A Qualitative Examination: Ageing and Religion
- Sean Lee
- May 4, 2021
- 49 min read
“What is the significance of religion in an individual’s health, and how does it change as they age?”
1. Introduction
1.1 Religion and Ageing in Singapore
1.2 Purpose of Research
2. Literature Review
2.1 How does Religion affect Health? 2.2 Theories 2.2.1 Health Belief Model (HBM) 2.2.2 Selection, Optimisation, Compensation (SOC) Model
2.3 Religion and Healthcare Around the World 2.4 Religion and Healthcare in Singapore
3. Methodology
3.1 Grounded Theory 3.2 Sampling method 3.3 Interviewee demographics
3.4 Interview procedures
4. Findings
4.1 Defining “Religion” and “Health”
4.2 Ageing and Health 4.3.1 Relationship between religiosity and ageing process 4.3.2 Crisis and religiosity 4.4 Religion and Health 4.4.1 The Three Types Health: Spiritual, Emotional & Physical
4.4.2 Religion as a way of life 4.4.3 Religious notions of Body vs Soul 4.4.4 Religion as a Source of Healing 4.5 Religion in a Secular Healthcare System (Religion and Health)
4.5.1 Doctors and Medicine as instrument of God
5. Discussion
5.2 Health Belief Model (HBM)
5.4 Limitations 5.4.1 Possible influence of other sociodemographic factors
6. Conclusion
1. Introduction
1.1 Religion and Ageing in Singapore
Ageing is often considered a time of loss and decline (Cohen & Koenig, 2003) in terms of deterioration in mental and physical capabilities, or the loss of social relationships. However, contrary to this belief, Singapore has constantly strived to view ageing as a period of growth and vitality, with its policies targeted towards encouraging this perspective. With a median age of 40 years old and a dependency ratio that could dwindle to 2.3 people per older adult by 2030 (Population SG, n.d.), the need for a successful ageing model is gradually increasing (Population SG, 2016).
The Action Plan for Successful Ageing was implemented in 2015 to support Singaporeans who are 65 years old and older. The plan consists of 70 initiatives in 12 areas including health,wellness, respect, social inclusion, and retirement adequacy, to name a few (Ministry of Health, n.d), of which healthcare plays an integral role in developing. This report aims to contribute to Singapore’s vision for a successful ageing population through studying an area that is closely associated to individuals’ ageing process, namely religion and its effects on an individual’s health. The link between religion and healthcare arises when we consider the percentage of religious persons amongst the ageing. In a 2015 report by the Department of Statistics, only 14.6% of people above the age of 55 identified as non-religious, compared to 23% amongst youth aged 15 to 24 (The Straits Times, 2016). This religious diversity, tolerance and the ‘freedom to worship’ has been an integral part of Singaporean society. According to the United States Central Intelligence Agency (2018), Singapore is the most religiously diverse country in the world with only a 16.4% non-religious population. The latest statistics show Singapore has having the following distribution of various religions.
Buddhism 33.9%
Islam 14.3%
Taoism 11.3%
Catholicism 7.1%
Hinduism 5.2%
Other Christian faiths 11%
Other religions 0.7%
No religion 16.4%
In examining the relationship between these two crucial issues in Singapore, this report strives to address the research question, “What is the significance of religion in an individual’s health, and how does it change as they age?”
1.2 Purpose of Research
Singapore’s population is both highly religious and ageing at a rapid pace. The prevalence of the biggest faiths suggest that they play a pivotal role in shaping the lives of Singaporeans, of which health can be considered a significant aspect. In this regard, it is worth studying how ageing, health, religion, and their intersections, affects an individual’s quality of life. It is thus paramount that we recognize the influence religion has on an individual’s perception of health as well as how they approach the Singaporean healthcare system. Such insights from our ageing population may lead to structural changes in the healthcare system that when implemented with appropriate multidisciplinary guidelines would lead to better healthcare for individuals across all religions.
2. Literature Review
2.1 How does Religion affect Health?
According to George, Ellison, and Larson, there are three aspects that explain how religion and religiosity affect an individual’s health (2002). The three aspects are:
Health Practices
Social Support
Psychosocial Resources
Health Practices describe how religious practices themselves are the source of positive health (George, Ellison & Larson, 2002). These are shown in two ways. The first, is that some religions “explicitly prescribe good health habits” (p. 193). For example, in Islamism, alcohol consumption is forbidden. The next is that many religions tell their members to respect their body as a “temple of the soul” (ibid.).
Social Support describes how being part of the wider religious community is beneficial to health. When contrasted with their non-religious counterparts who have a smaller network of social contacts. The social support of a wider social network has “powerful protective effects on health” (p. 194).
Psychosocial Resources explicate how religion is highly beneficial to three types of resources namely, Self-esteem, Self-efficacy, and Mastery. These resources have been shown to be beneficial to overall health and even “several other social factors that predict health and mortality, including socioeconomic status, stressful life events, chronic stressors, and social support” (p. 195).
2.2 Theories
2.2.1 Health Belief Model (HBM)
HBM is a public health model that investigates how various barriers and incentives influence an individual’s decision to engage in health behavior (“Theory at a Glance”, 2005). It breaks down decision making into six constructs, as follows.
Perceived susceptibility - how at risk a person believes he/ she is to an illness.
Perceived severity - how grave a person believes the illness to be
Perceived benefits - how effective a person believes the health action to be
Perceived barriers - how serious a person believes are the factors that can offset the perceived benefits.
Cues to action - how exposed to communications a person is regarding the health action.
Self-efficacy - how able an individual believes he/ she is able to engage in the health action (“Theory at a Glance”, 2005).
It is generally accepted that a person is more prone to diseases as they age. In Singapore, measures are in place to improve the affordability and accessibility of health check-ups and medical treatment for older individuals. Examples include the Community Health Assist Scheme (CHAS) Card, which sponsors medical treatment for select groups including elderlies (“About the Scheme”, n.d.) and subsidized rates for aged women to undergo breast and cervical cancer screening (“Breast & Cervical Cancer”, 2018).
However, a large part of whether individuals choose to participate in these free and subsidized schemes depends on their perception of their own health, ability and severity of the illnesses, as described in HBM. It is likely that religion can fit into one or many of the constructs in the HBM, to either encourage or discourage individuals from engaging in healthy practices. Therefore, it is likely useful to reference HBM in crafting and analysing interviews with religious older individuals to find out about how religion affects their health behavior.
2.2.2 Selection, Optimisation, Compensation (SOC) Model
The theory of Selection, Optimisation and Compensation (SOC) are three fundamental processes that are essential for successful development and ageing. Each different segment of the SOC model plays a part in the maximisation and minimisation of gains and losses respectively associated with successful development and ageing (Shaw, Gullifer and Wood, 2016).
The SOC model posits that as older adults begin to be aware of their limitations, they also begin to select and prioritise certain activities and goals over others. After which, they choose to optimise activities which are perceived to provide them with the highest levels of satisfaction and enjoyment. In turn, both the selection and optimisation of these preferred activities will ultimately compensate for the activities that have been forgone. The segment on compensation may also refer to the alteration of a particular goal where necessary. The SOC model will be used as a reference for analysing the themes found in the interviews. Insights generated from the analysis will then be used to enrich existing insights and theories on ageing and religion, possibly including the SOC model itself.
2.3 Religion and Healthcare Around the World
In recent years, there has been an increasing discussion on the role of religion in healthcare and in ageing worldwide, in part due to a realization that the split between medicine and religion have not delivered the best healthcare results (Koenig, 2001). Such research has indeed found a generally positive trend between religion and health, and many countries have begun incorporating insights from such studies into their healthcare systems (Williams and Sternthal 2007).
