A Meta-analysis of A Meta-analysis of Spirituality and Spirituality and Quality of Life Quality of Life Presented by Rick Sawatzky, Presented by Rick Sawatzky, MSN, RN MSN, RN Co-Investigators: Dr. P. Co-Investigators: Dr. P. Ratner, PhD, RN Ratner, PhD, RN Dr. L. Chiu, Dr. L. Chiu, PhD, RN PhD, RN
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A Meta-analysis of Spirituality and Quality of Life
A Meta-analysis of Spirituality and Quality of Life. Presented by Rick Sawatzky, MSN, RN Co-Investigators: Dr. P. Ratner, PhD, RN Dr. L. Chiu, PhD, RN. Background: Spirituality in the context of health. Conceptual themes of spirituality Existential Experiential Meaning and purpose - PowerPoint PPT Presentation
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A Meta-analysis of A Meta-analysis of Spirituality and Spirituality and Quality of LifeQuality of Life
Presented by Rick Sawatzky, Presented by Rick Sawatzky, MSN, RNMSN, RN
Co-Investigators: Dr. P. Ratner, Co-Investigators: Dr. P. Ratner, PhD, RNPhD, RN
Dr. L. Chiu, PhD, Dr. L. Chiu, PhD, RNRN
Background:Background:Spirituality in the context Spirituality in the context
of healthof healthConceptual themes of spiritualityConceptual themes of spirituality
ExistentialExistential ExperientialExperiential Meaning and purposeMeaning and purpose
Chiu, L., Emblen, J., VanHofwegen, L., Sawatzky, R., & Meyerhof, H. (2004). An integrative review of spirituality in the health sciences. Western Journal of Nursing Research, 26(4), 405-428.
Spirituality and HealthSpirituality and Health
Spirituality Health
Traditional research focus on external indicators
Religious behaviorsReligious affiliationReligious involvement
Morbidity and mortality rates based on medical diagnoses
An increase in a person’s An increase in a person’s spirituality, however experienced, spirituality, however experienced, is accompanied by an increase in is accompanied by an increase in health.health.
Trends in Spirituality Trends in Spirituality ResearchResearch
Spirituality is defined as a subjective Spirituality is defined as a subjective experienceexperience
Distinction between spirituality and Distinction between spirituality and religionreligion
Spirituality has implications for health-Spirituality has implications for health-related outcomesrelated outcomes Previous emphasis on external indicatorsPrevious emphasis on external indicators Current emphasis on “subjective” indicatorsCurrent emphasis on “subjective” indicators
Current Study:Current Study:A Meta-analysis of the A Meta-analysis of the Relationship between Relationship between
Spirituality and Quality of LifeSpirituality and Quality of LifeIs there a significant relationship Is there a significant relationship between spirituality and quality of between spirituality and quality of
life? life?
ObjectivesObjectives To synthesize results from completed studies to To synthesize results from completed studies to
determine whether there is empirical support for determine whether there is empirical support for a relationship between spirituality and quality of a relationship between spirituality and quality of life.life.
To provide an estimate of the strength of this To provide an estimate of the strength of this relationship.relationship.
To hypothesize and examine the existence of any To hypothesize and examine the existence of any potential related variables affecting this potential related variables affecting this relationship.relationship.
Study Design: A Meta-Study Design: A Meta-analysisanalysis
Specifying the domain of inquirySpecifying the domain of inquiry
Searching and retrieving Searching and retrieving studiesstudies
Coding study variablesCoding study variables
Analyzing across studiesAnalyzing across studies
A proposed A proposed conceptualization of conceptualization of
spiritualityspirituality““The feelings, thoughts, experiences, The feelings, thoughts, experiences, and behaviors that arise from a and behaviors that arise from a search for the sacred. The term search for the sacred. The term “search” refers to attempts to “search” refers to attempts to identify, articulate, maintain, or identify, articulate, maintain, or transform. The term “sacred” refers transform. The term “sacred” refers to a divine being or Ultimate Reality to a divine being or Ultimate Reality or Ultimate Truth as perceived by or Ultimate Truth as perceived by the individual”the individual”
Larson, D. B., Sawyers, J. P., & McCullough, M. E. (1998). Scientific research on spirituality and health: A report based on the Scientific Progress in Spirituality Conferences. New York: John M. Templeton Foundation.
