http://tcn.sagepub.

com/
Journal of Transcultural Nursing
http://tcn.sagepub.com/content/22/3/248
The online version of this article can be found at:

DOI: 10.1177/1043659611404426
2011 22: 248 originally published online 19 April 2011 J Transcult Nurs
Nelda C. Martinez and Valmi D. Sousa
(S-BRCS)
Cross-Cultural Validation and Psychometric Evaluation of the Spanish Brief Religious Coping Scale

Published by:
http://www.sagepublications.com
On behalf of:

Transcultural Nursing Society

can be found at: Journal of Transcultural Nursing Additional services and information for

http://tcn.sagepub.com/cgi/alerts Email Alerts:

http://tcn.sagepub.com/subscriptions Subscriptions:
http://www.sagepub.com/journalsReprints.nav Reprints:

http://www.sagepub.com/journalsPermissions.nav Permissions:

http://tcn.sagepub.com/content/22/3/248.refs.html Citations:

What is This?

- Apr 19, 2011 OnlineFirst Version of Record

- Jun 10, 2011 Version of Record >>

at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
Journal of Transcultural Nursing
22(3) 248 256
The Author(s) 2011
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1043659611404426
http://tcn.sagepub.com
Introduction
Religion is central to the lives of Mexican Americans (MAs)
and an important source of strength for them in stressful life
situations (Lujan & Campbell, 2006; Pargament, 1997).
However, with regard to diabetes, little is known about the
role of religion among MAs in coping with this chronic illness.
During times of illnesses, people are likely to seek ways in
religious practice to cope with their health situation (Pargament,
1997; Siegel, Anderman, & Schrimshaw, 2001), particularly
MAs for whom religion is a central part of their lives (Lujan &
Campbell, 2006; Pargament, 1997). In addition, research sug-
gests that religion influences the coping mechanisms and
health outcomes of individuals with chronic diseases, including
those with type 2 diabetes (Gordon et al., 2002; Siegel et al.,
2001). In fact, religious coping was found to be associated
with daily self-care management in a diverse sample of indi-
viduals with type 2 diabetes (Lager, 2006). Only a few instru-
ments measure how MAs use religion to cope with stressful
life events. Of those that do, none exist in Spanish. Thus,
there is a need for reliable and valid instruments in Spanish
that measure religious coping among MAs who primarily or
only speak Spanish, especially those individuals with diabetes.
This research reports the results of a two-phase methodological
study to (a) cross-culturally validate the Spanish version of
the Brief Religious Coping Scale (S-BRCS) and (b) examine
the psychometric properties of the S-BRCS with a sample of
Spanish-speaking individuals with type 2 diabetes residing
in El Paso County, Texas, located along the United States
Mexico border region.
Background and Significance
Diabetes and Mexican Americans
An epidemic of type 2 diabetes exists in the United States
Mexico border communities because of a combination of fac-
tors such as the ethnic background of the population, high-risk
genetic predisposition, poor lifestyle habits, and socioeconomic
conditions (Centers for Disease Control and Prevention, 2005;
Sharp, 1998). Approximately 78% of residents in these border
404426TCNXXX10.1177/1043659611404426Mart inez and SousaJournal of Transcultural Nursing
1
The University of Texas at El Paso, El Paso, TX, USA
2
The University of Kansas, Kansas City, KS, USA
Corresponding Author:
Nelda C. Martinez, School of Nursing, The University of Texas
at El Paso, 1101 North Campbell Street, El Paso, TX 79902, USA
Email: ncmartinez@utep.edu
Cross-Cultural Validation and Psychometric
Evaluation of the Spanish Brief Religious
Coping Scale (S-BRCS)
Nelda C. Martinez, PhD, RN
1
, and Valmi D. Sousa, PhD, RN
2
Abstract
Purpose: To evaluate the psychometric properties of the Spanish Brief Religious Coping Scale (S-BRCS). Design: A descriptive
correlational design was used to conduct the study among a convenience sample of 121 Mexican Americans with diabetes.
Results: The positive and negative religious coping subscales had Cronbachs alphas of .85 and .86, respectively. All interitem
and item-to-total correlations for each subscale were above the recommended criteria of .30. Factor loadings of the positive
subscale using oblique (oblimin) and orthogonal (varimax) rotation ranged from .71 to .86 and from .72 to .86, respectively.
Factor loadings of the negative subscale using oblimin and varimax rotation ranged from .64 to .83 and from .63 to .83,
respectively. Discussion and Conclusions: The S-BRCS was found to be a valid and reliable instrument to measure
religious coping among Spanish-speaking Mexican Americans with type 2 diabetes. Implications for Further Research and
Practice: Further psychometric evaluation of the S-BRCS among larger sample of Mexican Americans and other Hispanic
ethnic groups is warranted. The S-BRCS has the potential to become a standard instrument that can be used by clinicians who
work with Hispanic clients with diabetes mellitus to provide culturally competent diabetes care.
