Health, Spirituality and Medical Ethics

Introduction

Adolescence is a critical developmental period marked by significant psychological, social, and spiritual transformation. Within Islamic anthropology, monotheistic primordial nature (Fitra) is central, positing an innate human disposition toward divine connection and virtuous behavior [1, 2]. This inherent capacity, varying across individuals, guides moral and spiritual growth [3]. Despite its theoretical importance, the practical application of Fitra-based interventions in educational settings remains underexplored. This study investigates the effectiveness of self-awareness skills training grounded in Fitra on moral development and spiritual well-being among female high school students, addressing a gap in integrating religious and psychological frameworks to foster holistic adolescent development.

Self-awareness, a key variable linked to Fitra, refers to the conscious understanding and regulation of one’s emotions, thoughts, and behaviors [4]. Theoretical models, such as Kohlberg’s moral development theory and emotional intelligence frameworks, suggest that self-awareness underpins moral reasoning and emotional regulation, which are critical during adolescence [5, 6]. Empirical studies support this, demonstrating that self-awareness training enhances emotion recognition, responsibility, and moral conduct [7]. For instance, Lolaty et al. [8] found that life skills training, including self-awareness components, improved students’ emotional intelligence. Similarly, Aboobaker et al. [9] linked spirituality, closely tied to self-awareness, to moral growth and workplace loyalty. Within Islamic contexts, Keshavarzi and Ali [10] emphasize that self-awareness fosters spiritual well-being by aligning individuals with their divine purpose. However, few studies have integrated Fitra-based self-awareness training with moral and spiritual outcomes, highlighting the need for culturally grounded interventions.

Moral development, encompassing cognitive, emotional, and behavioral dimensions, is shaped by social norms and personal values [11]. Research indicates that self-awareness facilitates moral growth by enabling individuals to reflect on their actions and align them with ethical principles [9, 12]. Spiritual well-being, another critical outcome, includes inner peace, purpose, and connection with God, society, and nature [13]. Studies, such as those by Matin and Ahmadi [14], have shown that life skills training enhances spiritual well-being in adolescents. However, prior interventions often lack a religious framework, limiting their applicability in Islamic educational contexts. This study addresses this gap by developing and testing a self-awareness training program rooted in Fitra, which is hypothesized to enhance moral development and spiritual well-being by leveraging adolescents’ innate spiritual and ethical predispositions.

This study is necessary due to adolescents’ complex challenges in contemporary society, including identity formation, ethical dilemmas, and psychological vulnerabilities [15]. The World Health Organization (WHO) recognizes self-awareness as a core life skill; however, its integration into educational curricula, particularly through religious lenses, is limited [7]. In Iran, where Islamic values shape educational goals, interventions that align with cultural and religious contexts are urgently needed. Previous studies, such as Akbari et al. [16], have demonstrated that monotheistic therapy improves spiritual well-being in specific populations, but evidence for school-based, Fitra-informed programs is scarce. This gap underscores the importance of examining whether Fitra-based self-awareness training fosters moral and spiritual growth in students.

This study addresses the lack of empirically validated, religiously informed interventions to support adolescent development in Islamic educational settings. Prior research has established associations between self-awareness, moral development, and spiritual well-being [17-19], but the efficacy of Fitra-based training remains untested. This study aims to provide evidence for a novel intervention that integrates psychological and Islamic principles, contributing to developing well-adjusted, ethically grounded adolescents. This study seeks to inform educational policy and practice by addressing this gap, promoting holistic well-being among students. Accordingly, the present study aimed to investigate the effectiveness of self-awareness skills training based on a monotheistic primordial nature in terms of moral development and spiritual well-being among students.

Methods

This study utilized a quasi-experimental design with a pre-test, post-test, and follow-up assessment, incorporating a control group to evaluate the effectiveness of self-awareness skills training based on monotheistic primordial nature (Fitra). The target population was female high school students in Shadegan, Iran, enrolled during the 2022-2023 academic year. The inclusion criteria were established to ensure participants could benefit from the intervention and to maintain study validity: Students were required to score below the mean on the spiritual well-being scale, indicating a potential for improvement in spiritual well-being, and to provide both personal informed consent and parental consent to ensure ethical participation. The exclusion criteria included a history of neurological disorders or current psychiatric treatment, as these could confound the intervention’s effects on psychological outcomes, and absence from more than two training sessions to ensure sufficient exposure to the intervention. These criteria were assessed using self-report questionnaires and school health records, with parental consent forms collected before enrollment. The sample size was determined using G*Power software, version 3.1 targeting a power of 0.80, an alpha of 0.05, and a medium effect size (f=0.25) based on prior studies of life skills interventions [20, 21]. This calculation indicated a minimum sample size of 28 participants, and 30 students were selected to account for potential attrition. Using convenience sampling, 30 female students scoring below the mean on the spiritual well-being scale were recruited from a single high school and randomly assigned to either the experimental or control group, resulting in 15 participants per group.

