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July 2019 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA
Clayton-Jones, D., Haglund, K. A., Schaefer, J., Koenig, H. G. and George Dalmida, S. "Use of the Spiritual Development Framework in conducting spirituality and health research with adolescents." Journal of Religion and Health 58, no. 4 (August 2019): 1259-1271.
SUMMARY and COMMENT: This month's article illustrates the importance of a theoretical framework to a researcher's creation and accomplishment of a study. It also points up insights about work with an adolescent population and some findings about adolescent experience of spirituality (in the context of sickle cell disease), though more detailed results are presented in a separate article [--see Items of Related Interest, §I, below]. The Spiritual Development Framework (SDF) used here is itself worth consideration, and the stated purpose of the article is "to present the SDF as a useful framework for the investigation of spirituality among adolescents" [p. 1262].
The authors observe that "there is little literature addressing methods for conducting research in spirituality, religion, and health with adolescents" [p. 1260]. They look to a spiritual development framework (SDF) proposed by Peter L. Benson and Eugene C. Roehlkepartain in 2008 [--see Items of Related Interest, §II, below] as "a flexible approach to understanding spiritual development," with that concept being "defined as the process of growing the innate human capacity for self-transcendence leading the person to discern and experience meaning and purpose in life" [p. 1260].
According to the framework, three central developmental processes underpin spiritual development. Each process varies in how it occurs for different people. The processes are (a) awareness or awakening, (b) interconnecting and belonging, and (c) a way of living. ...Awareness is the process of being, or becoming aware of, or awakening to one's self, others, and the universe (which may be understood as including the sacred or divine) in ways that cultivate identity, meaning, and purpose. ...Interconnecting is the process of seeking, accepting, or experiencing meaning in one's relationship with others, the world, or the transcendent (often including an understanding of God or a higher power). ...A way of living is the process of conveying one's individuality and beliefs through relationships and activities that shape connections with oneself, others, and the transcendent. ...The three core processes of the SDF are significant in understanding the interplay between life experiences and one's spirituality. [pp. 1260-1261]
The authors give a graphical depiction of the framework [p. 1261] and helpful examples of each of the core processes in addition to breaking down results according to those processes [--see Table 2, p. 1268]. But most strikingly, they comment on the practical value of the SDF through an exemplar study of nine adolescents (15-19 years old) who participated in two one-hour semi-structured, individual interviews that explored the theme of spirituality in their living with sickle cell disease. The authors note many instances in which the SDF was key to the progress of that study:
- "The SDF was especially valuable as a reference to the researcher during the development of the interview guides," and "...facilitated refining of concepts and terminology used in questions..." [pp. 1262-1263]. "Use of the SDF allowed further development of the depth of the interview questions and the prompts for each question and incorporation of content that may not have been contemplated." [p. 1263]
- "In applying the process of Interconnectedness, the researcher was prompted to ensure that the beginning of the interview guides consisted of questions to lessen anxiety and convey that the researcher was interested in what the adolescents had to say." [p. 1263]
- "While the principal investigator (PI) considered having adult experts review the content of the interview guides for feedback, consideration of the SDF also directed the author to solicit the thoughts and reflections of adolescents around spirituality. This prompted the inclusion of adolescent content reviewers to provide feedback on the material contained within the interview guides and on the actual interview process." [p. 1263]
- "The principal investigator (PI) used the SDF for reflection and preparation before the one-on-one interviews. This preparation allowed the PI to be keenly aware of the significance of establishing rapport with adolescents, to be sensitive to verbal and nonverbal communication, and to be open to the adolescents' descriptions of their spirituality and life experiences." [pp. 1263-1264]
- "Review of the SDF concepts prompted the researcher to consider the manner in which spiritual development occurs rather than focusing solely on stage-driven concepts." [p. 1264] Also, "...[B]eing familiar with the SDF encouraged the researcher to have an awareness of developmental frameworks that are stage driven and how prior knowledge of such frameworks could impact data analysis." [p. 1265]
- "Use of the SDF allowed the researcher to remain open to interpretations of spirituality as described by the adolescents and enhanced interpretation of findings." [p. 1265] "Without use of the SDF, consistency in remaining open to individual descriptions may have been interrupted or reduced." [p. 1265]
- "Use of the SDF assisted the researcher in understanding the process of spiritual development in an age-specific population with diverse experiences." [p. 1265]
- "The SDF was valuable and used as a guide to develop conceptual definitions and language, the interview guides, and throughout the process of data analysis." [p. 1269]
The methodology of the study involved two interview guides, one for participants who indicated that they held religious beliefs, and one for those who indicated that they did not, according to information from demographic forms. "Each guide consisted of 24 open-ended questions that were accompanied by additional probes" [p. 1263]. Input from adolescent content reviewers led the researchers to revise some questions:
For example, ...an adolescent content reviewer reflected on the [double] question "What do you feel is the purpose of your life?" "What do you feel gives your life meaning?" one adolescent reviewer indicated "For the second part of that question, why don't you just ask "What gives your life meaning? I already know the question is based on my point of view." The question "What do you feel gives your life meaning" was revised as suggested. [p. 1263]
An adolescent content reviewer also suggested "adding an activity to promote comfort during the interview process in the event the teen exhibited signs of being nervous" [p. 1264]. A stress ball was provided to participants, and two people did make use of it during the first 10-15 minutes of the initial interview session. The researchers also intentionally conducted the interviews in a space with a window, and while participants "often looked outside the window during the interviews, ...most were engaged in the interview process up until it was time to end" [p. 1264].
