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



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.


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


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


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.


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).


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.


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


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)


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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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