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Ti le: In luence o Religious and Spi i ual Elemen s on Adhe ence o Pha macological
1
T ea men
2
Abs ac
3
The objec i e o his s udy is o know he in luence o eligious/spi i ual elemen s
4
on he adhe ence o pha macological he apy. The desc ip o s used o his li e a u e
5
e iew we e ‘‘medicine, medica ion, d ug, o ea men ,’’ ‘‘adhe ence o ea men ,’’ and
6
‘‘ eligion o spi i uali y o ai h o p aye ’’ in di e en da abases (CINAHL, PsycINFO,
7
PubMed). Finally, 23 a icles we e selec ed. A icles a ailable in ull ex , published
8
be ween 2010 and 2017, in English o Spanish we e included. The esul s showed ha
9
some s udies ela e posi i ely he R/S and he apeu ic adhe ence, bu o he s de e mine an
10
opposi e o e en mixed e ec , mainly add essing pa hologies such as HIV and o he
11
ch onic diseases. The in luence o eligiosi y/spi i uali y on he apeu ic adhe ence equi es
12
ha heal h p o essionals acqui e sensi i i y and compe ence o add ess hese issues wi h
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hei pa ien s.
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Keywo ds Religion; Spi i uali y; T ea men adhe ence; Pha macological he apy
15
Backg ound
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Since he mid- wen ie h cen u y, s udies show he ela ionship be ween eligiosi y/spi i uali y
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(R/S) and heal h (de Diego and Badan a 2017; de Diego 2016; Lucche i and
18
Lucche i 2014). This connec ion is highligh ed in a eas ela ed o he heal h p omo ion and
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he p e en ion o disease (By ne and P ice 1979; Le in 1994; Le in and Vande pool 1987;
20
Quiceno and Vinaccia 2009; Vaux 1976), such is he case o he in luence on adhe ence o
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clinical ea men s (Ba ía e al. 2016; S ewa e al. 2013; Aba zúa e al. 2011; Laos
22
Man ique 2010).
23
Howe e , heal h p o essionals con inue o ocus on p agma ic aspec s o hei wo k,
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which in many cases do no ake in o accoun he ype o belie s o pa ien s. This ob ia es
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he eali y ha people use hei eligion o con on p oblems ela ed o hei heal h o
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illness and ha his end does no disappea wi h he disco e y and e olu ion o
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inc easingly e ec i e and p ecise medical ea men s (Mo ei a-Almeida 2013).
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Pa ien s a e o en hose who demand comp ehensi e ca e including spi i ual o eligious
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ac o s as a way o imp o e he coping wi h diseases (Ca doso e al. 2014). I is also
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impo an o imp o e heal h p o essionals knowledge abou he belie s o he popula ion
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hey se e aiming o p o ide holis ic ca e, conside ing ha in he speci ic case o adhe ence
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o ea men , i is a condi ioning ac o (Ca asco 2015).
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Objec i e
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The objec i e o he s udy is o know he in luence o eligious and spi i ual elemen s on
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pha macological he apy’s adhe ence.
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Me hods
37
Rele an da abases ha e been used o his li e a u e e iew: CINAHL, PubMed, PsycINFO.
38
The sea ch s a egy was pe o med using hese desc ip o s: ‘‘medicine, medica ion,
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d ug, o ea men ,’’ ‘‘adhe ence o ea men ,’’ and ‘‘ eligion o spi i uali y o ai h o
40
p aye ,’’ combining hem wi h he Boolean ‘‘AND’’ (Table 1).
41
INSERT TABLE 1 HERE
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Inclusion c i e ia we e a icles wi h ull ex a ailable, published be ween 2010 and
43
2017, and whose heme was app op ia e o he objec i es. Exclusion c i e ia we e a icles
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e e ing o ela ionships be ween belie s and adhe ence o non-pha macological he apeu ic
45
ea men s. The selec ion esul ed among eading he i le, abs ac , and ull ex i i
46
was app op ia e. Finally, 23 scien i ic a icles we e selec ed.
47
Resul s
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The con en analysis o he li e a u e e iew shows he impac o eligious and spi i ual
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ac o s on he pha maco he apy adhe ence (Table 2).
