RELIGION, SPIRITUALITY AND CULTURE 101

What are we talking about when we talk about religion, spirituality or culture? 

Religion: Religion typically refers to a set of beliefs or practices concerned with the nature and meaning of existence. Many religions center on a transcendent force or power, like gods or a God. Others focus on achieving various forms of peace or enlightenment [1, 2].

Spirituality: Spirituality revolves around something beyond the physical self. It may involve a sense of purpose, meaning, hope, wholeness, or connection. Although spirituality is frequently associated with religion, people can express spirituality in non-religious contexts [3]. 

Culture: Culture is a complex set of interrelated features such as values, conventions, and beliefs that a group of people share. Culture may include religion, language, and art. People often use culture to interpret the world, including the behavior of others. Cultures evolve over time, and there is often a great deal of diversity within a culture [4]. 

Why do religion, spirituality and culture matter in healthcare?

There are so many different religions, forms of spirituality, and cultures that we are unable to cover each in the depth that they deserve. Therefore, we will write broadly while providing specific examples. Spirituality is clearly important in hospitals, as the presence of multi-faith chapels and chaplains indicates. However, other members of the health care team do not usually address spirituality. Various analyses point to the need to consider spirituality when providing health care. For instance, one multisite study of cancer patients found that 88% considered spirituality important to them, but that 72% reported having cancer care providers who didn’t meet their spiritual needs. Those with unmet spiritual needs experienced lower quality of care, satisfaction with care, and quality of life [5]. Being aware of a patient’s method of expressing spirituality also helps physicians understand patients’ priorities, which leads to better treatment decisions [6].

It is important to ensure that health care accounts for the diversity of spirituality, religion, and culture. These systems often come with practices relevant to health care, including dietary choices, preferred gender for providers, and traditional medicine [7]. For example, many Muslim patients pray five times a day in the direction of Mecca. The medical team should consider this practice when determining treatment plans, especially for long-term stays in the hospital. As another example, Hmong patients sometimes view illness differently from many people in the Western tradition; they often visit a shaman (txiv neeb) if their sickness does not have a physical manifestation [8]. To accommodate the large Hmong population in Merced, California, the Mercy Medical Center created a program in which people can request a certified shaman to treat their illness [9]. 

Xia Vang, a Hmong shaman, holds some of the tools she uses in Hmong healing ceremonies. Photo: Dignity Health [8]

What do we know about religion, spirituality and culture in medical and health professions education?

Science and religion were historically intertwined, until a shift away from spirituality in medicine in the twentieth century [9]. Now, medical education is increasingly recognizing the effect that religion and spirituality have on patients’ health. Upwards of 75% of U.S. medical schools have incorporated awareness of spirituality and religion into their curriculum [10]. Still, there is a difference between theory and practice; one survey found that, although 85% of physicians say they should be aware of their patient’s spiritual beliefs, fewer than 10% of providers actually ask about spirituality [11]. 

Related to the importance of recognizing a patient’s spirituality, there has been an increased effort to educate medical and health professionals on the importance of cultural humility, or our willingness to learn about the culture of others and acknowledge our own assumptions [12]. Despite the call to incorporate this concept into medical education, teaching the fundamental elements of cultural humility seems to remain a challenge in medical education. Many argue that there needs to be more research on how to teach cultural humility to future health care workers [12, 13].

How does the Bias Checklist address religion, spirituality and culture in health professions education content?

The Bias Checklist first asks: 

  • “Does the content include any mention of religion, spirituality or culture?”

If you answer no, you will be prompted to consider whether your content should mention religion, spirituality or culture.

Below are some examples of common ways in which bias, shame, stereotype and stigma toward religion, spirituality and culture can manifest in health professions education content:

  • Mocking particular religious beliefs, especially those that are considered "outside" of the mainstream

  • Presenting all deeply religious patients as irrational or rejecting mainstream medicine

  • Treating religious objections to certain types of medical intervention as more worthy of consideration than other personal beliefs

  • Any other comment about this subject that is meant to elicit laughter

Last, the Checklist asks: 

  • “Could the content be perceived as promoting stereotypes, bias, shame or stigma?”

What can we do to address this problem?

Content examples are coming soon!

Where can I go to learn more? 

