Impact of spiritual beliefs and faith-based interventions on diabetes management

Table 1 Empirical results on the impact of spiritual beliefs on diabetes management

Ref.	Study objective	Method/sample	Result
Darvyri et al[9]	To evaluate the impact of spirituality/religiosity on. T2DM management and to summarize the evidence regarding T2DM outcomes, as they are related to religiosity or spirituality of people with diabetes	A qualitative study (cross-sectional)	The results showed a positive relationship between religiosity/spirituality and improved T2DM management. It also suggests that participation in church and spiritual beliefs had ameliorating effects on stress levels and thus, on glycemic control of these patients with diabetes
Irajpour et al[29]	To explore the spiritual aspects of care for chronic Muslim patients	A qualitative-descriptive exploratory study was conducted in Isfahan, Iran, on a purposive sample of 25 participants, including patients, caregivers, nurses, physicians, psychologists, social workers, and religious counselors	The spiritual aspects of care for chronic Muslim patients fell into four main themes. Among the four major themes was the religious aspect, including doing religious rituals, attention to religious values, and providing the possibility of performing religious practices. The second theme is the pastoral aspect, which consisted of giving consultation for finding the meaning of life/death, achieving intellectual transcendence, and improving the patient's communication with herself/himself and others
Amadi et al[37]	To assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected socio-demographic variables (age, gender and occupational status)	Cross-sectional study (simple random sampling)	Participants in this study varied in their use of religion to cope with the stress of living with diabetes mellitus or depression according to their socio-demographic profile. Younger people with depression and diabetes used religious resources and religious coping methods to the same extent
Adejumo et al[38]	This study aimed to relate the psychosocial effects ofreligion and culture with the awareness, knowledge and attitude of Nigerians regarding diabetes prevention and care	Cross-sectional study (multi-centered random sampling)	Neglecting diabetes: 42% thought that if diabetes was neglected it could lead to kidney failure, and 23% thought it could lead to heart failure. Only 0.3% thought that neglecting diabetes could result in limb amputation 49% of patients would consult a doctor if they were ill, 43% would talk to family members, and 5% to their religious leaders. There were 7% who said they would comply with religious leaders in the management of diabetes. In terms of disease prevention, 7% of the participants would value their religious leaders
Heidarzadeh et al[39]	To explore the spiritual growth and its dimensions in the patients with type II diabetes mellitus	A qualitative study was conducted on adult patients with a history of at least one year of type II diabetes mellitus	The data analysis led to the emergence of 237 codes, three main themes, and seven subthemes. The primary themes included a tendency to spirituality, God-centeredness, and moral growth
Watkins et al[40]	To investigate the relationship among spiritual and religious beliefs and practices, social support, and diabetes self-care activities in African Americans with type 2 diabetes, hypothesizing that there would be a positive association	A cross-sectional design that focused on baseline data from a larger randomized control trial in132 participants: most were women, middle-aged, obese, single, high school educated, and not employed	Significant relationships between spiritual and religious beliefs and practices and general diet. Additional significant relationships were found for social support with general diet, specific diet, and foot care
Martinez et al[41]	To examined client opinions about, and experiences with religious interventions in psychotherapy	A sample of 152 clients at acounselling center of a University sponsored by the Church of Jesus Christ of Latter-day Saintscompleted a survey with ratings of specific religious interventions with regards toappropriateness, helpfulness, and prevalence	Out-of-session religious interventions were considered more appropriate by clients than in-session religious interventions, but in-session interventions were rated as more helpful

T2DM: Type 2 diabetes mellitus.

Table 2 Studies on the impact of faith-based interventions on diabetes management