50
INSERT TABLE 2 HERE
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Mos s udies add ess ch onic pa hologies: i s ly HIV/AIDS (9 a icles), secondly
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psychia ic diso de s (4 a icles), and inally cys ic ib osis (3 a icles). The emaining
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s udies add ess o he ch onic diseases such as diabe es melli us, ca dio ascula p oblems,
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in es inal disease, as hma o cance . O all he selec ed s udies, 9 show nega i e ela ionships
55
be ween R/S and pha macological adhe ence, and 7 de ec posi i e ela ionships.
56
On he o he hand, he e a e also 6 a icles ha show mixed esul s, bo h posi i e and
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nega i e, and 1 a icle whe e he exis ence o a ela ionship is no de e mined. Al hough in
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some s udies he eligious and spi i ual elemen s a e app oached simul aneously, in he
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majo i y he cul u al elemen s associa ed wi h eligion p edomina e. In gene al, eligion is
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no speci ied, bu among hose iden i ied, Islam s ands ou , ollowed by Ca holicism and
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P o es an ism. Fo he spi i ual elemen s, he a ibu ion o healing powe s o heale s o
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agen s o na u e such as wa e is equen .
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Discussion
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The e is a dispa i y o esul s in he s udies analyzed. While some show a posi i e ela ionship
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be ween R/S and he apeu ic adhe ence, in o he s an opposi e e ec is obse ed.
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One o he bes -known examples o he nega i e co ela ion is be ween con acep i e
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he apy and eligiosi y (Ca ajal and Ga ilanez 2014). O he imes he in luence is mixed
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(Pee e s e al. 2015; Zagozdzon and W o kowska 2017). In hese s udies wi h diabe ic
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pa ien s and wi h men al pa hology, espec i ely, he e a e cases whe e he R/S imp o es
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he adhe ence and o he s in which he opposi e occu s. While dep ession and eligiosi y did
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no co ela e wi h adhe ence, o spi i uali y he co ela ion was posi i e acco ding o he
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esul s o Ál a ez e al. (2016) in pa ien s wi h hea ailu e.
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In he case o HIV/AIDS (one o he diseases mos add essed in he selec ed s udies),
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he apeu ic adhe ence is ela ed o he supp ession o i al load, which dec eases he isk o
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mo bidi y, mo ali y, and subsequen ansmission o he i us. Acco ding o Tymejczyk
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e al. (2016), bo h his pa hology and CF a e associa ed wi h a sho ening o li e. This
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magni ies he impo ance o adhe ence o ea men and aises spi i ual o eligious
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p oblems (G ossoehme e al. 2013). In his espec , indings o Lyon e al. (2011) also
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coincide. They iden i y ha young people wi h HIV/AIDS a e mo e likely o ask hemsel es
80
‘‘Has God abandoned me?’’ In his case, adolescen spi i uali y was associa ed wi h
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less anxie y and dep ession and be e adap a ion o ch onic illness. Pa k and Nachman
82
(2010) also de ec ed a highe eligious sco e in he bes adhe ence o ea men in adolescen s
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wi h HIV. Howe e , Vyas e al. (2014) go opposi e esul s. The people leas
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adhe en o an i e o i al ea men we e hose who belie ed ha God would no u n away
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om hem, egula ly a ended eligious se ices, and p ayed and medi a ed.
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The use o spi i uali y as a me hod o coping wi h ch onic diseases can be posi i ely o
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nega i ely ela ed o he adhe ence o pha macological ea men depending on he ype o
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coping. Adhe ence is g ea e wi h posi i e coping s yles, e e ing o us ing an a achmen
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o God, inding meaning in li e, and being spi i ually connec ed wi h o he s (G ossoehme
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e al. 2016). The nega i e coping s yle—associa ed wi h wo se adhe ence— e e s o he
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lack o a achmen o God, he di icul ies in inding he meaning in li e, and spi i ual
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s uggles. These s uggles include ques ioning he exis ence o God, doub s abou lo e o
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ac s o God, o ede ining he s esso as a punishmen om God o he ac o an e il powe
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(F ei as e al. 2015). Con en ional belie s in God as a sou ce o com o , suppo , and help
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o cope wi h s esso s seem o be associa ed wi h be e adhe ence, while undamen alis
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belie s in God’s powe s o heal p e en some pa ien s om con inuing pha macological
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ea men (Tumwine e al. 2012). On he o he hand, Hobbs (2010) de e mined ha
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adhe ence o medica ion was no ela ed o spi i ual well-being, social suppo , o us in
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he doc o . Howe e , a signi ican posi i e co ela ion was ound be ween spi i ual wellbeing
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and us in he doc o , which could be a ac o a o ing his adhe ence.