In the United States, over four-fifths of hospitalized patients religious requirements, and a significant proportion prefer doctors to take into account of such needs (Peach, 2003). However, there exists a gap between the patients’ needs and professional practice. It is found that a large proportion of doctors do not attend to religious needs, nor do they actively delegate this task to religious professionals (Peach, 2003). Nonetheless, there are opportunities for doctors to take a more active role in addressing religious needs – 72 medical institutions instruct on religious evaluation and religion-informed treatment plans (Peach, 2003), while advisories also exist for specific religions. One example is a set of recommendations by the Metropolitan Chicago Healthcare Council
on engageing Hindu patients and their relatives, which explains Hindu beliefs, events, taboos, concerns and other needs to healthcare practitioners (“Guidelines for Health”, 2002).
Another notable case study is Taiwan, which ranks second in religious diversity only to Singapore (Cooperman & Lipka, 2014), and can hence be seen as highly relevant for comparative purposes. A study by Tzeng and Yin in 2006 identified that religion is a key factor in helping patients and their relatives tide through healthcare issues. Despite this, there is a lack of spiritual support systems in Taiwan’s institutionalized care, shown through the low percentage of hospitals featuring chapels for various religions and the lack of access to religious leaders (Tzeng & Yin, 2006). The study also found that cultural misunderstandings can happen between patients and healthcare professionals with the current system (Tzeng & Yin, 2006). The authors recommended classes on religious care for all healthcare professionals and formulating directives, amongst other measures.
Overall, it can be seen that the above case studies are focused on how religion in the institutionalized healthcare context may improve treatment outcome and well-being of patients. These are important points of reference for analysing Singapore’s medical landscape. At the same time, more can be done to examine health from a wider perspective, by also looking into elements such as everyday health maintenance. Furthermore, it is important to also study if religion has a direct link to health, instead of it being an advantageous ancillary to medical treatment.
2.4 Religion and Healthcare in Singapore
Due to the myriad of health issues humans experience as one ages, the need and importance of healthcare services increases. Furthermore, in a society like Singapore, a multiracial and diverse community with people who possess different cultural backgrounds and, specific to this report, religious beliefs. It is important for not only our community members but our societal values and services to be sensitive towards and cater to such diverse needs.
However, in Singapore’s healthcare practices, there is a lack of consideration of religious needs and values in our system. According to the 2016 edition of Singapore Medical Council’s (SMC) Ethical Code and Guidelines, the SMC Physician’s Pledge specifically states that a medical practitioner’s judgement should not be swayed by any extraneous values.
“... not allow the consideration of race, religion, nationality or social standing to intervene between my duty and my patient...” (SMC Ethical Code and Guidelines, 2016)
Furthermore, in section A1 under the ethical guidelines code - Duty of Care, point number 5 clearly states that medical judgements must be made for the benefit of the patient, regardless of external beliefs nor values, whether or not they are widely prevalent in the society.
“You must offer your patients treatments that are beneficial. Treatments are not legitimate just because there is little evidence of harm or because they are widely employed. You must have sufficient reason to believe that they are beneficial to your patients.” (SMC Ethical Code and Guidelines, 2016)
Thus, medical practices are guided by the rule that practitioners should make decisions objectively and be removed from other factors that may influence him or her from making a decision that is not considered medically right. This decision neglects factors such as religious beliefs that may be significant in the patients’ lives.
Religion is one of the major factors that is able to shape one’s lifestyle, beliefs, traditions and practices. Noted to be able to influence an individual to make decisions based on religious doctrines instead of logic (Cohen, 2003). Statistics to illustrate a trend between different religions and their willingness to donate organs shows an indication of how religious beliefs can influence one’s actions. According to the report, the willingness to donate based on a patient’s belief is ranked as follows: Non-Denomination > Buddhism > Others > Christianity > Roman Catholicism > Sikhism > Islamism > Hinduism (Chan & Ho, 2017). Thus showing that based on different religious beliefs, the way they view a certain medical procedure may differ and hence affecting the actions taken by individuals.
According to a news article by BBC, due to the ambiguity of the Quran’s definition of the act of organ transplants in Islamic beliefs, it has caused the Islamic community to be reluctant to both donate and receive organ transplants (McManus, 2015). Thus contributing to the shortage of organ donors in the society as well as deaths due to the inability to cure the patient without conducting an organ transplant.
3. Methodology
3.1 Grounded Theory
Our study and its inductive procedures are guided by Grounded Theory. Grounded Theory is “a method of explication and emergence” (Charmaz, p.156, 2008). As an emergent method, it takes a “systematic inductive, comparative, and interactive approach to inquiry” (ibid.). Interviews conducted have been systematically analysed to form several categories that we later formulated to themes that guide the later half of the paper. Besides themes, importantly as well, the method of Grounded Theory has helped us re-contextualise many of our group’s pre-conceived definitions. For example, we did not initially account for different perspectives or aspects of health prior to our interviews. Some interviewees addressed these other perspectives (e.g. Spiritual Health and “Mind” Health) and this forced us to reframe our interviews.
3.2 Sampling method
Given that our study is focused on depth of findings rather than breadth, we utilized a purposive, convenience-snowball sampling method to obtain participants. We each asked people close to us (friends, parents, relatives) for people who fit our participant criteria. In addition, after interviews, we would ask participants to recommend other interviewees.
3.3 Interviewee demographics
24 individuals were interviewed in this study, of which 20 were individuals with various religious faiths aged 48 to 80 years old. The other three interviewees were comprised of two medical social workers and one medical professor. The overall breakdown of interviewee profiles is summarized as follows and details are found in Appendix F.
5 Buddhist individuals
5 Christian individuals
6 Hindu individuals
5 Muslim individuals
2 Medical social workers
1 Medical professor
3.4 Interview procedures
Broadly, religion group interviewees were asked to share about their views and experiences on their religion, life and health outlook. Guiding questions for each interviewee group were prepared in a semi-structured format, following the general structure as follows.
Religion specific questions (Religion and Ageing)
Interviewees’ religiosity
Interviewees’ experience with religion through their lives
Interviewees’ interpretation of their religion
Health and Religion questions
Interviewees’ health outlook and practices
Interviewees’ ageing concerns
Interviewees’ interpretation of religious health teachings and practices
Medicine and religion questions
Interviewees’ relationship with Western and religious medicine
Interviewees’ take on measures to include religion in medical practice overseas
All interviews were recorded and transcribed for the coding process. All written references to the interviews were subsequently made anonymous to protect the identity of the interviewees. The structure of interviews for medical social workers and the medical professor were considerably different from the one shown above, and more information can be found in the detailed questions prepared for each religion can be found in Appendix A for Buddhists, Appendix B for Hindus, Appendix C for Muslims, Appendix D for Christians, Appendix E for Medical Health Professionals.
3.5 Data Analysis
The data was analysed using thematic analysis. Through open followed by axial coding, three themes common throughout the interviews were revealed, as follows.
Health and Religion
Religion and Ageing
Ageing and Health
4. Findings
From our findings, we have observed that the three variables addressed in this report, Religion, Health and Ageing, are interrelated. This relationship can be best understood through this model:
Figure 1: Model showing the relationship between Religion, Health and Ageing
4.1 Defining “Religion” and “Health”
In defining religion, most interviewees did not just narrow their understanding of the term to associations to physical aspects such as the religious site, activities, or the religious community, although these were important aspects of the religion. In fact, most interviewees saw religion as more than just visiting sites of worship and participating in religion-related activities, rather, they perceived it as a long-term relationship with their God:
B3: “To me, religion is basically having a relationship with the God. It gives me a sense of hope and identity. It is more than just saying prayers everyday or going to the temple during special occasions.”
