Health, Spirituality and Medical Ethics

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January 2022. Volume 8. Number 4
Hanieh Gholamnejad1 , Soolmaz Moosavi2 , Maryam Safara3*
1. Department of Medical-Surgical, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2. Department of Medical-Surgical, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3. Department of Psychology, Women Research Center, Alzahra University, Tehran, Iran.
* Corresponding Author:
Maryam Safara, PhD.
Address: Department of Psychology, Women Research Center, Alzahra University, Tehran, Iran.
E-mail: m.safara@alzahra.ac.ir
Review Article
Spiritual Health in Children: A Review Study
Background and Objectives: Achieving spiritual health is an aspect of human development and
there are differences in the spiritual health of children with adults. Despite the importance of the
issue of children’s spiritual health, there are very few studies in this field. Therefore, this review
study was conducted to review the knowledge about children’s spiritual health in the sources.
Methods: This scoping review study was performed using the JBI checklist. The electronic
databases of PubMed, Scopus, Ambis, Web of Science, Google Scholar, the database of Iranian
journals and magazines, and the database of the Jihad Daneshgahi Scientific Information Center
were searched for information.
Results: Spiritual health in children means awareness, inner experience of wonders, curiosity,
and belief in a strong force. The spiritual health in children are classified into three dimensions:
emotional, relational, and existential. Important factors affecting children’s spiritual health were the
child’s socio-cultural context, children’s own experiences, their relationship with others, parental
and media behaviors, and spiritual health outcomes, including a wide range of positive outcomes.
Conclusion: The findings of the present study showed that the concept of spiritual health and its
dimensions in children are as ambiguous as adults and also less attention has been paied to this
issue. On the other hand, based on the findings of the present study, most studies in this field have
been done in recent years, which could be a sign of increased sensitivity in this area. Therefore,
considering the important role and impact of the cultural context of each country, it is necessary
to conduct studies to explain the spiritual health of children and its indicators.
A B S T R A C T
Keywords:
Spiritual health, Child,
Spirituality, Family
Please cite this article as Gholamnejad H, Moosavi S, Safara M. Spiritual Health in Children: A Review Study. Health,
Spirituality and Medical Ethics Journal. 2022; 8(4):243-254. http://dx.doi.org/10.32598/hsmej.8.4.5
: http://dx.doi.org/10.32598/hsmej.8.4.5
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Article info:
Received: 21 Jul 2021
Accepted: 10 Nov 2021
Publish: 01 Jan 2022
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January 2022. Volume 8. Number 4
Introduction
ealth is one of the basic human needs that
plays an important role in sustainable
development [1]. Health is a comprehensive
and general concept that includes
physical, psychological, social, cultural,
emotional, and spiritual dimensions [2].
Enjoying spiritual health as one of the dimensions of
health [3] is a vague and complex process of human development
that provides coordination between the inner
forces of the individual. This dimension of health determines
the unity and integrity of the individual with the
characteristics of stability in life, peace, having a close
relationship with God, self, society, and environment [4].
According to Islamic knowledge, spiritual health is the
basis of human physical and mental health [5].
Spiritual health is a state with various levels, in which
the insights, tendencies, and abilities necessary for the
transcendence of the soul, which is the closeness to the
Almighty God, are provided so that all the God-given
powers and talents of man are used in a harmonious
and balanced way for this general goal, and internal and
external behaviors appear by them [6]. Despite much
research in the field of spiritual health, there is still no
single and comprehensive definition for it [7] and there
are also different views on spiritual health. Some scholars
in their studies consider spiritual health as believing
in the existence of God and performing religious practices
[8-10] and in fact defined spirituality in the context
of religion. On the other hand, secular views on spirituality
and spiritual health, which excludes religion from
spiritual health in general [11-15]. Also, some studies
consider striving for meaning and purpose and connecting
to a higher power as components of spiritual health,
while others consider self-awareness, connection to oneself
and others, and a superior reality as components of
spiritual health [16].
A review of studies shows that although the concept of
spiritual health is generally the same for all age groups,
there are differences in the spiritual health of children
with adults. For example, the free expression of emotions
or the occurrence of behaviors, such as laughing,
crying, screaming, running is mainly seen in children
[17]. However, in adults, self-control and anger are considered
components of spiritual health [18]. There is also
a need for approval from adults, presence at the moment
and purposeful activities to discover the world around,
visualize, play are specific components of children’s
spiritual health [17].
