MSBH7002 - Bmswbi

Body-Mind-Spirit Well-being Inventory 1 of 30
Running head: BODY-MIND-SPIRIT WELL-BEING

The Measurement of Body-Mind-Spirit Well-Being:
Toward Multidimensionality and Transcultural Applicability
S. M. Ng, J osephine K. Y. Yau, Cecilia L. W. Chan, Celia H. Y. Chan, and David Y. F. Ho
University of Hong Kong, Hong Kong, China

Author Note
S. M. Ng, RSW, RCMP, Centre on Behavioral Health, the University of Hong Kong, E-mail:
ngsiuman@hku.hk.
J osephine K. Y. Yau, MPhil, BSSc, Centre on Behavioral Health, the University of Hong
Kong, E-mail: joyau@hku.hk.
Cecilia L. W. Chan, PhD, Centre on Behavioral Health, the University of Hong Kong, E-mail:
cecichan@hku.hk.
Celia H. Y. Chan, MSW, BSSc, RSW, Centre on Behavioral Health, the University of Hong
Kong, E-mail: chancelia@hku.hk.
David Y. F. Ho, PhD, Centre on Behavioral Health, the University of Hong Kong, E-mail:
dyfho@hkusua.hku.hk.
Correspondence concerning this article should be addressed to Cecilia L.W. Chan, Centre on
Behavioral Health, the University of Hong Kong, G/F Pauline Chan Building, 10 Sassoon
Road, Pokfulam, Hong Kong, China, Tel: 852-25890501, Fax: 852-28166710, E-mail:
cecichan@hku.hk.

Keywords: holistic health, health assessment, Body-Mind-Spirit model.
Word count: 6,476 (including title page). Revised 22 Sept 2004.
Abstract
The Body-Mind-Spirit model of health promotion (Chan, Ho & Chow, 2002) guided the
construction of a multidimensional inventory for assessing holistic health. Named
Body-Mind-Spirit Well-Being Inventory (BMSWBI), it comprises four scales: Physical
Distress, Daily Functioning, Affect, and Spirituality (differentiated from religiosity and
conceived as ecumenical). Respondents (674 Chinese adults from Hong Kong) completed the
BMSWBI via the Internet. Results indicate that all four scales have high reliability, with alpha
coefficients ranging from .87 to .92, and concurrent validity. Factor analysis indicates that (a)
positive and negative affect form two distinct factors; and (b) spirituality comprises three
distinct aspects, tranquility, resistance to disorientation, and resilience. Spirituality is
positively associated with mental well-being, positive affect, satisfaction with life, and hope;
but negatively associated with negative affect and perceived stress. These results suggest that
the inventory may be used to assess different dimensions of health satisfactorily.

