1、A Meta-analysis of Spirituality and Quality of Life,Presented by Rick Sawatzky, MSN, RN Co-Investigators: Dr. P. Ratner, PhD, RNDr. L. Chiu, PhD, RN,Background: Spirituality in the context of health,Conceptual themes of spirituality Existential Experiential Meaning and purpose Transcendent Connected
2、ness / Relationship Power/Force/Energy,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 Health,An increase in a persons spirituality, however
3、 experienced, is accompanied by an increase in health.,Trends in Spirituality Research,Spirituality is defined as a subjective experienceDistinction between spirituality and religionSpirituality has implications for health-related outcomes Previous emphasis on external indicators Current emphasis on
4、 “subjective” indicators,Current Study: A Meta-analysis of the Relationship between Spirituality and Quality of Life,Is there a significant relationship between spirituality and quality of life? Objectives To synthesize results from completed studies to determine whether there is empirical support f
5、or a relationship between spirituality and quality of life. To provide an estimate of the strength of this relationship. To hypothesize and examine the existence of any potential related variables affecting this relationship.,Study Design: A Meta-analysis,Specifying the domain of inquiryDefining stu
6、dies characteristics Searching and retrieving studiesCoding study variablesAnalyzing across studies,A proposed conceptualization of spirituality,“The feelings, thoughts, experiences, and behaviors that arise from a search for the sacred. The term “search” refers to attempts to identify, articulate,
7、maintain, or transform. The term “sacred” refers to a divine being or Ultimate Reality or Ultimate Truth as perceived by 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 Spiritualit
8、y Conferences. New York: John M. Templeton Foundation.,Spirituality & Religion,Religion may or may not encompass “a search for non-sacred goals (such as identify, belongingness, meaning, health, or wellness) in a context that has as its primary goal the facilitation of the previous definition” Relig
9、ion refers to “the means and methods (i.e., rituals or prescribed behaviors) of the search that receive validation and support from within an identifiable group of people”,Attributes of Spirituality,Conceptualizing Quality of Life,Quality of life was conceptualized as a as a persons perception of hi
10、s/her quality of life however it is defined by the individual. Emphasis on the subjective perspective of QOL Largely synonymous concepts: Subjective wellbeing Life-satisfaction,Operationalization of QOL,The measurement of quality of life is based on (a) “persons perspectives of their overall quality
11、 of life and (b) their assessment of specific components of quality of life (i.e., physical, psychological and 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,
12、 8, 439-450.,Spirituality and Quality of life,QOL Wellbeing Life-Satisfaction,Spirituality,As analogous concepts,Spirituality and Quality of Life,As a multidimensional framework,Quality of Life,Physical,Social,Psychological,Spiritual,Spirituality and Quality of Life A Proposed Framework,Selection Cr
13、iteria for Instruments Measuring Spirituality,Instruments based on subjective ratings (i.e., self-reported ratings on a Likert-type scale) of spiritual experiences, beliefs or behavior associated with: an existential search for meaning and a relationship with a transcendent reality (e.g., God or div
14、ine being, Ultimate Reality, or Ultimate Truth).,Selection Criteria for Quality of Life Instruments,Quality of life is measured by: using subjective ratings of a persons self-reported quality of life, satisfaction with life or subjective well-being, or using instruments that measure quality of life
15、by statistically combining subjective ratings of multiple dimensions of life (e.g., physical, social, psychological and emotional dimensions). This refers primarily to broad multi-dimensional measures of quality of life or wellbeing.,Design: Literature Search,Search methods Electronic database searc
16、hes: CINAHL; PubMED; EMBASE; HEALTHSTAR; PsychINFO; SOCIAL SCIENCES CITATION INDEX; SCIENCE CITATION INDEX EXPANDED and the ARTS AND HUMANITIES INDEX Forward and backward citation searches Browsing Keywords Spiritual(ity), Religion / Religiosity / Religiousness, Transcendent / Transcendence, Existen
17、tial, Transpersonal and Sacred(ness) Quality of Life, Well(-)Being, Life-Satisfaction,Excluded studies,Case studies Qualitative studies Studies that measured quality of life based on external indicators or a single dimension Studies that measured spirituality based on the frequency of religious or s
18、piritual practices or behavior Studies prior to 1991 Studies not reported in English,Search Results,Total search database: 3,040 citations After initial screening of citation 371 study reports of potential interest were identified and retrieved 59 studies were excluded because the study was a case s
19、tudy, a qualitative study or was not reported in English. 200 studies were excluded because methodological inclusion criteria pertaining to the measurement of spirituality or quality of life were not met. 60 studies were excluded the criteria for calculating an effect size were not met. 1 study was
20、excluded because it reported findings on the same sample as another study. Final sample size: 62 primary ESs from 51 studies,Design: Coding,Study characteristics Setting Research design Sampling methodSample characteristics Age & gender Religious affiliation Cultural background,Characteristics of th
21、e instruments Classification of instruments Type of scales, # of items Psychometric informationEffect size data Statistics to calculate the effect size,Design: Statistical Analysis,Convert primary findings to a common metric Weigh primary ESs by inverse variances Weigh primary ESs by instrument reli
22、ability coefficients Analyze the distribution for Normality Homogeneity Examine for moderating variables Fixed, random or mixed multivariate analyses,Sample Description,Ethnic background (reported for 55%)Caucasian / “white”: 67.6%African American / “black”: 23.7%South American: 5.8%Asian: 0.8%Hispa
23、nic: 0.4%Other: 1.8%,59 ESs derived from 48 studies Total participant pool: 22,554,Sample Description,Religious affiliation (reported for 19.7%) Protestant: 34.7% Catholic: 35.2% Jewish: 4.1% Hindu: 0.1% Islam: 0.1% No religious affiliation: 9% Other: 14.9 % Unkown: 1.9%,Operational Definitions of S
24、pirituality,Results: Distribution of ESs,Results: Final Distribution,Mean Effect Sizes,Mixed effect model,Trimmed Mixed Effects Model,95% CI Associated with Each Categorical Group of QOL Instruments as Revealed by the ANOVA Analysis.,Implications,Theoretical Confidence in a moderate effect size (as
25、defined by Cohen, 1988) Failsafe N: 151 studies with r = 0.00 would be needed to reduce the mean effect size to .10. Spirituality as a unique concept in relation to quality of life,Implications,Operational The measurement of spirituality and quality of life explains a significant proportion of the variance Mean ES varies between .23 and .50 for spirituality instruments (R2 = 12%) Mean ES varies between .11 and .45 for quality of life instruments (R2 = 12%) Implications for selection of instruments Implication for power considerations,
