Defining spirituality in healthcare: a systematic review and conceptual framework.

Probably not a substantial claim: may not pass S3 (load-bearing).

The dimension immanence appeared in 5.42% of the analyzed definitions.

“Immanence | 5.42%”

Classified as probably not a substantial claim. May combine two claims.

There is a lack of consensus on the term spirituality and existing cultural gaps.

“However, due to the lack of consensus on the term and the existing cultural gaps, we propose a new spirituality framework, based on a systematic review of the literature”

Classified as probably not a substantial claim.

The proposed spirituality framework organizes all the dimensions found in the review except 'human aspect,' 'individual aspect,' 'dynamic process,' and 'necessity'.

“We present a spirituality framework proposition (Figure 2) that organizes all the dimensions found, except “human aspect,” “individual aspect,” “dynamic process,” and “necessity” because they can be understood as dimensions about the general spirituality nature, permeating all axes and cannot be dissociated and allocated to a single axis or dimension.”

Classified as probably not a substantial claim.

The first axis of the framework is composed of beliefs, practices, and experiences that promote connection.

“The first axis (upper white section) is composed of beliefs, practices, and experiences that promote connection.”

Classified as probably not a substantial claim.

The third axis of the framework refers to the development of values, personal growth, and sensations of meaning, purpose in life, well-being, support, and inner peace through connection with something that can affect the behavior of the individual.

“The third axis (lower gray section) refers to the development of values, personal growth, and sensations of meaning, purpose in life, well-being, support, and inner peace through connection with something that can affect the behavior of the individual.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Many aspects of the concept of spirituality remain unaddressed by existing frameworks, indicating the need for a new, more comprehensive approach that may fit diverse cultural and religious contexts.

“Although there are some frameworks proposals on the concept of spirituality as seen above, there are still many aspects of this concept that remain unaddressed, indicating the need for a new, more comprehensive approach that may fit into the diverse cultural and religious contexts discussed in this research.”

Classified as probably not a substantial claim. May combine two claims. The quote only partly states this claim.

The second axis of the framework comprises possible aspects that can be connected through spiritual beliefs, practices, or experiences, classified as sacred, life after death, spiritual beings, divine/God, self, community, nature, and art.

“In the second axis (middle dark gray section) are the possible aspects that can be connected through spiritual beliefs, practices, or experiences. They are classified as:”

Classified as probably not a substantial claim.

The review is the first study that systematically evaluated the most important and highly cited spirituality definitions under the healthcare field, instead of focusing on one specific area such as nursing or palliative care.

“To our knowledge, this is the first study that systematically evaluated the most important and highly cited spirituality definitions under the healthcare field, instead of focusing on one specific area such as nursing or palliative care.”

May combine two claims.

The review found that broader definitions tend to consider spirituality as experiences of connection with nature, social relations, and art, while narrower definitions place spirituality in a more theistic approach.

“Broader definitions tend to consider spirituality as experiences of connection with nature, social relations, and art, while narrower definitions place spirituality in a more theistic approach”

May combine two claims.

The review found that spirituality and religiosity are related and overlapping, varying according to cultural context and the dynamic quality of spirituality.

“From our results, we recognize that spirituality and religiosity are related and overlapping, varying according to the cultural context and to the dynamic quality of the spirituality itself.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Historically, the term spirituality was used to describe the practices of people who dedicated their lives into religious services or exemplify the teachings of their faith traditions.

“Historically, the term spirituality was used to describe the practices of people who dedicated their lives into religious services or exemplify the teachings of their faith traditions (Koenig, 2008).”

• cites Koenig, 2008 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Spirituality is a broad and complex concept which varies its understanding according to different cultural, religious and academic backgrounds.

“Spirituality is a broad and complex concept which varies its understanding according to different cultural, religious and academic backgrounds (i.e., religious persons, scientists, or lay persons; Koenig, 2008; la Cour and Götke, 2012).”

• cites Koenig, 2008 sourceNot checked yet

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• cites la Cour and Götke, 2012Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

There is a remarkable debate regarding the most accurate meaning and the possibility of having a single universal consensual definition for spirituality.

“there is a remarkable debate regarding the most accurate meaning, and regarding the possibility of having a single universal consensual definition for this concept (Peng-Keller, 2019).”

