Perceptions of the Efficacy of Prayer and Conventional Medicine for Health Concerns

Journal of Religion and Health (2020) 59:1–18

https://doi.org/10.1007/s10943-018-0704-1(0123456789().,-volV)(0123456789().,-volV)

ORIGINAL PAPER

1 2 3 Albert L. Ly • Anondah R. Saide • Rebekah A. Richert Published online: 12 October 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract Previous research has associated prayer practices with positive health outcomes, but few studies have examined: (a) the perceptions of prayer in relation to perceptions of the efﬁcacy of conventional medicine, and (b) whether the perceptions of prayer efﬁcacy differ based on illness type, context of prayer, and whether prayer is for the self or someone else. The current study surveyed 498 emerging adults at a public university. Conventional medicine was perceived as more effective for alleviating health concerns overall, but participants perceived prayer as most effective when performed in a group setting for someone else. Individuals perceived prayer as more effective than conventional medicine when they reported greater religious activity, lower health locus of control, and higher spiritual locus of control.

Keywords Perceived efﬁcacy Á Prayer Á Conventional medicine Á Health concerns

Introduction

Prayer is a common and prevalent religious practice in the USA; 85% of Americans pray at least once a week and 55% engage in prayer daily (NORC 2014; Pew Forum, 2014), whether praying for themselves (43%), being prayed for by others (24%), or praying in group settings (10%) (Bell et al. 2005). Prayer is also widely used for health: the 2002 National Health Interview Survey found that 45% of Americans incorporate prayer practices in addressing health concerns. As of 2016, 68% of Americans believe a person could be physically healed by God and reported that they had prayed for someone else to be healed by God, a belief mainly held among Protestants and Catholics (Barna 2016).

& Albert L. Ly [email protected] Anondah R. Saide [email protected] Rebekah A. Richert [email protected]

1 Department of Psychology, Loma Linda University, Loma Linda, CA 92350, USA 2 Department of Educational Psychology, University of North Texas, Denton, TX 76203, USA 3 Department of Psychology, University of California, Riverside, CA 92521, USA 123 2 Journal of Religion and Health (2020) 59:1–18

The current study examines perceptions of the efficacy of prayer in comparison with perceptions of the efficacy of conventional medicine for health concerns among a sample of emerging adults. While studies of praying for health concerns have sampled middle- aged and elderly individuals (e.g., Ang et al. 2002; Arcury et al. 2000; McCaffrey et al. 2004), we sought to investigate views of prayer for health concerns among a generation that is more secular and less religious than previous generations (Pew Forum 2015). The current study investigates the effects of two context variables (i.e., the setting and target of prayer) and medical illness type (i.e., acute, chronic, and psychological conditions). Additionally, the current study examines the influence of locus of control, religious engagement, and current health on perceptions of the efficacy of prayer and conventional medicine.

Prayer and Health

Various studies on prayer practices have highlighted small, positive associations with health outcomes, most of which are psychological (e.g., Rippentrop et al. 2005; Ross et al. 2008). These beneﬁts may be especially evident for those experiencing chronic illness, as they are more likely to participate in private religious practices such as prayer and meditation (Rippentrop et al. 2005). Frequent personal prayer is associated with fewer anxiety and depression symptoms and greater self-esteem (Francis and Kaldor 2002; Maltby et al. 1999; Meisenhelder and Chandler 2002). Similarly, engagement in prayer activities is associated with greater well-being, lower anxiety levels, and lower negative affect (Wachholtz and Pargament 2008). Although research suggests prayer is linked to positive health outcomes, it also has been linked to poorer perceptions of current health (Meisenhelder and Chandler 2002; Ross et al. 2008; Somlai et al. 1996).

The Social Component of Prayer

Although people pray in a variety of settings and contexts, the social and communal nature of religious organizations highlights the social aspect of the prayer. Major organized religions emphasize empathic and altruistic attitudes and behaviors toward others (Ellison 1992). Religious Americans are more likely than non-religious Americans to engage in volunteering and charitable giving, especially in their own communities (Lam 2002; Park and Smith 2000), as well as in informal helping behavior, such as donating blood, aiding homeless persons, and providing assistance in obtaining employment (Brooks 2006). Loveland et al. (2005) argued that prayer shifts concern for one’s personal needs in favor of the community. Additionally, perceptions of the efficacy of prayer may increase as individuals feel that their connection to a higher power enhances their ability to be an effective citizen (Harris 1999; Poloma and Gallup 1991). Thus, in addition to studying difference in judgments of efficacy by illness type, the current study also examined the role of social connection during prayer by testing whether individuals’ judgments about the efficacy of prayer differ depending on whether the prayer is: (a) in regard to one’s own health or the health of another person and (b) is conducted alone or in a group setting.