The Measurement of Body-Mind-Spirit Well-Being:
Toward Multidimensionality and Transcultural Applicability
A perusal of the literature on health psychology reveals a new development in recent
years: the embracement of linking health to spirituality (e.g. see Hill & Pargament, 2003).
Two vital elements, however, should be emphasized. The first is that spirituality is integral to
the conception of holistic health; indeed, spirituality is an essential component, and not just a
correlate, of holistic health. The second concerns the construct of spirituality itself.
Researchers (Baldacchino & Draper, 2001; Hill & Pargament, 2003; Richards & Bergin, 1997)
commonly accept the distinction between religiosity and spirituality, but have not considered
religious traditions outside of Christianity seriously in explicating the construct. In this article,
we intend to heed these two emphases, which are vital to both the conception and
measurement of holistic well-being.
Health is important not only to daily living, but also to our quest for happiness (Brief,
Butcher, George, & Link, 1993; Tran, 1992). The World Health Organization (1948) defines
health as a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity. The maximization of well-being and the minimization of
disease, which in turn enhances quality of life, should be the primary goal of health
intervention (WHOQOL Group, 1995). In addition, the WHO definition brings attention to
the multidimensionality of health (Stewart, 1992). Given the paradigmatic shift in the
conception of health in recent decades, a multidimensional health assessment of body, mind,
and spirit is warranted to reveal the dynamics and relationships between the different
components of holistic health.
Although a number of self-report instruments have been developed and validated, they
tend to be restricted to the diagnostic aspects of health (Ruehlman, Lanyon, & Karoly, 1999).
Most self-report instruments focus solely on either the physical or the mental aspects of health;
only a few, such as the General Health Questionnaire and Short-Form General Health Survey,
address both aspects. Clearly, a multidimensional instrument for the measurement of holistic
health is needed.
Such an instrument should be user-friendly for not only researchers but also practitioners.
Intervention outcome measures in health care settings rely heavily on scales, such as the Brief
Symptom Inventory, the Hospital Anxiety Depression Scale, and the Impact of Event Scale,
that are used to measure negative symptoms and affective states. The impact of social work
intervention on the promotion of general well-being, motivation, strength, and resilience in
life among patients cannot be measured easily by existing instruments. Some of the response
scales of commonly used measures of quality of life are also insensitive to social work
intervention.
This article reports our attempt to develop a multidimensional measure with two
distinctive goals: (a) Inclusion of spirituality as an essential dimension of health; and (b)
achieving transcultural applicability. As such, the measure promises to meet the needs of
social workers and human service professionals in different cultural contexts.
The Body-Mind-Spirit Model of Health Promotion
The Body-Mind-Spirit (BMS) model of health promotion developed by C. L. W. Chan,
Ho, and Chow (2002) may provide guidance for the development of a multidimensional
measure of holistic health. This model is distinctive in at least two ways. First, its aim is to
develop a holistic model of health promotion that gives full recognition to the
interconnectedness of body, mind, and spirit. It adds a dimension, spirituality, to the
conception of health, which has largely been ignored in the past. We believe that without this
dimension, any conception of health is incomplete. Second, the model integrates Eastern
health practices, such as meditation, yoga, and martial arts (e.g., Taiji), and Western
psychotherapeutic techniques.
The BMS model has been applied to divorced women (C. L. W. Chan, Chan, & Lou,
2001), infertile couples (C. H. Y. Chan, Chan, Ng, Ho, & Chan, 2004), and most extensively,
cancer patients (C. L. W. Chan, Ho, & Chow, 2002; C. L. W. Chan, Law, & Leung, 2000).
Its efficacy has been documented (C. H. Y. Chan et al., 2004; C. L. W. Chan et al., 2002).
Considerable work has also been carried out in the area of psychophysiological oncology, and
the preliminary findings indicate that the salivary cortisol levels of breast cancer patients
show a decline over the first 8 months following BMS intervention, which is concomitant
with significant improvements in their general health (R. T. H. Ho & Chan, 2003).
Rationale for the Development of a Multidimensional Assessment Tool
The present study, which is grounded in the BMS model, is an attempt to develop and
validate a multidimensional inventory of holistic health. We call this the Body-Mind-Spirit
Well-Being Inventory (BMSWBI). Our experience in the application of the BMS model
suggests that an assessment of holistic health should attend to at least the following
components. First, the way in which the body functions. Is it under physical distress? Second,
the way in which a person functions, physically, cognitively, and motivationally, in everyday
life. Is the person full of life energy? Third, a persons affective life, both positive and
negative. Fourth, spirituality: transcendent or existential values, meanings, and principles.
Accordingly, the BMSWBI comprises four components: physical distress, daily
functioning, affect, and spirituality. Of these four, spirituality presents the greatest challenge
to measurement, and may explain why attempts to measure it have been rather rare. The BMS
model imposes on researchers two key requirements. First, spirituality should be
differentiated from religiosity. Religiosity usually refers to beliefs, sentiments, and practices
that are anchored in a particular religion; its expression is often institutional and
denominational, as well as personal. Attending church, or going to a temple, is an example of
religiosity. Though not necessarily anchored in a particular religion, spirituality embodies
overarching values, meanings, and principles according to which one conducts one's life. It
concerns transcendent or existential questions, such as "What is the meaning of life?" --
enduring questions as old as the emergence of self-consciousness in human history.
Contemplativeness and self-reflectiveness are hallmarks of spirituality. According to Richards
and Bergin (1997): "Religious expressions tend to be denominational, external, cognitive,
behavioral, ritualistic, and public. Spiritual experiences tend to be universal, ecumenical,
internal, affective, spontaneous, and private. It is possible to be religious without being
spiritual and spiritual without being religious" (p. 13). We may add that it is also possible to
be both.
Second, the conceptualization of spirituality should be ecumenical, and not be biased
toward or anchored in a particular religion. By ecumenical, we mean more than transcending
denominational boundaries; we mean respecting and endeavoring to identify common core
values and beliefs across the main philosophical-religious traditions of the world. Research on
spirituality has been dominated by Christian theology, which views spirituality as having a
personal relationship with God and surrendering to his will (Thoresen, Harris, & Oman, 2001).
Although this is currently a mainstream view in psychological research, it has limited
transcultural applicability because views derived from other religions have been excluded.
Intellectual traditions of the East promise to inform research on spirituality. D.Y. F. Ho
(1995) has explored the psychological content, especially selfhood and identity, in four Asian
traditions: Confucianism, Taoism, Buddhism, and Hinduism. For instance, the Eastern
concept of psychological de-centering, as articulated by D.Y. F. Ho, has great relevance to
contemporary approaches to the attainment of health. To be de-centered is to facilitate
selflessness (which does not mean absence of self). Selflessness is an antidote to egocentrism
and fixation. We may obtain a glimpse of what it could be like to be de-centered from the
ideas of the Daoist philosopher Zhuangzi: acting with spontaneity, freedom from fixed ideas,
feeling at home with the cosmos, experiencing losing or forgetting oneself, contemplating
the equality of all things, and thinking of others as I. These are among the attributes we
would expect to find in a spiritual person. Likewise, Buddhist ideas of compassion, letting go
of fixations, and personal transformation speak clearly on the spiritual dimension of health. In
sum, Eastern conceptions of spirituality include the capacity to endure, even accept, suffering
or misfortune; to construct and reconstruct meaning; to maintain peace of mind, spirit, and
sense of direction, even in the face of misfortune or harsh external circumstances. These
conceptions are, of course, not necessarily alien to the West.
Toward Transcultural Applicability
Meeting the two requirements we have stipulated would be a step toward achieving
transcultural applicability in the assessment of spirituality. To our knowledge, they have not
been met in measures of spirituality presently available. Accordingly, the BMSWBI is
developed with the twin intentions of differentiating spirituality from religiosity, and of
moving toward ecumenism. We propose to adopt two strategies: (a) extracting commonalities
at higher levels of abstraction across philosophical-religious traditions, and (b) maximal
inclusiveness (or minimal exclusiveness). The strategy of extracting commonalities begins
with taking note of the ecumenical or transcultural significance of some of the world's great
religious teachings. For instance, the idea that Christ or Buddha nature is inherent in all
humankind is ecumenical in orientation. Similarly, the idea of all-embracing Dao (law of
nature) serves to transcend barriers both between and within cultures. Thus, health promotion
inspired by these ideas is a step toward the eventual realization of ecumenical ideals for
healthcare professionals, Eastern or Western. In this sense, then, Buddhism and Daoism
transcend cultural boundaries. No less strong a case may be made for the Western world
religions.
Extracting commonalities presupposes the existence of core values and precepts shared
by different philosophical-religious traditions, although their concrete expressions may take
different forms. It entails the identification of these core values and precepts at a high level of
abstraction. To illustrate, we may take the case of the Buddhist belief that suffering ceases
through selflessness; the moral implication is that, likening others to oneself, one should
reduce suffering in others. Its counterpart in Christianity, though not identical, may be
discerned. Suffering presents opportunities for acts of courage, forbearance, or kindness, as
well as for strengthening one's faith. The exemplar is the suffering of J esus for the salvation of
all humankind. Extraction then results in affirming the value of suffering as a spiritual
value--but leaving open what that value may contain or entail. For social workers in
healthcare settings, this spiritual value has clear implications for how suffering, even as grave
as that caused by an incurable disease, may be transformed into a positive force.
The strategy of maximal inclusiveness states that a core value or belief originating from
one of the world's main philosophical-religious traditions may be accepted into the fold of
ecumenical spirituality, if it is not absent, negated, or disavowed in any other. Thus,
maintaining inner peace, pursuing truth, striving to reach higher goals, valuing human life,
love of humanity, and so forth qualify as spirituality, because to our knowledge they are
upheld in all traditions. In contrast, atonement for original sin is specific to Christianity and,
therefore, does not qualify. To be maximally inclusive is to say that we do not have a fixed
conception of what spirituality entails. Individuals from different cultural or religious
backgrounds are free to construe their own versions of spiritual well-being. All we insist is
that spirituality is not left out of a holistic conception of health.

