Abstract
Spiritual health interventions have increasingly been recognized for their potential to improve general health outcomes. This study undertakes a systematic review and meta-analysis to evaluate their effectiveness on patient health in Iran. Data were gathered from PubMed, Scopus, Web of Science, and other relevant sources without time restriction. A random-effects meta-analysis was conducted using Stata version 16. Analysis of 53 studies, comprising both quasi-experimental and clinical trial designs, revealed 94 reported outcomes. Significant enhancements were observed in anxiety (SMD: -1.32), hope (SMD: 2.56), quality of life (SMD: 3.48), stress (SMD: -1.57), depression (SMD: -1.57), spiritual health (SMD: 3.27), and sleep quality (SMD: -1.71), while pain control showed no significant effect (SMD: -0.64). The findings of the current study demonstrate that, despite certain limitations, interventions grounded in spiritual health can effectively enhance both physical and psychological health indicators in patients; however, due to inherent study limitations, cautious interpretation is advised. Future research should leverage advanced tools, particularly artificial intelligence, to assess outcomes objectively, reducing reliance on self-reported data. Studies should also adhere to internationally recognized guidelines to minimize bias and employ larger sample sizes to improve the robustness and generalizability of findings.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40359-025-03275-x.
Keywords: Effectiveness, Spiritual health interventions, Health indicators, Patients
Introduction
Health, deemed a fundamental entitlement for all humanity, is construed as a multidimensional construct by the World Health Organization (WHO). According to the WHO, health signifies a state of holistic well-being encompassing physical, psychological, and social dimensions, transcending mere disease absence [1]. In recent years, spiritual health has garnered the attention of healthcare professionals as a pivotal facet of both individual and collective existence [2, 3]. Spiritual health comprises two facets: religious health and existential health. Religious health denotes an individual’s connection with the divine or an omnipotent force. On the other sideexistential health delineates people interactions with others, the environment, and our internal linkages, affording us the capability to amalgamate diverse dimensions and make assorted choices [4–6].
Over the preceding decades, myriad studies have sought to delve into the association between religious and spiritual convictions and the improvement of physical health. The results of these studies indicate that profound religious convictions can exert a substantial and conspicuous influence on mitigating mortality, morbidity, stress, anxiety, depression, suicide, and addiction [7–9]. Earlier investigations have evidenced that spirituality can bolster patients’ resilience against mental health upheavals subsequent to cancer diagnosis and treatment. Furthermore, an absence of spirituality among critically ill patients can culminate in heightened emotional anxiety, heightened pain and fatigue levels, augmented disease burden, and diminished quality of life [10–12].
Similar to global experiences, health system officials and researchers in Iran have recognized the significance and unique advantages of spiritual health interventions—such as their non-invasive nature, absence of adverse effects, cost-effectiveness, and high feasibility. Concurrently, they have taken into account the sociocultural characteristics of Iranian society, including the profound influence of Islam, collectivist values, and the integral role of spirituality within the healthcare paradigm. In light of these factors, Iranian health experts have systematically developed and implemented spiritually based interventions aimed at enhancing both physical and psychological health outcomes among patients. Such initiatives align with broader international efforts to integrate holistic and culturally sensitive approaches into healthcare, while also addressing the specific needs and values of the local population. By leveraging the synergistic relationship between spiritual well-being and overall health, these interventions contribute to a more comprehensive and patient-centered model of care [13–16]. Although many studies have been disseminated in this domain, most have been conducted in confined settings with restricted sample sizes, Therefore, they fail to furnish comprehensive and lucid information for decision-makers and planners. Consequently, there exists a necessity for a methodical synthesis of these studies’ outcomes to delineate a lucid portrayal of the prevailing scenario, which can be harnessed in decision-making and strategizing. Hence, this study was undertaken to systematically review and meta-analyze the efficacy of spiritual health-based interventions in augmenting patients’ health indicators in Iran.
Methodology
This study is a systematic review and meta-analysis conducted in 2025, following the systematic review methodology described in the book “Systematic Reviews to Support Evidence-Based Medicine” which offers direction on how to conduct and interpret systematic reviews, a key element of evidence-based medicine [17] and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence to the PRISMA guidelines facilitates rigorous and transparent reporting of systematic reviews, thereby enhancing their methodological completeness, reliability, and overall utility for evidence-based decision-making [18].
Search strategy
The search strategy for this study was meticulously designed in collaboration with a subject-matter expert to ensure methodological rigor and comprehensiveness. To optimize the retrieval of relevant literature, the strategy focused specifically on interventions related to spiritual health, encompassing terms and concepts pertinent to this domain. An experienced academic librarian subsequently implemented the search, employing systematic techniques to navigate electronic databases, refine keyword combinations, and apply appropriate filters. Relevant information was gathered through an initial keyword search in databases included PubMed, Scopus, and Web of Science, along with the use of Mesh terms (see Appendix 1, Search Strategy). There were no time restrictions placed on the article search. Additionally, to ensure comprehensive coverage, manual searches were conducted in reputable journals like the Journal of Religion and Health, International Journal of Palliative Nursing, Iran Journal of Nursing and Midwifery Research, and others, as well as hand searching on Google Scholar following the guidelines by Younger P. (2010) [19]. After filtering out articles with weak relevance to the study objectives, the selected primary articles were further verified through a secondary search to ensure a thorough review of the available literature. Unpublished sources (Grey literature) were also searched using databases such as the European Association for Grey Literature Exploitation (EAGLE) and Health Care Management Information Consortium (HMIC).
Inclusion and exclusion criteria
This study employed the PICO framework (Population, Intervention, Comparison, Outcome) to define criteria, including patients with physical health problems (to isolate spiritual interventions’ effects) while excluding those with mental health conditions (to avoid confounding variables). Interventions focused solely on spiritual health were included, whereas religious practices (e.g., prayer) or combined therapies were excluded to ensure specificity. Outcomes encompassed holistic health indicators (e.g., quality of life, anxiety), and only interventional studies in English/Persian were considered to maintain methodological rigor. Observational studies or tool-development research were excluded to prioritize causal evidence (Table 1).
Table 1.
