Medical

Communication

Biosci. Biotech. Res. Comm. 10(2): 197-201 (2017)

Spiritual well-being as predictor of health behavior

ef cacy in older patients of selected Medical

University Hospitals

Mousa Alavi

, Sedigheh Molavi

and Razieh Molavi

Nursing and Midwifery Care Research Centre, Faculty of Nursing and Midwifery, Isfahan University of Medical

Sciences, Isfahan, Iran

MSc Student Community Health Nursing, Faculty of Nursing and Midwifery, Isfahan, (Khorasgan) Branch,

Islamic Azad University Isfahan, Iran

MSc Elderly Nursing Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

ABSTRACT

Spiritual health is one of the aspects of health that is necessary to pay attention to this aspect. Spiritual health of the

aged is associated with several factors which in particular may affect other aspects of their health; therefore, this study

also sought to examine the relationship between spiritual health and self-ef cacy of health behaviors in the aged. In

this study, statistical population was patients aged 60 years and older who were hospitalized in two hospitals af liated

with Isfahan University of medical sciences. The subjects were recruited through convenience sampling method. The

data was collected by a three-part questionnaire consisted of a) demographic and health related characteristics, b) The

Self Rated Abilities for Health Practices Scale (SRAHP) and c) Spiritual Well-Being Scale (SWBS) and were analyzed by

descriptive and inferential statistics (mainly multiple regression analysis) in SPSS software. The subjects consisted of 210

participants (116 males, 93 females) with mean (SD) age of 72.5 (8.5) years. The results showed signi cant relationship

between health behaviors ef cacy and gender (t=2.44, df=207, p=.16), income (F

3,208

=5.8, P<.001) and education level

4,208

=9.25, P<.001). Findings showed that the entered predictor variables were accounted for 27% of total variance (R

)

of the health behaviors ef cacy (P<0.001, F

2, 207

=38.4). Spirituality may be an important explanatory factor of subjective

health behavior ef cacy in older patients. Therefore, it is worthwhile for the health care professionals to take spiritual

care into account as an important factor that may help the aged patients adopt healthy behaviors.

KEY WORDS: OLDER ADULT, SPIRITUAL HEALTH, HEALTH BEHAVIOR

197

ARTICLE INFORMATION:

*Corresponding Author: RaziehMolavi@yahoo.com

Received 15

March, 2017

Accepted after revision 18

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/10.2/34

198 SPIRITUAL WELL-BEING AS PREDICTOR OF HEALTH BEHAVIOR EFFICACY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Molavi et al.

INTRODUCTION

The growth of the aged population is increasing all

over the world (Borji et al., 2015a, Azami et al., 2016 b)

and the issue of population aging and its consequences

is one of the major issues that the world’s population

recently been involved with it ( Borji et al., 2016a, Borji

2016b). This signi cant increase in the aged in two dec-

ades, is one of the main challenges for the health care

system(Borji and Asadollahi, 2016).

The aged are at risk of health change for many

reason(Borji et al., 2017a), that the multiple physiological

and psychological changes, vulnerability and ultimately

different health challenges in the aged(khoukhazade,

2016, Mozafari et al., 2016),makes a large load on the

health system. Health behaviors are one of the major

criteria that determine health that have been identi-

 ed as an important underlying factor in the lack of

many diseases(O’Donnell et al., 2008); so that health

promotion and prevention of diseases directly is associ-

ated with these behaviors(Otaghi et al., 2016b, Azami

et al., 2016a). One of the most famous theories about

how to predict and description of application behavior

is Bandura’s learning theory which is one of the theo-

ries used in changing the behavior and it is one of the

most important structures of self-ef cacy (MN, 2015).

He believes that self-ef cacy is a signi cant predictor in

the intention of people for doing health behaviors and

accepting health patterns(MN, 2015, Azadbakht et al.,

2014). Self-ef cacy means the belief in your ability to

perform an action and can enable people to adopt health

promoting behaviors and leaving harmful behaviors

for health(Azadbakht M et al., 2014).Self-ef cacy is an

important precondition for self-managing in changing

the behavior(Larkin L et al., 2016). In particular, studies

conducted in the UK suggest that self-ef cacy of health

promotion behaviors associated directly with the health

and quality of life (QOL). (Azadbakht et al., 2014). QOL

is an important topic (Borji et al., 2016b).

In different study, social, physical and mental health

has been identi ed as factors associated with self-ef -

cacy of health-related behavior (21). For example, Rebe-

lin et al have supported in his study from the relation-

ship between social supports with health and its related

behaviors (Reblin and Uchino, 2009), Martinez from the

relationship between mental health with health pro-

motion behaviors(Martínez and RP, 2014)and Larkin et

al from the relationship of the aged self-ef cacy with

physical health and self-care behaviors (Larkin et al.,

2016).