Keywords
Spanish Brief Religious Coping Scale, instrument development, cross-cultural validation, psychometrics, Mexican Americans,
community health, survey design, Hispanic
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
Martinez and Sousa 249
regions are MAs, and these individuals, along with those
in the southwest Texas region, have type 2 diabetes (Texas
Diabetes Council [TDC], 2008). This represents a 2% higher
prevalence of diabetes than in other regions in the state of
Texas (TDC, 2008). MAs are more likely to be diagnosed
with type 2 diabetes at a younger age, exhibit higher fasting
glucose levels, and develop more severe forms of diabetes-
related complications such as renal failure, blindness, and
lower extremity amputations (Brown, Becker, Garcia, Barton,
& Hanis, 2002). Approximately 3.9 billion dollars are spent
on health care to treat these diabetes-related complications,
which is greatly attributed to hospitalization, particularly
because MAs do not have health care coverage or are under-
insured (Russo & Jung, 2006). However, little is known about
the efficacy of diabetes primary prevention programs for MAs
to avert hospital admission and associated health care costs.
The increased incidence and severity of diabetes compli-
cations among MAs has been associated with poor blood glu-
cose control (Brown et al., 2002; TDC, 2008). Hyperglycemia
and poor daily diabetes self-management are associated with
environmental and sociocultural factors, which include reli-
ance on folk healers for health advice, a tendency to consider
family needs as more important than individual personal
needs, geographic isolation from health care providers, lack of
transportation and health insurance, and language differences
with health care workers (Brown et al., 2002; Lipton et al.,
1996). Whereas MAs report that family support is especially
important (Wen, Shepard, & Parchman, 2004), a familys
lack of understanding and support is associated with anxi-
ety and depression affecting diabetes control and quality
of life of MAs with diabetes (Cherrington, Ayala, Sleath, &
Corbie-Smith, 2006).
MAs along the U.S. border with Mexico identify them-
selves with the Mexican culture more often than their coun-
terparts in other areas of the country (Harris, Eastman, Cowi,
Flegal, & Eberhardt, 1999; Sharp, 1998). This is reflected in
the low acculturation to the English language and the American
lifestyle, attributed to close geographic proximity of the bor-
der to Mexico and a large number of residents who are new
immigrants (approximately 25%) and first-generation MAs
(Marin & Marin, 1991; Sharp, 1998; U.S. Census Bureau,
2000). The MA culture consists of many strong and distinctive
characteristics that affect health (Purnell & Paulanka, 2003).
These include the use of the Spanish language, collectivism,
and nutritional intake of specific food groups, as well as socio-
cultural elements such as family, religion, and the use of
nontraditional curative herbs (Brown et al., 2002; Purnell &
Paulanka, 2003). These unique characteristics often dictate
how MAs cope with health problems that require lifestyle
change, especially with chronic illnesses such as type 2 dia-
betes (Brown et al., 2002). This requires health care providers
to acknowledge, understand, and appreciate the unique char-
acteristics of MAs to provide effective clinical diabetes man-
agement. Cultural sensitivity has been associated with positive
outcomes, including increased consumer satisfaction, improved
health education program completion rates, and compliance
with and adherence to prescribed medical regimens (Cross,
Bazron, Dennis, & Isaacs, 1989; Office of Minority Health,
2001). The national standards for diabetes self-management
education require a comprehensive cultural sensitivity that
acknowledges the religious beliefs and practices of indi-
viduals with diabetes (American Association of Diabetes
Educators, 2007). However, there are limited studies to deter-
mine culturally relevant interventions and outcome measures
associated with religion among MAs with diabetes (Oomen,
Owen, & Suggs, 1999). Measurements of religiosity have been
limited. For example, Schwab, Meyer, and Merrell (1994)
included only one item related to religion Its Gods will that
I have diabetes to measure health beliefs of low-income MAs
with diabetes. One item of an instrument cannot be a valid
measure of religious beliefs and therefore there is a need
for comprehensive, valid, and reliable measures of religious
beliefs. The religious affiliation of MAs transcends genera-
tions, and very little change in religious affiliation takes
place from one generation to the next (Markides & Cole,
1984). Approximately 90% of MAs are Catholic (Kane &
Williams, 2000; Markides, Martin, & Gomez, 1983); Methodist,
Presbyterian, and Baptist churches are represented within the
MA cultural group to a much smaller extent (Markides & Cole,
1984). MAs expect religiosity to be respected by diabetes
health care providers and integrated into the care that is deliv-
ered to them (Devlin, Roberts, Okaya, & Xiong, 2006; Purnell
& Paulanka, 2003). Therefore, it is critical to understand the
way they use religiosity to cope with health problems.
Measuring Religious Coping
The concept of religiosity is a functional indicator of belief and
behavior in coping with life events including both physically
and psychosocially stressful situations (Ano & Vasconcelles,
2004). Foremost and critically important is systematic assess-
ment of the role of religion in coping with stressful events.