Method
Respondents
The respondents consisted of a sample of 674 Chinese adults who voluntarily completed
the BMSWBI and a validity battery online via the Internet. Table 1 shows the characteristics
of the respondents.
Materials
BMSWBI. To construct the BMSWBI, a multidisciplinary task force composed of social
workers, psychologists, and a Chinese medicine practitioner was established to generate and
select items. The criteria for item selection included clarity, representativeness of the construct
being measured, and psychometric properties (e.g., corrected item-total correlation above .40).
Items that failed to meet these criteria were eliminated.
The end result is a self-report inventory comprising 56 items, of which 30 are negative,
for the measurement of holistic health (see Appendix). The inventory adopts an 11-point (or a
10-point) scale, with scores ranging from 0 (or 1) to 10; negative items are scored in the
reverse direction. Scores are summated over items, such that higher BMSWBI total scores
indicate better health. The inventory is divided into four scales: Physical Distress, Daily
Functioning, Affect, and Spirituality. Physical Distress measures the level of subjective
distress caused by specific physical symptoms that the respondents experienced during the
previous week. It consists of 14 items, examples of which are "constipation," "coldness of
hands or feet, "and "fatigue." Daily Functioning measures the respondents evaluation of their
daily functioning during the previous week. It consists of 10 items that pertain to physical
functions (e.g., "energy level"), cognitive functions (e.g., "concentration"), and motivational
functions (e.g., "work motivation"). Affect is a measure of the feelings and emotions of
respondents during the previous week. It consists of 19 items, of which 8 are positive and 11
are negative. Examples of positive items are "grateful," "contented," and "fortunate";
examples of negative items are "annoyed and irritable," "fearful," and "each day seems like a
year." Finally, Spirituality measures respondents core values, philosophy and meaning of life.
It comprises 13 items, of which 8 are positive and 5 are negative. An example of positive
items is I can face life with a moderate state of mind; an example of negative items is I
blame heaven for being unfair to me.
Validity battery. The instruments that served as indices of concurrent validity for the
BMSWBI were: (a) SF12 (Health Assessment Lab, 1995), a multipurpose measure of health
status that includes physical and mental components; (b) Chinese Affect Scale (Hamid &
Cheng, 1996), a measure of positive and negative emotional dispositions and states; (c)
Chinese Post-Traumatic Growth Inventory (S. M. Y. Ho, Chan, & Ho, 2004), which measures
positive life changes in people who have experienced trauma; (d) Satisfaction with Life Scale
(Diener, Emmons, Larsen, & Griffin, 1985); (e) Perceived Stress Scale (Cohen, Kamarck, &
Mermelstein, 1983), a measure of the degree to which situations in life are appraised as
stressful; and (f) Hope Scale (Snyder, Harris, Anderson, & Holleran, et al., 1991), a measure
of hope about future. These instruments are well established and have demonstrated
psychometric properties that justify their use as validity criteria.

