Grzegorz Bejda1, *Jolanta Lewko2, Agnieszka Kulak-Bejda3, Regina Sierzantowicz4, Bozena Kirpsza4, Agnieszka Lankau2, Piotr Szwedzinski6, Klaudiusz Nadolny5, 6, Elzbieta Krajewska-Kulak2, Jerzy Robert Ladny5, Anna Tyranska-Fobke7, Hady Razak Hady8
Effects of religion on selected health behaviors
Wpływ religii na wybrane zachowania zdrowotne
1University of Medical Science in Bialystok, Poland
2Department of Integrated Medical Care, Medical University of Bialystok, Poland
3Department of Psychiatry, Medical University of Bialystok, Poland
4Department of Surgical Nursing, Medical University of Bialystok, Poland
5Department Emergency Medicine and Disaster, Medical University of Bialystok, Poland
6Voivodeship Rescue Service in Katowice, College of Strategic Planning in Dabrowa Gornicza, Poland
72nd Department of Radiology, Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Poland
8Ist Department of General and Endocrine Surgery, University Clinical Hospital in Bialystok, Poland
Streszczenie
Wstęp. Religia spełnia wobec zdrowia wiele funkcji, takich jak: eksplikacyjna i sensotwórcza, normatywna i kontrolna, opiekuńcza i charytatywna, terapeutyczna – czy uzdrowieńcza.
Cel pracy. Celem pracy była ocena wpływu religijności na zachowania związane ze zdrowiem.
Materiał i metody. Badaniami objęto łącznie 790 osób hospitalizowanych z różnych przyczyn w trzech szpitalach wschodniej Polski. W badaniu zastosowano metodę sondażu diagnostycznego z wykorzystaniem: autorskiego kwestionariusza ankietowego, standaryzowanego Inwentarza Zachowań Zdrowotnych (IZZ) wg Juczyńskiego oraz standaryzowanej Wielowymiarowej Skali Umiejscowienia Kontroli Zdrowia (MHLC) wersja B. Wallston, B.S. Wallston, R. Devellis, w polskiej adaptacji Juczyńskiego. Uzyskano zgodę komisji bioetycznej Uniwersytetu Medycznego w Białymstoku numer R-I-002-434-2014 oraz pisemne zgody.
Wyniki. Osoby wierzące i praktykujące wykazywały się nieco lepszymi wskaźnikami zdrowotnymi w zakresie prawidłowych nawyków żywieniowych (p = 0,0134), zachowań profilaktycznych (p = 0,0015), nastawienia psychicznego (p = 0,0036). Osoby deklarujące się jako niewierzące i niepraktykujące przykładały większą wagę do wpływu wewnętrznej kontroli zdrowia na stan zdrowia (p = 0,0200).
Wnioski. W grupie ankietowanych potwierdzających swoją religijność, odsetek osób palących spożywających alkohol był niższy niż w grupie osób niewierzących czy niezdeklarowanych. Osoby religijnie niezdeklarowane częściej oceniały swój poziom zachowań zdrowotnych na poziomie niskim. Osoby wierzące i praktykujące wykazywały się nieco lepszymi wskaźnikami zdrowotnymi w zakresie prawidłowych nawyków żywieniowych, zachowań profilaktycznych i nastawienia psychicznego. Osoby deklarujące się jako niewierzące i niepraktykujące przykładały większą wagę niż osoby wierzące i praktykujące do wpływu wewnętrznej kontroli zdrowia na stan zdrowia.
Summary
Introduction. Religion serves health in many aspects, such as: explicative and meaning-creating, normative and control, care and charity, therapeutic – or healing.
Aim. The aim of the study was to assess the influence of religiosity on health-related behaviors.
Material and methods. The study involved a total of 790 people, hospitalized for various reasons in 3 hospitals in Eastern Poland. The study involved the method of a diagnostic survey using the author’s questionnaire, the standardized Inventory of Health Behaviors (IZZ) according to Juczyński and the standardized Multivariate Location of Health Control (MHLC) version B. Wallston, B.S. Wallston, R. Devellis, in the Polish adaptation of Juczyński. The consent of the bioethical committee of Medical University in Bialystok no. R-I-002-434-2014, as well as written consent from all the subject.
Results. Believers and practitioners showed slightly better health indicators in terms of proper eating habits (p = 0.0134), preventive behaviors (p = 0.0015), mental attitude (p = 0.0036). People who declared themselves as non-believers and non-practitioners paid more attention to the impact of internal health control on their health (p = 0.0200).
Conclusions. In the group of respondents confirming their religiosity, the percentage of smokers who consumed alcohol was lower than in the group of non-believers or un-declared. Religiously undecided people more often assessed their level of health behaviors at the low level. Believers and practitioners showed slightly better health indicators in terms of proper eating habits, preventive behaviors and mental attitude. People who declared themselves as non-believers and non-practitioners paid more attention than believers and practitioners to the influence of internal health control on their health.
