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Hope, the Foundation of Spiritual Health in Adolescents: A Qualitative Study

AUTHORS

Azam Shirinabadi Farahani 1 , Maryam Rassouli 2 , * , Farideh Yaghmaie 3 , Hamid Alavi Majd 4

AUTHORS INFORMATION

1 Department of Pediatric Nursing, School of Nursing and Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

2 Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

3 Department of Nursing, Zanjan Branch, Islamic Azad University, Zanjan, IR Iran

4 School of Para medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

ARTICLE INFORMATION

Iranian Red Crescent Medical Journal: 18 (12); e29328
Published Online: August 24, 2016
Article Type: Research Article
Received: April 23, 2015
Revised: May 24, 2015
Accepted: June 16, 2015
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Abstract

Background: Adolescence is a critical period in the life of human beings characterized by risk-taking behavior as one of its prominent features that affects the adolescent’s health. There is a direct relationship between spirituality and health-risk behaviors, indicating the need for promoting preventive interventions.

Objectives: The present study aims to explain the concept of hope as a component of spiritual health from the perspective of adolescents.

Methods: This qualitative study was conducted using the content analysis approach. Data were collected through in-depth, semi-structured interviews with high school students in Tehran (the capital city of Iran) who were selected through purposive sampling and with maximum diversity.

Results: Analysis of the data led to the identification of three categories: “connection with the source of hope,” “belief in finding solutions through efforts,” and “having an optimistic view”; the categories together formed the common theme “hope, the foundation of inner peace.”

Conclusions: Through effective interventions, health care providers are able to foster hope in adolescents and thus improve their spiritual heath.

Keywords

Hope Spirituality Health Adolescent

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background

Adolescence is one of the most critical stages of human growth and development, and is characterized by rapid changes in the physical, emotional, cognitive, and social dimensions (1). Adolescence is an important, sensitive, and a complex period in human growth (2). Adolescents are a vulnerable group considered risk-takers for the most part of this phase (3).

There is a direct relationship between spirituality and health-risk behaviors in adolescents (4, 5). In this age group, spiritual health is considered a predictor of mental health (1, 6), and studies have shown that spirituality promotes health in adolescents (7-10). There is a positive relationship between spiritual health and quality of life and hope (11, 12). Faith and spiritual beliefs create positive expectations that inspire hope and optimism (13). Hope gives meaning to life (14, 15), and spirituality is the source of meaningfulness in life (16). Furthermore, there exists a direct positive relationship between hope, resilience, spirituality, and satisfaction with life (9, 17). In other words, spirituality and spiritual health increase with hope and life satisfaction (17). Hope signifies the emphasis on achieving special goals (18) and is a prospective thinking model that engages capabilities and involves target-setting, designing of strategies for achieving goals, and drawing of motivations for executing those strategies (19). Despite the great effects of culture on spiritual health and the relationship between hope and the various aspects of health (17), there are limited qualitative studies in literature that have examined the relationship between hope and spiritual health in healthy Iranian adolescents. Given that stress factors such as concern about the future are common among adolescents (20) and that they can adversely affect their health, health care providers can promote the outcomes of health in adolescents, and consequently in the entire community, through fostering hope in adolescents (2).

2. Objectives

The researcher therefore decided to examine the concept of hope and its effects on spiritual health in Iranian adolescents. The present study was conducted to explain the concept of hope as a component of spiritual health from the perspective of adolescents.

3. Methods

This qualitative study was conducted using the conventional content analysis approach to explain adolescents’ perception of the concept of hope as a component of spiritual health through the coding and extraction of categories from accumulated data (21). The study population consisted of adolescents in their last three years of high school who were studying at schools across Tehran (the capital city of Iran). The study inclusion criteria consisted of the adolescents’ willingness to participate in the study and to recount their own experiences, and being in a state of mental health. Participants were selected through purposive sampling and with maximum diversity in terms of age, gender, school year, discipline, and type of school (22). For example, to select the school, four types of schools with the highest frequency were selected. Data were collected through in-depth, semi-structured interviews using open-ended questions (23); the study spanned from May to August 2014. Data saturation occurred with 21 interviews, with no new data surfacing and the previous data merely being repeated (24). The interviews were performed by one person (the researcher), a Ph.D. student in Nursing (Pediatric Nursing). She was able to interact and communicate with adolescents as she has worked with this age group. She is also familiar with the concepts of health, hope, and spirituality.