Results
Factor Structures
Because the items in Daily Functioning, Affect, and Spirituality appeared to be rather
heterogeneous, exploratory factor analysis was performed for these three scales. A principal
component analysis with oblique rotation was also performed. Factor extraction was based on
the criterion that the eigenvalues were over one, and visual inspection of scree plots.
For the Daily Functioning scale, a one-factor solution was found that accounted for 58%
of the total variance. All factor loadings were higher than .54 (Table 2). These results indicate
the unidimensionality of the scale. A two-factor solution was found for the Affect scale. The
two factors accounted for 57% of the total variance, with Factor 1 accounting for 42% and
Factor 2 accounting for 15%. All factor loadings were over .45 (Table 3). Factor 1, which
consisted of the 11 negative items, was named Negative Affect, and Factor 2, which consisted
of the 8 positive items, was named Positive Affect. These constituted two subscales of Affect.
Originally, there were 14 items on the Spirituality scale. One item was removed after
initial analysis because it was loaded on two factors. Exploratory factor analysis was
performed again, which resulted in a three-factor solution. The three factors accounted for
65% of total variance. The factor loadings of all of the items were above .45 (Table 4). Factor
1 consisted of five items that pertained to peace of mind, and was named Tranquility. Factor 2
consisted of five items that pertained to loss of direction and a lack of vitality, and was named
Disorientation. Factor 3 consisted of three items that pertained to being grateful and
responding to the challenge of predicaments, and was named Resilience. These constitute the
three subscales of Spirituality.
Reliabilities and Intercorrelations
Internal reliabilities and intercorrelations of the BMSWBI scales and subscales are
presented in Table 5. Cronbachs ranges from .76 to .95, indicating that reliabilities are
highly satisfactory. All intercorrelations were in the expected directions. For instance,
correlations that involved Positive Affect were reversed for those involving Negative Affect.
Of special interest is that the magnitude of the correlation between Physical Distress and
Spirituality (and their subscales) was small, and noticeably smaller than the other correlations
(e.g., those between Physical Distress and Daily Functioning or Affect, and especially those
between Daily Functioning or Affect and Spirituality). This result suggests that physical
distress may only have a minor impact on spiritual health, and that the magnitude of its
impact is smaller than that of affective or daily functioning.
Validity
All of the relationships between the BMSWBI scales and the instruments in the validity
battery were in the expected direction (Table 6). Daily Functioning, Affect, and Spirituality all
had a strong positive relationship with the SF12 mental health subscale. Affect had the
strongest relationship with the Chinese Affect Scale. Finally, Spirituality had the strongest
relationship with the Post-Traumatic Growth Inventory scale, which measures growth and
positive change after a crisis. All of the BMSWBI scales were moderately related to perceived
stress, with correlations that ranged from .40 to -.72. This means that the higher the
well-being in daily functioning, affect, or spirituality, the lower the perceived stress.
Conversely, the higher the physical distress, the higher the perceived stress. These results
provide some evidence of validity.

