19 Feb 03 Innate Health manuscript.doc
Amended 3-5-03, D. Larimer


Measuring Innate Health 1


Running Head: MEASURING EFFECTIVENESS OF INNATE HEALTH SEMINARS



Click here to view the SBI-34 questionnaire.







Development of an Instrument to Measure the Effectiveness of
Innate Health Seminars on Reducing Employee Stress

James Shumway, PhD
Judith Sedgeman, MA
Scott Cottrell, PhD
Deborah Larimer, MA



ABSTRACT
The purpose of this paper is to describe the development, field-testing, and analysis of the SBI-64, a psychological assessment instrument used to yield quantitative evidence of innate health outcomes among the general population. Field test procedures and methods included factor analysis, ANOVA, and pairwise tests of contrasts. The original version of the instrument was pilot tested with four hundred and forty-seven participants. Factor analysis, ANOVA, and pairwise tests of contrasts were used to evaluate the data. Factor analysis revealed four factors. ANOVA and the subsequent testing of means yielded expected directional changes after training for many of the items. Coefficient alpha reliability of the instrument was reported at 0.94. Analyses of content and construct validity indicate that the SBI-64 is a valid measure for assessing innate health outcomes among the general population. Predictive validity studies are underway.


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Development of an Instrument to Measure the Effectiveness of
Innate Health Seminars on Reducing Employee Stress

Background

(Define innate health) To test this model, seminars in innate health were developed based on a set of principles that describe the process of thinking as a power separate from the content of formed thought. These seminars attempted to focus people’s attention away from the analysis of, or coping with, thoughts they have already formed, and towards the recognition that thought is a constant, dynamic activity of the mind. The seminars stressed the premise that people can benefit from recognizing how and why thought content (as the product of a continuous and creative psychological function) is ever changing. The direct link between thought, emotion, perception and action, while well described in the cognitive literature (e.g., Dobson, date; Seligman, date; Czikszentmihalyi, date), is explained differently in the innate health model. Thus, the seminars attempted to generate optimism and to decrease stress and negativity through awakening people’s awareness of their resilient nature, and of the dynamic flow of thought. The seminars also stressed that understanding the innately self-guiding way in which thought works can lift people out of the cycle of inevitability that often results from the notion that people must take some action to change their negative or disturbing thoughts. The innate health model has promoted the idea that people can come to understand thought as an innately healthy, volitional source of change, regardless of the specific content of their thoughts at any given moment (e.g., Pransky, date; Mills, date; Sedgeman, date; Blevens, 1997). According to the model, changes in perception and experience depend upon how the thinker views (and uses) the power of thought. This concept distinguishes innate health from cognitive models that view formed thoughts as a reality that must be actively addressed.

Innate health literature has consistently pointed out that acquiring this understanding assists people to see their negative thinking as an indication that they have focused on insecure thought content, and to know that their natural flow of thought can be counted on to move them into a healthier, wiser state of mind if they leave their troubling thought alone, rather than ruminating on it (Banks; Crystal; Shuford; Kelly; Miller; Sickora; Pransky, J.; Pransky, G.; Mills; Sedgeman; Blevens). As an educational approach, innate health concepts can awaken a positive and sustained change in people regardless of their life circumstances. The goals of the model are often linked to the kinds of outcomes described by cognitive approaches (e.g., Dobson) as well as by techniques that quiet the mind such as meditation or yoga (e.g., Benson). There may be some similarities between these other approaches and innate health. Nevertheless, the model’s fundamental premise (that health is innate, and does not require external manipulation) demands that its outcomes be measured differently than in either the cognitive or mind/body approaches. Therefore, it is necessary to develop a measurement tool based upon the fundamental concepts of innate health.

Purpose

In the more than 20 years that innate health practitioners throughout the country in mental health, social work and education, the primary research methodology has been qualitative (e.g., Bailey; Bailey, Blevens, & Heath; Blevens, Bailey, Olson, & Mills; Borg; Crystal & Shuford; Fidler & McMahan; Kelley & Stack; Mills, Dunham, & Alpert; McCombs, Bland, & Shown; Miller & Sickora; Pransky, J.; Stewart; Roe & Bowser). No previous quantitative studies have been conducted with pre- and post- testing of a treated group, or with pre- and post- testing of a treated group with a control group. The purpose of this paper is to describe the initial development of the SBI-64 instrument, which may be used to yield quantitative evidence of innate health outcomes.