• cites Peng-Keller, 2019 sourceNot checked yet

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Classified as probably not a substantial claim.

Terms that did not appear in at least 3 definitions were excluded.

“Terms that did not appear in at least 3 definitions were excluded, as they corresponded to less than 2% appearance in the definitions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review was conducted and reported following the PRISMA statement.

“This is a systematic review based on the PRISMA statement for reporting systematic reviews and meta-analyses (Page et al., 2021).”

• cites Page et al., 2021 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A second author verified and unified all chosen dimensions from the selected definitions.

“After identifying all dimensions, from all selected definitions, a second author looked up into each definition in order to confirm and unify all chosen dimensions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review protocol was registered in PROSPERO (CRD42021262091).

“The protocol was registered in the PROSPERO international prospective registry of systematic reviews (registration number: CRD42021262091).”

Classified as probably not a substantial claim.

'Human aspect,' 'individual aspect,' 'dynamic process,' and 'necessity' are dimensions about the general spirituality nature, permeating all axes, and cannot be dissociated and allocated to a single axis or dimension.

“We present a spirituality framework proposition (Figure 2) that organizes all the dimensions found, except “human aspect,” “individual aspect,” “dynamic process,” and “necessity” because they can be understood as dimensions about the general spirituality nature, permeating all axes and cannot be dissociated and allocated to a single axis or dimension.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review gave insufficient consideration to the manner in which the definitions of spirituality were developed (e.g., conceptual versus empirical approaches to definition and measurement).

“Seventh, we gave insufficient consideration to the manner in which the definitions of spirituality were developed (e.g., conceptual versus empirical approaches to definition and measurement) and it should be considered in further research.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The experiences compose the subjective aspect, based on the individual perception of the presence of elements of interaction with the connecting object of spirituality, going beyond the bond through the intellect.

“The experiences compose the subjective aspect, based on the individual perception of the presence of elements of interaction with the connecting object of spirituality, going beyond the bond through the intellect.”

Probably not a substantial claim: may not pass S2 (checkable).

Spirituality is a human individual, dynamic characteristic.

“in which spirituality (1) is a human individual, dynamic characteristic;”

Probably not a substantial claim: may not pass S3 (load-bearing).

This perception of spiritual well-being is a concern for some religious faiths.

“This perception is a concern for some religious faiths, to enhance this feeling that can be called “spiritual well-being” (Moberg, 1984).”

• cites Moberg, 1984 sourceNot checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Identification of these dimensions can help researchers and health professionals to map how individuals understand and express their spirituality, making it operational.

“We believe that the identification of these dimensions can help researchers and health professionals to map how individuals understand and express their spirituality, making it operational.”

May combine two claims.

Patients want their doctors to address spirituality and most doctors and nurses consider important to integrate this aspect into their practice.

“patients want their doctors to address spirituality and most doctors and nurses consider important to integrate this aspect into their practice (Baetz et al., 2004).”

• cites Baetz et al., 2004 sourceNot checked yet

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May combine two claims.

Most included articles were from the United States and in English, resulting in low multicultural representativeness and a possible bias of an Anglo-Saxon, Western, and Judeo-Christian culture that may have impacted the definitions presented.

“Third, there is a low multicultural representativeness because most of the articles were from the United States, in English, showing a possible bias of an Anglo-Saxon, Western, and Judeo-Christian culture, which may have impacted the definitions presented in the articles.”

Probably not a substantial claim: may not pass S2 (checkable).

Spirituality leads to the development of values and positive inner feelings.

“and (3) leads to the development of values and positive inner feelings.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Medical and health-related sciences need a structure and relative consensus, since most instruments attempt to quantify its intangible construct in order to evaluate its impact and propose health-related interventions.

“While for the social sciences there is no major concerns for the lack of an universal definition of spirituality, medical and health-related sciences need a structure and relative consensus, since most instruments attempt to quantify its intangible construct in order to evaluate its impact and propose health-related interventions (Macdonald and Friedman, 2002; Hill and Pargament, 2008).”

• cites Macdonald and Friedman, 2002Not checked yet

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• cites Hill and Pargament, 2008 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

When content is exposed interconnecting the verbal and the visual, it facilitates the construction of connections, relationships, and understanding in the cognitive structure.

