| Sumario: | Abstract: Spiritual well-being plays a crucial role in one's perception of health and illness. Due to their vulnerable health, physical changes and deterioration, the elderly are at risk of encountering health problems, including chronic illnesses. Thus, Thai health care providers are especially interested in how the elderly maintain and promote their health through their sense of spiritual well-being. An enhanced sense of spiritual well-being has been found to play an important role in helping elderly with chronic illnesses deal with the health care issues they face on a daily basis. Although spiritual well-being has been defined, based on one's personal experiences, culture and context, little is known about the concept and no known instrument exists to measure it within the context of the Thai culture. The lack of an appropriate assessment tool for measuring spiritual well-being, within the Thai context, continues to make it difficult for health care providers, throughout Thailand, to measure and appropriately intervene with chronically ill elders in regards to their spiritual well-being. Therefore, the purposes of this study were to: develop the Thai Spiritual Well-being Assessment Tool for Elders with Chronic Illnesses (TSWBATECI); and, assess the tool's psychometric properties. The study design used qualitative and quantitative approaches to gather data. Qualitative data were obtained via review of the literature and three focus groups or individual interviews with 27 elders with chronic illnesses, who declared to be of a Buddhist, Islamic or Christian faith. From content analysis of the qualitative data, the TSWBATECI was developed. Content validity of the tool was examined by seven experts in spiritual development, comparative religion and spirituality in nursing and resulted in minor revisions of the items' wording. Following the content validity assessment, the instrument was given to 10 chronically ill elders who made suggestions on further item refinement so as to improve the tool's clarity and readability. The revised tool then was pilot tested on 90 chronically ill elders, from the three faiths, for the purpose of determining what items should be retained or deleted. Next, the instrument was administered to 600 chronically ill elders, who were of one of the three religious faiths, to test its reliability and construct validity via exploratory factor analysis. The outcome resulted in the tool being revised again, with the final version consisting of 41-items. Finally, the reliability and construct validity of the 41-item tool was tested, using secondorder confirmatory factor analysis, on 2160 chronically ill elders, who were of the three religious faiths. The final version of the instrument was found to account for 81.90% of the total explained variance. The content validity index of the tool was determined to be 0.82 to 0.95, and its' Cronbach's alpha coefficient was found to be 0.97. The instrument could be accurately described as having a goodness of fit ( X2 = 821.09, df = 747, X2 /df = 1.10, GFI = .96, RMSEA = .03, SRMR = .07). Thus, the Thai Spiritual Well-being Assessment Tool for Elders with Chronic Illnesses appeared to be a valid and reliable instrument for assessing spiritual well-being of elderly Thais with chronic illnesses.
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