C2: “The relationship is formed by communicating with him......three basic ways of communicating...... are ......praying, attending service, reading of the scripture.”
M3: “I feel much more closer to the god you see so what during my prayers when I ask I got it you see.”
H4: “Hinduism is not a religion actually. It is a way of life. It is a science actually. Just that, to deliver this science to the layman, they make rituals and practices and all that, so that they can practice it.”
For M3, to pray is to perform an act that brings him closer to God. However for B3, religion is more than just a performance of rituals. In fact, interviewees identified with their religion as influencing the intrinsic and internal parts of the individual’s belief system, even contributing to their sense of self. Likewise, Christians believe that Christianity should be approached as a relationship as opposed to a religion. The Hindu definition as stated by H4 is wider, as it considers Hinduism as a teaching of how one should live, backed by science.
C4: Being Healthy is being able to be mobile...........er er how do I say, eat and sleep well and think positively, I think that is healthy. So it is a state of mind as well as a physical
When asked to define their idea of “health”, a large number of interviewees related the term to being physically able and mentally active, as well as being able to contribute productively to society. Many Christian interviewees have identified being healthy as ‘being mobile’. This can be better understood as a means to achieve an acceptable quality of life in which they are no limited (physically) in their actions. All interviewees also viewed good health as being “very important” to them, and most were concerned about health, particularly about illnesses and disability, through ageing. On the other hand, others were confident that their current lifestyles could maintain an acceptable level of ‘health’ even as they age.
In elaborating on the relationship between religion and health, most participants drew a relational connection between practicing their religion and cultivating good health practices. For a Muslim interviewee, the act of fasting, which is a religious practice, is associated to health as well:
M4: “Optional fasting. It’s also partially got to do with health.”
A Buddhist interviewee also mentioned that entering his religion motivated a positive change in his lifestyle:
B5: “I was only interested in maybe gambling, smoking and drinking. I admit that I smoked in the past for 15 years since I left the army. But I felt that all these things have to be taken away after I entered the religion because they are no good for us. Because we also learn slowly that a good karma can also help you to have a better life in the future.”
In this instance, entering the religion was a turning point in the person’s life, which encouraged a change in lifestyle and a development of good health practices. Similarly, Shaw, Gullifer and Wood, found that religion is thought to be beneficial to health of older adults because religious practices provides a sense of support, comfort and security (2016).
4.2 Ageing and Health
As one grows older, individuals across faiths believe that their body will weaken, making it more susceptible to disease.
C1: “Physically, you may weaken, you can’t escape from that , god designed you in such a way, and god designed us like that
M4: “I’m over 40 because for muslims once you are over 40 you are old so you need to get ready or life after death.”
C3: “My mental agility is slower, I used to be able to have good memory and now I, I think it's harder to achieve. I am more conscious my own body ageing, ageing is quite different from being sick many people think that as you age you will grow sick but it is not true. you can grow old but not necessarily be sick.”
C2: “I am trying to minimize the the downtime that I have for whatever duration that god has assigned to me.”
H2: “...as we grow older, our bones become weak, we have knee pain, our eyesight goes down and a lot of other issues comes with that. And with women, even more you can say, in many ways, more than men.”
It can be seen that many interviewees, especially the older ones believe that ageing is an inevitable process that affects one both physically and mentally. However, C2 believes that ageing does not equate to illnesses and and individuals can delay the onset of this weakening by keeping oneself healthy, in a sense minimizing ‘downtime’ and maintaining one's quality of life.
4.3 Ageing and Religion
4.3.1 Relationship between religiosity and ageing process
To go beyond just claiming that religion is advantageous for older adults, it is also important to understand how older adults perceive religion in relation to their personal life experiences. Based on our interviews, the individuals expressed that it is not uncommon for them to use religion to manage their problems, or as a coping mechanism for certain issues that they have to come to terms with toward the end of their lives.
One aspect of the meaning in religion that may be of particular importance to older adults is the meaning of death and dying. While Thorson and Powell states that older adults tend to have lesser anxiety about death than younger adults, older adults are required to confront issues relating death and dying (2000), which generally pertain to concerns about their health:
B4: When I were young I never thought of having a religion. Maybe because I was too far from death at that time, so I never thought about have a religion...but now age is catching up with me already and my current health is not as good.
According to B4, there is an telling difference between in the importance that she attributed to religion when she was younger and as she ages. It is apparent that she viewed religion as a means for her to cope with health-related issues that she currently faces and which she associates with old age. As people age, some also find their needed support and comfort through prayers or through performing religious rituals:
B3: Chanting it will help you feel like you’re doing something that makes you happy. I am growing older already, so I feel that doing more chanting can protect me, can protect my family.
B5: Every day and night, we would chant the sutra, which helps us to feel relaxed, and calm and basically ease the troubles that we have. So it helps us to cool ourselves down so that we feel very happy, and we need to find this peace in our older years.
H3: “But once the age coming, you will believe in one way of life. The time is there to change you. Either you want to be follow the Christian? Same thing! God is one. All the path only bring you to the one”
H5: “Obviously, initially the mum plays the bigger role in my life, so we just follow the norm of the practice without understanding. Oh so you must go temple, and I was very staunch about it. You got to have vegetarian day, observe vegetarian diet, stuff like that and certain rudimentary practices that we just follow lah you know. But as I became older I questioned a lot of things, and while I am a Hindu myself I dare to indulge in things that I think are not practical.”
Based on this excerpt from B3, it can be seen that the act of chanting Buddhist sutras was a way that helped her feel a sense of protection over herself and her family in opposition her anxiety of growing older and gradual approaching the end of her life. This mirrors Cohen and Koenig’s research on religious coping, which refers to a powerful way in which people find meaning in their lives by feeling that God is present and helping them through their problems (2003). In a way, this can be seen in both B3 and B5’s excerpts, where practicing the religious ritual of chanting helps to ease their emotions and troubles and reassert a calm mental state, which is thought to be essential to cultivate their older years. In fact, religion beliefs can be associated to a number of ways of coping, including emotional comfort and resilience, social support, and reduction of death anxiety (Siegel and Schrimshaw, 2002).
However, interview excerpts from two unrelated Hindu interviewees (H3, H5) provided contrasting accounts of their religiosity through ageing. H3 stated that time naturally caused him to become more religious, which too echoes with Cohen and Koenig’s research as mentioned above (2003). However, for Hindus who preferred to indulge in the empirical basis of the religion, maturation and education would cause them to become less religious as they questioned and discovered the world, as is the case of H5.
4.3.2 Crisis and religiosity
Apart from examining the effect of religion on influencing one’s health, this report also investigated how certain turning points in the interviewees’ spiritual journey changed their outlooks or strengths in their faith. The ageing process is commonly associated to an increased possibility of crises, particularly health-related ones. As such, in relating to the SOC Model, upon being aware of these potential crises and issues that might befall them, the older adults begin to select certain activities that would further their goals of maintaining an acceptable level of health, religion is oft employed as a coping mechanism to deal with this concern of older adults:
C2: It could be a financial, emotional or physical health crisis, so as you grow older, your chance of having one of these are therefore even worse, these three at once delivered to you is going to be very high.
C2: It was only small little crisis that came to me (Made me look for God) when I lost our first. It was that time I started to ponder over, as there is something higher than you. I wouldn't say I was trying to get spiritual at that point of time, but it was then when the thinking of having a religion seem to step in.