Inclusion and exclusion criteria based on the PICO framework
| PICO Elements | Inclusion Criteria | Exclusion Criteria |
|---|---|---|
| Population | All patients with physical illness |
- Patients with mental health disorders (Dementia, Schizophrenia, drug users, etc.). - Children |
| Intervention | Interventions (any type) based on spiritual health |
− Other types of interventions aimed at promoting spiritual health − Religious interventions (reading the Quran, praying) − Combined interventions (simultaneous examination of the effects of spiritual health interventions and other interventions) |
| Comparison | Routine care or no intervention | Compare with other interventions (psychological interventions) |
| Outcome | General health indicators (mental-psychological, physical, and social health indicators) - such as: quality of life, depression, anxiety, hope, sleep quality, etc. | - Outcomes that were not patient-centered (system-based outcomes such as cost reduction) |
| Others | Studies published in English and Persian |
− Observational or non-interventional studies − Studies aimed at developing tools |
Study selection and screening
The entire process of selecting and screening articles was conducted independently by two members of the research team. Any discrepancies during the initial phase were resolved through discussionIf needed, referred to a third individual with more expertise. Initially, all article titles were examined, and those not aligned with the study objectives were excluded. Subsequently, abstracts and full texts of the articles were sequentially reviewed to identify studies meeting the inclusion criteria and having a weak association with the study objectives. EndNote X5 software was utilized for organization, reviewing titles and abstracts, and identifying duplicates. The PRISMA: 2020 flowchart was employed to report the outcomes of the selection and screening process [20].
Evaluation risk of bias in articles
The assessment the risk of bias in articles was carried out during the full-text screening phase by two independent assessors using the checklists of the revised JBI critical appraisal tool for evaluating the risk of bias in randomized controlled trials [21] and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies [22].These critical appraisal tools were designed to evaluate the methodological quality of a study and determine the extent to which a study has addressed potential biases in its design, conduct, and analysis. The tool for appraising quasi-experimental studies comprises 9 questions, while the tool for clinical trials includes 13 questions. These tools provide options such as “Yes”, “No”, “Unclear”, and “Not Applicable”. The final assessment score for each article was determined through consensus between the two assessors (based on the number of “yes” responses). Any discrepancies between the assessors were referred to a third assessor. In this study, articles were not excluded based on risk of bias assessment scores, and the assessment was solely conducted to inform readers about the bias status in the articles.
Data extraction
For data collection, an information-gathering form was manually developed using Excel software. To ensure the validity of the form, feedback was obtained from three experts in the field. For reliability confirmation, data from 5 articles were extracted as a pilot study to identify and address any deficiencies and issues in the initial form. Two individuals independently extracted data from the selected articles. The information included in the form consists of the author’s name, publication year of the article, study design (quasi-experimental or clinical trial), disease name, sample size in both intervention and control groups, mean age of individuals in both intervention and control groups, brief intervention description, number and duration of sessions (average duration was considered for cases reported as a range), questionnaires used along with their minimum and maximum scores, names of outcomes under investigation, mean and standard deviation of results in both intervention and control groups, and the effectiveness of the intervention on the investigated outcome (yes for a significant impact and no for a no significant impact). In cases where necessary information was not reported in the articles, an email was sent to the corresponding author of the articles. Two individuals independently extracted data, and in cases of ambiguity, assistance was sought from another member of the research team with more experience and knowledge.
Data analysis methods
To estimate the effectiveness of interventions, meta-analytical statistical methods (Standardized Mean Difference (SMD) with Hedges’ g model) and the random effects model were used. Stata software (StataCorp, version 16) was employed for conducting the meta-analysis [23]. The results were reported using Forest plots, where the size of each square represents the sample size and the lines drawn on either side of the square indicate the 95% confidence interval for each study. The I² index and Galbraith plots were used to assess the heterogeneity of study results. In this study, an I² value of less than 50% was considered low heterogeneity, an I² value between 50% and 74% was considered moderate heterogeneity, and an I² value of 75% or higher was considered high heterogeneity [24]. Subgroup analysis was conducted in certain domains based on the tools used for data collection. Meta-regression was performed based on the number and duration of sessions (minutes). Funnel plots and Egger’s regression test at a significance level of 0.1% [25] were used to assess publication bias. In cases where there was a potential for publication bias, the Trim and Fill test with the Linear estimator method was employed. Portions of the extracted data that were not eligible for meta-analysis were manually analyzed and reported using descriptive statistics (percentage, frequency, mean, etc.).
Results
From a total of 1,486 articles identified from databases and other sources, 474 duplicates were removed. During the title and abstract screening, 874 articles were excluded. The full text of 5 articles was not available. During the full-text review, an additional 80 articles were excluded. Ultimately, 53 articles were included in the study [10, 13, 26–76] (Fig. 1).
Fig. 1.
Screening process of studies related to the effectiveness of spiritual health interventions in improving general health indicators of Iranian patients
The information from the 53 reviewed articles is provided in Appendix 2 (Appendix 2 - Data Extraction Form). An analysis of the study types showed that approximately half were quasi-experimental studies, and the other half were clinical trials. The average age and number of participants in both the intervention and control groups were nearly identical. The most frequently studied diseases were cancers. A total of 374 spiritual health intervention sessions (with an average duration of about 73 min each) were conducted. Across all reviewed studies, 75 instruments were used to measure 94 outcomes (including repetitions). Out of the 94 outcomes examined, spiritual health interventions failed to significantly improve the desired outcome in only 7 cases, while the effects of these interventions were statistically significant in 87 cases (Table 2).
Table 2.
Characteristics of reviewed articles on the impact of spiritual health interventions on general health indicators of patients in Iran (53 articles)
| Variable | Results | Variable | Results |
|---|---|---|---|
| Year of Study Publication | From 2013 to 2024 < br > Median: 2019 | Average Age of Participants | Intervention Group: 46.21 years < br > Control Group: 45.9 years |
| Study Design | Clinical Trial: 26 (49%) < br > Semi-experimental: 27 (51%) | Sample Size | Intervention Group: 1572 < br > Control Group: 1573 |
| Diseases | Various Cancers: 18 (33.96%) < br > Cardiovascular Diseases: 10 (18.86%) < br > Thalassemia: 5 (9.43%) < br > MS: 4 (7.54%) < br > Hemodialysis: 4 (7.54%) < br > Stroke: 3 (5.66%) < br > Others: 7 (13.20%) | Interventions | Total Sessions: 374 < br > Average Sessions per Study: 10 < br > Average Session Duration: 72.8 min |
| Total Tools Used (with repetition) | 75 < br > WHOQOL-26: 6 (8%) < br > DAS-21: 4 (5.33%) < br > Snyder’s Hope Scale: 4 (5.33%) < br > Paloutzian and Ellison Spiritual Well-Being Scale: 4 (5.33%) | Total Outcomes Measured (with repetition) | 94 < br > Anxiety: 11 (11.70%) < br > Hope: 8 (8.51%) < br > Quality of Life: 7 (7.44%) < br > Depression: 6 (6.38%) < br > Spiritual Health: 6 (6.38%) < br > Stress: 4 (4.25%) < br > Pain: 4 (4.25%) < br > Fear: 4 (4.25%) < br > Others: 34 (36.17%) |
Meta-analysis results on the effect of spiritual health interventions on spiritual health indices
Anxiety
The results of 11 studies with a sample size of 291 people in each intervention and control group showed that the SMD in anxiety between the two groups was − 1.32 [-2.13 to -0.51, 95% CI], which is statistically significant, indicating the effectiveness of these interventions (Fig. 2). The heterogeneity test revealed high heterogeneity among the study results (I2 = 94.9%, Appendix 3-Fig A, Galbraith plot). The publication bias assessment indicated a relatively low likelihood of publication bias in this section (Publication bias-Egger test, P-value = 0.068, Z= -2.29, Appendix 4-Fig A, Funnel plot). “.
