Qualitative research studies point to the saliency of the emerging positive findings gleaned from the quantitative literature. Several studies that draw on one-on-one interviews, focus groups, and longitudinal ethnography find that organizational religiosity such as church membership, attendance, and social networks as well as individual religious and spiritual beliefs and prayer buoy mental health and increase positive coping with illnesses such as cancer (Collins, Villagran, & Sparks, 2008), chronic illness (Shawler & Logsdon, 2007), and arthritis (Abraído-Lanza, Guier, & Revenson, 1996). Black (1999) finds that elderly African American women living in poverty view their relationship with God as a partnership that allows them to keep their despair at bay and liberates them from their experiences of economic hardship.
Two studies of economically disadvantaged women find a more nuanced picture of religious coping. These women use religion as a way to understand and cope with illness and disability; however, religion is not viewed as a passive coping strategy when dealing with health issues and interacting with health providers (Abrums, 2000; Parish, Magaha, & Cassiman, 2008). Instead, the women interviewed in these studies consider their strong religious beliefs to be an active resistance strategy that helps them positively interact with health care providers even though they perceive providers as having negative stereotypes about their health practices (Abrums, 2000). While these women may not trust health providers, they follow their treatment advice and regimens because they believe that God is operating through them and therefore appropriately handling their health care.
Findings from qualitative studies also highlight the connection religiosity has to individuals ability or motivation for problem-solving that improves mental health. One study finds that strong spiritual beliefs in a higher power, especially when they are connected with beliefs about purpose, motivation, and learning from experiences, encourage positive health behaviors and help treat depression symptoms in a sample of inner-city pregnant and parenting teenagers (Shanok & Miller, 2007). Similarly, female child abuse survivors reported that their transition to positive behaviors involved a spiritual connection that allowed them to reframe their negative experiences to focus on what can be learned from them to move beyond them (Hall, 2003).
Although the qualitative studies point to the positive coping of religiosity, there are studies that highlight the complexity of religious beliefs that could act as both positive and negative coping mechanisms affecting mental health. One example includes a study of cancer patients of Mexican origin by Collins et al. (2008). Study participants use prayer to God as an active way to ask for help and gain strength or luchar (fight) to deal with their family members health problems. However, the study also finds negative religious coping that can lead to feelings of loss of control over the treatment of the disease and the avoidance of treatment information.
Another important issue raised in the qualitative research is that organizational religion is not always available to low-income elderly and nonelderly disabled who are too ill or frail to participate in church. It could be that strong religious beliefs coupled with limited ability to participate in organizational activities negatively influence overall mental health (Shawler & Logsdon, 2008). In sum, although the importance of religious beliefs and coping are confirmed by the qualitative studies, these findings point to the need for more tailored measures of religious beliefs, and the testing of a broader set of mediating pathways in quantitative models in order to disentangle positive and negative effects of religiosity.
2. Are various dimensions of religiosity and spirituality associated with better physical and self-rated health status among low-income populations?
The research literature in the area of physical health is not developed enough to draw any general conclusions about the effects for the low-income population.
The research literature in the area of physical health is not developed enough to draw any general conclusions about the effects for the low-income population. Because there are few studies that examine the relationship between religiosity and any one physical health indicator for the low-income population, the answer to this question is that it is too soon to tell. Table 5-2 highlights this review, which identifies 5 studies of diverse physical health outcomes that include self-ratings of chronic conditions such as asthma, arthritis, hypertension and diabetes, overall rating of health, physical quality of life, and records of dental caries (the number of untreated decayed surfaces on teeth). The findings from these 5 studies show positive, negative and null effects.