Interviews began with a general open-ended question such as, “what is your opinion of health?” and continued with questions leading to the main study question, that is, “what is the role of hopefulness in creating spiritual health?” Interviews lasted between 20 and 85 minutes (depending on the students themselves), were recorded with their consent, and were conducted individually in one of the school classrooms or in a public place near the student’s residence. Data were analyzed using the conventional content analysis method and were promptly transcribed after each interview. To engage with the data, the researcher listened to the interviews and reviewed the transcripts several times (25). The qualitative data were ultimately analyzed in MAXQDA-10. The entire interviews were considered as units of analysis. The meaning and content of the interviews according to their content and context as the initial codes were extracted, and then classified and named according to their similarities. Discussion about the coding and classification processes continued until a consensus was reached. With the continuous comparison method, similar categories were merged and main themes showing the students’ perceptions were ultimately extracted (24, 25).

To ensure the accuracy and rigor of the data, Lincoln and Cuba’s four criteria for judging the scientific accuracy of qualitative studies were used: credibility, confirmability, dependability, and transferability (26). The researcher had a prolonged involvement with the topic of the study and the adolescents as participants of the study. Ample time was given to participants for collecting the data and their trust was won by establishing good rapports. Data were assessed continuously and analyzed promptly. All the stages were recorded and reported in detail to make their follow-up possible for others. Transferability of the data was also accounted for with regard to maximum diversity in the sampling stage.

This study was part of a nursing Ph.D. dissertation of the researcher, and approved by the ethics committee affiliated to Shahid Beheshti University of Medical Sciences. To respect the ethical principles and to protect the rights of the participants, the research complied with the codes of ethics. After obtaining a letter of introduction from the deputy for research at Shahid Beheshti University of Medical Sciences and getting permission for conducting interviews from the Tehran ministry of education, offices of each district, and managers of high schools from which the samples were selected, the researcher introduced herself to the participants and briefed them about the objectives and methods of the study. Then, written informed consent was obtained from the students about the voluntary nature of participation, permission to record interviews, anonymity, and the possibility to withdrawing from the study at any stage. The researcher’s plan for using the interviews while protecting their anonymity was reasserted at the end of each interview.

4. Results

The study participants included twenty-one 16- to 18-year-old adolescents. The demographic characteristics are presented in Tables 1 and 2.

Table 1. Participants’ Demographic Characteristics
ParticipantAge, yGradeDisciplineSchool Type
P117ThirdHigh schoolPublica
P217ThirdHigh schoolPrivateb
P316SecondTechnical schoolPrivate
P418FourthHigh schoolPrivate
P518ThirdTechnical schoolPublic
P616SecondHigh schoolPublic
P717ThirdTechnical schoolPublic
P816SecondTechnical schoolPublic
P918ThirdHigh schoolPublic
P1017ThirdHigh schoolPrivate
P1116SecondHigh schoolPublic exemplaryc
P1217ThirdHigh schoolSampadd
P1317SecondHigh schoolPublic
P1417ThirdTechnical schoolPublic
P1516SecondHigh schoolPrivate
P1618FourthHigh schoolPublic
P1716SecondTechnical schoolPublic
P1816SecondHigh schoolPublic
P1917FourthHigh schoolPublic
P2018FourthHigh schoolPublic
P2116SecondTechnical schoolPrivate

aSchools funded by the government.

bSchools funded by people’s contributions.

cSchools selecting students through entry tests.

dSchools directed under the national organization for development of exceptional talents.

Table 2. Participants’ Demographic Characteristics
CharacteristicQuantity (%)
Sex
Girl12 (57.14)
Boy9 (42.86)
Age, y
168 (38.10)
178 (38.10)
185 (23.80)
Grade
Second9 (42.86)
Third8 (38.10)
Fourth4 (19.04)
Discipline
High school14 (66.67)
Technical school7 (33.33)
School type
Publica13 (61.91)
Privateb6 (28.57)
Public exemplaryc1 (4.76)
Sampadd1 (4.76)

aSchools funded by the government.

bSchools funded by people's contributions.

cSchools selecting students through entry tests.

dSchools selecting students through entry tests.

Analysis of the data led to the identification of three categories: “connection with the source of hope,” “belief in finding solutions through efforts,” and “having an optimistic view”; together they formed a common theme “hope, the foundation of inner peace” (Table 3).

Table 3. Categories and Subcategories of the Main Theme ‘Hope, the Foundation of Inner Peace”
ThemeCategorySub-Category
Hope, the foundation of inner peaceConnection with the source of hopeRemembrance of God
The enduring presence of the caring God
Hope in the endless mercy of the Divine Trust or reliance
through effortsRelying on personal capabilities
Seeking out collective wisdom
Belief in the existence of several strategies
Having an optimistic viewBelief in the transitory nature of crises
Anticipating miracles
4.1. Connection With the Source of Hope

According to the participating adolescents, connection with the source of hope was the first requirement for achieving hope, which is the basis of inner peace and which brings spiritual health. This profound connection consists of two subcategories: the “remembrance of God” and “trust.”

