Health, Spirituality and Medical Ethics

Introduction
The Qur’an calls worship one of the natural needs and the secret of human creation. If we consider worship as a combination of worship, prayer, seeking refuge, telling the secret, needing, and love, prayer is its highest example. Prayer is one of the vital religious obligations and one of the essentials of the holy religion of Islam, without which, other human actions are not accepted, and those who leave it are in the ranks of disbelievers [1]. The truth of prayer is the servant’s attention to his Lord and renewal of the covenant of servitude and declaration of submission to God Almighty [2].
In terms of belief in religion and religious values, young people are divided into two groups: Believing youth and non-believing youth. Believing youth have a good understanding of religious behaviors and pursue their life and future with faith, purposefulness, and a positive attitude toward religion. However, non-believing youth’s understanding of morals and values ​​is caused by the prevailing conditions at home; that is, religious beliefs are not formed based on exploration and questioning, and as a result, they do not have much depth [3].
In the tendency of young people and teenagers to pray, the three main elements of the home, place of education, and mass media play an essential role. If these elements follow a different path and goal in the programs and statements, it creates a contradiction in the person’s mind and the message does not lead to motivation and action in people [2].
Obstacles such as not being clear about the philosophy of prayer, weak religious foundations, impatience, not paying attention to prayer, preferring entertainment and television programs, not being familiar with the effects and blessings of prayer as individual limitations, lack of coordination of different parts of the university (self-service, education, administrative affairs) with prayer time as environmental restrictions, lack of attention of the community, family and friends towards prayer, the form of prayer (the imam of the congregation, the imam’s recitation, prolonging the prayer), the behavioral state of the prayer people, insufficient publicity about the prayer, the politicization of the prayer space, and prayer halls have been considered as the social restrictions of offering prayers [4-6]. Praying among students varies according to age, gender, marital status, type of course and field of study, grade point average, and residential status [7-10]. Yaqoubi et al.’s study showed that girls tend to pray more than boys, and married girls tend to pray more than unmarried girls [11].
Prayer has many effects and consequences in different dimensions, including the absence of guilt or its reduction, personality unity and family cohesion, increasing self-confidence, increasing self-esteem, giving meaning to life, and also in accepting and dealing with the complications of chronic diseases, such as cancer and heart rate [2, 11]. In his study, Haj Bagheri concluded that prayer, regardless of the religious aspect, has very positive effects on the soul, and performing it correctly has a significant effect on reducing anxiety and mental stress, eliminating arrogance and pride, and enhancing concentration and confidence [12]. Also, the study of Bahrainiyan et al. showed that the religiousness and spirituality of patients have a significant and direct relationship with their quality of life and better treatment [13].
Since young people as the future builders of the Islamic society are considered one of the greatest assets of this country and the effort to develop their religious knowledge and awareness is vital, and considering the place of prayer in the religious society of Iran where religion is an individual and social effective factor, the present study was designed and implemented to evaluate the prayer behavior of Rafsanjan University of Medical Sciences students and their attitudes toward prayer. Paying attention to the results of this study can facilitate planning to improve the state of prayer among students, increase their spiritual health, and eliminate existing weaknesses.
Methods
The current research is a cross-sectional descriptive-analytical study. participants of the study included all students of Rafsanjan University of Medical Sciences. The sampling method was census and sending the electronic link of the questionnaire through the press line system and inviting them to complete the questionnaire. A total of 192 students participated in this study. The inclusion criteria included students studying at the University of Medical Sciences who were willing to participate in the study, and the exclusion criteria included those who did not fill in the questionnaires completely. Also, the participants were justified on how to conduct the study, the confidentiality of the information, and the purpose of the study, all of them entering the study with full consent. The information was collected at the end of 2020.
The data collection tool in this study was a researcher-made questionnaire with three sections: Questions related to demographic information, questions related to prayer behavior, and attitude questions regarding prayer, causes of tendency, and its impact on life. The demographic information section includes 10 questions related to age, sex, marital status, educational level, grade point average, residential status, education, and parents’ occupation. Prayer behavior was measured with 17 questions on a 5-point Likert scale (always, most of the time, sometimes, rarely, and never) with a score range of 17 to 85. The answer “always” received a score of 5 and the answer “never” received a score of 1. Due to the negativity of statements 6, 7, 11, 13, and 14, these statements were scored inversely in the data analysis stage. The attitudes of the students regarding prayer, the causes of the tendency, and its impact on life were measured with 33 questions and a 5-point Likert scale from “completely agree” to “completely disagree” with a score range of 33 to 165. A score of 5 was given to the “completely agree” answer and a score of 1 to the “completely disagree” answer. Due to the negative statements 2, 4, 6, and 7, these statements were scored inversely in the analysis stage. It should be noted that the desired tool was prepared based on the review of studies and with the opinion of relevant professors in the office of the university leadership and its validity (determination of content validity ratio and content validity index) was checked with the help of the opinions of 8 religious science experts. The reliability of the tool was examined with the Cronbach alpha coefficient. The Cronbach alpha coefficient for awareness questions was 0.81 and 0.95 for attitude questions.