Fig. 2.
Meta-analysis of the effects of spiritual health interventions on anxiety scores of iranian patients using a random effects model
Hope
The results of eight studies, with a sample size of 337 in the intervention group and 333 in the control group, demonstrated a SMD in hope scores between the two groups of 2.56 [0.79–4.32 with 95% CI], indicating a statistically significant effect of these interventions (Fig. 3). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 98.8%) (Appendix 3, Fig B, Galbraith plot). Additionally, the assessment of publication bias indicated a relatively high probability of bias in this section (Publication bias - Egger test: P-value = 0.018, Z = 4.29) (Appendix 4, Fig B, Funnel plot). The Trim & Fill test suggested that potentially one study was unpublished due to publication bias, and incorporating the hypothetical results from this study adjusted the difference between the two groups to 2.78 [1.19–4.54 with 95% CI]. Nonetheless, the difference between the two groups remained significant, indicating that potential publication bias had minimal impact on the overall study results.
Fig. 3.
Meta-analysis of the effects of spiritual health interventions on hope levels in iranian patients using a random effects model
Quality of life
The results of seven studies, each with a sample size of 168 in both the intervention and control groups, showed a SMD in quality of life scores between the two groups of 3.48 [0.83–6.13 with 95% CI], indicating a statistically significant effect of these interventions (Fig. 4). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 98.6%) (Appendix 3, Fig C, Galbraith plot). Moreover, the publication bias assessment indicated a relatively high probability of bias in this section (Publication bias - Egger test: P-value = 0.008, Z = 3.69) (Appendix 4, Fig C, Funnel plot). The Trim & Fill test results suggested that potentially two studies were unpublished due to publication bias, and incorporating the hypothetical results from these studies adjusted the difference between the two groups to 4.67 [2.09–7.24 with 95% CI]. Nevertheless, the difference between the two groups remained significant, indicating that potential publication bias had minimal impact on the overall study results.
Fig. 4.
Meta-analysis of the effects of spiritual health interventions on the quality of life of iranian patients using a random effects model
Depression
The results of seven studies, each with a sample size of 163 in both the intervention and control groups, demonstrated a SMD in depression scores between the two groups of -1.57 [-2.90– -0.23 with 95% CI]. This indicates a statistically significant effect of these interventions in reducing depression among patients (Fig. 5). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 96.4%) (Appendix 3, Fig D, Galbraith plot). Additionally, the publication bias assessment indicated a relatively high probability of bias in this section (Publication bias - Egger test: P-value = 0.001, Z = -3.21) (Appendix 4, Fig D, Funnel plot). The Trim & Fill test results suggested that potentially two studies were unpublished due to publication bias, and incorporating the hypothetical results from these studies adjusted the difference between the two groups to -2.19 [-3.47– -0.90 with 95% CI]. Nevertheless, the difference between the two groups remained significant, indicating that potential publication bias had minimal impact on the overall study results.
Fig. 5.
Meta-analysis of the effects of spiritual health interventions on improving depression in iranian patients using a random effects model
Spiritual health
The results of five studies, each with a sample size of 198 in both the intervention and 193 in the control group, illustrated a SMD in spiritual health scores between the two groups of 3.27 [1.60–4.95 with 95% CI], indicating a statistically significant effect of these interventions in improving spiritual health among patients (Fig. 6). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 96.9%) (Appendix 3, Fig E, Galbraith plot). Additionally, the publication bias assessment indicated a relatively high probability of bias in this section (Publication bias - Egger test: P-value = 0.018, Z = 3.12) (Appendix 4, Fig E, Funnel plot). The Trim & Fill test results suggested that potentially one study was unpublished due to publication bias, and incorporating the hypothetical results from this study adjusted the difference between the two groups to 2.69 [0.90–4.48 with 95% CI]. Nevertheless, the difference between the two groups remained significant, indicating that potential publication bias had minimal impact on the overall study results.
Fig. 6.
Meta-analysis of the effects of spiritual health interventions on improving spiritual health in iranian patients using a random effects model
Stress
The results of four studies, each with a sample size of 101 in both the intervention and control groups, demonstrated a SMD in stress scores between the two groups of -1.32 [-2.05– -0.60 with 95% CI], indicating a statistically significant effect of these interventions in reducing stress among patients (Fig. 7). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 81.53%) (Appendix 3, Fig F, Galbraith plot). Additionally, the publication bias assessment indicated a relatively low probability of bias in this section (Publication bias - Egger test: P-value = 0.078, Z = -1.83) (Appendix 4, Fig F, Funnel plot).
Fig. 7.
Meta-analysis of the effects of spiritual health interventions on reducing stress in iranian patients using a random effects model
Control of pain
The results of four studies, each with a sample size of 154 in both the intervention and control groups, demonstrated a SMD in pain scores between the two groups of -0.64 [-1.56–0.28 with 95% CI], indicating a statistically non-significant effect of these interventions in controlling pain among patients (Fig. 8). The heterogeneity assessment revealed substantial heterogeneity among the study results (I² = 92.71%) (Appendix 3, Fig G, Galbraith plot). Additionally, the publication bias assessment indicated a low probability of bias in this section (Publication bias - Egger test: P-value = 0.60, Z = -0.52) (Appendix 4, Fig G, Funnel plot).
Fig. 8.
Meta-analysis of the effects of spiritual health interventions on pain control among iranian patients using a random effects model
Sleep quality
The results of 3 studies involving a sample size of 124 participants in both intervention and control groups showed a statistically significant difference in the mean standard score of sleep quality between the two groups, -1.71 [-2 --- -1.42 with 95% CI] (Fig. 9). The heterogeneity assessment indicated very low heterogeneity in the study results (I^2 = 0.00%) (Appendix 3 - Fig H, Galbraith plot). The assessment of publication bias also indicated a low likelihood of publication bias in the findings (Publication bias - Egger test (P-value = 0.64, Z = -0.46) (Appendix 4 - Fig H, funnel plot).