Introduction
Over the centuries, medicine and religion were often interwoven (1, 2). Ancient societies perceived reality mostly in the religious dimension and added specific meanings to religious images using them to interpret the meaning of existing events. The magical rituals were to be used to remove illnesses and remedy misfortunes, which, consequently, would ensure health and prosperity. Shamans, and then priests in ancient civilizations, were the first “doctors” who used not only agents soothing physical pain, but also therapeutic treatments that gave psychological relief (1, 2).
Beliefs often influence the decision of both, the physician and the patient (3) and the religion serves many functions for health, such as: explicative and meaning-creating, normative and control, caring and charity, therapeutic – or healing (4).
In the followers of some religious systems, there is a relationship between the level of their religiosity and the state of their health, and its strength increases with age, sometimes with total or partial loss of health. It depends on the principles of religion, gender, marital status and the nature of the relationship, as well as the content of beliefs, individual personal characteristics, cultural and social criteria, environmental and genetic determinants (1, 4-6).
In the literature (2, 7-13) it is pointed out that an important factor affecting the quality of the relationship between the patient and health care workers seems to be knowledge about patient’s religiosity and the possibility of occurrence of conflict between religious beliefs of the patient and medical recommendations based on the achievements of science.
Aim
The aim of the study was to assess the impact of religiosity on health-related behaviors (eating habits, preventive behaviors, positive psychological attitudes, health practices) and the dimensions of the location of health control: internal (the belief that control over my own health depends on myself), influence of others (belief that the state of their own health is the result of the impact of others, mainly medical personnel) and the impact of the case (the health condition depends on the case or other external factors).
Material and methods
The research covered a total of 790 people, including: 259 people aged 18-24 (group I), 189 people aged 25-49 (group II), 188 people aged 50-70 (group III), 154 people and age > 70 years (group IV). The patients were hospitalized for various reasons in 3 hospitals in Eastern Poland.
The study used the method of a diagnostic survey using the author’s questionnaire, the standardized Inventory of Health Behaviors (IZZ) according to Juczyński and the standardized Multivariate Location of Health Control (MHLC) version B. Wallston, B.S. Wallston, R. Devellis, in the Polish adaptation of Juczyński.
The questionnaire developed for the purposes of the study consisted of questions regarding: age, gender, place of residence, education, financial situation, self-evaluation of religiosity, including: creed; declaration of regarding yourself as a believer and practitioner; motives of faith consistent with the respondents’ beliefs; about the importance of religion in everyday life.
The standardized Inventory of Health Behaviors (IZZ) according to Juczyński is intended for the study of healthy and ill adults (14). It contains 24 statements describing various types of behaviors related to health (eating habits, preventive behaviors, positive mental attitude, health practices) (14). It allows to determine the general index of the severity of health behaviors and the severity of the four categories of these behaviors (14):
– proper nutrition taking into account mainly the type of food consumed,
– preventive behavior regarding compliance with health recommendations and obtaining information about health and disease,
– health practices – daily habits regarding sleep and relaxation as well as physical activity,
– positive psychological attitude – avoiding strong emotions, stress, depressing situations.
Internal compliance of the IZZ, based on Cronbach’s alpha, is 0.85 for the entire Inventory, and for its four subscales it is within the range of 0.60 to 0.65. In the test-retest examination conducted among 30 people with an interval of six weeks, a correlation coefficient of 0.88 has been obtained (14).
Standardized Multidimensional Health Control Location Scale (MHLC) version B. Wallston, B.S. Wallston, R. Devellis, in the Polish adaptation of Juczyński is a self-report tool and finds application in health promotion programs and in prophylactic interventions. It is based on the assumption that the internal location of health control is conducive to health-related behaviors, i.e. physical activity, smoking and drinking, weight control, prevention of HIV infection, etc. It turns out, however, that dependencies are more complex and that other variables are also important, such as sense of self-efficiency or health evaluation (14).
The MHLC scale in the Polish version, as in the original one, contains 18 statements and capture the beliefs about generalized expectations in three dimensions of the location of health control, i.e. (14):
– internal (W) – control over my own health depends on me,
– influence of others (I) – own health is the result of the influence of others, especially medical personnel,
– case (P) – the condition determines the case or other external factors.
The respondent must answer according to his or her convictions and express his attitude to the statements presented on a six-point scale: I strongly disagree (1 point) I strongly agree (6 points) (14).