Analysis of the interviews yielded 25 thematic codes (20 top-level codes and 5 sub-codes), listed with descriptions in a detailed table [--see Table 1, pp. 1266-1267]. This in turn led to the identification of four major themes:
...spirituality and religiosity as coping mechanisms, shaping of identity, influence of beliefs on health and illness, and expectations of healthcare providers. The theme spirituality and religiosity as coping mechanisms included six threads to include: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural meta-narratives, transcendent experiences, and acceptance and finding meaning. The theme expectations for healthcare providers included two threads: religiosity is private/personal and sharing spiritual and religious beliefs can be risky.
The only item in the thematic analysis that explicitly addresses sickle cell disease is that of "sickle cell experiences," referring to "...the individual's pain crisis experiences or other experiences related to their sickle cell disease" [p. 267, item #20 in Table 1]. For more specific results, readers should refer to the separate 2016 article by Clayton-Jones, et al. [--see Items of Related Interest, §I, below]. The coding/thematic categories are somewhat revealing at a high level, since the data did come from a SCD population.
"The exemplar [study] was provided in order to demonstrate the significance of the SDF when conducting research with adolescents living with SCD" [p. 1269], and for that purpose it supports the value of the SCD on two fronts. First, it shows that the SDF-informed methodology is feasible. In fact, five of the nine adolescents in the research also participated in a follow-up telephone interview that asked them to "Describe your experience with participating in this study." "They reported that the experience was 'enjoyable,' provided an opportunity to 'reflect' and 'express' themselves, and that they would participate in a similar study again" [p. 1265]. Particular responses are given in a table [--see Table 3, p. 1269]. Second, it shows how a theoretical model or framework is critical "throughout the research process" [p. 1262], not only in the creation and refinement of methodology but even in centering the researcher's thought and awareness before conducting the interviews. For this chaplain reader, the article issues an implicit challenge to Spirituality & Health researchers to keep one's theoretical/philosophical models clear and forefront during the entirety of any research project.
The bibliography contains many older references as a function of the paucity of research in the particular area of study, but some readers may be sensitive to the absence of a couple of well-known articles by Daniel Grossoehme et al. in the chaplaincy research community on adolescents and sickle cell disease. Actually, three articles by Cotton, S., Grossoehme, D. H., et al. are cited in the sister article reporting the study used here as an exemplar.
There is a printing error at the bottom of p. 1270, seemingly a carry-over from a reviewer's version, indicating anonymity in the article review procedure.
Suggestions for Use of the Article for Student Discussion:
This is a very readable article that could be especially useful to students considering a research project, challenging them to think about the theoretical grounding of their approach and hypotheses. However, for general discussion, a group might begin with the authors' definitions of spirituality, religion, and spiritual development [p. 1260]; and then move on to a consideration of the Spiritual Development Framework and examples of its core concepts [p. 1261]. (The figure on p. 1261 might be more confusing to some students than the quite nice examples in the text on that same page.) The group could then think about how this abstract model affected the principal investigator in quite practical ways. If the students are in a center where they have contact with adolescents, then the question could be asked about the possible value of the model/framework to their patient care (and perhaps a sickle cell disease clinician could be a guest at this discussion). Does the SDF have implications for non-adolescent contexts? Table 1 [pp. 1266-1267] might be too "busy" a source for discussion, but students might be asked which of the coding themes stand out to them as frequently figuring into patients' sharing. While the article champions the use of the SDF, the group might discuss how focusing on a particular framework/model might have downsides as well as upsides --how on the one hand theoretical models can support clarity of thought but on the other hand may risk constraining the ways a situation could be understood. The SDF helped the principal investigator to think beyond stage-driven theories. What kinds of stage-driven theories come to mind for the students (for childhood/adolescence or throughout the life-span)? Finally, the group could talk about the concerns over anxiety for the study participants that led to the use of a stress ball and setting of the interview where there would be a window. This could raise the broader topic of how students attend to the potential for patient anxiety -- adult as well as adolescent -- during pastoral visits.