As the first subcategory, the “remembrance of God” was defined as the constant presence of a caring God and the infinite Divine mercy. According to participants, the belief in the presence of God promises a safe haven that results in hope and ultimately peace: “I am sure there is a God that has created me and will always protect me and take my hand during the hard times. But non-believers feel lonely during times of hardship; it is as if there is no one to help them, which is what makes them lose their hope” (P11).

While stressing the attributes of God, participants claimed Him to be the cause of their hopefulness and believed “merciful” to be a becoming adjective for Him: “I believe that whatever I want from God from the bottom of my heart, God will grant me, unconditionally. God will surely help me during times of hardship, there’s no reluctance. When you feel this way, it motivates you to also put up with times of hardship” (P6).

“Trust” was another subcategory of “connection with the source of hope.” Hopefulness is a consequence of trust: “When I want to begin doing something, I place my trust in God; for instance, I say, ‘I place my trust in you God, to make this work out if it is for my good’. And God sees that I am making an effort and that I have placed my trust in Him, so He helps me and gives me whatever is for my good. This gives me peace of mind, or assurance that I will achieve my goal” (P9).

4.2. Belief in Finding a Solution Through Efforts

The belief in finding a solution is promising and a source of hope that then results in everlasting peace. This category consists of three subcategories: “relying on personal capabilities,” “seeking out collective wisdom,” and “belief in the existence of several strategies.” The adolescent participants of the study considered their personal capabilities, knowledge, and insight to play effective roles in finding solutions: “I try to solve my problems myself; I struggle with them because I know myself and because I consider myself fully capable of handling my problems. But I do a thorough research on the subject beforehand to see what I should do. When I do something that’s effective, which makes me feel good. I don’t tell my problems to anyone. Because, for instance, if I tell my mother, she makes it even more stressful” (P14).

Participants also stressed the importance of the belief in collective wisdom and using the principle of consultation: “I am used to seeking advice. Of course, when I have a problem I don’t know how to fix, I consult with people who are able and willing to help me. I think that it’s always good to consult with a wise person, whether it’s my father, my teacher, or a friend. What counts is the result, that the problem is fixed” (P15).

The belief in solving problems and in the existence of many different ways for finding a solution gives you peace and hopefulness. One participating adolescent asserted, “It makes me happy to think that there are still many different ways that I haven’t tried and many different things that I haven’t done that may end in finding a successful solution. This means having hope and being motivated” (P11).

4.3. Having an Optimistic View

To be positive and have an optimistic view is beyond an unfounded belief. It has a magnificent power for generating hope and peace. This category contains two subcategories: “belief in the transitory nature of crises” and “anticipating miracles.” Participants believed in the transitory nature of problems and talked about the magnificent effects of this belief: “In the face of problems, I try to remain collected. I’ve come to realize that nothing is forever. Problems, bad luck, none of them will stay forever; they come and go. This is what I myself believe, and my religion says the same thing. I assure myself that to make my problems disappear, I have to tolerate them” (P13). Miracle signifies the occurrence of an astounding and supernatural event, and waiting for a miracle is itself indicative of hope. Being hopeful and having a positive outlook brings peace.

One participant stated, “I believe in miracles and I believe that they are always possible. Of course, miracles of higher order concern only prophets, such as the Quran, but we, too, can experience small miracles. I have seen miracles myself. One time, on the way to an exam, a car nearly ran me over it stopped 2 cm from me. There was only 2 cm between us. Everybody said it was a miracle, that God had protected me. Had the car hit me, with such speed, who knows what would have happened? Miracles really help us when things are out of our control. You only need to have faith and understand it” (P1).

5. Discussion

The present study aimed to explain the concept of hopefulness as a component of spiritual health. As the foundation of peace, hopefulness produced three categories “connection with the source of hope,” “belief in finding solutions through efforts,” and "having an optimistic view.”

The adolescent participants of the study considered connection with the source of hope and with the essence of God as a determining factor for achieving peace and hopefulness. According to verse 28 of Surah Raad, “Those who have believed and whose hearts are assured by the remembrance of Allah. Unquestionably, by the remembrance of Allah hearts are assured.” They considered the remembrance of God to be the first step toward establishing this connection. The belief in God as the absolute power and having a connection with this superior power together help humans’ mental health (27, 28), enhance their confidence and peace (28), and increase hope in them (29).

