• Lubin R Deng, Kevin S Masters, Sarah J Schmiege, Edward Hess, and David B Bekelman.
• Denver/Seattle Center of Innovation, Department of Veterans Affairs Eastern Colorado Health Care System (L.R.D., E.H., D.B.B.), Aurora, Colorado, USA. Electronic address: lubin.deng@columbia.edu.
• J Pain Symptom Manage. 2021 Nov 1; 62 (5): 103410401034-1040.

ContextThe Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) is a 12-item measure of spiritual well-being in chronic illness originally developed in patients with cancer. The overall scale, a two-factor model (meaning/peace, faith), and a three-factor model (meaning, peace, faith) have been proposed for the FACIT-Sp, and consensus on the best factor structure has not been reached. In addition, the factor structure of the FACIT-Sp has not been considered in patients with heart failure.ObjectivesTo examine the factor structure of the FACIT-Sp in heart failure patients.MethodsA confirmatory factor analysis framework was used to test three competing models on 217 patients with heart failure using data from the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial. The overall scale (single factor), two-factor, and three-factor models were tested using baseline data, then confirmed with 12-month data. Model modifications were made based on empirical inspection of baseline data and replicated using 12-month data. Cronbach's alpha and correlations with measures of quality of life and psychological health were examined.ResultsAll three models had strong factor loadings on all items except the negatively worded items. The two-factor and three-factor models fit reasonably well after modifications, but the single factor did not fit well (1/2/3-factor: RMSEA 0.14/0.09/0.06, CFI 0.85/0.93/0.97, SRMR 0.09/0.05/0.04). Internal consistency was sufficient for all factors.ConclusionThe two-factor and three-factor models were supported in heart failure patients. The three-factor model demonstrated better statistical fit but was not more interpretable.Key MessageThis study investigated the factor structure of the FACIT-Sp in patients with heart failure. The two-factor and three-factor models were supported, but the single factor model was not. Negatively worded items did not perform well.Published by Elsevier Inc.

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