The spiritual dimension is a dimension of health

which some experts believe that serious attention to

this dimension is essential, (Fadardi 2015, Ya’qubi et al.,

2014). Search results not found in databases and scien-

ti c sites and also a study that examined the relation-

ship between two variables spiritual health and self-care

behaviors in the aged. Therefore, this study aimed to

investigate the relationship between spiritual health with

self-ef cacy of health behaviors in the aged patients in

selected hospitals in Isfahan University of Medical Sci-

ences.

MATERIAL AND METHODS

This study is a cross sectional analysis of correlation.

The study population comprised 210 patients aged 60

years and older who admitted in the selected hospitals

(Alzahra, and Noor & Aliasghar) af liated with IUMS

from April- August 2015. Convenience sampling method

was used to recruit the subjects from the mentioned hos-

pitals.

The data was collected by a three-part questionnaire

consisted of a) demographic and health related char-

acteristics, b) The Self Rated Abilities for Health Prac-

tices Scale (SRAHP) and c) Spiritual Well-Being Scale

(SWBS). SRAHP is a 28-item, 5-point scale to meas-

ure self-perceived ability to perform health-promoting

behaviors. It contains four subscales consisted of exer-

cise, nutrition, responsible health practice, and psycho-

logical Well Being. Each subscale has seven items. Items

are rated from 0 (not at all) to 4 (completely). Ratings

for each subscale are summed to get subscale scores.

Subscale scores are summed to get a total score. Total

scores ranged from 0-112 with higher scores indicat-

ing greater self-ef cacy for health practices. In a study,

Cronbach’s alpha was .94 for the total scale, and .92,

.81, .90 and .86 for the exercise, nutrition, psychological

well-being and responsible health practices subscales,

respectively(Ya’qubi et al., 2014).In an Iranian study on

elderly people, Cronbach’s alpha for total scale and each

subscales ranged from .73 to .84(Azadbakht et al., 2014).

To score the SWBS, the numerical values for each

response are added for each of the subscales (Existential

Well-Being: EWB and Religious Well-Being: RWB). Both

values for the subscales are then summed to get the total

SWBS value. Scores are ranged from 10 to 60 on the

subscales and 20 to 120 on the SWBS. Higher scores

indicate a higher perception of well-being. Coef cient

alphas have reported as .89 (SWB), .87 (RWB), and .78

(EWB) for each subscale. In an Iranian study on elderly

people, Cronbach’s alpha for the SWBS, EWB and RWB

reported as .93, .91 and .91 respectively (Ya’qubi et al.,

2014, Borji et al., 2015b)

After getting ethical and of cial permission, the

research aims and process were described for the sub-

jects. Moreover, they were ensured about the con den-

tiality of the information. After that, the researcher dis-

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS SPIRITUAL WELL-BEING AS PREDICTOR OF HEALTH BEHAVIOR EFFICACY 199

Molavi et al.

Table 1. Demographic characteristics of the patients

Variable

Mean (SD)

(%)

Age, mean (SE) 72.5(8.5)

Sex, n (%)

Female 12 (37.5)

Male 20(62.5)

Marriagestatus,

n (%)

Single 13(6.2)

Married 151(71.9)

Widowed 45(21.4)

Divorced 1(.5)

Income, n (%)

Without income 65(31)

Less than expenses 71(33.8)

Equals expenses 72(34.3)

More than expenses 2(1)

Residency, n (%)

Home 177(84.3)

Family 30 (14.3)

Nursing home 3(1.4)

Education, n (%)

Illiterate 105(50)

Primary education 59(28.1)

Middle school 20(9.5)

diploma 16 (7.6)

Academic studies 9(4.3)

Missing 1(.5)

Table 2. Demographic characteristics of the SWBS

and SRAHPS as well as their subscales

Main variables Mean Std. Deviation

RWB 48.43 7.24

EWB 36.67 11.41

Total SWB 85.07 17.29

Nutrition 12.39 6.72

Psychological well being 11.88 6.42

Exercise 6.88 6.87

Responsible health practice 13.40 6.36

Total SRAHPS 44.54 22.86

tributed the questionnaires, and the subjects  lled the

questionnaires personally, and or by researcher (in the

case of any problem with  lling). In addition to descrip-

tive statistics (percentiles, mean and standard devia-

tion) and some other analysis to examine the relation-

ship between demographic/health related characteristics

variables and the health behaviors ef cacy in the older

patients, our key analysis was linear multiple regres-

sion. This was used in order to examine the model of the

health behaviors ef cacy in the older patients based on

spiritual well-being subscales.

