Personal accounts of the role of God in health and illness among older rural African American and White residents

Chronic illness as cultural disruption: The impact of chronic illness on religious and cultural practice

The relationship between religion and health tends to be framed positively. Religion has been found to act as a coping mechanism and source of support in times of ill health. In this paper, we focus on the disruptive effect of chronic illness on religious practice and cultural engagement. Drawing on interviews with ethnic minority adults with end-stage kidney disease, who also identify as religious, we introduce the concept 'cultural disruption'. While religious practice and belief was found to provide strength and comfort we also found that chronic illness had a disruptive impact on religious and cultural practice that participants attempted to manage. To highlight the potential disruptive effect of chronic illness on religious faith and cultural engagement we identify three elements of cultural disruption-disruption to religious practice, disruption to sense of self and identity and disruption to wellbeing. We conclude by suggesting that understanding and accounting for the potential of cultural disruption when diagnosing, treating and supporting people with chronic illness offers an alternative entry point to the life-worlds of patients who identify as religious and the things that are important to them.

Relationship between spiritual intelligence and intolerance of uncertainty, anxiety and fear of Corona in the elderly

INTRODUCTION

The COVID-19 pandemic has caused physical and psychological health problems in the elderly. Spiritual intelligence has an effect on health and healing. The aim of this study determining the relationship between spiritual intelligence and intolerance of uncertainty, anxiety, and fear of corona in the elderly.

METHODOLOGY

A cross-sectional study was done on 207 elderly people who referred to comprehensive health service centers in Mashhad in 2022. The samples were selected based on the inclusion criteria using multistage and cluster sampling. To collect data, various questionnaires were used, including demographic characteristics (age, gender, marital status …), King's Spiritual Intelligence Questionnaire, Freestone's Intolerance of Uncertainty Questionnaire, Corona Anxiety Scale, and Coronavirus Fear Scale. Statistical analysis of variables was done using descriptive and analytical (independent t-test, Mann-Whitney, analysis of variance, linear regression) tests by means of STATA version 14.

RESULTS

The average level of spiritual intelligence was 54.1. Participants reported a high level of intolerance of uncertainty (M = 79.2) and fear of corona (M = 14.09). Education, economic status, and marital status were the predictors of spiritual intelligence of the studied subjects (r = 0.24, P < .05). Spiritual intelligence and gender were also related to uncertainty intolerance (r = 0.12, P < .05). Another finding of the study was the superiority of variables of spiritual intelligence and gender in predicting the level of anxiety of corona compared to other variables (r = 0.17, P < .05).

CONCLUSION

There was a relationship between spiritual intelligence, education, and gender with the level of fear and anxiety of corona. Therefore, planning and implementing educational projects based on increasing spiritual intelligence for the elderly with priority for elderly women and with a low level of literacy and income is recommended.

Attachment to God and Death Anxiety in Later Life: Does Race Matter?

Research suggests that religion plays a critical role in individuals' attitudes toward death in later life. The purpose of this study is to investigate whether a previously unexamined aspect of religion-secure attachment to God-is associated with death anxiety among U.S. older adults and whether this association varies across race. Using longitudinal data from a representative sample of adults aged 65 and older ( N = 936), the analyses reveal that secure attachment to God is associated with a decrease in death anxiety over time. Furthermore, the negative association between secure attachment to God and change in death anxiety is greater for older Blacks than their White counterparts. These results indicate that religion serves a protective function against death anxiety in later life. Moreover, religion provides greater psychological benefits for older Blacks than older Whites, reinforcing a long-standing claim that religion is particularly valuable for individuals from marginalized backgrounds.

Race, ethnicity, religious affiliation, and education are associated with gay and bisexual men's religious and spiritual participation and beliefs: Results from the One Thousand Strong cohort

OBJECTIVES

This study examined the rates of spirituality, religiosity, religious coping, and religious service attendance in addition to the sociodemographic correlates of those factors in a U.S. national cohort of 1,071 racially and ethnically diverse HIV-negative gay and bisexual men.

METHOD

Descriptive statistics were used to assess levels of spirituality, religiosity, religious coping, and religious service attendance. Multivariable regressions were used to determine the associations between sociodemographic characteristics, religious affiliation, and race/ethnicity with four outcome variables: (1) spirituality, (2) religiosity, (3) religious coping, and (4) current religious service attendance.