123 Journal of Religion and Health (2020) 59:1–18 3

Characteristics of the Individual

Religious Involvement

Individuals who are more religiously involved (e.g., attend religious service, pray) tend to engage in more health behaviors, such as using seatbelts, exercise, and not smoking (Hill et al. 2007; Holt et al. 2014). More religiously involved individuals, particularly women, also appear to live longer (McCullough et al. 2009, 2000). Other observed beneﬁts of religious involvement include greater optimism, lower depression, and positive social support (Maselko and Kubansky 2006; Schnall et al. 2012).

Locus of Control

Locus of control encompasses the degree to which individuals perceive control over the outcomes of events in their lives (Rotter 1966). An internal locus of control refers to the belief that the self can influence events and their outcomes; an external locus of control refers to the belief that events and their outcomes are driven by outside forces (Rotter 1966). Positive health outcomes, such as a lower risk of heart attack (Stu¨rmer et al. 2006) and mortality (Bosma et al. 1999), have been associated with internal locus of control (Wallston et al. 1976). Specific to prayer, a greater health internal locus of control has been positively related to using private prayer for coping and negatively related to perceived religiosity, after controlling for non-religious factors such as health status (Ai et al. 2005). Relatedly, health outcomes are often seen as inevitable and determined by God (Franklin et al. 2008; Wallston et al. 1999), and God is sometimes perceived as working though physicians to heal (Mansfield et al. 2002). Beliefs about God may affect health behavior. Although Debnam et al. (2012) found that active spiritual beliefs were related to positive health behaviors (e.g., physical activity, fruit and vegetable consumption), Kinney et al. (2002) found that participants who had greater belief that God mediates health were less inclined to adhere to recommendations for breast cancer screenings. Holt et al. (2003) found that an active spiritual locus of control (i.e., belief that a higher power empowers individuals to manage their health) was negatively related to perceptions that mammography is beneficial and positively related to foreseeing its potential barriers (e.g., associating mammography with pain, lacking transportation, cost of procedure, and worrying about breast cancer).

Current Study

The review of the past research on views of the efficacy of prayer revealed a number of dimensions that require clarification. Both the context (alone or in a group) and target (for self or other) of prayer, as well as a person’s own locus of control, likely influence how effective prayer is perceived to be in addressing health concerns. We investigate whether these variables contribute to either differences or are contributors to judgments of prayer efficacy. As increased prayer usage may be a response to poor health, we also examined self-perceptions of health status to gauge the effect of current health in the evaluation of prayer efficacy. A handful of studies have addressed illness type in the usage of prayer, and finding prayer is viewed as most effective for chronic and psychological conditions in addressing various illnesses and health concerns; however, these investigations do not include 123 4 Journal of Religion and Health (2020) 59:1–18 delineations of the effects of each (Arcury et al. 2000; McCaffrey et al. 2004). As such, we investigate in the current study the effects of illness type on judgments about the efficacy of prayer. Finally, although research has touched on the topic of religious differences in the investigation of prayer for health concerns (e.g., McCaffrey et al. 2004), we sought to compare perceptions of efficacy between religious affiliations as well, as no studies to our knowledge have examined potential differences between religious affiliations when considering perceptions of prayer efficacy. The aim of the current study was to address these lingering questions specifically with a sample of emerging adults. Emerging adulthood is a period of active reflection on the meaning of one’s religious and spiritual beliefs (Barry and Abo-Zana 2014; Richert and Saide 2018). Additionally, over the last five generations, researchers have seen a linear decrease in adults reportedly praying on daily basis, attending church services on a weekly basis, and stating that religion is very important in their lives (Pew Forum 2015). In light of significant changes in the religious landscape of the USA over the last 50 years (i.e., McCaffree 2017), we sought to examine the perceptions of prayer efficacy among this more secular generation to understand emerging perceptions of prayer and as a possible indicator of future use of prayer for health. The current study was guided by four sets of hypotheses. First, we predicted that emerging adults would perceive prayer as more efficacious for health-related concerns when (a) prayers are conducted in a group setting, and (b) when the recipient is someone else. Second, we predicted that participants would report greater perceptions of the efficacy of prayer (c) for chronic illnesses, and (d) in comparison with conventional medicine. Third, we predicted that (e) belief in the efficacy of prayer for health would be positively related to an active spiritual locus of control, an external health locus of control, involvement in religious activities, and current health status. Fourth, we predicted that religiously affiliated individuals would perceive prayer as effective, whereas religiously non-affiliated individuals would not.

