Development and validation of the Intrinsic Religiousness Inventory (IRI)

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study

BACKGROUND

The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals' motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas.

METHODS

SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona's IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure - PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications.

RESULTS

Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels.

CONCLUSIONS

Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.

Balancing hope at the end of life organisational conditions for spiritual care in palliative homecare in Sweden

The aim of this article is to examine how norms and values related to culture, religion, and spirituality were experienced and expressed by healthcare professionals caring for patients at the end of life in Advanced Care at Home (ACH) in Sweden, with a focus on how organisational aspects enabled or hindered spiritual care. Founded on participant observation with physicians and exploratory short-term fieldwork conducted between June and December 2019, findings show that physicians experienced communication problems relating to both religion and culture, yet were skilled in balancing hope and existential needs, medically and practically. However, all healthcare encompassed a secular bias complicating abilities to "read" religious and spiritual needs, reflecting a general lack of religious literacy among healthcare providers. ACH physicians and the palliative care team were facilitated by several organisational and structural conditions necessary for person-centred and spiritual care, including the non-hierarchical and interprofessional composition of care teams, continuity of care, space for physicians' reflection, and engagement in dialogue with patients and their relatives. Furthermore, the 6S palliative care ideology was promoted within the team, as was a creative outlook in supporting patients and their relatives' hope at the end of life. Nevertheless, interest varied. Some physicians were more skilled in dialogue, creativity and including the patient in medical decisions. Others were less focused on the person and maintained a strong emphasis on medicine, practicalities, and biomedical testing. Further, structural and organisational hindrances to person-centred and spiritual care were illuminated, including a lack of routines surrounding protecting the patient's needs in transitions from hospital to ACH. Even though the organisation of care in ACH provided conditions for person-centredness, the lack of religious literacy caused further hindrances to spiritual care. We conclude that, without religious literacy, and the ability to holistically meet patients' spiritual needs, care cannot be truly person-centred.

Praying for a Miracle: Negative or Positive Impacts on Health Care?

The belief in miracle, as a modality of spiritual/religious coping (SRC) strategy in the face of stress and psychic suffering, has been discussed in psychological literature with regard to its positive or negative role on the health and well-being of patients and family members. In contemporary times, where pseudo-conflicts between religion and science should have been long overcome, there is still some tendency of interpreting belief in miracle – as the possibility of a cure granted by divine intervention, modifying the normal course of events in a bleak medical diagnosis – as having unhealthy impacts in the care and treatment of health. This position seeks to find a base in the three characteristics of hoping in a miracle, frequently pointed out by psychological literature: (a) it would imply a negation of reality instead of its confrontation; (b) it would be a coping strategy focused on emotion instead of the problem; (c) it would imply seeking to modify the supposed desire of God by extra-natural facts. In this study, we shall critically discuss this position and the dangers of its crystallization by the use of SRC scales in which the act of praying for a miracle is previously classified as a negative strategy. We revisit some tendencies in psychological literature about the subject, taking into consideration the various facets of miracle, sociocultural facts, elements of idiographic nature, and their profound outcomes in the lives of people especially in health contexts. We illustrate the dangers of a hasty generalization of the results of nomothetic studies about the role of belief in miracle with two examples of research in the Brazilian context: one carried out with pregnant women with fetal malformation and the other with family members caring for children and adolescents with cancer under chemotherapeutic treatment. In both studies, the results do not confirm the predominance of the negative aspects associated with the act of praying for a miracle, which we discuss and analyze in light of the phenomenological perspective. In this perspective, “pray for a miracle”, as experienced by patients and caregivers, can be recognized as an act of openness to life (instead of isolation in a bleak perspective), bolstering hope, and the resignification of reality in the psyche.

Psychosocial and Drug Use Assessment of Regular vs. Non-Regular Ayahuasca Users in a Brazilian Sample: a Web-Based Survey

Background: Preliminary evidence suggests that long-term ayahuasca use is associated with better psychosocial outcomes and less drug use; however, available data on the association between ayahuasca intake frequency and psychosocial outcomes is limited. Objectives: We sought to characterize and investigate the association of regular ayahuasca use, as compared to non-regular use, on licit (alcohol and tobacco) and illicit (cannabis, psychostimulants, psychedelics, and non-medical opioids) drug use and psychosocial outcomes. Methods: An online-based cross-sectional survey was taken among people who use ayahuasca in Brazil assessing sociodemographic, drug and ayahuasca use, anxiety and depression (HAD-S), intrinsic religiosity (IRI), negative and positive affects (PANAS), satisfaction with life (SWLS), and five quality of life domains (WHOQOL-Brief). Multivariate regressions for each psychosocial outcome and drug use were performed comparing regular to non-regular ayahuasca users while correcting for sociodemographic variables. Results: A total of 286 valid answers were retrieved, divided into people with regular (n = 101) and non-regular (n = 185) ayahuasca use. Groups had similar sociodemographic profiles and lifetime use of drugs. In the multivariate analysis, regular use of ayahuasca was associated with lower anxiety (B: -0.97), negative affect (B: -2.62), general (B: 0.22) and physical (B: 0.17) quality of life, higher intrinsic religiosity scores (B: 4.16), and less past-month licit (OR = 0.30) and illicit (OR = 0.49) use of substances. Conclusions: Our results show that ceremonial regular ayahuasca compared to non-regular use is associated with better psychosocial and mental health outcomes and less drug use. Studies with repeated ayahuasca administration and extended follow-ups are essential to clarify the nature of ayahuasca's therapeutic effects and to guide future clinical research.

Epilepsy characteristics and cognitive, social, and mood functions in relation to intrinsic religiosity

PURPOSE

The purpose of the study was to relate the Intrinsic Religiosity Inventory (IRI) with clinical epilepsy variables, the occurrence of depressive symptoms, and the quality of life (QoL) of 169 adult people with epilepsy (PWEs). Data were compared with those of a similar control group (CG) without psychiatric disorders, with p < 0.05.

