Spiritual needs in Denmark: A population-based survey linked to Danish nationwide registers

Research output: ThesisPh.D. thesis

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This thesis contains information on an extensive study on spiritual needs in a population random sample. Various international and national guidelines on health care at both primary (general practice) and secondary (hospital) levels emphasize a holistic and patient-centred approach where care is delivered to alleviate and prevent physical, psychological, social, and spiritual suffering. This latter spiritual dimension has received relatively little attention in care and research but is gaining attention due to amounting robust evidence documenting protective health effects of spiritual factors such as affiliations, beliefs, and practices. In addition, needs related to spiritual aspects (called ‘spiritual needs’) might increase as a person ages, gets severely ill, or approaches death. Research shows that attention to such spiritual needs might improve patients’ health outcomes and health care professionals’ well-being and reduce the overall cost of care. However, knowledge of spiritual needs in supposedly secular cultures, such as the Danish, is sparse, limiting clinical administration and political attention to care that addresses spiritual needs. Increased knowledge of spiritual needs in the population is thus needed. Consequently, the purpose of this thesis was to examine the spiritual needs of adult Danes.

The EXIstential health COhort DEnmark (EXICODE) questionnaire was developed as a compiled questionnaire containing various validated translated instruments measuring existential and spiritual constructs. The EXICODE questionnaire was tested qualitatively through cognitive interviews (n=14) where good acceptability and comprehensibility were found. Further, testing showed decreasing issues with the questionnaire across iterative rounds hinting at questionnaire maturation. Some questions/scales were adjusted or omitted because of interviewee feedback and issues found.

The Danish Spiritual Needs Questionnaire (DA-SpNQ-20) (a 20-item instrument part of the EXICODE questionnaire) was then psychometrically tested in a testretest setup in a convenience sample of relatively healthy and young adult Danes (n=345). The instrument showed acceptable structural validity through both exploratory and confirmatory factor analysis, the latter within a structural equation model framework. However, model fit estimations failed to reach the level for a good fit. The DA-SpNQ-20 was established with four dimensions: Religious Needs, Existential Needs, Generativity Needs, and Inner Peace Needs.
Cronbach’s alphas as a measure of internal consistency were acceptable, good, or very good across dimensions and overall, with values between 0.73-0.93. Skewness and kurtosis analyses indicated some risk of floor effects, as expected with this ordinal scale designed primarily as a clinical tool, although the distribution was heterogenous across items. Repeatability was high with an ICC of 0.86 and low systematic error was shown in a Bland Altman plot. It was different from the WHO-5 Well-being index, providing evidence for discriminant validity. In conclusion, the DA-SpNQ-20 showed acceptable but not perfect validity and
reliability in a sample of healthy and relatively young adult Danes. More research is needed to further establish psychometric validity of the DA-SpNQ-20.

A random sample of 104,137 adult Danes was invited to participate in Wave I of the EXICODE study. In total, 26,678 randomly selected Danes participated (25.6%). Survey data was then linked to national health register data at an individual level. It was found, measured with the DA-SpNQ-20, that 81.9% of respondents reported at least one strong or very strong spiritual need. Inner peace needs were the most prevalent spiritual need in Danes, followed in rank by generativity needs, existential needs, and religious needs. In addition, existential and spiritual factors, low well-being, life satisfaction, and physical health were associated with positive OR for having spiritual needs. Responders and non-responders differed significantly on all measured variables indicating a selection bias. Findings were in line with theoretical understandings and expectations.

In conclusion, an instrument to measure spiritual needs was translated into Danish, qualitatively and quantitatively tested, and used to examine spiritual needs in a randomly selected sample of adult Danes. The thesis provides evidence for spiritual needs in Danes, although with limitations. This finding provides some support that Danes live in a post-secular culture, and thus supports that spiritual matters are salient for Danes.

Future research is needed to establish the clinical importance of spiritual needs, the link between spiritual needs and the actual need for spiritual care, and lastly the optimal way to address spiritual needs when people become patients.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
  • Hvidt, Niels Christian, Principal supervisor
  • Wehberg, Sonja, Co-supervisor
  • Søndergaard, Jens, Co-supervisor
Date of defence22. Mar 2024
Publication statusPublished - 9. Feb 2024

Note re. dissertation

Print copy of the full thesis is restricted to reference use in the library.


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