Fig. 9.
Meta-analysis of the effects of spiritual health interventions on sleep quality of iranian patients using a random effects model
Regression results
The meta-regression results using a random effects model based on the number of sessions of spiritual health interventions and the average duration of sessions (in minutes) indicated that these variables were significantly predictive significantly only in the domain quality of life and duration of interventions predicting hope (P < 0.05). In other domains, these variables were not significantly predictive (Table 3).
Table 3.
Regression results based on number of sessions of spiritual health interventions and average session duration (in minutes)
| Variable | Modifier | Coefficient [95% CI] | P>|Z| |
|---|---|---|---|
| Anxiety | Intervention Sessions (N) | -0.157 [-0.480–165] | 0.330 |
| Intervention Duration (minutes-mean) | -0.010 [-0.059–0.039] | 0.688 | |
| Hope | Intervention Sessions (N) | -0.022 [-0.857–0.812] | 0.958 |
| Intervention Duration (minutes-mean) | -0.080 [-0.152 --- -0.002] | 0.029 | |
| Quality of Life | Intervention Sessions (N) | 1.09 [0.756 --- 1.440] | < 0.001 |
| Intervention Duration (minutes-mean) | -0.115 [-0.208 --- -0.021] | 0.016 | |
| Depression | Intervention Sessions (N) | 0.322 [-0.447–1.092] | 0.411 |
| Intervention Duration (minutes-mean) | -0.002 [-0.054–0.050] | 0.934 | |
| Spiritual Health | Intervention Sessions (N) | -0.233 [-0.918–0.450] | 0.503 |
| Intervention Duration (minutes-mean) | -0.056 [-1.50–0.036] | 0.234 | |
| Stress | Intervention Sessions (N) | 0.007 [-0.047–0.062] | 0.788 |
| Intervention Duration (minutes-mean) | 0.003 [-0.025–0.033] | 0.796 | |
| Pain control | Intervention Sessions (N) | 0.060 [-0.349–0.470] | 0.772 |
| Intervention Duration (minutes-mean) | - | - | |
| Sleep Quality | Intervention Sessions (N) | - | - |
| Intervention Duration (minutes-mean) | - | - |
Results of risk of bias assessment
The average bias assessment score for clinical trial articles was estimated at 7.23 out of 13 (median 7). In three questions related to blinding, due to the nature of interventions, the option “not applicable” was chosen for all studies, which was a significant contributing factor to lower scores in these articles. Among the major shortcomings identified in this section, inadequate reporting on how individuals were allocated to intervention and control groups, lack of transparency in data handling, and insufficient reporting on how data from participants who dropped out of the study were managed were notable. The average bias assessment score for quasi-experimental articles was estimated at 6 out of 9 (median 6). One of the major shortcomings identified in this section was the lack of reporting or analysis of data about participants who dropped out of the study. Another significant issue in quasi-experimental articles was the absence of repeated measurements. (Attachment 5 - Results of Article Bias Assessment).
Discussion
In this study, 53 articles were reviewed, approximately half of which were quasi-experimental studies and the other half were clinical trials. This meta-analysis of spiritual health interventions demonstrated statistically significant improvements across multiple outcomes: anxiety (MD: -1.32, 95% CI: -2.13 to -0.51), hope (SMD: 2.56, 95% CI: 0.79–4.32), quality of life (SMD: 3.48, 95% CI: 0.83–6.13), depression (SMD: -1.57, 95% CI: -2.90 to -0.23), spiritual health (SMD: 3.27, 95% CI: 1.60–4.95), stress (SMD: -1.32, 95% CI: -2.05 to -0.60), and sleep quality (MD: -1.71, 95% CI: -2.00 to -1.42). Notably, quality of life and hope were influenced by intervention duration (p < 0.05), while pain control showed non-significant effects (SMD: -0.64, 95% CI: -1.56 to 0.28). Heterogeneity was high (I² >80% for most outcomes), but publication bias had minimal impact on significance.
As mentioned, the study results indicate a very positive impact of spiritual health interventions on improving health indicators among patients in Iran. This finding is consistent with results from various studies conducted in Iran and other countries. For instance, de Diego-Cordero et al. (2022), in their systematic review, examined the significant effects of spiritual health interventions on enhancing mental health, wellbeing, and spirituality [77]. Other studies’ results also demonstrate acceptable effectiveness of these interventions for various patient groups [78, 79]. Evidence, especially from systematic review studies, indicates that spiritual health interventions are not only effective for patients but also for other population groups [80, 81]. However, despite confirming the effectiveness of these interventions in texts, a concern exists in this regard regarding the cultural and religious structure of patients in Iran and how outcomes were measured, which were non-blind and self-reported by participants. One of the potential reasons for this high level of effectiveness may stems from patients’ fear of being considered culturally and religiously ignorant. Therefore, for a more accurate and realistic assessment of the effects of these interventions, it is better to use more precise and confidential methods. Another point worth mentioning is that most of the reported outcomes in studies had a mental (non-tangible) nature, and ambiguities and difficulties may have arisen in their measurement or reporting by study participants. Despite all these limitations and potential impacts, it seems that spiritual health interventions can be considered alongside other types of interventions in healthcare centers and should receive attention from policymakers and service providers. One of the disease groups that has received considerable attention from researchers is cancer patients. However, due to the diversity of diseases and the limited number of similar outcomes studied in this research, subgroup analyses based on disease type were not feasible. Nevertheless, initial investigations indicate that similar to overall results, spiritual interventions significantly improved general health indicators among cancer patients. This observation is clearly evidenced in the study by Xing L. et al. (2018), which examined the effectiveness of spiritual health interventions in cancer patients [82]. Furthermore, the findings of Oh PJ and Kim SH (2014) also confirm the (moderate) effectiveness of spiritual health interventions in enhancing health indicators among cancer patients [83]. Despite heterogeneous results across studies and significant methodological limitations in conducting these studies, it appears that due to the nature of cancer, where patients often find themselves in late stages of life or have minimal prospects for recovery, spiritual health interventions, especially in Islamic countries like Iran, can be considered as a non-invasive, low-cost, and effective intervention for these patients, attracting attention from policymakers and healthcare providers [84, 85].