The participating adolescents believed in the eternal presence of a caring God. This belief provides support to humans whenever needed (30). Most people believe in a superior power that protects them (31). People who adhere to the model of a “servant-loving God” find God’s presence next to them during times of hardship and use the hard times for the benefit of their own spiritual development and, therefore, possess a better mental health (32). Participants also talked about the endless mercy of a protector that facilitated their connection with Him and thus solidified hope in their soul. This human is hopeful of the Divine mercy and never drowns himself in hopelessness in the presence of the Divine. It is only non-believers that lose hope in God’s mercy (Surah Yusuf, verse 87).

Reliance on the unrivaled absolute is necessary for connecting with the Divine essence, who, as participants believed, brought them hope and peace. There is a significant relationship between the trust in God and hope in life (30). Reliance on God as advised in the form of religion leads to health and peace (27), peace and hope are important parts of life (33). The belief in finding solutions through efforts was the second determining factor the study participants took as effective in achieving hope and, subsequently, peace. In other words, they considered human efforts and capabilities most effective in finding solutions next in line after connection with the endless source of power. “And that there is not for man except that [good] for which he strives” (Surah Najm, verse 39). In fact, striving and making efforts is nothing but taking proper advantage of one’s capabilities and talents and is rather fulfilling duties that entail the individual’s physical, spiritual, and psychological efforts. This order entails numerous personal and collective consequences; for instance, it liberates humankind from futility and purposelessness, and makes him happy and hopeful (34).

Seeking out collective wisdom constituted the second subcategory. Participants said that they benefited from consultation for solving their problems, which then gave them hope and heartened them. It is a recommendation of the Quran to consult with others about different matters and the prophet was also encouraged to follow through with that recommendation (Surah Ali Imran, verse 159). The third subcategory was belief in the existence of several strategies. The participating adolescents said they were heartened through assuring themselves about the existence of several strategies yet remaining to be tried for solving the problem. In general, hopefulness has two dimensions: first, the motivational dimension, which intends to familiarize and accept the move toward one’s objectives; and second, the individual’s perceived capabilities, which intend to create and discover successful paths toward one’s objectives (35), as the empowerment of adolescents can improve their social health (36). The belief in the existence of several solutions for the problem one has faced and the obligation to find them have a crucial role in the actual solving of the problem and in the individual’s spirits and outlook.

In the present study, having an optimistic view and a positive attitude was proposed as a determining factor in achieving hope. There is a significant positive relationship between optimism and hope, as optimism is the tendency to believe that good things will happen in the future (35, 37). By optimism, humankind can find greater hope in his/her life (37). The belief in the transitory nature of crises was the first subcategory of this section. According to the participating adolescents, this belief could indeed foster hope in them. As commanded by the Quran, “Surely, with hardship comes ease” (Surah Inshirah, verse 6). Optimistic people often believe that bad events are only for that one moment and have nothing to do with the rest of life. A person such as that does not lose his hope during times of hardship, because he is certain that they will pass and that he will be rewarded for his patience (38); nurturing positive expectations through optimism creates positive feelings that encourage the individual in reaching his objectives despite all the obstacles. Optimism is a predictor of active coping behaviors, especially when stressors cannot be altered (37). Factors such as the coping style affect the individual’s degree of tolerance and patience (39). Anticipating miracles was another subcategory that the participating adolescents believed will complete the hopeful attitude. More than 80% of the people believed in miracles. The willingness to tell of miracles or supernatural phenomena increases when people have gained an extremely good and positive result out of an event (40).

Adolescence is a tumultuous period during which humans are more affected by the influx of emotions and change. This period is also intended for the formation of one’s social identity. Ending childhood and entering an adulthood of responsibilities is cause for stress. Taking risks and performing health-risk behaviors are dominant characteristics of this age that can affect the adolescent’s health. This truth reveals the need for paying greater attention to this age group and for promoting preventive interventions. Health has many different dimensions, including a spiritual dimension. The results of the present qualitative study showed that hope, which is defined by three categories “connection with the source of hope,” belief in finding solutions through efforts,” and "having an optimistic view” facilitates the achievement of peace and is considered the foundation of spiritual health. Health care providers can foster hope in adolescents through effective interventions. Reinforcing hope in adolescents is expected to improve their spiritual health as well.

Given the particular religious and local culture of Iran and its divergent description of the concept of spiritual health compared with other countries, the results of the present study can help enrich the existing knowledge on the subject and encourage scholars to explore and discuss the other components of spiritual health according to the country’s particular cultural and religious context. The strength of this study is that the adolescents’ perception of hope has been analyzed for the first time. However, the lack of rich resources examining spiritual health in different age groups, especially normal adolescents, in the country made comparison and discussion impossible, and this is considered a limitation of this study. Further studies should investigate the other components and dimensions of spiritual health according to the particular culture and bearing of different societies and in the other age groups as well.

Acknowledgements
Footnote
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