Spirituality & ReligionSpirituality & Religion
Religion may or may not encompass Religion may or may not encompass “a search for non-sacred goals (such “a search for non-sacred goals (such as identify, belongingness, meaning, as identify, belongingness, meaning, health, or wellness) in a context that health, or wellness) in a context that has as its primary goal the has as its primary goal the facilitation of [the previous facilitation of [the previous definition]” definition]”
Religion refers to “the means and Religion refers to “the means and methods (i.e., rituals or prescribed methods (i.e., rituals or prescribed behaviors) of the search that receive behaviors) of the search that receive validation and support from within validation and support from within an identifiable group of people” an identifiable group of people”
Attributes of SpiritualityAttributes of SpiritualityEssential Attributes of Essential Attributes of SpiritualitySpirituality
Spirituality is Spirituality is existential in existential in naturenatureIt is often described as It is often described as something that something that involves a search for involves a search for meaning and purpose meaning and purpose or as something that or as something that provides meaning and provides meaning and purpose.purpose.
Spirituality is Spirituality is relational in relational in naturenatureThe object of the The object of the relationship is relationship is something that lies something that lies beyond physiological, beyond physiological, psychological or social psychological or social domains of life. This domains of life. This object is defined as object is defined as being transcendent in being transcendent in nature or, as a life-nature or, as a life-force or energy.force or energy.
Conceptualizing Quality Conceptualizing Quality of Lifeof Life
Quality of life was conceptualized as a Quality of life was conceptualized as a as a person’s perception of his/her as a person’s perception of his/her quality of life however it is defined by quality of life however it is defined by the individual. the individual.
Emphasis on the subjective perspective of Emphasis on the subjective perspective of QOLQOL
Operationalization of Operationalization of QOLQOL
The measurement of quality of life is The measurement of quality of life is based onbased on (a) “[persons’] perspective[s] of their overall (a) “[persons’] perspective[s] of their overall
quality of life andquality of life and (b) their assessment of specific components of (b) their assessment of specific components of
quality of life (i.e., physical, psychological and quality of life (i.e., physical, psychological and social well-being)”social well-being)”
Mytko, J. J., & Knight, S. J. (1999). Body, mind and spirit: Towards the integration of religiosity and spirituality in cancer quality of life research. Psycho-Oncology, 8, 439-450.
Spirituality and Quality Spirituality and Quality of lifeof life
Spirituality and Quality Spirituality and Quality of Lifeof Life
As a multidimensional frameworkAs a multidimensional framework
Quality of Life
Physical Social Psychological Spiritual
Spirituality and Quality of Spirituality and Quality of LifeLife
A Proposed FrameworkA Proposed Framework
Dimensions of Life
Social Physical Psychological
Spirituality Life
Satisfaction Perceived Quality of Life
Subjective Well-Being
Quality of Life
Selection Criteria for Selection Criteria for Instruments Measuring Instruments Measuring
SpiritualitySpirituality Instruments based on subjective Instruments based on subjective
ratings (i.e., self-reported ratings ratings (i.e., self-reported ratings on a Likert-type scale) of spiritual on a Likert-type scale) of spiritual experiences, beliefs or behavior experiences, beliefs or behavior associated with:associated with:
an existential search for meaning an existential search for meaning andand a relationship with a transcendent a relationship with a transcendent
reality (e.g., God or divine being, reality (e.g., God or divine being, Ultimate Reality, or Ultimate Truth).Ultimate Reality, or Ultimate Truth).
Selection Criteria for Selection Criteria for Quality of Life InstrumentsQuality of Life Instruments
Quality of life is measured by:Quality of life is measured by: using subjective ratings of a person’s using subjective ratings of a person’s
self-reported quality of life, satisfaction self-reported quality of life, satisfaction with life or subjective well-being, with life or subjective well-being, oror
using instruments that measure quality using instruments that measure quality of life by statistically combining of life by statistically combining subjective ratings of multiple dimensions subjective ratings of multiple dimensions of life (e.g., physical, social, of life (e.g., physical, social, psychological and emotional dimensions). psychological and emotional dimensions). This refers primarily to broad multi-This refers primarily to broad multi-dimensional measures of quality of life or dimensional measures of quality of life or wellbeing.wellbeing.