Although the results of spiritual health-based interventions showed a positive effect on many indicators, the results showed that the effect of these interventions on patients’ pain control was not significant. This finding aligns with the results of the systematic review study by Gonçalves JPB et al. (2017), which investigated the impact of health interventions across different groups, including patients, healthcare providers, and healthy individuals, indicating that these interventions had a limited effect on pain improvement (although meta-analysis was not performed in Gonçalves JPB et al.‘s study). One reason for this may be the limited association between pain control and spirituality, along with the nature of the target groups studied in the present research, most of whom suffer from serious and chronic illnesses such as cancer and cardiovascular diseases. Therefore, it is recommended that, alongside spiritual care and interventions, other pain control methods should also be utilized for these patient groups.
Conclusion
The findings of the current study demonstrate that, despite certain limitations—including the self-reported and non-objective nature of the outcomes, the relatively high risk of bias across studies, and significant heterogeneity among study results—spiritual health-based interventions can effectively enhance both physical and psychological health indicators in patients. Therefore, these interventions, especially in Islamic countries like Iran, can serve as a non-invasive, cost-effective, and efficient intervention for patients, gaining attention from policymakers and healthcare providers. However, given the limitations and weaknesses present in the studies, greater caution should be exercised in interpreting and applying the results of these studies. Future studies should incorporate modern tools and technologies—particularly artificial intelligence—to measure outcomes objectively rather than relying on self-reported data. Additionally, adherence to internationally recognized guidelines in study design is recommended to minimize bias, along with increasing sample sizes to enhance the robustness and generalizability of findings.
Limitations and future directions
Although this study sought to deliver comprehensive and transparent insights for decision-makers and healthcare providers—through the identification, extraction, quantitative analysis (meta-analysis and meta-regression), and rigorous interpretation of findings on spiritual health interventions and their effects on health indicators—the majority of included studies exhibited significant limitations. Readers are cautioned to weigh these constraints when interpreting and applying the present findings.
A foremost limitation was the substantial heterogeneity observed across studies in key variables (e.g., disease types, intervention prevalence), which precluded meaningful aggregation without accounting for their inherent diversity. This impeded deeper analyses, particularly disease-specific subgroup analyses. Additional limitations of the reviewed studies included:
The reliance on subjective or self-reported outcomes may have been influenced by participants’ cultural or religious backgrounds. Given the religious beliefs and cultural background of most patients in Iran, they may unrealistically over-report the effects of spiritual health interventions.
Moderate to high risk of bias in most studies, compounded by the impracticality of blinding participants and intervention providers—a factor that may have introduced response bias.
Small sample sizes in most studies limit the generalizability of results.
A lack of long-term follow-up assessments, despite the potential enduring effects of spiritual interventions. Future research should prioritize longitudinal evaluations to address this gap.
The variability in diseases and interventions across studies hindered robust subgroup analyses. To improve precision, subsequent investigations should adopt more disease-specific approaches.
The lack of repeated measurements. Given the educational nature of interventions, which were mostly provided over a short period, it appears that assessing the sustainability of effects is far more critical and significant than immediate and short-term impacts.
Finally, despite exhaustive efforts, considerable heterogeneity persisted among the outcomes of the examined studies, underscoring the need for further methodological refinement in this field.
Overall, spiritual health interventions can be considered a non-invasive and cost-effective approach to improving certain health indicators in patients in Iran. However, due to methodological limitations, the results should be interpreted with caution. To enhance the rigor and reliability of future research, several methodological improvements are strongly recommended. First, modern tools and technologies—particularly artificial intelligence (AI)—should be employed to assess outcomes objectively, replacing traditional self-reporting measures whenever possible. This shift would minimize subjectivity and improve measurement accuracy. Second, researchers should prioritize objective, quantifiable outcomes over subjective measures to reduce potential biases and strengthen the validity of findings. Additionally, adherence to internationally recognized guidelines (e.g., CONSORT for clinical trials) is essential in study design to mitigate risks of bias and ensure methodological transparency. Finally, increasing sample sizes in future studies would enhance statistical power, improve generalizability, and yield more robust conclusions. Collectively, these advancements would elevate the quality of evidence and foster greater confidence in research outcomes.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Additional file 5-Risk of bias assessment
Acknowledgements
We would like to express our heartfelt appreciation to the Vice Chancellor for spiritual health research center of Iran University of Medical sciences for their financial support and assistance with this study.
Author contributions
SA, MN, FR, SA, and SK wrote the main manuscript text and KSA, MR, SY and HA prepared figures. All authors reviewed the manuscript.
Funding
Funding for this work was provided by the Spiritual Health Research Center of Iran University of Medical Sciences (Grant number: 30369).
Data availability
All data used in this study were extracted from published articles included in the systematic review and meta-analysis. No additional datasets were generated or analyzed during the current study.
Declarations
Ethics approval and consent to participate
This study was approved by the Research Ethics Committees of Iran University of Medical Sciences (Approval ID: IR.IUMS.REC.1403.205).
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Organization WH. Definition of health. 1948. http://www.who.int/suggestions/faq/zh/index.html.
- 2.Saad M, de Medeiros R. Advocating for the concept of spiritual health. Am J Emerg Med. 2021;45:563–4. [DOI] [PubMed] [Google Scholar]
- 3.Green C. Nurses and patients’ perspectives on spiritual health assessment. J Relig Health. 2021;60(1):122–33. [DOI] [PubMed] [Google Scholar]
- 4.Moeini M, Ghasemi TMG, Yousefi H, Abedi H. The effect of spiritual care on spiritual health of patients with cardiac ischemia. Iran J Nurs Midwifery Res. 2012;17(3):195. [PMC free article] [PubMed] [Google Scholar]
- 5.Organization WH. The world health report 2000: health systems: improving performance. World Health Organization; 2000.
