Journal of Religion and Health

, Volume 56, Issue 1, pp 89–108 | Cite as

Effect of a Faith-Based Education Program on Self-Assessed Physical, Mental and Spiritual (Religious) Health Parameters

  • Frans J. CronjéEmail author
  • Levenda S. Sommers
  • James K. Faulkner
  • W. A. J. MeintjesEmail author
  • Charles H. Van Wijk
  • Robert P. Turner
Original Paper


The aim of the study was to determine the effect of attending a faith-based education program (FBEP) on self-assessed physical, mental and spiritual health parameters. The study was designed as a prospective, observational, cohort study of individuals attending a 5-day FBEP. Out of 2650 sequential online registrants, those previously unexposed to the FBEP received automated invitations to complete 5 sequential Self-Assessment Questionnaire’s (SAQ’s) containing: (1) Duke University Religion Index (DUREL); (2) Negative Religious Coping (N-RCOPE); (3) Perceived Stress Scale (PSS); (4) Center for Epidemiology and Statistics-Depression Scale (CES-D); (5) Brief Illness Perception Questionnaire (BIPQ); and the (6) State Trait Anxiety Inventory (STAI). Pre-attendance SAQ (S1) was repeated immediately post-FBEP (S2), at 30 days (S3), 90 days (S4) and after 1 year (S5). Of 655 invited, 274 (42 %) succeeded, 242 (37 %) failed and 139 (21 %) declined to complete S1. Of the 274, 37 (14 %) were excluded at on-site interview; 26 (9 %) never attended the FBEP (i.e., controls: 5♂; 21♀; 27–76 years); and 211 (77 %) participated (i.e., cases: 105♂; 106♀; 18–84 years) and were analyzed over time: 211 (S1); 192 (S2); 99 (S3); 52 (S4); 51 (S5). IRB approval was via the Human Research Ethics Committee of Stellenbosch University. DUREL showed significant, sustained changes in Intrinsic Religiosity. N-RCOPE showed significant, lasting improvement. In others, median values dropped significantly immediately after the FBEP (S1:S2) for STAI-State p < 0.0001; PSS p < 0.0001; BIPQ p < 0.0001; and CES-D p < 0.0001; and at 1 month (S1:S3) for STAI-Trait p < 0.001; all changes were sustained (S3 through S5). This FBEP produced statistically and clinically significant changes; these lasted in those followed up >1 year.


Religion Mental health Spirituality Religion and Medicine Religion and Psychology 


Source of funding

None. However, two co-authors are employees of Be in Health Inc. Thomaston, GA, USA.