Achieving spiritual health is an ultimate goal for everyone.
Since each section or group of society has its specific
age, occupation, and skill requirements, the target
groups can be divided into different categories and specific
goals can be set for each with specific indicators. One
of these special groups is children. The spiritual health
of the child is focused on all aspects of his existence [19]
and despite its importance and impact on their physical
and emotional health, studies in this field are very
few and in the early stages. Understanding children’s
spirituality is an emerging field for research and lacks a
common or integrated theoretical framework [20]. Considering
the effects of spiritual health on the growth and
development of children and preventing the occurrence
of moral and behavioral crises in the later years of life,
the importance of studying and providing a comprehensive
definition of it seems necessary. Therefore, this
review study was conducted to review the knowledge
about children’s spiritual health in the sources.
Methods
This study is a scoping review that examines the extent
of research on children’s spiritual health to help understand
the knowledge available in this area. This study is
based on a systematic review checklist [written by Joanna
Briggs Institute (JBI)] [21].
Search strategy
This study was conducted from January 1, 2000, to
March 31, 2020, to find published studies on the spiritual
health of children based on the JBI systematic review
checklist. This checklist is designed to assess the methodological
quality of a study and includes 11 questions.
These questions examine the clarity of the research question,
the relevance of the inclusion criteria to the research
question, the search strategy appropriate to the research
question, the appropriateness of the resources sought,
methods for reducing errors in data extraction, and appropriate
methods for combining data [22].
The search consisted of three steps. In the first step, a
limited search was conducted on Medline and Google
Scholar, and the terms in the title and abstract of the
obtained articles were analyzed. In the second step, using
the keywords obtained from the first step, the search
syntax was designed and then a search was conducted
in all electronic databases of PubMed, Scopus, Embase,
Web of Science, Google Scholar, the database of Iranian
journals, and magazines (Magiran) and the database of
the Scientific Information Center of Jihad Daneshgahi
(SID). In the third stage, the references of the obtained
H
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
articles were examined to find related studies. The syntax
was used for systematic search in the PubMed database.
PubMed
The use keyword were spirituality ([MeSH Major Topic]
OR spiritualities [tiab] OR Religion [tiab] OR “spiritual
health” [tiab] OR spiritual wellbeing [tiab]) AND
(Children [tiab] OR Child [tiab] OR Minors [tiab] OR
Kids [tiab] OR pediatric [tiab]).
Study selection process
At this stage, studies were reviewed based on inclusion
and exclusion criteria. Inclusion criteria were as follows:
1- English or Persian language of study, 2- Focus
of study on children’s spiritual health, and 3- Results
on children’s spiritual health. Studies in the field of the
spiritual health of sick adults or children and in-hospital
conditions were excluded from the study.
Two independent researchers conducted an initial
screening of studies based on the title and abstract of the
articles. In the next step, these two researchers studied
the articles, in which it was possible to deal with the
spiritual health of children in more detail, by obtaining
their full text.
Data extraction and management
After discussing with the team members, information,
such as study details (author, publication date, type of journal,
place of study, purpose, design, type of study, sample
size, and main findings) and participants’ details (age and
gender) was extracted. The data extracted from the entered
studies were re-examined by all authors (Figure 1).
Results
Describing studies
From a total of 13820 extracted studies, 4533 study of
Web of Science, 3151 study of Scopus, 2695 of Embase,
2764 study of PubMed, 60 study of Google Scholar, 49
studies from Iranian publications and magazines, and 27
studies from the database of the SID Information Center
were obtained. In the first stage, repeated articles (5364
studies) were removed. In the second stage, 3816 studies
were excluded from studies due to the different titles
and purposes. In the third stage, the study abstract was
reviewed and 1904 studies were deleted and 169 studies
were excluded after the complete review of the study,
due to inappropriate content. Finally, 27 studies were
included for review (Flowchart No. 1). 27 studies were
from 2004 to 2020. Nearly half of these studies were car-
Figure 1. Flowchart of the screening of the studies based on the PRISMA chart
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
Table 1. Final accepted articles based on search protocol
Row Author/Year Country Type of Study/Purpose Results
1 Mata McMahon
et al., 2020 [23] America
Qualitative-grounded theory/
Perception of educators in
secular educational centers of
children’s spirituality
Children’s spirituality is in eight main areas of communication
(with the world, nature, and others), moral virtues, discovering
the meaning of life, belief in God, self-awareness, presence
at the moment, humanity, and inner feelings.