The data was analyzed by SPSS software version 18 via descriptive statistics and Pearson correlation tests, independent t-test, and One-way analysis of variance (ANOVA) at a significance level of less than 0.05.
Results
The Mean±SD score of the age of the responding students was 22.05±3.93 years with a range of 18 to 50 years. A total of 169 participants were girls (88%) and 23 participants (12%) were boys. Also, 88% of the participants were single and 12% were married. Table 1 lists other demographic characteristics (Table 1).
A total of 60.9% of students reported that they performed daily prayers and 17.7% of them reported that they perform their prayers early; 88% believed that parents’ prayer affects their children’s prayer. The Mean±SD score of students’ behavior regarding praying is 59.21±8.92 out of 85. Table 2 lists the frequency distribution of students’ answers to behavioral questions about prayer.
The Mean±SD) score of students’ attitudes about praying was 121.99±19.97 out of 165. Table 3 lists the frequency distribution of students’ responses to attitude questions regarding prayer and its benefits. A total of 81.3% of students agreed with the opinion that prayer is thanksgiving for God’s blessings. According to the findings of Table 3, among the crucial attitudes of students towards the effects of prayer in different dimensions of life is the creation of peace and vitality of the soul (86.5%), the role of prayer in the formation of order and discipline in life (81.8%), causing good mood (76.6%), family cohesion (76.1%), and reducing anxiety and stress (76%).
A direct and significant correlation was observed between the average score of attitude and the behavior of praying (P<0.001) (r=0.642), in the sense that students’ stronger and higher attitudes and beliefs towards prayer can have a direct impact on their prayer. A significant difference was also observed between the average score of the prayer behavior of male and female students (P=0.046).
A significant relationship was observed between the average score of students’ attitudes and the variables of father’s education, father’s and mother’s occupation (P<0.05) (Table 4). The least significant difference (LSD) post hoc test showed a significant difference between the mean attitude score of students whose mother’s education level was primary and students whose mother’s education level was secondary school or diploma (P=0.024) and students whose mother had a university education (P=0.002). In other words, students whose mothers were illiterate or had elementary education had a better attitude toward prayer and its benefits. Also, the LSD post hoc test showed a significant difference between the average attitude score of students whose fathers were unemployed and those whose fathers were employed (P=0.001), or whose fathers’ job was free (P=0.001) as well as with students whose fathers were retired (P=0.002). In other words, students whose fathers were unemployed had a better attitude toward prayer and its benefits.
In this study, no correlation and a significant relationship were observed between the average score of students’ prayer behavior with the average age and grade point average, educational level, place of residence, education, and parents’ occupation (P>0.05). No significant relationship was observed between the average score of students’ attitudes towards prayer and gender, marital status, educational level, and place of residence (P>0.05).
Discussion
The present study was designed and implemented to evaluate the prayer behavior of Rafsanjan University of Medical Sciences students and their attitudes toward prayer. In this research, 60.9% of students reported that they perform daily prayers and 17.7% of them reported that they perform their prayers early. In Yaqoubi et al.’s study, 70% of the students performed daily prayers and did it seriously [11], and in Musa Rezaei et al.’s study, 62.25% of Isfahan University of Medical Sciences students always prayed [14]. Therefore, maybe it is possible to develop a culture of praying among students by forming a think tank and using the opinions of all students and officials regarding prayer, holding cultural workshops, and publications, and also using the experiences of successful universities in this matter.
A significant difference was observed between the mean scores of male and female students regarding prayer. The results of Nasirzadeh et al.’s study also showed that female students tend to pray more [1]. Such a similar result was obtained in the study conducted by Mujahid et al. and Yaqoubi et al. [11, 15]. One of the reasons for the tendency and motivation of most girls to pray is their emotional nature.
