Development and Validation of a Questionnaire to Assess Satvasara (Mental Strength) - A Descriptive Study

INTRODUCTION

Ayurveda is the science of life. It describes life as the complex combination of Sharir (body), Indriya (senses), Satva (mind), and Atma (soul).  This signifies the role of Manas in the maintenance of health. Acharya Sushrut has described health as physical health as well as mental health.  Raja and Tama, these are the two manas doshas. Pragyaaparadh  has a role in the manifestation of physical and mental disorders. Pragyaparadh occurs due to vitiation of Raja and Tama Dosha. Satva Guna enhancement is one of the most important things to be focused on during treatment.

Mental well-being is defined as a state of mind where an individual can develop their potential& work productively, and cope with the normal stresses of life. Psychological well-being is considered crucial for comprehensive health and happiness and has been linked to improved mental health, better physical health, and a longer life expectancy.

Mental health plays a major role in proper digestion of food. Acharya Charak has emphasized the role of mindful eating under Aaharvidhividhan. Mindful eating nurtures the parasympathetic nervous system which further supports digestion by increasing salivary secretions, and stimulating gastric juices, digestive enzymes, and bile to facilitate nutrient assimilation and extraction.  This demonstrates the significance of mental health in maintenance of healthy status of Jatharagni.

For better mental strength, it is highly essential to enhance the Satva Guna. Satvavajaya Chikitsa is also considered one of the three pillars of treatment.  To protect the mind from unhealthy subjects, it is again essential to have a predominance of Satva.

To assess the level of Satva in an individual, Acharya Punarvasu has mentioned Satva examination under Dashavidha Pariksha . He has classified the level of Satva into three categories, namely Pravara, Madhyama, and Avara Satva. Further, he has also mentioned the qualities of Purush having the extent of Satva  Guna (Satvasara Purush). By assessing Satva, it is possible to enhance Satva Guna through Adravyabhuta Chikitsa (non-pharmacological interventions), Sadvritta (code of conduct), Yoga practices, meditation, Pranayama, and other therapies as part of the treatment. Avara Satva people are prone to psychological disorders; by these interventions we can prevent future psychosomatic disorders. Incorporating Satvasara assessment into treatment approaches can provide alternative or complimentary methods for managing mental health conditions.

REVIEW OF LITERATURE

The qualitative scale to assess the level of Satva as Pravar –Madhyam-Avar has been prescribed by Acharya Charak. The current published literature was searched to know the availability of tools for assessing Satva Sara. Aswathy et al  have developed a tool for the assessment of Satvasara based on the attributes given in Charak Samhita and divided them into the Attitude, Intellectual, and Activity domains.  Kiran et al have studied the use of assessment of Satvasarata (essence of psyche) in prognosis of female patient of breast cancer receiving chemotherapy. They used a Satvasara questionnaire developed by MUHS. Gaikwad et al. have observed the relationship between Satvasara and emotional maturity. Resmy et al  studied the correlation between Satvasara and stress among students at Ayurveda College. Stress is assessed by the Perceived Stress Scale 10. There is another tool by Ayusoft software  (C-DAC-Centre for Development of Advance Computing) for assessment of all types of Sara. This tool has sara and asara features for each Sara.

LACUNA IN THE EXISTING KNOWLEDGE

The tool for the assessment of Satvasara prescribed by Acharya Charak is qualitative and is in abstract form.

Though few researchers have worked in the past towards development and validation of Satvasara tool, lacunas were observed in the previous work. Aswathy et al. have developed a Satvasara assessment tool in which domain specific questions are not able to be identified. Questions are ambiguous and lack clarity. The questionnaire is lengthy, and the scoring pattern is also not clear. Kiran et al. used a Satvasara questionnaire which is not validated. The questions are not specific and need furthermore questions to catch the predictors. Dichotomous questions are only used to capture responses, which makes it difficult to assess the related attributes of an individual. Gaikwad et al. used a tool which is not available in the public domain. No data on structure, validation or reliability is available for this tool. Resmy et al. have studied the relationship between Stress and Satvasara. The tool used to assess Satvasara is not linked with published research. The tool prepared by Ayusoft C-DAC is very lengthy, assessment of only one sara is not possible, all dimensions essential to assess Satvasara of an individual is not included and the tool is not available in the public domain for free use.

NEED OF THE STUDY

There is no proper validated scale available in the public domain to assess the Satvasara. So, there is a need to develop and validate a quantitative scale in the form of questionnaire to assess the level of Satva in an individual. Status of mental well-being depends on the level of Satva. Individuals need an enhanced level of Satva to attain complete mental well-being. Assessment of Satvasara will offer a new approach in management of psychological disorders. Hence, there is a need to develop and validate a questionnaire for the assessment of Satva for the prediction of psychosomatic disorders. In the present study, Satvasara questionnaire will be developed and validated.

RESEARCH QUESTION

How to assess/measure Satvasara through a tool.

 AIM OF THE STUDY

To develop and validate a questionnaire to assess Satvasara

 RESEARCH OBJECTIVES

1.         To develop a questionnaire on Satvasara.

2.         To validate Satvasara questionnaire.

MATERIALS AND METHODS

Development and validation of preliminary questionnaire to assess Satvasara

Based on the classical texts and available literature, the predictors will be compiled.

The questions will be frame under various domains for different predictors.

For face validity, the questionnaire will be reviewed by the experts to look for any corrections.

Changes will be made according to expert’s suggestions, and the questionnaire will be revised.

For content validity, the questionnaire will be sent to 10-15 experts for their expert remarks.

The data will be analyzed using appropriate statistical tools.

Pilot testing will be done on 30 subjects. The questionnaire will be revised if needed.

The data will be analyzed to calculate Cronbach’s alpha for overall questions and for each question.

Inter-rater reliability and Intra-rater reliability will be checked, and the questionnaire will be finalized.

Study- Descriptive

Place of study: Delhi

Duration: 12 Months

SAMPLE SIZE :300

With reference from the article (Tsang S, Royse F, Terkwi A Guidelines for developing, translating and validating a questionnaire in perioperative and pain medicine Official publication of Saudi Anesthetic Association (SUPPL1) Page 12) and checking the feasibility of the research and research subjects we take the sample size to be 300.

INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA

1.     Self-declared apparently healthy subjects aged 18-30 years.

2.     Individuals who have no history of any acute or chronic illness which may impact mental health of the individual.

3.     Individuals willing and able to participate in the study.

EXCLUSION CRITERIA

1.     Individuals having history of any psychological/psychiatric disorder.

2.     Individuals who are on any kind of medication.

3.     Individuals who underwent counseling by the psychologist.

PLAN OF STUDY

Questionnaire will be developed and validated for the assessment of Satvasra

The study participants will be enrolled after taking the informed consent

Satvasara will be assessed using the developed questionnaire through online google forms or by the physical form

The data will be compiled and analyzed. Findings will be submitted in the form of thesis.

OUTCOME OF STUDY

Development of standardized questionnaire for the assessment of Satvasara.

Validation of Satvasara questionnaire.