2 Michaelson, 2020
[24] Canada
Qualitative-content analysis/
Conceptualization and
definition of spiritual health in
children
The four dimensions of spiritual health include communication
with oneself, others, nature, and the higher power. Consequences
of spiritual health include feeling calm and in control
of oneself, being honest with oneself, having an open mind,
being balanced, taking time for oneself, and caring for oneself.
3
Polemikou and
Da Silva , 2020
[25]
Portugal
Quantitative-review/Understanding
the concept of spirituality
and spiritual development
in children
Spiritual relationships are defined as relationships with oneself,
others, God, and nature. Important dimensions of spirituality
include love, wonder, and amazement at the greatness
of the world, pleasure, ecstasy, ambition, integrity, beauty,
music, art, and science.
4 Dillen, 2020 [26] Philippines
Quantitative-review/Examining
the role of context on children’s
spirituality
context is a factor influencing the spirituality of children and in
addition to the living environment includes socio-cultural context
such as ethnicity and race and related factors such as age
and gender, socio-economic conditions, place of residence,
religious background, and children’s own experiences such as
illness, migration or death of parents.
5 Sajedi and Sajedi,
2020 [27] Iran
Qualitative-contractual content
analysis/Providing a definition
of spiritual health, determining
the components and indicators
of children’s spiritual health
from the perspective of experts
Indicators of spiritual health include theology and God-centeredness,
hope in God in all problems of life, obedience to
religious orders, modeling the lifestyle of Imams and using
them, knowing the Hereafter and its relationship with the
world. Parents’ behaviors can play a positive or negative role
in promoting children’s spiritual health.
6 Nauli and Mulyono,
2019 [28] Indonesia
Quantitative-correlation/
Determining the relationship
between children’s level of spirituality
and their resilience
Happy children, no stress and depression, easier control of
emotions, comfortable adaptation to circumstances are the
consequences of spirituality in children.
7 Heland-Kurzak,
2019 [29] Poland
Qualitative-phenomenology/A
study of the attitudes of
children of different religions
(Catholic, Orthodox, and
Protestant) towards God and
the differences in their level of
religion
Most children believe that God is merciful, very great, and
invisible. The best way to communicate with God is through
prayer, and helping other people, especially those in need, is
a way to please God
8 Harris, 2019 [30] America
Quantitative-case/Study of the
effect of Roger’s approach on
children’s spirituality
The search for spiritual identity occurs with the support of parents
and teachers through daily activities and communication
to discover the meaning of one’s existence and to share one’s
perceptions with peers. Emotions, tolerance, uniqueness, and
love are important elements of spirituality in children.
9 Mata-McMahon,
2020 [20] America
Qualitative-content analysis/
Examining school teachers’ perceptions
of ways to strengthen
children’s spirituality
Teaching appreciation of nature, thinking, and contemplation,
yoga, and meditation are important ways to strengthen the
spiritual health of children in school.
10 Robinson, 2019
[31] Australia
Qualitative-phenomenology/A
study of the experiences and
approaches of teachers in
religious centers on ways to
strengthen the spirituality of
children
Outdoor games such as planting and watering plants help children
grow spiritually. In addition, empathy and love for people
and strong relationships with adults are very important.
11 Mata-McMahon,
2019 [15] America
Qualitative-grounded theory/A
study of secular teachers’
perceptions of their spirituality
and the approaches they use to
strengthen children’s spirituality
Teachers through actions such as helping to express emotions
creatively through music, art, and dance, communicating with
nature such as thinking about nature, engaging in intellectual
activities such as yoga and prayer, communicating and respecting
others, playing and exercising, and finally talking about
spirituality contributes to spiritual growth.
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
Row Author/Year Country Type of Study/Purpose Results
12 Khazaei and
khazaei, 2018 [4] Iran
Quantitative-review/Study of
spirituality and spiritual health
in different religions
Spiritual health includes observing healthy behaviors such as
healthy eating, maintaining, providing, and promoting your
physical and mental health, and reducing stress. Its consequences
are ensuring peace, satisfaction, and vitality in the
community and disease prevention, increasing disease tolerance,
faster disease recovery.