Method

Participants

The current study sampled 498 undergraduate students at a large, public four-year university in the Pacific Southwest. Participants came from diverse educational programs (33.7% social sciences, 30.1% biological/chemical sciences, 10.1% business, 7.6% humanities, 4.2% engineering, 12.0% undeclared). Participants were excluded from analyses if they reported never praying at all (n = 79), resulting in a final sample of 419 participants. Ages ranged from 17 to 34 (M = 19.22, SD = 1.662; 66.8% female). Par- ticipants identified as: Hispanic/Latino (n = 162, 38.7%), Asian (n = 156, 37%), White/ Caucasian (n = 49, 11.7%), Middle Eastern (n = 29, 6.9%), other (n = 29, 6.9%), Black/ African-American (n = 26, 6.2%), Native American/Alaska Native (n = 10, 2.4%), and Native Hawaiian/Pacific Islander (n = 8, 1.9%). They also identified as: Catholic Christian (n = 147, 35.1%), Protestant Christian (n = 98, 23.4%), non-affiliated or non-religious (n = 52, 12.4%), 11.0% Muslim (n = 46, 11.0%), and other (n = 20, 11.7%).

123 Journal of Religion and Health (2020) 59:1–18 5

Materials

Participants completed an online survey measuring their perception of the efﬁcacy of prayer and conventional medicine, and their health and spiritual locus of control. In addition, participants provided demographic information, such as their age, gender, race/ ethnicity, and religious afﬁliation, as well as their frequency of religious involvement and current health status.

Measures

Perception of Prayer Efficacy for Health Concerns

Perceptions of the efficacy of prayer for health concerns were assessed by asking participants how effective they believe prayer to be in addressing 18 medical conditions. These conditions were categorized as: acute (broken bones, fever, infection, the common cold, inflammation, allergic reaction), chronic (arthritis, diabetes, heart disease, high blood pressure, hepatitis, allergies, nerve problems), and psychological (anxiety disorder, depression, drug/alcohol addiction, obsessive–compulsive disorder, schizophrenia). Questions about the efficacy of prayer were asked in each of four prayer contexts: praying privately for oneself (18 items; Cronbach’s a = 0.981), praying privately for someone else (18 items; Cronbach’s a = 0.985), praying in a group setting for oneself (18 items; Cronbach’s a = 0.990), and praying in a group setting for someone else (18 items; Cronbach’s a = 0.991). For each of the four prayer conditions, the questions were asked in the format, ‘‘How effective is prayer for the following?’’ followed by the three sets of medical conditions on a 4-point Likert-type scale, ranging from not effective (1) to very effective (4).

Perception of Prayer Efficacy of Conventional Medicine

Perceptions of the efﬁcacy of prayer for conventional medicine were assessed using the same medical conditions for the perceived efﬁcacy of prayer scale and with the same 4-point Likert-type scale, ranging from not effective (1) to very effective (4). These questions were asked in the format, ‘‘How effective is conventional medicine for the following?’’ The reliability statistics for this variable were as follows: conventional medicine for acute conditions (Cronbach’s a = 0.961), for chronic conditions (Cronbach’s a = 0.967), for psychological conditions (Cronbach’s a = 0.947); combined reliability (Cronbach’s a = 0.966).

Difference in Perception of Efficacy between Prayer and Conventional Medicine

The difference in perceptions of efficacy between prayer and conventional medicine was calculated by subtracting the composite perceived efficacy of prayer score from the composite perceived efficacy of conventional medicine score (M = 0.786, SD = 1.199). The further a score is from zero (in either direction), the greater the difference in perceptions of efficacy between prayer and conventional medicine. A positive score indicates greater belief in the efficacy of conventional medicine, while a negative score indicates greater belief in the efficacy of prayer. 123 6 Journal of Religion and Health (2020) 59:1–18

Health Spiritual Locus of Control

Health spiritual locus of control was measured using an adapted version of the measure used in Holt et al. (2003). The scale included internal (Cronbach’s a = 0.840) and external (Cronbach’s a = 0.534) health loci of control, as well as active spiritual (Cronbach’s a = 0.856) and passive spiritual loci of control (Cronbach’s a = 0.849) subscales. One question (I have no control over my health) was added to the external dimension from the original scale to improve reliability and face validity. Participants responded on a 5-point Likert scale, ranging from very untrue of me (1) to very true of me (5).