RESULTS

Overall, participants endorsed low levels of spirituality, religiosity, and religious coping, as well as current religious service attendance. Education, religious affiliation, and race/ethnicity were associated with differences in endorsement of spirituality and religious beliefs and behaviors among gay and bisexual men. Men without a 4-year college education had significantly higher levels of religiosity and religious coping as well as higher odds of attending religious services than those with a 4-year college education. Gay and bisexual men who endorsed being religiously affiliated had higher levels of spirituality, religiosity, and religious coping as well as higher odds of religious service attendance than those who endorsed being atheist/agnostic. White men had significantly lower levels of spirituality, religiosity, and religious coping compared to Black men. Latino men also endorsed using religious coping significantly less than Black men.

CONCLUSIONS

The implications of these findings for future research and psychological interventions with gay and bisexual men are discussed. (PsycINFO Database Record

What is the Meaning of Life? Women's Spirituality at the End of the Life Span

Spiritual exploration often occurs after the loss of a significant other or with the impending death of oneself. Twenty-six older women were intensively interviewed; none had experienced a recent loss or terminal illness. Many wanted to understand their place in the order of things and were not looking to organized religion for answers. Dominant themes that emerged from the interviews included: a need to feel connected; spiritual questioning; existential angst; thoughts about death and dying; and, to a lesser degree, reliance on organized religion. Some older women—African Americans, Latinas, and women of lower socioeconomic status—turned to the Bible, prayer, and Church for answers to their questions, but most did not. These data suggest that spiritual questioning—independent of organized religion, significant loss, or impending death—is a natural part of the aging process as one approaches the end of the life span.

"We Hide Under the Scriptures": Conceptualization of Health Among United Methodist Church Clergy in Kenya

As community leaders, clergy are well-positioned to impact the health of their congregants. Clergy's conceptualizations of health influence their own self-care and how they minister to others. Interviews and focus group discussions on health conceptualizations and health-seeking behaviors were conducted with 49 United Methodist Church clergy in Western Kenya. Data were analyzed using interpretative phenomenological methods. Participants defined health holistically using an environmental health model. Some participants reported not seeking health care so their congregants would believe that their faith kept them healthy. Participants who believed that health comes directly from God reported seeking health care less often. Participants also reported combining traditional indigenous medicine with Western medicine. This study has implications for health promotion among Kenyan clergy and offers the first study of health conceptualization among clergy in Africa.

African Americans' Culturally Specific Approaches to the Management of Diabetes

Spirituality is an important multidimensional cultural resource and coping strategy used by many African Americans for managing chronic diseases such as diabetes. Yet, few studies examine meaning and interpretation of colloquial terms frequently used for coping within the context of a community culture. We designed an interpretive qualitative study to gain a deeper understanding of a colloquial phrase, "I ain't claiming it," used among Project SuGar research participants when discussing diabetes. Thematic analysis revealed two major themes, Acknowledgment and Denial, as coping mechanisms through an active or passive relationship with God. Sub-theme of acknowledgment was presented as front seat driver and sub-theme for denial of the disease presented as back seat driver. These meanings encompass a range of culturally specific coping strategies for self-management that health providers should consider and implement as part of providing patient-centered care to enhance better outcome strategies.

"Trouble won't last always": religious coping and meaning in the stress process

Meaning-based coping, particularly religious coping, might lead to positive emotions in stressful situations. Religious coping is common among older adults. We explored the experience of religious coping, organizational religious affiliation, and one's relationship with God among older adults with advanced chronic illness and their caregivers. Research questions included: How is religious coping experienced in this context? How is a relationship with God experienced in coping? How is meaning experienced in this context? Brief qualitative interviews uncovered descriptions of experiences using the qualitative descriptive method. Three themes were identified: God is a provider, one's religion and relationship with God when coping are essential, and the God-person relationship is intimate. Care recipients coped through their personal relationship with God, whereas caregivers coped through religious beliefs and support. Meaning was defined as purpose, responsibility, and duty.

Belief in divine control, coping, and race/ethnicity among older women with breast cancer

BACKGROUND

Belief in divine control is often assumed to be fatalistic. However, the assumption has rarely been investigated in racial/ethnic minorities.

OBJECTIVES

This study aims to examine the association between belief in divine control and coping and how the association was moderated by ethnicity/acculturation in a multi-ethnic sample of breast cancer patients.

METHODS

Latina, African American, and non-Hispanic White older women with newly diagnosed breast cancer (N=257) from a population-based survey completed the scale of Belief in Divine Control and the Brief COPE.

