Martha R. Crowther

The measurement of religiosity and spirituality: Examples and issues from psychology

After a history of mostly ambivalence and neglect, organization‐focused research has shown a steadily growing interest in religiosity and spirituality over the past decade. While organizational scholars have been slower to incorporate religion and spirituality into their research, psychologists have progressed enough to have a well‐developed specialty area, the psychology of religion. This paper delves into the psychology of religion literature by presenting and discussing existing measures, their construction and specific purposes. This paper seeks to encourage, hearten and assist those who are beginning to explore religion and spirituality in the organizational studies.

Should clinicians incorporate positive spirituality into their practices? What does the evidence say?

Most of the rhetoric decrying the incorporation of basic and positive spiritual care into clinical practice is not based on reliable evidence. We briefly review the current evidence, which demonstrates that (a) there is frequently a positive association between positive spirituality and mental and physical health and well being, (b) most patients desire to be offered basic spiritual care by their clinicians, (c) most patients censure our professions for ignoring their spiritual needs, (d) most clinicians believe that spiritual interventions would help their patients but have little training in providing basic spiritual assessment or care, (e) professional associations and educational institutions are beginning to provide learners and clinicians information on how to incorporate spirituality and practice, and (f) anecdotal evidence indicates that clinicians having received such training find it immediately helpful and do apply it to their practice. We point out the reasons that much more research is needed, especially outcome-based, clinical research on the effects of these spiritual interventions by clinicians.We conclude that the evidence to date demonstrates trained or experienced clinicians should encourage positive spirituality with their patients and that there is no evidence that such therapy is, in general, harmful. Further, unless or until there is evidence of harm from a clinicians provision of either basic spiritual care or a spiritually sensitive practice, interested clinicians and systems should learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians and health care systems should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort on which their hope, health, and well-being may hinge.

Vulnerability of Older Latino and Asian Immigrants with Limited English Proficiency

OBJECTIVES: To explore the implications of limited English proficiency (LEP) for disparities in health status and healthcare service use of older Latino and Asian immigrants.

Cognitive Status, Stroke Symptom Reports, and Modifiable Risk Factors Among Individuals With No Diagnosis of Stroke or Transient Ischemic Attack in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background and Purpose— Vascular disorders that increase risk for stroke may be accompanied by decrements in cognitive functioning and by stroke symptoms in the absence of diagnosed stroke or transient ischemic attack. This study evaluates relationships among cognitive status, stroke symptom reports, and cardiovascular and behavioral factors. Methods— REasons for Geographic and Racial Differences in Stroke (REGARDS), a prospective population study of stroke incidence, assesses stroke risk with telephone interviews and in-home physicals. Excluding subjects with a history of stroke or transient ischemic attack, this analysis includes 14 566 black and white men and women ≥45 years of age. Incremental logistic models examine baseline relationships among cognitive status (Six-item Screener scores), stroke symptom reports, demographics, health behaviors, cardiovascular indices, and depressive symptoms. Results— A history of stroke symptoms was related to impaired cognitive status after adjusting for age, gender, race, and education but not after adjusting for poor health behaviors, vascular risk factors, and depressive symptoms. Odds of experiencing a stroke symptom increased 35% with each of five modifiable factors (hypertension, diabetes, smoking, lack of exercise, depressive symptoms), and odds of cognitive impairment increased an additional 12% with each modifiable factor. Lifelong abstinence from alcohol, lack of exercise, and depressive symptoms were independently related to impaired cognitive status. Conclusions— The increased likelihood of cognitive impairment among subjects reporting stroke symptoms in the absence of a diagnosed stroke or transient ischemic attack suggests that such symptoms are not benign and may warrant clinical evaluation that includes a cognitive assessment. Future studies that include brain imaging may clarify the etiology of these symptoms.

Spirituality Among Older African Americans

Recent changes in gerontology have drawn attention to the role of spirituality among older adults. Demographic trends suggest that the number of African Americans over the age of 65 is increasing, with the largest shift to occur in persons 85 years of age and older. Given the paucity of information available regarding the relationship between spirituality and aging along with the increase in the number of older African Americans, a literature review of these concepts is sorely needed. This paper provides a thorough profile of older African Americans, with a review of historical and cultural factors that have informed the spiritual development of this population. Additionally, attention is given to methodological issues such as definitions, measures, sampling, and research designs at the interface of development and spirituality in this population. The paper also reviews findings to date about the effects of spirituality on physical and mental health among older African Americans.