In the first excerpt, it can be seen that interviewee C2, believes that with age, it is inevitable that we face ‘crises’ that would cause one to question if a higher being exists and as a result one would inadvertently become more religious. The attraction to Christianity as a religion could stem from its notion of ‘God’s plan’, and that in many aspects of their lives, Christians commit themselves to God, trusting in his plan for them. This tend serves as a source of comfort for many Christians allowing them to be better able to face the inevitable crises of life. This belief can be extended into how Christians face crises of health as well.
C1: In this instances, I sought God diligently, seriously. (Q:Name one particular instance) I was in the bed roughly about 12 midnight having severe pain, very severe, for a moment I thought I was going to die, so what I did was in that position, I put my hand on my heart and kept praying, for almost 15 minutes non-stop. Because I don’t tell her (his wife) cause she will be wondering what is happening you know? And will I kept praying and you believe it? The pain stopped, so after the pain has stopped I felt something fresh and vibrant in mine heart area.
B2: When I wake up every morning I always feel like I want to die. I cannot breathe, I cannot live. So I talked to the Master then, and he told me to pick up chanting. So I chanted for about 4 months without fail. I chanted until I started to get better. But at that point in time when you take blood tests, they are all red marks, all the unhealthy indicators. Until I chanted for a while, all my health indicators came down by themselves. I didn’t do anything, I didn’t do medicine, nothing. But my faith was renewed.
This belief can be attributed to the teaching of the bible which states that ‘For I know the plans I have for you, declares the LORD, plans to prosper you and not to harm you, plans to give you hope and a future.’(Jeremiah 29:11 New International Version). This serves as a source of comfort for Christians as they face inevitable trials and tribulations in their lives, in which they believe that despite their current circumstances, God would resolve their problems. Furthermore, it can be seen for B2 that religion was integral to her recovery process from depression, wherein she chanted sutras that made her feel better emotionally and mentally. The eventual recovery from a particular health ordeal or crisis was a turning point for both the Christian and Buddhist interviewees, which strengthened their belief in their religion.
4.4 Religion and Health
4.4.1 The Three Types Health: Spiritual, Emotional & Physical
The common consensus across all religions have indicated that across religions, individuals mostly believe that the different healths of spiritual, emotional and physical are interconnected sharing a reciprocal relationship. However what differs is in the relative importance in which individuals rank the various healths.
C3: “When I was a non-Christian, I used to think of health as just physical health, but now since I have grown a lot older, I began to realize that physical health and your mental, emotional and spiritual health are all interconnected. If I were to rank them, your spiritual and emotional health will come first.”
H2: “Health is not just physical health, it’s a state of mental and physical health ... but if you are not mind and body aligned together and that’s when you have a lot of issues, other issues.”
Although Christians differ in terms of what they believe to be the most ‘important’ health, majority of christians believe spiritual health to be the most important as ultimately they believe that when they are spiritually strong, they would be able to derive physical and emotional ‘health’ from God.
C3: “And when you have yours spiritual health and you emotional health right, you will find that you physical health will follow, you cannot have physical health leading to spiritual and emotional health. You emotional and spiritual health must come first before psychical health is achieved.”
Hindus on the other hand seems to value the idea of “balance”, with most participants giving equal weight to both mental and physical health. The best summary of this stance is provided by H2 above.
4.4.2 Religion as a way of life
In relation to religion and health, most interviewees mentions that religion provides a sense of stability amidst the unpredictable process of ageing which causes a deterioration of health, a loss of mobility and eventually death. Our initial investigation was positioned by our study of religion as affecting the state of one’s spiritual, mental, emotional and physical health, although the majority of Buddhist, Hindu, and Muslim interviewees distinguished between just mental and physical health. Based on our results, some Muslim interviewees revealed the inverse relationship from what was initially proposed. For them, being healthy is a means of becoming a better muslim and the Quran gives them the means to do so. In addition, being healthy in Islam is a sign of an obedient and faithful muslim. In the same light, the Buddhists interviewees also expressed that their faith was a means through which they could exercise good health, mostly through their diet.
For example, M4 mentioned that the Prophet Muhammad would tell people with a “pouch”, referring to a belly, to “do something about it”.
M4: “Yes because we are only borrowing the physical body. It is the soul that will be questionable so how as a muslim do I take care of my body. Second when I read up on the prophet Muhammad’s era uh. People with pouch uh, Muhammad will actually tell them to do something about it. He doesn’t like uh Muslim men with a pouch. So they must either fast or do something.”
From the excerpt, we can see the Prophet’s solution to the pouches, fasting. From this excerpt, we see that for some Muslims, Fasting is not just a religious practice but a way to be fit and thus healthy. Once healthy, they are better able to practice their faith, for example, prayer as shown in the excerpts below.
M3: “of course ah. If you don’t have if you don’t stay fit, how are you going to do the praying. If you are not healthy then how are you to do the praying.”
M4: “Ultimately when you’re healthy ah, you can become a better muslim because you can do the prayer. Because some -people you know when you do the prayer you must bend you must rokok ah, then you need to prostrate, not anybody can do because that part is actually the body, the leg, the knee ah because after 50 uh I see people doing it on chair because they cannot bend, they cannot prostrate, so I think it’s a waste uh”
B5: “As I indulged myself in the religion, they always tell us that to remain healthy, try to avoid taking all those unnecessary food that people usually take. So I am now fully vegetarian. I am a full vegetarian for about 28 years. It is good to be a vegetarian because you don’t kill lives, and at the same time it keeps you healthy, but they didn’t make it a requirement.”
In H4’s quote in Section 4.1, it is already mentioned how Hinduism is a way of life to him. An example is as follows.
H4: “Because for example, a Hindu before he goes inside a temple or before the prayer, he must go around the temple three times. So the explanation is, you are coming from an outside, like for example, work. You are very stressed, you are worked up or you had a quarrel. Or you are not feeling very good. When you go in, you sync first, you cool down. So you go around walking and get yourself in sync with the environment.”
From these excerpts we can see that in them practicing their religion, they are becoming healthy as well. For M4, the act of prayer is a form of exercise. For B5, being vegetarian keeps him healthy. This also shows a counter-narrative in that the spiritual element of physical healing.
While most interviewees acknowledged that religion was a medium that would promote good health, some interviewees also cited examples where an indulgence in religious practices could backfire, thereby negatively influencing different aspect of their lives. This was demonstrated by this excerpt:
B4: “I see that their (my sister and my brother-in-law) lives are really improving in a sense where they have a very calm mind. But one thing I realised is that they give up their life – they don’t really go travelling, they don’t really join events or activities. This is why I feel that they should have some improvement in the social aspect of their lives. If you chant and meditate everyday and you don’t do anything else, it feels as though your life is not balanced.”
In such instances, it may be seen that practicing one’s religion bolsters mental health to an extent, but if practiced excessively may adversely affect another aspect of their life, such as their social life.
4.4.3 Religious notions of Body vs Soul
The dichotomy between body and soul has been a theme oft repeated amongst different religions.
B1: “I feel that once a person died, the spirit is left behind. The body is actually nothing already. It may be said that the spirit is reincarnated...So the body is a vessel for you to practice your religion and prepare for your afterlife, and cultivate good health in your next life”
C3: “Now, what use is that, I need to respect this body, as this is the only thing I have on this earth until I dies. It’s like you have one dress and you got to wear it until your last day, wouldn’t you take good care of it, it would be terribly silly if you do not take good care of your dress and it turns out tattered and torn.”