“Based on learning theories, when content is exposed interconnecting the verbal and the visual, it facilitates the construction of connections, relationships, and understanding in the cognitive structure (Peer et al., 2021).”

• cites Peer et al., 2021 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Research over the last decades has been growing substantially in the field of 'Spirituality and Health,' showing a significant influence of spiritual and religious beliefs on both mental and physical health outcomes.

“Research over the last decades has been growing substantially in the field of “Spirituality and Health,” showing a significant influence of spiritual and religious beliefs on both mental and physical health outcomes (Damiano et al., 2016)”

• cites Damiano et al., 2016 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Spirituality can be analyzed through multiple dimensions, and identifying these dimensions may clarify how individuals interact with their spirituality and which aspects have greater impact on health and treatment.

“Spirituality can be analyzed through multiple dimensions, which identification may clarify how individuals interact with their spirituality, and which aspects greater impact more on health and treatment (Lunder et al., 2011; MacDonald et al., 2015).”

• cites Lunder et al., 2011 sourceNot checked yet

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• cites MacDonald et al., 2015 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The framework's constructs may not apply to the linguistic variety in countries like India and China.

“Forth, although English is the main language in the scientific literature, the constructs of this framework need to be made for other languages that have large worldwide representation, since the contents described here may not apply to the linguistic variety in countries like India and China, for example.”

Classified as probably not a substantial claim.

The framework presents the dimensions as a non-hierarchical and non-static construction, which flow according to the individual's context and experiences.

“The framework was designed as a didactic scheme, presenting the dimensions as a non-hierarchical and non-static construction, which flow according to individual’s context and experiences.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some religious/spiritual beliefs are, for example, the existence of a higher, transcendent power or the continuity of life after death.

“Some religious/spiritual beliefs are, for example, the existence of a higher, transcendent power or the continuity of life after death.”

• cites Banks-Wallace and Parks, 2004Not checked yet

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• cites Markani et al., 2013 sourceNot checked yet

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May combine two claims.

This process is related to improving patients' outcomes, managing chronic pain, or dealing with a diagnosis such as cancer.

“This process is related to improving patients’ outcomes, manages chronic pain, or deals with a diagnostic as cancer (Breitbart, 2002; Vachon, 2008; Dedeli and Kaptan, 2013; Weber and Pargament, 2014; Bernard et al., 2017).”

• cites Breitbart, 2002 sourceNot checked yet

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• cites Vachon, 2008 sourceNot checked yet

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• cites Dedeli and Kaptan, 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The proposed framework is newly proposed and still lacks validation by other studies.

“Fifth, this framework is herein newly proposed, and thus, it still lacks a validation by other studies.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The role of funders on the manuscripts was not evaluated, posing risks of bias for the adopted definitions of each article.

“Another important point is that funders role on the manuscripts was not evaluated, posing risks of bias for the adopted definitions of each article.”

May combine two claims.

Spirituality is generally related to diminished numbers of substance use, suicidal attempts and depression prevalence, less hospitalization, better coping with disease, better treatment adherence, and lower mortality rates.

“Spirituality is generally related to diminished numbers of substance use, suicidal attempts and depression prevalence, less hospitalization, better coping with disease, better treatment adherence, and lower mortality rates (Moreira-Almeida et al., 2006; Guimarães and Avezum, 2007; Lucchetti et al., 2011).”

• cites Moreira-Almeida et al., 2006 sourceNot checked yet

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• cites Guimarães and Avezum, 2007Not checked yet

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• cites Lucchetti et al., 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The credibility of the included references was assessed by authors reading the full text of each article and by scientometric parameters such as number of citations, which could be considered a limitation.

“Sixth, the credibility of the included references was assessed by authors reading the full text of each article, as well as assessing the usual scientometric parameters, i.e., number of citations, which could be considered another limitation.”

May combine two claims.

Several barriers limit addressing R/S, including the lack of training by health professionals and the lack of clear defined concepts.

“several barriers limit addressing R/S, including the lack of training by health professionals and the lack of clear defined concepts (Best et al., 2015; Menegatti-Chequini et al., 2019).”

