Ecospirituality and Health: A Systematic Review

Vol.:(0123456789) Journal of Religion and Health (2024) 63:1285–1306 https://doi.org/10.1007/s10943-023-01994-2 1 3 ORIGINAL PAPER Ecospirituality andHealth: ASystematic Review RocíodeDiego‑Cordero1· AliciaMartínez‑Herrera2· ManuelCoheña‑Jiménez3 · GiancarloLuchetti4· JoséMiguelPérez‑Jiménez1,5,6 Accepted: 21 December 2023 / Published online: 30 January 2024 © The Author(s) 2024 Abstract Environmental changes are affecting human health. A renewal of the way we understand and relate to the planet is needed. Ecospirituality brings together the terms spirituality and environment and is born as a means of solution to this dilemma. This systematic review aimed to find out the influence of ecospirituality on global health. A search of scientific literature was carried out in the main health science databases. A review was conducted to critically evaluate the studies that identified relevant ecospiritual aspects regarding health care for communities. After a systematic search and screening, and following specified methodological criteria, a total of 14 articles were selected in the review. The findings of the review suggest that a new perspective in our worldview such as ecospirituality will provide us with the necessary keys to improve health. To understand ecospirituality, we must keep in mind the indigenous way of life, which is the clear example to follow to achieve environmental health and global health. Ecospirituality leads to a healthier environment, and as this is directly related to health, there is also an improvement in global health. Keywords Ecology· Spiritual· Spirituality· Environment· Health Introduction Negative environmental changes drastically affect society, leading to growing interest in how the environment can affect different individuals and societies around the world. In this context, several areas of interest have focused on human, animal, and plant health and their respective ecosystems. Among these areas, there is growing scientific evidence regarding about the role of spirituality and its connection with the environment in people’s physical and mental health (Moreno-Sánchez, 2022). In modern societies, health professionals must have greater knowledge of the relationship between health and the environment, with the aim of promoting preventive actions. Furthermore, if health professionals increase their knowledge in Extended author information available on the last page of the article 1286 Journal of Religion and Health (2024) 63:1285–1306 1 3 this area, they can form interdisciplinary teams to discuss environmental policies and collaborate with decision-making processes. Indeed, the health sector needs to be recognized as one of the main pillars of environmental policy, which is why it needs space and skills to work with environmental work sectors, thus being able to know their restrictions and opportunities. In this way, appropriate health promotion, environmental and health services, and workplaces can be guaranteed, making the health sector sustainable from an environmental perspective (Moreno- Sánchez, 2022). In this sense, renewal of the way we understand and relate to the planet is necessary. In recent decades, we have witnessed a significant environmental crisis, as highlighted by Pope Francis in the second encyclical “Laudato Si” (Bolaños- Sánchez etal., 2015). It is a call for attention to all humanity without making distinctions of religion or race, with the purpose of remembering that we only have one planet on which we can live; and that our permanence on it depends on the respect and care we give it (Villalobos, 2015). This connection between spirituality and the environment is called “Ecospirituality,” and it is a term used by those facing the current environmental crisis (Lincoln, 2000). It is important to highlight that, although this concept is new, indigenous people have already connected these dimensions for centuries, since their decolonial movement promotes socio-environmental justice, where through their knowledge, beliefs, and styles of inhabiting and caring for the land, approach the term ecospirituality. The culture prominent in the Western world does not contemplate that human life and non-human life cannot be sustained without each other. It generally supports a materialistic world in which only the accumulation of profits is considered, without considering the reproduction of life. Therefore, we face an environmental crisis that could have a significant influence on health and lifestyle (Silva-de-la-Rosa, 2022). Figure1 summarizes the conceptual framework used in this review. This framework, a more holistic view of the environment is offered, covering different aspects for the environment, which includes spirituality. In fact, several researchers have agreed that nature is one facet of spirituality, as seen in the definition of spirituality provided by Puchalski etal. (2009), who consider spirituality as “an