health and Life Orientation Measure (SHALOM (Fisher 2010)), from the existing published resources. ...
A Single Case Narrative of Spirituality Following Aphasia from Traumatic Brain Injury: Findings about Forgiveness and Freedom Using WELLHEAD and SHALOM
Article
Full-text available
  • May 2019
Rehabilitation has neglected the spirituality of people with aphasia, a neurogenic impairment of language for communication and thought processes. Aphasia reduces scope for adjustment processes where words are normal currency, such as forgiveness and reconciliation. A single case narrative was generated from a case series exploring the feasibility of spiritual health assessment in aphasia. The individual had traumatic brain injury, with the primary symptom of aphasia, giving the first detailed account of its kind. The WELLHEAD spirituality toolkit provided a structured interview approach, exploring spirituality in terms of 'meaning and purpose' within four dimensions, WIDE, LONG, HIGH and DEEP, incorporating patient-reported outcome measures and goal-setting, with feedback interviews. Spiritual Health and Life Orientation Measure (SHALOM) generated a comparator spiritual health assessment. The quantitative feedback measures and self-reported outcomes were complemented by detailed qualitative interview transcripts subject to systematic thematic analysis in NVivo. The findings were co-constructed and systematically verified. This non-religious narrative evidenced the accessibility, acceptability, and impact of the resources. Self-forgiveness was paramount for freedom to journey into the unknown beyond self with 'Calm', towards helping others and accepting help. Religion, Faith and Belief were reconceptualised. Forgiveness of self and others was integral and instrumental in recovery, offering avenues for further investigation and application.
View
Adjustment processes in chronic aphasia after stroke: Exploring multiple perspectives in the context of a community-based intervention
Article
Full-text available
  • Apr 2013
Background: The impact of chronic aphasia following stroke on quality of life (QOL) is widely acknowledged, with improved QOL recognised as an important outcome in aphasia recovery and supported by emerging quantitative measures. One of the key constructs recognised as contributing to QOL in other chronic conditions is psychosocial adjustment, the mechanisms of which are little understood for the person with aphasia. Aims: This study addressed adjustment processes in aphasia by exploring multiple perspectives from people engaged in the Communication Hub for Aphasia in North Tyneside (CHANT), a two-year community intervention for long-term aphasia. The study aimed to explore the adjustment process over time in people with aphasia using thematic analysis of personal narratives derived from a combination of sources: semi-structured interviews with reflections on experiences, quantitative measures of change in QOL and self-assessments of change. Methods & Procedures: Three people with mild or moderate chronic aphasia and three people without aphasia involved in CHANT were recruited (a carer, a volunteer, and a local government employee) to participate in semi-structured interviews at two- to three-month intervals over a 12-month period. A total of 28 semi-structured interviews were transcribed and analysed thematically by a small team using NVivo8 software. Narrative data were interpreted within the broader context of QOL measures and self-assessments of living with aphasia (Mumby & Whitworth, 201244. Mumby , K. and Whitworth , A. 2012. Evaluating the effectiveness of intervention in long-term aphasia post-stroke: The experience from CHANT (Communication Hub for Aphasia in North Tyneside). International Journal of Language & Communication Disorders, 47: 398–412. [CrossRef], [PubMed], [Web of Science ®]View all references). Outcomes & Results: Changes over time that reflected evidence of psychosocial adjustment from the multiple perspectives of the participants covered five core themes: Intervention type, Effectiveness, Barriers, Facilitators, and QOL. A model is proposed to encapsulate the barriers and facilitators that impacted on the process of adjustment and contributed to QOL for individuals involved in the intervention. This model is consistent with the domains from other classifications based on the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 200154. World Health Organization . 2001. International Classification for Functioning, Disability and Health (ICF), Geneva: Author. View all references), viewing adjustment as a progression towards “wholeness”. The processes involved in personal (and specifically, emotional) adjustment to aphasia are explored, including three stages in rationalisation—Looking back, Looking around, and Looking forward—and the process of transforming negative emotional reactions into positive outcomes. Conclusions: The processes of adjustment in chronic aphasia are complex and vary both over time and according to individual perspectives and circumstances. This preliminary longitudinal study identified commonalities in participants engaged in long-term intervention over 12 months, enabling models of adjustment to be proposed for further exploration and evaluation.
View
Religion, Spirituality and Speech-Language Pathology: A Viewpoint for Ensuring Patient-Centred Holistic Care
Article
Full-text available
  • Jan 2015
This paper presents a viewpoint concerning the largely neglected clinical relevance of spirituality and religious belief in speech-language pathology (SLP) assessments, interventions and outcomes across the lifespan. An overview of the refereed SLP literature is presented with regard to religion and spirituality. It was found that while there is increasing research with regard to spirituality, health and well-being, there is very little specific to SLP. What is available and clinically relevant, generally relates to holistic care and/or cultural and linguistic diversity. Amidst the health care literature, however, there is a growing number of recommended instruments (for religious/spiritual screening) sensitive to inter-cultural and interfaith issues that are currently available to medical, nursing, allied health and chaplaincy practitioners. These instruments can also be of value to SLPs to ensure holistic assessments and interventions. It would seem timely for SLPs (and other allied health practitioners) to consider including spiritual screenings/assessments as part of their clinical practice so as to ensure appropriate holistic care. This would also mean undertaking research and including relevant education within tertiary institutions and professional development programs. [Obtain full article: Institutional library or directly from Springer, New York: http://link.springer.com/article/10.1007/s10943-015-0001-1 ].