In the current study, a significant relationship was observed between students’ attitudes toward prayer and the variables of mother’s education and mother’s occupation, so that students whose mothers were illiterate or had elementary education had a better attitude about prayer and its benefits. Also, a significant relationship was observed between students’ attitudes and the variables of the father’s education and the father’s occupation. In Kavosi et al.’s study, a significant difference was observed between the average tendency to pray and the education of the student’s parents at Neyshabur University of Medical Sciences, and the influence of literate parents on the tendency, guidance, and attraction of children to prayer was less compared to less literate parents [5]. The low level of parents’ education, especially the mother of the family being a housewife, has caused them to spend more time creating orientation and motivation for their children’s religious and devotional issues.
In this study, no significant relationship was observed between the attitude of students regarding prayer with the variable of gender and marital status. The results by Tabatabai et al. showed no statistically significant difference between the attitude of Ferdowsi University of Mashhad students towards prayer according to gender and marital status [16]. While in the study of Kavosi et al., the tendency of married students to pray was more than single students, and a statistically significant relationship existed between the marital status and gender of students with the tendency to pray [5].
In the present study, no significant relationship was observed between students’ attitudes toward prayer with educational level and place of residence. While in Dadkhah et al.’s study, a statistically significant relationship was observed between the residence status and the attitude of the students of Ardabil University of Medical Sciences towards prayer, and the students living in the dormitory had a more positive attitude than the non-dormitory residents. Also, students of the lower levels of education had a higher positive attitude [17].
In the present study, 88% of students believed that parents’ prayer affects their children’s prayer. In the study conducted by Nasirzadeh et al. conducted among the students of Shiraz University, praying was associated with being encouraged to pray by parents [1]. Considering that parents are good patterns for their children in the matter of praying, it is effective to create the ground and provide conditions, such as creating a spiritual atmosphere, bowing and honoring prayer, and praying in the presence of children to facilitate this matter. In addition, 69.8% of students believed that observing professors praying affects their tendency to pray. In Hadavi and Heshmati’s study, a statistically significant relationship was observed between the religious atmosphere of university professors and the degree of the tendency of Shahed University campus students [6].
In the current study, 86.5% of the students believed that prayer causes peace and vitality to the soul. Shojaei showed a significant positive relationship between the attitude and practical commitment to prayer and the happiness of Mohaghegh Ardabili University students [18].
In this research, 76% of the students believed that prayer reduces anxiety and stress. The results of Shirzad et al.’s research showed that practical commitment to prayer has a significant relationship with the mental health of female students of Tehran University [19]. In Akbari’s study, adherence to prayer predicts the level of mental health [20]. The findings of Yazidi and Jame’i Nadoshan’s study showed a significant positive relationship between the tendency to pray and mental health, and the mental health of students can be predicted through the variable of the tendency to pray [21]. In the study conducted by Khoshnoudi et al., students who paid attention to performing prayer showed a lower level of depression [22]. Considering the role of prayer and religious orientation in mental health, the cultural officials of the university should pay special attention to this matter and strengthen religious attitudes and increase the performance of religious duties by creating various and appropriate educational programs.
In this study, the students knew the role of prayer in the formation of order and discipline in life (81.8%), in creating a good mood (76.6%), and in family cohesion (76.1%). In the study conducted by Banakar et al., students of the Faculty of Medical Sciences of Fasa reported their attitude towards the effectiveness of prayer in religious, belief, and mental health areas at a high level, in cultural, social, and moral areas at a medium level, and educational, economic and physical areas at a low level [23].
Considering that young people form the dynamic stratum of any society and many behavioral paths are being formed and consolidated during youth and student life, and the fact that universities have always been an educational institution, applying and paying attention to the results of this type of research will be useful to institutionalize prayer among academics.
Conclusion
Based on the findings of the present research, it is concluded that about three-fifth of the students perform their daily prayers and the majority of them believed that the prayer of their parents and teachers affect their prayers. Stronger and better attitudes, beliefs, and convictions of students toward prayer can have a direct effect on their prayer. Students whose mothers were illiterate or had elementary education had a better attitude about prayer and its benefits. Also, students whose father was unemployed had a better attitude toward prayer and its benefits.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Rafsanjan University of Medical Sciences (No. IR.RUMS.REC.1398.169).
Funding
This research was supported by Rafsanjan University of Medical Sciences.
Authors' contributions
Conceptualization, Supervision and Data Analysis: Mostafa Nasirzadeh; Methodology: Mostafa Nasirzadeh and Abbas Sadeghi Hasan Abadi; Data collection and Investigation: Leili Mazar and Yaser Salim Abadi; Writing the original and final manuscript version: All authors.
Conflict of interest
All authors declare no conflict of interest.
Acknowledgments
We deeply thank all the students, the university officials, especially the education department for their cooperation, and the deputy of research and technology of the University for their Financial Support.