Introduction
Methods
Eligibility Criteria
Search Strategy
Study Selection Process
Data Extraction
Quality Assessment
Data Synthesis
Results
Study Selection
Description Of Included Studies
Designs And Countries Of Study
Participant Characteristics
Authors (publication year), country, (reference) | Study design/sample size | Cardiovascular disease type and setting | Religiosity and/or spirituality measure/religion(s) type | Medication adherence measure | Major findings | Limitation(s) | Conclusion(s) |
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Abel WM & Greer DB (2017), USA (W. M. Abel & D. B. Greer, 2017) | Cross-sectional study (n = 80) | Hypertension, North Carolina hair salons, Black churches, community events, and social nomination | 1. Nine spiritual/religious questions developed by the investigator (Christianity) | One subscale of the 14-item Hill-Bone Compliance to High Blood Pressure Therapy scale | 1. No significant correlation between medication adherence and attending church/religious services, praying, reading Bible/religious material, and strength of spiritual beliefs 2. Data support that as spiritual and religious beliefs increased, medication adherence increased, but this relationship did not reach statistical significance | 1. The sample was primarily recruited by snowball technique through church members 2. Non-random and small sample size used in the research 3. Study results are limited by the low reliability of the new investigator-developed spiritual/religious data collection tool | There was no significant association between religious beliefs, spirituality and medication adherence among African American women suffering from hypertension |
Cross-sectional study (n = 130) | Heart failure clinic at the Hospital de Clínicas de Porto Alegre | 1. Duke University Religion Index (DUREI) 2. The World Health Organization Quality of Life Spirituality, Religiosity and Personal Beliefs (WHOQoL SRPB) (No religion reported) | Repetitive Education and Monitoring for Adherence for Heart Failure (REMADHE) | 1. A significant association between spirituality and medication adherence was reported (r = 0.26, p = 0.003) 2. Intrinsic religiosity showed association with medication adherence score (r = 0.20, p = 0.02) | 1. Cross-sectional design was used; it was inadequate to show a causal relationship 2. Future studies need to determine whether these findings are replicable in different religious and cultural backgrounds 3. The effect of spirituality on adherence to various heart failure management facets was not individually assessed | Spirituality has an important role in managing heart failure patients. This study suggests that all health care providers and the patients with heart failure should have awareness of the role of spirituality in medication adherence management | |
Kretchy I et al. (2013), Ghana (Kretchy et al., 2013) | Cross-sectional study (n = 400) | Hypertension, two tertiary hospitals in Ghana (KATH, KBTH) | 1. Duke University Religion Index (DUREI) 2. Spiritual Perspective Scale (Christians 90%, Muslims 5%, Traditional religion 1%) | Morisky Medication Adherence Scale (8-item) | 93.3% of the patients were poorly adherent to their medications. Spirituality (p = 0.018), but not religiosity (p = 0.474), was related directly to medication non-adherence | Generalization to a larger population is limited because they recruited the participants from tertiary hospitals only, while there are many patients with hypertension in other settings in Ghana | The high level of religiosity and spirituality of patients with hypertension increased their trust in divine healing instead of adhering to their medications |
Greer DB & Abel WM (2017), USA (Greer & Abel, 2017) | Mixed-methods design (n = 20) | Hypertension, African American Baptist church in rural East Texas | The Brief Religious/Spiritual Coping Scale (Christianity) | Hill-Bone Compliance to High Blood Pressure Therapy scale | The dominant theme that emerged from participants interviews was prayer. Prayer helped the women adhere to their anti-hypertensive treatment regimen | 1. Generalization to a larger population and inferential statistics were limited due to participants' very small sample size and heterogeneity 2. Data saturation was obtained with 20 participants, and the qualitative phase of the study was weighted more than were the quantitative measures 3. Sampling was done in only one rural area in Texas with only African American women; generalizations to the larger population remain limited | This study suggests the importance of including R/S in the management of hypertension. Furthermore, prayer helps patients take their medication regularly |
