Skip to main content

Advertisement

SpringerLink
Log in

Modeling the effects of spirituality/religion on patients’ perceptions of living with HIV/AIDS

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Spirituality/religion is an important factor in health and illness, but more work is needed to determine its link to quality of life in patients with HIV/AIDS.

Objective

To estimate the direct and indirect effects of spirituality/religion on patients’ perceptions of living with HIV/AIDS.

Design

In 2002 and 2003, as part of a multicenter longitudinal study of patients with HIV/AIDS, we collected extensive demographic, clinical, and behavioral data from chart review and patient interviews. We used logistic regression and path analysis combining logistic and ordinary least squares regression.

Subjects

Four hundred and fifty outpatients with HIV/AIDS from 4 sites in 3 cities.

Measures

The dependent variable was whether patients felt that life had improved since being diagnosed with HIV/AIDS. Spirituality/religion was assessed by using the Duke Religion Index, Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being—Expanded, and Brief RCOPE measures. Mediating factors included social support, self-esteem, healthy beliefs, and health status/health concerns.

Results

Approximately one-third of the patients felt that their life was better now than it was before being diagnosed with HIV/AIDS. A 1-SD increase in spirituality/religion was associated with a 68.50% increase in odds of feeling that life has improved—29.97% due to a direct effect, and 38.54% due to indirect effects through healthy beliefs (29.15%) and health status/health concerns (9.39%). Healthy beliefs had the largest effect on feeling that life had improved; a 1-SD increase in healthy beliefs resulted in a 109.75% improvement in feeling that life changed.

Conclusions

In patients with HIV/AIDS, the level of spirituality/religion is associated, both directly and indirectly, with feeling that life is better now than previously. Future research should validate our new conceptual model using other samples and longitudinal studies. Clinical education interventions should focus on raising awareness among clinicians about the importance of spirituality/religion in HIV/AIDS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dunkel-Schetter C, Feinstein LG, Taylor SE, Falke RL. Patterns of coping with cancer. Health Psychol. 1992;11:79–87.

    Article  PubMed  CAS  Google Scholar 

  2. Davies B, Reimer JC, Brown P, Martens N. Fading Away: the Experience of Transition in Families with Terminal Illness. Arnityville: Baywood: 1995.

    Google Scholar 

  3. Idler EL. Religion, health, and nonphysical senses of self. Social Forces. 1995;74:683–704.

    Article  Google Scholar 

  4. Ellison CG, Levin JS. The religion-health connection: evidence, theory, and future directions. Health Educ Behav. 1998;25:700–20.

    Article  PubMed  CAS  Google Scholar 

  5. Meraviglia MG. The effects of spirituality on well-being of people with lung cancer. Oncol Nurs Forum. 2004;31:89–94.

    Article  PubMed  Google Scholar 

  6. Pargament KI, Smith B, Koenig HG. Patterns of positive and negative religious coping with major life stressors. J Sci Study Religion. 1998;37:710–24.

    Article  Google Scholar 

  7. Pargament KI, Koenig HG, Tarakeshwar N. Negative Religious Coping Predicts Mortality Among the Medically Ill. Annual Meeting of the American Psychological Association. Washington, DC: American Psychological Association; 2000.

    Google Scholar 

  8. Pargament KI, Tarakeshwar N, Ellison CG, Wulff KM. Religious coping among the religious: the relationships between religious coping and well-being in a national sample of Presbyterian clergy, elders, and members. J Sci Study Religion. 2001;40:497–514.

    Article  Google Scholar 

  9. McCullough ME. Research on religion-accommodative counseling: review and meta-analysis. J Counsel Psychology, 1999;46:1–7.

    Google Scholar 

  10. McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C. Religious involvement and mortality: a meta-analytic review. Health Psychol. 2000;19:211–22.

    Article  PubMed  CAS  Google Scholar 

  11. Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. Am Psychol. 2003;58:64–74.

    Article  PubMed  Google Scholar 

  12. Miller WR, Thoresen CE. Spirituality, religion, and health, An emerging research field. Am Psychol. 2003;58:24–35.

    Article  PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention. HIV/AIDS among Hispanics in the United States. Available at: http://www.cdc.gov/hiv/pubs/facts/hispanic.htm. Accessed June 26. 2004.

  14. Pargament KI, McCarthy S, Shah P, et al. Religion and HIV a review of the literature and clinical implications. South Med J 2004;97:1201–9.

    Article  PubMed  Google Scholar 

  15. Kaldjian LC, Jekel JF, Friedland G. End of life decisions in HIV positive patients: the role of spiritual beliefs. AIDS 1998;12:103–7.