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In ela ion o elemen s o R/S ha a o adhe ence o ea men , some wo ks should be
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highligh ed. A s udy ha add essed he adhe ence o o al ho monal he apy in women wi h
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cance showed ha 94% was adhe en du ing Ramadan. Al hough his pe cen age was
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lowe han ha epo ed in mon hs o non- as ing (96%), no s a is ically signi ican di e ences
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we e obse ed. Main aining his adhe ence du ing Ramadan was acili a ed by he
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non-complex schedules o hese medica ions and he ela i e lack o hei side e ec s. In
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his way women ins ead o aking d ugs du ing he day did so a nigh , a which ime ea ing
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and d inking a e allowed by Islam (Zeeneldin e al. 2012). These ac o s could also explain
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he di e ences ob ained in he s udy by Hani e al. (2013), whe e du ing he Ramadan as ,
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ea men wi h ildaglip in esul ed in be e adhe ence o ea men compa ed o
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sul onylu eas in Muslim pa ien s wi h diabe es melli us. Al hough Dá ila So o e al. (2014)
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emphasized ac o s a o ing adhe ence o o al an idiabe ics such as ma i al s a us, educa ional
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le el, and he p esence o o he ch onic pa hologies, cul u al o belie aspec s a e
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no aken in o accoun once again.
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In ano he s udy o Muslim people, he desi e o ul ill he obliga ions o as ing a ec ed
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he adhe ence o an i e o i als, bu also hese people wan ed o a oid he ques ions o
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ela i es and iends who did no know hei HIV s a us (Ume Tocco 2017).
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Dalmida e al. (2017) showed ha he sa is ac ion o social suppo as well as p aying a
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leas once a day was signi ican ly associa ed wi h 90% adhe ence o an i e o i al ea men .
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Also in pa ien s wi h HIV/AIDS and high eligiosi y, Tumwine e al. (2012)
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de e mined he main easons o adhe ence o no o pha macological ea men . Among
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he suppo e s we e he pe cep ion o he ine ec i eness o p aye s o cu e HIV, he
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con inuous counseling om mul iple sou ces, and belie s such as ha God heals in di e en
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ways. Howe e , he main easons associa ed wi h non-adhe ence in pa ien s wi h
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high eligiosi y we e ela ed o he suppo o biblical sc ip u es, eachings and p ophecies
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o eligious leade s and es imonies o ‘‘com ades al eady healed’’ who had s opped ART
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o explain hei decisions. O he belie s based on he locus o di ine con ol e lec lowe
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sco es o he apeu ic adhe ence in A icans who epo ed ha God played an in luen ial
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ole in hei as hma in ela ion o whi e pa ien s (Ahmedani e al. 2013). These esul s
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coincide wi h Finoccha io-Kessle e al.’s (2011) who ob ain ha hose people who
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belie ed ha God con olled hei HIV s ongly we e less p one o an adhe ence o 90% o
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mo e. The ac i e coping s yle, a lowe pe cep ion o God as a con olle o heal h, and a
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lowe pe cei ed s ess we e he bes p edic o s o g ea e adhe ence.
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In ela ion o spi i ual belie s, in E hiopia, he healing po en ial o holy wa e was
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associa ed wi h non-adhe ence o ART (Tymejczyk e al. 2016). In ano he s udy pe o med
136
in Tanzania (Thielman e al. 2014), mos pa icipan s who ook an i e o i als
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sough an he bal cu e o HIV by going o a spi i ual leade . The isi o he heale was
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associa ed wi h a signi ican , bu no pe manen dec ease in adhe ence o ea men ,
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highligh ing a igue as an in luen ial ac o in making he decision o go o he heale . On
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ano he occasion, he p esence o eligion displaced he belie in Mapuche heale s as he
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main ac o s in he p ocess o heal h eco e y. Ne e heless, hey con inued using medicinal
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he bs, o complemen he pha macological ea men o hei ch onic pa hology, o
143
diminish he side e ec s o o enhance he he apeu ic e ec (Ba ía e al. 2016).