It is noteworthy to point out that Buddhist interviewees viewed the body merely as a “vessel” to practice their religion in attempt to transition into their afterlife smoothly. B1 mentioned that there is less importance attributed to the body, whereby it is reduced to “nothing” upon the individual’s passing. Instead, as it is believed that a person’s soul transcends death, the purpose of practicing religion lies in cultivating good health in their next life, rather than their current life.
On the other hand, echoing M4’s point on “borrowing the physical body”, C3 statement stems from the bible verse of ‘Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies.’(1 Corinthians 6:19-20 New International Version). and hence like Muslims, Christians see themselves as personally responsible to care for their own bodies as neglect of your body will lead to illnesses.
C4: “God does not cause the sickness upon you but rather I feel that because in your pursuit of certain particular things that cause you to neglect your body therefore your body are subjected to these diseases due to your neglect...;..To be healthy means to say it is something good for your body so if you take care of your body it should not contradict God's principle.”
C4: “So in that aspect the Christian is saying that this kind of trials will make you realize that you need God.”
M3: “When you healthy you forget about god, this is where god will curse you.”
Neglect and its consequence of illnesses are seen as a result of disobeying the Godly principle of caring for the body that was given to you. Additionally, this illness may also serve as a reminder for Christians to come back to God, highlighting how the physical aspect of health is intrinsically linked to the spiritual aspect of health. For M3, forgetting God when healthy will result in God ignoring you in future times of need.
Nonetheless, there are individuals who would rather not indulge the concept of soul. It manifested in a Hindu individual who is not devoutly religious.
H6: So there is such a thing as soul, that leaves your body, but where does your soul go? I, it’s a big question I don’t know. (Question: But for yourself, you want to believe that there is a soul, there is a concept of a soul.) Ya. But where it goes, what happens to it, I don’t know.
One likely explanation is that individuals who are more concerned about the “way of life” aspect of Hinduism and less concerned about ritual and dogma naturally gravitate towards greater concern for more worldly concerns of well-being and contribution to society, and less towards more spiritual concerns.
4.4.4 Religion as a Source of Healing
Of the Muslim interviewees, only one gave account of Religion and God as sources of healing. The interviewee, M3, believed most strongly in the intervention of God in our lives. However, interestingly, in establishing this connection, he did not claim that it happened directly from God. Instead, he said that he himself had to show his own love and willingness in order for God to see it and reward his sincerity. This love shown was for his daughter who was suffering from eczema as shown below:
M3: “So my 2nd one uh got eczema, so I try to buy medicine try to control the eczema. Rather than we just leave it to her. We need to give full support to her. ... Because why? The touch is there. When you do yourself, you don’t have the loving. When your father do, the loving is there. Then the on top see no? you will want to take care of your children, I help you. Then get better little bit little. If you don’t have the touch, you don’t help you will feel lonely.”
C5 echos the same view that if one asks God will healing, and if the heart is sincere, he will grant the request:
C5:”There was once I was seriously sick my second year I was supposed to go for an exam so two weeks before exam I had fever on and off , I could not even walk 5 Steps let alone take my exam. On the day of the exam I mean before I go for my exam I already told the Lord that you have to help me as it is something that doctors cannot help me, my parents could not help me..... I didn't know how I was going to make it. I lifted at my pen and writing and writing and somehow I wasn't feeling sick..... After the exam, I felt like I had the energy of a normal person, I was walking out of the corridor with new energy, this energy is not my own energy and it was then that I that knew that it must be God.”
Through this anecdote, C5 exercises the Christian right of ‘Ask and it will be given’ (Matthew 7:7. New International Version) as it was written in the Bible.
Nevertheless, one Hindu individual exhibited antagonism towards Western medicine due to his belief in Ayurveda, the traditional Hindu form of medicine, as seen below.
H3: First I don’t want to go to the doctor. Even my wife, she also never believe. We will try our own medicine. Like er, sorry Agnesh, you can check for me err, Tulsi? The kind of plant we have, you take the leaf it’s something like the mint and you put some black pepper and you boil it and you take. Very good.
H3: And in between, whenever I’m getting cure, I myself go to the doctor and start telling them. This your medicine, now I’m cutting now. And I’m going to follow up this. “Eh come on lah, relax first, let it cure first, then you do your one”. But some of them, some of the doctor they believe also. And they telling “it’s okay, no problem, you can take, this is very good.”
H3: So this is give you extra, to let the hormone you know, wake up, certain things this and that. Later part I myself, he’s giving me 56 pills or tablets, is for 3 month medicine, I become the 2nd doctor I cut down. After the balance I give my friends all. Those all they need.
4.5 Religion in a Secular Healthcare System (Religion and Health)
4.5.1 Doctors and Medicine as instrument of God
C1: I would say that doctors are appointed by god.....But the fact remains both are CORRELATED, you know what mean. You go to doctor he gives you the medicine, it is a stepping stone, then god come in, so so he has taken this medicine, heal him. Doctors are argents, instruments (of god)! C4: So that healing itself does not rely on the antibiotics that we take but rather God gives us the antibodies in our body to fight. So in that aspect, the healing process is here (Points at self).
In this excerpt, C1 highlights another aspect of ‘God’s Plan’, of which would include how doctors and (Western) medicine are instruments of God and that alone are insufficient for healing. They only serve as aids to the God-given ability for our bodies to heal through its immune system, hence for Christians true healing can only be derived from God. In C1’s case he would trust the design of God over the use of medicine.
C4: If you were to trace back the history of medical, they, they they have a vow , and the vow is to... and the objective of the health is to bring life and relief to mankind. With that that oath, it’s actually in line with our creator's oath, so err, as far as I am concerned, the medical people, this group are actually on the good track ah. They are not the basis of what religion but they will just go ahead to save a life
Additionally, Christians also believe that doctors and medicine itself are part of God’s design and hence there can be no conflict between the procedures of medicine and the Christian faith. This is reflected in C4’s belief that the hippocratic oath is in line with christian principle, and hence there can be no conflict between although the same cannot be said for Traditional Chinese Medicine.
The sharpest contrast to the Christian faith exhibited above can be found in the statements provided by some Hindu interviewees. None of the Hindu interviewees wanted to draw connections between Hinduism and the medical profession, believing that this would cause unnecessary complications for healthcare workers (H6). However, some supported greater inclusion of religion in nursing and the social work profession (H1).
H6: ...hospital is a place for treatment, not a religious place. So if you’re going to introduce this, then you’ll see lots of different religions in the ward. Can you imagine in an operation theatre, you’ll have a Hindu god there, a Jesus there, a Jesus Christ there? Yeah, then the priest there, then, it doesn’t make sense la. A surgery is a surgery.
H1:Because, you see the people closest to offering any kind of support to the elderly are the social workers and the healthcare workers, right? Be it on a daily basis, be it on a regular basis right. And if they are appreciative of what religion can play in a role of keeping them calm and maybe accept what has happened to them and maybe say yes, it is time to pass on and then... and do that they will be very appreciative that they can even help the patient, you know go through that stage.
4.5.2 Position of Religion within Healthcare system
From a Healthcare Professional standpoint, the procedures adopted in medical procedures are scientifically driven to a large degree. According to the 2016 edition of Singapore Medical Council’s (SMC) Ethical Code and Guidelines, medical decisions made by physicians are centred around the making the ‘right’ decision for patients’ survival. Doctors recommend procedures that will optimise a patient’s quality of life regardless of their cultural, racial or religious background.
However, the Singapore healthcare system in general does not completely neglect the element of religion. Interviews from medical social workers (MSW) have shown that religious perspectives on medical procedure can be altered to cater to the family’s needs and religious values.
