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Health Implications of Religiosity and Spirituality

Starting on January 11, 2016 we are featuring the article titled “The Influence of Religiosity and Spirituality on Rural Parents’ Health Decision Making and Human Papillomavirus Vaccine Choices” by Tami Thomas, PhD; Amy Blumling, BSN; Augustina Delaney, BSN. Their analysis reveals possibilities for nursing interventions that are based on understanding of the relationship between people’s faith beliefs and their health. While this article is featured you can download it at no cost on the ANS website, then return here and share your responses.

Dr. Thomas shared this background about their work:

In the kinds of places most of us are fortunate enough to live in, we don’t have to worry about the safety of our own health or that of our loved ones (not counting those who would rather listen to Jenny McCarthy than their licensed nurses and physicians). But there are still plenty of places in the United States that still do not have access health promotion knowledge, such the advantages of a preventative HPV vaccine, that could likely one day save the lives of their children. So how are we supposed to respectfully andpeds-clinic-300 effectively approach and inform these rural communities so they too can have this beneficial health information?

While we know that HPV types 6, 11, 16 and 18 are responsible for approximately 99% of cervical cancers and 90% of genital warts.1-3 And as HPV vaccination protects against HPV related cancers, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend that both girls and boys as young as 9 to 10 years old receive the HPV vaccine to prevent HPV-related cancers, including cervical cancer and related morbidities4. Given in a series of three injections over a six-month period, the HPV vaccine can be administered to children as young as 9 and adults up to 26 years old.5 Simple, right? But once again, how are we, as nurses, expected to efficiently and efficaciously relay these facts to underserved populations? Answer – find a trusted and shared experience that fosters acceptance, love, and the exchange of positive information.

Researchers have consistently implied that spirituality and religiosity are positively associated with physical and mental health in minority communities.6-8 These associations have been consistently found among rural populations, where influence of these constructs appear to be linked to attitudes about health, the health decision making processes, and perceptions of health-related outcomes.9-14 Drawing upon Hill & Pargament’s research, religiosity, which was defined as participation in religious social structures, was a recurring and important theme when discussing HPV vaccination. Although religiosity related comments were not always directly related to HPV or HPV SAM_300vaccination, it did emerge as an important influence discussing how they approach health management issues. Subjective commitment to spiritual or religious beliefs, or spirituality, was found to influence the ways in which parents perceived their control over their children and coping with health issues potentially related to HPV vaccination. Together, religiosity and spirituality were found to play integral roles in these parents’ lives and influenced their attitudes towards HPV vaccination uptake for their children.

So in 2010, with this basic idea in hand, I started ferrying myself and a small group of student assistants on a 4 hour drive from my then famously lovely home in Atlanta to the much lesser well-known and often ignored East Georgia county of Screven, population 14,593. To so many, it looks like the kind of place that looks like every other area far removed from urban life, covered in wildflowers and cotton fields, the kind of place one passes through to get somewhere else – when we first made the 5:30 AM drive, I was sleepily asked “where are we, Dr. Thomas?” by my young passengers. In a situation like that, with red clay caking up the wheel-wells of your car, missing the familiarity of brand name restaurants and shops, it can be intimidating. But what we found was not only a need, but also warmth and willingness from the church community we had come to speak with and gather opinions from.

Screven county, as well as the other rural communities included in this study, had no local pediatrician, and parents often had to drive more than 60 minutes to receive primary healthcare for their children. While local health departments in these rural areas provided healthcare for children and had the HPV vaccine, the hours of operation and availability of the HPV vaccine, secondary to dispensing costs, were often limiting RWJ-Thomas-300for parents who were working fulltime. In short, overcoming barriers to HPV vaccination would require collaborative efforts among rural parents. Concordantly, our findings suggested that in the context of faith-based initiatives the inclusion of parents would be essential to increase HPV vaccination in these kinds of areas. We found that through the use of community churches and faith-based approaches, HPV prevention and vaccine uptake activities could be improved in this population and in other such communities that are imbued with religious and spiritual values.

Across the 2 years spent on this study, so many important things were learned. For instance, we now understand that the church community in a perfect conduit for educating caregivers on HPV issues and how imperative it is that we use the input of this community, which is of great cultural importance, to fashion more effective methods of various health interventions in rural areas. But we also now know that unfamiliar isn’t synonymous with scary, but that it actually can mean the pleasant surprise of a kind act like opening a restaurant ahead of schedule so a bunch of city people can get their morning coffee before they head off to collect their scientific data. We know that understanding individual culture goes well beyond foreign country colloquialisms and strange food, but that it includes their spiritual beliefs or even lack thereof.

As nurses, it is out sacred duty to carry the responsibility of spreading messages of health promotion, like the merits of HPV vaccination, with trust and kindness. Having this kind of knowledge will hopefully allow nurses in the future to convey such information in the appropriate context to foster great understanding and therefore better-informed caregiver decision-making and healthier people.


