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Religiosity and Patient Activation Among Hospital Survivors of an Acute Coronary Syndrome

  • Hawa O. AbuEmail author
  • David D. McManus
  • Catarina I. Kiefe
  • Robert J. Goldberg
Original Research

Abstract

Background

Optimum management after an acute coronary syndrome (ACS) requires considerable patient engagement/activation. Religious practices permeate people’s lives and may influence engagement in their healthcare. Little is known about the relationship between religiosity and patient activation.

Objective

To examine the association between religiosity and patient activation in hospital survivors of an ACS.

Design

Secondary analysis using baseline data from Transitions, Risks, and Actions in Coronary Events: Center for Outcomes Research and Education (TRACE-CORE) Study.

Participants

A total of 2067 patients hospitalized for an ACS at six medical centers in Central Massachusetts and Georgia (2011–2013).

Main Measures

Study participants self-reported three items assessing religiosity—strength and comfort from religion, making petition prayers, and awareness of intercessory prayers for health. Patient activation was assessed using the 6-item Patient Activation Measure (PAM-6). Participants were categorized as either having low (levels 1 and 2) or high (levels 3 and 4) activation.

Results

The mean age of study participants was 61 years, 33% were women, and 81% were non-Hispanic White. Approximately 85% derived strength and comfort from religion, 61% prayed for their health, and 89% received intercessory prayers for their health. Overall, 58% had low activation. Reports of a great deal (aOR, 2.02; 95% CI, 1.44–2.84), and little/some (aOR, 1.45; 95% CI, 1.07–1.98) strength and comfort from religion were associated with high activation, as were receipt of intercessions (aOR, 1.48; 95% CI, 1.07–2.05). Praying for one’s health was associated with low activation (aOR, 0.78; 95% CI, 0.61–0.99).

Conclusions

Most ACS survivors acknowledge religious practices toward their recovery. Strength and comfort from religion and intercessory prayers for health were associated with high patient activation. Petition prayers for health were associated with low activation. Healthcare providers should use knowledge about patient’s religiosity to enhance patient engagement in their care.

KEY WORDS

patient activation patient engagement self-management complementary and integrative medicine religiosity spirituality acute coronary syndrome 

Notes

Funding Information

Transitions, Risks, and Actions in Coronary Events: Center for Outcomes Research and Education (TRACE-CORE) was financially supported by National Institutes of Health (U01HL105268). At the time the study was conducted, DDM was funded by the National Heart, Lung, and Blood Institute (RO1HL126911, RO1HL135219, RO1HL136660, R15HL121761). Partial support for RJG was provided by the National Heart, Lung, and Blood Institute (1R01HL126911-01A1, 5R01HL125089-02, 5R01HL115295-05). CIK was funded by National Institutes of Health/National Institute of Mental Health (R01MH112138) and National Institutes of Health/National Center for Advancing Translational Sciences (U54 RR 026088). The funding agencies were not involved in the data collection, analysis, interpretation, writing, and submission of the paper for publication.

Compliance with Ethical Standards

The Institutional Review Boards at participating sites approved this study. Written informed consent was obtained from each participant.

Conflict of Interest

Dr. David McManus receives sponsored research support from Bristol Myers Squibb, Pfizer, Biotronik, and Boehringer Ingelheim and has consulted for Bristol Myers Squibb, Pfizer, Samsung Electronics, and FlexCon. The other authors declare no potential conflict of interest.