13 Surr, 2016 [32] America
Qualitative-grounded theory/
Clarification of the concept of
spirituality to better educate
teachers to work with children
Methods of spirituality in children include happiness, kindness,
love for others, communication with friends and relatives,
curiosity about the environment, enjoyment of favorite
activities, creativity, and imagination. To strengthen children’s
spirituality, a calm and stress-free environment should be created.
Children should ask their questions freely and have the
opportunity to think in silence and calm.
14 Khani and Tammeh,
2016 [33] Iran
Qualitative-content analysis/
Identifying children’s spiritual
styles
The four main approaches for children to know God include
word-driven (reading books and teaching), emotion-driven
(nature), symbol-driven (prayer in times of trouble), and actiondriven
(helping the needy, fasting ..).
15
Meghdadi and
Javadpour, 2016
[6]
Iran
Quantitative-conceptual analysis/
Determining the foundation
of a child’s spiritual education
and the role of parents in
promoting it
Elements of spiritual health include: honesty, trustworthiness,
helping the weak, observing personal cleanliness, social skills such
as communicating with others and associating with worthy people,
kindness, self-control or patience, purposefulness and finding
meaning in life, doing individual and social spiritual affairs, Healthy
environment, clean nutrition, faith, trust in God and love. The consequences
of spiritual health include vitality, hope, satisfaction,
heartfelt confidence, having a healthy heart in the person, establishing
a dynamic relationship based on moral virtues, love, and affection
with oneself, others, and the world around.
16
Cervantes and
Arczynski, 2105
[34]
America
Quantitative-review/Determining
concepts related to spirituality
in children and providing a
practical solution
Spiritual health in children means increasing awareness, inner
experience of wonders, curiosity, belief in a strong force, and excellence
in the path of life.
17 Moriarty, 2013
[35] Australia
Qualitative-content analysis/
Examining the effect of exercise
on children’s spirituality
Physical activity and exercise increase sensory awareness, improve
relationships with others, and strengthen a child’s identity.
18 King, 2013 [36] British
Quantitative-review/Define
children’s spirituality and determine
the factors affecting it
Children’s spiritual world includes their living environment,
their dreams, hopes, experiences, fears, and pains. Factors affecting
the spiritual health of children are the teachings of parents,
teachers, and friends. The consequences of strengthening
spirituality include the deep discovery of the world, love of life,
creativity, acceptance of oneself as part of a larger society, and
contributing to world peace and tranquility.
19 Moore, 2012 [16] Canada
Qualitative-content analysis/Examining
children’s understanding
of spirituality and God
Having positive feelings when praying, talking to God in times of
sorrow, loneliness, and unhappiness, believing in the presence
of God everywhere, believing in God’s help directly and indirectly
in all matters, hearing God and answering their prayers, Belief
in the existence of the soul and belief in the mercy of God is part
of children’s perceptions of God.
20 Boynton, 2011
[37] Canada
Quantitative-review/Examine
the spirituality of children from
different perspectives
Spiritual health and religion have a semantic overlap. Spiritual
health has a great impact on the development of other aspects
of children’s lives. Cultural structure, values, ideals are effective
factors in children’s spiritual health. Spirituality affects children’s
health, happiness, and well-being.
21 Moore et al.,
2011 [38] America
Qualitative-content analysis/
Study of spiritual experiences of
children with different religious
backgrounds
The most common indicator of spirituality was praying and then
believing in the existence of God and His help in all stages of life.
The consequence of spirituality in children is mental health.
22 Bosacki et al.,
2010 [7] Canada
Quantitative-review/examining
the impact of different media
on children’s spirituality
Weekend activities such as attending church, reading religious
books by parents, listening to music, reading the Bible, watching
TV, and religious movies are the most common spiritual elements
in children’s lives that are influenced by the media.