View
A Meta-Analysis of the Relationship Between Spirituality and Quality of Life
Article
Full-text available
  • Jun 2005
The relationship between spirituality and various dimensions of health and quality of life has been extensively examined during the past decade. Though several literature reviews have been conducted in an attempt to synthesize research findings pertaining to the relationship between spirituality and health, a meta-analysis of studies examining spirituality in relation to quality of life has not been identified. The present study was designed to: (a) determine whether there is empirical support for a relationship between spirituality and quality of life, (b) provide an estimate of the strength of this relationship, and (c) examine potential moderating variables affecting this relationship. The research design followed accepted methods for quantitative meta-synthesis. Potential moderating effects of several methodological differences and sample characteristics were examined using meta-analytic approaches with multivariate linear regression and analysis of variance. An extensive multidisciplinary literature search resulted in 3,040 published reports that were manually screened according to pre-established selection criteria. Subsequent to the selection process, 62 primary effect sizes from 51 studies were included in the final analysis. A random effects model of the bivariate correlation between spirituality and quality of life resulted in a moderate effect size (r = 0.34, 95% CI: 0.28–0.40), thereby providing support for the theoretical framework underlying the study wherein spirituality was depicted as a unique concept that stands in relationship to quality of life. Subsequent regression analyses indicated that differences among operational definitions of spirituality and quality of life were associated with the variability in estimates of the magnitude of the relationship (R2 = 0.27). Other potential moderators, such as age, gender, ethnicity, religious affiliation and sampling method were examined but the findings pertaining to these variables were inconclusive because of limitations associated with the sample of primary studies. The implications of this study are mostly theoretical in nature and raise questions about the commonly assumed multidimensional conceptualization of quality of life.
View
Development and Application of a Spiritual Well-Being Questionnaire Called SHALOM
Article
Full-text available
  • Dec 2010
The Four Domains Model of Spiritual Health and Well-Being was used as the theoretical base for the development of several spiritual well-being questionnaires, with progressive fine-tuning leading to the Spiritual Health And Life-Orientation Measure (SHALOM). SHALOM comprises 20 items with five items reflecting the quality of relationships of each person with themselves, other people, the environment and/or God, in the Personal, Communal, Environmental and Transcendental domains of spiritual well-being. SHALOM has undergone rigorous statistical testing in several languages. SHALOM has been used with school and university students, teachers, nurses, medical doctors, church-attenders, in industry and business settings, with abused women, troubled youth and alcoholics. SHALOM provides a unique way of assessing spiritual well-being as it compares each person’s ideals with their lived experiences, providing a measure of spiritual harmony or dissonance in each of the four domains.
View
Measuring Spirituality as a Universal Human Experience: A Review of Spirituality Questionnaires
Article
Full-text available
  • Jul 2012
  • J RELIG HEALTH
Spirituality is an important theme in health research, since a spiritual orientation can help people to cope with the consequences of a serious disease. Knowledge on the role of spirituality is, however, limited, as most research is based on measures of religiosity rather than spirituality. A questionnaire that transcends specific beliefs is a prerequisite for quantifying the importance of spirituality among people who adhere to a religion or none at all. In this review, we discuss ten questionnaires that address spirituality as a universal human experience. Questionnaires are evaluated with regard to psychometric properties, item formulation and confusion with well-being and distress. Although none of the questionnaires fulfilled all the criteria, the multidimensional Spiritual Well-Being Questionnaire is promising.
View
Instruments Measuring Spirituality in Clinical Research: A Systematic Review
Article
  • Jul 2011
  • J GEN INTERN MED
Numerous instruments have been developed to assess spirituality and measure its association with health outcomes. This study's aims were to identify instruments used in clinical research that measure spirituality; to propose a classification of these instruments; and to identify those instruments that could provide information on the need for spiritual intervention. A systematic literature search in MEDLINE, CINHAL, PsycINFO, ATLA, and EMBASE databases, using the terms "spirituality" and "adult$," and limited to journal articles was performed to identify clinical studies that used a spiritual assessment instrument. For each instrument identified, measured constructs, intended goals, and data on psychometric properties were retrieved. A conceptual and a functional classification of instruments were developed. Thirty-five instruments were retrieved and classified into measures of general spirituality (N = 22), spiritual well-being (N = 5), spiritual coping (N = 4), and spiritual needs (N = 4) according to the conceptual classification. Instruments most frequently used in clinical research were the FACIT-Sp and the Spiritual Well-Being Scale. Data on psychometric properties were mostly limited to content validity and inter-item reliability. According to the functional classification, 16 instruments were identified that included at least one item measuring a current spiritual state, but only three of those appeared suitable to address the need for spiritual intervention. Instruments identified in this systematic review assess multiple dimensions of spirituality, and the proposed classifications should help clinical researchers interested in investigating the complex relationship between spirituality and health. Findings underscore the scarcity of instruments specifically designed to measure a patient's current spiritual state. Moreover, the relatively limited data available on psychometric properties of these instruments highlight the need for additional research to determine whether they are suitable in identifying the need for spiritual interventions.
View
The Shape of Discipleship. The Reader
  • Jan 2017
  • 16-17
  • K Mumby
  • E Q Hobbs
Mumby, K., & Hobbs, E. Q. (2017). The Shape of Discipleship. The Reader, 117 (1): 16-17.