Discussion
As practitioners, we aimed at building scales that are user-friendly, sensitive to
intervention and can easily be adopted by front-line social workers. To begin with, we take
note of a number of limitations to the present study. First, a convenience sample was used.
Most of the respondents in the present sample were relatively young and highly educated.
Therefore, the generalizability of the results is limited. Second, we have not yet estimated the
stability of the BMSWBI over time. Third, the BMSWBI and the instruments that were used
for validation were all self-report measures, and therefore the problems that are associated
with self-report data, especially that of self-inflated correlations (Nunnally, 1978), may arise.
In future studies, assessment techniques other than self-reporting (e.g., peer reporting and
behavioral measures of health) are advisable.
Despite these limitations, the present study has yielded some results of both practical
and theoretical interest. The psychometric properties of the BMSWBI, such as the reliability
and factor structure, are satisfactory, and some evidence of validity has been obtained. The
BMSWBI may be used as an efficient, multidimensional measure of holistic health with some
confidence. Its capacity to reflect the enhancement of positive living makes it especially
useful to healthcare professionals and medical social workers who are engaged in intervention
based on the BMS or similar models.
The interconnectedness of body and mind has been well-documented (e.g. Pelletier &
Herzing, 1987). Consistent with previous research, the relationships between physical distress,
daily functioning, and affect that were found in the present study provide further support for
considering body-mind interconnectedness as essential to the conception of health. The
present study also found that positive and negative affect form two separate factors. This adds
to the growing empirical evidence that they should not be construed as polar opposites on a
dimension (Diener, Suh, Lucas, & Smith, 1999). Positive affect is not simply the reverse of
negative affect, or vice versa. Conceptually, it is important to recognize that polarity is distinct
from dimensionality. Methodologically, it is more appropriate to represent positive and
negative affect on two unipolar dimensions, rather than on a single bipolar dimension. More
generally, the positive and the negative aspects of coping may have differential effects on
health, psychological growth, or quality of life. For instance, S. M. Y. Ho et al. (2004) have
shown that positive coping is a more potent determinant of posttraumatic growth than
negative coping (e.g., negative emotion and depression).
The magnitude of the correlations among the four BMSWBI scales (Table 5), which
ranged from low to moderate, suggests that Spirituality measures a health dimension that is
distinct from, and not reducible to, those measured by the other three scales. In particular, the
fact that Spirituality is only weakly related to Physical Distress, as well as to SF12 Physical
(see Table 6), carries an important message. Despite being physically distressed, many people
can remain spiritually healthy: tranquil, oriented, and resilient. This message has strong roots
in the Eastern idea that the spirit may gain control, and even master, the body. It provides both
direction and grounds for optimism for social work intervention in healthcare settings.
Attending to spirituality may enhance the overall health of those in need of care, regardless of
their physical condition. It puts the emphasis on positive living, growth, and transcendence,
rather than on disease and deficits, in accordance with the BMS model of intervention.
Our attempt to measure spirituality is the most ambitious part of this study. We have
obtained some evidence that, to a substantial extent, spirituality is associated with mental
well-being, positive affect, satisfaction with life, and hope in the positive direction; but
negatively with negative affect and perceived stress. Spirituality implies the wisdom to accept
unchangeable circumstances (emotion-focused coping) and to see difficulties as challenges
(problem-focused coping). We have identified three distinct aspects of spirituality: tranquility,
resistance to disorientation, and resilience. A spiritually healthy person remains inwardly
tranquil in the midst of external turmoil, retains a sense of direction in the midst of confusion,
and displays resilience in the face of hardship or suffering. Such a person embodies core
values rooted in religious and philosophical traditions, both Eastern and Western. The extent
to which these aspects of spirituality are found in diverse populations invites cross-cultural
research.
In conclusion, the development of the BMSWBI represents a step toward
multidimensional and transcultural assessment of holistic health. Formidable challenges to
research remain: more evidence for validity and demonstration of transcultural applicability.
We hope that our insistence on the inclusion of spirituality is an impetus for social workers in
healthcare settings to reexamine current theory and practice.