Park CL et al. (2008), USA (Park et al., 2008) | Cross-sectional study (n = 202) | Congestive heart failure (CHF), Cincinnati Veterans Administration Medical Center and University of Cincinnati Medical Center | Four subscales from the NIA/Fetzer Brief Measure of Religion and Spirituality (BMMRS) (No religion reported) | Compliance measure developed by Sherbourne, Hays, Ordway, DiMatteo, & Kravitz (1992) | 1. Religious commitment was predictive of more adherence to CHF-specific behaviors (reporting new symptoms, exercise, medication, and stress management) | 1. A majority of the participants were men 2. The assessment of adherence behaviors was based on self-report 3. The study should be considered more exploratory than definitive, focusing on a single disease and a single group of individuals 4. Other variables that may account for the relationships between religion and health, such as personality, were not assessed | These results suggest that some aspects of religiousness have positive effects, other aspects have adverse effects, and still, others appear unrelated to the performance of particular health behaviors |
Yon AS (2013), USA (Yon, 2013) | Cross-sectional study-pilot study (n = 62) | Hypertension, Chatham Crossing Medical Center | 1. Duke University Religion Index (DUREI) 2. Spiritual Health Locus of Control Scale (SHLCS)/Self-ranking of spirituality (Christianity) | 1. Morisky Compliance Assessment Scale (MMAS 4-Item) 2. Morisky Medication Adherence Scale (MMAS 8-item) | 1. A positive relationship with adherence was observed for organized religiosity (OR = 1.79; 95% CI 0.58–5.46), non-organized religiosity (OR = 1.05; 95% CI 0.37–2.99), and for intrinsic religiosity (OR = 1.41; 95% CI0.46–4.34), where patients with high religiosity had higher odds of reporting adherence than those with low religiosity 2. After controlling for race, self-ranking of spirituality was significant in relation to self-reported adherence (p = 0.04) 3. Patients who rated themselves as highly spiritual had higher odds of reporting adherence to their medications than had those with low spirituality (OR = 4.12; 95% CI 1.09–15.61) | 1. The results may not be generalizable to other chronic diseases, younger adults, or populations outside the geographical region of Central North Carolina 2. The cross-sectional design of the present study did not permit determinations of causal relationships among the variables 3. The unobserved heterogeneity or unmeasured confounding affected the findings (as other mediating variables affect the relationships between spirituality, adherence behavior, and blood pressure) 4. The current study may have been heavily biased toward the Christian faith due to its population and the geographical region in which it was conducted | A better understanding of the mechanisms and role of spirituality in medication-taking behavior and health outcomes will aid researchers and health professionals develop culturally sensitive and patient-centered interventions to improve medication adherence and cardiovascular outcomes |
Harvin LA (2018), USA (Harvin, 2018) | Quasi- experimental design (n = 10) | Hypertension, Central Church of Christ | Spiritual Perspective Scale (SPS) (Christianity) | The medication adherence section is composed of three questions regarding medication usage | The Wilcoxon test revealed a statistically significant increase in medication adherence scores of the participants following the hypertension management sessions,(p = 0.034) | 1. Convenience sampling was employed in the selection of participants 2. Generalization to a larger population is limited due to the small sample size | Results of this project contribute to the limited body of knowledge regarding spirituality and its potential role in managing chronic diseases, especially among African Americans |
Loustalot F (2006), USA (Loustalot, 2006) | Cross-sectional design (n = 5302) | Hypertension (home, office, or Jackson Heart Study (JHS)) | 4 measures utilized to assess religion and spirituality including organizational religiosity (OR), non-organizational religiosity (NOR), religious coping (RC), and daily spiritual experiences (DSE) (No religion reported) | 31 of the JHS Medication Survey Forms | 1. Those with more religious activities were more likely to be categorized as hypertensive 2. Organized religious had a negative nonsignificant relationship with hypertensive (B = -0.059, Odds Ratio = 0.943, p = 0.566) | 1. Instrumentation, sample, and research design. The inclusion of religious media as a component of the OR measure made it difficult to assess the contribution of formal attendance in religious activities versus more-private watching of televised church activities 2. The data utilized for this study were from the baseline exam of the JHS. As these are the only current data available, the study is cross-sectional and is unable to speak to fluctuations among variables | This study supports the potential buffering effect of religion and spirituality on hypertension with lower levels of actual blood pressure among those reporting more religious or spiritual practices |