Related Items of Interest:
I. The report of the original study used as an exemplar in the current article:
Clayton-Jones, D., Haglund, K., Belknap, R. A., Schaefer, J. and Thompson, A. A. "Spirituality and religiosity in adolescents living with sickle cell disease." Western Journal of Nursing Research 38, no. 6 (2016): 686-703. [(Abstract:) This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents (Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants' descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD.]
Note: also in 2016, Dora Clayton-Jones and Kristin Haglund published the following review:
Clayton-Jones, D. and Haglund, K. "The role of spirituality and religiosity in persons living with sickle cell disease: a review of the literature." Journal of Holistic Nursing 34, no. 4 (December 2016): 351-360. [(Abstract:) PURPOSE: Sickle cell disease (SCD) is a serious debilitating chronic illness, affecting approximately 90,000 Americans and millions globally. Spirituality and religiosity (S/R) may ease the burden faced by persons living with SCD. The purpose of this study was to examine the role of S/R in adolescents and adults living with SCD in the research literature. METHOD: The electronic databases Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing/Academic, ProQuest Health Module, PsycINFO, Medline, PubMed, and the American Theological Library Association were searched from January 1995 to December 2014. FINDINGS: Of the 89 studies retrieved, 11 articles between 2001 and 2013 met the inclusion criteria and were reviewed. Four themes emerged. The themes included (a) S/R as sources of coping, (b) S/R enhance pain management, (c) S/R influence health care utilization, and (d) S/R improve quality of life. DISCUSSION: Use of S/R may be significant in coping with SCD, managing pain, affecting hospitalizations, and affecting quality of life. This review can direct researchers exploring S/R in adolescents and adults living with SCD.]
II. The spiritual development framework at the heart of the present article was proposed in 2008 by Peter L. Benson and Eugene C. Roehlkepartain, at that time co-directors of the Center for Spiritual Development in Childhood and Adolescence, part of the Search Institute (Minneapolis, MN), of which they were also president and vice-president, respectively. The Center for Spiritual Development in Childhood and Adolescence was a project funded form 2003-2009 by the Templeton Foundation, with Benson receiving an original $2 million grant. For more on the Institute's work in this area, see their Spiritual Development page, which includes a bibliography.
Benson, P. L. and Roehlkepartain, E. C. "Spiritual development: a missing priority in youth development." New Directions for Youth Development 2008, no. 118 (Summer 2008): 13-28. [(Abstract:) Addressing the spiritual development of young people has the potential to strengthen youth work and its outcomes. Spiritual development matters because it is an intrinsic part of being human and because young people themselves view it as important. This article reviews the research that points to positive impacts of spiritual development for youth and notes that in an increasingly pluralistic society, everyone needs to build skills for negotiating religious and spiritual diversity. The authors propose that spiritual development involves, in part, the dynamic interplay of three dimensions: belonging and connecting, awareness and awakening, and a way of living. Three initial challenges and opportunities are emerging: empowering youth to explore core developmental issues, motivation and focus, and multisector engagement.]
Note: foundational to the 2008 Benson & Roehlkepartain article was the following publication:
Benson, P. L., Roehlkepartain, E. C. and Rude, S. P. "Spiritual development in childhood and adolescence: toward a field of inquiry." Applied Developmental Science 7, no. 3 (2003): 205-213. [(Abstract:) Sustained attention to spiritual development during childhood and adolescence in the social and developmental sciences has the potential to significantly enrich and strengthen the understanding of the core processes and dimensions of human development. This article seeks to set the stage for such an inquiry by exploring 6 themes for building a multifaceted agenda. It argues that spiritual development is (a) under- studied; (b) a complex, multifaceted concept; (c) grounded in a human propensity; (d) overlaps with and includes many aspects of religious development; (e) a developmental process that is shaped by both individual capacities and ecological influences; and (f) a potentially powerful resource for positive human development.]