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Table 1: Characteristics of Respondents

Characteristic N Percentage
Gender
Male 188 28%
Female 483 72%
Age
20 or below 161 24%
21-30 413 61%
31-40 65 10%
41-50 35 5%
Education level
University or college undergraduate 161 24%
University postgraduate 513 76%
Marital status
Single 610 91%
Married 57 8%
Separated/divorced 5 <1%
Widowed 2 <1%
Number of children
0 627 95%
1 23 4%
2 9 1%
Religion
None 415 63%
Catholic 47 7%
Christian 155 23%
Buddhist 38 6%
Others 5 1%

Table 2: Factor Structure of Daily Functioning

Item Factor 1 (58%)
Energy level .868
Daily work/doing household chores .834
Dealing with difficulties .826
Concentration .819
Work motivation .806
Memory .790
Feeling on getting up .775
Sleeping .674
Appetite .594
Physical strength .544

Table 3: Factor Structure of Affect

Factor (% of variance)
Item 1 (42%) 2 (15%)
Factor 1: Negative Affect
Emotionally upset .840 .126
Sad .807 .058
Fearful .804 .040
Insecure .772 .002
Annoyed and irritable .751 -.110
Nervous .743 -.037
Helpless .740 -.128
Angry .728 .091
Worried .717 -.167
Lonely .662 -.095
Each day seems like a year .447 -.046
Factor 2: Positive Affect
Contented -.029 .838
Fortunate -.024 .833
Tender and loving .045 .748
Graceful .233 .740
Carefree -.159 .712
Happy -.102 .662
Full of confidence -.152 .662
Relaxed and at ease -.177 .610
Table 4: Factor Structure of Spirituality

Factor (% of variance)
Item 1 (44%) 2 (12%) 3 (9%)
Factor 1: Tranquility
I can be content with whatever comes. .922 .133 -.019
I can face life with a moderate state of
mind.
.904 .019 -.031
I can take something up, or let go of it. .813 -.102 .031
I feel calmness and harmony deep in
my heart.
.808 -.092 -.029
I deal with difficulties methodically. .505 -.141 -.226
Factor 2: Disorientation
I have lost direction in life. -.056 .850 -.073
I lack the vitality of life. -.036 .785 .025
I dont understand why predicaments
come to me.
.048 .778 .045
I dont know how to love myself. -.148 .770 -.169
I blame heaven for being unfair to me. .098 .561 .221
Factor 3: Resilience
To me, facing a predicament is a
challenge and a learning opportunity.
.052 .016 -.859
Predicaments can make me stronger. .060 -.010 -.806
I am grateful to people around me for
all the things they do for me.
.019 .021 -.748
Table 5. Reliabilities and Intercorrelations Among BMSWBI Scales and Subscales