Religious Activity

Religious activity was calculated as an average of four questions about how often the participant prays and participates in religious activities at home, at a religious institution, and at religious events such as holidays. Participants responded on a 9-point Likert scale, ranging from never (1) to multiple times per day (9) (4 items; Cronbach’s a = 0.886).

Health Status

Health status was measured via one question: ‘‘How would you rate your overall health?’’ A greater score indicated greater self-reported health. Participants responded on a 5-point Likert scale, ranging from poor (1) to excellent (5).

Procedure

Participants completed an online questionnaire as part of a larger survey investigating the role of cognition in religious experiences. The entire survey took 30 min to complete. All participants were awarded credit hours toward meeting a course requirement.

Results

Overview of Analysis

Analyses were conducted in four parts. First, we examined contextual conditions (setting and target) with regard to perceptions of prayer efficacy. Second, we analyzed efficacy by illness type and mode of treatment (i.e., conventional medicine versus prayer) to assess differences in perception. Third, we examined differences between religious affiliations for the perceived efficacy of the two modes of treatment. Fourth, we analyzed predicted variables related to the perception of efficacy of prayer, conventional medicine, and the difference in efficacy of the two modes of treatment (prayer versus conventional medicine). Because each condition for the perceived efficacy of prayer for health was highly correlated with the others, a composite variable (Cronbach’s a = 0.987) was created for use in the second and third set of analyses. Means and standard deviations for these variables are presented in Table 1.

123 ora fRlgo n elh(00 911 7 59:1–18 (2020) Health and Religion of Journal

Table 1 Correlations, means, and standard deviations for study variables 123456789

1. Perception of efficacy difference score – 2. Perception of efficacy, prayer - 0.717*** – 3. Perception of efficacy, conventional medicine 0.460*** 0.234*** – 4. Religious activity - 0.466*** 0.599*** 0.086 – 5. Internal LoC 0.170*** - 0.105* 0.079 - 0.056 – 6. External LoC - 0.161** 0.091 - 0.078 0.177*** - 0.108* – 7. Active spiritual LoC - 0.369*** 0.334*** - 0.086 0.250*** 0.048 0.281*** – 8. Passive spiritual LoC - 0.498*** 0.523*** - 0.030 0.448*** - 0.106* 0.313*** 0.686*** – 9. Health status - 0.040 0.111* 0.068 0.082 0.168** - 0.098* 0.009 0.052 – M 0.967 2.433 3.103 4.437 4.394 2.709 2.932 2.974 3.786 SD 1.162 0.966 0.730 1.854 0.703 0.923 1.241 1.314 0.739

*p \ .05, **p \ .01, ***p \ .001 n = 418 123 8 Journal of Religion and Health (2020) 59:1–18

3.5

2.5

PERCEIED EFFICACY 1.5

1 Self Other Self Other Private Prayer Group Prayer Acute Chronic Psychological

Fig. 1 Comparisons of mean ratings for the perception of efﬁcacy of prayer by setting, target, and illness. Error bars show ± 1 conﬁdence interval

Perceptions of the Efficacy of Prayer: Setting, Target, and Illness Type

A 2 (setting: private, group) X 2 (target: self, others) X 3 (illness type: acute, chronic, psychological) within-subjects repeated-measures ANOVA was conducted to examine differences in perception of the efficacy of prayer among prayer setting and target, as well as illness type (see Fig. 1). Results indicated a small, significant main effect of setting, 2 F(1,412) = 28.837, p \ 0.001, gpartial = 0.065, such that participants had greater belief in the efficacy of prayer in group settings (M = 2.484, SD = 0.050, 95% CI [2.385, 2.583]) as opposed to private (M = 2.392, SD = 0.046, 95% CI [2.302, 2.403]). There was also a moderate, significant main effect of prayer target, F(1,412) = 40.374, p \ 0.001, 2 gpartial = 0.089. Participants had greater belief in the efficacy of prayer for others (M = 2.507, SD = 0.050, 95% CI [2.408, 2.606]) as opposed to prayer for themselves (M = 2.369, SD = 0.047, 95% CI [2.277, 2.462]). There was a large, significant main effect of illness, F(1,412) = 153.70, p \ 0.001, 2 gpartial = .272. Participants had greatest certainty about the efficacy of prayer for psychological conditions (M = 2.709, SD = 0.049, 95% CI [2.612, 2.805]) compared to chronic (M = 2.374, SD = 0.051, 95% CI [2.274, 2.474]) and acute types (M = 2.232, SD = 0.051, 95% CI [2.132, 2.331]). A follow-up paired-samples t test found that prayer was seen as more effective for chronic than acute conditions, t(417) = 6.116, p \ 0.001, d = 0.137. Results indicated no significant interaction effect between setting and target of prayer, 2 F(1,412) = 0.399, p = 0.528, gpartial \ 0.001. There also was no interaction between prayer 2 setting and illness type, F(1,412) = 0.817, p = 0.442, gpartial \ 0.001. There was a small but significant interaction between target and illness, F(1,412) = 23.295, p \ 0.001, 2 gpartial = 0.054. As Fig. 1 depicts, this interaction reveals that participants perceived prayer as most effective when performed for someone else and for psychological illness; con- versely, prayer was perceived as least effective when conducted for personal reasons and for acute illness.