Methods

Instrument Development

During the three-year process that has led to the SBI-64 in its current form, the instrument went through several iterations and re-evaluations, and a second instrument, generated from a totally different approach to the process, was also tested, re-tested, and eventually merged with the first to form the SBI-64, the current instrument. A working group was convened in August, 1998, consisting of experienced practitioners and authors in the innate health field, individuals familiar with social/behavioral research and the psychometric measures commonly used in psychology and psychiatry to study cognitive change, and individuals familiar with study design. Agreement by these experts provided the initial content validity for the items in the instrument, which was designed to explore two aspects of participants’ thinking:
(1) self-reported state of mind, and
(2) the degree to which the respondents could link their state of mind with the function of thought.

Experienced practitioners gathered in September, 1998 at a meeting for innate health faculty from around the country, and completed the instrument. Their feedback upon taking the instrument provided the first external review of the original set of items, and helped to identify poorly worded items, items that did not accurately reflect an understanding of the principles of innate health, and the amount of time necessary to complete the questionnaire. The instrument was again reviewed in January, 1999 by a faculty group of innate health practitioners convened for a meeting in Vancouver, BC, Canada. They were also asked to fill out the questionnaire intuitively, and then to review it carefully to make suggestions or comments.

This instrument, consisting of 125 questions, was completed by 98 people (about 25% of whom were highly involved and experienced in innate health) at the Annual Meeting of the Aequanimitas Foundation in San Jose, CA in June, 1999. Participants were asked to fill out the questionnaire intuitively, and then go back over it and read it critically (not changing any of their initial answers) and comment to the committee on their review of the questions. Consideration of these responses and re-evaluation of the questions based on consistency of the answers was the next step for the instrument development group.

After this review, the initial questionnaire was set aside, and in September, 1999 a reconfigured work group convened to take a fresh look at developing a new measure in a different way. Because the principles and psycho-spiritual outcomes of the understanding of innate health (that are the heart of the teaching being evaluated) are set forth in the writings of Sydney Banks, the group selected one of Banks’ books, The Missing Link, as the conceptual source for constructing a new instrument. The fundamental concepts that describe a healthy psycho-spiritual view point were drawn from this book and used to develop simple statements for the new questionnaire, which was then submitted to an experienced group of practitioners for testing and review. (Jamie, sounds like you are describing the development of the Stress Cure Questionnaire, which was what we used The Missing Link to construct. If so, then the following paragraph is inaccurate, because IRB approval to combine the UES, LAS, and SCQ was received in January, 2001. If not, then the previous paragraph is inaccurate, because the UES items were not drawn directly from the book, but from various practitioners’ understandings of Syd’s work. That discussion—as you may remember--was a large part of why Judy asked us to go back to the book and extract concepts for a new questionnaire.)

Questions which survived that review were merged with questions from the first instrument that survived review, and the instrument was then submitted for IRB approval to be used with naïve subjects in innate health seminars called Foundations classes, which were being presented in different cities throughout the U.S. by a variety of practitioners during 1999 and 2000.

Field Testing of Draft Instrument

The revised questionnaire was designed to assess the outcomes and effectiveness of the foundations of human understanding seminar. The revised questionnaire packet had four parts. A cover letter explained the process and purpose of the questionnaire. It also informed participants that completing the questionnaire was entirely voluntary and that their responses would remain anonymous. Second, participants were asked to share demographic information, such as gender, age, marital status, and occupation. Third, thirty-seven questions on a
four-point scale (never, sometimes, often, always) asked participants to reflect on their cognitive processes and well being. Fourth, nineteen questions on a four-point scale ranging from strongly disagree, disagree, agree, to strongly agree, asked participants to reflect on how they respond to life stressors and feelings.

Foundations of human Understanding courses were conducted in 12 cities around the United States by different seminar leaders with considerable experience in the practice and teaching of the principles that explain innate health. (It would be good here to specify what a “Foundations” course is). Courses combined lecture with dialogue and discussion, and were held in typical seminar locations such as hotels and conference centers. Seminar leaders followed the course objectives, but were free to design the course format--for example, whether to break the larger group into smaller groups for discussion, or whether to use audiovisual materials or handouts. All course attendees received a free copy of The Missing Link (Banks, date). Course teachers remained in contact with each other and stayed aligned, throughout the year, on the purpose and nature of the course, and remained committed to the research effort. Each course was two and one half days in length (for a total of 12 hours). An assistant (who was not teaching the class) explained the research process and the questionnaire, invited the course participants to complete the questionnaire, and answered any questions. The questionnaire was distributed and individuals either filled it out or turned it in blank, at their discretion. The instructor then taught the seminar, engaging the participants in discourse, and answering questions. At the end of the course, the questionnaire was handed out once more. Instructions were repeated, and the course participants were given the opportunity to fill out the questionnaire again. Course sizes ranged from seven to as many as 130 participants.

