Religion, Spirituality, and Health

1. Religion, Spirituality, and Health Chapter 11 Handbook of Health Social Work, 2nd Edition Created by Teri Browne

2. Religion & Spirituality in the US • 56% of Americans state that religion is “very important” in their lives • 51.2% agree that at least daily, “I find comfort in my religion or spirituality”

3. Religion & Spirituality in the US • Regional differences • 36% in Northeast • High of 82% in Mississippi

4. Research on religion and spirituality over the life span is confounded by age, cohort, and period effects • People experiencing severe stress, disability, illness, or dying (and their family members) often have heightened interest in spirituality

5. Religion, Spirituality and Health • What individuals know and believe, to a large extent, will be influenced, if not determined, by personal experience.

6. Religion, Spirituality and Health • Studying spirituality scientifically is a very exciting although somewhat precarious enterprise. • This is a field filled with prejudices, biases for and against spirituality…

7. Religion, Spirituality and Health • Regardless of whether we hold spiritual or materialistic beliefs, religious or anti-religious postures or not, we have a responsibility to explore the relationship between spirituality and health in order to improve our knowledge and our care for human beings

8. Definitions • 31 definitions of religiousness and 40 definitions of spirituality • Popular and scholarly understandings of religion and spirituality have changed

9. Definitions • Many people now differentiate spirituality and religion • Possible for people to identify themselves as either religious or spiritual, both religious and spiritual, or neither

10. Dichotomizing religion and spirituality in this way may be problematic • Simple dichotomy obscures complexity

11. Speaking of individual spirituality and institutional religion ignores two basic facts: • 1) virtually all religions are interested in matters spiritual • 2) every form of religious and spiritual expression occurs in some social context

12. CRITERION FOR SPIRITUALITY • The feelings, thoughts, and behaviors that arise from a search for the sacred.

13. CRITERION FOR SPIRITUALITY • The term “search” refers to attempts to identify, articulate, maintain, or transform. • The term “sacred” refers to a divine being, ultimate reality, or ultimate truth as perceived by the individual.

14. CRITERION FOR RELIGION/RELIGIOUSNESS • The feelings, thoughts, and behaviors that arise from a search for the sacred. The term “search” refers to attempts to identify, articulate, maintain, or transform. The term “sacred” refers to a divine being, ultimate reality, or ultimate truth as perceived by the individual. AND/OR

15. CRITERION FOR RELIGION/RELIGIOUSNESS • A search or quest for non-sacred goals (such as identity, belongingness, meaning, health, or wellness) in a context that has as its primary goal the facilitation of (A); AND

16. CRITERION FOR RELIGION/RELIGIOUSNESS • The means and methods (e.g., rituals or prescribed behaviors) of the search that receive validation and support from within an identifiable group of people.

17. Caution • Researchers cannot distinguish between and draw clear conclusions about the relationships between spirituality, humanism, positive psychology, and health • May confuse causes and consequences

18. History • A religious or spiritual history may be the best means of assessing these intertwined and overlapping dimensions.

19. History • Religious and spiritual histories are especially well suited to clinical practice, but because they are highly qualitative, they are less amenable to research on religion and health outcomes.

20. History • These dimensions are interrelated. For example, besides participating in weekly worship services, many people participate in private religious activities, such as prayer, watching religious television, listening to religious radio, meditation, or reading scripture or other religious literature. Such activity may be encouraged by organizational participation but may also occur in its absence.

21. As Krause (2008) argues, it is time to move beyond simple conceptualizations of religion and spirituality “If researchers hope to better understand the relationship between religion and health, then more attention must be given to the complex ways in which religion is measured” (pp. 5–6).

22. How does religion impact health? • Some religious groups prescribe and encourage what Oman and Thoreson (2005) refer to generally as lifestyle health behaviors.