BMSWBI scale or
subscale
a

Reliab
ility
b

Physic
al
Distres
s
Daily
Functi
oning
Affect Negati
ve
Affect
Positiv
e
Affect
Spiritu
ality
Tranqu
ility
Disor
ientat
ion
Resilie
nce
Physical Distress (14-) .87
Daily Functioning (10+) .92 -.41
Affect (19) .92 -.42 .68
Negative Affect (11-) .92 .47 -.56 -.91
Positive Affect (8+) .88 -.23 .68 .79 -.48
Spirituality (13) .89 -.27 .65 .73 -.61 .67
Tranquility (5+) .89 -.26 .57 .61 -.48 .61 .86
Disorientation (5-) .83 .25 -.55 -.70 .63 -.55 -.84 -.52
Resilience (3+) .76 -.10 .43 .40 -.28 .44 .71 .53 -.41
BMSWBI total (56) .95 -.63 .82 .91 -.82 .74 .82 .71 -.73 .50

Note. The scales and subscales are scored such that higher scores indicate better health for
Daily Functioning, Affect, Positive Affect, Tranquility, Resilience and BMSWBI total (with
negative items scored in the reverse direction), but indicate poorer health for Physical Distress,
Negative Affect, and Disorientation. All correlations are significant at the .01 level (2-tailed).
a
Numbers within parentheses indicate numbers of scale or subscale items. +=positive items,
- =negative items.
b
Cronbachs .

Table 6: Correlations Between the BMSWBI and the Validity Battery

BMSWBI
scale or
subscale
SF12
Physical
SF12
Mental
Chinese
Affect
Scale
Positive
Affect
Chinese
Affect
Scale
Negativ
e Affect
Post-Tra
umatic
Growth
Inventor
y Intra
personal
Post-Tra
umatic
Growth
Inventor
y Inter
personal
Perceive
d Stress
Scale
Satisfact
ion with
Life
Scale
Hope
Scale

BMSWBI
total
.26** .76** .73** -.73** .25** .19** -.76** .62** .74**
Physical
Distress
-.30** -.39** -.24** .42** .00 -.01 .40** -.18** -.30**
Daily
Functioning
.32** .66** .63** -.57** .24** .16** -.66** .55** .72**
Affect
.18** .73** .74** -.76** .20** .20** -.72** .60** .63**
Negative
Affect
-.19** -.66** -.56** .76** -.09* -.09* .67** -.47** -.53**
Positive Affect
.14** .61** .75** -.50** .30** .27** -.57** .59** .60**
Spirituality
.12** .66** .66** -.55** .38** .24** -.62** .64** .76**
Tranquility
.11** .57** .59** -.45** .36** .22** -.54** .49** .63**
Disorientation
-.08* -.60** -.54** .56** -.24** -.17** .57** -.63** -.64**
Resilience
.10* .35** .43** -.22** .38** .23** -.34** .38** .56**

**p <.01
* p <.05

Appendix
Body-Mind-Spirit Well-being Inventory (BMSWBI)

(A) Physical Distress
During the past week, how much distress did the following symptoms (if any) bring you? Please
circle the numbers that best fit your condition. (0 No distress at all, 10 Extreme distress)

Distress to you when symptom appeared

N
o

d
i
s
t
r
e
s
s

a
t

a
l
l

H
a
r
d
l
y

a
n
y

d
i
s
t
r
e
s
s

E
x
t
r
e
m
e

d
i
s
t
r
e
s
s

1. Headache 0 1 2 3 4 5 6 7 8 9 10
2. Dizziness 0 1 2 3 4 5 6 7 8 9 10
3. Insomnia 0 1 2 3 4 5 6 7 8 9 10
4. Blurred vision 0 1 2 3 4 5 6 7 8 9 10
4. Sore throat and/or hoarse voice 0 1 2 3 4 5 6 7 8 9 10
5. Difficulty in breathing 0 1 2 3 4 5 6 7 8 9 10
6. Palpitation 0 1 2 3 4 5 6 7 8 9 10
7. Chest pain 0 1 2 3 4 5 6 7 8 9 10
8. Stomach Discomfort 0 1 2 3 4 5 6 7 8 9 10
9. Diarrhea 0 1 2 3 4 5 6 7 8 9 10
10. Constipation 0 1 2 3 4 5 6 7 8 9 10
11. Coldness of hands or feet 0 1 2 3 4 5 6 7 8 9 10
12. Back pain 0 1 2 3 4 5 6 7 8 9 10
13. Fatigue 0 1 2 3 4 5 6 7 8 9 10

Copyright 2004 Centre on Behavioral Health.
(B) Daily Functioning
The aim of this section is to understand your daily functioning during the past week. Please circle
the numbers that best fit your condition.
(1 Extremely poor, 10 Extremely good)