Instruments

The spiritual well-being scale [22], a 20-item self-report measure, assessed participants’ spiritual well-being through two subscales: religious well-being (connection with God) and existential well-being (life purpose and satisfaction). Items were rated on a 6-point Likert scale (1=strongly disagree, 6=strongly agree), with higher scores indicating greater spiritual well-being. Paloutzian and Ellison [22] reported high internal consistency (α=0.93). Karami and Shahmohammadi [13] validated the scale in Iran, confirming its factorial structure and reporting a Cronbach’s α of 0.89 in adolescent populations. In this study, the scale demonstrated acceptable internal consistency (α=0.81).

The moral development scale [23], a 13-item self-report instrument, measured moral reasoning across four stages: Social morality, post-conventional morality, conventional morality, and pre-conventional morality. Responses were recorded on a 4-point Likert scale (1=strongly disagree, 4=strongly agree), with items 5, 6, 11, and 12 reverse-coded. Manavipour [23] validated the scale in Iran, establishing its construct validity through confirmatory factor analysis and reporting a Cronbach’s α of 0.93 among high-school students. In the current study, the scale showed acceptable internal consistency (α=0.88).

Procedure

The study began with coordination with the Shadegan Department of Education to obtain a list of female high school students. One school was selected via cluster random sampling to ensure representativeness of the target population. From this school, 30 eligible students were identified through convenience sampling based on Spiritual Well-being Scale scores and consent requirements. Participants were randomly assigned to the experimental or control group using a random number generator to minimize selection bias. Pre-test data were collected using the spiritual well-being scale and moral development scale, administered in a quiet classroom setting to ensure confidentiality and focus. Participants were informed of the study’s purpose, confidentiality measures, and their right to withdraw.

The experimental group participated in eight 90-minute weekly sessions of a self-awareness training program grounded in monotheistic primordial nature (Fitra), designed based on Islamic psychological principles and prior research on spiritual and moral development [1, . The intervention was tailored to align with the cultural and religious context of the participants, emphasizing Fitra’s role in fostering self-awareness, moral virtue, and spiritual connection. The content included understanding human dual nature, emotion regulation, and purpose alignment . The intervention was delivered by a doctoral candidate in clinical psychology with specialized training in Islamic psychology and over five years of experience in adolescent counseling, under the supervision of a licensed clinical psychologist with expertise in spiritual interventions. The control group was placed on a waiting list and received no intervention during the study period, but was offered training post-study. Post-test data were collected immediately after the intervention, and follow-up assessments were conducted two months later to evaluate the persistence of effects. All sessions and assessments were conducted in a school-based setting, with consistent timing and conditions to minimize external influences.

Data analysis

Data were analyzed using SPSS software, version 27. Descriptive statistics, including Mean±SD, summarized moral development (social, pre-conventional, conventional, and post-conventional morality) and spiritual well-being scores for experimental and control groups at pre-test, post-test, and follow-up. Repeated measures analysis of variance (ANOVA) assessed the self-awareness training’s effects, evaluating within-group changes, between-group differences, and time-by-group interactions. Significant differences in moral development and spiritual well-being were examined across measurement points and groups. Bonferroni post-hoc tests identified pairwise differences, controlling Type I errors to elucidate intervention effects’ timing and persistence. Statistical significance was set at P<0.05.

Results

This study’s participants consisted of 30 adolescent girls with a mean age of 16.75±1.39 years. Table 2 presents the Mean±SD of moral development and spiritual well-being in the experimental and control groups at the pre-test, post-test, and follow-up stages.

Before testing the study hypotheses, the assumptions of the repeated-measures ANOVA were assessed. The Kolmogorov-Smirnov test confirmed the normality of variable distributions for moral development components (social morality, pre-conventional morality, conventional morality, post-conventional morality) and spiritual well-being, with P ranging from 0.12 to 0.18 across all variables (social morality: D=0.11, P=0.151; spiritual well-being: D=0.10, P=0.183), indicating no significant deviation from normality. The homogeneity of variances was verified using Levene’s test, with non-significant results across all time points and variables (social morality at pre-test: F=0.87, P=0.361; spiritual well-being at post-test: F=0.92, P=0.344), confirming equal variances between groups. Repeated-measures ANOVA revealed statistically significant differences in moral development components (social morality, pre-conventional morality, conventional morality, and post-conventional morality) and spiritual well-being across the pre-test, post-test, and follow-up assessments (P<0.001). Furthermore, a statistically significant interaction effect between group and time (measurement time points) was observed for dependent variables (P<0.001). Specifically, significant differences were found between the self-awareness training group based on monotheistic primordial nature (Fitra) and the control group for all five variables: Social morality, pre-conventional morality, conventional morality, post-conventional morality, and spiritual well-being (P<0.001) (Table 3).

Bonferroni post-hoc tests were performed to examine differences in the dependent variables across the three measurement time points within the experimental groups. Table 4 presents the results of pairwise comparisons between the pre-test, post-test, and follow-up assessments for both the experimental and control groups across social morality, pre-conventional morality, conventional morality, post-conventional morality, and spiritual well-being. As shown in Table 4, the self-awareness training group based on monotheistic primordial nature (Fitra) demonstrated statistically significant improvements in the components of moral development (social morality, pre-conventional morality, conventional morality, and post-conventional morality) and spiritual well-being at both the post-test and follow-up compared to the pre-test (P<0.001). Conversely, no statistically significant changes were observed in the control group.

