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Abstract
Objective
To explore a potential role for spirituality in medication-related needs assessment for integrated care in chronically ill populations.
Method
A systematic literature review was conducted to explore the impact of faith beliefs on health and/or medication adherence in individuals with depression and/or HIV+/AIDS. Retrospective electronic medical record review of adult HIV+ patients of an urban primary care clinic with integrated mental health services was conducted, with Substance Abuse and Mental Illness Symptoms Screener (SAMISS), major depressive disorder (MDD) incidence over the preceding year, and history of contact with a spiritual advisor. A convenience sample was interviewed to qualitatively assess potential medication therapy management needs and medication-related problems. Another sample was examined utilizing the Daily Spiritual Experience Scale.
Results
The literature reports positive influence on health behaviors, coping and outcomes; and poor medication adherence and treatment decisions due to patient passivity or resistance. Spiritual advisor contact (not limited to a specific religion) was significantly associated with MDD absence (1.7% vs. 15.3%, P<0.005) and inversely related to SAMISS, depression, and poor health behaviors. Patient interviews reflected significance of faith in terms of insight and acceptance of illness, the role or need for medications, coping, and medication adherence. An illustrative model was designed based on the literature and data collection.
Conclusion
Spiritual assessment may help identify positive or negative influence on health. Spiritual interventions could be beneficial in promoting adherence and positive health outcomes. Further research is recommended.
Acknowledgments
This work was supported by pilot funds awarded to Dr. Oji through a grant from the National Institutes of Mental Health (NIMH) R25MH08066 and in part from the National Institutes of Health (NIH) Contract No. HH5N261200800001E awarded to Dr Evaristus Nwulia. The content is solely the responsibility of the authors and does not necessarily represent the official views or policies of the NIMH or NIH Department of Health and Human Services. The contributions of Dr Suad Kapetanovic, MD, University of Southern California; Dr Patricia Noumedem, PharmD, Howard University; also FMCS staff, especially James Perry, CACI, are appreciated.
Disclosure
The authors report no conflicts of interest in this work.