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Review

Review and Characterization of Portuguese Theses, Dissertations, and Papers about Spirituality in Health

by
Joana Romeiro
1,
Helga Martins
1,
Sara Pinto
2 and
Sílvia Caldeira
1,*
1
Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Palma de Cima, 1649-023 Lisbon, Portugal
2
CINTESIS—Center for Research in Health Technologies and Services, Escola Superior de Saúde de Santa Maria, 4049-024 Porto, Portugal
*
Author to whom correspondence should be addressed.
Religions 2018, 9(9), 271; https://doi.org/10.3390/rel9090271
Submission received: 13 July 2018 / Revised: 10 August 2018 / Accepted: 5 September 2018 / Published: 11 September 2018
(This article belongs to the Special Issue Selected Papers from Spirituality in Healthcare Conference 2018 “Spirituality at a Crossroads”)
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Abstract

:
Research about spirituality has grown widely in the past decades and the interest in health care is also evident in Portugal. This literature review aims to identify and to characterize Portuguese theses, dissertations, and papers about spirituality in health, and to provide a systematic overview of the knowledge concerning this subject. The search was conducted in February 2017 and updated in January 2018. Four independent reviewers screened and analyzed all citations, and a total of 76 results were included. Publications started in 2002 and include master degree dissertations (n = 37), scientific papers (n = 31), and PhD theses (n = 8). Papers were published in 24 national and international journals. Most papers were psychology- and nursing-related and had a quantitative design (n = 55). Samples were mostly composed of patients living with a chronic disease (n = 20) or elderly (n = 11). The Spiritual Well-Being Questionnaire (SWBQ) was the most used tool. A multidisciplinary approach is regarded as foundational in implementing spirituality in the provision of health care and the results underline the interest on this topic from other disciplines rather than nursing. Further studies must provide a deeper understanding of spirituality in children, adolescents or families’ perspective bringing new insights to advanced health practice.

1. Introduction

Spirituality is an individual dimension and a complex and universal phenomenon (Barber 2012). Several attempts to define the concept have been made based on the subjective nature of spirituality, and different conceptual approaches can be found in the literature throughout the years. Recently, spirituality has been defined as “a way of being in the world in which a person feels a sense of connectedness to self, others, and/or a higher power or nature; a sense of meaning in life; and transcendence beyond self, everyday living, and suffering” (Weathers et al. 2016, p. 93). The same authors identified connectedness, transcendence, and meaning in life as the main attributes of the concept (Weathers et al. 2016). Spirituality plays a critical role in human existence, on perceptions of health and well-being, and relates to patients’ quality of life (Koenig 2012; Papathanasiou et al. 2014) from the beginning to the end of life (Crowther and Hall 2017; Romeiro et al. 2017a, 2017b). Closely related to challenging and unpredictable life events, spirituality was proven to be supportive and therapeutic during adverse health conditions (Koenig 2012; Timmins and Caldeira 2017). For example, chronic, terminal, and/or unexpected illness seems to trigger patients’ and families’ suffering and evoke spiritual coping mechanisms regardless religious affiliation (Weathers et al. 2016).
Since ancient times, spirituality has evolved side by side with health-related practices. For example, religious leaders were pioneers in hospitals’ organization and were basilar in setting the foundations for current professional standards of health care (Koenig 2012; Theofanidis and Sapountzi-Krepia 2015). Nevertheless, over the years a fragmentation of care is often stated, based on the scientific advances, which led to a transformation in the way patients were treated, mostly reduced to the physical and biological aspects of treatments (Papathanasiou et al. 2014). This reductionist approach, and the implications on the assessment and the intervention towards patient’s health, set in action a holistic and patient-centered care movement (Papathanasiou et al. 2014). Despite this new paradigm, health concept is currently and internationally defined as a state of well-being (physical, social, or mental) and not simply the absence of disease (WHO 2014). The spiritual dimension of health care seems to be kept absent, as critically pointed out by some authors, and is still a missing dimension of the health concept (Dhar et al. 2013).
One of the barriers of the absence of spirituality in health care is the subjectivity of the concept, and several measurement tools have been developed to measure its complex nature (Austin et al. 2018). These revealed the positive influence of religion and spirituality on the physical (e.g.,: immune system functioning, longevity, dementia, heart diseases, hypertension, among others), mental (like anxiety, depression, and suicidal ideation), lifestyle (e.g., physical activity, smoking, sexuality, and others) and social aspects (such as marital relationships, social interactions, and social support) of a person’s life (Koenig 2012; Lucchetti and Lucchetti 2014). A recent review uncovered the existence of 75 tools from which 25 were found to be used in clinical environments (Austin et al. 2018). A synthesis of Brazilian literature found only two instruments translated into European Portuguese (Lucchetti et al. 2013). In addition, a review of 15 years of worldwide spiritual research in health has revealed a wide and growing interest regarding this phenomenon with major developments in mental health (Koenig 2012). The United States and England were the countries with the highest numbers of published papers (Koenig 2012). Moreover, in Portugal the only study aiming to map the scientific evidence related to spirituality in health comprised only nursing literature (Caldeira et al. 2011a). Therefore, this study aims a broader perspective as the goal is to characterize the Portuguese theses, dissertations, and papers about spirituality in health disciplines. The paper will provide a new insight of research about this phenomenon and highlight the development and knowledge gaps that may provide guidance to future research.