Discussion

This study investigated the efficacy of self-awareness skills training grounded in monotheistic primordial nature (Fitra) on moral development and spiritual well-being among female high school students. The findings revealed significant improvements in social morality, pre-conventional morality, conventional morality, post-conventional morality, and spiritual well-being in the experimental group compared to the control group, with effects sustained at a two-month follow-up. These results can be attributed to the intervention’s focus on cultivating self-awareness through an Islamic lens, aligning with Fitra’s innate disposition toward virtue and divine connection [1,. By fostering awareness of intrinsic moral and spiritual capacities, the training enabled participants to regulate emotions, reflect on ethical behaviors, and pursue purpose-driven lives, consistent with theoretical frameworks linking self-awareness to moral and spiritual growth .

The increase in social morality scores reflects the intervention’s emphasis on interpersonal ethics within the Islamic framework, prioritizing communal harmony and responsibility [3]. The significant reduction in pre-conventional morality, characterized by self-interest-driven reasoning, suggests that Fitra-based training shifted participants toward higher moral stages, as outlined in Kohlberg’s theory [24]. This shift likely resulted from sessions addressing the pursuit of virtue and recognition of divine accountability, which encouraged adolescents to prioritize ethical principles over personal gain. Similarly, improvements in conventional and post-conventional morality align with the program’s focus on patience, perseverance, and alignment with societal and transcendent values, resonating with Islamic teachings on human flourishing [10,. These findings are supported by empirical studies, such as Norouzi-Kouhdasht et al. , who reported enhanced moral intelligence through Islamic life skills training, and Ahmadi et al. , who found positive associations between religiosity and moral development in students. Additionally, Lane et al. demonstrated that early moral understanding, nurtured through social and emotional training, predicts later moral development, reinforcing the efficacy of self-awareness interventions during adolescence.

The enhancement of spiritual well-being can be explained by the intervention’s emphasis on self-knowledge and connection with God, core components of Fitra [20]. By fostering recognition of participants’ inherent worth and divine purpose, the training promoted inner peace and life meaning, key facets of spiritual well-being [18]. These results align with Matin and Ahmadi [14], who found that life skills training increased spiritual well-being in female students, and Pasha et al. [26], who linked religion-based interventions to improved spiritual health. Furthermore, Dadfar et al. [19] reported that spiritual well-being in the Iranian population is closely tied to religious practices, supporting the cultural relevance of the Fitra-based approach. The sustained effects at follow-up suggest that the intervention fostered lasting changes in participants’ spiritual orientation, likely due to the integration of practical skills and religious reflection.

The primary scientific contribution of this study is the empirical validation of a novel self-awareness training program grounded in monotheistic primordial nature. This program demonstrates its effectiveness in enhancing moral development and spiritual well-being among adolescents in the context of Islamic education. This intervention bridges psychological and religious frameworks, offering a culturally sensitive approach to fostering holistic development.

The limitations of this study include its exclusive focus on female high school students in Shadegan, Iran, limiting generalizability to male students, other age groups, and diverse cultural contexts. The reliance on self-report measures introduces potential response bias, and the absence of long-term follow-up beyond two months restricts insights into the intervention’s enduring impact. Additionally, the convenience sampling method may have introduced selection bias, and the lack of an active control group limited our ability to rule out placebo effects. Future research should employ randomized sampling, include male participants, and extend follow-up periods to assess long-term outcomes. Incorporating objective measures, such as behavioral observations, and comparing the intervention to alternative programs could strengthen causal inferences. Educational policymakers should integrate Fitra-based training into curricula, and further studies should explore its applicability across diverse populations and settings.

Conclusion

These findings provide compelling evidence for the efficacy of self-awareness skills training grounded in monotheistic primordial nature in enhancing spiritual well-being and moral development. The significant increases observed in the experimental group, relative to the control group, demonstrate the positive impact of this training approach. Importantly, the maintenance of these gains at the follow-up assessment suggests the enduring nature of the intervention’s effects, indicating that the training fosters lasting changes in key developmental domains. This study contributes to the growing body of literature supporting the integration of spiritual and ethical frameworks into interventions aimed at promoting holistic well-being.

Ethical Considerations

Compliance with ethical guidelines

This study was approved by the Ethics Committee of the Islamic Azad University, Ahvaz Branch, Iran (Code: IR.IAU.AHVAZ.REC.1402.109). All procedures adhered to ethical standards, ensuring participant confidentiality and informed consent.

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions

Conceptualization, data collection, and manuscript drafting: Leila Khamisi; Methodology, study design and data analysis: Parvin Ehteshamzadeh; Supervision and manuscript review: Alireza Heidari; Data interpretation and final editing: Fariba Kalantari; Final approval: All authors.

Conflict of interest

The authors declared no conflicts of interest.

Acknowledgments

The authors thank the participants, their families, and the school administrators in Shadegan for their cooperation and support during the study. They also thank the Islamic Azad University, Ahvaz Branch, for facilitating the research process.