Understanding the Nature and Role of Spirituality in Relation to Coping and Health: A Conceptual Framework.

Abstract The past several years have seen a virtual explosion of research in the area of religion, spirituality, coping, and health. Despite this inundation, most studies have remained at the descriptive level of analysis. It has only been within the past few years that more complex associations, pathways (i.e., mediation), and possible models concerning the influence of religion and/or spirituality on health have been investigated. One psychosocial model of adjustment that holds promise as a potential scaffold for the organization and understanding of these vast data on spirituality is the transactional model of stress and coping originally put forth by Lazarus and Folkman (1984). The present paper uses the basic tenets (e.g., dynamic process) and structural components (e.g., coping behaviour) of the transactional model as a framework for the integration of the growing empirical literature on spirituality, coping, and health. The resultant application of the model in a spiritual context was reviewed by four spiritual care workers and/or chaplains from different religious backgrounds. These multifaith chaplains critiqued the fit of this model in relation to their understanding of health and coping from their faith perspective and offered suggestions on modifications to the model that would create a better fit. Over the past 20 years, the study of religion, spirituality, and coping has become an abundant area of research. This surge in interest in religion and spirituality may be due to the fact that many people turn toward their faith under extreme circumstances such as severe illness (Ganzevoort, 1998; Oxman, Freeman, & Manheimer, 1995). Religious coping in particular has demonstrated associations with a variety of social, personal, and situational factors, as well as links to psychological and physical health (Harrison, Koenig, Hays, Eme-Akwari, & Pargament, 2001; Koenig & Futterman, 1996). As a result, attempts have been made to integrate aspects of religiosity and spirituality into psychosocial models of adjustment (e.g., Daaleman, Kuckelman Cobb, & Frey, 2001). While these models are insightful, they often present religiosity as having a cognitive role (Dull & Skokan, 1995), thus ignoring its other possible functions in the overall coping process. As well, such models can be limited in their focus on a Christian view of religion (Nooney & Woodrum, 2002; Stolley, Buckwalter, & Koenig, 1999) rather than on what could be considered the broader concept of spirituality (Stifoss-Hanssen, 1999). The purpose of this paper is to organize and integrate the diverse findings and concepts found within this literature into a conceptual model of the role of spirituality in coping. In its vastness, the existing literature on spirituality, coping, and health can be overwhelming to the established, as well as to the new, researcher in this area. Although rich in possibility, this literature is plagued by a lack of consistency in the definitions given to spirituality, the domains of spirituality investigated, and in the diverse measures used to assess spirituality. As a whole, the empirical work also tends to remain at the descriptive level with little reference to an overarching conceptual model that could guide hypotheses and set the groundwork for the investigation of specific pathways of effect among the various spiritual constructs. As a leading researcher in this field, Pargament (1997) makes reference to the transactional model of stress and coping (Lazarus & Folkman, 1984) as a potential point of departure for understanding and organizing research on religiosity and spirituality. Notably, he has focused on the process of religious coping behaviour with some additional emphasis on religious appraisals or attributions in response to various life stressors (e.g., Pargament & Hahn, 1986; Pargament, Koenig, & Perez, 2000). Pargament continues to expand the application of these religious and spiritual domains in the coping process, most recently addressing the importance of spiritual attachment (connection) to God as a key factor in driving the religious coping process (Belavich & Pargament, 2002). …

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