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
ried out between 2018 and 2020. The highest number of
studies was related to the United States (n=9). Five study
was related to Muslim countries, of which four studies
were conducted in Iran. The number of studies in European
countries was five. Studies in non-Muslim countries
had different religions (Christian, Orthodox, Catholics,
and Muslims), and part of them were secular. The
number of writers varied from 1 to 4 people. Of the 27
articles entered in the study, 4 cases were in Persian and
23 cases in English. Methodologically, 13 cases were
qualitative and the rest were conducted in a quantitative
and overview method. Most qualitative and quantitative
studies followed the discovery of the concept of spirituality
in children and their ways to strengthen it (Table 1).
Findings showed that the spiritual health of children in
three areas of the concept of spiritual health, dimensions,
and indicators, factors affecting spiritual health, and the
outcome of spiritual health have been studied in studies.
At the heart of the concept of spiritual health and its dimensions
in children is the concept of increasing awareness,
inner experience of wonders, curiosity, belief in the
existence of a strong force [37]. On the other hand, spiritual
health as an important dimension of human health in
each person is different from the other and is a protective
factor for health and well-being, especially when facing
problems and helps to overcome problems [24]. Therefore,
spiritual health includes observing health behaviors
such as healthy eating, maintaining, providing, and promoting
one’s physical and mental health, and reducing
stress [4]. Some studies have shown that children’s spiritual
health is similar to that of adults in four dimensions:
relationship with self, others, nature, and superior power.
Communicating with oneself is about finding meaning in
life, being purposeful, and experiencing joy in life. Concerning
others, the important elements of spiritual health
include kindness, forgiveness, striving to make the world
a better place for others, and helping others. The dimension
of communication with the higher power includes
such things as communication with God, reading the Bible,
and doing religious affairs [24]. Moral virtues (love,
forgiveness, compassion, respect, non-judgment of others,
kindness, compassion, acceptance of circumstances,
and honesty), discovering the meaning of life (curiosity,
asking questions, accepting the opinions of others and
personal beliefs), belief in God (Talking about God and
religious books such as the Bible, reading the Bible,
believing in the soul), self-awareness (self-knowledge,
ability to move and do things within one’s ability), presence
at the moment, humanity and inner feelings (easy
expression of positive and negative emotions) also indicates
spiritual health [23].
Elements of spiritual health include honesty, trustworthiness,
helping the weak, observing personal cleanliness,
social skills such as communicating with others
and associating with worthy people, kindness, self-control
or enduring hardships, purposefulness and finding
meaning in life, doing Individual and social spiritual affairs,
improving the environment, clean nutrition, faith,
Row Author/Year Country Type of Study/Purpose Results
23
Ruddock and
Cameron, 2010
[39]
British
Quantitative-review/Determining
the concept of spirituality in
school-age children
Characteristics of children who grow up spiritually are values
and behaviors such as knowing and understanding the beliefs
of themselves and others, respecting themselves and others,
empathizing with and helping others, the ability to defend their
goals, values, principles and beliefs, value beauty, love, order,
goodness, truth and understanding your feelings and emotions.
24 Kirmani and Kirmani
,2009 [40] America
Qualitative-content analysis/
study of spiritual identity and its
impact on children
The spiritual identity of individuals manifests itself in one or
more of the following ways: Emotion centered Communitycentered
Nature-centered-World-centered-Ancestor-centered-
Event-centered-Transcendental-centered
25 Hyde, 2008 [10] Australia
Qualitative-phenomenology/
Determining the characteristics
of children’s spirituality in
Catholic schools
The four characteristics of spirituality in children include the
following: Presence at the moment - Consolidation of consciousness
- Search for meaning - Spiritual search
26 Takriti et al., 2006
[41] British
Qualitative-content analysis/
Determining the perception of
children with different religious
backgrounds from God
The most important attributes of God in performing miracles
are creation and kindness to all. Praying, going to religious
places, and wearing special clothes or food are considered religious
behaviors. Doing good deeds and avoiding bad deeds
are considered as part of religion.
27 Houskamp et al.,
2004 [17] America Quantitative-review/Determining
spirituality in children
Three spiritual dimensions in children include emotional, relational,
and existential.
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
trust in God and love [6]. Children’s spiritual world
includes their living environment, their dreams, hopes,
experiences, fears, and pains [36]. Emotions, tolerance,
uniqueness, and love are important elements of spirituality
in children [30].