essential element of humanity. It encompasses individuals’ search for meaning and purpose; it includes connection with others, with oneself, with nature, and with what is significant or sacred; and encompasses secular and philosophical, as well as religious and cultural, beliefs and practices.” Therefore, it is necessary to put into practice a spirituality that takes nature into account to seek the strategies and skills necessary to take care of each other and survive in the best possible conditions (Silva-de-la-Rosa, 2022). This review aimed to provide a broader view of the influence of ecospirituality on global health. To this objective, the authors will investigate the relationship of this term within the indigenous population, the repercussions of ecospirituality on the mental and physical health of individuals, the influence of spiritual beliefs in the transitions toward environmental sustainability, and the ecospiritual initiatives designed for health promotion. 1287 1 3 Journal of Religion and Health (2024) 63:1285–1306 Methods Study Selection andEligibility Criteria Studies with qualitative/quantitative/mixed experimental designs that considered ecospirituality and health were included. The eligibility criteria for this review were as follows: The inclusion criteria were articles published in the past 5 years (between 2018 and 2023) and available in English and Spanish. Articles published in other languages, not subjected to peer review, were only available in Abstracts and not assessing the objectives of this review were excluded. Quality Appraisal The quality of the studies was appraised using the Mixed Method Appraisal Tool (MMAT) (Hong etal., 2018). Developed to the assess the methodological quality of empirical studies, the latest version of MMAT includes two screening questions and five criteria for each of the following five study designs (Hong etal., 2018). The study designs were as follows: (a) qualitative; (b) randomized controlled trial; (c) nonrandomized; (d) quantitative descriptive; and (e) mixed Fig. 1 Conceptual framework 1288 Journal of Religion and Health (2024) 63:1285–1306 1 3 methods studies. An overall score of the quality appraisal of each study and a detailed appraisal are presented. Search Strategy A literature review was conducted between February and May 2023. The PubMed, Scopus, and Web of Science databases were used for this review. The search strategy was designed based on the DeCS/MeSH descriptors, and terms were combined using the Boolean operators "AND" and "OR" as follows in Table1. Study Selection andData Extraction After the search was performed searching by two independent researchers, all references were imported using the Mendeley reference manager version 1.19.8. Any disagreements regarding inclusion were resolved by a third researcher. In this review, the sources of information are classified into primary sources (close to the topic investigated, that is, the most direct information without the existence of intermediaries, such as surveys or interviews), secondary sources (based on the primary sources, there are intermediaries), synthetic, analytical, or reorganizing sources (e.g., reviews or biographies), and tertiary sources (compilation of primary and/ or secondary sources and their comments on the subject, e.g., guides or indexes) (Cruz-García, 2019). Then, a thematic categorization was carried out with the main findings identified during the analysis, which was carried out through discussions by the researchers, who examined themes or patterns of meaning within the data and Table 1 Search strategy Database strategy CINAHL (from 2018 to 2023) #1 AND #2 1 (spiritual*[All Fields] OR ecospirituality [All Fields] OR "spiritualism"[MeSH Terms] OR "spiritualism"[All Fields] OR "spirituality"[MeSH Terms] OR "spirituality"[All Fields] OR "spiritualities"[All Fields] OR "spirituality s"[All Fields] OR "spiritually"[All Fields] OR "spirituals"[All Fields]) 2 ("ecolog*"[All Fields]) (environ*[All Fields] OR "environment"[MeSH Terms] OR "environmental"[All Fields] OR "environmentalist"[MeSH Terms] AND ("spiritual*"[All Fields]) Limiters applied English language, peer-reviewed Search results on 30/05/2023 1289 1 3 Journal of Religion and Health (2024) 63:1285–1306 grouped the studies into themes. The obtained themes are described in the next section of the manuscript. Results A flowchart was developed according to the PRISMA Statement (Page et al., 2021). First, 5919 articles were retrieved from the databases using Boolean expression. After eliminating duplicate records (n = 138), it remained 5781 references, which were assessed through the title and abstract. Among these references, 26 were eligible for full-text reading, while the others were out-of-theme or not adherent to the inclusion/exclusion criteria. No results were obtained from the gray literature search. Full-text reading of the 26 references resulted in the Fig. 2 Flow diagram of screening 1290 Journal of