Research prior to the development of an instrument for this
measure was based on a crude assessment of largely singular
religious practices such as church attendance and frequency
of prayer (Hill & Hood, 1999). This led to the development
of a comprehensive Religious Coping instrument (RCOPE)
composed of a list of multidimensional and interrelated reli-
gious activities to reflect ways of coping with crisis in daily life
(Pargament et al., 1988). These religious activities included
spiritually based coping, good deeds coping, coping by express-
ing discontent, coping through interpersonal religious sup-
port, coping by pleading, and religious avoidance coping. The
RCOPE measures five major constructs: (a) coping to find
meaning, (b) coping to gain control, (c) coping to gain com-
fort and closeness to God, (d) coping to gain intimacy with
others and closeness to God, and (e) coping to achieve a life
transformation (Pargament et al., 1988). After further devel-
opment and refinement of the RCOPE, another valid, reli-
able, and short instrument, the Brief Religious Coping Scale
(Brief RCOPE), was derived and found to have a good
model fit (goodness of fit index = .95, Delta 2 fit index = .95,
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
250 Journal of Transcultural Nursing 22(3)
relative noncentrality index = .95, and root mean square error
of approximation = .06; Pargament, Smith, Koenig, & Perez,
1998). Therefore, the English version of this valid and reliable
instrument was chosen to be translated and validated among
MAs. The purpose was to have a culturally and linguistically
appropriate instrument that measured religious belief and
that might influence health outcomes among MAs.
The Spanish Version of the Brief
Religious Coping Scale
The S-BRCS was derived from the original English version
of the Brief RECOPE (Pargament et al., 1998). This 14-item,
4-point Likert-type scale consists of two subscales: positive
religious coping (7 test items) and negative religious coping
(7 test items). Responses on both of these subscales range
from 0 = not at all to 3 = a great deal. However, because it
is known that MAs have difficulty with Likert-type scales,
the response options without a number are used in the
S-BRCS. Therefore, the response options for each item of the
instrument are Nunca = not at all, Alguna Vez = somewhat,
Con Frecuencia = quite a bit, and Mucho = a great deal.
In addition, as in the English version, each subscale of the
S-BRCS is scored individually to measure and reflect each
distinctive pattern of positive and negative religious cop-
ing; hence, these two subscales are not correlated with each
other. Examples of positive and negative items of the scale
include Item 1 (positive) Busqu una conexin mas fuerte
con Dios (Look for a stronger connection with God) and
Item 8 (negative) Me pergunt si Dios me haba abando-
nado (Wondered whether God had abandoned me).
Method
Research Design
A descriptive correlation design was used to conduct this
two-phase methodological study. This approach is widely used
to refine and evaluate the psychometric properties of research
instruments (Burns & Grove, 2005; Polit & Beck, 2008).
Forward- and back-translations were used to cross-cultural
validate the S-BRCS. Scale and item analysis and exploratory
factor analysis were used in a field testing to assess the factor
structure of the S-BRCS that best describes the data.
Phase 1: Cross-Cultural Validation of the S-BRCS. The English
language version of the RCOPE was forward-translated
into Spanish using the multistep Cross-Cultural Adaptation
of EnglishSpanish Language Instruments: Independent Par-
allel Translation Methodology. Three bilingual Hispanic
Americans with Spanish as their first language forward-
translated the RCOPE from English to Spanish independent
of each other.
These individuals were (a) male, native of Mexico, with
a postsecondary administration degree from an academic
institution in Mexico; (b) female, native of Puerto Rico, high
school graduate, and coordinator of a local Hispanic/Latino
community health care center that included diabetes educa-
tion programs; and (c) female, third-generation MA, native of
southwest Texas, and doctoral student in biological sciences.
Following the return of their independent translations within
1 month, a research team meeting was held to evaluate the
Spanish-language versions of the instrument. The three trans-
lated versions of the scale had considerable variance in seman-
tics and syntax.
Consensus was reached by the research team that two of
the translated versions of the scale had more semantic simi-
larities on their items. These two Spanish versions of the scale
were then back-translated into English by two other indepen-
dent bilingual professional translators. The two versions of the
Spanish translation and their back-translations were reviewed
and compared by the principal investigator and research team,
who have research and clinical experience with MA popula-
tion groups. Subsequent research team meetings were held
until consensus was reached on the final cross-culturalvalidated
Spanish version of the scale that resulted in reference to the
instrument as the Spanish Brief Religious Coping Scale
(S-BRCS). This final Spanish version was revised and
edited further to meet the requirements of Spanish grammar
and structure by another translator who was a certified, mas-
ters-prepared Spanish translator, native of Mexico, and cur-
rent resident in El Paso County, Texas. Through this process,
a cross-cultural valid Spanish version of the scale was
derived that was semantically and linguistically appropriate
for Mexicans and MAs.
Phase 2: Psychometric Testing of the S-BRCS
Setting. The data collection site for this study was El Paso
County, Texas, located on the United StatesMexico border
where 80% of the people are MAs with an annual average
per capita income of $9,000 (U.S. Census Bureau, 2000).