Happiness, kindness, love for others, communication
with friends and relatives, curiosity about the environment,
enjoyment of favorite activities, creativity,
and imagination are the most important dimensions of
children’s spirituality from the perspective of John Surr
[32]. However, Bosacki et al. summarized the dimensions
of children’s spirituality in the religious dimension
and included activities such as attending church, reading
religious books by their parents, listening to music, reading
the Bible, watching TV, and watching religious films
were considered as spiritual elements in children’s lives
[7]. Ruddock et al. consider recognizing and understanding
the beliefs of oneself and others, respecting oneself
and others, empathizing with and helping others, being
able to defend the goals of one’s values, principles and
beliefs, valuing beauty, love, order, goodness, the truth,
and understanding of their feelings and emotions :as char:acteristics
of children who have developed spirituality
[39]. Hyde defines four characteristics of children’s spirituality:
1. Presence at the moment: Awareness of situations,
events, and people in the present. 2- Integrating
awareness: focusing on several situations 3- Searching
for meaning: curiosity and asking about the world around
and what happened. 4- Spiritual search: Relationship
with family, altruism, and helping the needy [10] In the
field of spiritual health indicators, few studies have been
done. Theology and God-centeredness, hope in God in
all problems of life, obedience to religious orders, modeling
the lifestyle of Imams and their help [27, 38], and
finally knowing the Hereafter and its relationship with
the world is one of the indicators of spiritual health [37].
The second focus of findings includes factors affecting
the spiritual health of children, a group of studies in addition
to the importance of individual characteristics of
the child such as age, gender, ethnicity, and race, as well
as children’s own experiences such as migration or death
of parents, emphasize the role of socio-cultural context,
religious background and socio-economic conditions of
the child on the spiritual health of the child. [24, 26, 28,
34, 37], Mata-McMahon et al. children’s relationships
with others such as family, teachers, friends and classmates,
relationships with nature, sports and games, music,
art and dance, thinking, and prayer are among the
factors affecting the spiritual health of children [15]. Sajedi
H and Sajedi A. show the behaviors of parents such
as religious education appropriate to the child’s capacity,
religious stories and films, and the role of various media
on the spiritual health of children [27]. According to
Robinson, empathy and love for people and strong relationships
with adults, and relationships with nature can
also affect a child’s spiritual health [31].
The focus of spiritual health outcomes illustrated a
wide range of positive outcomes. Meghdadi and Javadpour
considered the feeling of peace and self-control,
happiness, time and self-importance, hope, and dynamic
communication based on moral virtues with others and
the world around them as the most important consequences
of spiritual health in children [6]. In addition
to feeling happy and relaxed, Michaelson cited the lack
of stress and resilience to problems as consequences
of spiritual health [24]. In King’s study, the growth of
wisdom, love of life, and creativity were mentioned as
the consequences of spiritual health [36] and Boynton
pointed to the increase in quality of life and the feeling of
well-being resulting from spiritual health [37].
Discussion
In the focus of the concept of health and its dimensions,
an attempt has been made to explain the concept
of children’s spiritual health, but the findings of the study
showed that although studies have been done in this area,
this concept is vague and there is a consensus to define
this concept in children. does not have. So that each person
can have a different definition of spiritual health [42].
In addition, researchers in different fields have different
views on this field and everyone has expressed different
definitions and applications for spiritual health according
to their expertise. Some have defined spiritual health
in the field of medical sciences and for providing health
services [43]. While some people have defined spirituality
in the areas of belief, consciousness, and practice.
In their study of 73 studies using thematic analysis,
Sessanna et al. report that the concept of spirituality is
defined in four main themes: 1) Spirituality as a religious
system of beliefs and values (spirituality=religion). In
these studies, there is no distinction between spirituality
and religion, and the relationship between spirituality
and health is measured by religious practices and beliefs;
2) Spirituality is the meaning of life, purpose, and relationship
with others; In these studies, spirituality is defined
as the relationship with others and the relationship
with a superior being; 3) spirituality as a secular system,
a set of beliefs and values; In these studies, spirituality,
and religion are introduced as two separate phenomena;
4) Spirituality is introduced as a metaphysical concept or
transcendent phenomenon [44].
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
Although the results of studies show that there is rarely
a person without religious beliefs [45] and there is a relationship
between religion and spiritual health, but the
definition of spiritual health in different religions, despite
the commonalities, can be different, although the meaning
can be considered the main goal of all religions. In
the Islamic approach, God is the creator of all beings and
the universe and their life and death are in His hands.