Religion and Health (2024) 63:1285–1306 1 3 inclusion of 14 studies, of which: Four were case studies, seven were literature reviews, one was a cross-sectional study, one was a longitudinal study, and one was a mixed method study (Fig.2). Result ofQuality Appraisal Appendix 1 outlines the results of the MMAT quality appraisal of the individual studies. One study was identified as a mixed method (Nawrath etal., 2022), nine as qualitative studies (Bellehumeur etal., 2022; Lestar & Böhm, 2020; Cloud & Redvers, 2023; Denis etal., 2022; Hategan, 2021; Keaulana etal., 2021; Skoko etal., 2021; Nalau etal., 2018; Oberholzer-Dent etal., 2023), and four as quantitative studies (Kras & Keenan, 2020; Oliveira etal., 2022; Vitorino etal., 2018; Walls et al., 2022). All included studies addressed both screening questions, stated the research aims, and justified the findings to answer the research questions. Overall, all studies met three or more of the five quality appraisal criteria of the MMAT. The thematic categorization resulted in the following categories shown in Fig.3: Category A: Indigenous sphere and its relationship with ecospirituality and global health. Category B: Association between ecospirituality and physical and mental health. Category C: Spiritual beliefs and their role in the study of transitions toward environmental sustainability and global health. Category D: Ecospiritual initiatives for health promotion. An analysis and synthesis table was also prepared with the essential information for each result included (Table2). Fig. 3 Coding tree with the main categories 1291 1 3 Journal of Religion and Health (2024) 63:1285–1306 Table 2 Results Author year/country Design and sample Aims Main results/categorization of results Oberholzer-Dent etal. (2023)/EEUU Study of cases Research the contemporary work of the California Indian Basket Weavers Association and demonstrate how indigenous environmental justice is put into practice Addressing environmental management from an indigenous perspective obtains multiple environmental benefits and, in turn, improves the health of individuals./A Kras and Keenan (2020)/EEUU Study of cases Understand how the natural environment influences the lives of adult residents living on these entire New England islands and guide future research The natural environment plays a vital role in the lives of the inhabitants of the New England Islands, causing an improvement in their mental health./A, B Vitorino etal. (2018)/EEUU Transversal study Investigate how different levels of spirituality and religiosity affect quality of life and mental health Having high levels of both spirituality and religiosity is associated with a better quality of life (psychological, social, and environmental)./B Nalau etal. (2018)/Nueva Zelanda Study of cases Determine how indigenous and traditional knowledge relates to climate change adaptation and ecosystembased adaptation Recognizing indigenous governance systems and indigenous and traditional knowledge will give us a different vision in our connection with nature, thus improving health./A Lestar and Böhm (2020)/Inglaterra Literature review Defend the inclusion of spirituality, as a worldview, in the study of transitions toward sustainability Ecospiritual communities are a mechanism to address health problems and reduce negative consequences of the social determinants of health due to better treatment with the natural environment./C Bellehumeur etal. (2022)/Canadá Literature review Explore the relationship between humans and nature through positive psychology A new "consciousness" is emerging in which people define their quality of life in spiritual and relational rather than materialistic terms./B, C Skoko etal. (2021)/Croacia Literature review Demonstrate that religious people cope better and more easily with the dangers that can damage mental health Religiosity appears to be a crucial factor in prolonging human life and greater resistance to some diseases./B Denis etal. (2022)/Francia Literature review Investigate a systemic approach that integrates the biological, psychological, and social systems that can influence health or disease The biopsychosocial model is the most precise theoretical and clinical model of health and illness that we currently have./D 1292 Journal of Religion and Health (2024) 63:1285–1306 1 3 Table 2 (continued) Author year/country Design and sample Aims Main results/categorization of results Walls etal. (2022)/EEUU & Canadá Longitudinal study Examine seven different indicators of sociocultural integration and identify patterns of responses across these indicators and determine their relevance to well-being The connection between humans and the sense of belonging to a group and to nature influences better physical and mental health./C, D Keaulana etal. (2021)/EEUU Literature review Identify and summarize existing measures of connectivity, relatedness, and attitudes toward land, nature, and/or the environment and evaluate the