Publié : 03 avr. 2006, 04:03
par A.T.
Voici une autre étude sur les effets de la prière sur la santé, publiée dans la revue Holistic Nursing Practice (mars-avril 2006). Contrairement à l'étude précédente, on examine ici le pouvoir de la prière faite par le malade lui-même. Plus précisément, il s'agit d'évaluer le pouvoir de la prière sur la diminution de quatre symptômes (anxiété, dépression, fatigue et nausées) reliés au sida. L'étude conclut à une certaine efficacité de la prière.
Malgré le biais dû au fait que ce sont les malades eux-mêmes qui évaluent le degré d'efficacité de la prière, il est fort probable que la prière ait une certaine efficacité, comme la méditation en aurait aussi selon d'autres études, ces techniques amenant une réduction du stress.
Prayer as a complementary health strategy for managing HIV-related symptoms among ethnically diverse patients.
Christopher Lance Coleman, Lucille S. Eller, Kathleen M. Nokes, Eli Bunch, Nancy R. Reynolds, Inge B. Corless, Pam Dole, Jeanne K. Kemppainen, Kenn Kirksey, Liz Sefieik, Patrice K. Nicholas, Mary Jane Hamilton, Yun-Fang Tsai, William L. Holzemer. Holistic Nursing Practice. March-April 2006 v20 i2 p65(8 ).
Data were analyzed from an ethnically diverse convenience sample comprising 1071 adults participating in a multisite study. Older African Americans, Hispanics, and females were more likely to use prayer as a complementary health strategy for HIV-related anxiety, depression, fatigue, and nausea. Implications for future studies are discussed. KEY WORDS: complementary health strategies, ethnicity, HIV/AIDS, prayer, symptom management Holist Nurs Pract 2006;20(2):65-72
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Previous studies have demonstrated differences in how ethnic groups relied on different complementary health strategies such as prayer for managing health conditions. (1-3) Studies investigating the effects of prayer on health discovered that there is a strong association between the efficaciousness of prayer, one's belief in the efficacy of prayer, improved functional health status, better coping with hemodialysis, and managing acute healthcare problems. (1,4-6) The findings from these studies suggest that when faced with the uncertainty of health conditions, individuals who used prayer as complementary health strategy reported improved physical and psychological well-being. Regardless of the physical or psychological condition, prayer was associated with better physical or psychological well-being among individuals with an illness.
Considerable research has documented the significance of prayer to both the physical and the mental health of African Americans. (7-10) These studies underscored the significance of using prayer as a complementary health strategy for maintaining psychological and physical well-being. The central hypothesis pursued by these studies investigated whether prayer, used as a complementary health strategy, would influence psychological or physical health outcomes in African Americans. The consensus was clear: African Americans attributed their physical and psychological well-being to engaging in prayer as a complementary health strategy for managing the sequelae associated with their health conditions.
One researcher highlighted the historical significance of religion to African Americans and reported that most African Americans have some religious affiliation, which could explain their reliance on prayer for coping with stress related to illnesses or disease states. (11) These findings have implications for understanding the prevalence to which other ethnic groups rely on prayer as an alternative complementary health strategy for managing health conditions. For example, they could provide a framework to guide the manner in which nurses/healthcare providers construct clinical modalities to help patients manage their illness experience. In addition, knowing that certain ethnic groups are more likely to rely on prayer as an alternative complementary health strategy provides a potential rationale for nurses and other healthcare providers to integrate the use of prayer into their clinical practice.
The question arising from the above findings is do ethnic groups differ in their use of prayer as a complementary health strategy for managing health conditions? Studies exploring this question discovered a pattern that suggested nonwhites relied on prayer differently than whites for coping with chronic pain, functional impairment, and depression. (12-15) What makes these findings compelling to our analysis is that nonwhites were more likely to rate prayer as an important and efficacious complementary health strategy than the white study participants.
Since few studies have explored the use of prayer as a complementary health strategy for managing human immunodeficiency virus (HIV)-related symptoms among ethnically diverse HIV-infected individuals, the primary objective of this analysis was to describe the differences in the use of prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea in an ethnically diverse sample (N = 1071 adults) who were HIV seropositive participating in a multisite study. The study sites were located in the United States, Taiwan, and Norway.
