Assignment: Spiritual beliefs

In the United States, an estimated 25.8 million people, or 8.3% of the population, have been diagnosed with type 2 diabetes.¹ Of these, 4.9 million (18.7%) are non-Hispanic Blacks aged 20 years or older.¹ For African Americans, the incidence of complications from type 2 diabetes, such as cerebrovascular disease, renal failure, and amputations, is much higher than in non-Hispanic Whites.¹

These diabetes complications may be reduced or prevented with optimal diabetes self-care. Self-care knowledge, skills, and activities are considered cornerstones of diabetes treatment. Self-care of diabetes is burdensome, due to the complexity of maintaining and managing daily self-care activities, including exercise, diet modification, and medication adherence. According to the American Association of Diabetes Educators,² there are seven diabetes self-care behaviors: being active (physical activity and exercise); eating healthy (diet composition and caloric content); taking medications; monitoring (e.g., blood glucose, weight, blood pressure); problem solving, especially for blood glucose (high and low levels, sick days); reducing risks (to decrease diabetes complications; smoking cessation); and healthy coping (psychosocial adaptation). These behaviors have been identified as measurable outcomes of effective diabetes education and thus should be implemented at both individual and population levels to achieve the desired outcomes of prevention of diabetes complications and physical and psychological well-being.

Spiritual and religious beliefs and activities can aid in coping with a chronic illness by providing support, confidence, and hope, or they can interfere with successful coping, as people may neglect self-care activities by relying on prayer and/or meditation to manage their illness.³ Empirical evidence demonstrates the relationship between spirituality and self-management of hypertension,⁴ but few studies have examined the impact of spirituality on diabetes self-management.⁵ Thus, little is known about how spiritual beliefs and practices and social support affect self-care of diabetes in African American adults.⁶ Several significant themes have emerged from previous studies concerning spirituality, religion, and diabetes in African Americans: spirituality is an important source of emotional support; God is perceived as central in providing strength to deal with daily challenges; God is often called upon for help in controlling diabetes; and a strong belief in God, prayer, meditation, and support from church members were all sources of support.^3, 5–8 In one study in Black women with type 2 diabetes, religion and spirituality were related to glycemic control,⁹ whereas in another study, religion and spirituality were related to less likelihood of lifetime smoking among African Americans.¹⁰

The aforementioned findings and gap in the literature led us to address the possibility of bridging spiritual and religious beliefs into diabetes self-management. Spiritual beliefs include the relationship to a superior being and are related to an existential perspective on life, death, and the nature of reality.¹¹ Religious beliefs include practices/rituals such as prayer or meditation and engagement with religious community members. While spiritual and religious beliefs have significant overlap, the authors chose to examine both of these concepts because they are frequently brought into the forefront when coping with illness. Additionally, it is important to examine both of these concepts because some people may consider themselves to be spiritual but may not necessarily endorse being religious. Whereas religious beliefs and practices are more easily measured, ¹² the authors wanted to examine the broad context of individuals’ systems of belief, specifically their perceptions on the meaning of life, illness, and existential concerns.¹³ Given the need to examine both spiritual and religious beliefs and practices in the process of coping with an illness, the Systems of Belief Inventory (SBI) was chosen to measure these constructs.

The specific aim for this study was to examine the relationship between (a) spiritual and religious beliefs and practices, and social support; and (b) diabetes self-care activities in African Americans with type 2 diabetes. This is an important topic because African Americans experience numerous diabetes disparities (i.e., highest rates of diabetes, diabetes complications, and diabetes-related mortality rates).¹⁴

Given that little is known about how spiritual and religious beliefs and practices affect self-care of diabetes in African American adults, this study examined the relationship between spirituality, religion, and diabetes self-care activities, including diet, physical activity, blood glucose self-testing, and foot care behaviors in this population. Because some research exists supporting the relationship between spirituality and religion and lifetime smoking in African Americans,¹⁰ a negative association was hypothesized between spirituality and religion and smoking. In particular, it was hypothesized that those who score higher on measures of spiritual and religious beliefs and practices and social support will participate in more diabetes self-care activities and smoke less.