Exploring Spirituality and Technology Receptivity Among a Sample of Older Blacks to Inform a Tailored Chronic Disease Self-Management mHealth Intervention

Figures & data

Box 1 Focus Group Moderator Guide Questions

1.	What does the term chronic disease mean to you?
2.	What does the term chronic disease management mean to you?
3.	What type of challenges do you experience with managing your chronic conditions? (Probe individual responses)
4.	Are there any other factors that help you cope with your chronic conditions?
If there is no mention of spiritual or religious beliefs, then go to the question 6. Skip if discussed.
5.	In what ways have you spiritual or religious beliefs helped you cope with your chronic conditions?
6.	How do you define spirituality?
7.	How do you define religion? (Probe: similarities or differences).
8.	In what way has your health care provider addressed your spiritual needs?
9.	What are some examples of how your health care providers can incorporate spirituality/religion into helping people self-manage their chronic conditions?
10.	We are going to transition here a bit, what are your thoughts about a computers and technology?
11.	How do you use technology to manage your chronic conditions?
12.	We would like to create an education program that can be used on a computer or iPad while you wait for your appointment. What type of information would be useful to you?
13.	How do you feel about an education program that incorporates religion/spirituality into helping you manage your chronic conditions?
14.	What types of messages would be useful? Probe: Testimonials? Storytelling? Inspirational passages?
15.	Is there anything else that we did not talk about that you would like to add to the discussion?

Table 1 Demographic Characteristics of Participants by Gender

Item	Response	Male	Female	Total
Identify as Black or African American	Yes	14	13	27
	No	0	2	2
Born in the United States	Yes	14	2	16
	No	1	13	14
Marital status	Single (never married)	8	3	11
	Married	3	4	7
	Separated	0	1	1
	Divorced	3	5	8
	Widowed	0	2	2
Household income before taxes in the past 12 months	Less than $25,000	12	6	18
	$25,000 to $34,999	1	1	2
	$35,000 to $49,999	0	2	2
	$50,000 to $74,999	0	0	0
	$75,000 to $99,999	1	4	5
	$100,000 to $149,999	0	1	1
	$150,000 or more	0	0	0
Highest degree or level of education completed	Less than high school	6	2	8
	High school graduate	0	3	3
	Some college, no degree	1	2	3
	Associate degree	1	2	3
	Bachelor’s degree	4	3	7
	Graduate or professional degree	2	3	5
	Ph.D.	0	0	0

Note: *Missing responses not reported.

Table 2 Chronic Illness of Participants by Gender

Item	Response	Male	Female	Total
Two or more chronic diseases	Yes	13	13	26
	No	2	2	4
Has the following conditions	Arthritis	3	7	10
	Asthma	1	1	2
	Diabetes	6	7	13
	Cancer	0	0	0
	Heart Disease	0	1	1
	High Blood Pressure	11	10	21
	High Cholesterol	0	5	5
	HIV/AIDS	13	1	14
	Kidney Disease	0	1	1
	Multiple Sclerosis	0	1	1
	Obesity	4	3	7
	Osteoporosis	0	2	2
	Other	2	4	6

Note: *Missing responses not reported.

Table 3 Religious and Spiritual Practices of Participants by Gender

Item	Response	Male	Female	Total
Self-identified religion	Christian	12	15	27
	Other	3	0	3
Attend formal religious meetings at least twice per month	Yes	12	15	27
	No	2	0	2
Frequency of praying	Not at all	0	0	0
	Every few months	0	0	0
	Once a month	0	0	0
	A few times a month	1	0	1
	Once a week	1	1	2
	Once a day	4	0	4
	More than once each day	8	14	22

Note: *Missing responses not reported.