About 73% of the people living in the region are English and
Spanish speaking with 97% reporting that they speak Span-
ish fluently (U.S. Census Bureau, 2000). They have a mean
age of 53.7 years, with a greater percentage reflecting lower
levels of education and income and more difficulty finding
work (Martinez & Bader, 2007). This county is designated by
the federal government as medically underserved and is char-
acterized as a health professional shortage area (Sharp, 1998).
Approximately 7.4% of this population has diabetes mellitus
(TDC, 2008).
Sample. A convenience sample of 121 individuals with dia-
betes mellitus was recruited from four sites in El Paso County:
(a) a Catholic church, (b) a diabetes community education cen-
ter, (c) a senior citizen center, and (d) a community health care
center. The sample consisted of subjects who self-reported as
being Mexican/MA, 21 years old and older, diagnosed with
type 2 diabetes, using one or more prescribed diabetes treat-
ments (e.g., healthy eating only, a combination of healthy
eating and oral hypoglycemic agents, or a combination of
oral hypoglycemic agents and insulin therapy), monolingual
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
Martinez and Sousa 251
in Spanish or bilingual Spanish and English speaking with
Spanish as their primary language, and able to read and write
in Spanish. Subjects were excluded from participation if they
self-reported a medical history of physical disability (e.g.,
blindness) or psychological condition associated with cog-
nitive impairment (e.g., depressive disorder), were English-
speaking only, or were bilingual English and Spanish speaking
but with Spanish not their primary language.
Instruments and variables. In addition to the S-BRCS previ-
ously described, a demographic questionnaire was used to col-
lect background information on elements such as age, gender,
education and income levels, duration of diabetes, prescribed
diabetes treatments, diabetes education experience, self-rating
of diabetes knowledge, religious affiliation, and religious ser-
vice attendance and activities.
Procedure for data collection. Following approval of the
study by the Institutional Review Board at The University of
Texas at El Paso, the primary investigator of this study along
with research assistants attended various meetings at each of
the four recruitment sites. With the support of site personnel,
people in the community were provided with a description of
the study, the projected time line for their participation, and
elements of the privacy and confidentiality issues of their
study participation. Those who agreed to participate com-
pleted the S-BRCS either on site or at their home and returned
the instrument by mail using a preaddressed stamped enve-
lope provided by the research team. For retest purposes, par-
ticipants were mailed a second copy of the instrument within
2 weeks and asked to return it using a preaddressed stamped
envelope. Participants completion and return of the survey
implied their consent for participation in the study. To enhance
the response rate, 1-week and 2-week reminder cards were
mailed to participants.
Data analysis. SPSS (Version 17.0) was used to perform
data analysis. Descriptive statistics were used to characterize
the study sample and items of both the positive and negative
religious coping subscales. Cronbachs coefficient alpha and
scale and item analysis were used to determine the subscales
internal consistency and homogeneity. Pearsons correlation
coefficients were used to determine testretest reliability and
distinctive positive and negative patterns of the scales.
Factor analysis was used to examine the patterns of factor
loading of the items of both positive and negative religious
coping scales.
Results
Characteristics of the Sample
A total of 121 participants were involved in this study. Of
these, 5 participants (4.1%) were removed because of the
limited number of responses they provided to both positive and
negative subscale test items. This resulted in a final sample
of 116 that was used for psychometric data analysis in which
111 participants (95.7%) responded to all items on the positive
religious subscale and 112 participants (96.5%) responded to
all items on the negative religious subscale. For testretest
reliability purposes, 48 subjects (41.4%) completed and returned
the second copy of the instrument. The majority of subjects
(80%) were 68 years old or younger (age ranged from 36 to
88 years, mean = 58.76, SD = 11.75), were female (78%), and
spoke only Spanish (56%). Thirty-eight percent of the partici-
pants had at least some middle school education and a yearly
income of less than $20,000 and almost half (49.6%) reported
they had health insurance. The majority of participants (77%)
reported having diabetes mellitus for 10 years or less, and
62% of them used only oral hypoglycemic agents to man-
age diabetes. Although 73% attended a formal diabetes self-
management education program, only 35% reported that
their diabetes knowledge was satisfactory. A total of 82% of
the participants indicated that they were Catholic with 59.5%
reporting they attended religious services at least once a week.
Almost all participants (93.4%) indicated they prayed about
health problems, and a large number (65%) reported that they
prayed every day. Based on the study sites, 73% of the par-
ticipants came from the Catholic Church and 11% each from
the community diabetes education center and the community
health care center. The remaining 5% of participants were
from the senior citizen center. Most of the participants were
able to complete the items of the S-BRCS at their respective
sites and in approximately 8 minutes (timed by the investi-
gator or a research assistant).