According to Islamic teachings, the tendency towards
spirituality is rooted in the God-seeking nature of man
[46]. Therefore, it can be said that belief in God is the
common denominator of all religions. But differences
such as one-dimensionality, differences in values and
worldviews in different religions can be different and
affect spiritual health indicators. In humanist religions,
man is a material being and all his emotions and feelings
revolve around material issues. While from a religious
point of view, a healthy person is the result of spiritual
balance and unity of other dimensions. There are also
differences in meaning in different religions. In Islam,
meaning is manifested in faith and belief in God, while
in some religions, material issues are also involved [47].
Therefore, it seems that the definition and meaning of
spiritual health can be extracted from its application [48,
49] and this issue is especially important for planning in
the field of children and implementing measures for their
spiritual health [24]. Researchers consider spirituality and
spiritual health in children as an inherent dimension that
affects their communication, creativity, and interaction in
the outside world [50]. Thus, studies have used spiritual
health in the education of children, religious growth and
education, and in some studies, the role of spiritual health
during illness. In general, the findings of studies showed
that children’s spiritual health has four dimensions of
the relationship with self, God, others, and nature, and
to achieve spiritual health, it is necessary to improve and
strengthen communication in these four areas.
In terms of connection with God or the transcendent
being, children have a tendency and commitment to religious
issues, regardless of their affiliation with a particular
religion. In communicating with others, kindness
and forgiveness are important to children. In the field of
communication with self, finding meaning and happiness,
and in the field of communication with nature, having
passion and excitement in nature and loving it represents
the spiritual health of children [24]. Hay and Nye’s
model shows a sense of awareness, a sense of mystery,
and a sense of worth reflects the capacity of the child’s
spiritual health. A sense of awareness means understanding
the presence and ability to coordinate. A sense of mystery
refers to children’s interest and curiosity to know
the world in which they live. Children develop a wide
range of cognitive abilities from birth, based on which
they identify the world around them. Sense of value is
based on children’s ability to experience a range of emotions
from fear to happiness, from despair to hope [12].
It seems that the spiritual health of children needs
meaning in terms of insight, orientation, and habits.
Therefore, the child’s awareness and cognition, as well
as his mental information, should be such as to create
a deep belief in him and ultimately improve his behavior
and lifestyle. In other words, achieving and enjoying
spiritual health in four dimensions must be at different
levels of insight, orientation and behavior.
Based on the findings of the study, another focus of
studies in the field of the spiritual health of children is
to examine the factors affecting it. Spiritual health and
growth are highly dependent on the context that nurtures
this existential dimension. In this area, not only the
situation in which they experience spirituality but also
gender, socio-economic status and religion are important
here [51]. The environmental-social model refers
to the impact of different contexts on children’s spiritual
health. These areas include micro-systems (family,
school, peer group, or religious community) and macrosystems
(dominant cultural values and ideologies) [52].
The socio-cultural pattern shows the influence of adults
and peers. Parents, relatives, clergy, educators, older siblings,
and friends can act as mentors and role models.
Each of these individuals, as educators, can provide the
ground for spiritual connection and greater understanding
and interaction with collective rituals and worships
[53]. The interactive model expresses the interaction of
children and parents [42, 54]. Most studies have pointed
to the role of parents in children’s spiritual health. Sajedi
H. and Sajedi A. consider parenting education to be
the most important factor in promoting spiritual health
[27] and according to the teachings of Islam, attention
to spiritual health should be done before the formation
of sperm. Parents’ level of education, religious beliefs,
place of residence, type of nutrition, family communication
status all affect spiritual health [55]. Therefore,
spirituality and spiritual health in children is not a static
concept and is very much influenced by others, parents,
teachers, researchers, and peers [26].
There is very little research on cultural diversity [51].
Therefore, according to the findings of the study, it can
be said that the role of parents in spiritual education to
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
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January 2022. Volume 8. Number 4
achieve the spiritual health of the child is more prominent
than other factors, especially at younger ages. The child
can be very influenced by parents because of their trust
and interest in them and observing their behavior. Therefore,
it seems that parents’ self-awareness and understanding
of their important role is the first step to take steps in
the field of children’s spiritual health. Parents’ words and
the things they say are the easiest way to convey concepts.