Black G et al. (2006), USA (Black et al., 2006) | Cohort study design (n = 95) | Heart failure, Outpatient heart failure clinic and inpatient units | Spirituality Assessment Scale (SAS) (Christianity) | Heart Failure Compliance Questionnaire (HFCQ) | There was no relationship or correlation between the variables of spirituality and compliance among the Heart Failure participants (r = 16,393; P = 0.115) | 1. Small sample size 2. The reliability of the HFCQR 3. The degree of compliance can change from 1 day to the next, and even hour by hour for these patients 4. Situational factors such as illness, family gatherings, family illness, and the business of holidays may affect compliance 5. The use of self-reports, convenience sampling, and response rate bias | The findings of this study may have practical implications for health care professionals helping individuals cope with a chronic illness |
Measures of Religiosity/Spirituality
Religiosity and/or spirituality measure (Reference) | Number of items | Instrument description | Scoring system |
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Nine spiritual/religious questions developed by the investigator (Abel & Greer, 2017) | 9 | Questions were reviewed for face validity by three community-dwelling African American women and for content validity by two nurse scientists with spiritual/religious training. Cronbach’s alpha was run on the four Likert-type questions, yielding an acceptable coefficient for newly developed items of 0.524 | NA |
1. Duke University Religion Index (DUREL) (Alvarez et al., 2016) | 5 | The DUREL scale has five items that describe three dimensions of religiosity known to best correlate with health-related outcomes: organizational (ORA); non-organizational (NORA); and intrinsic religiosity (IR) | The score ranges from 1 to 30 points, and higher scores indicate elevated levels of religiosity |
2. The World Health Organization Quality of Life Spirituality, Religiosity and Personal Beliefs (WHOQoL-SRPB) (Alvarez et al., 2016) | 32 | It is composed of 32 items distributed in eight factors (Spiritual Connection, Meaning of Life, Awe & Wonder, Wholeness & Integration, Spiritual Strength, Inner Peace, Hope & Optimism and Faith) in a general index composed of 4 items (SRPB Global), originally of the SRPB domain of the WHOQOL-100 | NA |
1. Duke University Religion Index (DUREL) (Kretchy et al., 2013) | 2 | A two-item measure assessing two domains of religiosity: organized religious activity (ORA), i.e., (“How often do you attend church or religious meetings?”), and non-organized religious activity (NORA), i.e., (“How often do you spend time in private religious activities, such as prayer meditation, or Bible study?”). Responses range from 1 (“more than once a week”) to 6 (“never”) for ORA and 1 (“more than once a day”) to 6 (“rarely or never”) for NORA. DUREL has been validated in health research with Cronbach’s alpha values ranging from 0.75 to 0.88 | Scoring is based on a separate regression model for each item |
2. Spiritual Perspective Scale (SPS) (Kretchy et al., 2013) | 10 | (SPS) is designed to measure perceptions of the extent to which participants hold certain spiritual views and engage in spiritually related interactions. Each of the 10 items uses a 6-point Likert-type scale ranging from strongly disagree to strongly agree and is scored using the mean | Scores above the mean indicate high spiritual involvement, and those below the mean value indicate the reverse |
Brief Religious/Spiritual Coping scale (Greer & Abel, 2017) | 10 | The brief RCOPE consisted of a 10-item, 4-point Likert scale. Five positive items addressed searching for a spiritual connection, collaborative religious coping, seeking spiritual support, benevolent religious reappraisal, and ritual purification, while the five negative items addressed punishing God reappraisal, spiritual discontent, self-directed religious coping, religious doubts, and anger at God. Cronbach’s alpha was 0.63 for the positive subscale, and 0.58 for the negative subscale | The positive and negative brief RCOPE subscale scores ranged from 1 to 4 (1 A great deal; 2 Quite a bit; 3 Somewhat, and 4 Not at all). The overall brief RCOPE item responses include 1 = Very involved, 2 = Somewhat involved, 3 = Not very involved, and 4 = Not involved at all. Scoring consists of summing positive and negative items. Positive and negative brief RCOPE subscale scores range from 5 to 20, with lower scores indicating higher levels of R/S coping |