RESULTS

Belief in divine control was positively related to approach coping (i.e., positive reframing, active coping, and planning) in all ethnic groups. Belief in divine control was positively related to acceptance and negatively related to avoidance coping (i.e., denial and behavioral disengagement) among low-acculturated Latinas.

CONCLUSIONS

Negative presumptions about fatalistic implications of belief in divine control should be critically reappraised, especially when such skepticism is applied to racial/ethnic minority patients.

Spiritual practices in self-management of diabetes in African Americans

In this qualitative study, African Americans described 3 orientations about spiritual practices and diabetes self-management: Spiritual practice as effort toward self-management; spiritual practice and self-management as effort toward healing; and spiritual practice as effort toward healing. Spiritual practices may influence diabetes self-management in African Americans and be a resource in care.

Medication adherence beliefs of community-dwelling hypertensive African Americans

BACKGROUND AND OBJECTIVE

Medication adherence is low among hypertensive patients regardless of ethnic background. However, the prevalence of nonadherence is higher among African Americans when compared with their white American counterparts. Recognizing African American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. The purpose of this qualitative study was to explore community-dwelling hypertensive African American behavioral, normative, and control beliefs regarding their adherence to antihypertensive medications.

SUBJECTS AND METHODS

A community and academic partnership was formed to conduct 3 audio-taped focus groups with 40 hypertensive and low-income African American adults aged 18 years and older. Interview questions were based on the theory of planned behavior. All transcripts from the tapes were analyzed using thematic analysis.

RESULTS AND CONCLUSIONS

Behavioral beliefs associated with medication adherence identified both positive and negative outcomes. Family, friends, neighbors, and God were associated with normative beliefs. Limited financial resources, neighborhood violence, and distrust of healthcare professionals were key control beliefs. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of community-dwelling hypertensive African Americans who fit a similar demographic profile. These findings are important because they can be used to tailor interventions to increase their medication adherence.

Chronic illness self-care and the family lives of older adults: a synthetic review across four ethnic groups

The purpose of this paper is to integrate the literature on family and social ties among older ethnic minority men and women with the literature on chronic illness self-care among elders in these groups, in order to increase understanding of social influences on self-care behavior, raise questions for future research, and inform culturally appropriate interventions to maximize the health-promoting potential of social relationships. The paper presents demographic and chronic illness prevalence information, and then summarizes literature about patterns of chronic illness self-care behaviors for older African-Americans, Latinos, Asian-Americans, and American Indians in the U.S. For each group, the sociological literature about residential, cultural, and socioeconomic patterns, family lives, and other social ties is then reviewed, and the self-care literature that has accounted for these patterns is discussed. Finally, six themes are outlined and related questions are identified to further illuminate the social context of older adults' chronic illness self-care.

Health, religion, and meaning: a culture-centered study of Druze women

Against the backdrop of contesting the mainstream biomedical models of health communication, the culture-centered approach suggests dialogic research methodologies to coconstruct meanings of health through direct engagement with cultural communities. In this project, we engaged in in-depth interviews and informal conversations with elderly Druze women and their caregiver daughters to develop an understanding of the intersections of religion and health meanings in the context of aging women in this Lebanese community. Attending to the cultural constructions of health, particularly in religious contexts, opens up the discursive spaces of health communication to alternative cosmologies of health, illness, healing, and curing. Four themes emerged as a result of our grounded theory analysis: health as faith; mistrust, privacy, and modern medicine; polymorphic health experiences; and health as structure. These themes serve as the backdrop for playing out the competing tensions between the local and the global in the realm of interpretations of health meanings.

Religious involvement, beliefs about God, and the sense of mattering among older adults

Using data from a 2001–2002 sample of adults aged 65 and older living in the Washington, DC metropolitan area, we examine the associations among religious involvement (as measured by the frequency of attendance at religious services and praying), the belief in divine control, and the sense of mattering—a key component of the self-concept. We also assess the extent to which these patterns vary by gender, race, and education. Findings indicate indirect effects of religious attendance on mattering through divine control beliefs and the frequency of social contact. Praying increases mattering indirectly only through divine control beliefs. Moreover, divine control beliefs are more strongly associated with mattering among women, African Americans, and individuals with less education. We discuss the contribution of these findings for theory about the links between religious involvement, beliefs about God, and psychosocial resources, and the influence of core dimensions of social status and stratification.