psychometric properties of these scales Increasing connections with nature, the land, and the broader environment can improve the overall meaning of life and human well-being./A, C Hategan (2021)/Rusia Literature review Investigate trends: ecophilosophy, ecotheology, and counseling to apply them in the community The use of ecological advice in practice allows people to generate new strategies to face the environmental crisis and thus motivate them to change their lifestyle for a healthier one./D K Literature review Expand understanding and connectivity between indigenous traditional knowledge, sacred places, spirit, and environmental health The connection with nature and the environment improves health in all its aspects, in addition to attitudes and behaviors./A Oliveira etal. (2022)/Brasil Study of cases To investigate the influence of religiosity and spirituality on the adoption of prophylactic behaviors and the perception of risk of vulnerability to the disease More religious/spiritual people more frequently adopt prophylactic behaviors./C, D Nawrath etal. (2022)/Reino Unido Sequential mixed methods study Explore the perception between mental health and green spaces of a population of low socioeconomic levels Green spaces can play a fundamental role in increasing mental health in low socioeconomic populations./B 1293 1 3 Journal of Religion and Health (2024) 63:1285–1306 Discussion This study aimed to critically review the current evidence regarding the influence of ecospirituality on global health. The findings of the review highlighted the repercussions of ecospirituality for the mental and physical health of individuals and the influence of spiritual beliefs in the transition toward environmental sustainability. The synthesis of key findings from the 14 included studies was summarized in four categories. Category A: Indigenous Sphere andIts Relationship withEcospirituality andGlobal Health The results included in this review show how colonialism has had an impact on the current environmental crisis and argue that, in the future, the knowledge of indigenous individuals must be taken into account to establish links with the environment. Indigenous peoples are highly vulnerable to the negative impacts of climate change given their dependence on climate-sensitive resource-based livelihoods. This is aggravated because their financial, technological, and political resources are very limited, being on the margins of the prevailing capitalist society, which prevents them from reacting and making their needs known to rulers. Despite this, they have historically demonstrated their ability to adapt to climate and social, cultural, political, and economic changes. This resilience can be used as a powerful tool to assist in the implementation of future environmental projects for this population (Nalau etal., 2018). It is very important to give indigenous populations the value they deserve and to offer proposals for the protection of life and the great biodiversity they have managed to preserve, despite the complex scenario of climate change. Because of colonization and uncontrolled environmental management, indigenous people today face many obstacles. Ecosystem degradation, settler management of indigenous lands, herbicides and pesticides, competition with commercial collectors, and inadequate waste disposal have destroyed the ecosystems in which these communities operate. Indigenous environmental justice (IAJ) understands environmental harm and proposes relationships with the environment through indigenous vision. Considering that the colonization process and the environmental crisis are directly related, the authors want to achieve the authority of indigenous peoples and the survival of this environmental catastrophe through the vision of justice in indigenous terms. The current environmental crisis recognizes the importance of indigenous communities and their relationship with the land to address this critical aspect, thus improving health. To understand the equitable and accurate use of natural resources, one must first understand the cultures that have developed based on this idea (Oberholzer-Dent etal., 2023). A paradigm shift focusing on rights and equality is needed, with inclusion being the fundamental principle for closing structural inequality gaps. In this sense, ecospirituality is a tool that combines ecospirituality. Knowledge of indigenous peoples establishes an important conception of the vision of the world and environment. Each of the existing indigenous peoples has 1300 Journal of Religion and Health (2024) 63:1285–1306 1 3 Another initiative would be the use in practice of the concept called eco-coun- seling, which consists of preventing and addressing life problems and conflicts related to life crises through an approach that integrates the interaction of personal and environmental factors. This focus empowering individuals for self-help and initiative, making them responsible for their