Religiousness was assessed with four subscales from the NIA/Fetzer Brief Measure of Religion and Spirituality (Park et al., 2008) | 2 | Religious support was assessed with two items regarding the extent to which one’s congregation would help with illness or other problems rated on a scale from 1 (none) to 4 (a great deal) (internal consistency reliability = .87). Commitment was assessed by asking participants the degree to which they tried to bring their religious beliefs over into other aspects of their lives from 1 (strongly disagree) to 4 (strongly agree). Positive and negative religious coping was each assessed with two items (e.g., “I work with God as partners,” and “I feel God is punishing me,” respectively) (internal consistency reliabilities = .82 and .89, respectively) | Items were rated on a scale from 1 (not at all) to 4 (a great deal) |
The Duke University Religion Index (DUREL) (Yon, 2013) | 5 | Is a widely used five-item measure. The five single items measure organizational and non-organizational religiosity; the three-item subscale measures intrinsic religiosity. The overall scale has been shown to have high test–retest reliability (intra-class correlation = 0.91), high internal consistency (Cronbach’s α = 0.78–0.91) and high convergent validity with other measures of religiosity (r’s = 0.71–0.86) | Items in the subscales are scored on a five-to-six-point Likert-type scale |
Spiritual Health Locus of Control Scale (Yon, 2013) | 13 | Is a 13-item, two-dimensional scale that assesses active and passive spiritual health locus of control beliefs. It was adopted from Holt and colleagues (2003, 2007). On the SHLCS, Cronbach’s α for the active dimension (11 items) ranges from 0.78 to 0.89 and from 0.56 to 0.76 for the passive dimension (2 items) | Item responses are scored on a four-point Likert-type scale that ranges from strongly disagree (1) to strongly agree (4) |
Self-Ranking of Spirituality (Yon, 2013) | 1 | Is a one-item assessment of spiritual intensity that asks participants to rate the extent to which they consider themselves spiritual/religious. This item was adopted from the brief multidimensional measure of religiousness/spirituality (BMMRS) developed by a panel of experts on spirituality and health research at the Fetzer Institute and the National Institute on Aging and has been included on numerous spiritual surveys in combination with other spiritual measures; it has also been used as a single-item measure of spirituality | Responses range from 4 (very spiritual/religious) to 1 (not spiritual/religious et al.) |
The Spiritual Perspective Scale (SPS) (Harvin, 2018) | 10 | Is a 10-item questionnaire that measured participants’ spiritual views and the extent to which they hold those views and engage in spiritually related behaviors. Examples of questions that inquire about frequency of spiritually related behaviors include “How often do you engage in private prayer or meditation?” and “I seek spiritual guidance in making decisions in my everyday life. Positive correlations between the scale and spiritual backgrounds have been noted, with all item-scale correlation’s above 0.60 and the Cronbach’s alpha above 0.90 | Responses can range from 1 to 6 on a Likert-type scale, 1 = Not Likely to 6 = Always. Respondents scores were averaged to arrive at a spiritual perspective score, which can range from 1.0 to 6.0 |
The 4 measures utilized to assess religion and spirituality included organizational religiosity (OR), non-organizational religiosity (NOR), religious coping (RC), and daily spiritual experiences (DSE) (Loustalot, 2006) | 5 | All measures were obtained as part of the self-administered Approach to Life C form completed by the participant following the HII and returned to the clinic at the time of the baseline exam. Each measure was assessed as a continuous variable. OR, a measure of organized religious activities including attendance at religious services, was measured in question 1. The question states, “In general, how often do you attend the main worship service of your church or otherwise participate in organizational religion (such as watching services on TV, listening to services on the radio, participating in Bible study groups, etc.)?” NOR, the private practice of religious activities outside of the church, synagogue, or other place of worship was assessed in question 2. It states, “Within your religious or spiritual tradition, how often do you pray privately or meditate in places other than at church, mosque, temple, or synagogue?” Both OR and NOR have limited publications founding their psychometric properties, but are frequently used in social surveys and health-related research | OR and NOR were measured using an 8-level Likert type scale, ranging from “more than once a day” to “never.” Lower scores were correlated with more religious activities |