123 Journal of Religion and Health (2020) 59:1–18 9

Perception of Efficacy: Mode of Treatment and Illness Type

Preliminary paired-samples t tests were conducted to compare means for the composite variables for perceived efficacy of prayer for health (M = 2.433, SD = 0.966) versus the efficacy of conventional medicine (M = 3.103, SD = 0.730). Results revealed participants viewed conventional medicine to be more effective for health conditions, t(416) = 12.740, p \ 0.001, d = 0.775. These efficacy perceptions were weakly but positively correlated, r = 0.237, p \ 0.001. A 2 (mode of treatment: prayer, conventional medicine) X 3 (illness type: acute, chronic, psychological) within-subjects repeated-measures ANOVA was conducted to examine differences between modes of treatment based on illness type. Results indicated a strong, significant main effect of mode of treatment, F(1,416) = 152.728, p \ 0.001, 2 gpartial = 0.269 (see Fig. 2). Participants reported greater belief in the efficacy of conventional medicine (M = 3.074, SD = 0.036, 95% CI [3.004, 3.144]) as compared to prayer (M = 2.431, SD = 0.047, 95% CI [2.338, 2.524]). Results also indicated a small, signifi- 2 cant main effect of illness type, F(1,416) = 10.177, p \ 0.001, gpartial = 0.024. Participants reported greater belief in the efficacy of treatment for acute conditions (M = 2.798, SD = 0.034, 95% CI [2.732, 2.865]) as compared to chronic (M = 2.758, SD = 0.035, 95% CI [2.689, 2.827]) and psychological conditions (M = 2.701, SD = 0.036, 95% CI [2.630, 2.772]). Lastly, there was a moderate, significant interaction between mode of treatment and 2 illness type, F(1,416) = 316.889, p \ 0.001, gpartial = 0.432 (see Fig. 2). Prayer was seen as most effective for psychological and least effective for acute conditions, and conventional medicine was perceived as most effective for acute and least effective for psychological conditions. Both treatments were perceived as similarly effective for psychological conditions, but conventional medicine was perceived as more effective for chronic and acute conditions.

3.5

2.5

1.5

1 PERCEIVED EFFICACY 0.5

0 Acute Chronic Psychological

Prayer Conventional Medicine

Fig. 2 Comparisons of mean ratings for the perception of efﬁcacy by mode of treatment and illness type. Error bars show ± 1 conﬁdence interval 123 10 Journal of Religion and Health (2020) 59:1–18

4.5

3.5

2.5

2 PERCEIVED EFFICACY 1.5

1 Protestant Catholic Muslim Non-Affiliate Other

Prayer Conventional Medicine

Fig. 3 Perceptions of the efficacy of prayer and conventional medicine by religious affiliation. Error bars show ± 1 confidence interval

Differences by Religious Affiliation

Two one-way, between-subjects ANOVAs were conducted to test for differences in efficacy beliefs by religious affiliation (see Fig. 3). There was a significant effect of religious affiliation for prayer efficacy, F(4,387) = 13.667, p \ 0.001, g2 = 0.124. A Tukey’s post hoc test revealed religious non-affiliates had significantly lower prayer efficacy than the other four affiliation groups (Protestant, Catholic, Muslim, and others), p \ 0.001, which did not significantly differ from each other, ps [ 0.05. For conventional medicine, there were no religious group differences in perception of efficacy, F(4,387) = 0.445, p = 0.769, g2 = 0.005.

Variables Predicting Perception of Efficacy

The fourth set of analyses examined which variables predicted: (a) the perception of efficacy for prayer, (b) the perception of efficacy for conventional medicine, and (c) the difference in perceptions of both for each individual (i.e., prayer–conventional medicine difference score). Three-stage hierarchical linear regressions (see Table 2) were conducted for each dependent variable. The predictor variables included religious activity, health status, internal and external health locus of control, and active and passive spiritual locus of control. Religious activity was entered in the first step of the model; health status was entered in the second step. The third step included the remaining variables.