III. The following recent research on adolescents and sickle cell disease mentions spirituality as a theme:
Foster, N. and Ellis, M. "Sickle cell anaemia and the experiences of young people living with the condition." Nursing Children and Young People 30, no. 3 (May 11, 2018): 36-43. [(Abstract:) AB Sickle cell anaemia (SCA) is a life-threatening haemoglobin disorder acknowledged for its unpredictability and painful episodes. The aim of this qualitative literature review was to explore the experiences of young people living with SCA and its effect on their lives. The objective was to critically review selected primary research and make recommendations for practice, education and research. After reviewing potential articles using EBSCOhost, inclusion and exclusion criteria were devised and six appropriate studies were found with most participants in the 10-25 years age range. These studies were conducted in the UK and the United States. The Critical Appraisal Skills Programme qualitative research checklist was used to evaluate the articles. Thematic analysis identified three themes: acceptance, support and unpredictability, with sub-themes of spirituality and discrimination. It was clear that SCA affected multiple areas of young people's lives. Recommendations are made for practice, education and research.]
IV. For chaplains not familiar with the wider health care literature on adolescents and spirituality, addressing sickle cell disease but also other health issues, the following is a small sample that may be thought-provoking:
Cheng, J., Purcell, H. N., Dimitriou, S. M. and Grossoehme, D. H. "Testing the feasibility and acceptability of a chaplaincy intervention to improving treatment attitudes and self-efficacy of adolescents with cystic fibrosis: a pilot study." Journal of Health Care Chaplaincy 21, no. 2 (2015): 76-90. [(Abstract:) Religious factors are known to contribute to treatment adherence in different patient populations, and religious coping has been found to be particularly important to adolescents dealing with chronic diseases. Adherence to prescribed treatments slows disease progression and contributes to desirable outcomes in most patients, and, therefore, adherence-promoting interventions provided by chaplains could be beneficial to various patient populations. The current article describes a pilot study to test the feasibility of a theoretically and empirically based chaplain intervention to promote treatment adherence for adolescents with CF. Cognitive interviews were conducted 24 with adolescents with CF, and content analysis was used to identify themes, which informed revision of the intervention protocol. The authors thought that presenting the methods and results of this pilot study would be helpful for chaplains who want to conduct intervention research. The results indicated that the proposed intervention was acceptable and feasible to deliver in hard copy or an electronic platform.]
Cotton, S., Grossoehme, D. and McGrady, M. E. [University of Cincinnati College of Medicine, OH]. "Religious coping and the use of prayer in children with sickle cell disease." Pediatric Blood & Cancer 58, no. 2 (February 2012): 244-249. [(Abstract:) While adolescents and adults with sickle cell disease (SCD) have reported using religion to cope with SCD, there is no data examining religious coping in young children with SCD. The purpose of this qualitative study was to: (1) describe the types of religious coping used by children with SCD; (2) describe the content and frequency of prayer used in relation to SCD; and (3) examine how children viewed God/Higher Power in relation to their SCD. PROCEDURE: Children with SCD participated in a semi-structured interview and an art drawing exercise focused on the use of general coping and religious coping. Interviews were coded, organized, and analyzed using a template organizational style of interpretation and NVivo 8.0 qualitative software. RESULTS: Of the 19 participants, the average age was 8.05 years (SD +/-1.81); 11 were female (58%); all (100%) were African-American and 9 (47%) were Protestant. Children used religion to gain control, make meaning, and find comfort. Most children reported praying to get well, to keep from getting sick, and to get out of the hospital. Children described a functional God who made them take their medicine or took them to the hospital and an emotional God who made them happy and comforted them when they were sad or scared. CONCLUSIONS: These children with SCD reported using religion to help cope with the illness. Providers should be aware of the importance of religion to many of these children and integrate religion, as appropriate, into discussions about coping with SCD.]
Cotton, S., Grossoehme, D., Rosenthal, S. L., McGrady, M. E., Roberts, Y. H., Hines, J., Yi, M. S. and Tsevat, J. "Religious/Spiritual coping in adolescents with sickle cell disease: a pilot study." Journal of Pediatric Hematology/Oncology 31, no. 5 (May 2009): 313-318. [(From the abstract:) Religious/spiritual (R/S) coping has been associated with health outcomes in chronically ill adults; however, little is known about how adolescents use R/S to cope with a chronic illness such as sickle cell disease (SCD). Using a mixed method approach (quantitative surveys and qualitative interviews), we examined R/S coping, spirituality, and health-related quality of life in 48 adolescents with SCD and 42 parents of adolescents with SCD. Adolescents reported high rates of religious attendance and belief in God, prayed often, and had high levels of spirituality (eg, finding meaning/peace in their lives and deriving comfort from faith). Thirty-five percent of adolescents reported praying once or more a day for symptom management. The most common positive R/S coping strategies used by adolescents were: "Asked forgiveness for my sins" (73% of surveys) and "Sought God's love and care" (73% of surveys).]
