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Article Excerpt
During the past decade, the scope of literature concerning spirituality has expanded into a wide range of health care contexts (Koenig. 2001; Meraviglia, 2004; Post. Puchalski. & Larson. 2000; Smith & McSherry, 2004). Spirituality issues have been included in areas of research such as oncology (Flannelly. Flannelly, & Weaver, 2002; Meraviglia, 2004). medical psychology (McEwen. 1998; Hill & Pargament. 2003). and cardiac care (Harris et al.. 1999). In the field of rehabilitation, the role of spirituality in the lives of individuals with disabilities has become a major topic of study related to coping with severe, chronic suffering and losses (McColl et al.. 2000a; McColl et al.. 2000b).
Although deemed an important topic by people with disabilities (Chally & Carlson, 2004). there continues to be inadequate information and contrasting perspectives related to people with disabilities in the growing body of spirituality literature. Treloar (2002) reported that spiritual beliefs enabled people with disabilities and family members to establish meaning for disability and to cope with the challenges of losses associated with disability. These results may appear to be encouraging in regard to the potential benefits of spiritual beliefs for individuals with disabilities. but the study included participants affiliated only with evangelical Christian churches. Participants with disabilities from diverse faiths who do not hold similar religious and/or spiritual beliefs may respond quite differently when asked to address the role of spirituality in their lives.
Numerous authors have characterized the experience of disability as a succession of losses, and as such, may create a context for spiritual changes (McColl et al., 2000a; Selway & Ashman, 1998). Disability -associated challenges may prompt one to question traditional concepts about a higher being, as well as to question the purpose of his/her own life, and in deed, the purpose of life in general. Although reflection on these questions may provide the impetus for personal and spiritual development, authors such as Ross (1995) have noted that the increased isolation that often accompanies the experience of disability may make a spiritual quest more difficult. Whether or not the experience of disability encourages or limits spiritual growth is not fully understood. These notions and the concern that spirituality is " an underused resource in the rehabilitation process" (Underwood-Gordon, Peters, Bijur, & Fuhrer, 1997, p.225) underscore the need to focus on understanding how spirituality may benefit individuals in long term rehabilitation.
Many authors have recommended clarifying the meaning of the terms, spirituality and religiousness (Anandarajah, 2001; Koenig, George, Titus, & Meador, 2004). Although related, these terms are not used synonymously. Religiousness is associated with specific rituals and a doctrine that is shared with a group (Koenig et aI., 2004), while spirituality is viewed as one's inner beliefs or world view about the meaning and purpose of life and/or the quest for understanding these concepts (Thomas, 2000). In this sense, even without religious affiliation, individuals may consider themselves to be strongly spiritual.
Despite clarification of the difference in meaning between spirituality and religion, there continues to be a lack of consensus concerning the definition of spirituality (Bash, 2004; Henery, 2003; MacLaren, 2003; Narayanasamy, 2002; Smith & McSherry, 2004). Howard and Howard (1996) stressed that spirituality refers to a person's, "subjective perception and experience of something or someone greater than him/herself"' (p. 18). In this view, spirituality is defined as an individual's personal beliefs about the forces that influence his or her life and the transcendent aspects of life. Other authors such as Taylor (2001) have emphasized that spirituality is a cultural phenomenon that should be considered within a cultural context and therefore subjective to a society, with no universal definition. While some researchers have expressed concern over the absence of a universal definition of spirituality, others have stressed the importance of addressing the broad components that are commonly used to characterize spirituality. Concept analyses of spirituality by Meraviglia (1999) and Tanyi (2002) have identified attributes most often used to define spirituality. These attributes include: a person's views about what is meaningful, connectedness with self, significant others, nature and/or higher power.
As Meraviglia and Tanyi, McColl et al., (2000a) analyzed the commonalities of spiritual characteristics, but with a slightly different perspective. They focused on the types of relationships consistently found in the definitions of spirituality, highlighting three types of relationships: self, others, and larger than or beyond the world. The relationship types served as the foundation of their attempt to develop a theoretical base for exploring spiritual disability issues. They used a simple matrix to analyze spiritual issues identified as important by individuals with disabilities in light of these relationships. The authors concluded that the framework offered a meaningful structure for conceptualizing spirituality in relation to individuals with disabilities. While offering an organizational structure for reviewing spiritual issues, this conceptual framework appears to shed little light on understanding the complex role spirituality plays in the lives of people with disability.
Even though a universal definition of spirituality remains elusive, perhaps most authors can agree with Anandarajah's (2001) description of spirituality as, "a complex and multidimensional part of the human experience" (p. 82). He continues to elaborate that spirituality is a broad term that includes cognitive and philosophic aspects, namely, "the search for meaning, purpose and truth in life and the beliefs and values by which an individual lives" (p. 83). For the purposes of this study, spirituality was defined broadly as a person's views of the world, particularly, how a person explains the world and the forces that impact her or his life.
The primary goal of the current study was to describe the emerging themes that characterized the role of spirituality in the lives of men and women with severe disabilities. The current study expanded the findings of an earlier study involving women with disabilities (Boswell, Knight, McChesney, & Hamer, 2001), by adding the perspectives of male participants with disabilities to explore spiritual issues discussed by the combined group.
Methods
This study was conducted using qualitative methods implemented by an interdisciplinary team of five researchers representing areas of expertise that included exercise and sport science, health education and promotion, recreation and leisure, and English. Adults with severe disabilities were recruited for the study through purposive...
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