- 6.Salmabadi M, Sadeghbojd MF, Farshad MR, Zolfaghari S. Comparing the spiritual health and quality of life in addicted and non-addicted patients in the City of birjand, Iran. Int J High Risk Behav Addict. 2016;5(1). [DOI] [PMC free article] [PubMed]
- 7.Asadi Z, Jackson AC, Moradpour F, Cheraghi MA, Sharifi F, Bahramnezhad F. Investigating the relationship between spiritual health, meaning in life, and death attitudes among COVID-19 patients discharged from icus: A Cross-Sectional study in Iran. J Relig Health. 2023;62(4):2984–96. [DOI] [PubMed] [Google Scholar]
- 8.Naghmeh R, Sadat Hoseini AS, Dehghan Nayeri N. Spiritual health consequences from the Iranian adolescents’ perspective. J Relig Health. 2024;63(1):344–55. [DOI] [PubMed] [Google Scholar]
- 9.Tahan M, Azari F. Spiritual health in Iranian university students: a systematic review and meta-analysis. Neuropsychopharmacologia Hungarica: Magyar Pszichofarmakologiai Egyesulet lapja = official J Hung Association Psychopharmacol. 2022;24(2):78–84. [PubMed] [Google Scholar]
- 10.Moeini M, Taleghani F, Mehrabi T, Musarezaie A. Effect of a spiritual care program on levels of anxiety in patients with leukemia. Iran J Nurs Midwifery Res. 2014;19(1):88–93. [PMC free article] [PubMed] [Google Scholar]
- 11.Ho RTH, Chan CKP, Lo PHY, Wong PH, Chan CLW, Leung PPY, Chen EYH. Understandings of spirituality and its role in illness recovery in persons with schizophrenia and mental-health professionals: a qualitative study. BMC Psychiatry. 2016;16(1):86. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Gomez-Castillo BJ, Hirsch R, Groninger H, Baker K, Cheng MJ, Phillips J, Pollack J, Berger AM. Increasing the number of outpatients receiving spiritual assessment: a pain and palliative care service quality improvement project. J Pain Symptom Manag. 2015;50(5):724–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Salimi T, Tavangar H, Shokripour S, Ashrafi H. The effect of spiritual self-care group therapy on life expectancy in patients with coronary artery disease: an educational trial. J Rafsanjan Univ Med Sci. 2017;15(10):917–28. [Google Scholar]
- 14.Ashabi B, Kazeminia M, Nazari M, Oshnookhah M, Mahmoudi E, Mahvar T, Javanbakht Z, Kamravamanesh M. The effect of Religious-Spiritual education and care on the quality of life of Iranian women: A systematic review and Meta-Analysis. J Relig Health. 2024;63(3):2291–313. [DOI] [PubMed] [Google Scholar]
- 15.Borji M, Mousavimoghadam SR, Salimi E, Otaghi M, Azizi Y. The impact of spiritual care education on anxiety in family caregivers of patients with heart failure. J Relig Health. 2019;58(6):1961–9. [DOI] [PubMed] [Google Scholar]
- 16.Faraji A, Khalily M, Naghibzadeh ZA, Kazeminia F, Kazeminia M. The effect of Religious-Spiritual education and care on the life quality of Iranian elderly: A systematic review and Meta-Analysis. J Relig Health. 2023;62(5):3042–69. [DOI] [PubMed] [Google Scholar]
- 17.Khan S, Kunz K, Kleijnen R, Antes J. G: Systematic reviews to support evidence-based medicine. 2011;2.
- 18.Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Reviews. 2015;4(1):1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Younger P. Using Google scholar to conduct a literature search. Nurs Standard (Royal Coll Nurs (Great Britain): 1987). 2010;24(45):40–6. quiz 48. [DOI] [PubMed]
- 20.Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, Aromataris E, Munn Z. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synthesis. 2023;21(3):494–506. [DOI] [PubMed] [Google Scholar]
- 22.Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Systematic reviews of effectiveness. Joanna Briggs Institute reviewer’s manual. Australia: edn.: The Joanna Briggs Institute Adelaide; 2017. pp. 3–10. [Google Scholar]
- 23.Tzemos N, Lim PO, MacDonald TM. Valsartan improves endothelial dysfunction in hypertension: a randomized, double-blind study. Cardiovasc Ther. 2009;27(3):151–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical Res ed). 2003;327(7414):557–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Res ed). 1997;315(7109):629–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Davari S, Rahimian Boogar I, Talepasand S, Evazi MR. Effect of spiritual-religious intervention on illness perception in women with breast cancer. Health Spiritual Med Ethics. 2018;5(4):28–35. [Google Scholar]
- 27.Abdi A, Soufinia A, Borji M, Tarjoman A. The effect of religion intervention on life satisfaction and depression in elderly with heart failure. J Relig Health. 2019;58(3):823–32. [DOI] [PubMed] [Google Scholar]
- 28.Afrasiabifar A, Mosavi A, Jahromi AT, Hosseini N. Randomized controlled trial study of the impact of a spiritual intervention on hope and spiritual well-being of persons with cancer. Investigacion Y Educ En Enfermeria. 2021;39(3). [DOI] [PMC free article] [PubMed]
- 29.Asgarizadeh G, Babayi M, Karamoozian M. The effectiveness of spiritual group therapy on quality of life and life satisfaction among HIV-Positive patients. J Res Health. 2019;9(7):655–62. [Google Scholar]
- 30.Solaymani A, Shariatnia K, Akbari H. Comparing the effects of cognitive hypnotherapy and spiritual therapy on death anxiety in women with breast cancer. J Prev Med. 2022;9(3):280–91. [Google Scholar]
- 31.Nequee F, Janbozorgi M. Investigating the effects of spiritually multidimensional psychotherapy on the patients’ anxiety after bypass surgery. Posit Psychol Res. 2023;8(4):37–54. [Google Scholar]
- 32.Noghani F, Fereidouni Sarijeh P, Sahrif Nia H. The effect of spiritual therapy on hope and Self-efficacy of Hemodialysis patients. Evid Based Care. 2024;13(4):40–6. [Google Scholar]
- 33.Raisi M, Kahrazehi F, Sanagouye Moharer G. The effectiveness of spiritual confrontation skills on pain Self-efficacy in patients with severe thalassemia. J Relig Health. 2021;8(2):1–8. [Google Scholar]
- 34.Abdi K, Arefi M, Afsharnia K, Amiri H. The effectiveness of spiritual group therapy and acceptance and commitment therapy in increasing life expectancy and quality of life among cancer patients. Health Spiritual Med Ethics. 2023;10(1):27–34. [Google Scholar]
- 35.Oshvandi K, Torabi M, Khazaei M, Khazaei S, Yousofvand V. Impact of hope on stroke patients receiving a spiritual care program in iran: A randomized controlled trial. J Relig Health. 2024;63(1):356–69. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Bagheri M, Afshar M, Sadat Z. The effect of spiritual counseling on happiness among patients with multiple sclerosis. Feyz Med Sci J. 2021;25(2):876–83. [Google Scholar]