Spirituality Assessment Scale (SAS) (Black et al., 2006) | 28 | The SAS comprises 28 questions with a 5-point Likert scale and is divided into four subscales: (1) purpose and meaning in life, (2) inner resources, (3) unifying interconnectedness, and (4) transcendence. The SAS has demonstrated high internal consistency and reliability (α = 0.92). Reliability of the SAS in the current study was 0.89. Internal consistency of SAS subscales for purpose and meaning in life, inner resources, unifying interconnectedness, and transcendence were 0.746, 0.732, 0.731, and 0.64, respectively | Scores range from 28 to 140, with a lower score indicating a higher level of spirituality |
Measures of Medication Adherence
Medication adherence measure (references) | Number of items | Instrument description | Scoring system |
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14-item Hill-Bone Compliance to High Blood Pressure Therapy scale (W. M. Abel & D. B. Greer, 2017) | 8 | The Medication Adherence (eight items) subscale, along with one item that addressed prescription refills | Responses are scored on a 4-point Likert scale from 1 (“none of the time”) to 4 (“all of the time”). Lower scores represent greater adherence and can range from 9 (perfect adherence) to 36 (complete non-adherence) |
Repetitive Education and Monitoring for Adherence for Heart Failure (REMADHE) (Alvarez et al., 2016) | 10 | The questionnaire is composed of ten questions involving four domains: use of medications (one question); food and fluids (seven questions); alcohol consumption (one question); and medical appointments (one question) | The score ranges between 0 and 26 points, with higher scores indicating better patient adherence. A REMADHE score equal to or higher than 18 points indicates adequate level of adherence |
Morisky Medication Adherence Scale (MMAS) (Kretchy et al., 2013) | 8 | The scale has 8 items on which respondents score from zero to eight. The MMAS reliability measure was 0.83 for a study on hypertensive outpatients | The scale has 8 items on which respondents score from zero to eight and enables categorization as low adherence (< 6), medium adherence (6 – < 8), and high adherence (8). Patients who scored low and moderate were grouped as poorly adherent to allow for statistical analysis |
Hill-Bone Compliance to High Blood Pressure Therapy scale (Greer & Abel, 2017) | 14 | The Hill Bone CHBPT scale is a 14-item 4-point Likert scale that was designed to assess compliance to blood pressure treatment and addresses three important domains: sodium intake, keeping appointments, and medication adherence. For this study, the term compliance was interchanged with the term adherence. Cronbach’s alpha for this sample of women was 0.81 | The instrument is scored by summing the three subscales for a total score. Scores for each item range from 1 to 4 (1 = none of the time, 2 = some of the time, 3 = most of the time, and 4 = all of the time), with a total score range from 14 (minimum) to 56 (maximum). Higher scores indicate a lower level of adherence |
8 | Eight health behaviors that are particularly important for CHF patients to adhere to (reporting new symptoms, exercise, stress management, medication, diet salt reduction, fluid intake, smoking, and alcohol use). Four items were loaded on a factor that named CHF-related behaviors, which included reporting new symptoms, exercising, taking medication, and managing stress. Factor loadings for the four items ranged from 0.472 to 0.772. The second factor included two behaviors involving diet (salt and fluid intake); factor loadings were 0.802 and 0.850. The third factor included two behaviors involving substance use (smoking and alcohol); factor loadings were .806 and .595. There was minimal cross-loading of items, and the overall variance accounted for by the three factors was 60.4 percent. The alpha coefficients for these three adherence factors were 0.65, 0.69, and 0.62, respectively | Participants were asked the following: 1. To what extent has your doctor discussed each of the following topics with you? Responses were rated on a scale from 1 (not at all) to 4 (to a great extent); 2. What has your doctor told you about each of the following? Responses were rated from 1 (nothing at all) to 4 (a great deal of information); and 3. How much do you follow your doctor’s advice about each of the following? Responses were rated from 1 (not at all) to 3 (completely) | |