2. Materials and Methods

A literature review based on a systematic search was independently conducted by all four authors in February 2017 and updated in January 2018. The search was conducted on seven international databases (PubMed; CINAHL with full text; MEDLINE with full text; MedicLatina; Academic Search Complete; SciELO and Web of Science) and on Portuguese databases including RCAAP (Open Access Portuguese Scientific Repository) and repositories of three nursing schools: Lisbon (Escola Superior de Enfermagem de Lisboa—ESEL), Coimbra (Escola Superior de Enfermagem de Coimbra—ESEnfC) and Porto (Escola Superior de Enfermagem do Porto—ESEP). Search terms with truncation were searched with no time limit and included “spirituality”, “religion” and “health”. Additionally, some other related words such as “forgiveness”, “hope” and “well-being” in English and/or Portuguese were used in accordance with each database (Table 1).
Papers considered eligible were primary studies, articles, PhD theses and masters dissertations, available in a full-text format, conducted by Portuguese researchers (as first authors) in national samples and in a health context, regardless of the health discipline. Editorials, opinion articles, reports, and literature reviews were excluded. The search and protocol strategy followed the PRISMA guidelines (Figure 1). Initial search retrieved a total of 5308 results. Then, 48 duplicates were removed and 5260 studies remained. Reviewers screened those results and from the 138 obtained documents, 62 were excluded with reasons after reading the full text. Discrepancies in results were solved through joint discussion. Finally, a total of 76 results were included in this review.
Data was gathered and extracted to a pre-defined Excel sheet comprising author(s), title, theme of study, type of publication, discipline, university or journal of publication, design, sample, aim, spiritual instruments used, results, limitations, and suggestions.

3. Results

A total of 76 Portuguese studies about spirituality have been included (Table 2). The first paper was published in 2002 (Caldeira 2002). Moreover, a growing interest in this theme led to the increasing publication of papers through time, and most studies were published in 2015 (n = 14), 2014 (n = 11), and 2016 (n = 10).
Although 76 documents were identified, a total of 111 different authors were listed (Table 3).
Academic documents (PhD theses and master’s dissertations) (n = 45), and scientific papers (n = 31) were identified in this study. In addition, a wide range of health disciplines was dedicated to the study of spirituality (Table 4) with the highest number of published papers on this topic presented by psychology (n = 38) and nursing (n = 23).
Most studies used a quantitative (n = 55), qualitative (n = 7), or mixed design (n = 6). Although there was a tendency to use a quantitative approach, the number of qualitative studies increased between 2010 and 2012 (Figure 2).
Samples ranged from eight (Garrett 2010; Martinho 2016) to 1876 participants (Gouveia 2011). Participants shared similar characteristics, but some studies included both adolescents and their parents (Simões and Simões 2015), physicians and nurses (Alves 2011), people with chronic or acute illness (Branco 2015), health professionals, clients and caregivers (Catré et al. 2014), health professionals (Albuquerque 2009; D. M. d. S. Pereira 2014), individuals with different religious backgrounds (Freire et al. 2016; Garrett 2010), palliative care professionals and volunteers (Martins 2011), and working and retired individuals (Verbisck 2010). Patients with chronic disease (n = 20), elderly (n = 11), and adults (n = 9) (Table 5) were the most frequent participants.
According to the aim of each study, it was possible to list 76 different themes (Table 6). Links between spirituality and oncology (n = 14), mental health (n = 9), and instruments’ validation (n = 7) were found to be more frequent in the selected studies.
Quantitative or mixed-method research used a wide range of instruments to measure spirituality (Table 7), in a total of 78 tools. The Portuguese version of the Spiritual Well-Being Questionnaire (SWBQ) was the most used to measure spirituality (n = 25).
Regarding the time frame, only one study was found to be longitudinal (Marques et al. 2013), and aimed to determine the relationship between hope, spirituality, religious practice, and life satisfaction in Portuguese students. All remaining studies were cross-sectional.
Specific characteristics of the articles and theses/dissertations included in this review are presented as follows.

3.1. Articles

Thirty-one primary studies were published in 24 different journals (11 national and 13 international journals) (Table 8). Although studies included Portuguese participants, papers were published in journals from the United States (n = 8), followed by Brazil (n = 3), Japan (n = 1), the Netherlands (n = 1), England (n = 1), and Switzerland (n = 1). The highest number of papers were published in Portuguese-written journals (n = 16) when compared to English-written journals (n = 15) (Table 8). Indexed journals were most chosen (n = 21).
Evidence related to spirituality started to be published by Portuguese authors in 2002 (Table 9). However, only since 2007 a consistent number of studies started to be published, and in 2016 the highest number of papers was published (n = 6). Not surprisingly, psychology (n = 16) and nursing (n = 12), were the health disciplines most found in this review.