Table 4 Additional Selected Participant Excerpts

Theme	Subtheme	Excerpt	Participant
Religion and Spirituality as a Way of Life	Spirituality is a belief in an entity greater than oneself.	“My spirituality is that I believe that there is a God, He is a creator and He’s my master.”	FG3, F
	Religion is Formalized	“.it’s a lifestyle that um you choose according, and I use the Bible as my guide, especially the book of Proverbs. If you were to try to do everything in the book of Proverbs, obey and also the commands that God has already put out there, the ten. The ten commandments, there are many more, but those ten, if you were to follow those ten, everything else will fall into place.	FG3, F
	Religion is Man-made	You know, so as for, if you start following different types of religion, I find, I’m speaking only for me … you’re setting yourself up to be disappointed because a lot of the times, we’re not, we can’t live up to expectations that a lot of religions have on us.	FG1, M
		So she joined this (name withheld) church and following all these different rules and then decided she didn’t need college anymore [multiple people gasp]. Because they told her as a female, she didn’t need to have any college education because she is supposed to be getting married, having children, this that and the other.	FG2, F
Facilitators to Chronic Disease Self-management	The power of prayer	“And I have this thing about, people may get me angry, disappointments may come, whether it’s emotionally, financially, whatever. But just the fact that I know God gave me a new day, [unclear], it calms me down. And I always say to myself when the stress that I get, “This too shall pass.”	FG2, F
		And I’m in there reading the thing, she [the physician] come back, I’m in tears. I’m like, ‘oh my goodness.’ She said you’re reading it, huh. She said, ‘You want to pray?’ And I’m like, ‘For real? Yes!’ I mean I really broke down.	FG5, F
		She [the physician] pray with me and she pray when I’m leaving, before she prescribe anything, yeah. And that was, that really touched me, you know. And I just, sometimes I would go to her, just pay the money and go because I wanted to meet with her, you know, and that that says to me, a lot. She would never be in a rush to get you out, you know, like most of the doctors in-and-out, you know. She listen to you and she pray with you	FG3, F
	Use of Natural remedies	I get the karela bush, the cerasee bush and I boil it. And I make juice out of it, like mauby. I add my anise essence, and so on, and it takes just like mauby … They said it can keep your blood sugar low, you know, from getting too high. Keep your blood sugar level, down. I don’t know but since they say it’s good, it’s good for your blood sugar and high blood pressure and all that. When I see it around my yard, I boil some.	FG2, F
	Stress Management	I agree what he said about stress because stress is a big part of taking care of yourself. I I’ve learned not to let things bother me because when I get stressed out my body starts to break down.	FG1,M
		Thankfully stress is just how you handle it. How you handle it, you know. Do you handle it in a positive manner, or do you handle it in a negative manner? And you know, positive manner means that you work through it.	FG1, M
Barriers to Chronic Disease Self-Management	The Challenge of Medication Adherence	“Uric acid and I have too much uric acid in my body. So I did not take it seriously but when I um stopped taking the tablet that she gave me, when I went back to her, she told me, the doctor told me, “You got to take the medicine. It’s not going to heal you, but it will maintain … ”	FG3, F
	The Lack of Diet and Exercise	You know, with me, with my chronic illnesses and so, you know, whenever I go to the doctor, my bloodwork is, you know, pretty good, but I know I need to lose some weight. I know I need to get it off, but that’s the hardest thing, I love to eat.	FG4, M
Readiness for Technology for Disease and Medication Education	Information seeking	Many many times I go on the computer and look up, I like to look up things like, illnesses, all the contraindications. And and what you can do to help reduce in terms of, eliminate symptoms or whatever.	FG 2, F
		It’s helpful to me cause I wanted to know why I have a pain in my back. And this morning I went on there and they were telling me I can go to a chiropractor and he, there’s a new something that they can use to help with the pain.	FG 2, F
		“Researching medications, side effects.”	FG1, M
	mHealth	if I go to one doctor or one hospital, and they can go and just pull up your thing right away, I think they will be better able to serve you if they are able to do that. Because many times you go to a doctor and they say they need some record	FG 3, M
	Barriers to technology use	“I have my children, that [when] I don’t understand, I can call.”	FG 2, F
		“When it comes to your health, I do not think that should be put no, into computers or different things, cause it, it could be put in the wrong hands.	FG1, M
	Recommendations	Just leave some Daily Word stuff there that they can pick up and read while sitting in the waiting room. Some people may get more spiritually inspired, you know?	FG2, F

Abbreviations: FG, focus group; F, female; M, male.