MSW1: ... the father brought a mixture from the temple to say that he wanted to give this to the patient... the case went up to ethics who decided that since the patient is we are already not doing anything for the patient, we're just waiting for her to pass away naturally then there is no harm la... So to me, this is how religion or spirituality comes in line with medicine or with healthcare...
Taking this into account, it shows that the Singapore healthcare system is clearly segregated, with people holding different roles, focusing on various priorities in the organisation. Specific to this interview, MSW1 shares about how religion can come into play when making a medical decision for a patient. However, for this case, the religious practice was conducted due to the doctors resigning to the fact that there was no way to save the patient. Hence, even though religious practices are infiltrated into the healthcare system to accommodate our diverse needs, such alternatives are only considered when the patient has no chance of survival. Thus religion is seen as a means to aid patients in palliative care, when medicine has failed to remedy the situation. However this highlights that religion is not taken into account during the process of treatment.
In contrast to religious perceptions where they believe that God is the driving force that guide doctor’s along medical procedures, doctors and medical social workers have a more tactical and practical approach in analysing the situation. According to section C - Relationship with patients, under component C3 - Personal beliefs, point 3 states that it is advised medical professionals to avoid providing personal beliefs while counselling patients.
“...it is better not to personally provide spiritual counselling to your patients, to prevent misunderstanding and loss of objectivity. But if patients request it from you and you decide to personally provide spiritual counselling or support to your patients, you must ensure that your objectivity, judgment and professionalism in medical decision making are not compromised to patients’ detriment.” (SMC Ethical Code and Guidelines, 2016)
Hence, this suggests that to enable medical professionals to provide an objective view, one has to be detached from his or her personal beliefs to administer a professional treatment. This is in contrast to religious beliefs as they view religion as the primary driving force in healthcare procedures. Furthermore, MSW1 shares about the different roles in the healthcare sector and claims that:
MSW1: ... religion will not decide how we treat our patients yea, uh we are very much governed by our own sort of medical ethics and by our laws la in terms of what can or cannot be done for patients.
Therefore, the key difference between religious beliefs and healthcare professional’s values is the emphasis placed on God’s role in healthcare in religious beliefs. They claim that God uses doctors as mediums to guide them in their procedure to cure patients, whereas healthcare professionals view the factor of religion as a supplementary variable that does not affect medical procedure but enhance the quality of healthcare services to cater to specific and sensitive needs of family members and their religious beliefs.
Relating this to Section 4.3 - Ageing and Religion, the current healthcare system in Singapore does accommodate to the patient’s and family's needs for spiritual comfort through providing resources such as a book titled ‘When Your Loved One Passed Away’ for religious and undertaker contacts when a patient has passed. Furthermore to aid the family in coping with their loss, hospitals have located quiet rooms for patients to grieve, pray and come to terms with the situation in the presence of their religious leaders. Hence, enhancing the quality of healthcare services that benefit an individual’s spiritual health which is particularly relevant to the elderly as religion becomes increasingly prominent as an individual ages.
5. Discussion
5.1 Insight and Interpretation
The current study aimed to explore the significance of religion on health and how ageing changes this. One of the most interesting insights was how religious practices and rituals were in themselves a method of keeping healthy. For example, a notable thread between the Hindus, Buddhists and Muslims is that they retain these practices. For the Hindus, their meditation and yoga help with their mental and spiritual health. The Buddhists also recite mantras and sutras to stay mentally healthy. For the Muslims, prayer is a form of physical and spiritual exercise. The Buddhists and Hindus practice these more intentionally for health while the health improvements for Muslims came as a side benefit of their faithfulness. However, Christians interviewed did not specify any particular rituals that lead to a healthier lifestyle but they believe that developing a relationship with
God would improve their spiritual health that would also translate into an improvement of both their physical and emotional health. Also in common is how a majority of the Hindus, Buddhists, Christians and Muslims, despite their religious faiths, still rely on modern medicine and healthcare. Notably for the Hindu and Muslims interviewees, modern medicine represented a separate, but important part of the healing process.
5.2 Health Belief Model (HBM)
In the Health Belief Model, different factors serve to influence an individual’s perception of illnesses and health behavior related to the illness (See 2.2.1). In Section 4.3.1, it is established that a person’s religiosity can either increase or decrease as they age. In Section 4.4.5, we found that high levels of devotion to a religion can negatively impact a person’s relationship to modern Western medicine and the healthcare system in Singapore.
Given these insights, religion can be a factor that is seen to affect an individual’s health
behavior in varying degrees and directions. For example, the Hindu individual who only trusts traditional medicine stemming from his or her religion would find it aversive to seek medical help. On a personal level, this serves to augment perceived limitations of a health behavior in HBM. In a larger picture, it prevents traditional and Western medicine from complementing each other.
On the other hand if the precedent of religion includes that individuals are personally responsible to ensure their health, this may serve to compel individuals to partake in both the adoption of a healthy lifestyle as well as the utilization of the Singaporean healthcare system to maintain their health. Example being diligently scheduling preventive health screenings, which would augment the perceived benefits of health behavior under the model, as failing to do so will result in negative implications in both physical and religious aspects.
Overall, the inter-personal and inter-faith differences make it hard for any entity governing across religions, be it in the healthcare or governance sphere, to create one-size-fits-all solutions for this conundrum. One recommendation stemming from such insights is that religious leaders can take the lead in creating targeted communications to bridge any gaps between the Singapore’s modern healthcare system and traditional medical practices.
5.3 Selection, Optimisation, Compensation (SOC) Model
The SOC describes steps that an ageing person might go through. In many of the interviews, upon realising their ailments and their growing age, many recognise these as limitations to their lives and thus crises as mentioned above. Upon realisation of their growing limitations, they start selecting to prioritise religion as an activity in response to this. For example, B3 started chanting more because she felt like it could “protect [her]” and her family. In this case, it also shows an optimisation of an activity, providing her with a sense of comfort and protection in the face of her coming death. This preferred activity eventually compensate for her realisation of lost time and physical ability, instead working to gain favour with whoever controls her afterlife. The same rings true for M4, who upon realising their old age, see the preparation for their afterlife as an imperative. In return for their loss of youth, they gain in their afterlife “bank”, a term used by M3 to describe the depository of good deeds we need to collect in order to gain access to Heaven.
5.4 Limitations
5.4.1 Possible influence of other sociodemographic factors
The interviews conducted for this study focused on elucidating relationships between ageing, healthcare and religion in a the interviewees’ lives. However, such firm focus may have caused us to place less emphasis on other sociodemographic factors that affect health, ageing and even religion.
For example, while the interviews produced information on the interviewee’s family background and influences on them, the content is always framed as an explanation to religion or health, since the original question was framed that way. Therefore, the real impact of surrounding sociodemographic factors may not be fully explicated.
5.4.2 Low response rate from medical professionals
We approached 15 healthcare workers in attempting to understand the role religion plays in Singapore’s healthcare system. However, only three individuals agreed to having interviews with us. Religion may be a highly sensitive issue in the healthcare sphere, as seen from an online backlash after TODAY newspaper published an article that singled out Malay and Indian cuisine for health concerns (Tan, 2017; in response to Wong & Toh, 2017). Medical professionals may feel that certain information regarding religion and race of patients and the general population would not be appropriate outside of the healthcare sphere, and hence avoid such conversations with us. As such, we may have interviewed a skewed sample of healthcare professionals that does not allow us to ensure fair representation of the healthcare industry in Singapore.