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In he case o o he diseases such as cys ic ib osis in child en, he pa en s’ R/S has
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in luenced bo h ea men adhe ence and decision making; lowe le els o R/S we e
146
associa ed wi h wo se adhe ence, pe haps due o g ea e pa en al anxie y due o he lack o
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di ine suppo o cope wi h hei child en’s illness (G ossoehme e al. 2015). The in luence
148
o he R/S was con a y in he HTA. In an in e en ion pe o med by K e chy e al. (2013),
149
i is e iden ha he spi i ual belie s o he pa ien s inc eased hei con idence in he
150
expec a ion o di ine healing, hus dec easing he adhe ence o he ea men wi h
151
an ihype ensi e
152
d ugs. Howe e , in he s udy by Sil a e al. (2016), weekly eligious a endance
153
was associa ed wi h a lowe p e alence o hype ension compa ed o pa icipan s
154
who did no a end eligious se ices. The social suppo o hese p ac ices could a o
155
no malized blood p essu e igu es.
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Fo psychia ic diso de s, al hough in ecen decades esea ch on eligion and
157
schizoph enia has inc eased, hese ha e mainly ocused on hallucina ions and delusions
158
(Gea ing e al. 2011). Some o he limi ing ac o s o d ug adhe ence ha e been he belie
159
in he supe na u al causes o men al illness ela ed o he suppo o eligious and spi i ual
160
sou ces (Abdel Aziz e al. 2016). In pa ien s wi h men al illness, Touche e al. (2012)
161
obse ed he in luence o he R/S bo h in he medica ion ea men adhe ence (delays in
162
sea ching o ea men and non-adhe ence o i ) and in he pa icipa ion in psycho he apy.
163
This was due o expe imen a ion in 14.4% o con lic s be ween hei spi i ual and eligious
164
iews and psychia ic ea men s.
165
De ini ely, o add ess he R/S o pa ien s and make i a mechanism ha a o s he apeu ic
166
adhe ence, i would be necessa y o c ea e specialized depa men s o manage he
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in eg a ion o spi i uali y wi h con en ional ea men in hospi als, such as hose iden i ied
168
by Lucche i e al. (2012); spi i ual he apies we e pe o med by olun ee s and o e ed
169
ee o cha ge o pa ien s and s a . In ano he s udy (Huguele e al. 2011), pa ien s showed
170
willingness o discuss eligious issues wi h hei psychia is . Also S olo y e al. (2013)
171
showed how pa ien s we e mo e engaged, in ol ed, and be e connec ed wi h hei doc o
172
when he doc o had a g ea e knowledge o he pa icula eligion. The e o e, i is
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impo an o p omo e cul u al sensi i i y and o e assis ance om he heal h sys em.
174
Conclusions
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The posi i e o nega i e in luences o eligious and spi i ual elemen s on adhe ence o
176
pha macological he apy a e e idenced. The e o e, i is necessa y o design in e en ions
177
aimed a encou aging he use o posi i e coping s a egies and add essing he ad e se
178
implica ions o eligious a alism.
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The e a e nume ous pa hological p ocesses o pha macological ea men s linked o he
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R/S. Those who add ess HIV/AIDS s and ou , in which he social suppo p o ided by
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belonging o a ce ain eligion o p ac ices such as p aye has posi i e e ec s o adhe ence
182
o ART.
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Heal h p o essionals should be awa e o he ole ha R/S plays in he li e o pa ien s.
184
They mus espec belie s and include hem in ca e planning. This will p omo e a holis ic
185
pa ien -cen e ed app oach and will suppo hem in making sel -ca e decisions.
186
Re e ences
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Aba zua Ibáñez, F., Ja a Roye , K., López Sando al, E., & Pa do Zúñiga, D. (2011). Relación en e
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engagemen and adhe ence. Schizoph enia Resea ch, 126(1–3), 150–163.
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