Prayer

For the prayer model, the linear combination of all predictors accounted for 44.7% of the 2 variance in perception of the efﬁcacy of prayer, Radj = 0.447, F(6, 412) = 57.388, p \ 0.001. Participants who engaged in more religious activities were more certain that prayer is effective for health concerns, b = 0.599, p \ 0.001. Lower levels of external 123 Journal of Religion and Health (2020) 59:1–18 11

Table 2 Hierarchical linear regression results for perceptions of efﬁcacy in prayer, conventional medicine, and the difference between modes BBSE b 95% CI for B Adjusted F change R2 Lower Upper

Prayer Step 1 Religious activity 0.312 0.020 0.599*** 0.272 0.352 0.357 233.575*** Step 2 Religious activity 0.310 0.020 0.594*** 0.269 0.350 0.360 2.605 Health status 0.083 0.051 0.063 - 0.018 0.184 Step 3 Religious activity 0.239 0.021 0.459*** 0.197 0.281 0.447 17.441*** Health status 0.078 0.049 0.059 - 0.018 0.174 Internal health LoC - 0.091 0.052 - 0.066a - 0.193 0.011 External health LoC - 0.102 0.041 - 0.097* - 0.182 - 0.022 Active spiritual LoC 0.027 0.040 0.035 - 0.051 0.106 Passive spiritual 0.231 0.041 0.314*** 0.150 0.312 LoC Conventional medicine Step 1 Religious activity 0.034 0.019 0.086 - 0.004 0.072 0.005 3.132a Step 2 Religious activity 0.032 0.019 0.081 - 0.006 0.070 0.006 2.348 Health status 0.060 0.048 0.061 - 0.035 0.155 Step 3 Religious activity 0.046 0.021 0.117 0.004 0.088 0.019 2.369a Health status 0.038 0.049 0.038 - 0.059 0.135 Internal health LoC 0.084 0.052 0.080 - 0.019 0.186 External health LoC - 0.048 0.041 - 0.061 - 0.129 0.032 Active spiritual LoC - 0.070 0.040 - 0.120a - 0.149 0.008 Passive spiritual 0.014 0.041 0.026 - 0.067 0.095 LoC Difference between modes Step 1 Religious activity - 0.292 0.027 - 0.466*** - 0.345 - 0.238 0.215 115.329*** Step 2 Religious activity - 0.292 0.027 - 0.466*** - 0.345 - 0.238 0.213 0.003 Health status - 0.004 0.068 - 0.002 - 0.138 0.131 Step 3 Religious activity - 0.195 0.028 - 0.311*** - 0.250 - 0.139 0.333 19.609*** Health status - 0.033 0.065 - 0.021 - 0.160 0.094 Internal health LoC 0.222 0.069 0.135** 0.087 0.358 External health LoC 0.029 0.054 0.023 - 0.077 0.135 Active spiritual LoC - 0.113 0.053 - 0.121* - 0.217 - 0.010

123 12 Journal of Religion and Health (2020) 59:1–18

Table 2 continued

BBSE b 95% CI for B Adjusted F change R2 Lower Upper

Passive spiritual - 0.236 0.054 - 0.267*** - 0.343 - 0.129 LoC ap \ .10, *p \ .05, **p \ .01, ***p \ .001 n = 418 locus of control (b = - 0.097, p = 0.013) and higher levels of passive spiritual locus of control (b = 0.314, p \ 0.001) also were related to a greater belief in the efﬁcacy of prayer. Health status, internal health locus of control, and active spiritual locus of control were not signiﬁcant predictors, ps [ 0.05.

Conventional Medicine

For the conventional medicine model, the linear combination of all predictors (religious activity; health status; internal, external health locus of control; and active, passive spiritual locus of control) accounted for 1.9% of the variance in perception of the efﬁcacy of 2 conventional medicine, Radj = 0.019, F(6, 412) = 2.369, p \ 0.05. However, none of the individual predictors were signiﬁcant.

Difference Score

For the difference model, the linear combination of all predictors accounted for 33.3% of the variance in the difference of perception between prayer and conventional medicine, 2 Radj = 0.333, F(6, 411) = 35.688, p \ 0.001. As in the prayer model, participants who engaged in more religious activities were more certain that prayer is effective for health concerns, b = - 0.466, p \ 0.001. Lower internal health locus of control (b = 0.135, p = 0.01), higher active spiritual locus of control (b = - 0.121, p = 0.032), and higher passive spiritual locus of control (b = - 0.267, p \ 0.001) also were related to a greater belief in the efﬁcacy of prayer over conventional medicine. In sum, although participants generally viewed conventional medicine as more effective than prayer (per t test above), participants who believed prayer could be as effective as conventional medicine were more likely to engage in religious activities, have higher spiritual locus of control (both active and passive), and have lower internal locus of control.