RESULTS

A higher intrinsic religiosity (IR) was observed in PWEs when compared with the CG. Impairment in multiple cognitive domains was found in 41 (24.2%) cases, and a score >15 in the Neurological Disorders Depression Inventory for Epilepsy was observed in 44 (26%) cases. In PWE, a greater IR was associated with the use of more than one antiepileptic drug (AED), epileptiform activity (EA) in the left hemisphere, temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and the absence of depressive disorders. An early age of onset and the social functioning dimension of the Quality of Life in Epilepsy Inventory (QOLIE-31) were the predictive factors for a higher IR in the linear multivariate regression analysis.

CONCLUSION

The IR was significantly higher in PWE. A higher IR was related to TLE-HS, EA in the left hemisphere, later onset of epilepsy, a better performance in the semantic verbal fluency (SVF) test, and the absence of depressive disorders, suggesting a complex neurophysiological relationship involving multiple factors.

The Catalogue of Spiritual Care Instruments: A Scoping Review

Spiritual care has been a growing focus in international healthcare research over the last decades. The approaches to spiritual care are many and derive from many different medical fields and different cultural contexts and often remain unknown across healthcare areas. This points to a potential knowledge gap between existing instruments and the knowledge and use of them cross-disciplinarily and cross-culturally, and thus best practice insights are not sufficiently shared. This article contributes to the growing field of spiritual care by providing an overview of the various approaches (henceforth instruments) to assess patients’ spiritual needs in view of improving spiritual care. This was done through a scoping review method. The results of the review were collected and catalogued and presented here as ‘The Catalogue of Spiritual Care Instruments’. The included instruments derive from a wide range of geographical contexts and healthcare areas and are aimed at patients and healthcare professionals alike, clearly showing that spiritual care is a focus in healthcare internationally. However, it also shows the difficulties of defining spiritual care, the importance of local contexts, and the difficulties of cross-cultural validity. The catalogue contains 182 entries and is available as an interactive platform for the further development of spiritual care internationally.

[Spirituality/religiousity measurement and health in Brazil: a systematic review]

Spirituality/religiousness has been regarded as an important dimension for health studies and services. The present study consists of a systematic review on health and spirituality/religiousness, specifically, instruments for its measurement. In order to do so, we searched for papers using the keywords "scales spirituality religiousness" and "scales spirituality religiousness and health" in CAPES, DOAJ, Lilacs, Pubmed, Scielo and Web of Science, from 2000 to 2017. The search returned 500 studies, from which 35 were selected, considering their originality, availability, language (English or Portuguese), and description of scales for measuring spirituality/religiousness and adapted for the Brazilian culture. From such papers, 16 instruments were identified; the instruments with most studies were the WHOQOL-100 (as well as its reduced version and the SRPB module), the Spiritual Well-Being Scale and the RCOPE scale. We conclude that studies on this field are scarce, for, although many instruments are described, the continuity of their validation is poor.

Image of God, religion, spirituality, and life changes in breast cancer survivors: a qualitative approach

Religion and spirituality are much studied coping mechanisms; however, their relationship to changes in behaviors, relationships, and goals is unclear. This study explored the impact of a breast cancer diagnosis on religion/faith and changes in behaviors, relationship, or goals. In this qualitative study, women, who participated in a larger, quantitative study, completed written responses to questions regarding the role of religion/faith in their lives, the impact of their diagnosis on their image of God and on faith/religious beliefs, and any changes in behaviors, relationships, or life goals were examined. Based on previous findings noting differences in psychological outcomes based on a higher (HE) or lesser (LE) engaged view of God, 28 (14 HE; 14 LE) women were included in the analysis. Awareness of life and its fleeting nature was common to all. Ensuing behaviors varied from a need to focus on self-improvement-egocentrism (LE)-to a need to focus on using their experiences to help others-altruism (HE). Study results suggest that seemingly small, but highly meaningful, differences based on one's worldview result in considerably different attitudinal and behavioral outcomes.

Measuring spirituality and religiosity in clinical research: a systematic review of instruments available in the Portuguese language

CONTEXT AND OBJECTIVES

Despite numerous spirituality and/or religiosity (S/R) measurement tools for use in research worldwide, there is little information on S/R instruments in the Portuguese language. The aim of the present study was to map out the S/R scales available for research in the Portuguese language.

DESIGN AND SETTING

Systematic review of studies found in databases.

METHODS

A systematic review was conducted in three phases. Phases 1 and 2: articles in Portuguese, Spanish and English, published up to November 2011, dealing with the Portuguese translation and/or validation of S/R measurement tools for clinical research, were selected from six databases. Phase 3: the instruments were grouped according to authorship, cross-cultural adaptation, internal consistency, concurrent and discriminative validity and test-retest procedures.

RESULTS

Twenty instruments were found. Forty-five percent of these evaluated religiosity, 40% spirituality, 10% religious/spiritual coping and 5% S/R. Among these, 90% had been produced in (n = 3) or translated to (n = 15) Brazilian Portuguese and two (10%) solely to European Portuguese. Nevertheless, the majority of the instruments had not undergone in-depth psychometric analysis. Only 40% of the instruments presented concurrent validity, 45% discriminative validity and 15% a test-retest procedure. The characteristics of each instrument were analyzed separately, yielding advantages, disadvantages and psychometric properties.

CONCLUSION

Currently, 20 instruments for measuring S/R are available in the Portuguese language. Most have been translated (n = 15) or developed (n = 3) in Brazil and present good internal consistency. Nevertheless, few instruments have been assessed regarding all their psychometric qualities.