3.2. Academic Documents

Theses and dissertations were developed as a requisite of either master degree (n = 37) and doctoral (PhD) degree (n = 8). The first study published in 2009 was a master’s dissertation (Table 9). Masters’ dissertations registered a consistent approach to spirituality throughout the years. Still, PhD research on the same topic started no later than 2011. The Instituto Superior de Psicologia Aplicada (ISPA) was the academic institution with more documents (n = 10), and the highest number of doctoral studies were conducted in Universidade Católica Portuguesa (UCP) (n = 6). Findings also revealed that research about spirituality conducted within PhD programmes was only found in UCP, ISPA, and Instituto Universitário de Lisboa (ISCTE-IUL), and masters’ dissertations were identified in 12 national academic institutions (Table 10). Psychology (n = 21), palliative care (n = 6), and nursing (n = 5) revealed a higher number of authors and most documents were masters’ dissertations. Nevertheless, health advanced studies, such as PhD theses in nursing (n = 6), were the most frequent when compared to other disciplines.
The quantitative design was the most used (n = 28) in masters’ dissertations and in PhD theses, followed by qualitative design (n = 6) and mixed-methods (n = 4). People with chronic health conditions were the most frequent participants (n = 10). A general analysis of the findings (Table 10) highlighted oncology (n = 6), mental health (n = 5), geriatrics (n = 3), palliative care (n = 3), and spiritual distress (n = 3) as the main themes addressed in the academic studies. Diagnostic validation, hospital care, and hospitalized patients were singular aspects found to be studied in PhD studies and not on masters’ dissertations. Still, diabetes, end of life, meditative practices, spiritual care, and spiritual distress were studied in both academic degrees.

4. Discussion

This review focused on characterizing Portuguese theses, dissertations, and papers about spirituality in health. It brings a new insight towards the academic literature as it identified 76 Portuguese scientific documents related to spirituality research in health disciplines. The findings revealed that Portuguese publication about spirituality in health started in 2002. Interestingly, Portuguese and Brazilian studies about spirituality and religion were most published in 2003–2004 (Damiano et al. 2016).
Overall, these results have contributed to the acknowledgement that Portuguese studies are expanding and are not only limited to nursing (Caldeira et al. 2011a). In fact, this study points to a primary evidence that clearly extrapolates the four studies reported in one nursing review conducted between the years of 1990 and 2010 (Caldeira et al. 2011a), and reinforces the multidisciplinary interest also previously addressed in an international review conducted between 1999 and 2013 (Lucchetti and Lucchetti 2014).
While psychology was the discipline that gathered the highest number of results in this Portuguese review, psychiatry was in a Brazilian review (Damiano et al. 2016). Nevertheless, nursing was found important in this type of research (Damiano et al. 2016).
Samples, such as elderly and adult patients suffering from chronic illness, such as cancer, have predominated, confirming previous statements of the lack of research on a national level related to the study of spirituality in people with nononcologic health issues (Ferreira et al. 2016), and in different phases of lifespan (Romeiro et al. 2017a, 2017b). On the other hand, mental health and spirituality revealed a significant relationship, which has been underlined in literature (Koenig 2012).
Although three types of methodological approaches were used, the quantitative approach was the most frequent. This may be due to the primary need to firstly quantify, measure, and generalize a phenomenon before understanding the subjective nature and the deep meaning (Ferreira et al. 2016), which is critical in spirituality. In this regard, 78 instruments were identified in Portuguese research with predominance of the Spiritual Well-Being Questionnaire (SWBQ) (Gomez and Fisher 2003), translated and validated to the Portuguese population (Gouveia et al. 2009). From the 76 Portuguese studies that were conducted, seven were used to validate spiritual tools to a national context, which reflects the lack of instruments available to authors and transculturally adapted to the Portuguese population, not only to the specificities of this sample but to particular settings.
When analyzing the time frame, a scarce number of studies adopted a longitudinal design. Longitudinal studies have been considered necessary in the study of spirituality to decrease the gap of knowledge related to patients’ spirituality across time (Martins et al. 2017).
Regarding the nature of the scientific papers, it was possible to determine the recurrence of PhD theses and masters’ dissertations (n = 45) when comparing with published articles (n = 31). Most of the international selected journals derive from the USA which goes in line with previous findings of a review of 15 years of publications on spirituality and religion (Lucchetti and Lucchetti 2014). Portuguese authors seemed to prefer Portuguese-written and English-written journals, although the majority chose national or Brazilian to other journals. This might be explained by the closeness between both languages when compared to other foreign idioms. The journals had a specific scope, related to the theme, such as religion, psychology, and nursing.
Since this is an original review, there is no comparison with other Portuguese reviews related to master dissertations and doctoral theses addressing spirituality and religion. Yet, a palliative care and bibliometric nursing study conducted in 2016 discloses the existence of a higher number of academic masters degrees when compared to doctoral degrees (Damiano et al. 2016). This might also justify the higher number of masters’ dissertations (n = 37) when compared with PhD theses (n = 8) in this review.
Furthermore, it is of no surprise that ISPA, traditionally dedicated to psychological research and education, was the university that presented the highest numbers of masters’ dissertations related to spirituality. However, most nursing doctoral theses were conducted at the UCP. Doctoral research included essentially samples of adults, and this interest of nurses has been reported before (Basto 2012). In addition, the number of theses exceeds the number of published articles which may indicate that Portuguese PhD findings are still not being properly disclosed (Basto 2012).
These findings should be analyzed considering some limitations, such as the possibility of some theses/dissertations being available only in print and the delay between the viva and the publication in online repositories, which might have compromised the analysis and extraction of significant information. Moreover, it was also acknowledged the possibility of some documents, mainly theses, not being listed in the universities repositories and being only available in a hand or physical search in libraries.

