Measuring Religiousness in Health Research: Review and Critique

Although existing measures of religiousness are sophisticated, no single approach has yet emerged as a standard. We review the measures of religiousness most commonly used in the religion and health literature with particular attention to their limitations, suggesting that vigilance is required to avoid over-generalization. After placing the development of these scales in historical context, we discuss measures of religious attendance, private religious practice, and intrinsic/extrinsic religious motivation. We also discuss measures of religious coping, wellbeing, belief, affiliation, maturity, history, and experience. We also address the current trend in favor of multi-dimensional and functional measures of religiousness. We conclude with a critique of the standard, “context-free” approach aimed at measuring “religiousness-in-general”, suggesting that future work might more fruitfully focus on developing ways to measure religiousness in specific, theologically relevant contexts.

Sabbath Keeping and Its Relationships to Health and Well-Being: A Mediational Analysis

Prior research showing positive relationships between indicators of religiousness and health has generally defined and measured religion broadly. In addition, researchers have not given much attention to the pathways through which the relationship between religion and health is maintained. The result is a lack of specificity that fails to address questions about how and why religion is associated with health. The present study sought to address these limitations and clarify the ties between religion and health through a finer grained analysis of one specific aspect of religiousness (Sabbath keeping) and four possible mediators (religious coping, religious support, diet, and exercise) through which it might affect health. We examined data from a sample of Seventh-day Adventists in North America (N = 5,411), and bootstrapping analysis revealed that the association between Sabbath keeping and physical and mental health was partially mediated by all four mediators. Implications and limitations of the findings are discussed.     

Resource loss,religiousness, health,and posttraumatic growth following Hurricane Katrina

This study examined associations among resource loss, religiousness (including general religiousness, religious comfort, and religious strain), posttraumatic growth (PTG), and physical and mental health among a sample of Mississippi university students soon after Hurricane Katrina hit the Gulf coast in 2005. Resource loss was negatively associated with health, but positively associated with PTG. Religious comfort was associated with positive outcomes, and religious strain was associated with negative outcomes. Religious comfort buffered the negative effects of resource loss on emotional health. Ancillary analyses indicated that associations between resource loss and health were mediated by religious strain. Implications of this research are described for mental health practitioners engaged in disaster recovery work.     

Delay Discounting as a Function of Intrinsic/Extrinsic Religiousness,Religious Fundamentalism,and Regular Church Attendance

Delay discounting occurs when the subjective value of an outcome decreases because its delivery is delayed. Previous research has suggested that the rate at which some, but not all, outcomes are discounted varies as a function of regular church attendance. In the present study, 509 participants completed measures of intrinsic religiousness, extrinsic religiousness, religious fundamentalism, and whether they regularly attended church services. They then completed a delay-discounting task involving five outcomes. Although religiousness was not a significant predictor of discounting for all outcomes, participants scoring high in intrinsic religiousness tended to display less delay discounting than participants scoring low. Likewise, participants scoring high in religious fundamentalism tended to display more delay discounting than participants scoring low. These results partially replicate previous ones in showing that the process of discounting may vary as a function of religiousness. The results also provide some direction for those interested in altering how individuals discount.     

Is Conservative Religiousness Inherently Associated with Poorer Health for Sexual Minorities?

Results of path analysis involving sexual minority participants (N?=?1317) from diverse sociopolitical contexts revealed health outcomes to be associated with internalized homonegativity and the resolution of conflict between religious and sexual minority identities. Contrary to expectations, several markers of religiousness were not directly associated with either improved or worsened health outcomes for depression or anxiety. However, religious activity moderated the influence of internalized homonegativity (IH) on depression such that IH was less strongly related to depression among individuals who frequently attended religious services than among individuals who infrequently attended religious services. These findings have special salience for advancing a more accurate understanding of conservatively religious sexual minorities and directing culturally sensitive research, clinical services, and public policy.

     

Do Spiritual Struggles Predict Poorer Physical/Mental Health Among Jews?

