Spirituality, Religious Involvement, and Health System Utilization in Tegucigalpa, Honduras
Background: Spirituality and religious practices can motivate proactive health behavior. Although beliefs and practices may lead to different health behaviors, it is important to recognize the contribution of both to allopathic and complementary and alternative health system utilization. There is a lack of empirical research in this area, especially in Honduras, containing a culture rich in spirituality and religious affiliation.
Methods: Ethical review boards at Duke University and the National Autonomous University of Honduras approved the study protocol. A cross-sectional questionnaire survey was administered in urban Tegucigalpa, Honduras, and a final sample of 600 respondents was obtained. The primary independent measures were self-rated spirituality, religious affiliation, church attendance, and private devotion time. The primary outcome measures were: 1) hypothetical health system use, 2) an estimate of actual preventive health system use, 3) an estimate of actual curative health system use, and 4) an estimate of the relative risk of non-adherent behavior using the Medication Adherence Report Scale (MARS).
Results: Among the 600 respondents of the final sample, 499 (83.2%) had seen a physician in the previous year, either for routine check-up or for "sick use" and received some form of medication. Fewer (430/600, 72.0%) had used a complementary and alternative medical system or treatment (excluding prayer used for health reasons). The majority of respondents believed that natural medicine has no side effects (70.2%) and does not interfere with medicine from the physician (62.8%). Nearly all (93.2%) of the respondents felt that prayer was "very important" in curing sickness. Respondents were significantly more likely to prioritize the physician first, compared to natural medicine, if they were older than 25, had less than secondary education, were not a student, knew that natural medicine has harmful side effects, and knew natural medicine can interfere with medicine from a physician. Respondents were significantly more likely to use a combination first if they were 18-24 years old, had at least a secondary education, were unemployed, were students, and thought natural medicine does not interfere with medicine from the physician.
Self-rated spirituality, religious affiliation, church attendance, and private devotion time had significant crude associations with some, but not all, of the outcome measures. There were no significant associations with hypothetical health system use. Nearly two-thirds (65.9%) of those who associated with a specific religion went to a physician for a routine check-up last year compared to 43.0% of those who did not (p<0.001). Among those who attended church, 67.3% went for a routine check-up compared to 44.0% of those who did not attend (p<0.001). In addition, 64.9% of respondents who had a private devotion time, compared to 40.3% of those who did not, had a routine check-up (p<0.001). Self-rated spirituality had only a mild association with having a routine check-up (p<0.05) and using non-prayer complementary and alternative medicine (p<0.05). Those who associated with a religion were more likely to have received some form of medicine from an allopathic physician last year (80.7% vs. 61.3%, p<0.001). Likewise, 82.0% percent of churchgoers compared to 62.7% of those that did not go to church received medicine (p<0.001). Finally, 58.9% of those with a daily private devotion time, compared to 44.2% of those without one, reported adherent behavior (p<0.01).
Conclusion: Self-rated spirituality and religious involvement are significantly associated with the utilization of the preventive and curative allopathic health systems and adherence to medication in Tegucigalpa, Honduras. These findings deserve further consideration and have implications in both health policy and patient care in Honduras, a country with a thriving spiritual and religious culture.
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