5. Conclusions

This study provides the characterization of Portuguese theses, dissertations, and papers about spirituality in health, mapping the scientific knowledge development that has occurred in the country. It is evident the growth of interest related to this phenomenon in health disciplines, although with a still slow progression when compared to worldwide research on the topic. A multidisciplinary approach is foundational in implementing spirituality in health care and the results underline the interest in this topic from other disciplines, rather than only nursing. Most studies are quantitative, cross-sectional, and descriptive or focused on theoretical concerns. Further studies must provide a deeper and closer understanding of spirituality in patients’ or families’ perspective that could bring new insights to practice. Also, including children and adolescents as participants in the research about spirituality in these health-care disciplines could provide a broad understanding of the phenomenon across the lifespan and in a wide variety of sets and health-related experiences other than chronic illness.
Despite the limitations, the study provides an innovative insight into the development of Portuguese health disciplines and exerts the need for further studies, namely with a qualitative and longitudinal design. This would allow forthcoming synthesis and meta-synthesis capable of gathering and generalizing findings to the Portuguese population. Finally, advanced studies are claimed, and publication of results in other journals than Portuguese-written might propel national research to an international level and contribute to the understanding of the spiritual dimension and implications in health.

Author Contributions

Conceptualization, J.R., S.P., S.C.; Data extraction and analysis, J.R., S.P., H.M., S.C.; Writing—Original Draft Preparation, J.R.; Writing—Review & Editing, J.R., S.P., H.M., S.C.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Religions 09 00271 g001 550
Figure 1. PRISMA flow diagram of this systematic review.
Figure 1. PRISMA flow diagram of this systematic review.
Religions 09 00271 g001
Religions 09 00271 g002 550
Figure 2. Evolution in time of the studies’ design included in this review.
Figure 2. Evolution in time of the studies’ design included in this review.
Religions 09 00271 g002
Table
Table 1. Terms used in search per data base.
Table 1. Terms used in search per data base.
PubMedCINAHL with Full Text; MEDLINE with Full Text; MedicLatina; Academic Search CompleteSciELOWeb of ScienceRCAAPESELESEnfCESEP
Spirit * AND Portug * (all fields)Spiritual (abstract) AND health (text) AND Portugal (text)Espiritualidade AND Portugal (all fields)Spirit * AND Portugal (all fields)Espirit * OR Relig * AND Saúde (theme)Spiritual (all fields)Espirit * (title)Espiritualidade (title)
Relig * AND Health AND Portug * (all fields)Forgive * (abstract) AND Health (text) AND Portugal (text)Espiritual AND Portugal (all fields)Relig * AND Health AND Portugal (all fields)Perdão AND Saúde (theme)Espiritualidade (all fields)Espirit * (theme)Espiritualidade (theme)
Hope AND Portug * (all fields)Hope (abstract) AND Health (text) AND Portugal (text)Religião AND Portugal (all fields)Forgive * AND Portugal (all fields)Espiritualidade AND Saúde (theme)Religião AND Religiosidade (all fields)Relig * (title)Religião (title)
Forgive * AND Portug * (all fields)Religious (abstract) AND Health (text) AND Portugal (text)Religiosidade AND Portugal (all fields) Espiritual * (title) AND Saúde (theme)Perdão (all fields)Relig * (theme)Religião (theme)
(((Spirit * OR Relig *) AND Portug *) NOT brazil *) (all fields)Religion * (abstract) AND Health (text) AND Portugal (text)Perdão AND Portugal (all fields) Bem estar spiritual (title) AND Saúde (theme)Esperança (all fields)Perdão (title and theme)Perdão (title)
Esperança AND Portugal (all fields) Esperança (title) AND Saúde (theme) Esperança (title)Esperança (title)