Although spirituality and religion are generally associated with higher levels of physical and mental well-being, spiritual struggles, which involve tension in regard to spiritual issues, have been identified as a risk factor for poorer physical and mental health, especially among individuals with greater levels of personal religiousness. However, studies in this area have utilized predominantly Christian samples and the importance of spiritual struggles to Jews is not known. We proposed and tested two competing models in an adult Jewish community sample: (a) the Universal Effects model in which spiritual struggles were proposed to be associated with decreased levels of physical/mental health, and more problematic for more religious Jews, and (b) the Differential Effects model in which spiritual struggles were proposed to be generally unrelated to the physical/mental health of Jews, and even less impactful on religious Jews. We found some support for both models. Spiritual struggles were modestly associated with lower levels of physical/mental health in the sample as a whole, even after controlling for demographic covariates. However, at the highest levels of spiritual struggle, Orthodox Jews exhibited an increase in physical and mental health whereas non-Orthodox Jews' health continued to decrease.     

Religion as Moderator of the Sense of Control–Health Connection: Gender Differences

ABSTRACT

Objectives. Sense of personal control is a key marker of successful aging, yet little is known about its relation to religiousness and personal adversity among older adults. This study investigated the relation between two different religious orientations, a church-centered religiousness and a non-church-based spiritual seeking, sense of control, physical health, and gender in late adulthood.

Methods. The participants consisted of a community sample of men and women (N = 156) in their late sixties and mid-seventies who were born in the San Francisco Bay Area. Three-way ANOVAs were used to test in separate analyses, the effects of religiousness and spiritual seeking on sense of control among men and women who were either in good or poor physical health.

Results. Both religiousness and spiritual seeking buffered women, but not men, against loss of sense of control due to poor physical health. The buffering effect of religiousness and spiritual seeking was associated with different psychological characteristics: high life satisfaction for religiousness and engagement in life review for spiritual seeking. For men, the absence of a buffering effect of either religiousness or spiritual seeking was associated with disengagement from involvement in daily activities.

Discussion. Our findings highlight (1) the importance of employing multidimensional models of religion in studying its effect on psychosocial functioning in late adulthood and (2) the possibility that men and women who are high in religiousness and spiritual seeking regulate their sense of control using different adaptive strategies.     

Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research

Empirical studies have identified significant links between religion and spirituality and health. The reasons for these associations, however, are unclear. Typically, religion and spirituality have been measured by global indices (e.g., frequency of church attendance, self-rated religiousness and spirituality) that do not specify how or why religion and spirituality affect health. The authors highlight recent advances in the delineation of religion and spirituality concepts and measures theoretically and functionally connected to health. They also point to areas for areas for growth in religion and spirituality conceptualization and measurement. Through measures of religion and spirituality more conceptually related to physical and mental health (e.g., closeness to God, religious orientation and motivation, religious support, religious struggle), psychologists are discovering more about the distinctive contributions of religiousness and spirituality to health and well-being.     

A Review of Spiritual and Religious Measures in Nursing Research Journals: 1995--1999

Background: A series of systematic reviews has revealed relatively high levels of interest in religion and spirituality in different nursing specialties, but not in general nursing research journals. Purpose: To identify the extent to which spirituality and religiousness were measured in all quantitative and qualitative research articles published in Research in Nursing and Health, Nursing Research, Advances in Nursing Science (ANS), and Image: The Journal of Nursing Scholarship from 1995 to 1999. Methods: A full-text search was conducted of ANS and Image using the Ovid search system. Nursing Research and Research in Nursing and Health were hand searched for spiritual/religious measures. Characteristics of selected studies, the measures taken, and their uses were coded for data analysis. Results: A total of 564 research studies were identified, of which 67 (11.9%) included at least one measure of spirituality or religiousness. A significant difference was found between the percentage of qualitative and quantitative studies that contained measures of these concepts. Of the 119 qualitative studies, 23 (19.3%) contained a measure of religion or spirituality, compared to 44 of the 445 (9.9%) quantitative studies. Nominal indicators of religious affiliation were the most commonly used measures in the quantitative studies and measures of religion and spirituality were rarely used in the analyses. Although only a few quantitative or qualitative studies intended to focus on religion or spirituality, these themes often emerged spontaneously in the qualitative research. Conclusions: Research in Nursing and Health, Advances in Nursing Science, Nursing Research, and Image: The Journal of Nursing Scholarship all published research measuring spirituality and religiousness during the time-period studied. The rate at which spirituality and religion appeared in these nursing research articles is substantially higher than that found in most fields outside of nursing. Even more frequent inclusion of spiritual and religious variables and richer measures of spirituality and religiousness would help to increase the available scientific information on the role of spirituality and religion in nursing care.     