Internal Consistency and Item Analysis
of the Positive Subscale of the S-BRCS
Initial analysis for internal consistency of the positive reli-
gious coping subscale yielded Cronbachs alpha of .81. The
analyses of variance with Tukeys test for nonadditivity and
Hottellings T-square test were both statistically significant
(p < .01), indicating this internal consistency was estimated
appropriately. Interitem correlations showed that test Item 6
Ped perdn por mis pecados (Asked for forgiveness for
my sin) and Item 7 Me enfoqu en la religin para olvidar
mis problemas (Focused on religion to stop worrying about
my problems) had correlation coefficients below the recom-
mended criteria of .30 (Ferketich, 1991; Nunnally & Bernstein,
1994), suggesting their inconsistency and nonhomogeneity
intended for appropriate items in this subscale. Subsequent
analysis showed that if Item 6 were deleted from the subscale,
Cronbachs alpha would increase from .81 to .83; hence this
item was deleted from the positive religious coping subscale.
With this test item removed, the next analysis showed that
Cronbachs alpha would now increase from .83 to .85 if test
Item 7 were deleted from the subscale. Thus, test Item 7 was
also deleted from the subscale. As shown in Tables 1 and 2,
new analysis showed that all interitem and item-to-total
correlation coefficients were >.30, which suggested that all
items were then consistent with each other and with the
overall subscale to measure positive religious coping.
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
252 Journal of Transcultural Nursing 22(3)
Internal Consistency and Item Analysis
of the Negative Subscale of the S-BRCS
Initial internal consistency reliability testing of the negative
religious subscale yielded Cronbachs of .84. The analysis
of variance with Tukeys test for nonadditivity and the
Hottellings T-square test were both statistically significant
(p < .01), indicating the internal consistency was estimated
appropriately. Interitem correlations showed that Item 13
Decid que fue el diablo quien hizo esto (Decided the devil
made this happen) had a correlation coefficient below the
recommended criteria of .30 (Ferketich, 1991; Nunnally &
Bernstein, 1994), suggesting inconsistency and nonhomoge-
neity. In addition, if this item was deleted from the subscale,
Cronbachs alpha would increase from .84 to .86; hence test
Item 13 was deleted from the negative religious coping sub-
scale. As shown in Tables 2 and 3, new analysis showed all
interitem and item-to-total correlation coefficients of this
subscale were >.30, which suggested that all items were then
consistent with each other and with the overall subscale.
Descriptive statistics of the items of the final five-item posi-
tive religious coping subscale and six-item negative reli-
gious coping subscale suggested that all items had sufficient
variance for inclusion in a factor analysis.
TestRetest Reliability of Both Subscales of the S-BRCS
The testretest reliability between the first and second test
of the positive religious coping subscale was r = .78 (p <
.01) and r = .72 (p <.01) for the negative religious coping
subscale. These findings suggest that both these subscales
had acceptable reliability. Per recommendation of the author
of the religious coping scale (Pargament, 1998), we also
confirmed that the mean scores of the positive and negative
religious coping subscales were uncorrelated on both test
(r = .06, p > .05) and retest (r = .01, p > .05). These findings
support the conclusion that the positive and negative sub-
scales measure distinctive patterns of religious coping.
Factorial Structure of the S-BRCS
An initial principal component factor analysis was conducted
on the 14 items of the S-BRCS. Both the KaiserMeyer
Olkin measure of sampling adequacy of .77 and the Bartletts
test of sphericity significance level (
2
= 745.105, df = 91, p <
.001) indicated the data were appropriate for factor analysis.
This factor analysis extracted three factors with eigenvalues
greater than 1, which was consistent with the scree plot.
Although the three extracted factors together explained
62.85% of the item variance of the S-BRCS, only two items,
Item 6 Ped perdn por mis pecados (Asked for forgiveness
for my sin) and Item 7 Me enfoqu en la religin para olvi-
dar mis problemas (Focused on religion to stop worrying
about my problems) loaded on Factor 3. This supported the
item analysis previously reported. Items 6 and 7 on the posi-
tive religious coping subscale were not consistent with the
other items of the subscale. Since a factor with three or fewer
factor loadings is considered unstable (Costello & Osborne,
2005), we deleted these two items from subsequent factor
analysis. A new principal component analysis with oblique
rotation was conducted on the remaining 12-item scale. This
new analysis extracts only two factors with eigenvalues greater
than 1, which was also consistent with the scree plot. The
two factors explained 58.80% of the item variance of the
S-BRCS. However, only Item 13 Decid que fue el diablo
quien hizo esto (Decided the devil made this happen) loaded
on Factor 3, which had an eigenvalue below the standard
recommendation of at least 1. Again, a factor with three
or fewer factor loadings is considered unstable (Costello &
Osborne, 2005); therefore, this item was also deleted from
subsequent factor analysis
The final factor analysis used the principal component
analysis method for two factors with both oblique (oblimin)
and orthogonal (varimax) factor rotations of the remaining
11 items of S-BRCS. Although varimax rotation alone would
be appropriate because the two factors are uncorrelated
(Munro, 2005), oblique (oblimin) rotation was conducted to
be able to compare the findings with the original scale in
English (Pargament et al., 1998), which reported factor anal-
ysis using oblique rotation only. As shown in Table 2, the
two extracted factors of this new model together explained
62.4% of the scale items variance. The two factors had
eigenvalues of 3.669 and 3.210, respectively. They were
consistent with the scree plot (Figure 1) and explained 33.3%
and 29.1% of the scale variance, respectively, which was
higher than the previous factor analyses described above. As
shown in the component plots of oblimin rotation (Figure 2)
and varimax rotation (Figure 3), the variance accounted for
by each factor and the scree plot analysis were consistent
with a two-factor solution. As also shown in Table 2, each
item of scale had a strong factor loading using oblique rota-
tion (ranging from .64 to .86) and varimax rotation (ranging
from .63 to .86), exceeding the criterion of at least .32 to
retain a factor (Tabachnick & Fidell, 2001). The estimate of
reliability of Factor 1 (the positive religious coping subscale)
and Factor 2 (the negative religious coping subscale) also
met the recommended criteria for internal consistency with
Cronbachs alphas of .85 and .86, respectively. If any items
of the positive or negative subscales were deleted, there were
no changes in Cronbachs alpha. These two final models were
Table 1. Positive S-BRCS ItemItem Correlation Matrix
Items 1 2 3 4 5
1 1.00
2 .66 1.00
3 .38 .53 1.00
4 .49 .65 .64 1.00
5 .43 .62 .55 .67 1.00
Note: S-BRCS = Spanish Brief Religious Coping Scale.
