Extended Abstract

Abstract

Patients suffering from refractory diseases, in addition to physical distress, face extensive psychological, social, and especially spiritual challenges that intensify feelings of helplessness, meaninglessness, and identity confusion. In such circumstances, Mullah-based spiritual care—grounded in religious beliefs and values—can help patients reconstruct meaning and experience inner peace. The present study was conducted with the aim of examining the effect of Mullah-based spiritual care intervention on improving the spiritual health of patients with refractory diseases hospitalized in Seyyed Al-Shohada Hospital in Isfahan.

Keywords: Mullah-based spiritual care, spiritual health, refractory patients

1. Statement of the Problem

Refractory diseases, due to their chronic and progressive nature, affect multiple dimensions of patients’ lives and create extensive physical, psychological, social, and spiritual consequences. Since health is a multidimensional concept, its spiritual dimension plays a fundamental role in patient adjustment, meaning-making, reducing anxiety, and fostering hope. However, evidence indicates that patients with difficult-to-treat conditions often experience weakened connections with God, themselves, and others, and thus require effective interventions to strengthen this essential component of health.

Despite the importance of spiritual health in the adjustment of patients with refractory diseases, the extent and nature of the impact of Mullah-based spiritual care—as an approach rooted in religious and spiritual values—on improving their spiritual health has not been sufficiently investigated in Iran. This research gap, particularly in clinical settings such as Seyyed Al-Shohada Hospital, underscores the necessity of the present study.

The main objective of this study is to evaluate the effectiveness of Mullah-based spiritual care in enhancing the spiritual health of patients with refractory diseases hospitalized in Seyyed Al-Shohada Hospital in Isfahan. In line with this overarching aim, the study seeks to assess the effect of the spiritual intervention delivered by Mullahs, based on the spiritual care package derived from the Mousavizadeh and Torkan model (2023), on various dimensions of spiritual health, including meaning and purpose in life, connection with God, sense of peace in suffering, and attitudes toward death. Secondary goals include comparing patients’ spiritual health scores before and after the intervention, examining the moderating effects of age and gender, and analyzing the qualitative aspects of patients’ spiritual experiences throughout the care process.

2. Research Method

This study employed a quasi-experimental design with pretest–posttest and a control group. The statistical population consisted of cancer patients hospitalized in Seyyed Al-Shohada and Al-Zahra Hospitals in Isfahan. From these, 34 patients were selected through convenience sampling and randomly assigned to intervention and control groups (17 each).

The data collection tool was the Paloutzian and Ellison Spiritual Well-Being Scale (SWB), which includes two components: religious well-being and existential well-being (Cronbach’s alpha = 0.87). The intervention was implemented over four to six sessions by a trained Mullah, based on the spiritual care package designed using the Mousavizadeh and Torkan model (2023). The control group received only routine hospital care. Data were analyzed using SPSS-20 and paired t-test, ANCOVA, and Bonferroni post hoc test.

3. Findings

Data analysis showed no significant difference between the two groups regarding spiritual health before the intervention (p > 0.05). However, after the implementation of the spiritual care program, the mean spiritual health score in the intervention group increased significantly (posttest mean: 56.47±9.01 vs. 45.2±12.91 in the control group; p < 0.001). Significant differences were observed in both religious and existential well-being components (p < 0.05). ANCOVA results, after controlling for age, gender, and education, confirmed these findings. The Bonferroni test showed a mean difference of 8.3 points between the two groups. The greatest effect of the intervention appeared in the “acceptance and action” component, while the smallest was seen in the “depression” component. Overall, the results demonstrated that Mullah-based spiritual care can meaningfully improve spiritual health, enhance hope and meaning, and promote inner peace among patients with refractory diseases. The presence of trained Mullahs in hospitals—as a source of existential and spiritual relief—plays an important role in reducing anxiety and supporting psychological adjustment. Therefore, integrating Mullah-based spiritual care into hospital care and palliative programs, along with specialized training for healthcare staff, is recommended. Longitudinal studies and comparisons with psychological interventions such as mindfulness and Acceptance and Commitment Therapy (ACT) are also suggested.

4. Acknowledgement & Funding

· The manuscript did not receive a grant from any organization.

5. Conflict of Interest

·        The authors declare no conflict of interest.

6. Author contribution

All authors share equal responsibility for the content of this paper.

Zahra Asgari; Email: asgari.za@gmail.com; ORCID: 0000-0001-7239-2048

Rouhollah Mousavizadeh; Email: mosavizadeh@med.mui.ac.ir; ORCID: 0000-0003-0557-9392

Mahdi Ahmadi Faraz; Email: dm_ahmadifaz@yahoo.com

Mohammad Torkan; Email: poudineh@gmail.com

Ebrahim Kolivand; Email: kolivand.ebrahim.isf@gmail.com

Firoozeh Faroughi; Email: firoozehfarooghi@gmail.com