Discussion

The current study examined perceptions of the efﬁcacy of prayer for health concerns, exploring the effects of two contextual prayer variables (i.e., the setting and target of prayer) as well as the type of medical illness a prayer is addressing (i.e., acute, chronic, and psychological conditions). This study also tested how perceptions of the efﬁcacy of prayer and conventional medicine related to religious activity, health status, and health and spiritual loci of control. 123 Journal of Religion and Health (2020) 59:1–18 13

The Social Context of Praying for Health

Participants perceived prayer as most effective when conducted in a group setting and for other people, indicating that participants view prayer (at least in the context of health) as a social practice. Most organized religious traditions engage in communal worship involving group prayer and highly regard social supportiveness (Buttrick 1942; Heiler 1932/1958). Altruistic responsibility for others often is stressed in religious worship and is salient in religious individuals as a way of encouraging prosocial behaviors such as civic engagement (Putnam and Campbell 2010; Wuthnow 2004). Additionally, theorists have argued that prayer functions by emphasizing the needs of the local community and can be viewed as more effective when individuals see their connection with a higher power to make them a better citizen (Harris 1999; Loveland et al. 2005; Poloma and Gallup 1991). Our findings support these theories and indicate those who pray likely construe praying for others as a form of helping behavior: It provides a benefit to members of the community by aiding someone in time of need. Considering the group context of prayer, comparison of religious groups found that religiously non-affiliated participants perceived prayer to be significantly less effective for health concerns than religiously affiliated participants. Although past studies found Catholics and Jews reported praying less frequently than Protestants for health concerns (McCaffrey et al. 2004), differences in views of prayer efficacy did not emerge in the current sample. An admitted limitation to the current study is that the samples of Muslim, non-affiliated, and ‘‘other’’ participants were smaller than the samples of Catholic and Protestant participants. However, indicating the social nature of prayer, the primary difference in views of prayer efficacy emerged between those who did and did not identify with a religious tradition.

Prayer versus Conventional Medicine

Although participants viewed prayer as more effective if conducted in social contexts and for others, in general prayer was viewed as less effective than conventional medicine overall. However, when prayer was perceived of as being effective, it was considered most effective in addressing psychological conditions, rather than chronic or acute conditions. These perceptions of efficacy contrast with findings suggesting that people view prayer as more effective for chronic, rather than psychological conditions (McCaffrey et al. 2004). A possible explanation for this difference in findings may be attributed to the fact that our sample was younger than the sample in McCaffrey et al. (2004). We consider the impli- cations of the age of our sample below. The view that prayer is particularly effective for psychological conditions is consistent with Barrett’s (2001) findings that when engaging in petitionary prayer, college students are more likely to petition God to enact psychological causation (e.g., change someone’s opinion) than to enact biological causation (e.g., not get dehydrated). An additional issue may be related to the tangibility of the effect of prayer. The effects of psychological illness are often less evident to those not experiencing the illness than the effects of other chronic or acute health conditions. As Sharp (2013) has argued, when a prayer goes unanswered (or evidence of the answered prayer is not immediately apparent), individuals engage in a variety of justification processes to explain the lack of ‘‘answer’’ without disconfirming the existence of God. The current findings suggest participants may be more likely to believe that prayer is effective for psychological illnesses because the effects of those illnesses are 123 14 Journal of Religion and Health (2020) 59:1–18 less tangibly seen than in the case of the illnesses measured under acute and chronic conditions. The impact of prayer on the psychological illness of another person may not be evident to the individual who engaged in prayer on their behalf; thus, an attribution of the effectiveness of prayer on psychological conditions may be an easier conclusion to make relative to acute and chronic conditions.