METHODS
Data were collected using a convenience sample of 1071 (n = 876, United States; n = 118, Norway; and n = 77, Taiwan) HIV-infected individuals who were participating in a multisite study investigating health strategies for symptom management as one of its objectives by the University of California, San Francisco (UCSF) International HIV/AIDS (acquired immunodeficiency syndrome) Nursing Research Network. For this analysis, the data collected were analyzed from a demographic questionnaire developed by the authors, an HIV symptom checklist, and self-care activity sheets containing categories of complementary health strategies for symptom management. For the multisite study, data were collected from community-based clinics, outpatient clinics, peer support groups, and through the mail.
In the multisite study, participants were asked to select the number of days the HIV-related symptoms--anxiety, depression, fatigue, and nausea--were experienced during the past week. If a particular symptom was endorsed, they were asked to rate the frequency (the number of days the symptoms occurred) and intensity of the HIV symptom on a scale of 1 to 10 (1 = low, 10 = very high). For each symptom endorsed, the participants were instructed to select self-care management strategies from a 23-item checklist categorized by activities/thoughts, exercise, medications, complementary therapies, substance use, and other strategies.
Our analysis focused on the complementary therapy category, therefore, we selected only those cases where prayer was used as a complementary health strategy, to describe the predictors of prayer use for managing HIV-related anxiety, depression, fatigue, and nausea.
STUDY INSTRUMENTS
A demographic questionnaire developed by the authors was used to collect data on the following characteristics: gender; age; race/ethnicity; education; income; health insurance; employment; HIV data--AIDS diagnosis, CD4 counts, and HIV symptoms; and whether an individual believed they acquired HIV from having sex with a man or a woman.
Self-care study sheets
The self-care activity sheets were derived from an earlier study investigating self-care symptom management in people living with HIV/AIDS. Participants in this previous study were asked in an open-ended format to identify the most occurring physical and psychological symptoms. Twenty-three self-care behaviors were reported and were categorized by activities and thoughts, exercise, medications, complementary therapies, substance use, and other. For each self-care activity, participants were asked to indicate yes or no as to whether they had tried a particular health strategy, how often they used the strategy (daily, weekly, or monthly), and the effectiveness of the health strategy on a scale of 1 to 10 (1 = not at all effective; 10 = very effective) for managing HIV-related symptoms.
Prayer was a symptom management strategy within the complementary category for only the following HIV-related symptoms: anxiety, depression, fatigue, and nausea. Therefore, we chose to focus our analysis on the use of prayer as a complementary health strategy for managing these symptoms. Content validity of the scale was supported by nurse experts in HIV/AIDS care and additional pilot testing of the items was conducted with persons with HIV/AIDS.
The Revised Sign and Symptom Checklist for Persons with HIV Disease
The Revised Sign and Symptom Checklist for Persons with HIV Disease (SSC-HIV rev) has 3 parts; however, for the analysis only part I and part II were used. (16,17) Part I consists of 45 items and 11 factor scores, along with a total score, with reliability estimates ranging from 0.76 to 0.91; part II consists of 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective. (16) For the scale, experiencing HIV symptoms can range from mild (1) to moderate (2) to severe (3). Symptoms are only endorsed if an individual is experiencing them on the day of data collection and are left blank if not experienced on that day. For the analysis, the mean number of HIV symptoms was calculated.
Human subjects protection
An institutional review board for the protection of human subjects approved the study protocol for each site--California State University, Fresno; Hunter College, City University of New York; Massachusetts General Hospital, Institute of Health Professions, Boston, Mass; Ohio State University; College of Nursing of Rutgers, the State University of New Jersey; St Vincent's Hospital, New York; Texas A&M University--Corpus Christi; University of California, San Francisco; University of North Carolina, Wilmington; College of Nursing, Virginia Commonwealth University; National Taiwan University; and University of Oslo. Informed consent was obtained, providing an explanation of the study purpose, procedures, possible risks and discomforts, and benefits. Assurance of confidentiality was provided through a written consent form prior to administering the questionnaire.
