Religiosity & Pregnant Women Research Article.

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679623 research-article2016 WJNXXX10.1177/0193945916679623Western Journal of Nursing ResearchCyphers et al. Research Report The Relationship Between Religiosity and Health-Promoting Behaviors in Pregnant Women Western Journal of Nursing Research 2017, Vol. 39(11) 1429–1446 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0193945916679623 journals.sagepub.com/home/wjn Natalie A. Cyphers1, Andrea D. Clements2, and Glenda Lindseth3 Abstract Pender’s health promotion model guided this descriptive/correlational study exploring the relationship between religiosity and health-promoting behaviors of pregnant women at Pregnancy Resource Centers (PRCs). A consecutive sample included women who knew they were pregnant at least 2 months, could read/write English, and visited PRCs in eastern Pennsylvania. Participants completed self-report surveys that examined religiosity, demographics, pregnancy-related variables, services received at PRCs, and health-promoting behaviors. Women reported they “sometimes” or “often” engaged in health-promoting behaviors, Hispanic women reported fewer health-promoting behaviors than non-Hispanic women, and women who attended classes at the centers reported more frequent health-promoting behaviors than those who did not attend classes. In separate multiple linear regressions, organized, non-organized, and intrinsic religiosity and satisfaction with surrender to God explained additional variance in health-promoting behaviors above and beyond what Hispanic ethnicity and attending classes at the PRCs explained in pregnant women at PRCs. 1DeSales University, Center Valley, PA, USA Tennessee State University, Johnson City, TN, USA 3University of North Dakota, Grand Forks, ND, USA 2East Corresponding Author: Natalie A. Cyphers, Department of Nursing and Health, DeSales University, 2755 Station Avenue, Center Valley, PA 18034, USA. Email: natalie.cyphers@desales.edu 1430 Western Journal of Nursing Research 39(11) Keywords pregnancy, religiosity, health-promoting behaviors, Pregnancy Resource Center The health decisions made during pregnancy can have lifelong consequences for a woman and her child (Centers for Disease Control and Prevention [CDC], 2013). Consequently, encouraging healthy behaviors by pregnant women has been a focus for maternal/child health care professionals for many years; yet, the results of these efforts remain inconsistent (U.S. Department of Health and Human Services, 2013).

To promote healthy behaviors during pregnancy, it is necessary to determine the factors that influence a woman’s health-promoting behaviors. Religiosity, or religiousness, includes “membership and participation in the organizational structures, beliefs, rituals, and other activities related to a religious faith like Judaism, Hinduism, Islam, or Christianity” (Moberg, 2008, p. 101). For many religions, an important part of the religious beliefs includes a person taking care of his or her health, through such things as healthy eating or avoidance of substance use (Koenig, 2012). In a comprehensive review of literature examining the health habits of individuals and their level of religiosity/spirituality, Koenig (2012) reported that many of the researchers found as the level of religiosity/spirituality of individuals increased, healthier behaviors were exhibited, such as a decrease in smoking, an increase in physical activity, and an improvement in diet. Religiosity research has also been conducted with pregnant women including investigating health behaviors during pregnancy. Increased religiosity was associated with a decreased likelihood of smoking (Burdette, Weeks, Hill, & Eberstein, 2012; Mann, McKeown, Bacon, Vesselinov, & Bush, 2007), alcohol use (Page, Ellison, & Lee, 2009), and marijuana use (Page et al., 2009), and a greater likelihood of better maternal nutrition during pregnancy (Burdette et al., 2012). Although the mechanism is not clear, religiosity in some women has been associated with positive maternal health behaviors. The health promotion model (HPM), a middle-range theory based on expectancy-value theory and social cognitive theory, provides a holistic, multidimensional framework for exploring a person’s health-promoting behavior (Pender, Murdaugh, & Parsons, 2011) and was the theoretical model that framed this research study. The HPM was revised for this study to focus on individual characteristics (personal factors) and behavior-specific cognitions and affect (interpersonal influences) and to look at the relationships between these variables and the behavioral outcome of health-promoting behaviors, measured by the Health-Promoting Lifestyle Profile II (HPLP II; see Figure 1; 1431 Cyphers et al. Individual Characteristics and Experiences Personal factors: demographic data, pregnancy-related, and religiosity Behavior-Specific Cognitions and Affect Interpersonal Influences: services received at the Pregnancy Resource Center and religiosity Behavioral Outcomes Health-Promoting Behavior (measured by HealthPromoting Lifestyle Profile II) Figure 1. Revised health promotion model for study of pregnant women at Pregnancy Resource Centers. Cyphers, 2015).