Understanding the nature and role of spirituality in relation to medication adherence: a proposed conceptual model

Racial disparities in hypertension prevalence and its attendant complications are well documented. Spirituality is an important component of African American beliefs and a small body of literature suggests that spirituality influences hypertension management in African Americans. This article describes a conceptual model of spirituality that may be useful for developing interventions for increasing medication adherence and decreasing blood pressure in African Americans diagnosed with hypertension.

Religious participation and DSM-IV disorders among older African Americans: findings from the National Survey of American Life

OBJECTIVES

This study examined the religious correlates of psychiatric disorders.

DESIGN

The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837).

METHODS

Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined.

PARTICIPANTS

Data from 837 African Americans aged 55 years or older are used in this analysis.

MEASUREMENT

The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed.

RESULTS

Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder.

CONCLUSIONS

This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Spirituality

The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.

Religious Coping Among African Americans, Caribbean Blacks and Non-Hispanic Whites

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African American, Caribbean Blacks and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.

Aesthetic surgery and religion: Islamic law perspective

BACKGROUND

Plastic surgeons are called upon to perform aesthetic surgery on patients of every gender, race, lifestyle, and religion. Currently, it may seem natural that cosmetic surgery should be perceived as permissible, and in our modern liberal age, it seems strange to attempt justifying certain surgical acts in the light of a particular cultural or religious tradition. Yet every day, cruel realities demonstrate that although the foremost intention of any scripture or tradition has been mainly to promote religious and moral values, most religions, including Christianity, Islam, and Judaism, invariably affect human behavior and attitude deeply, dictating some rigid positions regarding critical health issues.

METHODS

A Web search was conducted, and the literature was reviewed using the Medline search tool.

RESULTS

Islamic law closely regulates and governs the life of every Muslim. Bioethical deliberation is inseparable from the religion itself, which emphasizes continuities between body and mind, between material and spiritual realms, and between ethics and jurisprudence.

CONCLUSIONS

The rule in Islam is that individuals should be satisfied with the way Allah has created them. Islam welcomes, however, the practice of plastic surgery as long as it is done for the benefit of patients. Even if it clearly considers "changing the creation of Allah" as unlawful, Islamic law is ambiguous regarding cosmetic surgery. Its objection to cosmetic surgery is not absolute. It is rather an objection to exaggeration and extremism. It has been mentioned that "Allah is beautiful and loves beauty."

The association of health and functional status with private and public religious practice among rural, ethnically diverse, older adults with diabetes

PURPOSE

This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes.

METHODS

Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701 community-dwelling elders with diabetes in two rural North Carolina counties. Outcome measures were private religious practice, church attendance, religious support provided, and religious support received. Correlates included religiosity, health and functional status, and personal characteristics. Statistical significance was assessed using multiple linear regression and logistic regression models.

FINDINGS

These rural elders had high levels of religious belief, and private and public religious practice. Religiosity was associated with private and public religious practice. Health and functional status were not associated with private religious practice, but they were associated with public religious practice, such that those with limited functional status participated less in public religious practice. Ethnicity was associated with private religious practice: African Americans had higher levels of private religious practice than Native Americans or whites, while Native Americans had higher levels than whites.

CONCLUSIONS

Variation in private religious practice among rural older adults is related to personal characteristics and religiosity, while public religious practice is related to physical health, functional status, and religiosity. Declining health may affect the social integration of rural older adults by limiting their ability to participate in a dominant social institution.

The role of spirituality in the self-management of chronic illness among older African and Whites

This study used data from in-depth interviews collected from 88 African American and White men and women aged 65 years and older who reside in Allegheny County, Pennsylvania. The purpose of this study was to understand the role of spirituality in the self-management of chronic illness among this population. Thematic content analysis addressed two specific questions: (1) how do older adults use spirituality to help manage their chronic illness, and (2) are there any racial differences in the use of spirituality. Several core themes emerged from the linkage of spirituality and self-management: God: the healer, God: the enabler through doctors, faith in God, prayer as a mediator, spirituality as a coping mechanism, combining conventional medicine and spiritual practices, and empowering respondents to practice healthy eating habits. These results display racial differences in the use of spirituality in the self-management of chronic illness. African American elders were more likely than White elders to endorse a belief in divine intervention. White elders were more likely than African America elders to merge their spirituality in various self-management practices. Despite these differences, spirituality can play an integral part in a person's health and well-being of chronically ill elders.