- 37.Sajadi M, Niazi N, Khosravi S, Yaghobi A, Rezaei M, Koenig HG. Effect of spiritual counseling on spiritual well-being in Iranian women with cancer: A randomized clinical trial. Complement Ther Clin Pract. 2018;30:79–84. [DOI] [PubMed] [Google Scholar]
- 38.Asgari E, Norouzi M, Radmehr H, Mohammadi H. Examining the effect of spiritual health on hope and coping strategies among patients with multiple sclerosis (Ms). J Res Relig Health. 2017;3(3):5–17. [Google Scholar]
- 39.Asadzandi M, Mazandarani HA, Saffari M, Khaghanizadeh M. Effect of spiritual care based on the sound heart model on spiritual experiences of Hemodialysis patients. J Relig Health. 2022;61(3):2056–71. [DOI] [PubMed] [Google Scholar]
- 40.Keivan N, Daryabeigi R, Alimohammadi N. Effects of religious and spiritual care on burn patients’ pain intensity and satisfaction with pain control during dressing changes. Burns: J Int Soc Burn Injuries. 2019;45(7):1605–13. [DOI] [PubMed] [Google Scholar]
- 41.Khezri E, Bagheri-Saveh MI, Kalhor MM, Rahnama M, Roshani D, Salehi K. Nursing care based on the Support-Based spiritual care model increases hope among women with breast cancer in Iran. Supportive Care Cancer: Official J Multinational Association Supportive Care Cancer. 2022;30(1):423–9. [DOI] [PubMed] [Google Scholar]
- 42.Goli R, Faraji N, Maroofi H, Hassanpour A. Effect of spiritual care on the quality of life in patients who underwent intracranial hemorrhage surgery: a randomized controlled trial. Int J Surg (London England). 2024;110(1):167–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Zamaniyan S, Bolhari J, Naziri G, Akrami M, Hosseini S. Effectiveness of spiritual group therapy on quality of life and spiritual Well-Being among patients with breast cancer. Iran J Med Sci. 2016;41(2):140–4. [PMC free article] [PubMed] [Google Scholar]
- 44.Yousofvand V, Torabi M, Oshvandi K, Kazemi S, Khazaei S, Khazaei M, Azizi A. Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial. Complement Ther Med. 2023;77:102981. [DOI] [PubMed] [Google Scholar]
- 45.Kamian S, Taghdisi M, Azam K, Estebsari F, Ranjbaran S, Geravand A. Effectiveness of spiritual health education on increasing hope among breast cancer patients. Iran J Health Educ Promotion. 2014;2(3):208. [Google Scholar]
- 46.Tayyebi A, AHADI H, RAFIEPOOR A, KRASKIAN MA. The effectiveness of spiritual therapy on increasing CD4 cell and quality of life in AIDS patients. J Res Behav Sci. 2020;17(4):695–704. [Google Scholar]
- 47.Azimian J, Soleimany Ma, Sharif SP, Banihashemi H. The effect of spiritual care program on death anxiety of cardiac patients: A randomized clinical trial. Avicenna J Nurs Midwifery Care. 2019;27(1):1–10. [Google Scholar]
- 48.Fereidouni Sarijeh P, Kia B, Mahmoodi M, Salahi Nejad M. The effect of spiritual therapy on resiliency of Hemodialysis patients. Avicenna J Nurs Midwifery Care. 2021;29(4):264–72. [Google Scholar]
- 49.Baljani E, Azimpour A, Babaloo T, Rahimi J, Cheraghi R. The impact of spiritual counseling in hope of patients with cancer. Nurs Midwifery J. 2017;15(9):696–703. [Google Scholar]
- 50.Sepahvand F, Rezaei F, Mirderikvand F. Evaluation of the effectiveness of spiritual therapy based on positive thinking on spiritual health, psychological hardiness and death anxiety in women with beta thalassemia major. Sci J Iran Blood Transfus Organ. 2022;19(3):224–33. [Google Scholar]
- 51.Rafiee Shafigh M, Rajaei A, Janbozorgi M. The effectiveness of spiritually multidimensional psychotherapy (SMP) on psychological capital and stress symptoms of patients with type 2 diabetes. Int J Appl Behav Sci. 2021;8(4):1–10. [Google Scholar]
- 52.Tajbakhsh F, Hosseini MA, Rahgozar M. The effect of Religious-Spiritual care on stress post surgery coronary artery bypass graft patients. Iran J Rehabilitation Res Nurs. 2016;2(4):57–65. [Google Scholar]
- 53.Khanaliloo R, Lotfiekashani F. The effectiveness of spirituality-based acceptance and commitment therapy on depression and dysfunctional attitudes in patients with multiple sclerosis. Qur̓ān Va ṭib (Quran and Medicine) 2020;5(1):93–109.
- 54.Yousefian Z, Ahadi H, Mojmanari AK. The effectiveness of spirituality therapy on psychological distress and resilience of thalassemia patients. J Psychol Sci. 2020;18(84):23–35. [Google Scholar]
- 55.Yousefian Z, Ahadi H, Keraskian Mojmanari A. Effectiveness of spirituality therapy on the qualify of life and mindfulness of the patients with thalassemia. Med J Mashhad Univ Med Sci. 2020;62(51):750–60. [Google Scholar]
- 56.Ghaempanah Z, Rafieinia P, Sabahi P, Makvand Hosseini S. Evaluation of the effectiveness of spiritual/religion intervention on spiritual coping and psychological well-being among woman with cancer. Cult Psychol. 2021;5(1):34–60. [Google Scholar]
- 57.Ameri Z, Askari P, Heidarei A, Bakhtiarpour S. The effectiveness of spirituality therapy training on tolerance to distress and death anxiety among patients with leukemia: A pilot study. Community Health. 2021;8(2):275–88. [Google Scholar]
- 58.Saeidi Taheri Z, Zandi MA, Ebadi A. The effect of spiritual care based on ghalbe Salim model on the sleep quality of the patients with coronary artery disease. Iran J Crit Care Nurs. 2014;7(2):94–103. [Google Scholar]
- 59.saeedi taheri z. Asadzandi m, Ebadi a: the effect of spiritual care based on GHALBE SALIM model on spiritual experience in patients with coronary artery disease. J Nurs Educ. 2013;1(3):45–53. [Google Scholar]
- 60.Khorami Marekani A, Naseri O, Radfar M, Khalkhali H. Evaluating the effect of spiritual counseling on spiritual well-being of cancer patients undergoing chemotherapy in omid research-treatment hospital in urmia, in 2014. Nurs Midwifery J. 2016;14(7):592–600. [Google Scholar]
- 61.Bahreinian A, Radmehr H, Mohammadi H, BAVADI B, MOUSAVI MR. The effectiveness of the spiritual treatment groupon improving the quality of life and mental health in women with breast cancer. 2017.
- 62.Kazemi M, Heidari S, Azimpoor A, Babaloo T, Baljani E. The impact of spiritual counseling on life satisfaction of patients with cancer: a clinical trial study. Scientific Journal of Hamadan Nursing & Midwifery Faculty-ISSN 2018, 2008:2819.