    Article  PubMed  CAS  Google Scholar 

  16. Lorenz KA, Hays RD, Shapiro MF, Cleary PD, Asch SM, Wenger NS. Religiousness and spirituality among HIV-infected Americans. J Palliat Med. 2005;8:774–81.

    Article  PubMed  CAS  Google Scholar 

  17. Ironson G, Solomon GF, Balbin EG, et al. The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Ann Behav Med. 2002;24:34–48.

    Article  PubMed  Google Scholar 

  18. Tsevat J, Sherman SN, McElwee JA, et al. The will to live among HIV-infected patients. Ann Intern Med. 1999;131:194–8.

    PubMed  CAS  Google Scholar 

  19. Honiden S, Sundaram V, Nease RF, et al. The effect of diagnosis with HIV infection on health-related quality of life. Qual Life Res. 2006;15:69–82.

    Article  PubMed  Google Scholar 

  20. Belcher AE, Dettmore D, Holzemer SP. Spirituality and sense of well-being inpersons with AIDS. Holist Nurs Pract. 1989;3:16–25.

    PubMed  CAS  Google Scholar 

  21. Klitzman R. The Lives of Men and Women with HIV. Chicago: Ivan R. Dee; 1997.

    Google Scholar 

  22. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

    Google Scholar 

  23. Beckley RE, Koch JR. The Continuing Challenge of AIDS: Clergy Responses to Patients, Friends, and Families. Westport: Auburn House; 2002.

    Google Scholar 

  24. Sowell R, Moneyham L, Hennessy M, Guillory J, Demi A, Seals B. Spiritual activities as a resistance resource for women with human immunodeficiency virus. Nurs Res. 2000;49:73–82.

    Article  PubMed  CAS  Google Scholar 

  25. Peterman AH, Fitchett G, Cella DF. Modeling the Relationship Between Quality of Life Dimensions and an Overall Sense of Well Being. New York: Third World Congress of Psycho-oncology; 1996.

    Google Scholar 

  26. Koenig H, Parkerson GR Jr, Meador KG. Religion index for psychiatric research. Am J Psychiatry, 1997;154:885–6.

    PubMed  CAS  Google Scholar 

  27. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp). Ann Behav Med. 2002;24:49–58.

    Article  PubMed  Google Scholar 

  28. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56:519–43.

    Article  PubMed  CAS  Google Scholar 

  29. Brown TA. Confirmatory Factor Analysis for Applied Research. New York: Guilford Press; 2006.

    Google Scholar 

  30. Holmes WC, Shea JA. A new HIV/AIDS-targeted quality of life (HAT-QoL) instrument: development, reliability, and validity. Med Care. 1998;36:138–54.

    Article  PubMed  CAS  Google Scholar 

  31. Justice A, Holmes W, Gifford A, et al. Development and validation of a self-completed HIV symptom index. J Clin Epidemiol. 2001;54(suppl 1): S77–90.

    Article  Google Scholar 

  32. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.

    PubMed  CAS  Google Scholar 

  33. Kilbourne AM, Justice AC, Rollman BL, et al. Clinical importance of HIV and depressive symptoms among veterans with HIV infection. J Gen Intern. Med. 2002;17:512–20.

    Article  PubMed  Google Scholar 

  34. Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12:255–66.

    Article  PubMed  CAS  Google Scholar 

  35. Cohen S, Mermelstein R, Kamarck T, Hoberman S Measuring the functional components of social support. In: Sarason I, Sarason B, eds. Social Support: Theory, Research and Applications. The Hague: Martinus Nijhoff: 1985;73–94.

    Google Scholar 

  36. Robinson J, Shaver P. Measuring Social Psychological Attitudes. Ann Arbor: Institute for Social Research; 1969.

    Google Scholar 

  37. Scheier M, Carver C. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4:219–47.

    Article  PubMed  CAS  Google Scholar 

  38. Kline RB. Principles and Practice of Structural Equation Modeling. 2nd ed. New York: Guilford Press; 2005.

    Google Scholar 

  39. Pedhazur EJ. Multiple Regression in Behavioral Research: Explanation and Prediction. 3rd ed. Fort Worth: Harcourt Brace College Publishers: 1997.

    Google Scholar 

  40. Mickley JR, Soeken K, Belcher A. Spiritual well-being, religiousness and hope among women with breast cancer. Image J Nurs Sch. 1992;24:267–72.

    Article  PubMed  CAS  Google Scholar 

  41. Mickley J, Soeken K. Religiousness and hope in Hispanic- and Anglo-American women with breast cancer. Oncol Nurs Forum. 1993; 20:1171–7.

