Consistent with research conducted on the general population, this initial review of the literature indicates a positive association between organizational and nonorganizational religiosity and mental health outcomes for various subgroups of patients and community members who are economically vulnerable. The research findings do contain important nuances, however. There is some indication that the effects may be stronger for low-income clinical populations that are coping with diseases such as cancer compared with low-income community members. Some studies point to contradictory effects of organizational and nonorganizational religiosity on mental and physical health outcomes. There are a limited number of studies of the effects of religion on overall general and physical health, and the results are inconclusive. Evaluations of secular cancer screening educational interventions convened or promoted by churches do not find that religiosity increases participation in diagnostic tests such as mammograms and pap smears for low-income women.
The literature focused on religion and health is voluminous and spans several outcomes. Going forward, this research area needs to develop large-scale data sets, longitudinal data collection, and more focused measures of religious health practices and religious beliefs. The causal mechanisms and paths that underlie the positive associations between religion and health have not been established. In sum, the literature to date leaves policymakers and practitioners with more questions than answers.
The religion and health research focused on the low-income population is sparse and needs to increase markedly to catch up to the research focused on the general population. Thus, the first gap to address is the lack of research. Specific gaps in the current empirical research for the low-income population include:
- A lack of national longitudinal data collection that focuses on detailed measures of behavioral and physical health that includes comprehensive measures of religiosity for diverse religious groups, as well as preferences for religious or spiritually based health services.
- Inadequate measures of spirituality or religious beliefs and religious practices from diverse religions that are specific to health. Most measures focus on individuals religiosity in general and do not include religious practices from diverse religions. Religious measures are also not specific to economically vulnerable groups, such as barriers to church participation due to limited resources, stigma, or lack of churches in poor neighborhoods.
- Inconsistent distinctions between private or nonorganizational religiosity compared to public or organizational religiosity. Preliminary results show some indication that organizational religiosity may affect health outcomes differently compared with nonorganizational religiosity. These differences should be tested systematically.
- A lack of research on the effects of religiosity and spirituality on physical health, treatment, and use of health services. Most of the studies of physical health in the low-income population are based on self-ratings of health conditions without measures of provider assessments, biological markers, or diagnostic tests. It is unclear whether patients with higher levels of religiosity respond to treatments or take up services differently compared with less religious patients. When possible, studies of patients services utilization should be linked to insurance claims data.
- Inconsistent testing of mediating pathways between religion and health and a lack of consistent set of control variables. It is unclear whether the effects of religiosity operate directly on health outcomes or indirectly through various mechanisms including increased social networks or peer effects or physiological processes. None of the studies in the low-income population controlled for secular activities that may influence health.
- A lack of systematic analysis of whether religiosity has any buffering effects or operates differently for particular subgroups. There are a limited number of studies that examine differences in the effects by demographics and economic resources. Few studies examine whether religiosity exerts different effects depending on health status, acute and chronic conditions, and health insurance.
- Limited research designs that do not go beyond establishing correlations. Addressing selection issues and motivation to participate in religious activities has not been adequately addressed.
- A limited number of qualitative research studies focusing on religious and spiritual attitudes about health practices and how these practices and attitudes affect health behavior and interactions with health care providers.
- A lack of any experimental studies of programs that use religious messaging or curricula to improve health outcomes.
- Limited research on community religiosity and how attitudes and access to religious organizations affect individual health behaviors.