RESULTS
Data were analyzed using SPSS Version 12.0 on the final sample of 1071 ethnically diverse HIV-infected men and women who were from multiple study sites within the United States, Norway, and Taiwan, with a mean age of 41.80 [+ or -] 8.36 years having a range of 20 to 84. The sample comprised African Americans (n = 448, 25%), whites/Anglo non-Hispanics (n = 273, 18%), Hispanics/Latinos (n = 189, 12%), Asians/Pacific Islanders (n = 126, 2%), Native American Indians (n = 17, 1%), and other (n = 13). These ethnic categories were also used to classify the study participants from Taiwan and Norway. Hereafter, nonwhite will be used to classify African Americans, Hispanics/Latinos, Asian Pacific Islanders, and Native Americans, and white will be used to classify those who are whites/Anglo non-Hispanics.
The demographic data indicated a greater proportion of the white study participants reported attending college and beyond than the nonwhite study participants. A higher proportion of nonwhites study participants had medical insurance and had more children. A greater proportion of the white study participants knew their CD4 cell counts than the nonwhite study participants. Both groups reported fairly similar mean scores of HIV symptoms, but their scores did not differ significantly. Comparatively, a higher number of the white study participants reported having sex with men, and more nonwhite study participants reported having sex with women. A greater frequency of the white study participants reported acquiring HIV by having sex with men.
Chi-square analysis determined significant differences exist between the nonwhite and white study participants and the frequency of prayer use for managing HIV-related anxiety, depression, fatigue, and nausea. Seventy-two percent of nonwhites reported experiencing anxiety in the past week, and 73% of those experiencing anxiety reported using prayer as a complementary health strategy.
A higher proportion of nonwhite study participants who experienced HIV-related anxiety, depression, fatigue, and nausea during the past week reported using prayer as a complementary health strategy for alleviating these HIV-related symptoms than the white study participants. The t test showed that while the nonwhite study participants rated the effectiveness of prayer as a complementary health strategy for managing HIV-related anxiety, depression, and fatigue significantly higher than the white study participants; overall, both groups rated prayer to be efficacious, and the differences in the rating of effectiveness was not significant (Tables 1-3).
Because few studies have described predictors of self-prayer as complementary health strategy for symptom management for individuals living with HIV/AIDS, a multiple logistic regression analysis was used to describe the predictors of the use of prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea when controlling for demographic variables in an ethnically diverse sample.
For analysis, the ethnicity of the United States, Taiwan, and Norway
study participants was dummy coded into the following groups: 1 = African Americans, 2 = whites, 3 = Asian Pacific Islanders, 4 = Hispanics, and 5 = Native Americans. Gender, income, and education were dummy coded as follows: gender: 1 = female, 0 = nonfemale; income: 1 = not adequate, 0 = adequate; and education: 1 = completed high school or more, 0 = high school or less. Listwise deletion was used in the analytic strategy to address missing values. Four regression models using simultaneous entry were calculated on the HIV-related symptoms--anxiety, depression, fatigue, and nausea--with the use of prayer or not using prayer as the dependent variable. The Hosmer and Lemeshow Test was used to test the overall fit of the logistic regression models.
Because the study participants varied in their selection of prayer as a complementary health strategy for a given HIV-related symptom, the sample size varied among the 4 regression models. The regression analysis showed that African Americans were 6.17 times and Hispanic Americans 2.67 times more likely to use prayer for managing HIV-related anxiety than whites. In addition, for every 0.029 increase in age, the study participants were 1.0 times more likely to use prayer than those who were younger. Females were 1.8 times more likely to use prayer for managing symptoms of anxiety than the male participants.
When using prayer for managing depressive symptoms, African Americans were 5.78 times and Hispanic Americans 2.8 times more likely to rely on prayer than the white study participants. Older study participants experiencing an increase in HIV symptoms were more likely to use prayer than younger participants or those reporting few HIV symptoms. Females were 2.2 times more likely to use prayer for depression than male study participants. To manage symptoms of fatigue, African Americans were 4.6 times and Hispanic Americans 3.4 times more likely to use prayer than the other ethnic groups. Those reporting experiencing a 0.008-unit increase in HIV symptoms and a 0.037-unit increase in age were 1.0 times more likely to use prayer to manage symptoms of fatigue.