Religiosity had not been previously studied with the HPM, but as religiosity can also be considered a personal factor according to Pender (N. Pender, personal communication, July 9, 2013), it was included in this research study. Previous research using the HPM identified several factors associated with health-promoting behaviors of pregnant women. Esperat, Feng, Zhang, and Owen (2007) reported that ethnicity was a significant predictor of healthpromoting behaviors in pregnant women (β = .384, p < .01). Researchers also identified that pregnant women with lower educational levels (p < .001) and lower socioeconomic status (p < .01) reported fewer health-promoting behaviors (Kavlak et al., 2013; Lin, Tsai, Chan, Chou, & Lin, 2009).

Bond, Jones, Cason, Campbell, and Hall (2002) reported a weak correlation between religious preference and the Stress subscale of the HPLP II. In addition, Kavlak et al. (2013) studied the relationship between a woman’s feelings about her pregnancy and health-promoting behaviors. Women with unplanned pregnancies had significantly (p < .05) lower HPLP scores than women who had planned pregnancies (Kavlak et al., 2013). The use of the HPM to study health-promoting behaviors in pregnant women can provide important insight for maternal/child health care providers.

Purpose The purpose of this study was to explore the relationship between religiosity and health-promoting behaviors of pregnant women at Pregnancy Resource Centers (PRCs). The primary aims of this descriptive correlational study were to (a) describe the health-promoting behaviors of pregnant women at PRCs, (b) explore the relationship between each of the following sets of variables (religiosity, demographics, pregnancy-related variables, or services obtained at the PRCs) and health-promoting behaviors of pregnant women at 1432 Western Journal of Nursing Research 39(11) PRCs, and (c) determine the percentage of variance that religiosity explains in the frequency of health-promoting behaviors, above and beyond what the other variables explain, in pregnant women at PRCs. Method Study Design and Sample This descriptive correlational study, conducted in eastern Pennsylvania, sampled pregnant women who visited PRCs. PRCs are community centers that offer Christian faith-based approaches to care for pregnant women, including pregnancy tests, prenatal classes, and parenting classes (Family Research Council, 2009). One primary focus of PRCs is to provide support to women who report an unintended pregnancy (Family Research Council, 2009), which may place them at risk for practicing fewer health-promoting behaviors (Kavlak et al., 2013). Although not all women who visit PRCs report unintended pregnancies, very little research has been conducted with pregnant women at PRCs (Hill, 2005; Stark, 2012).

Therefore, this study specifically targeted pregnant women at PRCs. It was estimated by the PRC directors that approximately 372 pregnant women visited the 11 PRC data gathering sites during the study period. From the 372 pregnant women, those who met the inclusion criteria were available for recruitment and consecutive sampling. Religiosity & Pregnant Women Research Article.

The inclusion criteria for this study included (a) being a pregnant woman who had known she was pregnant for at least 2 months, (b) having visited a PRC, (c) being 18 years of age or older, and (d) being able to read and write English. An a priori power analysis was conducted using Khamis and Kepler’s (2010) formula (N ≥ 20 + 5k; k = the number of predictors) to estimate minimum sample size for multiple linear regression with reliability as the criterion in studies with “new variables or populations from which the quantities for an effective power analysis are not available” (p. 514). Based on a conservative estimate of 10 variables entered into the multiple linear regression model after preliminary univariate analysis with a p value of