23. How does religion impact health? • Prohibitions on • Alcohol and illegal drugs • Cigarette smoking • Sexual Behavior

24. How does religion impact health? • Encourage healthier diets • Sabbath keeping.

25. How does religion impact health? • Many religious groups promote gratitude for the gift of life, and encourage respect and care for the human body as the temple of God

26. How does religion impact health? • Religion is associated with increased use of preventative healthcare and adherence to medical regimens

27. How does religion impact health? • Religious beliefs may motivate healthier living and use of preventative care

28. How does religion impact health? • Religious settings may directly provide information, instrumental support (e.g., transportation), or on-site preventative or screening services.

29. How does religion impact health? • Most religious groups provide significant social support for their members, especially when members need it most

30. In research on religion and health, a commonplace finding is that people’s religious involvement is related to both the amount and the quality of social support they experience

31. How does religion impact health? • Through religion “people understand their role in the universe, the purpose in life, and develop the courage to endure suffering” (George et al., 2000, p. 111).

32. How does religion impact health? • Religious traditions provide a variety of coping resources to assist people in dealing with illness, suffering, and death

33. How does religion impact health? • Although religious coping may be beneficial in general, it appears especially beneficial for people dealing with chronic illness or with the loss of a loved one

34. How does religion impact health? • Most religious traditions endorse forgiving attitudes and behaviors, which may help people in several ways. • Those unwilling to forgive “often relieve the hurtful act over and over” = stress = poor health outcomes.

35. How does religion impact health? • “Forgiving others helps restore and renew social ties that were previously a source of significant support” (p. 1218). • These ties may produce better health. • “Forgiving others promotes positive emotions” (p. 1218)

36. How does religion impact health? • Religious traditions promote altruism and service to others by offering both reasons and opportunities for involvement (volunteering, philanthropy, altruism, etc) • These activities are associated with both mental and physical health

37. These positive emotional states, in turn, may affect health by reducing allostatic load (AL). AL represents the cumulative wear and tear on one’s body from adapting to the demands of everyday living. These demands require ongoing adjustments to maintain physiological systems within normal operating ranges.

38. How does religion impact health? • Faith-based efforts to improve community health are becoming more popular. • Very important to improve community health • HIV/AIDS • Breast cancer • Colon cancer

39. HOW DOES RELIGION IMPACT HEALTH? • Research has consistently demonstrated that suicide rates vary by religious tradition and by level of participation: both religious affiliation and religious participation serve as protective factors for suicide

40. SPIRITUAL ASSESSMENT • Religiously competent practice requires continual efforts to individualize assessments and to avoid stereotyping and making assumptions.

41. SPIRITUAL ASSESSMENT • Major professional organizations now recommend or even require practitioners to conduct routine spiritual assessment as part of competent practice.

42. SPIRITUAL ASSESSMENT • In recognition of the foregoing benefits, the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) requires a spiritual assessment of all patients in hospitals, nursing homes, and home-health agencies

43. SPIRITUAL ASSESSMENT • The Joint Commission also requires that medical, nursing, and psychiatric training programs prepare their students to provide culturally sensitive healthcare, including sensitivity to deeply held religious beliefs

44. SPIRITUAL ASSESSMENT • World Health Organization has emphasized the importance of addressing religion and spirituality in clinical practice

45. Tools for assessing religion and spirituality • See chapter for details • Include brief screening tools • Verbal and pictorial • Life maps • Genograms • Ecomaps

46. Intervention • professionals may encourage or “support those that the patient finds helpful”

47. Intervention • ensure the patient has access to desired religious resources, ranging from religious reading or listening material to hospital chaplains

48. Intervention • ensure that patients have visits with clergy and other members of their religious communities • Very related to communication and culture

49. Intervention • recognize chaplains or community religious leaders as part of the healthcare teams, especially in hospitals, residential institutions, and hospice agencies

50. COMPLEX RELATIONSHIP BETWEEN RELIGION AND HEALTH IN AMERICAN SOCIETY • Advance Directives • Euthanasia • Immunizations • HIV/AIDS