  1. Bergua, V., Meillon, C., Potvin, O., Bouisson, J., Le Goff, M., Rouaud, O., & Amieva, H. (2012). The STAI-Y trait scale: Psychometric properties and normative data from a large population-based study of elderly people. International Psychogeriatrics, 24(7), 1163–1171. doi: 10.1017/S1041610212000300.CrossRefPubMedGoogle Scholar
  2. Borras, L., Mohr, S., Brandt, P. Y., Gillieron, C., Eytan, A., & Huguelet, P. (2007). Religious beliefs in schizophrenia: Their relevance for adherence to treatment. Schizophrenia Bulletin, 33(5), 1238–1246. doi: 10.1093/schbul/sbl070.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Broadbent, E., Kydd, R., Sanders, D., & Vanderpyl, J. (2008). Unmet needs and treatment seeking in high users of mental health services: Role of illness perceptions. Australian and New Zealand Journal of Psychiatry, 42(2), 147–153. doi: 10.1080/00048670701787503.CrossRefPubMedGoogle Scholar
  4. Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60(6), 631–637. doi: 10.1016/j.jpsychores.2005.10.020.CrossRefPubMedGoogle Scholar
  5. Burns, V. E., Drayson, M., Ring, C., & Carroll, D. (2002). Perceived stress and psychological well-being are associated with antibody status after meningitis C conjugate vaccination. Psychosomatic Medicine, 64(6), 963–970. Retrieved from
  6. Carpenter, L. L., Tyrka, A. R., McDougle, C. J., Malison, R. T., Owens, M. J., Nemeroff, C. B., & Price, L. H. (2004). Cerebrospinal fluid corticotropin-releasing factor and perceived early-life stress in depressed patients and healthy control subjects. Neuropsychopharmacology, 29(4), 777–784. Retrieved from,
  7. Choi, S. W., Schalet, B., Cook, K. F., & Cella, D. (2014). Establishing a common metric for depressive symptoms: Linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychological Assessment, 26(2), 513–527. doi: 10.1037/a0035768.CrossRefPubMedGoogle Scholar
  8. Cohen, S. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385.CrossRefPubMedGoogle Scholar
  9. Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006 and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334.CrossRefGoogle Scholar
  10. Cohen, S., Kessler, R. C., & Underwood, L. G. (1995). Measuring stress: A guide for health and social scientists. New York: Oxford University Press.Google Scholar
  11. Cohen, S., Tyrrell, D. A., Russell, M. A., Jarvis, M. J., & Smith, A. P. (1993). Smoking, alcohol consumption, and susceptibility to the common cold. The American Journal of Public Health, 83(9), 1277–1283. Retrieved from,
  12. Crawford, J., Cayley, C., Lovibond, P., Wilson, P., & Hartley, C. (2011). Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales. Australian Psychologist, 46, 3–14.CrossRefGoogle Scholar
  13. Cruess, D. G., Antoni, M. H., Kumar, M., Ironson, G., McCabe, P., Fernandez, J. B., … Schneiderman, N. (1999). Cognitive-behavioral stress management buffers decreases in dehydroepiandrosterone sulfate (DHEA-S) and increases in the cortisol/DHEA-S ratio and reduces mood disturbance and perceived stress among HIV-seropositive men. Psychoneuroendocrinology, 24(5), 537–549. Retrieved from,
  14. Culhane, J. F., Rauh, V., McCollum, K. F., Hogan, V. K., Agnew, K., & Wadhwa, P. D. (2001). Maternal stress is associated with bacterial vaginosis in human pregnancy. Maternal and Child Health Journal, 5(2), 127–134. Retrieved from
  15. Diego, M. A., Field, T., & Hernandez-Reif, M. (2001). CES-D depression scores are correlated with frontal EEG alpha asymmetry. Depress Anxiety, 13(1), 32–37. Retrieved from,<32::AID-DA5>3.0.CO;2-G/abstract
  16. Ebrecht, M., Hextall, J., Kirtley, L.-G., Taylor, A., Dyson, M., & Weinman, J. (2004). Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Psychoneuroendocrinology, 29(6), 798–809. Retrieved from,
  17. Epel, E. S., Blackburn, E. H., Lin, J., Dhabhar, F. S., Adler, N. E., Morrow, J. D., & Cawthon, R. M. (2004). Accelerated telomere shortening in response to life stress. Proceedings of National Academy of Sciences USA, 101(49), 17312–17315. Retrieved from,
  18. Fewtrell, M. S., Kennedy, K., Singhal, A., Martin, R. M., Ness, A., Hadders-Algra, M., … Lucas, A. (2008). How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Archives Disease in Childhood, 93(6), 458–461. doi: 10.1136/adc.2007.127316
  19. Grossoehme, D. H., VanDyke, R., & Seid, M. (2008). Spirituality’s role in chronic disease self-management: Sanctification of the body in families dealing with cystic fibrosis. J Health Care Chaplain, 15(2), 149–158. doi: 10.1080/08854720903163312.CrossRefPubMedGoogle Scholar
  20. Holzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., … Lazar, S. W. (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience, 5(1), 11–17. Retrieved from,
  21. Kemppainen, J., Kim-Godwin, Y. S., Reynolds, N. R., & Spencer, V. S. (2008). Beliefs about HIV disease and medication adherence in persons living with HIV/AIDS in rural southeastern North Carolina. Journal of the Association of Nurses in AIDS Care, 19(2), 127–136. doi: 10.1016/j.jana.2007.08.006.CrossRefPubMedGoogle Scholar
  22. Koenig, H. G. (2007). Physician’s role in addressing spiritual needs. The Southern Medical Journal, 100(9), 932–933. Retrieved from
  23. Koenig, H. G., & Büssing, A. (2010). The Duke University Religion Index (DUREL): A five-item measure for use in epidemological studies. Religions, 1(1), 78–85. Retrieved from
  24. Kramer, J. R., Ledolter, J., Manos, G. N., & Bayless, M. L. (2000). Stress and metabolic control in diabetes mellitus: methodological issues and an illustrative analysis. Annals of Behavioral Medicine, 22(1), 17–28. Retrieved from