• cites Best et al., 2015 sourceNot checked yet

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• cites Menegatti-Chequini et al., 2019 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Individuality as a dimension of spirituality emphasizes the importance of looking at each person and their subjective experience, pointing to person-centered care whose goal is a meaningful life.

“Individuality as a dimension of spirituality emphasizes the importance of looking at each person and their subjective experience, pointing to the person-centered care whose goal is a meaningful life”

Classified as probably not a substantial claim.

The definitions of spirituality are multifactorial, including religious heritage, culture, generation, and nationality.

“The definitions of spirituality are multifactorial, including religious heritage, culture, generation, and nationality (Gall et al., 2011).”

• cites Gall et al., 2011 sourceNot checked yet

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Classified as probably not a substantial claim.

Practices correspond to the dimension of behavior, being social or individual, public or private, that requires the engagement of the individual to perform activities such as meditating, praying, or going to meetings of the group that shares his/her spiritual/religious beliefs.

“Practices correspond to the dimension of behavior, being social or individual, public or private, that requires the engagement of the individual to perform activities such as meditating, praying, or going to meetings of the group that shares his/her spiritual/religious beliefs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The first axis can be understood as a spirituality starter point.

“It can be understood as a spirituality starter point.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The proposed framework provides a common ground where elements of different components of spirituality, which are not usually associated, can be understood in a coherent scenario, helping researchers to better design and comprehend their findings and readers to build a common ground of knowledge.

“In this sense, what we herein propose is a common ground where elements of different components of spirituality, which are not usually associated, can be understood in a coherent scenario, helping researchers to better design and comprehend their findings, as well readers to build a common ground of knowledge.”

May combine two claims.

Spirituality can be considered a source of coping to handle crisis and stressful moments, and related to positive meanings in face of challenges, such as in health problems.

“Spirituality can be considered a source of coping to handle crisis and stressful moments, and related to positive meanings in face of challenges, such as in health problems.”

• cites Breitbart, 2002 sourceNot checked yet

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• cites Vachon, 2008 sourceNot checked yet

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• cites Dedeli and Kaptan, 2013Not checked yet

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Classified as probably not a substantial claim.

PubMed was chosen because it is a medical database and the definitions of spirituality included in these articles were more likely to be related to healthcare.

“First, we only included one database and, for this reason, articles indexed only in other databases were not included; PubMed was chosen because this is a medical database and the definitions of spirituality included in these articles were more likely to be related to healthcare.”

• AssumptionRests on an assumption: Definitions of spirituality in articles indexed in PubMed are more likely to be related to healthcare.

Classified as probably not a substantial claim. May combine two claims.

Beliefs can be considered as the cognitive dimension of spirituality, an affirmation of something considered real, which varies according to the culture.

“Beliefs can be considered as the cognitive dimension of spirituality, an affirmation of something considered real, which varies according to the culture.”

May combine two claims.

The review included only one database (PubMed), so articles indexed only in other databases were not included.

“First, we only included one database and, for this reason, articles indexed only in other databases were not included; PubMed was chosen because this is a medical database and the definitions of spirituality included in these articles were more likely to be related to healthcare.”

May combine two claims.

The dimension 'meaning' may exist in religious or non-religious individuals, pointing to a universal characteristic that can be used to assess the patient's spirituality.

““Meaning” as a dimension of spirituality may exist in religious or non-religious individuals, pointing to an universal characteristic that can be used to assess the patient’s spirituality”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Spirituality can be understood as a characteristic common to all humans, but it is a particular expression of each one.

“Even though spirituality can be understood as a characteristic common to all humans, it is a particular expression of each one.”

Probably not a substantial claim: may not pass S2 (checkable).

Spirituality is expressed through beliefs, practices, and experiences in the search for connection with something that promotes meaning and personal growth.

“(2) is expressed through beliefs, practices, and experiences in the search for connection with something that promotes meaning and personal growth;”

Probably not a substantial claim: may not pass S2 (checkable).

Spirituality identified as a plural construct in a visual structure organization can guarantee an understanding of the complexity of this phenomenon.

“Spirituality identified as a plural construct in a visual structure organization can guarantee an understanding of the complexity of this phenomenon.”