The female participants were 2.4 times more likely to use prayer for managing fatigue. The final model showed that for every 0.009-unit increase of HIV symptoms, study participants experiencing HIV symptoms were 1.0 times--and the female participants 2.4 times--more likely to use prayer for managing nausea than the male participants who reported experiencing few HIV symptoms (Tables 4-7).
DISCUSSION
Regardless of ethnic group, prayer was used for managing HIV-related anxiety, depression, fatigue, and nausea. Nevertheless, ethnic groups did differ in their use of prayer. These findings are consistent with previous studies, however; it contributes new knowledge about how prayer is used as a complementary health strategy for the management of HIV-related anxiety, depression, fatigue, and nausea in an ethnically diverse sample of HIV-infected individuals. Very few studies have examined the use of prayer as a health strategy for managing HIV-related anxiety, depression, fatigue, and nausea among HIV-infected individuals. Our analysis described the significance of certain predictors of the use of prayer as an efficacious alternative complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea among the study participants. However, there are limitations to consider.
STUDY LIMITATIONS
The use of a cross-sectional design limits the generalizability of the findings of our analysis. While we did control for socioeconomic status and gender, the lack of an experimental design did not allow us to control for all of the potential confounders to our analysis. Hence, further rigorous studies are needed to determine whether our findings can be replicated. In addition, we acknowledge that there are inherent weaknesses in relying on self-report data on the use of prayer as a complementary health strategy, as perception is subjective. Geographic differences were also not accounted for in the analysis given the sample sizes varied, therefore, our ability to attribute any differences in the use of prayer by national or international origin is clearly limited. While it is feasible to report international variations in the use of prayer, one must interpret any finding with caution given the differences in religious or spiritual practices between the United States, Taiwan, and Norway, which is why no contrasts comparisons were made between the United States and the other countries.
In addition, while our analysis is significant, we clearly bear in mind that we did not assess previous prayer activities. Furthermore, we did not investigate the effectiveness of intercessory prayer (ie, praying for others), as it was not the objective of the analysis. These limitations make it essential for future researchers to employ more robust study designs to continue investigating the efficacy of the use of prayer as a complementary health strategy for managing HIV-related symptoms.
Previous research studies indicated that prayer has been used as a complementary health strategy for managing stroke, rheumatoid arthritis, depression, and self-esteem. (17-21) A central empirical finding reported by these studies is that study participants perceived prayer to be helpful for managing the uncertainty associated with these conditions. Studies examining complementary health strategies used by persons with HIV infection provided data that substantiated how individuals with HIV infection sought a variety of health strategies for managing their HIV-related anxiety and fatigue. (22-24)
Because of the uncertainty that each day brings to an individual living with HIV/AIDS, the feasibility of being able to access alternative resources to traditional medical care becomes paramount. Nurses/healthcare providers are challenged to incorporate alternative therapeutic approaches when teaching HIV-infected individuals effective health strategies for managing the comorbidities associated with HIV infection. An understanding of how different ethnic groups may employ alternative complementary health strategies to manage their HIV-related symptoms has the potential to provide nurses/healthcare providers with the necessary tools for enhancing the physical and mental well-being of their patients who are HIV seropositive.
Although our analysis did not specifically examine the effects of intercessory prayer, we employed an analytical method to capture self-report data about the use, frequency, and the effectiveness of using self-prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea.
Based on the analysis, the physical or psychological benefit derived from using prayer as a complementary health strategy for HIV-related anxiety, depression, fatigue, and nausea warrants further exploration of the use of prayer for managing symptoms experienced by individuals living with HIV infection. When individuals are experiencing a physical illness such as HIV infection, our analysis revealed that prayer is a significant buffer for coping with the unpleasant symptoms associated with HIV infection. This important finding provides data to nurses/healthcare providers about the frequency and effectiveness of the use of prayer as a complementary health strategy.
Exploring how to incorporate prayer into clinical practice as a complementary health strategy for alleviating HIV-related anxiety, depression, fatigue, and nausea are important clinical practice activities for nurses/healthcare providers providing medical care to an ethnically diverse HIV-infected population. Investigating whether the frequency of prayer is correlated with the amount of HIV-related anxiety, depression, fatigue, and nausea experienced by HIV-infected individuals--or whether nurses/healthcare providers are sufficiently trained in using prayer for promoting healthy responses among HIV-infected populations that are ethnically diverse--are important clinical implications that warrant further investigation.