  25. Kremer, H., Ironson, G., & Porr, M. (2009). Spiritual and mind-body beliefs as barriers and motivators to HIV-treatment decision-making and medication adherence? A qualitative study. AIDS Patient Care STDS, 23(2), 127–134. doi: 10.1089/apc.2008.0131.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Kvaal, K., Ulstein, I., Nordhus, I. H., & Engedal, K. (2005). The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. International Journal of Geriatric Psychiatry, 20(7), 629–634. doi: 10.1002/gps.1330.CrossRefPubMedGoogle Scholar
  27. Leon, K. A., Hyre, A. D., Ompad, D., Desalvo, K. B., & Muntner, P. (2007). Perceived stress among a workforce 6 months following hurricane Katrina. Social Psychiatry and Psychiatric Epidemiology, 42(12), 1005–1011. Retrieved from,
  28. Leventhal, E. A. (1984). Aging and the perception of illness. Research Aging, 6(1), 119–135. Retrieved from
  29. Lyon, M. E., Garvie, P. A., Kao, E., Briggs, L., He, J., Malow, R., … McCarter, R. (2011). Spirituality in HIV-infected adolescents and their families: FAmily CEntered (FACE) advance care planning and medication adherence. Journal of Adolescent Health, 48(6), 633–636. doi: 10.1016/j.jadohealth.2010.09.006
  30. Malarkey, W. B., Pearl, D. K., Demers, L. M., Kiecolt-Glaser, J. K., & Glaser, R. (1995). Influence of academic stress and season on 24-h mean concentrations of ACTH, cortisol, and beta-endorphin. Psychoneuroendocrinology, 20(5), 499–508. Retrieved from,
  31. McAlonan, G. M., Lee, A. M., Cheung, V., Cheung, C., Tsang, K. W. T., Sham, P. C., … Wong, J. G. W. S. (2007). Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. The Canadian Journal of Psychiatry, 52(4), 241–247. Retrieved from
  32. Mellins, C. A., Havens, J. F., McDonnell, C., Lichtenstein, C., Uldall, K., Chesney, M., & Bell, J. (2009). Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care, 21(2), 168–177. doi: 10.1080/09540120802001705.CrossRefPubMedGoogle Scholar
  33. Newport, F. (2012). In US, 77 % Identify as Christian. Retrieved from from Gallup, Inc.
  34. Oei, T. P., Evans, L., & Crook, G. M. (1990). Utility and validity of the STAI with anxiety disorder patients. British Journal of Clinical Psychology, 29(Pt 4), 429–432. Retrieved from
  35. Pargament, K., Feuille, M., & Burdzy, D. (2011). The brief RCOPE: Current psychometric status of a short measure of religious coping. Religions, 2(1), 51–76. Retrieved from
  36. Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543. doi: 10.1002/(SICI)1097-4679(200004)56:4<519:AID-JCLP6>3.0.CO;2-1.CrossRefPubMedGoogle Scholar
  37. Parsons, S. K., Cruise, P. L., Davenport, W. M., & Jones, V. (2006). Religious beliefs, practices and treatment adherence among individuals with HIV in the southern United States. AIDS Patient Care STDS, 20(2), 97–111. doi: 10.1089/apc.2006.20.97.CrossRefPubMedGoogle Scholar
  38. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  39. Schein, R. L., & Koenig, H. G. (1997). The Center for Epidemiological Studies-Depression (CES-D) Scale: Assessment of depression in the medically ill elderly. International Journal of Geriatric Psychiatry, 12(4), 436–446. Retrieved from,<436::AID-GPS499>3.0.CO;2-M/abstract
  40. Smith, K. V., & Goldman, N. (2011). Measuring health status: Self-, interviewer, and physician reports of overall health. Journal of Aging and Health, 23(2), 242–266. doi: 10.1177/0898264310383421.CrossRefPubMedGoogle Scholar
  41. Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  42. Stanley, M. A., Bush, A. L., Camp, M. E., Jameson, J. P., Phillips, L. L., Barber, C. R., & Cully, J. A. (2011). Older adults’ preferences for religion/spirituality in treatment for anxiety and depression. Aging and Mental Health, 15(3), 334–343. doi: 10.1080/13607863.2010.519326.CrossRefPubMedGoogle Scholar
  43. Stansbury, J. P., Ried, L. D., & Velozo, C. A. (2006). Unidimensionality and bandwidth in the Center for Epidemiologic Studies Depression (CES-D) Scale. Journal of Personality Assessment, 86(1), 10–22. doi: 10.1207/s15327752jpa8601_03.CrossRefPubMedGoogle Scholar
  44. Stewart, D. E., & Yuen, T. (2011). A systematic review of resilience in the physically ill. Psychosomatics, 52(3), 199–209. doi: 10.1016/j.psym.2011.01.036.CrossRefPubMedGoogle Scholar
  45. Stone, A. A., Mezzacappa, E. S., Donatone, B. A., & Gonder, M. (1999). Psychosocial stress and social support are associated with prostate-specific antigen levels in men: Results from a community screening program. Health Psychology, 18(5), 482–486. Retrieved from,
  46. Storch, E. A., Strawser, M. S., & Storch, J. B. (2004). Two-week test-retest reliability of the Duke Religion Index. Psychological Reports, 94(3 Pt 1), 993–994. Retrieved from
  47. Tenenbaum, G., Furst, D., & Weingarten, G. (1985). A statistical reevaluation of the STAI anxiety questionnaire. Journal of Clinical Psychology, 41(2), 239–244. Retrieved from

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Interdisciplinary Health Sciences, Faculty of Health SciencesUniversity of StellenboschParowSouth Africa
  2. 2.Be in Health IncThomastonUSA
  3. 3.Division of Community Health, Faculty of MedicineUniversity of StellenboschParowSouth Africa
  4. 4.South African Military Health ServiceInstitute for Maritime MedicineSimon’s TownSouth Africa
  5. 5.Division of Biostatistics and EpidemiologyMUSCCharlestonUSA

Personalised recommendations