actions, since the healthy individual is taken and what is sought is to enhance their capabilities. Ecology gave rise to the concepts of ecophilosophy and ecospirituality. These two concepts can help establish a new vision in modern society. The ecological trend that unites these terms is responsible for resolving the situations corresponding to the environmental crisis. Using these terms with a spiritual approach through eco-counseling in the health sector benefits the community. By addressing it through ecophilosophy and ecospirituality, it seeks to develop new skills and abilities in the community following an ecological basis (Hategan, 2021). The previous studies indicate that counseling causes greater success at a lower cost for the health professional who implements it, in addition to making the patient show more security and motivation to change their lifestyle to a healthier one. Even health institutions benefit from this technique because it increases the quality of care perceived by patients and improves working relationships between health professionals. The final beneficiary of the practice of counseling turns out to be the society that ends up adopting healthier behaviors (Bimbela, 2009). On the other hand, as established in the Code of Ethics of the International Council of Nurses (ICN) in the element “Nurses and global health,” nurses examine the importance of the social determinants of health and act on them, coming from health programs. Furthermore, they recognize the impact of the natural environment on human health and, therefore, support any decision that reduces practices harmful to the environment (International Council of Nurses, 2021). This approach suggests the incorporation of ecospirituality in the daily practice of health professionals. Recommendations forClinical Practice The following recommendations can be drawn from the rapid review. In 2013, Pope Francis issued an encyclical letter called Laudato si, which urges the global community to take care of the environment as a concern shared by all. Pope Francis discussed the various outcomes of scientific progress and acknowledged its contributions to human advancement. Nonetheless, he emphasized the need for humanity to recognize the limitations of scientific endeavors. Scientists should prioritize respecting humanity and maintaining an attitude of reverence for other living beings (Compendium of the Social Doctrine of the Church, 2006). Scientists should employ empirical science for the common good, as stated in the Catechism of the Catholic Church, which firmly asserts that human power has boundaries and causing needless suffering or death to animals is contrary to human dignity (Gregg, 2006). In addition, in 2023, it has been published Pope Francis’ new Apostolic Exhortation Laudate Deum on the climate crisis. The Holy Father addresses the situation of climate change in Laudate Deum ("Praise God") because "a human being who pretends to take the place of God becomes the worst danger to himself" (LD 73) 1301 1 3 Journal of Religion and Health (2024) 63:1285–1306 after the Encyclical Letter Laudato si’ promulgated on the Solemnity of Pentecost 2015. The Apostolic Exhortation Laudate Deum, directed at individuals of goodwill, consists of six chapters. In the final chapter titled "Spiritual Motivations," the Holy Father urges individuals from various religious backgrounds to act. Additionally, he emphasizes to Catholics that their faith obliges them to protect God’s creation by respecting the laws of nature and appreciating the beauty and abundance of God’s handiwork. Furthermore, health professions, such as nursing, consider global care as part of their daily work in their professional code of ethics: Nurses value health care as a human right, affirming the right, nurses lead or contribute to sound health policy development, nurses contribute to population health and work toward the achievement of the United Nations Sustainable Development Goals and nurses collaborate and practice to preserve, sustain, and protect the natural environment, and are aware of the health consequences of environmental degradation, e.g., climate change. They advocate for initiatives that reduce environmentally harmful practices to promote health and well-being (International Council of Nurses, 2021). Therefore, considering ecospirituality as part of health care will contribute to providing more global, fair, and humanized care. Limitations This study has important strengths. This review has allowed the authors to update knowledge about ecospirituality and identify gaps in the evidence base and the possibility of raising new research questions. However, this study has several limitations that should also be taken into account. The first is that the search was carried out in only three databases (PubMed, Scopus, and WOS), which has prevented access to all the articles that may have been carried out in relation to the research question posed. Only studies on