Morisky Compliance Assessment Scale (Yon, 2013) | 4 | Morisky is a four-item scale that asks, (1) Do you ever forget to take your medicine? (2) Are you careless at times about taking your medicine? (3) When you feel better, do you sometimes stop taking your medicine? and (4) Sometimes if you feel worse when you take the medicine, do you stop taking it? The Morisky scale has been shown to be reliable (Cronbach’s α = 0.61) and to demonstrate both concurrent and predictive validity, but it does not capture behavior for specific medications. This measure is a general assessment of adherence and is not disease or medication-specific. It was selected for its feasibility, considering that the data for Aim 1 were collected in the context of a larger study | Its score is calculated by assigning one point for each answer of “no” and zero points for each answer of “yes.” Patients answering “yes” to one or more questions are viewed as possibly having problems with medication adherence |
8-item Morisky Medication Adherence Scale (MMAS-8) (Yon, 2013) | 8 | This self-reported adherence scale was developed from the 4-item Morisky instrument used in Aim 1 (the pilot study) and supplemented with additional items to better capture barriers to adherence behavior. The new scale was determined to have higher reliability than the 4-item scale (α = 0.83 vs. α = 0.61) after its original validation in a sample of 1367 hypertensive patients; it was chosen in lieu of the 4-item scale used in Aim 1 because of its better reliability and because it is a disease-specific measure of adherence | MMAS-8 scores, which range from 0 to 8, have previously been dichotomized into two levels of adherence: high (score = > 6) and low (score = < 6) |
The medication adherence section is composed of three questions regarding medication usage (Harvin, 2018) | 3 | Participants rated themselves using a seven-point Likert scale on how often they take their prescribed blood pressure medications | The possible range for the responses to the three questions are 0–21. Participants who score a 21 are considered adherent to their medication regimen |
Item 31 of the JHS Medication Survey Form (Loustalot, 2006) | 31 | Medication habits were assessed by a series of 11 questions on medication-taking behaviors included in item 31 of the JHS Medication Survey Form. The questions were adapted from ‘the National Survey of Black Americans’, and limited psychometric data are available. The content of the questions has been noted as barriers to medication adherence in other studies | Potential responses included, “reason indicated,” “not a reason,” and “don’t know.” Participants who reported “reason indicated” or “don’t know” were classified as non-adherent for the particular item. Each of the 11 items was summed for a composite score ranging from 0 to 11, with higher scores representing less medication adherence |
Heart Failure Compliance Questionnaire (HFCQ) (Black et al., 2006) | 8 | The HFCQR is a self-administered 5-point Likert scale that consists of 8 questions on compliance to prescribed activities. The original Heart Failure Compliance Questionnaire (HFCQ) consisted of five questions on compliance. A panel of 6 experts established content validity of the HFCQ, and an internal consistency of 0.68 was obtained using Cronbach’s α. For this study, the HFCQ was revised to include 3 critical prescribed activities: daily weighing, checking for edema, and early reporting of increasing symptoms | Scores range from 8 to 40, with lower scores indicating higher levels of compliance |
Study Quality Assessments
Authors (Pub. year) country (reference) | Preliminaries | Introduction | Design | Sampling | Data collection | Ethical matters | Results | Discussion | Total% | Classification |
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4 | 5 | 4 | 4 | 4 | 4 | 4 | 4 | 83 | Moderate | |
4 | 5 | 4 | 3 | 4 | 5 | 4 | 4 | 83 | Moderate | |
4 | 5 | 4 | 3 | 3 | 3 | 4 | 4 | 75 | Low | |
4 | 5 | 5 | 4 | 5 | 4 | 4 | 4 | 88 | Moderate | |
4 | 5 | 3 | 3 | 3 | 4 | 3 | 5 | 75 | Low | |
4 | 5 | 5 | 5 | 5 | 5 | 4 | 5 | 95 | High | |
5 | 5 | 4 | 3 | 4 | 3 | 4 | 4 | 80 | Moderate | |
4 | 5 | 4 | 5 | 4 | 4 | 4 | 5 | 88 | Moderate | |
4 | 5 | 3 | 3 | 4 | 4 | 4 | 4 | 78 | Moderate |
Association Between Religiosity/Spirituality And Medication Adherence
Discussion
Authors (publication year), country (reference) | Type of measurement R/S | Definition of the construct(s) | The effect of R/S on medication adherence | Comment(s) |
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Religious beliefs and spirituality | Not mentioned “Though often used interchangeably, spirituality and religion are separate but related concepts” | There was no relationship between religious beliefs/ spirituality and medication adherence | In this study there was no clear definition of religious beliefs and spirituality | |