5.2.3 Sensitivity of Topic
The research topic sometimes necessitated for interviewees to give personal anecdotes which are often sensitive and controversial. Topics such as death of a family member to personal healthcare procedures were probed and discussed and for some, these pieces of information was too much to give. Besides low participation rates, the sensitivity of some of these stories kept many of the interviewees from giving us accounts that could have further embellished the paper. In respect for some of them, we have even left out some (despite them being in the transcript) in our analysis and findings.
5.2.4 Data Oversaturation
Data collected came from people of different faiths, cultures, and beliefs. This meant that in collating and synthesising the data, there were snippets of information unique and novel to each group that was left out. The time allowed for the project and the overall scope also limited what we could do with the data. Also, being from different sources, having to interpret these different sources and putting them under specific categories required plenty of subjective categorisation.
6. Conclusion
Overall, it has been observed that differences between religions do necessitate in the need for healthcare professionals to maintain a sense of religious awareness when interacting with their religious patients. As opposed to adopting macro one-size-fits-all policies or guidebooks as implemented by the authorities, healthcare professionals are to be personally aware of their patient’s religious background as so as to dispense appropriate medical advice tailored to their religious sensibilities. Concurrently, we acknowledge that there is a small minority whose trust of religion results in them being aversive and antagonistic to Western medicine. Therefore, it is on the onus of religious leaders to encourage their followers to not only lead healthier lives but also encourage and advocate for the integration of traditional religious methods and modern western medicine under the banner of better health and in the process pave the way for a healthier Singapore in the years to come.
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Appendix A - Interview Questions for Buddhists
Screen Questions
What is your religion?
What is the religion that your family practices?
What is your age?
Religion-specific questions
How long have you been a Buddhist/Taoist?
How religious would you describe yourself?
How often do you go to sites of worships (i.e.: temples)?
Has the extent of religiousness changed throughout your life?
Can you tell me about instances when you feel that your religion becomes most important to you?
Daily life/certain occasions?
Are you comfortable about sharing with others about Buddhism/Taoism?
Does this level of comfort differ between people?
Health-religion questions
What does being healthy mean to you?
How do you try and remain healthy in your daily life?
Have you had any major illnesses in the past few years? If yes, can you tell me about it?
Did Buddhism/Taoism support you during this period? How so?
Generally, how do you feel your health (physical and mental) and religion are related
Is there any cause and effect?
Medicine-religion questions
What are your views on modern medicine?
Does your religion affect you in taking up any medical procedures?
Are there any instances where you refuse modern medicine and rely on your religion to recover from an illness etc?
I will now be going through some medical themes I researched on:
Meditation and Chanting
Meditation techniques and chanting are a core part of Buddhist tradition to prevent mental and physical illness. Do you practice this, how far do you think this technique is effective?
What are your views when people say they manage to survive an ordeal because they have chanted/meditated?
Karma
Do you believe in karma? i.e.: if we accumulate bad karma we are more likely to get sick and receive harm
Are there any personal experiences with regard to karma you don’t mind sharing?
How does this affect your way of life?
Death
What are some views you have on death that perhaps you got from your religion? (i.e.: after- life, life support, euthanasia?
How far do you agree with these religious views? How different or similar are they
Ageing-health-religion questions
Are you concerned about your own health throughout the years?
How concerned are your health in the future?
Do you think doctors and medicine today will sufficiently address your needs as you age?
Yes/ No/ Areas for improvement
How will religion come in, in such a scenario then?
Do you think that Singapore’s healthcare system considers religion in the treatment process?
Have you asked/would you ask for customized treatment by religion?
Do you think that it is necessary for the healthcare system to incorporate religion in the treatment process of patients
Appendix B - Interview Questions for Hindus
Screen questions
What is your age
What is your religion?
Religion-specific questions
How long have you been practicing Hinduism?
How religious would you describe yourself?
Has it changed throughout your life?
When are the times when your religion shines through the most (when you most think about it)?
Daily life?
Certain occasions?
Tell me about an instance
Help me understand – Hinduism states that there is one universal god. How do you then form a relationship with god, or attempt to approach god?
Are you comfortable about sharing about Hinduism?
Does this level of comfort differ between people?
Tell me about an instance where you shared about Hinduism
“ you chose not to share about your religion
Health-religion questions
What does being healthy mean to you?
How do you try to maintain this balance in your daily lives?
I understand that in Hinduism, health is governed by a system known as Ayurveda. Is Ayurveda important in your life and health?
How much do you follow it?
Are there specific instances in your life now that is against the principles of Ayurveda, but you stick to it anyway?
Why?
What do you feel about it?
Have you tried to improve upon it?
Are you worried about falling ill, in a religious sense?
Have you had any major illnesses in the past few years? Tell me about it.
Did Hinduism support you during this period?
So in general, how related do you feel your health and religion are?
Cause and effect?
Medicine-religion questions
How do you see modern medicine?
Is it very different from the teachings of Hinduism?
Are there conflicts? Do you seek to resolve them in any way? Comfortable with living with these conflicts?
Does your religion affect you in any medical procedures?
I will be going through some medical themes that I found online.
Food
Ayurvedic system – hot/cold food. Link to public health campaigns e.g. diabetes. Support? Opinion?
Karma
Cause and effect in diseases
As people age, they tend to get more diseases. Link to religion, karma?
Mental health
Stigma?
“Evil eye”, karma
Any personal experiences/ stories you’ve heard that you’re comfortable with sharing?
Death
Life support
Suicide, euthanasia?
Any personal experiences/ stories you’ve heard that you’re comfortable with sharing?
Ageing-health-religion questions
Are you concerned about your own health through the years?
Are you feeling different from a few years back?
Have you had any diseases? Are you concerned about diseases in the future?
Cancer
Diabetes
Opinion wrt Hinduism? (Yes/ No/ How)
Do you think doctors and medicine today will sufficiently address your needs as you age?
Yes/ No/ Areas for improvement
How will religion come in, in such a scenario then?
Are you comfortable with sharing about your parents’ experiences with modern medicine?
Have there been any conflicts?
How religious are they wrt you?
So you’re avoiding some of the things they did/ So you’re sticking to some of the things they did.
What about you? Do you think the medical field is sufficient for you?
Is healthcare in Singapore catered by religion?
Have you asked for customized treatment by religion?
Do healthcare institutes provide it without your asking? / After you prompt?
Do you think it’s necessary?
Some states in US and Australia have guidebooks on interacting with Hindu patients. I have at least not seen a public copy of such guides in Singapore. Necessary?
Conclusion questions
What are your aspirations from now till your death?
Interesting question based on something I’ve heard: Live not by what you want to be, but by how you want to die. It’s from a storybook. What is your opinion on this?
Appendix C - Interview Questions for Muslims
Screening questions
What is your age
What is your religion?
Religion-specific questions
How long have you been a Muslim?
How religious would you describe yourself?
Has it changed throughout your life?
When are the times when your religion shines through the most (when you most think about it)?
Daily life?
Certain occasions?
Tell me about an instance
How do you form a relationship with god, or attempt to approach god?
Are you comfortable about sharing about Islam with other people?
Does this level of comfort differ between people?
Tell me about an instance where you shared about Islam
“ you chose not to share about your religion
Health-religion questions
What does being healthy mean to you?
How do you try to maintain this balance in your daily lives?
I understand that in Islam, health is holistic; many of the teachings emphasise the importance of the preservation of the living body.
Can you tell me about specific teachings you apply to your daily life?
Why?
What do you feel about it?
Have you tried to improve upon it?
Are you worried about falling ill, in a religious sense?
Have you had any major illnesses in the past few years? Tell me about it.
Did Islam support you during this period?
So in general, how related do you feel your health and religion are?