Esperança AND Portugal (all fields) Espiritual (title) Esperança (theme)Esperança (theme)
* Truncation searching.
Table
Table 2. References included in this review.
Table 2. References included in this review.
Author(s) YearAuthor(s) Year
(Albuquerque 2009)(Marques 2014)
(Alves 2011)(Marques 2012)
(Andrade 2014)(Marques et al. 2013)
(Araújo et al. 2017)(Martinho 2016)
(Azevedo 2016)(Martins 2011)
(Branco 2015)(Martins et al. 2015)
(Brito 2014)(Melo 2015)
(Caldeira 2002)(Mendes 2013)
(Berenguer 2013)(Moreira 2011)
(Caldeira et al. 2017a)(Neves 2017)
(Caldeira et al. 2017b)(Pacheco 2012)
(Caldeira et al. 2014)(Paredes and Pereira 2017)
(Caldeira et al. 2016a)(Pedro 2015)
(Caldeira et al. 2016b)(F. M. P. Pereira 2012)
(Caldeira et al. 2011b)(Pereira and Marques 2015)
(Carneiro et al. 2014)(D. M. d. S. Pereira 2014)
(Castro 2016)(Pereira et al. 2016)
(Catré et al. 2014)(Pestana et al. 2007)
(Conceição 2014)(Pimenta 2010)
(Correia 2017)(Pimenta et al. 2014)
(Cruz 2012)(Pinto 2012)
(Dias 2015)(Pinto and Pais-Ribeiro 2007)
(Ermel et al. 2015)(Pinto and Pais-Ribeiro 2010)
(Ferreira 2011)(Pinto et al. 2012)
(Ferreira and Neto 2002)(Queiroga 2013)
(França 2009)(Rego 2008)
(França 2010)(Rego et al. 2009)
(Freire et al. 2016)(Rodrigues 2013)
(Garrett 2010)(Roldão 2015)
(Gouveia 2011)(Santos 2014)
(Gouveia et al. 2012)(Sapage 2015)
(Gouveia et al. 2009)(Silva 2015)
(Humboldt et al. 2013)(Da Silva and Pereira 2017)
(Jesus 2015)(Simões and Simões 2015)
(Jorge et al. 2016)(Soares and Amorim 2015)
(Junior 2012)(Teixeira 2016)
(Lopes 2014)(Travado et al. 2010)
(Mangia 2015)(Verbisck 2010)
Table
Table 3. First authors and authorship of studies included in this review.
Table 3. First authors and authorship of studies included in this review.
AuthorsFirst AuthorAuthorship
Yes/Nonn
Acácio CatréNo-1
Alexandrina SimõesYes11
Amélia FigueiredoNo-1
Ana Calapez GomesNo-1
Ana Cristina RegoYes12
Ana MeloYes11
Ana CruzYes11
Ana MarquesYes11
Ana ParedesYes11
Ana Paula da ConceiçãoYes12
Ana Verissímo FerreiraYes11
Anabela de Sousa SoaresYes11
Anabela PereiraNo-1
Andreia GarrettYes11
Andreia Filipa JesusYes11
Andreia PereiraYes12
Andreia Raquel MartinsYes11
Arménio RegoYes11
Cândida PintoYes12
Carla MoleiroNo-1
Catarina SapageYes11
Catarina RamosNo-1
Célia ErmelNo-1
Constança PaúlNo-1
Cristina CanavarroNo-1
Cristina MartinsNo-1
David EstevensNo-1
David RosmarinNo-1
Diana JorgeYes11
Dulce PereiraYes11
Emilia Campos de CarvalhoNo-4
Erika ChavesNo-1
Félix NetoNo-1
Filipa PimentaYes12
Filomena PereiraYes11
Fiona TimminsNo-3
Francis CarneiroYes11
Francisco Gil No-1
Francisco PimentelNo-1
George JuniorYes11
Graça EsgalhadoNo-1
Henrique PereiraNo-1
Inês BritoYes11
Isabel AzevedoYes11
Isabel Albuquerque Yes11
Isabel LealNo-3
Jaclin’ FreireYes11
Jeremias TeixeiraYes11
Joana BairradasNo-1
Joanna MitchelNo-1
João MendesYes12
Joao MarocoNo-1
João Paulo PestanaYes11
João SilvaYes11
Joaquim FerreiraNo-1
José Carlos MartinsNo-1
José Eduardo SilvaYes11
José Pais-RibeiroNo-4
Joseph ConboyNo-1
Katia LopesYes11
Lia AraújoYes11
Lia RodriguesYes11
Lia VenturaNo-1
Liliana RoldãoYes11
Luigi Grassi No-1
Luzia TravadoYes11
Maik CastroYes11
Manuela FredericoNo-1
Marco PereiraNo-1
Margarida VieiraNo-6
Maria Graça PereiraNo-1
Maria Isabel AmorimNo-1
Maria João GouveiaYes33
Maria João AndradeYes11
Maria MarquesYes11
Maria Nazarete CatréYes11
Maria Zita Castelo BrancoYes11
Mariana MarquesNo-1
Mariana NevesYes11
Marilena VerbisckYes11
Marina FerreiraYes11
Marina CunhaNo-1
Marta MartinhoYes11
Marta MarquesNo-2
Miguel Pina CunhaNo-1
Monique Correia AlvesYes11
Nuno CorreiaYes11
Oscar RibeiroNo-1
Patrícia PachecoYes11
Paula MangiaYes11
Priscilla Midori FurutaNo-1
Regina Célia ErmelYes11
Sandra DiasYes11
Sandra Moreira Yes11
Sara PintoYes22
Sérgio PimentaYes11
Shane J. LopezNo-1
Sílvia CaldeiraYes89
Sofia FrançaYes11
Sofia Von HumboldtYes12
Solange SoutoNo-1
Sónia SimõesNo-1
Susana MarquesYes11
