Pamela A. Ratner

A Meta-Analysis of the Relationship Between Spirituality and Quality of Life

The relationship between spirituality and various dimensions of health and quality of life has been extensively examined during the past decade. Though several literature reviews have been conducted in an attempt to synthesize research findings pertaining to the relationship between spirituality and health, a meta-analysis of studies examining spirituality in relation to quality of life has not been identified. The present study was designed to: (a) determine whether there is empirical support for a relationship between spirituality and quality of life, (b) provide an estimate of the strength of this relationship, and (c) examine potential moderating variables affecting this relationship. The research design followed accepted methods for quantitative meta-synthesis. Potential moderating effects of several methodological differences and sample characteristics were examined using meta-analytic approaches with multivariate linear regression and analysis of variance. An extensive multidisciplinary literature search resulted in 3,040 published reports that were manually screened according to pre-established selection criteria. Subsequent to the selection process, 62 primary effect sizes from 51 studies were included in the final analysis. A random effects model of the bivariate correlation between spirituality and quality of life resulted in a moderate effect size (r=0.34, 95% CI: 0.28–0.40), thereby providing support for the theoretical framework underlying the study wherein spirituality was depicted as a unique concept that stands in relationship to quality of life. Subsequent regression analyses indicated that differences among operational definitions of spirituality and quality of life were associated with the variability in estimates of the magnitude of the relationship (R 2 =0.27). Other potential moderators, such as age, gender, ethnicity, religious affiliation and sampling method were examined but the findings pertaining to these variables were inconclusive because of limitations associated with the sample of primary studies. The implications of this study are mostly theoretical in nature and raise questions about the commonly assumed multidimensional conceptualization of quality of life. Copyright Springer 2005

Stress, Social Support, and Sense of Coherence:

In the Salutogenic Model, Aaron Antonovsky suggested that a sense of coherence (SOC) is the key determinant in the maintenance of health. He theorized that individuals with a strong SOC have the ability to (a) define life events as less stressful (comprehensibility), (b) mobilize resources to deal with encountered stressors (manageability), and (c) possess the motivation, desire, and commitment to cope (meaningfulness). To determine the effects of SOC on health outcomes, a greater understanding of the development and maintenance of SOC is necessary. Data from the 1994 Canadian National Population Health Survey were analyzed to investigate the effects of stress, social support, and recent traumatic life events on SOC. As predicted, stress and recent traumatic events were found to be inversely related to SOC, and social support was positively related. Traumatic events encountered in childhood were stronger predictors of SOC than traumatic life events experienced in adulthood.

Communicating Cancer Risk Information: The Challenges of Uncertainty.

Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicating cancer risk information is germane to a number of health professions including physicians, geneticists, genetic counsellors, psychologists, nurses, health educators and social workers. Based on a literature review of 75 research reports, expert opinion papers and clinical protocols, we provide a synthesis of what is known about the communication of cancer risk information and make recommendations for the enhancement of knowledge and practice in the field.

Challenges of citizen participation in regional health authorities

Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.

Sense of coherence as a moderator of the effects of stressful life events on health

Study objective: To test the hypothesis that Antonovsky’s concept of sense of coherence (SOC) moderates (that is, buffers) the health impacts of stressful life events in a population based sample. Design: Multiple linear and Poisson regression analyses of longitudinal data from a national survey of population health were used to examine the relations among SOC, the experience of recent stressful life events (for example, family breakdown, financial crisis, physical abuse), and two outcomes, self reported health status (SRH) and self reported number of physician visits during the previous year. Setting: General population of Canada. Participants: Nationally representative sample of household residents aged 30 years of age or greater surveyed in 1998 and 2000 (n = 6505). Main results: After controlling for age, sex, and previous health status, a significant moderating effect (t = 2.24, p = 0.025) in the expected direction was found on respondents’ SRH. The mean difference in SRH between those who did and did not experience a recent stressful life event was 0.24 (95% CI: 0.16, 0.32) in people with a below average SOC and 0.04 (95% CI: −0.04, 0.11) in people with a higher than average SOC score. The postulated moderating effect of SOC was not significant (t = 1.1, p>0.05) in predicting the number of visits to a physician. Conclusions: SOC seems to buffer the impact of recent stressful life events on SRH.

Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women

This study examined the long-term effectiveness of a postpartum smoking relapse prevention intervention by evaluating the smoking status and smoking cessation self-efficacy of original study participants at 12 months following delivery. Two hundred and thirty-eight women who had participated in a randomized clinical trial, a nurse-delivered relapse prevention intervention, were visited in their homes. Data were collected on smoking status, self-efficacy, mental health, alcohol use, breast feeding, social support, smoking in the social environment, and sociodemographics. Smoking status was verified with measures of carbon monoxide in expired air. The 12-month continuous smoking abstinence rate was 21.0% in the treatment group and 18.5% in the control group; odds ratio (OR) = 1.17, 95% confidence interval (CI) = 0.62-2.22. One half (50.4%) of the control group and 41.2% of the treatment group reported smoking daily at 12 months; OR = 1.45, 95% CI = 0.87-2.43. The treatment group attained higher self-efficacy. Four variables were associated with relapse to daily smoking; breast feeding and mental health had protective effects, while partners who smoked and greater amount smoked prior to pregnancy had adverse effects.

Preventing smoking relapse in postpartum women

BACKGROUND Although many women quit smoking during pregnancy, the majority resume smoking shortly after giving birth. OBJECTIVES To test a program to prevent smoking relapse in the postpartum period by comparing the rates of continuous smoking abstinence, daily smoking, and smoking cessation self-efficacy in treatment and control groups. METHODS In a randomized clinical trial, nurses provided face-to-face, in-hospital counseling sessions at birth, followed by telephone counseling. The target population included women who quit smoking during pregnancy and who gave birth at one of five hospitals. The 254 participating women were interviewed 6 months after delivery and assessed biochemically to determine smoking status. RESULTS The 6-month continuous smoking abstinence rate was 38% in the treatment group and 27% in the control group (odds ratio [OR] = 1.63, 95% confidence interval [CI] .96 - 2.78). Significantly more control (48%) than treatment (34%) group participants reported smoking daily (OR = 1.80, 95% CI = 1.08 - 2.99). Smoking cessation self-efficacy did not vary significantly between the groups. CONCLUSIONS Smoking cessation interventions focusing on the prenatal period have failed to achieve long-term abstinence. Interventions can be strengthened if they are extended into the postpartum period.

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.

Decentralization as a determinant of autonomy, job satisfaction, and organizational commitment among nurse managers

The purpose of this study was to test a theoretical model of the following variables, decentralization, professional autonomy, job satisfaction, and organizational commitment. Data were collected through a comprehensive survey of first-line nurse managers (N = 200) in acute care hospitals with more than 100 beds in British Columbia, Canada. The final model excluded all explored personal characteristics of the nurse manager-gender, health or vitality status, marital status, age, education, and years of supervisory or management experience. Job satisfaction was found to be an important predictor of organizational commitment. However, decentralization was most important because it affected organizational commitment directly, as well as indirectly, through professional autonomy and job satisfaction.

Tobacco dependence: adolescents' perspectives on the need to smoke

To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.