Dallas, R. H., Wilkins, M. L., Wang, J., Garcia, A. and Lyon, M. E. [St. Jude Children's Research Hospital, Memphis, TN]. "Longitudinal Pediatric Palliative Care: Quality of Life and Spiritual Struggle (FACE): design and methods." Contemporary Clinical Trials 33, no. 5 (Sep 2012): 1033-1043. [(Abstract:) As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-month post-intervention. The primary outcome measures will be in congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice.]
Damsma Bakker, A. A., van Leeuwen, R. R. R. and Roodbol, P. F. P. "The spirituality of children with chronic conditions: a qualitative meta-synthesis." Journal of Pediatric Nursing 43 (November-December 2018): e106-e113. [This is a broad review, but it does cite the 2016 Clayton-Jones & Haglund study.]
Flavelle, S. C. "Experience of an adolescent living with and dying of cancer." Archives of Pediatrics & Adolescent Medicine 165, no. 1 (Jan 2011): 28-32. [(Abstract:) This is a case report of a 15-year-old boy with osteosarcoma who died a year after diagnosis. It is based upon an analysis of his 90-page personal journal, which revealed five themes: adolescent development, escape from illness, changing relationships, symptoms, and spirituality. See esp. the section on Spirituality on p. 31.]
Grossoehme, D. H. "Development of a spiritual screening tool for children and adolescents." Journal of Pastoral Care and Counseling 62, nos. 1-2 (Spring-Summer 2008): 71-85. [(Abstract:) A chaplain's ability to provide care where it is most needed depends upon some method of pastoral triage. Screening for spiritual needs of children and adolescents has been a largely neglected area. A Delphi panel developed elements to be included in a tool to screen 10-18 year olds' spiritual needs and resources. The Delphi panelists were informed of survey results of school-aged children and adolescents' opinions on spiritual issues important to them if they were hospitalized. A case study of the tool's use was conducted with a convenient sample of children and adolescents. Subsequent pilot use of the tool by five pediatric chaplains demonstrated the tool's utility in identifying patients' spiritual issues, ability to serve as a springboard to deeper discussion, and as a basis for initiating discussion of spiritual concerns with other disciplines on the healthcare team. Feedback indicates the potential clinical usefulness of this tool for hospitalized children and adolescents.]
Pehler, S. R. and Craft-Rosenberg, M. M. "Longing: the lived experience of spirituality in adolescents with Duchenne Muscular Dystrophy." Journal of Pediatric Nursing 24, no. 6 (December 2009): 481-494. [(Abstract:) Although much has been written regarding ill adolescents, research has not described their spiritual response. The purpose of this descriptive phenomenological study was to describe the lived experiences of spirituality in adolescents with Duchenne muscular dystrophy using van Manen's phenomenological method. Findings from nine teens showed that the essential theme of spirituality was "longing," the strong desire for something unattainable. Consistent with Reed's (1992) paradigm for understanding spirituality, participants mediated their longing through "Connecting with others, self, and beyond self." These findings support the need for nursing to assess spirituality in teens and determine developmentally appropriate interventions to ameliorate longing.] [This was our December 2009 Article-of-the-Month.]
Ragsdale, J. R., Hegner, M. A., Mueller, M. and Davies, S. "Identifying religious and/or spiritual perspectives of adolescents and young adults receiving blood and marrow transplants: a prospective qualitative study." Biology of Blood and Marrow Transplantation 20, no. 8 (August 2014): 1242-1247. [(Abstract:) The potential benefits (or detriments) of religious beliefs in adolescent and young adults (AYA) are poorly understood. Moreover, the literature gives little guidance to health care teams or to chaplains about assessing and addressing the spiritual needs of AYA receiving hematopoietic stem cell transplants (HSCT). We used an institutional review board-approved, prospective, longitudinal study to explore the use of religion and/or spirituality (R/S) in AYA HSCT recipients and to assess changes in belief during the transplantation experience. We used the qualitative methodology, grounded theory, to gather and analyze data. Twelve AYA recipients were interviewed within 100 days of receiving HSCT and 6 participants were interviewed 1 year after HSCT; the other 6 participants died. Results from the first set of interviews identified 5 major themes: using R/S to address questions of "why me?" and "what will happen to me;" believing God has a reason; using faith practices; and benefitting from spiritual support people. The second set of interviews resulted in 4 major themes: believing God chose me; affirming that my life has a purpose; receiving spiritual encouragement; and experiencing strengthened faith. We learned that AYA patients were utilizing R/S far more than we suspected and that rather than losing faith in the process of HSCT, they reported using R/S to cope with illness and HSCT and to understand their lives as having special purpose. Our data, supported by findings of adult R/S studies, suggest that professionally prepared chaplains should be proactive in asking AYA patients about their understanding and use of faith, and the data can actively help members of the treatment team understand how AYA are using R/S to make meaning, address fear, and inform medical decisions.]