However, it should be noted that direct verbal instruction,
especially if repeated, may reduce their desire.
Another important point is the coordination of parents’
verbal education with their behavior and performance
as well as their lifestyle. In such situations, the child
becomes distrustful of the principles and knowledge
learned over time by observing the contradictory behavior
of the parents. Informed, purposeful, and creative
parents for their child’s spiritual health use appropriate
and memorable opportunities for spiritual education and
seek to promote their child’s spiritual health by combining
different and effective methods [27]. In conclusion,
it can be said that the context of raising a child and the
context in which he grows up play a very important role
in spiritual health. Parents are the most important factors
affecting the spiritual health of children from birth and
also in different stages of life because parents are aware
of the influence of other factors such as friends, school,
etc. at every stage of the development process and as a
result take appropriate and timely action.
The next focus in spiritual health studies is to examine
the consequences of spiritual health in children. Considering
the role of spirituality and the importance of spiritual
health in the health of other dimensions, it seems that spiritual
health is effective on children’s vision and attitude
and has an effect on children’s success. Findings show
that spiritual health is effective on mental health, physical
health, and sense of well-being and also helps the child to
cope with problems by increasing adaptation [56].
Some studies have mentioned the consequences of spiritual
health to support the child in stressful situations. So
that having spiritual health in children is helpful when
going through developmental stages and stress caused by
new and diverse situations [57]. This leads to a decrease in
alcohol and drug use in adolescence and adulthood, especially
in critical situations [56]. According to the findings,
it can be said that having spiritual health and promoting it
affects different levels and different aspects of existence
and lays the foundation for adult personality. Therefore,
it seems that having spiritual health plays an important
role in different levels of prevention. This is especially important
when planning and designing interventions. Such
children, in addition to being less prone to crises at different
stages of life and being able to manage their conflicts
and issues, but also as future parents can be effective in
transmitting this cycle and raising a capable generation.
Conclusion
The findings of the present study showed that the concept
of spiritual health and its dimensions in children is
ambiguous and there is no clear and integrated definition
for this concept in children. On the other hand, attention
to the concept of spiritual health in children has been
less than adults. Because direct research on children to
gain their experiences in this regard has received less attention
and most studies have focused on the concept of
spiritual health and spirituality when suffering from the
disease, and therefore less attention has been paid to recognizing
this dimension and its development. However,
children are the best source of information in this regard,
and understanding their experiences in the field of spirituality
and spiritual health is important to know more
and understand their responses at different stages of life.
The findings showed that the spiritual health of children,
like adults, is explained in four areas of relationship with
God or a higher being, others, self, and nature. Concerning
God, prayer has been considered in all cultures. While
studies in the context of Islamic culture, in addition to
prayer, theology, God-centeredness, recourse, and imitation
of the Imams have also been considered. In relationships
with others, more attention is paid to the ability to
communicate with friends and respect people. Based on
the findings of the present study, most studies have been
conducted in recent years, which could be a sign of increased
sensitivity in this area.
Considering that most of the studies have been done in
European and American countries and with the dominant
culture in those countries and few studies have been done
in Islamic countries. Therefore, considering the important
role and impact of the cultural context of each country, it is
necessary to conduct studies to explain the spiritual health
of children and its indicators to pave the way for planning
and designing targeted interventions for children as the future
makers of the country.
Ethical Considerations
Compliance with ethical guidelines
Gholamnejad H. et al. Spiritual Health in Children. Health Spiritual Med Ethics J. 2022; 8(4):243-254
252
January 2022. Volume 8. Number 4
There were no ethical considerations to be considered in
this research.
Funding
This research was supported by the research project ,
Funded by the Alzahra University.
Authors' contributions
Conceptualization and Supervision: Maryam Safara;
Methodology, Investigation, Writing-original draft:
Hanieh Gholamnejad and Soolmaz Moosavi; Writing
-review & editing: All authors; Data collection & Data
analysis:Hanieh Gholamnejad and Soolmaz Moosavi;
Funding acquisition and Resources: Maryam Safara.
Conflict of interest
There are no conflict of interests in this study.
Acknowledgments
The authors thank all the children and parents who
helped us with this research.
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