Design: Literature Design: Literature SearchSearch
PubMED; EMBASE; HEALTHSTAR; PubMED; EMBASE; HEALTHSTAR; PsychINFO; SOCIAL SCIENCES CITATION PsychINFO; SOCIAL SCIENCES CITATION INDEX; SCIENCE CITATION INDEX INDEX; SCIENCE CITATION INDEX EXPANDED and the ARTS AND HUMANITIES EXPANDED and the ARTS AND HUMANITIES INDEX INDEX
Forward and backward citation searchesForward and backward citation searches BrowsingBrowsing
Religiousness, Transcendent / Transcendence, Religiousness, Transcendent / Transcendence, Existential, Transpersonal and Sacred(ness)Existential, Transpersonal and Sacred(ness)
Quality of Life, Well(-)Being, Life-SatisfactionQuality of Life, Well(-)Being, Life-Satisfaction
Excluded studiesExcluded studies
1.1. Case studiesCase studies2.2. Qualitative studiesQualitative studies3.3. Studies that measured quality of life Studies that measured quality of life
based on external indicators or a based on external indicators or a single dimensionsingle dimension
4.4. Studies that measured spirituality Studies that measured spirituality based on the frequency of religious or based on the frequency of religious or spiritual practices or behavior spiritual practices or behavior
5.5. Studies prior to 1991Studies prior to 19916.6. Studies not reported in EnglishStudies not reported in English
Search ResultsSearch Results Total search database: Total search database: 3,0403,040 citations citations After initial screening of citation After initial screening of citation 371371 study study
reports of potential interest were identified and reports of potential interest were identified and retrievedretrieved 59 studies were excluded because the study was a 59 studies were excluded because the study was a
case study, a qualitative study or was not reported in case study, a qualitative study or was not reported in English.English.
200 studies were excluded because methodological 200 studies were excluded because methodological inclusion criteria pertaining to the measurement of inclusion criteria pertaining to the measurement of spirituality or quality of life were not met. spirituality or quality of life were not met.
60 studies were excluded the criteria for calculating 60 studies were excluded the criteria for calculating an effect size were not met.an effect size were not met.
1 study was excluded because it reported findings on 1 study was excluded because it reported findings on the same sample as another study.the same sample as another study.
Final sample size: Final sample size: 6262 primary ES’s from primary ES’s from 5151 studiesstudies
Design: CodingDesign: Coding
Study Study characteristicscharacteristics SettingSetting Research designResearch design Sampling methodSampling method
Sample Sample characteristicscharacteristics Age & genderAge & gender Religious affiliationReligious affiliation Cultural backgroundCultural background
Characteristics of the Characteristics of the instrumentsinstruments Classification of Classification of
instrumentsinstruments Type of scales, # of itemsType of scales, # of items Psychometric informationPsychometric information
Effect size dataEffect size data Statistics to calculate the Statistics to calculate the
Spirit Dummy Var. 2 -.2227 .0975 -.4139 -.0315 .0224 -.2931
Spirit Dummy Var. 3 .0080 .0985 -.1851 .2012 .9350 .0101
QOL Dummy Var. 1[2] .2793 .1476 -.0100 .5687 .0585 .2706
QOL Dummy Var. 2 .3705 .1032 .1683 .5727 .0003 .5074
ANOVA Spirituality Categories
Pearson Correlation
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Rel
Exist & Rel
MEAN ES
Ambiguous
Exist
Mean
(n = 12)
(n = 12)
(n = 59)
(n = 20)
(n = 15)
30.r
23.r
39.r
50.r
34.r
Pearson's Correlation
-0.2 0.0 0.2 0.4 0.6 0.8
General Multi-dimensional
Overall QOL - Wellbeing - Lifesat.
Disease Specific Multi-dimensional
37.r
11.r
45.r9n
6n
44n
95% CI Associated with Each Categorical Group of QOL Instruments as Revealed by the ANOVA Analysis.
ImplicationsImplications TheoreticalTheoretical
Confidence in a moderate effect size (as defined by Confidence in a moderate effect size (as defined by Cohen, 1988)Cohen, 1988)
Failsafe N: 151 studies with Failsafe N: 151 studies with r r = 0.00 would be = 0.00 would be needed to reduce the mean effect size to .10. needed to reduce the mean effect size to .10.
Spirituality as a unique concept in relation to quality Spirituality as a unique concept in relation to quality of lifeof life
ImplicationsImplications
OperationalOperational The measurement of spirituality and The measurement of spirituality and
quality of life explains a significant quality of life explains a significant proportion of the varianceproportion of the variance
Mean ES varies between .23 and .50 for Mean ES varies between .23 and .50 for spirituality instruments (Rspirituality instruments (R22 = 12%) = 12%)
Mean ES varies between .11 and .45 for Mean ES varies between .11 and .45 for quality of life instruments (Rquality of life instruments (R22 = 12%) = 12%)
Implications for selection of instrumentsImplications for selection of instruments Implication for power considerationsImplication for power considerations