Supplementary material

11606_2019_5345_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 18 kb)

References

  1. 1.
    Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017; 135:e146-e603.CrossRefGoogle Scholar
  2. 2.
    Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S76.CrossRefGoogle Scholar
  3. 3.
    Moljord IE, Lara-Cabrera ML, Perestelo-Pérez L, Rivero-Santana A, Eriksen L, Linaker OM. Psychometric properties of the Patient Activation Measure-13 among out-patients waiting for mental health treatment: A validation study in Norway. Patient Educ Couns 2015; 98:1410–17.CrossRefGoogle Scholar
  4. 4.
    Hibbard JH, Greene J. What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Aff. 2013; 32: 207–14.CrossRefGoogle Scholar
  5. 5.
    Abu HO, Anatchkova MD, Erskine NA, Lewis J, McManus DD, Kiefe CI, Santry HP. Are we “missing the big picture” in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization. Appl Nurs Res 2018; 44:60–66.CrossRefGoogle Scholar
  6. 6.
    Koenig HG, Larson DB, Larson SS. Religion and coping with serious medical illness. Ann Pharmacother 2001; 35: 352–59.CrossRefGoogle Scholar
  7. 7.
    McConnell TR, Trevino KM, Klinger TA. Demographic differences in religious coping after a first-time cardiac event. J Cardiopulm Rehabil. 2011; 31: 298–302.CrossRefGoogle Scholar
  8. 8.
    Lucchese FA, Koenig HG. Religion, spirituality and cardiovascular disease: Research, clinical implications, and opportunities in Brazil. Rev Bras Cir Cardiovasc. 2013; 28:103–28.CrossRefGoogle Scholar
  9. 9.
    Koenig HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012; 2012:278730.CrossRefGoogle Scholar
  10. 10.
    Ellison CG, Levin JS. The religion-health connection: Evidence, theory, and future directions. Health Educ Behav. 1998; 25:700–720.CrossRefGoogle Scholar
  11. 11.
    Gall TL, Charbonneau C, Clarke NH, Grant K, Joseph A, Shouldice L. Understanding the nature and role of spirituality in relation to coping and health: a conceptual framework. Can J Psychol. 2005; 46:88–104.CrossRefGoogle Scholar
  12. 12.
    Debnam KJ, Holt CL, Clark EM, Roth DL, Foushee HR, Crowther M, Fouad M, Southward PL. Spiritual health locus of control and health behaviors in African Americans. Am J Health Behav. 2012;36(3):360–72.CrossRefGoogle Scholar
  13. 13.
    Reyes-Ortiz CA, Rodriguez M, Markides KS. The role of spirituality healing with perceptions of the medical encounter among Latinos. J Gen Intern Med. 2009;24 Suppl 3(Suppl 3):542–547.CrossRefGoogle Scholar
  14. 14.
    Waring ME, McManus RH, Saczynski JS, Anatchkova MD, McManus DD, Devereaux RS, Goldberg RJ, Allison JJ, Kiefe CI, TRACE-CORE Investigators. Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education (TRACE-CORE): design and rationale. Circ Cardiovasc Qual Outcomes. 2012; 5:44–50.CrossRefGoogle Scholar
  15. 15.
    Goldberg RJ, Saczynski JS, McManus DD, TRACE-CORE investigators, et al. Characteristics of Contemporary Patients Discharged From the Hospital After an Acute Coronary Syndrome. Am J Med. 2015; 128:1087–93CrossRefGoogle Scholar
  16. 16.
    Anderson JL, Adams CD, Antman EM, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127:663–828.CrossRefGoogle Scholar
  17. 17.
    Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005; 40:1918–30.CrossRefGoogle Scholar
  18. 18.
    Patient Activation Measure (PAM) 6 License Materials. In: Insignia Health.Google Scholar
  19. 19.
    Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004; 39:1005Y1026.CrossRefGoogle Scholar
  20. 20.
    Aung E, Donald M, Williams GM, Coll JR, Doi SA. Joint influence of patient assessed chronic illness care and patient activation on glycaemic control in type 2 diabetes. Int J Qual Health Care 2015; 27:117–24.PubMedGoogle Scholar
  21. 21.
    Zimbudzi E, Lo C, Ranasinha S, et al. Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study. BMJ Open. 2017; 7:e017695.CrossRefGoogle Scholar