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
Martinez and Sousa 253
Table 2. S-BRCS Item Analysis and Principal Component Factor Analysis With Both Oblique and Varimax Rotation (N = 116)
Factor
Loading
Factor and Change
in if Item Deleted h
2
ItemtoTotal
Correlation Factor/Item Obl Var
Factor 1: Positive Religious Coping Scale (eigenvalue = 3.669,
explained variance = 33.3%)
.85
1. Busqu una conexin ms fuerte con Dios (Look for a strong
connection with God)
.72 .71 .85 .52 .57
2. Busqu el amor y el cuidado de Dios (Sought Gods love and care) .86 .86 .81 .73 .76
3. Busqu la ayuda de Dios para renunciar a mi coraje (Sought help
from God in letting go of anger)
.77 .77 .84 .59 .63
4. Trat de llevar a cabo mis planes junto con Dios (Tried to put my
plans into action together with God)
.86 .86 .80 .74 .76
5. Trat de ver cmo podra Dios estar tratando de fortalecerme en esta
situacin (Tried to see how God might be trying to strengthen
me in this situation)
.81 .81 .82 .67 .69
Factor 2: Negative Religious Coping Scale (eigenvalue = 3.210,
explained variance = 29.1%)
.86
1. Me pregunt si Dios me haba abandonado (Wondered whether
God had abandoned me)
.77 .77 .83 .60 .65
2. Sent que Dios me estaba castigando por mi falta de devocin (Felt
punished by God for my lack of devotion)
.82 .82 .82 .69 .70
3. Me pregunt que es lo que hice para que Dios me castigara
(Wondered what I did for God to punish me)
.83 .83 .82 .69 .73
4. Cuestion el amor de Dios por m (Questioned Gods love for me) .76 .76 .83 .58 .65
5. Me pregunt si mi iglesia me haba abandonado (Wondered
whether my church had abandoned me)
.76 .76 .83 .58 .65
6. Cuestion el poder de Dios (Questioned the power of God) .64 .63 .85 .43 .52
Note: S-BRCS = Spanish Brief Religious Coping Scale; Obl = oblique; Var = varimax; h
2
= communality.
Table 3. Negative S-BRCS ItemItem Correlation Matrix
Items 6 7 8 9 10 11
6 1.00
7 .58 1.00
8 .52 .79 1.00
9 .50 .54 .49 1.00
10 .43 .45 .58 .48 1.00
11 .35 .35 .39 .54 .44 1.00
Note: S-BRCS = Spanish Brief Religious Coping Scale.
the best factor structures for the positive and negative reli-
gious coping subscales.
Discussion and Conclusions
This study supports the cross-cultural validation and psycho-
metric properties of the S-BRCS. The items and response
format of scale were found to be appropriate for Spanish-
speaking MAs. Participants on the field testing did not voice
any difficulty in reading and selecting the response that best
described their religious coping. Two items on the positive
religious coping subscale and one item on the negative reli-
gious coping subscale did not work well among the sample of
MAs who participated in this study. This pattern was observed
during item analysis and factor analysis. It may be that the
sample of MAs did not see Perdn de pecados (forgiveness
of sins), religin para olvidar problemas (religion as a way
to stop worrying about problems), and fue diablo quien hizo
esto (devil made this happen) important for their religious
coping. The results of factor analysis also confirmed this pat-
tern. Further investigation of the use of these items of the
scale among a larger sample of MAs is warranted, since those
items belonged to the composite of their respective subscales
in testing of the English version of the scale in American
samples (Pargament et at., 1998).
Both the final five-item positive religious coping subscale
and the six-item negative coping subscale had Cronbachs
alphas above the minimum recommendation of .70 for inter-
nal consistency (Nunnally & Bernstein, 1994), and all inter-
item and item-to-total correlation coefficients were >.30 for
homogeneity (Ferketich, 1991). In fact, Cronbachs alphas
for the positive and negative subscales were .85 and .86,
respectively. These findings are consistent with those reported
on the English version of the scale with two American sam-
ples, in which Cronbachs alphas ranged from .87 to .90 for
the positive subscale and from .78 to .81for the negative scale,
respectively (Pargament et al., 1998).