These courses were supported by a grant from a private Foundation so that they could be offered free to the public. Thus, the courses attracted attendees from many backgrounds, experiences, and employment categories (Note: the participants were primarily white, middle-aged, college-educated women, so it’s inaccurate to include the statement about diverse ages and educational levels). Participants were self-selected by their interest in the subject described in course literature as “the foundations of human understanding.” Two courses were offered: Foundations I, and Foundations II. Foundations I introduced the innate health concepts, and Foundations II reinforced and expanded upon the same concepts. In Foundations I (on which the early instrument-development was based) the stated program objectives were to:
1) Explore the nature of a principle-based approach to human understanding and the effect of principles on a field of study;
(2) Learn the three Principles of Mind, Thought and Consciousness;
(3) Learn how these principles provide an explanation of the full range of human behaviors and experience;
(4) Learn the operation and relevance of these principles in people’s lives and how they explain and predict people’s moment-to-moment levels of psychological well-being or distress and behavioral options; and
(5) Learn how and why understanding these principles leads to improved psychological health, resiliency, stability and calm (The Sydney Banks Institute for Innate Health, sample course flyer, Fall, 2000).

Analysis

Four hundred and forty seven (447) participants in the Foundations seminars completed the questionnaire prior to training. Participants required approximately 15-20 minutes to complete the questionnaire. Following the trainings, 247 participants completed the post-questionnaire. Six-month follow-up of those who completed the post-questionnaire yielded 59 participants that could be matched with the original questionnaires. To assess the degree of association of the items (see comment at end of sentence), a principal components factor analysis was conducted using an orthogonal Varimax rotation with Kaiser normalization. (Factor analysis eliminates redundancy in a large set of correlated variables, and then represents the large set with a smaller set of factors that serve to identify some underlying dimension of the data. Is this what you mean by “assessing the degree of association”?) For comparison of pretest, posttest, and six-month follow-up data, a one-way repeated-measures ANOVA was performed. Pairwise post-hoc comparisons (contrast tests) were performed when differences in the ANOVA were found among the pretest, posttest, and six-month follow-up data because the samples were not independent.

Results

Factor analysis extracted four factors that relate to people’s understanding of their use of thinking:
(1) ways of thinking that relate to success;
(2) ways of thinking that relate to clarity;
(3) ways of thinking that relate to resiliency;
(4) ways of thinking that relate to moods.

The first two factors, “ways of thinking that relate to success” and “ways of thinking that relate to clarity”, explained over 32% of the variance in response in the first set of questions (measuring the amount of time respondents felt certain ways). The second two factors, “ways of thinking that relate to resiliency” and “ways of thinking that relate to moods”, explained over 42% of the variance for the second set of items (measuring the degree of agreement or disagreement with certain statements).

Factor 1 -- “Things people think are limitations to success” -- measured the amount of time that respondents felt a specified way, and consisted of the following statistically significant items (intended directional differences between pretest, posttest, and six-month follow-up):
a) “I worry”,
b) “I get nervous when I have to make choices”,
c) “I get stressed out”,
d) “My life takes effort”, and
e) “It’s hard for me to get over feeling bad”.

Factor 2 -- “Things that people think are limitations to clarity -- consisted of the following four statistically significant items:
a) “I work hard to avoid mistakes”,
b) I’ve got a lot on my mind”,
c) “I feel the way I do because of stuff that happens around me”, and
d) “Rude behavior annoys me”.

Factor 3 – “People’s understand of their own states of mind” -- measured the strength of agreement or disagreement of responses, and consisted of the following statistically significant items:
a) “When I’m in a bad mood, I feel I have to do something to get over it”,
b) “When I can’t figure something out, I get frustrated”,
c) “When I fail at something, I start to doubt myself”, and
d) “When I have a lot to do, I get really tense”.

Factor 4) – “People’s understanding of their own resiliency” -- consisted of the following statistically significant items:
a) “When I’m unhappy, I know it won’t last”,
b) “When I’m down, I don’t take my thinking seriously”,
c) “When I’m upset, I calm down before acting”, and
d) “When someone hurts me, I know I’ll get over it”.

Analysis of the means and pairwise comparisons shows statistically significant trends from pretest to posttest through six-month follow-up in the desired direction (an improvement in participants’ responses after training and maintaining their post-training levels of responses after six-months. (Are you planning to include a graph or table of the results?) Evidence of construct validity was generated by the high degree of consistency between the extracted factors and the principles of foundations of human understanding.