The approval of the Bioethical Committee of Medical University in Bialystok, Poland no. R-I-002-434-2014 and written consent from all the subject has been given as well as the Dean of the Faculty of Health Sciences and the head of the General Hospital in Wysokie Mazowieckie, the University Hospital in Bialystok, and the St. Jadwiga’s of the Queen Provincial Hospital No. 2 in Rzeszow and the Provincial Specialist Hospital in Biala Podlaska. The study has been conducted from November 2014 to November 2015.
Statistical analysis
The statistical tests were used in order to assess whether the relationships observed in the sample are the result of more general regularity prevailing in the whole population or just an accidental result. Their result is the so-called test probability (p), whose low values indicate the statistical significance of the considered dependence.
In the analysis of the link between religiosity and selected aspects of health behaviors, selected methods of descriptive statistics and statistical inference were used. The selection of the applied statistical tests depended on the nature of the compared measures of both phenomena, for two nominal (text) features, the so-called contingency tables presenting the percentage distribution of the value of one of the variables relative to the other, and the significance of the relationship between the two variables was assessed using the chi-square independence test. The one-way analysis of variance (ANOVA) is a statistical method for comparing the average level of a numerical feature in several populations.
In this test, the null hypothesis is put, according to which in all compared groups the numerical feature under consideration has the same average level. On the basis of the test probability value p, determined upon the analysis of variance, this hypothesis can be rejected (when p is correspondingly low), which means the influence of the grouping factor on the level of the numerical feature. The test of variance analysis requires two assumptions: about the normality of the distribution of a numerical feature in each of the considered groups and the same level of variation (the so-called homogeneity of variance) of the numerical attribute in individual groups. It should be noted, however, that from many studies, the high resistance of ANOVA tests to the violation of these assumptions is apparent.
Results
790 people were subject to the survey. The vast majority of respondents (71.8%) were women, and the rest (28.2%) – men. The percentage distribution of individual age groups was similar, with a slightly higher percentage of the youngest (18-24 – 32.8%). The remaining results are illustrated in table 1.
Tab. 1. Respondents age
| Age (years) | N | % |
| 18-24 | 259 | 32.8 |
| 25-49 | 189 | 23.9 |
| 50-70 | 188 | 23.8 |
| > 70 | 154 | 19.5 |
The majority of respondents (62.2%) were urban residents, and the remaining 37.8% – lived in villages.
Among the respondents, more than half (53%) had secondary education, every third bachelor, or master, and one in seven – vocational. The remaining results are illustrated in table 2. The missing data did not affect the value of statistical analyzes.
Tab. 2. Respondents education level
| Education | N | % |
| vocational | 111 | 14.1 |
| secondary | 419 | 53.0 |
| bachelor | 118 | 14.9 |
| higher | 127 | 16.1 |
| no response | 15 | 1.9 |
The vast majority of respondents defined their financial situation as good (42.6%) or average (41.7%). The percentage of people assessing their financial status high or very low was small. The remaining results are illustrated in table 3. The missing data did not affect the value of statistical analyzes.
Tab. 3. Respondents financial situation
| Financial situation | N | % |
| very good | 46 | 5.8 |
| good | 336 | 42.6 |
| average | 329 | 41.7 |
| rather bad | 31 | 3.9 |
| bad | 9 | 1.1 |
| no response | 39 | 4.9 |
As many as 92.1% of respondents declared themselves as Catholics. The second largest group were Orthodox (2.4%), and non-believers accounted for 2.6% of the discussed population. The remaining results are illustrated in table 4.
Tab. 4. Creed declared by respondents
| Creed | N | % |
| judaism | 2 | 0.3 |
| catholic | 728 | 92.1 |
| lutheranism | 1 | 0.1 |
| muslim | 2 | 0.3 |
| orthodox | 19 | 2.4 |
| jehova’s witness | 7 | 0.9 |
| non-believer | 21 | 2.6 |
| i do not know | 10 | 1.3 |
Due to the fact that the main aim of the study is to examine the relationship between religiosity and health, first the study of the distribution of responses to questions related to religiosity was thoroughly examined. Then, based on the results contained in the question “Do you consider yourself a believer and practitioner?” were selected those questions that allowed the diversity of the surveyed population in terms of religiosity. Such a question could not, for example, be considered on the subject of a declared creed, as almost all of the respondents were Catholics.
As many as 3/4 respondents are people who declare themselves as believers and practitioners. Nevertheless, a group of tens of non-believers (or at least non-practitioners) and an even larger group of “doubters”, let us examine the impact of the answer to the health behaviours preferred by the respondents, which will be taken into consideration in the next sections of this study. The remaining results are illustrated in table 5.
Tab. 5. Respondents declaration regarding faith
| Are you a believer and practitioner? | N | % |
| yes | 610 | 77.2 |
| no | 48 | 6.1 |
| hard to say | 132 | 16.7 |
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