- 63.Haddadi Kuhsar AA, moradi a G, Bonab B, Imani F. Comparing the effectiveness of spiritual therapy based on Iranian culture with mindfulness based on reduction stress (MBSR) in reducing depression, anxiety and stress in patients with chronic pain. Clin Psychol Stud. 2018;8(31):1–30. [Google Scholar]
- 64.Asadollahi F, Taher NH, Kalantary M, Mehrabi HA, Afshar H, Daghaghzadeh H. Effectiveness of spiritual therapy on somatic symptoms in female patients with irritable bowel syndrome. J Res Behave Sci. 2014;12(3):317–27. [Google Scholar]
- 65.Sepahvand F, Rezaei F, Mirderikvand F. Evaluation of the effect of spiritual therapy based on positive thinking on depression and fatigue in women with beta thalassemia major in khorramabad, Iran. J Relig Health. 2023;10(2):46–53. [Google Scholar]
- 66.Nazemi Ardakani F, Bahrami Ehsan H, Alipour A, Bayat N. Effectiveness of religious-spiritual intervention based on Islamic approach on psychological and immune indices in patients with rheumatoid arthritis. Appl Psychol Res Q. 2016;6(4):113–31. [Google Scholar]
- 67.Soltani F, Chahqui M, Arab M, Hosseini S-F, Dabbagh F. The effect of spiritual care on pain in patients undergoing coronary artery bypass grafting. Iran J Cardiovasc Nurs. 2017;5(4):20–1. [Google Scholar]
- 68.Babamohamadi H, Kadkhodaei-Elyaderani H, Ebrahimian A, Ghorbani R, Tansaz Z. Effects of spiritual care based on GHALBE SALIM model on quality of life of patients with acute myocardial infarction. Koomesh. 2019;21(2):262–70. [Google Scholar]
- 69.Mohamad karimi M, Shariatnia K. Effectiveness of spiritual therapy on the life quality of the women with breast cancer in Tehran. Nurs Midwifery J. 2017;15(2):107–18. [Google Scholar]
- 70.Hashemi BM, Sarabian S, Kashani Lotfabadi M, Hosseini S, Mohammadi A. The effect of spiritual intelligence training on human dignity in patients with cancer: clinical trial. Avicenna J Nurs Midwifery Care. 2019;27(4):209–21. [Google Scholar]
- 71.Aghajani M, Afaze MR, Morasai F. The effect of spirituality counseling on anxiety and depression in Hemodialysis patients. Evid Based Care. 2014;3(4):19–28. [Google Scholar]
- 72.Asadi M, Asadzandi M, Ebadi A. Effects of spiritual care based on ghalb Salim nursing model in reducing anxiety of patients undergoing CABG surgery. Iran J Crit Care Nurs. 2014;7(3):142–51. [Google Scholar]
- 73.Momeni Ghale-Ghasemi T, Musarezaie A, Moeini M, Naji Esfahani H. The effect of spiritual care program on ischemic heart disease patients’ anxiety, hospitalized in CCU: A clinical trial. J Res Behav Sci. 2013;10(6):554–64. [Google Scholar]
- 74.Motavakel N, Maghsoudi Z, Mohammadi Y, Oshvandi K. The effect of spiritual care on sleep quality in patients with multiple sclerosis referred to the MS society of Hamadan City in 2018. Avicenna J Nurs Midwifery Care. 2020;28(1):36–45. [Google Scholar]
- 75.Ebrahimi Dastgardi N, Raisi Z, Rezaei S, Nik Yar H. [The effectiveness of spiritual therapy on anxiety and pain intensity in patients with traumatic brain injury]. Psychol Relig. 2023;16(1):45–60. [In Farsi]. [Google Scholar]
- 76.Amini K, Tahrekhani M. The effects of spiritual care on fatigue and pain among patients with cancer receiving chemotherapy: A randomized controlled trial. Holist Nurs Pract. 2022;36(6):335–43. [DOI] [PubMed] [Google Scholar]
- 77.de Diego-Cordero R, Suárez-Reina P, Badanta B, Lucchetti G, Vega-Escaño J. The efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health: A systematic review and meta-analysis. Appl Nurs Research: ANR. 2022;67:151618. [DOI] [PubMed] [Google Scholar]
- 78.Reynolds N, Mrug S, Wolfe K, Schwebel D, Wallander J. Spiritual coping, psychosocial adjustment, and physical health in youth with chronic illness: a meta-analytic review. Health Psychol Rev. 2016;10(2):226–43. [DOI] [PubMed] [Google Scholar]
- 79.Liu Q, Jiang L, Ho KY, Lam KKW, Lam W, Yang F, Mao T, Sun M, Shen B, Ho JM, et al. Spiritual interventions among pediatric patients with cancer: A systematic review and Meta-Analysis. J Pain Symptom Manag. 2024;68(1):e8–20. [DOI] [PubMed] [Google Scholar]
- 80.Sharifnia AM, Fernandez R, Green H, Alananzeh I. The effectiveness of spiritual intelligence educational interventions for nurses and nursing students: A systematic review and meta-analysis. Nurse Educ Pract. 2022;63:103380. [DOI] [PubMed]
- 81.de Diego-Cordero R, Zurrón Pérez MP, Vargas-Martínez AM, Lucchetti G, Vega-Escaño J. The effectiveness of spiritual interventions in the workplace for work-related health outcomes: A systematic review and meta-analysis. J Nurs Adm Manag. 2021;29(6):1703–12. [DOI] [PubMed] [Google Scholar]
- 82.Xing L, Guo X, Bai L, Qian J, Chen J. Are spiritual interventions beneficial to patients with cancer? A meta-analysis of randomized controlled trials following PRISMA. Medicine. 2018;97(35):e11948. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 83.Oh PJ, Kim SH. The effects of spiritual interventions in patients with cancer: a meta-analysis. Oncol Nurs Forum. 2014;41(5):E290–301. [DOI] [PubMed] [Google Scholar]
- 84.Nouri M, Ostadtaghizadeh A, Sari AA. COVID-19 in homelessness: a worldwide scoping review on vulnerabilities, risks, and risk management. Social Work Public Health. 2022;37(4):303–18. [DOI] [PubMed] [Google Scholar]
- 85.Nouri M, Ostadtaghizadeh A, Vickery J, Azami-Aghdash S, Sari AA. Universal health coverage for people experiencing homelessness in disasters: a scoping review. J Social Distress Homelessness 2024:1–17.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Additional file 5-Risk of bias assessment
Data Availability Statement
All data used in this study were extracted from published articles included in the systematic review and meta-analysis. No additional datasets were generated or analyzed during the current study.