  22. 22.
    Cohen S, Williamson GM. Perceived Stress in a Probability Sample of the United States, in: S. Spacapan, S. Oskamp (Eds.), The Social Psychology of Health. Newbury Park, CA: Sage, 1988, pp. 31–67.Google Scholar
  23. 23.
    Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16:606–13.CrossRefGoogle Scholar
  24. 24.
    Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure of assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166:1092–97.CrossRefGoogle Scholar
  25. 25.
    Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010; 304:76–84.CrossRefGoogle Scholar
  26. 26.
    Sherbourne CD, Stewart AL. The MOS Social Support Survey. Soc Sci Med. 1991; 32:705–14.CrossRefGoogle Scholar
  27. 27.
    Ferrucci L, Lungo DI, Guralnik JM, et al. Is the telephone interview for cognitive status a valid alternative in persons who cannot be evaluated by the Mini Mental State Examination? Aging (Milano). 1998; 10:332–38.PubMedGoogle Scholar
  28. 28.
    Ware JEJ, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). 1. Conceptual framework and item selection. Med Care. 1992; 30:473–83.CrossRefGoogle Scholar
  29. 29.
    Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. JACC. 1995; 25:333–41.CrossRefGoogle Scholar
  30. 30.
    Oxman TE, Freeman DH, Manheimer ED. Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosom Med. 1995; 57: 5–15.CrossRefGoogle Scholar
  31. 31.
    Schnall E, Wassertheil-Smoller S, Swencionis C, et al. The relationship between religion and cardiovascular outcomes and all-cause mortality in the women’s health initiative observational study. Psychol Health 2010; 25:249–63.CrossRefGoogle Scholar
  32. 32.
    Pew Research Center. Religion and Public life. http://www.pewforum.org/2015/11/03/chapter-2-religious-practices-and-experiences/#private-devotions. Accessed 4 December 2018
  33. 33.
    Govier I. Spiritual care in nursing: a systematic approach. Nurs Stand 2000; 14:32–6.CrossRefGoogle Scholar
  34. 34.
    Ahn YH, Kim BJ, Ham OK, Kim SH. Factors associated with patient activation for self-management among community residents with Osteoarthritis in Korea. J Korean Acad Nurs 2015; 26:303–11.CrossRefGoogle Scholar
  35. 35.
    Carey SA, Tecson KM, Bass K, Felius J, Hall SA. Patient activation with respect to advanced heart failure therapy in patients over age 65 years. Heart Lung. 2018; 47:285–89.CrossRefGoogle Scholar
  36. 36.
    Koenig HG, Berk LS, Daher NS, et al. Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness. J Psychosom Res. 2014; 77: 135–43.CrossRefGoogle Scholar
  37. 37.
    Abu HO, Ulbricht C, Ding E, Allison JJ, Salmoirgo-Blotcher E, Goldberg RJ, Kiefe CI. Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review. Qual Life Res. 2018; 27:2777–97.CrossRefGoogle Scholar
  38. 38.
    Fosarelli P. Outcomes of Intercessory Prayer for those who are Ill: Scientific and Pastoral Perspectives. Linacre Q. 2011;78:125–37.CrossRefGoogle Scholar
  39. 39.
    Crawford CC, Sparber AG, Jonas WB. A systematic review of the quality of research on hands-on and distance healing: Clinical and laboratory studies. Altern Ther Health Med. 2003; 9:A96–104.PubMedGoogle Scholar
  40. 40.
    Byrd T, Cohn LD, Gonzalez E, Parada M, Cortes M. Seatbelt use and belief in destiny among Hispanic and nonHispanic drivers. Accid Anal Prev. 1999; 31:63–5.CrossRefGoogle Scholar
  41. 41.
    Powe B, Finnie R. Cancer fatalism: the state of science. Cancer Nurs. 2003; 26:454–467.CrossRefGoogle Scholar
  42. 42.
    Isaac KS, Hay JL, Lubetkin EI. Incorporating Spirituality in Primary Care. J Relig Health. 2016; 55:1065–77.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Division of Cardiovascular Medicine, Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA

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