ecospirituality were included in this review. Besides, there is also a language restriction, and articles published in other laguanges were not included. Finally, authors set our date limit to the past 5 years aiming to present an update panorama of the field. Therefore, studies published before 2018 were not included. Conclusions A new perspective in our vision of the world such as ecospirituality will provide humanity with the necessary keys to improve environmental health and thereby achieve global health. To understand ecospirituality, humanity must keep in mind the indigenous way of life, which is the clear example to follow to achieve environmental health and global health. Ecospirituality evokes pro-environmental behaviors and increases mental health. Ecospirituality leads toward a healthier environment, and since the environment is directly related to health, there is also an improvement in overall health. It is necessary for the health sector to use a biopsychosocial model for its care, where work is done in the spiritual sphere and through it strategies based on ecospirituality are applied, such as sociocultural integration and ecocounseling. 1302 Journal of Religion and Health (2024) 63:1285–1306 1 3 Appendix1 Quality Assessment ofIncluded Studies Mixed Method Studies Study Total score Is there an adequate rationale for using a mixed methods design to address the research question? Are the different components of the study effectively integrated to answer the research question? Are the outcomes of the integration of qualitative and quantitative components adequately interpreted? Are the divergences and inconsistencies between quantitative and qualitative results adequately addressed? Do the different components of the study adhere to the quality criteria of each tradition of the methods involved Nawrath etal. (2022) 5/5 Yes Yes Yes Yes Yes Qualitative study Study Total score Is the qualitative approach appropriate to answer the research question? Are the qualitative data collection methods adequate to address the research question? Are the findings adequately derived from the data? Is the interpretation of results sufficiently substantiated by data? Do the different components of the study adhere to the quality criteria of each tradition of the methods involved Bellehumeuret al. (2022) 3/5 Yes Yes Yes No Cannot tell Cloud and Redvers (2023) 3/5 Yes Yes Yes No Cannot tell Denis etal. (2022) 4/5 Yes No Yes No Yes Hategan (2021) 5/5 Yes Yes Yes Yes Yes Keaulana etal. (2021) 5/5 Yes Yes Yes Yes Yes Lestar and Böhm (2020) 3/5 Yes Yes Yes No Cannot tell Nalau etal. (2018) 3/5 Yes Yes Yes No Cannot tell 1303 1 3 Journal of Religion and Health (2024) 63:1285–1306 Oberholzer- Dent etal. (2023) 3/5 Yes Yes Yes No Cannot tell Skoko etal. (2021) 3/5 Yes No Yes Yes Cannot tell Quantitative Studies Study Total score Is the sampling strategy relevant to address the research question? Is the sample representative of the target population? Are the measurements appropriate? Is the risk of nonresponse bias low? Is the statistical analysis appropriate to answer the research question? Kras and Keenan (2020) 5/5 Yes Yes Yes Yes Yes Oliveira etal. (2022) 5/5 Yes Yes Yes Yes Yes Vitorino etal. (2018) 5/5 Yes Yes Yes Yes Yes Walls etal. (2022) 5/5 Yes Yes Yes Yes Yes Yes—1; no—0; and cannot tell—0 Funding Funding for open access publishing: Universidad de Sevilla/CBUA. The authors have not disclosed any funding. Declarations Competing interests The authors have not disclosed any competing interests. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/. References Bellehumeur, C. R., Bilodeau, C., & Kam, C. (2022). Integrating positive psychology and spirituality in the context of climate change. 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Authors and Affiliations RocíodeDiego‑Cordero1· AliciaMartínez‑Herrera2· ManuelCoheña‑Jiménez3 · GiancarloLuchetti4· JoséMiguelPérez‑Jiménez1,5,6 * Manuel Coheña-Jiménez [email protected] Rocío de Diego-Cordero [email protected] 1306 Journal of Religion and Health (2024) 63:1285–1306 1 3 Alicia Martínez-Herrera [email protected] Giancarlo Luchetti g.lucche[email protected] José Miguel Pérez-Jiménez [email protected] 1 Research Group PAIDI-CTS 969 Innovation inHealthCare andSocial Determinants ofHealth, Department ofNursing, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, Seville, Spain 2 Department ofNursing, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, Seville, Spain 3 Research Group PAIDI-CTS589: Advances inPodiatric Surgery, Department ofPodiatry, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, C/Avenzoar, 6, 41009Seville, Spain 4 School ofMedicine, Federal University ofJuiz de Fora, JuizdeFora, Brazil 5 Institute ofBiomedicine ofSeville (IBiS), Department ofNursing, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, Seville, Spain 6 Institute ofBiomedicine ofSeville (IBiS), Universitary Hospital Virgen Macarena, University ofSeville, Seville, Spain