Susana QueirogaYes11
Teresa PessoaNo-1
Tereza Laís ZutinNo-1
Thaís TavaresNo-1
Tiago SantosYes11
Valdemar PedroYes11
Vânia FrançaYes11
Vilma MartinsYes11
Table
Table 4. Health disciplines of studies included in this review.
Table 4. Health disciplines of studies included in this review.
Health DisciplineTotal
n%
Psychology3850.00
Nursing2330.26
Palliative Care79.21
Bioethics11.32
Health Management11.32
Intercultural Relationships11.32
Medicine11.32
Mental Health11.32
Physiotherapy11.32
Sociology11.32
Not explicit11.32
Total76100.00
Table
Table 5. Characteristics of participants included in the studies.
Table 5. Characteristics of participants included in the studies.
ParticipantsTotal
n%
People with a chronic illness2024.39
Elderly1113.41
Nurses910.98
Individuals910.98
Adults910.98
Health professionals67.32
Adolescents22.44
Caregivers22.44
Meditative practitioners22.44
People with psychiatric disorders22.44
Students22.44
Volunteers22.44
Key-informants11.22
Parents11.22
People with acute illness11.22
Spiritual leaders11.22
Teachers11.22
Not explicit11.22
Total82100.00
Table
Table 6. Main themes of the studies included in this review.
Table 6. Main themes of the studies included in this review.
ParticipantsTotal
n%
Oncology1417.07
Mental health910.8
Validation of scales78.54
Education56.10
Hospital care44.88
Meditative practices44.88
Religiosity/religious practices44.88
Palliative care33.66
Spiritual care33.66
Spiritual distress44.88
Death22.44
Diabetes22.44
Diagnostic validation33.66
End of life22.44
Psychopathological symptoms22.44
Caregivers of the elderly11.22
Emotions/resilience11.22
Faith11.22
Health centers and family health units11.22
Health contexts11.22
Hope11.22
Hospitalized patient11.22
Institutionalized and community-based elderly11.22
Loneliness11.22
Management11.22
Menopause11.22
Organizations11.22
Parents and teenagers/ shame/ anxiety11.22
Retirement11.22
Total82100.00
Table
Table 7. List of instruments used in the studies included in this review.
Table 7. List of instruments used in the studies included in this review.
Instruments (Short Name) (n = 78)Total
n%
Spiritual Well-being Scale; Spiritual Well-Being Questionnaire (SWBS; SWBQ; SWBQp)2516.89
Satisfaction with Life Scale (SWLS)64.05
Positive and Negative Affect Schedule (PANAS)53.38
Spiritual Assessment Scale (SAS)53.38
Medical Outcomes Study 36—Item Short—Form Health Survey (MOS SF-36); SF-36v2 (version 2)42.70
Spirituality Assessment Scale (ES)42.70
Spiritual Health and Life-Orientation Measure (SHALOM)42.70
Escala de Avaliação da Espiritualidade de Pinto & Pais-Ribeiro (EAE)32.03
Psychological Well-Being Scale (PWB)32.03
Geriatric Anxiety Inventory (GAI)32.03
Geriatric Depression Scale (GDS)32.03
Integrated Spiritual Intelligence Scale (ISIS)32.03
Spirituality and Spiritual Care Rating Scale (SSCRS)32.03
The World Health Organization Quality of Life—BREF (WHOQOL-BREF)32.03
Brief COPE21.35
Dispositional Flow Scale-2 (short version) (DFS-2)21.35
European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLC-C30)21.35
Functional Assessment of Cancer Therapy General (FACT-G)21.35
Hospital Anxiety and Depression Scale (HADS)21.35
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)21.35
Older Americans Resources and Services (OARS)21.35
Peace of Mind Scale (PoM)21.35
Scale for Assessment of Spirituality in Health Contexts (EAECS)21.35
The World Health Organization Quality of Life—SRPB (WHOQOL-SRPB)21.35
Affective Well-Being Scale (AWB)10.68
Assessment Questionnaire of Self-care activities with Diabetes10.68
Beck Depression Inventory (BDI-II)10.68
Brief Scales of Perspectives on Death 10.68
Brief Symptom Inventory (BSI)10.68
Cancer Worries Inventory (CWI)10.68
Center of Epidemiological Studies Depression Scale (CES-D)10.68
Children’s Hope Scale (CHS)10.68
Death Attitude Profile-Revised (DAP-R)10.68
Duke University Religion Index (DUREL)10.68
Emotional Expressivity Scale (EEE)10.68