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
254 Journal of Transcultural Nursing 22(3)
Figure 1. S-BRCS scree plot
Note: S-BRCS = Spanish Brief Religious Coping Scale.
Figure 2. S-BRCS component plot in oblique (oblimin) rotation
Note: S-BRCS = Spanish Brief Religious Coping Scale.
The results of factor analysis confirmed distinctive
positive and negative cooping subscales. The two subscales
together explained 62.4% of the item variance and had
strong factor loadings above the recommended criteria of .32
(Tabachnick & Fidell, 2001). The explained variance of each
factor for the positive and negative religious coping subscales
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
Martinez and Sousa 255
ranged from .52 to .67 and from .43 to .69, respectively. The
factor loadings for the positive subscale using oblique and
varimax rotation ranged from .72 to .86 and from .71 to .86,
respectively. The factor loading for the negative subscale using
oblique and varimax rotation ranged from .64 to .83 and
from .63 to .83, respectively. The pattern of factor loadings
was the same with oblimin as varimax rotation. The findings
using oblimin rotation are supported by those reported by
Pargament et al. (1998), who used oblique rotation.
Limitations of the study include the use of convenience
sample, one area of the State of Texas only being covered,
and lack of variation regarding religious affiliation. Despite
these limitations, the findings of our study support an
S-BRCS that is short and reliable. However, we recommend
further testing of the scale in a larger sample of MAs from
other religious affiliations. The S-BRCS is easy to use and
takes approximately 8 minutes to complete. The scale can be
used in clinical practice and research to assess religious cop-
ing among MAs with diabetes mellitus. This information
may be used to provide culturally sensitive diabetes care that
includes diabetes self-management education.
Implications for Further
Research and Practice
Having a valid and reliable instrument that measures reli-
gious coping among MAs offers clinicians a way to assess
and provide diabetes care that is tailored and culturally sen-
sitive. The format of the responses makes it easy to use
among populations with low literacy, especially Mexicans or
MAs whose primary or sole language is Spanish. The
S-BRCS can be useful to examine the influence of religion
on the coping mechanisms and health outcomes in this eth-
nic group with type 2 diabetes. Future research could extend
the usability of the S-BRCS by testing its psychometric
properties among other Hispanic ethnic groups to develop
other specific cross-cultural formats. The S-BRCS has the
potential to become a standard instrument that can be used
by clinicians who work with Hispanic clients with diabetes
mellitus who may need to assess religiosity as a vital step in
providing culturally competent diabetes care.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article:
This study was funded by Faculty Research Support Program,
The University of Texas at El Paso, and supported in part by Grant
No. R03NR009059-01, National Institute of Nursing Research,
National Institutes of Health, Rockville, Maryland.
References
American Association of Diabetes Educators. (2007). AADE posi-
tion statement: Individualization of diabetes self-management
education. The Diabetes Educator, 33, 45-49.
Figure 3. S-BRCS component plot in varimax rotation
Note: S-BRCS = Spanish Brief Religious Coping Scale.
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from
256 Journal of Transcultural Nursing 22(3)
Ano, G. G., & Vasconcelles, E. B. (2004). Religious coping and
psychological adjustment to stress: A meta-analysis. Journal of
Clinical Psychology, 61, 461-480.
Brown, S. A, Becker, H., Garcia, A. A., Barton, S. A., & Hanis, C. L.
(2002). Measuring health beliefs in Spanish-speaking Mexican
Americans with type 2 diabetes: Adapting an existing instru-
ment. Research in Nursing & Health, 25, 145-158.
Burns, N., & Grove, S. K. (2005). The practice of nursing research:
Conduct, critique, and utilization (5th ed.). St. Louis, MO:
Elsevier Saunders.
Centers for Disease Control and Prevention. (2005). National dia-
betes fact sheet: general information and national estimates on
diabetes in the United States. Atlanta, GA: U.S. Department of
Health and Human Services.
Cherrington, A., Ayala, G. X., Sleath, B., & Corbie-Smith, G. (2006).
Examining knowledge, attitudes and beliefs about depression
among Latino adults with type 2 diabetes. The Diabetes Educator,
32, 603-613.
Costello, A. B., & Osborne, J. (2005). Best practice in exploratory
factor analysis: Four recommendations for getting the most from
your analysis. Practical Assessment Research & Evaluation,
10(7). Retrieved from http://pareonline.net/pdf/v10n7.pdf
Cross, W. E., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989).
Towards a culturally competent system of care. Washington,
DC: Georgetown University.
Devlin, H., Roberts, M., Okaya, A., & Xiong, Y. M. (2006). Our lives
were healthier before: Focus groups with African American,
American Indian, Hispanic/Latino, and Hmong people with dia-
betes. Health Promotion Practice, 7, 47-55.