Religion, Spirituality, and Health Service Use by Older Hospitalized Patients

Background: Religious and spiritual beliefs and practices are common among medical inpatients, and may impact length of hospital stay (LOS) and other health services (HSU) during hospitalization. Methods: 812 consecutively admitted patients age 50 or over to Duke University Medical Center were assessed. Measures of religiousness and spirituality included religious TV/radio (RTV), self-rated religiousness (SRR), observer-rated spirituality (ORS), and daily spiritual experiences (DSE). The primary outcome was LOS. Results: RTV and SRR predicted longer LOS, whereas ORS and DSE predicted shorter LOS (p 0.05). Effects of RTV onLOS were stronger among women, but explained by worse health status. The effects of DSE on LOS were stronger among non-whites. Among those reporting high DSE, diagnostic tests and total procedures also tended to be less common. Conclusions: Religious activities, attitudes, and spiritual experiences are weak predictors of LOS and HSU during hospitalization. Whether the prediction is positive or negative depends on the religious or spiritual characteristic.     

After the New Age

This article explores the connections between conventional religion and the New Age, using data from a major online questionnaire study, Survey2001 , that was sponsored by the National Geographic Society and the National Science Foundation. It begins with two competing hypotheses. (1) Involvement in conventional religion discourages involvement in unconventional para-religion because conventional religion competes with para-religion. (2) Conventional religion encourages unconventional para-religion by promulgating supernatural assumptions about the nature of humanity and the universe. Factor analysis of 20 putatively New Age agree-disagree questionnaire items reveals that 15 of them define a general New Age factor, supported by secondary anti-paranormal and anti-alien factors. Three measures of conventional religiousness show complex relations to the New Age items. Analysis using factor scores indicates that both hypotheses express real effects that cancel each other out for many people. Individual subjective religiousness and personal prayer or meditation correlate strongly positively with the New Age among respondents who never attend religious services. The study considers denominational differences, then concludes by showing that a curvilinear relationship exists between religiousness and acceptance of New Age beliefs.     

Understanding the Relationship Between Religiousness, Spirituality, and Underage Drinking: The Role of Positive Alcohol Expectancies

Research has consistently found that religiousness and spirituality are negatively associated with underage drinking. However, there is a paucity of research exploring the mechanisms by which these variables influence this important outcome. With 344 underage young adults (ages 18–20; 61 % women), we investigated positive alcohol expectancies as a mediator between religiousness and spirituality (measured separately) and underage alcohol use. Participants completed the Religious Commitment Inventory-10, Daily Spiritual Experiences Scale, Alcohol Expectancies Questionnaire, and Drinking Styles Questionnaire. Results indicate less positive alcohol expectancies partially mediate the relationship between both religiousness and spirituality and underage alcohol use. This suggests religiousness and spirituality’s protective influence on underage drinking is partly due to their influence on expectations about alcohol’s positive effects. Since underage drinking predicts problem drinking later in life and places one at risk for serious physical and mental health problems, it is important to identify specific points of intervention, including expectations about alcohol that rise from religious and spiritual factors.     

Religious Orientation, Mature Faith, and Psychological Distress: Elements of Positive and Negative Associations

There are substantial data exploring the link between religiousness and health, yet there is little consensus regarding the nature of the relationship between religiousness domains and mental health. The purpose of this study was to identify the types of mental health outcomes associated with religiousness domains. Participants included 251 ( M = 19.02; range = 17–25) young adults who completed self-report measures of religiousness (Intrinsic, Extrinsic, and Quest Orientations, Faith Maturity Scale), and psychological distress subscales (SCL-90-R). We identified significant relationships between each of the religiousness measures and the SCL-90-R subscales and analyzed the relative contributions of each of the religiousness measures in predicting psychological distress with hierarchical multiple regression. The Faith Maturity Scale was a particularly robust predictor of positive and negative psychological adjustment. The specific pathways by which religiousness influences mental health outcomes remain to be elaborated in future research.     