E
x
t
r
e
m
e
l
y

p
o
o
r

E
x
t
r
e
m
e
l
y

g
o
o
d
1. Physical strength 1 2 3 4 5 6 7 8 9 10
2. Concentration 1 2 3 4 5 6 7 8 9 10
3. Sleeping 1 2 3 4 5 6 7 8 9 10
4. Appetite 1 2 3 4 5 6 7 8 9 10
5. Memory 1 2 3 4 5 6 7 8 9 10
6. Daily work/doing household chores 1 2 3 4 5 6 7 8 9 10
7. Energy level 1 2 3 4 5 6 7 8 9 10
8. Dealing with difficulties 1 2 3 4 5 6 7 8 9 10
9. Work motivation 1 2 3 4 5 6 7 8 9 10
10. Feeling on getting up 1 2 3 4 5 6 7 8 9 10

(C) Affect
The following expressions describe feelings and emotions. Please circle the numbers that best
describe your condition during the past week. Of course, peoples feelings and emotions vary daily,
so please consider how you felt generally during the past week.
(0 Not at all, 10 Extremely strong)

N
o
t

a
t

a
l
l

E
x
t
r
e
m
e
l
y

m
i
l
d

E
x
t
r
e
m
e
l
y

s
t
r
o
n
g

1. Lonely 0 1 2 3 4 5 6 7 8 9 10
2. Nervous 0 1 2 3 4 5 6 7 8 9 10
3. Insecure 0 1 2 3 4 5 6 7 8 9 10
4. Happy 0 1 2 3 4 5 6 7 8 9 10
5. Emotionally upset 0 1 2 3 4 5 6 7 8 9 10
6. Relaxed and at ease 0 1 2 3 4 5 6 7 8 9 10
7. Annoyed and irritable 0 1 2 3 4 5 6 7 8 9 10
8. Worried 0 1 2 3 4 5 6 7 8 9 10
9. Angry 0 1 2 3 4 5 6 7 8 9 10
10. Fearful 0 1 2 3 4 5 6 7 8 9 10
11. Sad 0 1 2 3 4 5 6 7 8 9 10
12. Grateful 0 1 2 3 4 5 6 7 8 9 10
13. Contented 0 1 2 3 4 5 6 7 8 9 10
14. Helpless 0 1 2 3 4 5 6 7 8 9 10
15. Carefree 0 1 2 3 4 5 6 7 8 9 10
16. Each day seems like a year 0 1 2 3 4 5 6 7 8 9 10
17. Full of confidence 0 1 2 3 4 5 6 7 8 9 10
18. Fortunate 0 1 2 3 4 5 6 7 8 9 10
19. Tender and loving 0 1 2 3 4 5 6 7 8 9 10


(D) Spirituality
Please circle the numbers that best fit how you react to the following thoughts, feelings, or
behaviors. (There are no right or wrong answers. Please answer according to your own feelings.)
(0 Totally disagree, 10 Totally agree)

T
o
t
a
l
l
y

d
i
s
a
g
r
e
e

T
o
t
a
l
l
y

a
g
r
e
e

1. I have lost direction in life. 0 1 2 3 4 5 6 7 8 9 10
2. I dont know how to love myself. 0 1 2 3 4 5 6 7 8 9 10
3. I dont understand why predicaments come to
me.
0 1 2 3 4 5 6 7 8 9 10
4. To me, facing a predicament is a challenge
and a learning opportunity.
0 1 2 3 4 5 6 7 8 9 10
5. I am grateful to people around me for all the
things that they do for me.
0 1 2 3 4 5 6 7 8 9 10
6. I blame heaven for being unfair to me. 0 1 2 3 4 5 6 7 8 9 10
7. Predicaments can make me stronger. 0 1 2 3 4 5 6 7 8 9 10
8. I lack the vitality of life. 0 1 2 3 4 5 6 7 8 9 10
9. I can be content with whatever comes. 0 1 2 3 4 5 6 7 8 9 10
10. I can face life with a moderate state of mind. 0 1 2 3 4 5 6 7 8 9 10
11. I feel calmness and harmony deep in my heart. 0 1 2 3 4 5 6 7 8 9 10
12. I can take something up, or let go of it. 0 1 2 3 4 5 6 7 8 9 10
13. I can deal with difficulties methodically. 0 1 2 3 4 5 6 7 8 9 10

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