Ferketich, S. (1991). Focus on psychometrics: Aspects of item analysis.
Research in Nursing & Health, 14, 165-168.
Gordon, P. A., Feldman, D., Crose, R., Schoen, E., Griffing, G., &
Shankar, J. (2002). The role of religious beliefs in coping with
chronic illeness. Counseling and Values, 46, 162-174.
Harris, M. I., Eastman R. C., Cowie, C. C., Flegal, K. M., & Eber-
hardt, M. S. (1999). Racial and ethnic differences in glycemic
control of adults with type 2 diabetes. Diabetes Care, 22, 403-
408.
Hill, P. C., & Hood, R. W. (1999). Measures of religiosity. Birmingham,
AL: Religious Education Press.
Kane, M. N., & Williams, M. (2002). Perceptions of South Florida
Hispanic and Anglo Catholics: From whom would they seek
help? Journal of Religion and Health, 39, 107-121.
Lager, J. M. (2006). Relationship among religious coping, psy-
chosocial factors, and quality of life in individuals with type
2 diabetes (Unpublished doctoral dissertation). Texas A&M
University, College Station.
Lipton, R., Lose, L., Giachello, A., Carrol, M., Girotti, M. H., &
Mendez, J. J. (1996). Factors affecting diabetes treatment and
patient education among Latinos: Results of a preliminary
study in Chicago. Journal of Medical Systems, 20, 267-276.
Lujan, J., & Campbell, H. B. (2006). The role of religion on the
health practices of Mexican Americans. Journal of Religion &
Health, 45, 183-195.
Marin, G., & Marin, B. V. (1991). Research with Hispanic populations.
Newbury Park, CA: Sage.
Markides, K., & Cole, T. (1984). Change and continuity in Mexican
American religious behavior: A three-generation study. Social
Science Quarterly, 65, 618-625.
Markides, K. H., Martin, H. W., & Gomez, E. (1983). Older Mexican
Americans: A study in an urban barrio. Austin: University of
Texas Press.
Martinez, N. C., & Bader, J. (2007). Analysis of behavior risk fac-
tor surveillance system data to assess the health of Hispanic
Americans with diabetes in El Paso County, Texas. The Diabe-
tes Educator, 33, 691-699.
Munro, B. H. (2005). Statistical methods for health care research (5th
ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Nunnally, J., & Bernstein, I. (1994). Psychometric theory (3rd ed.).
New York, NY: McGraw-Hill.
Office of Minority Health. (2001). National standards for culturally
and linguistically appropriate service in health care: Executive
summary (No. 282-99-0039). Washington, DC: U.S. Department
of Health and Human Services.
Oomen, J. S., Owen, L. J., & Suggs, L. S. (1999). Culture counts:
Why current treatment models fail Hispanic women with type 2
diabetes. The Diabetes Educator, 25, 220-225.
Pargament, K. I. (1997). The psychology of religion and coping:
Theory, research, practice. New York, NY: Guilford Press.
Pargament, K. I., Kennell, J., Hathaway, W., Grevengoed, N.,
Newman, J., & Jones, W. (1988). Religion and the problem-
solving process: Three styles of coping. Journal for the Scien-
tific Study of Religion, 27, 90-104.
Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998).
Patterns of positive and negative religious coping with major life
stressors. Journal for the Scientific Study of Religion, 37, 710-724.
Polit, D. F., & Beck C. T. (2008). Nursing research: Generating and
assessing evidence for nursing practice (8th ed.). Philadelphia,
PA: Lippincott Williams & Wilkins.
Purnell, L. D., & Paulanka, B. J. (2003). Transcultural healthcare:
A culturally competent approach (2nd ed.). Philadelphia, PA:
F. A. Davis.
Russo, C. A., & Jung, H. J. (2006). Hospital stays among patients
with diabetes, 2004 (HCUP Statistical Brief No. 17). Rockville,
MD: Agency for Healthcare Research and Quality.
Schwab, T., Meyer, J., & Merrell, R. (1994). Measuring attitudes
and health beliefs among Mexican Americans with diabetes.
The Diabetes Educator, 20, 221-227.
Sharp, J. (1998). Bordering the future: Challenge and opportunity
in the Texas border region. Austin, TX: Comptroller.
Siegel, K., Anderman, S. J., & Schrimshaw, E. W. (2001). Religion
and coping with health related stress. Psychology & Health, 16,
631-653.
Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statis-
tics (4th ed.). Needham Heights, MA: Allyn & Bacon.
Texas Diabetes Council. (2008). Texas diabetes fact sheet 2008.
Austin: Texas Department of Health.
U.S. Census Bureau. (2000). Your gateway to census 2000. Retrieved
from http://www.census.gov/main/www/cen2000.html
Wen, L. K., Shepard, M. D., & Parchman, M. L. (2004). Family
support, diet, and exercise among older Mexican Americans
with type 2 diabetes. The Diabetes Educator, 30, 980-993.
at University of Bucharest on January 28, 2013 tcn.sagepub.com Downloaded from