Toward an Understanding of Religious Tolerance: Quest Religiousness and Positive Attitudes Toward Religiously Dissimilar Others

We interact frequently with individuals with religious beliefs that vary from our own. Although we may naturally prefer interacting with religiously similar others, individuals vary in their attitudes toward religiously dissimilar others. In the present set of studies, we examined how variability in quest religiousness affects religious tolerance. In Study 1 (N = 159), we found that quest religiousness in Christian undergraduates was associated with positive attitudes toward both non-Christian religious groups and atheists. In Study 2, 118 Christian undergraduates evaluated vignettes regarding a devout moral or an average morality Christian (ingroup) or Muslim (outgroup). Participants preferred moral targets relative to less moral targets. However, when rating moral targets, participants high in quest religiousness preferred the Muslim target (religious outgroup member), whereas those low in quest religiousness preferred the Christian target (religious ingroup member). We discuss implications for the links between quest religiousness and religious tolerance.     

Cross-National Analysis of the Influence of Cultural Norms and Government Restrictions on the Relationship Between Religion and Well-Being

This study examines the interaction between cultural religious norms and governmental restrictiveness as country-level moderators of the relationship between individual religiousness and well-being, including both happiness and physical health. Data come from five waves of World Values survey data from 221 separate surveys conducted in 88 countries, with data from 317,109 individuals. Three dimensions of individual religiousness were assessed, along with corresponding country-level norms aggregated from these measures. Three-way cross-level interactions were tested to examine whether the extent of government restriction modified the relationship between national religious norms and the individual-level association between religious factors and well-being outcomes. Results supported the hypothesis that self-reported religion is most strongly related to greater happiness and better self-reported health in societies where it is freely and widely practiced. In contrast, religiousness may be harmful when it is relatively deviant, and restrictions of freedom may serve to further exacerbate this effect. These results suggest that the positive association between religion and well-being is not universal, but depends upon the right to express religion freely and the opportunity to practice with like-minded others.     

Religious Coping and Church-Based Social Support as Predictors of Mental Health Outcomes: Testing a Conceptual Model

This study assesses religious coping and church-based social support as mechanisms explaining religious benefits to mental health. We build on recent research and test an explanatory model using the 1998 General Social Survey. The model considers both institutional and individual aspects of religiousness, and their interrelations, as predictors of mental health outcomes. It considers negative effects of religion along with the well-known positive effects. We found that benefits of attendance, a measure of institutional participation, are mediated by church-based social support. Benefits of prayer, an individual form of religiousness, are mediated by the similarly privatized religious coping. Institutional measures of religion were found to impact individuals' religious coping styles. Implications are suggested for the scientific study of religion as well as for the applied efforts of clergy, pastoral counselors, and lay church members concerned with improving religious benefits.     

Episcopal Measure of Faith Tradition: A Context-Specific Approach to Measuring Religiousness

Precise measurement of religiousness remains a vexing problem. In addition to relying almost exclusively on self-report, existing measures of religiousness pay little attention to the specific context of religious belief, and this may override distinctive norms of particular faith traditions and potentially confound the conclusions drawn from such research. To address these limitations, the authors describe a modified form of narrative content analysis that could eventually sort respondents into distinct theological traditions. A pilot test among Episcopalians demonstrates encouraging reliability (kappa 0.74, 95% LCI 0.47, P < 0.0002), and tests for convergent and discriminate validity suggest that the context of religious belief is both relevant and insufficiently assessed by the existing paradigm of religious measurements. If validated in a religiously diverse sample, this approach could be combined with existing, context-free measures of religiousness to generate more meaningful findings.     

Psychosocial factors in outcomes of heart surgery: the impact of religious involvement and depressive symptoms.

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness.     

Development and Initial Validation of an Implicit Measure of Religiousness‐Spirituality

An implicit measure of religiousness‐spirituality (RS) was constructed and used in two studies. In Study 1, undergraduates completed a Religiousness‐Spirituality Implicit Association Test (RS‐IAT) and several self‐report measures of RS and related constructs (e.g., religious fundamentalism, authoritarianism). Informants rated the participants’ RS. The RS‐IAT was internally consistent. Implicit RS correlated positively with self‐reported RS, spiritual transcendence, spiritual experiences, religious fundamentalism, and intrinsic religiousness. Informant ratings correlated positively with participants’ self‐reported religiousness but not implicit RS. In Study 2, implicit RS accounted for unique variability in self‐reported attitudes toward gay men and lesbian women when controlling for self‐reported religiousness and right‐wing authoritarianism. These findings demonstrate that an implicit measure of trait RS explains some variability in attitudes that self‐report measures do not. An implicit measure of RS could advance the scientific study of religion beyond what is known from self‐report measures.