Spiritual wellbeing in sub-Saharan Africa: the meaning and prevalence of ‘feeling at peace’

Abstract

Introduction and aims Palliative care (PC) is an urgent public health issue in Africa, but evidence to inform the spiritual dimension of PC is lacking. Feeling at peace is strongly correlated with spiritual wellbeing (SWB), and occurs in spiritual measures validated cross-culturally in PC populations. We aimed to: Determine levels of SWB among PC patients in South Africa and Uganda. Explore how patients interpret ‘feeling at peace’. Methods Cross-sectional survey using the APCA African Palliative Outcome Scale (POS) item: ‘Over the past 3 days, have you felt at peace?’ (‘0= no, not at all’ – ‘5= yes, all the time’). Semi-structured interviews including cognitive interviewing of the POS, analysed thematically. Results 285 patients surveyed; mean age 40.1; 69.1% women; diagnosis: 80.7% HIV; 17.7% cancer; 1.6% other. Mean peace score 2.92. 27.0% scored 0–1. 72 patients interviewed in 7 languages. Mean age 45.1; 66.7% women; diagnosis: 59.7% HIV; 40.3% cancer. Interpretations of peace fell into four categories: perception of self/ world (peace as a feeling/acceptance/experience); relationship with others; relationship with God; health-related. Barriers to peace included uncontrolled pain, stigma, economic/family worries. Conclusion This is the first study into the SWB of PC patients in sub-Saharan Africa. >25% of patients had not felt at peace in the previous 3 days, or only very rarely. Feeling at peace was interpreted in existential, social, religious and physical terms. Asking whether a patient feels at peace may be effective in eliciting concerns in African PC.

Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study

“…A topic guide will be used during health professional interviews. The topic guide aligns with stages of the data-use conceptual framework15: data demand (eg, current availability, use and quality of data for clinical decision-making), data collection (eg, feasibility of digital technology approaches to patient-level data collection), data availability (eg, clinical triggers in management of patients with advanced cancer, capacity to respond to information, information needs to inform patient care) and data utilisation (eg, sharing and accessing data via digital health approaches, data reporting priorities to regional and national health authorities). Causal elements linked to organisational, technical and behavioural factors influencing data use will be explored for each stage.…”

“…A major challenge to developing palliative cancer care across the African region is the lack of local evidence to ensure practice is evidence-based and replicable and reflects the needs of the population served 6. Evidence to date has revealed that patients with advanced cancer in SSA have a high burden of physical and psychological symptoms, would prefer to have full information and better communication around their needs and care options, experience spiritual distress, their family caregivers face compounded poverty and psychological distress 11–18. It is essential to create channels for gathering patient-level data as an indicator of quality as well as to inform clinical practice and audit.…”

Does being on TB treatment predict a higher burden of problems and concerns among HIV outpatients in Kenya? a cross-sectional self-report study

“…This calls for holistic management for patients even though they may have a strong immune system. A cross-sectional study among HIV (81%) and cancer (18%) conducted in Uganda and South Africa reported 27% burden of worst peace scores (Selman, Harding, Higginson, Gysels, & Speck, 2011).…”

Culture and spirituality: essential components of palliative care

“…These meanings influenced how patients were able to accommodate their distress and illustrate how the influence of culture and belief should feature in the assessment of pain 10. Selman also illustrates, and gives guidance, regarding culturally sensitive spiritual care for people from black and minority ethnic populations in the UK 11. Evidence indicates that people from minority ethnic groups are less likely to receive palliative care 12 13.…”