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Self assessment 3

Spiritual Well-Being Questionnaire
This questionnaire explores your views on the term spiritual. Assess each item against the question “How much
is this a component of spirituality?” For each item, respond using the scale from 1 (very little) to 5 (very much).

1 = Very Little 2 = Little 3 = Medium 4 = Much 5 = Very Much

Note: The form will total your points for each domain and the entire assessment at the bottom of the page.

1. Celebrating significant moments
2. Zest for life
3. The place of obedience in living
4. Valuing personal instincts
5. Awareness of life’s mysteries
6. Appreciating life as it happens
7. Justice
8. Honesty
9. Experiencing drama
10. Experiencing art
11. Trust between individuals
12. Forgiveness between individuals
13. Appreciating the natural environment
14. Moments of solitude
15. Appreciating beauty
16. Having responsibilities
17. Scientific understanding of the universe
18. Admiring something
19. Religious belief
20. Belonging to a faith community
21. Perception of living as a response to God (Other)
22. Personal relationship with God (Other)
23. Reverence to God (Other)
24. Admiring God (Other)

Your total score:

Score

24-120

Interpretation
Your total score reflects your overall spiritual well-being.

Source: Adapted from Fisher, J. W., Francis, L. J., & Johnson, P. (2000). Assessing spiritual health via four domains
of spiritual wellbeing: The SH5DI. Pastoral Psychology, 49, 133–145.

Personal well-being
(Items 1–6)

Your domain scores: Higher scores indicate that you give priority to that domain.

Communal well-being
(Items 7-12)

Environmental well-being
(Items 13-18)

Transcendental well-being
(Items 19-24

  1. Q1:
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  7. Q7:
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  10. Q17:
  11. Q10:
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  14. Q14:
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  18. Q19:
  19. Q13:
  20. Q20:
  21. Q21:
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  24. Q24:
  25. TotalScore: 0
  26. Personal Score: 0
  27. Communal Score: 0
  28. Environmental Score: 0
  29. Transcendental Score: 0

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