I learn best by…

Reading

  • “Understanding the Role of Spirituality in Medicine: A Resource for Medical Students” by James Behan, et al. Available online at: https://www.aamc.org/media/24831/download →

  • Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice, edited by Michael Balboni and John Peteet

Watching

Listening

Need a consultation?

The following people have identified themselves as experts in aspects of religion, spirituality and culture as they relate to health professions education and are willing to be contacted with questions regarding your content.

  • Cultural humility: Nayla Khoury, MD, Assistant Professor of Psychiatry, SUNY Upstate Medical University (email: khouryn@upstate.edu)

  • Religion and medicine: Robert R. Lebel, MD, Professor of Pediatrics, SUNY Upstate Medical University (email: lebelr@upstate.edu)

Have something to add? 

Email us at biaschecklist@gmail.com with any of the following:

  • Recommendations for additional important content to include above, or suggested corrections or clarifications → use the subject header “Religion, Spirituality and Culture 101 - Correction”

  • Suggestions for additional questions to add to the Bias Checklist → use the subject header “Religion, Spirituality and Culture 101 - Checklist Question”

  • Suggestions for additional resources for learning more → use the subject header “Religion, Spirituality and Culture 101 - Learn More”

  • Examples of curricular bias, including before and after versions of content → use the subject header “Religion, Spirituality and Culture 101 - Example”

  • Your name, credentials, affiliation, area(s) of expertise, and brief biography or summary of qualifications if you are willing to serve as an expert consultant → use the subject header “Religion, Spirituality and Culture 101 - Consultant”

References

  1. Encyclopedia Britannica. (August 14, 2023). Religion. https://www.britannica.com/topic/religion

  2. History.com Editors. (September 5, 2023). Buddhism. https://www.history.com/topics/religion/buddhism

  3. Siddall, Philip J., et al. (2015). Spirituality: What Is Its Role in Pain Medicine? Pain Medicine, 16(1), 51-60. https://doi.org/10.1111/pme.12511

  4. Spencer-Oatey, Helen. (2012). What is Culture? GlobalPAD Core Concepts. https://warwick.ac.uk/fac/soc/al/globalpad-rip/openhouse/interculturalskills_old/core_concept_compilations/global_pad_-_what_is_culture.pdf

  5. Lazenby, Mark. (2018). Understanding and Addressing the Religious and Spiritual Needs of Advanced Cancer Patients. Seminars in Oncology Nursing, 34(3), 274-283. https://www.clinicalkey.com/nursing/#!/content/playContent/1-s2.0-S0749208118300421

  6. Jimenez Maldonado, Alexis. (May 14, 2021). Spirituality and Health. Harvard Medical School Center for Primary Care. https://info.primarycare.hms.harvard.edu/review/spirituality-health

  7. Ayonrinde, Oyedeji. (2003). Importance of Cultural Sensitivity in Therapeutic Transactions. Dis Manage Health Outcomes, 11(4), 233-248. http://dx.doi.org/10.2165/00115677-200311040-00004

  8. Bion, Xenia Shih. (February 27, 2020). Hmong Community Planted Spiritual Roots in Merced Hospital. California Health Care Foundation. https://www.chcf.org/blog/hmong-community-planted-spiritual-roots-merced-hospital/

  9. Puchalski, Christina Maria. (2010). Religion, medicine, and spirituality. Asian Pacific Journal of Cancer Prevention, 11, 45-49. https://pubmed.ncbi.nlm.nih.gov/20590349/

  10. Herschkopf, Marta, et al. (2017). Religion and Spirituality in Medical Education. In M. Balboni & J. Peteet (Ed.), Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice (pp. 195-214). Oxford University Press. 

  11. Koenig, Harold G. (2004). Taking a Spiritual History. JAMA, 291(23), 2881-2882. 10.1001/jama.291.23.2881 

  12. Solchanyk, Daniel, et al. (2021). Integrating Cultural Humility into the Medical Education Curriculum. Teaching and Learning in Medicine, 33(5), 554-560. https://doi.org/10.1080/10401334.2021.1877711

  13. Isaacson, Mary. (2014). Clarifying Concepts: Cultural Humility or Competency. Journal of Professional Nursing, 30(3), 251-258. https://doi.org/10.1016/j.profnurs.2013.09.011

contributing writer(s)

Maddy Lee, MD Candidate

Sophie Pollack-Milgate, BA

last updated October 4, 2023