1. Dunne EF, Nielson CM, Stone KM, Markowitz LE, Giuliano AR. Prevalence of HPV infection among men: A systematic review of the literature. J Infect Dis. Oct 15 2006;194(8):1044-1057.

2. Hu D, Goldie S. The economic burden of noncervical human papillomavirus disease in the United States. American journal of obstetrics and gynecology. May 2008;198(5):500.e501-507.

3. Joseph DA, Miller JW, Wu X, et al. Understanding the burden of human papillomavirus-associated anal cancers in the US. Cancer. Nov 15 2008;113(10 Suppl):2892-2900.

4. Centers for Disease Control and Prevention. ACIP recommends all 11-12 year-old males get vaccinated against HPV. 2011.

5. National and state vaccination coverage among adolescents aged 13 through 17 years–United States, 2010. MMWR. Morbidity and mortality weekly report. Aug 26 2011;60(33):1117-1123.

6. Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. Journal of clinical psychology. Apr 2005;61(4):461-480.

7. Koenig HG, McCullough, M.E., Larson, D.B.;. Handbook of religion and health. Oxford, England: Oxford University Press; 2001.

8. Seybold KSH, P.C. The Role of Religion and Spirituality in Mental and Physical Health. Current Directions in Psychological Science. 2001;10(1):21-24.

9. Cates JR, Brewer NT, Fazekas KI, Mitchell CE, Smith JS. Racial differences in HPV knowledge, HPV vaccine acceptability, and related beliefs among rural, southern women. J Rural Health. Winter 2009;25(1):93-97.

10. Holt CL, Clark EM, Roth D, et al. Development and Validation of Instruments to Assess Potential Religion-Health Mechanisms in an African American Population. J Black Psychol. May 1 2009;35(2):271-288.

11. Holt CL, McClure SM. Perceptions of the religion-health connection among African American church members. Qual Health Res. Feb 2006;16(2):268-281.

12. Pargament KI, Magyar-Russell, G., Murray-Swank, N.A. The sacred and the search for significance: Religion as a unique process. Journal of Social Issues. 2005;61(4):665-687.

13. Thomas T, Strickland O, DiClemente R, Higgins M. An Opportunity for Cancer Prevention During Preadolescence and Adolescence: Stopping HPV Related Cancer through HPV Vaccination. Special Supplement to the Journal of Adolescent Health, 2013;52 (2013) S60-S68, DOI: 10.1016/j.jadohealth.2012.08.011

14. Thomas T; Strickland O, DiClemente R; Haber M, Higgins M. Rural African American Parents’ Knowledge and Decisions about HPV Vaccination. The Journal of Nursing Scholarship, 2013; 44:4, 358–367. DOI: 10.1111/j.1547-5069.2012.01479.x Epub 2012 Nov. 5

3 Comments Post a comment
  1. Living in Appalachia, that is, East Tennessee we are studying EOL concerns of PLWHA in Appalachia. The value on religion, religious practices, church support and then the religious basis for stigmatization of HIV make it complex. (Of course not all rural people are in the “Bible belt”). Nursing science needs to focus on the influence of belief, church social support, and religious cultural structure on how we develop interventions with such communities. It would seem a participatory action research approach would be spiritually enhancing as well as emancipatory. Happy MLK Day. Black Lives Matter. Rural Black lives matter also. Spirituality and religion is salient in urban and rural African American churches. Much more practical, theoretical and even ethical discussion needs to take place. I think of the converse, religious ideologically motivated political pressure that is exclusionary and it emphasizes the need for critical theories to be used developed inductively as we engage rural communities in ways directly interacting with their spirituality. Am I too hesitant?

    January 18, 2016
    • Tami Thomas, PhD, RN, CPNP, FAANP, FAAN #

      I echo the two posts above and would say that an understanding of the issues begins with listening to the communities, families and individuals we encounter as we strive to improve health outcomes. The incorporation of religion and spirituality into the development of nursing interventions maybe the lynch pin in improving health outcomes for under-served communities. I agree Black Lives matter and Rural Black Lives matter – I would also say that all rural lives matter and all urban lives matter as well. The same dearth of information on religiosity and spirituality in urban areas may also apply. Lets all work together to ensure that religion and spirituality are all always considered when communicating with those we serve – it is our duty and privilege as nurses…

      January 18, 2016
  2. Hesitant? Not exactly!! Thank you so much for sharing your ideas and your passion with us! Sometimes it is prudent to hesitate a bit and think through what needs to be done, and your ideas about moving forward with emancipatory / participatory projects to address the challenges in specific communities provide a wonderful basis for reflection and action! Best wishes in your work, and share more of your ideas here any time! Peggy

    January 18, 2016

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