Further Modifications

Methods

The field-tested instrument, described above was subsequently combined with the Stress Cure Questionnaire, which was being used in Innate Health seminars that specifically targeted stress reduction. (This is where you want to describe the construction & amp; philosophical basis of the SCQ.) Stress is identified as an underlying factor in health risk (Goetzel, Anderson, Whitmer, Ozminkowski, Dunn, Wasserman). (Add dates and appropriate punctuation.) The Stress Cure Questionnaire consisted of 112 items. An advisory committee composed of health care professionals and researchers was convened to examine both questionnaires. The committee’s charge was to determine which items could be collapsed into one questionnaire that would be used for all innate health training seminars. After carefully analyzing all items, the committee deleted similar and redundant items. This is a limitation on the generalizability of the findings. For example, one item was worded: “My life is hard.” This item was similar to another item, worded, “My life takes effort.” The committee also teased out items that could be used with a single four-point scale (strongly agree to strongly disagree). Items worded both positively and negatively were selected. That is, ideally the participants would respond strongly agree (a positive response) or strongly disagree (a negative response). For example, one positive item was worded, “I feel relaxed,” which would lend itself to a strongly agree response. The resulting revised instrument consisted of 64 items. This instrument was pilot-tested in innate health seminars. Participants completed the SBI-64 before the seminar. Each seminar was conducted over two days. Immediately following each seminar, the participants again completed the SBI-64. A total of 91 participants completed both the pre- and post-tests.

Analysis

Using one independent variable (time), a paired-sample t-test with alpha = .05 was conducted. (Need to add some information here.)

Results

The pilot-test results indicated that 51 out of the 64 questions yielded significant differences between the pre-test and post-test responses. Preliminary results suggest that the instrument discriminates adequately between the pre-training and post-training responses. Moreover, the direction of the mean differences suggests that participants’ responses improved after the seminar training. (Good to include a table of means here.)

The reliability of the SBI-64 in these pilot tests was computed using Cronbach’s alpha coefficient. The SBI-64 instrument yielded a reliability of .94. These results suggest that participants’ responses are likely to be highly reliable. Coupling the results of both the t-test and the reliability analyses suggests that the SBI-64 may be a valuable instrument for determining the effectiveness and outcomes of the Innate Health seminars.

Discussion

Given that the purpose of this work is to describe the initial development of an instrument to yield quantitative and scientifically verifiable evidence, there are a number of limitations that need to be acknowledged to adequately interpret the data described in this paper. These limitations are not unique and can be found to various degrees in the development of any psychological assessment instrument.

First, the research design employed a convenience sample of voluntary participants and no comparison groups were available. Therefore, there was no way to tell whether or not the observed changes were due to the training or to some other variable such as response bias.

Second, a considerable number of cases had to be eliminated from the original analysis either because participants took the test at only one time (pre- or post-), or because they did not remember their identification codes. Both of these conditions resulted in unusable data that could not be matched over time (i.e., pre-test through six-month follow-up). Third, as is common with the development of psychological assessment instruments, follow-up completion rates were not as high as pre-and post-test completion rates--generating another source of data loss. Further, follow-up questionnaires were mailed to participants, and many had either moved or choose not to respond. Under such conditions, the possibility must be considered that only those participants who were favorably inclined toward the seminar content may have responded when asked for follow-up.

It would be difficult to validate the SBI-64 using existing psychological measures that assess behaviors and perceptions, irrespective of the understanding from which they are derived, because they are likely to have different philosophical and cognitive bases than the SBI-64. For example, the Rahe and Holmes Stress Scale looks at the cumulative effects of external stressors as indicators of the quality of people’s life experiences, although newer iterations of that scale incorporate questions more focused on people’s inner life. (Rahe, Veach, Tolles, Murakami; Miller, Rahe) The SF-36 (Ware), which was selected as a possible validation measure for the SBI-64, looks at people’s general mental and physical status, again without reference to their understanding of where mental health comes from or how it could change. (Need to say something here about why the SF-36 was selected, e.g., widely used in health assessment, well-validated, and nationally normed.)

The hypothesis that the SF-36, however, could correlate with people’s general state of mind suggested that it, or at least some portions of it, might be useful in the validation process for the SBI-64. The State-Trait Anger Scale (Spielberger), because it measures impulsive behaviors that result from negative thought taken seriously, could also correlate with the SBI-64 to some extent, and therefore, can also be considered in the validation process.
A primary goal of this research was to develop an instrument sensitive to changes in thoughts, feelings, perceptions, and/or behaviors as a function of changes in understanding the nature of thought. There does not appear to be any existing measure that correlates directly with the depth of change in that understanding. Therefore it was necessary to develop a new measure. The results obtained from pilot testing the SBI-64 have been encouraging, because of the consistency in response from participants in the innate health seminars. These results have been reflective of the early, surprising, finding that there was no significant decline in positive response on the field-test version of the questionnaire from post-test to six-month follow-up. This finding suggests the need for further research on the impact of innate health training and how best to measure its impact.


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