Ref.	Topic	Study objective	Sample	Intervention	Result
Duru et al[47]	Sisters in Motion: A randomized controlled trial of a faith-based physical activity intervention	To evaluate a faith-based intervention (“Sisters in Motion”) intended to increase walking among older, sedentary African American women	Sixty-two African American women > 60 yr	Multi-component curriculum including scripture readings, prayer, goal-setting, a community resource guide, and walking competitions. Both intervention and control participants participated in physical activity sessions	At 6 mo, intervention participants had increased their weekly steps by 9883 on average, compared to an increase of 2426 for controls (P = 0.016); SBP decreased on average by 12.5 mmHg among intervention participants and only 1.5 mmHg among controls (P = 0.007)
Fitzgibbonet al[64]	Results of a faith-based weight loss intervention for black women	The goals of the study were to estimate the effects of a 12-wk culturally tailored, faith-based weight loss intervention on weight loss, dietary fat consumption and physical activity	Fifty-nine overweight/obese black women were randomized to one of the two interventions	"Faith on the Move," intervention	Although the results were not statistically significant, the effect size suggests that the addition of the faith component improved results.
Sattinet al[65]	Community trial of a faith-based lifestyle intervention to prevent diabetes among African-Americans	To reduce weight and fasting plasma glucoseand increase physical activityfrom baseline to week-12 and to month-12 among overweight parishioners through a faith-based adaptation of the diabetes prevention program called “FBAS”	604 African Americans, aged 20 to 64 years single-blinded, cluster-randomized, community trial	FBAS is an adapted faith-based diabetes prevention program	FBASparticipants had a significant difference in adjusted weight loss compared with those in HE (2.62 kg vs 0.50 kg, P = 0.001) at 12-wk and (2.39 kg vs − 0.465 kg, P = 0.005) at 12-mo and were more likely (13%) than HE participants (3%) to achieve a 7% weight loss (P < 0.001) at 12-wk and a 7% weight loss (19% vs 8%, P < 0.001) at 12-mo.
Gutierrez et al[66]	Health, community, and spirituality: Evaluation of a multicultural faith-based diabetes prevention program	To evaluate FFF, a faith-based diabetes prevention program for black and Latino congregants at churches in low-income New York City neighborhoods	Participants (n = 183)	FFF, a faith-based diabetes prevention program. FFF is a 12-wk, bilingual program developed by the Bronx Health REACH Coalition, FFF includes nutrition education and fitness activities while incorporating Bible-based teachings that encourage healthy lifestyles	Participants reported statistically significant improvements in knowledge and healthy behaviors from baseline. Increased numbers of participants reported exercising in the past 30 d, eating fruit daily, being able to judge portion sizes, and reading food labels
Frank et al[67]	A faith-based screening/education program for diabetes, CVD, and stroke in rural African Americans	To investigate the effectiveness of a faith-based screening/education program for reducing diabetes, cardiovascular diseases, and stroke in rural African Americans	120 parishioners from African American churches	The program included education about the prevention of diabetes and cardiovascular diseases	Positive feedback was recorded by both pastors and participants
Rhodes et al[68]	Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis	To assess costs and cost-effectiveness of implementing FBAS, a church-based 18-session lifestyle education intervention for African Americans	604 overweight participants in 20 churches	FBAS, a church-based 18-session lifestyle education intervention	Per-person intervention cost of FBAS was $50.39 more than HE ($442.22 vs $391.83 per person), and adjusted differences in weight change (1.9 kg [95%CI: 1.0-2.8]) and waist circumference (2.4 cm [95%CI: 1.3-3.4]) were both significant. For a modest increase in cost, FBAS led to greater weight and waist reductions among African Americans in a church setting
McElfish et al[69]	Design of comparative effectiveness of a randomized controlled trial testing a WORD DPP vs a PILI DPP for Marshallese in the United States	To investigate the comparative effectiveness trial testing 2 DPP interventions designed to reduce participant's weight, lower HbA1c, encourage healthy eating and increase physical activity	384 Marshallese participants from 32 churches located in Arkansas, Kansas, Missouri, and Oklahoma	WORD DPP focuses on connecting faith and health to attain a healthy weight, eat healthily, and be more physically active. In contrast, PILI DPP is a family and community-focused DPP curriculum specifically adapted for implementation in Pacific Islander communities	Ongoing
Goode[70]	The effect of a diabetes self-management program for African Americans in a faith-based setting (pilot study)	To test a 6-wk faith-based diabetes self-management program for African American adults diagnosed with diabetes	32 African Americans 18 yr or older participate in the study	Diabetes self-management education intervention	There were significant improvements among participants in diabetes knowledge, self-efficacy, diabetes symptom management, and improvements in diabetes self-care activities (diet, exercise, and foot care)

CVD: Cardiovascular disease; DPP: Diabetes prevention program; FBAS: Fit body and soul; FFF: Fine, fit, and fabulous; PILI DPP: Pacific culturally adapted diabetes prevention program; WORD DPP: Faith-based diabetes prevention program.