    PubMed  CAS  Google Scholar 

  42. Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E Exploring the relationships among spiritual well-being quality of life, and psychological adjustment in women with breast cancer, Psycho-oncology. 1999;8: 429–38.

    Article  PubMed  CAS  Google Scholar 

  43. Bourjolly JN. Differences in religiousness among black and white women with breast cancer. Soc Work Health Care. 1998;28:21–39.

    Article  PubMed  CAS  Google Scholar 

  44. Idler EL, Kasl SV. Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability. J Gerontol B Psychol Sci Soc Sci. 1997;52:S306–16.

    Google Scholar 

  45. Simoni JM, Ortiz MZ. Mediational models of spirituality and depressive symptomatology among HIV-positive Puerto Rican women. Cultur Divers Ethnic Minor Psychol. 2003;9:3–15.

    Article  PubMed  Google Scholar 

  46. McCullough ME, Laurenceau JP. Religiousness and the trajectory of self-rated health across adulthood. Pers Soc Psychol Bull. 2005;31: 560–73.

    Article  PubMed  Google Scholar 

  47. Folkman S. Positive psychological states and coping with severe stress. Soc Sci Med. 1997;45:1207–21.

    Article  PubMed  CAS  Google Scholar 

  48. Schwartz CE, Sprangers MAG. Adaptation to Changing Health: Response Shift in Quality-of-Life Research. Washington, DC: American Psychological Association; 2000.

    Google Scholar 

  49. Beaton DE, Tarasuk V, Katz JN, Wright JG, Bombardier C “Are you better?” A qualitative study of the meaning of recovery. Arthritis Rheum. 2001;45:270–9.

    Article  PubMed  CAS  Google Scholar 

  50. Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. Assessing change in chronic pain severity: the chronic pain grade compared with retrospective perceptions. Br J Gen Pract. 2002;52:269–74.

    PubMed  Google Scholar 

  51. Guyatt GH, Norman GR, Juniper EF, Griffith LE. A critical look at transition ratings. J Clin Epidemiol. 2002;55:900–8.

    Article  PubMed  Google Scholar 

  52. Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H. Capturing the patient’s view of change as a clinical outcome measure. JAMA. 1999;282:1157–62.

    Article  PubMed  CAS  Google Scholar 

  53. Association of American Medical Colleges. Report III of the medical school objectives project. Contemporary issues in medicine: communication in medicine; 1999.

  54. Barnett KG, Fortin AH. Spirituality and medicine. A workshop for medical students and residents. J Gen Intern Med. 2006;21:481–5.

    Article  PubMed  Google Scholar 

  55. JCAHO. Spiritual Assessments. Availabic at: http://www.jointcommission.org/AccreditationPrograms/HomeCare/Standards/FAQs/Provision+of+Care /Assessment/Spiritual_Assessment.htm. Accessed August 10, 2006.

  56. Puchalski C. Spirituality in health: the role of spirituality in critical care. Crit Care Clin. 2004;20:487–504.

    Article  PubMed  Google Scholar 

  57. Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3:129–37.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for the Study of Health, University of Cincinnati, PO Box 670840, 45267-0840, Cincinnati, OH, USA

    Magdalena Szaflarski, Anthony C. Leonard & Joel Tsevat

  2. Department of Family Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Magdalena Szaflarski

  3. Department of Sociology, University of Cincinnati, Cincinnati, OH, USA

    P. Neal Ritchey

  4. Veterans Healthcare System of Ohio (VSN 10), Cincinnati, OH, USA

    Anthony C. Leonard, Joseph M. Mrus & Joel Tsevat

  5. Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA

    Joseph M. Mrus & Joel Tsevat

  6. Department of Psychology, University of North Caroilna at Chariotte, NC, USA

    Amy H. Peterman

  7. Department of Sociology, University of Texas at Austin, Austin, TX, USA

    Christopher G. Ellison

  8. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Michael E. McCullough

  9. Department of Religious Studies, University of Miami, Coral Gabies, FL, USA

    Michael E. McCullough

Authors
  1. Magdalena Szaflarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Neal Ritchey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony C. Leonard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph M. Mrus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amy H. Peterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher G. Ellison
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael E. McCullough
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joel Tsevat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Magdalena Szaflarski.

Additional information

The authors have no conflicts of interest to report.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Szaflarski, M., Ritchey, P.N., Leonard, A.C. et al. Modeling the effects of spirituality/religion on patients’ perceptions of living with HIV/AIDS. J GEN INTERN MED 21 (Suppl 5), S28–S38 (2006). https://doi.org/10.1111/j.1525-1497.2006.00646.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00646.x

Key words

Search

Navigation