Our analysis contributes to the evidence found in other studies describing the use of prayer as a complementary health strategy for improving the health of individuals with declined functional status, lung cancer, and poor psychological well-being. (1-3) Ethnicity, gender, age, and HIV symptoms were significant predictors of the use of prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea in the analysis. Our analysis suggests that for the study participants experiencing HIV-related anxiety, depression, fatigue, and nausea, ethnic differences, being older, experiencing HIV symptoms, and being female accounted for the selection of prayer as a complementary health strategy. However, the authors do not suggest the findings are an indication that whites did not value the use of prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea. On the other hand, our analysis indicated one's ethnicity did predict the odds of the use of prayer, which may be a reflection of the cultural norms within a particular ethnic group.
NURSING IMPLICATIONS
The analysis is relevant to nurse/healthcare providers when developing clinical health strategies for improving health outcomes in HIV-infected patients. Hence, nurses/healthcare providers can be more cognizant that while not all ethnic groups rely on the use of prayer, for those who do, engaging in self-prayer may buffer the stress associated with HIV-related anxiety, depression, fatigue, and nausea. In addition to nurses/healthcare providers, our analysis has implications for researchers as well.
RESEARCH IMPLICATIONS
Our analysis provides a foundation for future work to continue to explore the prevalence of self-prayer among different ethnic groups living with HIV/AIDS. Since few studies have explored the use of prayer as a complementary health strategy for managing HIV-related anxiety, depression, fatigue, and nausea, more studies are needed to corroborate our analysis. This is essential since our analysis was limited by a nonprobabilistic design and other factors previously described.
Future research should employ designs that are more rigorous to tease out the complex intricacies associated with using prayer as complementary health strategy for symptoms associated with HIV infection. More studies examining both intercessory prayer and self-prayer as a complementary health strategy for managing HIV-related symptoms are necessary because more knowledge about the use of these activities for managing disease-related symptoms, in general, and among the symptoms experienced by HIV-infected individuals, will advance the science of using prayer as a complementary health strategy.
CONCLUSIONS
Understanding behavior responses to HIV infection and other health conditions is complex and is often difficult to quantify. However, given the plethora of empirical evidence describing the importance of prayer as a complementary health strategy, more research is clearly warranted to compare the efficacy of prayer along with other clinical health modalities that could be potentially beneficial to individuals who are HIV seropositive.
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* Christopher Lance Coleman, PhD, MPH, APRN-BC, ACRN * Lucille S. Eller, PhD, RN
* Kathleen M. Nokes, PhD, RN, FAAN * Eli Bunch, DNSc, RN * Nancy R. Reynolds, PhD, CNP, FAAN
* Inge B. Corless, PhD, RN, FAAN * Pam Dole, EdD, MPH, RN, NP * Jeanne K. Kemppainen, PhD, RN
* Kenn Kirksey, PhD, RN, APRN-BC, CNS * Liz Seficik, PhD, RN, CS
* Patrice K. Nicholas, DNSc, MPH, RN, ANP * Mary Jane Hamilton, PhD, RN
* Yun-Fang Tsai, PhD, RN * William L. Holzemer, PhD, RN, FAAN
From the University of Pennsylvania, Philadelphia, Pa (Dr Coleman); the College of Nursing of Rutgers, the State University of New Jersey (Dr Eller); the Hunter College, City University of New York (Dr Nokes); the University of Oslo (Dr Bunch); the Ohio State University (Dr Reynolds); the Massachusetts General Hospital, Institute of Health Professions, Boston, Mass (Drs Corless and Nicholas); the Greenwich House, New York (Dr Dole); the University of North Carolina, Wilmington, NC (Dr Kemppainen); the University of California, San Francisco (Holzemer); the Ben Taub General Hospital, Houston, Tex (Dr Kirksey); the Texas A&M University--Corpus Christi (Drs Seficik and Hamilton); and the National Taiwan University, Taiwan (Dr Tsai).
Et oui, c'est ça le vrai altruisme. 