Escala de Ansiedade Estado/Traço para crianças10.68
Escala de Vergonha Externa10.68
Fordyce Emotions Questionnaire10.68
Francis Scale of Attitude Towards Christianity10.68
Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp)10.68
Herth Hope Index-PT (HIHI-PT)10.68
Indecisiveness Scale (IS)10.68
Inventory of Subjective Experiences of Suffering in Diseases (IESSD)10.68
Loneliness Scale—UCLA 10.68
Measure of subjective happiness10.68
Meditative Experience Effects (MEE-DM)10.68
Menopause Symptoms’ Severity Inventory (MMSI-38)10.68
Mental Health Inventory (MHI)10.68
Mini Mental State Examination (MMSE)10.68
Mini-Mental Adjustment to Cancer (Mini-MAC)10.68
Multidimensional Measurement of Religiousness and Spirituality10.68
Neecham Confusion Scale10.68
NEO-Five Factor Inventory (NEO-FFI) 10.68
Philadelphia Geriatric Center Morale Scale (PGCMS)10.68
Posttraumatic Growth Inventory (PTGI)10.68
Questionário de Bem-Estar Espiritual dos Pais (BEE)10.68
Questionário Sobre Necessidades Espirituais (instrumento português) (QSNE)10.68
Questionnaire of the Five Facets of Mindfulness (QCFM)10.68
Religion and Religiosity by Quaresma Scale10.68
Religious Practices’ Questionnaire10.68
Resilience Scale for Adults (RSA)10.68
Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ)10.68
Scale to assess flourishing10.68
Self-Compassion Scale (SELFCS)10.68
Short-Form with 12 items (SF-12)10.68
Social Support Questionnaire (SSQ6; SSQ6p)10.68
Spiritual and Religious Attitudes in Dealing with Illness (SpREUK)10.68
Spiritual Care Competence Scale (SCCS)10.68
Spiritual Coping Questionnaire (SCQ)10.68
Spiritual Intelligence Self-Report Inventory (SISRI-24)10.68
Spiritual Well-Being Scale Score10.68
Spirituality (Visual Analog Scale 0–10)10.68
Spirituality at work scale10.68
Students’ Life Satisfaction Scale (SLSS)10.68
The Resilience Scale10.68
The World Health Organization Quality of Life (WHOQOL)10.68
Valuation of Life Scale10.68
Vocational Certainty Scale (ECV)10.68
Total148100.00
Table
Table 8. Characteristics of journals within the studies were published.
Table 8. Characteristics of journals within the studies were published.
JournalnWritten LanguageCountry
Journal of Religion & Health5EnglishUnited States
Análise Psicológica2PortuguesePortugal
Psicologia, Saúde & Doenças2PortuguesePortugal
Revista de Enfermagem Referência2PortuguesePortugal
Arquivos de Medicina1PortuguesePortugal
Cadernos de Saúde1PortuguesePortugal
Cancer Nursing1EnglishUnited States
ConsCiências1PortuguesePortugal
CuidArte Enfermagem1PortugueseBrazil
International Journal of Nursing Knowledge1EnglishUnited States
Journal of Happiness Studies1EnglishNetherlands
Japanese Psychological Research1EnglishJapan
Journal of Occupational Health Psychology1EnglishUnited States
Open Theology1EnglishUnited States
Palliative and Supportive Care1EnglishEngland
Psychological Reports1EnglishUnited States
Psychology, Community & Health1EnglishPortugal
Religions1EnglishSwitzerland
Revista Latino-Americana de Enfermagem1PortugueseBrazil
Revista Nursing1PortuguesePortugal
Revista Portuguesa de Enfermagem de Saúde Mental1PortuguesePortugal
Revista Portuguesa de Investigação Comportamental e Social1PortuguesePortugal
Revista Portuguesa de Saúde Pública1PortuguesePortugal
REUOL. Revista de Enfermagem UFPE On Line1PortugueseBrazil
Table
Table 9. Year of publication, health-related disciplines and design of the studies.
Table 9. Year of publication, health-related disciplines and design of the studies.
Yearn%
200226.45
200726.45
200813.23
200939.68
201013.23
201113.23
201226.45
201326.45
2014412.90
201539.68
2016619.35
2017412.90
Total31100.00
Health Disciplines
Psychology1651.61
Nursing1238.71
Mental Health13.23
Not explicit13.23
Palliative Care13.23
Total31100.00
Methodological approach
Quantitative2787.10
Mixed-methods26.45
Qualitative13.23
Not explicit13.23
Total31100.00
Table
Table 10. Characteristics of academic studies and comparison between master dissertations and PhD theses.