Cause and effect?
Medicine-religion questions
How do you see modern medicine?
Is it very different from the teachings of Islam?
Are there conflicts? Do you seek to resolve them in any way? Comfortable with living with these conflicts?
Does your religion affect you in any medical procedures?
In what way?
I will be going through some medical themes that I found online.
Mental health
Stigma?
“Evil eye”, karma
Any personal experiences/ stories you’ve heard that you’re comfortable with sharing?
Death
Life support
Suicide, euthanasia?
Any personal experiences/ stories you’ve heard that you’re comfortable with sharing?
Ageing-health-religion questions
Are you concerned about your own health through the years?
Are you feeling different from a few years back?
Have you had any diseases? Are you concerned about diseases in the future?
Cancer
Diabetes
Opinion wrt Islam? (Yes/ No/ How)
Do you think doctors and medicine today will sufficiently address your needs as you age?
Yes/ No/ Areas for improvement
How will religion come in, in such a scenario then?
Are you comfortable with sharing about your parents’ experiences with modern medicine?
Have there been any conflicts?
How religious are they wrt you?
So you’re avoiding some of the things they did/ So you’re sticking to some of the things they did.
What about you? Do you think the medical field is sufficient for you?
Is healthcare in Singapore catered by religion?
Have you asked for customized treatment by religion?
Do healthcare institutes provide it without your asking?/ After you prompt?
Do you think it’s necessary?
Some states in US and Australia have guidebooks on interacting with Muslim patients. I have at least not seen a public copy of such guides in Singapore. Necessary?
Conclusion questions
What are your aspirations from now till your death?
Interesting question based on something I’ve heard: Live not by what you want to be, but by how you want to die. It’s from a storybook. What is your opinion on this?
Appendix D - Interview Questions for Christians
Screen questions
What is your age?
What is your religion?
Religion-specific questions
How long have you been practicing Christianity?
How religious would you describe yourself?
Has it changed throughout your life?
Do you have any testimonies to share?
Daily life?
Certain occasions?
Tell me about an instance
In Christianity it is stated that there is one universal god. How do you then form a relationship with God, or attempt to approach God?
Are you comfortable about sharing about Christianity?
Does this level of comfort differ between people?
Tell me about an instance where you shared about Christianity.
You chose not to share about your religion.
Is Christianity a religion or relationship? Tell me why you think so.
Health-religion questions
What does being healthy mean to you?
How do you try to maintain this balance in your daily lives?
I understand that Christians are called to of honor God first in all that they do and all will fall into place. Does this apply to health?
How much do you follow it?
Are there specific instances in your life where your desires conflict with these principles, but you stick to it anyway?
Why?
Are you worried about falling ill, in a religious sense?
Have you had any major illnesses in the past few years? Tell me about it.
Did Christianity support you during this period?
So in general, how related do you feel your health and religion are?
Cause and effect?
Medicine-religion questions
How do you see modern medicine?
Is it very different from the teachings of Christianity?
Are there conflicts? Do you seek to resolve them in any way? Comfortable with living with these conflicts?
Does your religion affect you in any medical procedures?
What are your views on Death
What does it mean to you? Do you fear it? Why?
What are your views on Life support – an extension of One’s life?
What does it mean to you?
Do you support or oppose? Why?
What are your views on Suicide?
What does it mean to you?
Do you support or oppose? Why?
What are your views on euthanasia?
Do you support or oppose? Why?
What does it mean to you?
Does this differ from Suicide or Life support?
(Note for Probes: Explore the connections between these three aspects, look out for potential confusion between the terms (Suicide, Life support, Euthanasia). In particular, acceptance or aversion of the term itself rather than the act the term represents, based on Personal/Christian views.)
Ageing-health-religion questions
Are you concerned about your own health through the years?
Are you feeling different from a few years back?
Have you had any diseases? Are you concerned about diseases in the future?
With respect to life-threatening illness such as Cancer?
How does Christianity support you in this sense?
Do you think doctors and medicine today will sufficiently address your needs as you age?
Yes/ No/ Areas for improvement
How will religion come in, in such a scenario then?
Are you comfortable with sharing about your parents’ experiences with modern medicine?
What was their religion?
Have there been any conflicts (Between their religion and the procedures that can undergo)?
What about you? Do you think the medical field is sufficient for you?
Is healthcare in Singapore catered by religion?
Do healthcare institutes provide it without your asking?/ After you prompt?
Do you think it’s necessary?
Concluding questions
What are your aspirations from now till your death?
Appendix E - Interview Questions for Healthcare Professionals
What is your religion?
What is your age?
How long have you been religious?
If less than 10 years: What did you convert from?
What were your motivations for doing so?
How religious are you?
Do you go to sites of worship? How often? What is your attitude when you go there?
Who do you go with?
When you are down, have you ever thought about god? Tell me about that instance. If not, what do you think about?
Are you comfortable with sharing with your religion? To who? Tell me about one instance. If not, why aren’t you comfortable? Would you shy away from discussions? Tell me about it.
What religion does your family practice?
How long have they practiced this religion?
Did your parents introduce you to this religion in your childhood
How does religion support you in your daily life?
Share with us an instance when religion was evident in your life.
What does being healthy mean to you?
When was the sickest you have ever been? Tell me about it.
Do you feel that your health and religion are linked?
If not, why do you feel so?
If so, in what ways do you feel they are linked?
Does your religion prevent you from undergoing certain healthcare procedures?
If yes,
What are some examples of these healthcare procedures?
In what way does your religion prevent you from undergoing these procedures?
If, under the circumstance that you really needed to use these healthcare procedures due to your health reasons, would you permit yourself to do so?
What does your religion say about health?
Is bad health your fault? Is it fault of the environment?
Does it challenge science?
Does it bother you?
Do you have to make certain religious decisions about death? Is this decision legal/ possible in Singapore?
What are your views on death? How are they affected by your religion? (i.e.: afterlife, rituals)
On a scale of 1 to 10, 1 being not at all and 10 being no deviation, how closely do you follow the funeral rituals dictated by your religion?
What are some examples of these funeral rituals?
Let’s talk about euthanasia.
What does your religion say?
Is that in line with SG laws?
What is your personal opinion? (Does the gap between ideal and reality bother you?)
What does your family/ friends think?
Do you think about it?
Under what circumstances do you think your religion will be shaken?
In the instance if you are faced with a life threatening illness, would you feel that religion would be more or less important?
Do you think that religion will become more important to you as you age?
If so why?
Which aspects of religion would become more important?
How will that reflect what your changing values (If any) (as you age)
How important is a sense of community to you?
Do you think this will change as you age?
How does your religion contribute to a sense of community?
How does community influence how religious you are?
Healthcare Specific Questions
Can you share about your role as a medical social worker
Are you religious?
How much does your patient’s religion affect the way you administer healthcare/approach your clients?
How big of a role does religion play in the healthcare setting/practice?
E.g. Do you keep it in mind when interacting with the patients?
Are there certain medical procedures that are influenced by religion, and coded in law?
Are there declarations that religious individuals make that will have an effect on your prescriptions
Are there gray areas? How do you approach them?
Have there been attempts to cover these gaps? By who? Success?
Have you had any experiences of conflict/ issues with religion? Was it resolved/ how resolved? What did you feel? What did you learn?
Are you comfortable with it?
Would it conflict with your personal and professional interest/ duty?
Do you see it as a big problem?
Do you know of any other countries that have religion more encoded into their healthcare practice than Singapore? In what way? How does it affect the practice?
Have you noticed any trends between ageing and religion?
Appendix F - Participant Demographic Information
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