Reynolds, N., Mrug, S., Britton, L., Guion, K., Wolfe, K. and Gutierrez, H. "Spiritual coping predicts 5-year health outcomes in adolescents with cystic fibrosis." Journal of Cystic Fibrosis 13, no. 5 (September 2014): 593-600. [(Abstract:) BACKGROUND: Positive spiritual coping in adolescent patients with cystic fibrosis (CF) is associated with better emotional functioning, but its role in health outcomes is unknown. METHODS: Adolescents diagnosed with CF (n = 46; M = 14.7 years) reported on their use of positive and negative spiritual coping. Measures of nutrition status (BMIp), pulmonary function (%FEV1), and hospitalizations were obtained for a five-year follow up period. Changes in BMIp and %FEV1 scores were estimated with hierarchical linear models; days hospitalized were modeled with negative binomial regression. RESULTS: Positive spiritual coping was associated with slower decline in pulmonary function, stable vs. declining nutritional status, and fewer days hospitalized over the five-year period. Negative spiritual coping was associated with higher BMI percentile at baseline, but not with health outcomes over time. CONCLUSIONS: These results suggest that positive spiritual coping plays a key role in maintaining long-term health of adolescent patients with CF.] [This was our July 2014 Article-of-the-Month.]
Reynolds, N., Mrug, S., Wolfe, K., Schwebel, D. and Wallander, J. "Spiritual coping, psychosocial adjustment, and physical health in youth with chronic illness: a meta-analytic review." Health Psychology Review 10, no. 2 (June 2016): 226-243. [(Abstract:) OBJECTIVE: The current systematic review and meta-analysis aimed to assess the strength of the relationships between religious/spiritual coping strategies and psychosocial adjustment and physical health in youth with chronic illness. BACKGROUND: Faced with medical stressors and uncertainty about their illness, spiritual beliefs and behaviours are important for youth with chronic illness. Research suggests that some spiritual coping strategies are helpful (positive), while others are not (negative), and these dimensions of spiritual coping are important predictors of functioning among youth with chronic illness. METHOD: Fourteen studies, published between 1990 and 2015, met inclusion criteria for the meta-analysis and were analysed using both a fixed effects model and random effects model (REM). RESULTS: Findings revealed significant, small to moderate associations between negative spiritual coping and more concurrent internalising problems (REM r = .34), lower quality of life (REM r = -.34), and poorer health (REM r = -.08). Under the fixed, but not REM, the combined effects showed small to moderate significant relationships between positive spiritual coping and fewer internalising problems (r = -.19) and better physical health (r = .19). CONCLUSION: The results reveal that spiritual coping is an important coping strategy for paediatric patients. Consistent with findings among adults with chronic illness, negative spiritual coping puts paediatric patients at risk for psychosocial maladjustment and poorer health. Intervention research is needed to determine if targeting spiritual coping improves health and psychosocial well-being.]
V. In January 2004, Child and Adolescent Psychiatric Clinics of North America published a special theme issue (vol. 13, no. 1) on religion and spirituality in pediatrics. While the research articles in the issue are now a bit dated, the following articles may be of general interest for background reading on religious traditions:
Al-Mateen, C. S. and Afzal, A. "The Muslim child, adolescent, and family." Pp. 183-200.
Black, N. "Hindu and Buddhist children, adolescents, and families." Pp. 210-220.
Mercer, J. A. "The Protestant child, adolescent, and family." Pp. 161-182.
Murrell, K. "The Catholic child, adolescent, and family." Pp. 149-160.
Rube, D. M. and Kibel, N. "The Jewish child, adolescent, and family." Pp. 137-148.
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