Religious Involvement and Locus of Control

Increased belief in the efficacy of prayer was related to greater religious involvement and passive spiritual locus of control, as well as lower external health locus of control. The finding that religious involvement contributes to a greater belief in efficacy of prayer mirrors previous studies that have documented a relation between religious involvement, prayer, and positive health (e.g., Francis and Kaldor 2002; Hill et al. 2007; Holt et al. 2014; Maltby et al. 1999). Additionally, although the effects were small, participants viewed prayer to be more effective if they perceived less external control over their health outcomes and also if they felt that a higher power had control over their health. The past research has noted that some view God as controlling health and illness (Wallston et al. 1999) and as determining unavoidable health outcomes (Franklin et al. 2008). The findings from the current study suggest that belief that God has a role in driving health trajectories is associated with greater belief in the efficacy of prayer. As such, our findings offer additional support for the supposition that for more religiously invested individuals, beliefs about prayer and its effectiveness for health are reinforced and internalized in the form of increased passive spiritual locus of control and decreased external locus of control. None of the variables examined in the regression models predicted perceptions of the efficacy of conventional medicine. However, increased belief in the efficacy of prayer in relation to conventional medicine (i.e., difference score regression analysis) was related to greater religious involvement, lower internal health locus of control, and higher active and passive spiritual locus of control. Taken together, evaluating prayer as more effective than conventional medicine may be a product of greater religious involvement of the individual. Similarly, less internal control over health outcomes and greater belief in God’s role in mediating health outcomes appear to factor into evaluations of prayer as an effective tool in addressing health concerns over conventional medicine. As in the analysis concerning prayer, these findings can likely be explained by the possibility that greater religious investment confirms these beliefs through locus of control; for example, an individual may evaluate prayer as more effective than conventional medicine as their religious involvement manifests decreased perceived control of health outcomes and/or belief that God intervenes. However, in the current study both active and passive spiritual locus of control predicted greater belief in prayer over conventional medicine. These findings suggest individuals higher in both forms of spiritual locus of control are more likely to view prayer as more effective than conventional medicine. Finally, in the analyses predicting perception of efficacy, health status was not a significant predictor above and beyond religious activity, likely because the participants were in the emerging adult phase of development and generally had a shorter history of experience with illness compared to older individuals; as such, their beliefs about health and medicine may reflect more limited personal experience. On the other hand, participants’ responses do indicate general views of prayer at a time in life when their own health concerns may not be salient.

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Limitations and Future Directions

In the current study, we aimed to examine perceptions of the efficacy of prayer and conventional medicine in an emerging adult sample. However, one limitation is that emerging adults are less likely to be actively religious and are more likely to identify as non-religious than older individuals (Putnam and Campbell 2010; Pew Forum 2014). Future research could examine other unique features of this population in regard to both their health concerns and their evolving religious identity. Similarly, future research should examine the perceptions of the efficacy of prayer and conventional medicine across generations within families to investigate these perceptions as influenced by age and experience with illness and health afflictions. A second limitation is that the survey did not account for differing conceptions of prayer. Our survey did not ask for a specific definition for prayer, which allowed participants to provide responses based on their personal beliefs about prayer, and therefore amenable to the religious and ethnic diversity of our sample. However, the study is limited in its ability to account for diverse views of prayer when interpreting the findings. Par- ticipants’ views of prayer are subject to individual, religious, spiritual, and cultural vari- ations; as a result, future research may add a qualitative examination of various views on prayer in order to explore the relation between differing definitions and practices of prayer to views of efficacy for health concerns. Relatedly, there are several prayer-specific factors the study did not address. For example, participants’ views of prayer efficacy may be related to the duration or type of prayer (Poloma and Pendleton 1989): meditative (e.g., personal conversation with God), ritualist (e.g., recitation from a prayer book), petitionary (e.g., requesting things from God), and colloquial (e.g., unstructured prayer). Future studies could systematically delineate the multifaceted nature of prayer. Moreover, although differences in efficacy perceptions across religious affiliations emerged, the inadequate number of participants for each group restricted the ability to compare religious groups. Future research should explore differences within religious traditions. A third limitation is that the external health locus of control scale had low reliability. Prior studies using this scale have typically tested older Christian women undergoing breast cancer screenings (Debnam et al. 2012; Holt et al. 2003). This study measured it with emerging adults, and it may be that this construct does not hold well in samples that are younger and more religiously and ethnically diverse. Lastly, it is important to note that while the current study examined the influence of current health, the measure of current health did not gauge whether participants had experienced any health concerns related to the medical conditions surveyed in the current study. Therefore, the current findings cannot speak to whether efficacy perceptions were influenced by direct experience with the illness and health afflictions in the measures.

Conclusion

The current findings suggest that the perception of efficacy of prayer for health concerns is subject to contextual factors that concern the setting in which prayers are conducted and for whom they are performed. Moreover, perceptions of the efficacy of prayer and conventional medicine relate to different categories of illness. Perceptions of the efficacy of prayer also appear to be influenced by individual factors that relate to religious activity and locus of control factors, but not with current health. Future research may further the examination 123 16 Journal of Religion and Health (2020) 59:1–18 of prayer and its subjective efficacy in addressing health concerns with the inclusion of broader individual and health-related factors that influence them.

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