Spirituality | Not mentioned | There is an clear association between spirituality and medication adherence among patients with heart failure “1. A significant association between spirituality and medication adherence was reported (r = 0.26, p = 0.003) 2. Intrinsic religiosity showed association with medication adherence score (r = 0.20, p = 0.02).” | In this study there is no any definition of spirituality | |
Spirituality & Religious belief | “Formerly, spirituality and religiosity were examined as a one-dimensional construct” “religion is generally inter-related with spirituality since the former provides a structured environment for spiritual exploration and practices in life and the two constructs have been conceptualized to influence the development of each other. For example, religious practices encourage spiritual growth and spiritual activities are often an important aspect of religious participation” | There is an relationship Between spirituality and medication adherence but not religiosity | The high level of religiosity and spirituality of patients with hypertension increased their trust in divine healing instead of adhering to their medications | |
Religious/spirituality | Not mentioned | Prayer helped the women adhere to their anti-hypertensive treatment regimen | Health care provider should learn more about patient’s belief | |
Park CL et al. (2008), USA (Park et al., 2008) | Religion/Spirituality | Not mentioned | Religious commitment was predictive of more adherence to CHF-specific behaviors (reporting new symptoms, exercise, medication, and stress management) | few studies that have specifically documented some relationship between religiousness and adherence |
Spirituality | Not mentioned | The current study suggested that there is an association between spirituality and medication adherence among older patients with hypertension | The discovery of these associations provides direction for future studies that will aid in understanding how health professionals can use this information to provide culturally sensitive and patient-centered care that will improve medication adherence and cardiovascular outcomes | |
Spirituality | Not mentioned | The Wilcoxon test revealed a statistically significant increase in medication adherence scores of the participants following the hypertension management sessions, (p = 0.034) | Results of this project contribute to the limited body of knowledge regarding spirituality and its potential role in managing chronic diseases, especially among African Americans | |
Religion and spirituality | Religion and spirituality may appear to be used interchangeably throughout this text and, in many cases, the degree of overlap allows for little distinction. However, they were conceptually defined as separate concepts, each with individual and overlapping attributes. Religion was defined as rituals, practices, and experiences involving a search for the sacred (i.e., God, Allah, or other similar figure) that are shared within a group. Spirituality was defined as a search for meaning and purpose in life, which seeks to understand life’s ultimate questions in relation to the sacred. Where religion may be formal, organized, group-orientated, ritualistic, or objective, spirituality has been viewed as informal, non-organized, self-reflective, experiential, and subjective (Koenig et al., 2001; Loustalot, 2006) | 1. Those with more religious activities were more likely to be categorized as hypertensive 2. Organized religious had a negative nonsignificant relationship with hypertensive (B = -0.059, Odds Ratio = 0.943, p = 0.566) | This study supports the potential buffering effect of religion and spirituality on hypertension with lower levels of actual blood pressure among those reporting more religious or spiritual practices | |
Spirituality | Spirituality bestows multiple positive psychologic and psychosocial benefits to persons with chronic illness. Increased optimism and hope, positive meaning in life, and positive self-image were defined as invaluable byproducts of spirituality by patients dying of heart failure. Psychosocially, an important characteristic of spirituality includes community support for heart failure patients. Morris found that a relationship existed between higher spirituality levels and disease regression in patients with coronary artery disease. Koenig indicated a correlation between spirituality and less need for acute care and long-term services. A study by Hardin et al. concluded that the inclination to use prayer and meditation was less prevalent in patients with later stages of heart failure than in patients experiencing earlier stages of the disease | There was no relationship or correlation between the variables of spirituality and compliance among the heart failure participants (r = 16,393; P = 0.115) | The findings of this study should be interpreted with caution and possibly as inconclusive due to the small sample size |