Before linear multiple regression analysis, the data

were checked to ensure meeting the key assumptions of

the analysis. For each of the four psychosocial predic-

tor variables, the tolerance statistic was found >.20 and

the Variance In ation Factor (VIF) was <10, indicating

absence of multi-collinearity. Moreover, the Durbin-

Watson statistic was between 1 and 3, indicating inde-

pendence of error (TZ., 2014.). Results of this statisti-

cal analysis included non-standardized coef cient (B),

standard deviation coef cient () and R square (R

) val-

ues. SPSS (Statistical Package for the Social Sciences)

version 16 was used for all analyses, and all analyses

were two-tailed. The study was approved by the IUMS

research Committee (295031). Participants signed an

informed consent and were given written information

and were ensured that their participation would be vol-

untary. Moreover, they were ensured about the con -

dentially of their information.

RESULTS AND DISCUSSION

The means (SD) of quantitative variables and frequency

(percent) of qualitative variables are represented in

Table 1. The descriptive statistics of SRAHP and SWBS

along with their subscales are presented in the table 2.

All variables related to health related characteristics

and demographic data (i.e. age, gender, marriage sta-

tus, income, residency status and education level) were

examined to see if they have signi cant relationship with

the health behaviors ef cacy. The results showed sig-

ni cant relationship between health behaviors ef cacy

and gender (t=2.44, df=207, p=.16), income (F

3,208

=5.8,

P<.001) and education level (F

4,208

=9.25, P<.001).

Findings from multiple regression analysis showed

that of two out of three of the predicting variables (i.e.

EWB and SWB) entered in the model have signi cant

relationship with the health behaviors ef cacy. However,

the RWB has not signi cantly predicted the criterion

variable (Table 3). The model of predicting health behav-

iors ef cacy was signi cant (P<0.001, F

2, 207

=38.4) and

entered predicting variables were accounted for 27% of

total variance (R

) of the health behaviors ef cacy.

The  ndings of the study that was done to investigate

the relationship between spiritual health and self-ef -

cacy of health behaviors in the aged patients in selected

hospitals of Isfahan University of Medical Sciences stat-

ing that spiritual health is generally predicts self-ef -

cacy of health behaviors of the aged. Although simi-

lar studies have not been conducted in the aged, some

previous studies that have examined the relationship

between spiritual health and health-related variables

and health-related behaviors in the aged have empha-

sized the importance of spiritual health. For example,

positive and signi cant relationship between spiritual

200 SPIRITUAL WELL-BEING AS PREDICTOR OF HEALTH BEHAVIOR EFFICACY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Molavi et al.

health with life satisfaction(Ya’qubi et al., 2014, Anand

et al., 2017), quality of life (Fadardi 2015, Chaves and

CA, 2015), reducing perceived stress (Martínez and RP,

2014), physical health (Boswell G et al., 2006)have been

supported. The study of the predictive role of spiritual

health dimensions showed that although existential

health is a more decisive role in the self-ef cacy of

health-related behaviors; which implies the aged trying

to achieve the purpose and meaning in life (Takkinen

and I., 2001), which directs them to higher compatibility

and more logical confrontation with the disease(Anand

V et al., 2017). Evidence emphasized the decisive role

of spirituality in shaping human behavior. For example,

the  ndings of Musgrave et al showed that spiritual-

ity and religiosity leads to prevention, health promo-

tion behaviors and deal with the health problems(HG,

2012). The results of Mills et al in patients with heart

failure also showed that spirituality leads to more self-

ef cacy(Mills et al., 2015) and results of Fadardi et al

showed that there is a signi cant relationship between

self-ef cacy and trust in God (Fadardi 2015).

The  ndings of this study consistent with the view

of some experts emphasize that more attention to the

technical aspects of care and treatment, it is necessary

to emphasize the spiritual care(Min J-Ah et al., 2013).It

also stressed that spirituality is an important source of

strength and support in all stages of life but it is more

important in the aged (Jadidi et al., 2011).

CONCLUSION

Spirituality may be an important explanatory factor of

subjective health behavior ef cacy in older patients.

Therefore, it is worthwhile for the health care profes-

sionals to take spiritual care into account as an impor-

tant factor that may help the aged patients adopt healthy

behaviors. Future studies are needed to examine effect

of improving spiritual care on health behavior ef cacy

in older patients. Nurses can improve people’s health,

therefore it is recommended that interventions be per-

formed by nurses for health promotion.

CONFLICT OF INTEREST

There is no con ict of interest between authors.

SOURCE OF FUNDING

Isfahan University of Medical Science.

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