Spirituality in African Americans with diabetes: self-management through a relationship with God

The purpose of this study was to develop a theoretical model about how the spirituality of African Americans affects their self-management of diabetes. The sample consisted of 29 African American men and women, ages 40 to 75, with type 2 diabetes. The authors used a grounded theory design and collected data using minimally structured interviews. The method of analysis was constant comparison. The core concept identified was Self-Management Through a Relationship With God. Participants fell into one of three typologies: (a) Relationship and Responsibility: God Is in Background; (b) Relationship and Responsibility: God Is in Forefront: (c) Relationship and Relinquishing of Self-Management: God Is Healer. These typologies varied according to how participants viewed their relationship with God and the impact of this relationship on their self-management. The spirituality of these African Americans was an important factor that influenced the self-management of their diabetes.

African Americans and diabetes: Spiritual role of the health care provider in self-management

How African Americans with type 2 diabetes perceive the spiritual role of health care providers (HCPs) and the effects of that role on self-management was explored using a qualitative descriptive analysis. The sample consisted of 29 African American men and women ages 40-75 with type 2 diabetes and 5 ministers of African American churches. A spiritual relationship with their health provider was important in helping participants manage their diabetes. Three typologies from a parent study were expanded with a focus in this extended study on the meaning ascribed to spiritual relationships with providers and the impact of these relationships on self-management. Care perceived as spiritual may be an important component of providing culturally sensitive health care to African Americans and may facilitate their self-management.

Environmental contexts of ultimate decisions: why White nursing home residents are twice as likely as African American residents to have an advance directive

OBJECTIVES

The purpose of this study was to determine the extent to which observed differences between White and African American nursing home residents in having an advance directive are attributable to differences between the groups in personal characteristics, the organizational environment of the nursing home, and the geographical environment of the counties in which the nursing homes are located.

METHODS

By using the Medical Expenditure Panel Survey Nursing Home Component matched with county-level measures from the Area Resource File, we modeled the probability of having an advance directive as a function of nursing home resident, facility, and county characteristics for African American and White residents.

RESULTS

The probability of having an advance directive was 27.0% for African American residents and 63.6% for White residents. Nearly half of this 36.6 percentage point gap could be explained by group differences in personal, facility, and county characteristics.

DISCUSSION

County characteristics play a more prominent role than do personal or facility measures in explaining the observed ethnic gap in the prevalence of advance directives. Additional studies should focus further on geographic, health status, and attitudinal variations among nursing home residents that may account for the remaining ethnic difference in the prevalence of advance directives among nursing home residents.

Delivering culturally sensitive care: the perceptions of older Arabian gulf Arabs concerning religion, health, and disease

Health professionals need to be cognizant of the varying perceptions of health shared by people from different religious, sociocultural, and linguistic backgrounds to deliver culturally sensitive health care. In this qualitative study, the authors used semistructured interviews to provide insight into how 10 older Arabian Gulf Muslim persons understand and perceive health and illness with emphasis on the role of Islam in formulating health behaviors. Participants' views were strongly influenced by their religious convictions. Good health was equated with the absence of visible disease, with participants demonstrating limited understanding of silent or insidious disease. They attended doctors for treatment of visible disease rather than seeking preventive health care for diseases such as hypertension, diabetes, and hyperlipidemia. Building on the results from this study could help inform both health service planners and providers to improve the appropriateness, relevancy, and effectiveness of aged care services for these individuals.

RECRUITING AND RETAINING AN ETHNICALLY DIVERSE SAMPLE OF OLDER ADULTS IN A LONGITUDINAL INTERVENTION STUDY

This paper describes strategies developed to recruit and retain an ethnically diverse sample in a longitudinal intervention of 246 participants in the SeniorWISE study. The ethnic and socioeconomic differences of these participants necessitated the use of different methods of effectively communicating with this population. Recruitment benefited from the use of focus groups, media attention, and personal appearances in the community. Educational strategies included modification of language and examples. Testing sessions were called interviews, and team members were available to answer questions and to read the instruments to participants, when desired. Participants were sent birthday cards and a monthly newsletter. The study is 90% completed.

Spirituality and self-management of diabetes in African Americans

Attention to spirituality is especially important for nurses when providing care to African Americans. Spirituality is deeply embedded in their rich cultural heritage. For many African Americans, spirituality is intertwined into all aspects of life, including beliefs about health and illness. Therefore, it is imperative that nurses understand the relationship between African American spirituality, health, and self-management of illness to provide culturally competent care to African Americans. The purpose of this article is to summarize the research literature on African American spirituality, health, and self-management as it relates to Type 2 diabetes, an illness that involves complex self-care management. Recommendations for holistic nursing practice and research related to this literature are also identified.