Widowhood and Spirituality: Coping Responses to Bereavement

SUMMARY Nearly half of women age 65 or older are widows and nearly 70% of these women live alone. Because older women are three times more likely than their male counterparts to be widowed, widowhood has been labeled a primarily female phenomenon. This review article has two aims: (a) to discuss the impact of widowhood on the lives of older women and (b) to discuss how religion and spirituality may be used as coping methods for conjugal loss. After reviewing the literature the authors conclude that older women use religious coping as well as religious and spiritual beliefs and behaviors to facilitate positive adjustment to the loss of a spouse.

The stage-specific role of spirituality among African American Christian women throughout the breast cancer experience.

This study presents the results of semistructured interviews conducted with 18 African American Christian women regarding the role of spirituality throughout their breast cancer experiences. The spiritual themes relevant for phases of the breast cancer experience are identified. Analysis resulted in the identification of 11 codes and 5 subcodes that corresponded to the diagnosis, treatment, and posttreatment phases of the breast cancer experience. Most of the survivors indicated that their spirituality and faith assisted them throughout the breast cancer experience. Discussion focuses on the spiritual resources used by the participants at the different stages in the breast cancer experience. Attention is given to implications for how professionals can use these resources to assist African American women coping with breast cancer.

Stroke Symptoms in Individuals Reporting No Prior Stroke or Transient Ischemic Attack Are Associated With a Decrease in Indices of Mental and Physical Functioning

Background and Purpose— Stroke symptoms in the absence of recognized stroke are common, but potential associated dysfunctions have not been described. Methods— We assessed quality-of-life measures using the Physical and Mental Component Summary scores of the Short Form 12 (PCS-12 and MCS-12) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Differences in mean PCS-12 and MCS-12 scores were assessed among participant groups symptoms-free (n=16 090); history of stroke symptoms but free of stroke/transient ischemic attack (n=3404); history of stroke (n=1491); and history of transient ischemic attack (n=818). Results— Participants with symptoms (but no diagnosis) had average PCS-12 scores 5.5 (95% CI: 5.2 to 5.9) points lower than those without symptoms, a difference similar to transient ischemic attack (6.0; 95% CI: 5.3 to 6.7) and over one half the effect of stroke (8.4; 95% CI: 8.0 to 9.0). MCS-12 scores were 2.7 (95% CI: 2.4 to 3.0) points lower for those with symptoms, −0.5 for transient ischemic attack (95% CI: 0.0 to −1.1), and −1.6 for stroke (95% CI: −1.2 to −2.0). Differences in demographic and vascular risk factors, health behaviors, physiological measures, and indices of socioeconomic status did not fully explain these differences. Those reporting history of weakness or numbness had larger current decrements in physical functioning, and those reporting history of inability to express themselves or understand language had larger current decrements in mental functioning. Conclusions— Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called “silent stroke,” there appear to be many individuals with possibly symptomatic cerebrovascular disease—either stroke or transient ischemic attack—who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign.

Spiritually Based Intervention to Increase Colorectal Cancer Screening Among African Americans: Screening and Theory-Based Outcomes From a Randomized Trial

Colorectal cancer screening has clear benefits in terms of mortality reduction; however, it is still underutilized and especially among medically underserved populations, including African Americans, who also suffer a disproportionate colorectal cancer burden. This study consisted of a theory-driven (health belief model) spiritually based intervention aimed at increasing screening among African Americans through a community health advisor-led educational series in 16 churches. Using a randomized design, churches were assigned to receive either the spiritually based intervention or a nonspiritual comparison, which was the same in every way except that it did not contain spiritual/religious content and themes. Trained and certified peer community health advisors in each church led a series of two group educational sessions on colorectal cancer and screening. Study enrollees completed a baseline, 1-month, and 12-month follow-up survey at their churches. The interventions had significant pre–post impact on awareness of all four screening modalities, and self-report receipt of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. There were no significant study group differences in study outcomes, with the exception of fecal occult blood test utilization, whereas those in the nonspiritual intervention reported significantly greater pre–post change. Both of these community-engaged, theory-driven, culturally relevant approaches to increasing colorectal cancer awareness and screening appeared to have an impact on study outcomes. Although adding spiritual/religious themes to the intervention was appealing to the audience, it may not result in increased intervention efficacy.

Spiritual health locus of control and health behaviors in African Americans.

OBJECTIVE To examine relationships between spiritual health locus of control beliefs and various health behaviors. METHODS A cross-sectional survey of a national sample of African Americans assessed spiritual beliefs, fruit and vegetable consumption, physical activity, and alcohol consumption. RESULTS Active spiritual beliefs were positively associated with fruit consumption and negatively associated with alcohol consumption. Passive spiritual beliefs were associated with lower vegetable and increased alcohol consumption. Among male participants, passive spiritual beliefs were associated with higher alcohol consumption. CONCLUSIONS Findings suggest that dimensions of spiritual health locus of control beliefs have complex and varying relationships with health behaviors.