Table 10. Characteristics of academic studies and comparison between master dissertations and PhD theses.
YearMaster DissertationsPhD ThesesTotal
n%n%n%
200925.4100.0024.44
2010410.8100.0048.89
2011513.51112.50613.33
2012410.81112.50511.11
201312.70337.5048.89
2014616.22112.50715.56
2015924.32225.001124.44
2016410.8100.0048.89
201725.4100.0000.00
Total37100.008100.0045100.00
University/Institute/School
Escola Superior de Enfermagem do Porto (ESEP)25.4100.0024.44
Escola Superior de Enfermagem de Lisboa (ESEL)12.7000.0012.22
Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL-IPL)12.7000.0012.22
Universidade Aberta (UAB)12.7000.0012.22
Universidade do Algarve12.7000.0012.22
Universidade Católica Portuguesa (UCP)25.41675.00817.78
Universidade de Coimbra (UC)25.4100.0024.44
Universidade Lisboa (UL)616.2200.00613.33
Universidade Lusófona38.1100.0036.67
Universidade Porto (UP)513.5100.00511.11
Instituto Superior de Psicologia Aplicada (ISPA)924.32112.501022.22
Instituto Superior Miguel Torga (ISMT)410.8100.0048.89
Instituto Universitário de Lisboa (ISCTE-IUL)00.00112.5012.22
Total37100.008100.0045100.00
Health Disciplines
Bioethics12.7000.0012.22
Health Management12.7000.0012.22
Intercultural Relationships12.7000.0012.22
Medicine12.7000.0012.22
Nursing513.51675.001124.44
Palliative Care616.2200.00613.33
Physiotherapy12.7000.0012.22
Psychology2156.76112.502248.89
Sociology00.00112.5012.22
Total35100.008100.0045100.00
Methodological approach
Quantitative2464.86450.002862.22
Qualitative513.51112.50613.33
Mixed-methods25.41225.0048.89
Not explicit616.22112.50715.56
Total37100.008100.0045100.00
Participants
Meditative practitioners12.5600.0012.13
Key-informants12.5600.0012.13
People with a chronic disease615.38450.001021.28
People with acute illness00.00112.5012.13
Elderly615.3800.00612.77
Adults615.38112.50714.89
Adolescents12.5600.0012.13
People with psychiatric conditions12.5600.0012.13
Caregivers12.5600.0012.13
Nurses37.69225.00510.64
Health professionals410.2600.0048.51
Parents12.5600.0012.13
Spiritual leaders12.5600.0012.13
Students410.2600.0048.51
Individuals12.5600.0012.13
Volunteers25.1300.0024.26
Total39100.008100.0047100.00
Themes
Caregivers of the elderly12.4400.0012.04
Death24.8800.0024.08
Diabetes12.44112.5024.08
Diagnostic validation00.00112.5012.04
Education24.8800.0024.08
Elderly37.3200.0036.12
Emotions/resilience12.4400.0012.04
End of life12.44112.5024.08
Health centers and family health units12.4400.0012.04
Health professionals12.4400.0012.04
Hospital care00.00112.5012.04
Hospitalized patient00.00112.5012.04
Institutionalized and community-based elderly12.4400.0012.04
Loneliness12.4400.0012.04
Meditative practices24.88112.5036.12
Mental health512.2000.00510.20
Oncology614.6300.00612.24
Organizations12.4400.0012.04
Palliative care37.3200.0036.12
Parents and teenagers/shame/anxiety12.4400.0012.04
Psychopathological symptoms12.4400.0012.04
Religiosity/religious practices12.4400.0012.04
Spiritual care12.44112.5024.08
Spiritual distress24.88112.5036.12
Validation of scales24.8800.0024.08
Volunteers12.4400.0012.04
Total41100.008100.0049100.00

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Romeiro, J.; Martins, H.; Pinto, S.; Caldeira, S. Review and Characterization of Portuguese Theses, Dissertations, and Papers about Spirituality in Health. Religions 2018, 9, 271. https://doi.org/10.3390/rel9090271

AMA Style

Romeiro J, Martins H, Pinto S, Caldeira S. Review and Characterization of Portuguese Theses, Dissertations, and Papers about Spirituality in Health. Religions. 2018; 9(9):271. https://doi.org/10.3390/rel9090271

Chicago/Turabian Style

Romeiro, Joana, Helga Martins, Sara Pinto, and Sílvia Caldeira. 2018. "Review and Characterization of Portuguese Theses, Dissertations, and Papers about Spirituality in Health" Religions 9, no. 9: 271. https://doi.org/10.3390/rel9090271

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