title: Spirituality, Religiosity, and Health: a Comparison of Physicians' Attitudes in Brazil, India, and Indonesia.
abstract: BACKGROUND
  One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice.
  
  
  OBJECTIVE
  The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia.
  
  
  METHODS
  This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA.
  
  
  RESULTS
  A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues.
  
  
  CONCLUSIONS
  Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.
authors.affiliation: Federal University of Juiz de Fora, Avenida Eugênio do Nascimento s/n - Aeroporto, 36038330, Juiz de Fora, MG, Brazil. g.lucchetti@yahoo.com.br.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Lucchetti
authors.affiliation: Harvard Divinity School, Harvard University, Cambridge, MA, USA.|AdiBhat Foundation, New Delhi, India.
authors.forename: Parameshwaran
authors.initials: P
authors.lastname: Ramakrishnan
authors.affiliation: University of Airlangga, Surabaya, Jawa Timur, Indonesia.
authors.forename: Azimatul
authors.initials: A
authors.lastname: Karimah
authors.affiliation: Marilia Medical School, Marilia, Brazil.
authors.forename: Gabriela R
authors.initials: GR
authors.lastname: Oliveira
authors.affiliation: Goa University, Bambolim, Goa, 403001, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Dias
authors.affiliation: Goa University, Bambolim, Goa, 403001, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Rane
authors.affiliation: B.R.K.R. Govt. Ayurvedic Medical College, Hyderabad, India.
authors.forename: A
authors.initials: A
authors.lastname: Shukla
authors.affiliation: Gandhi Institute of Yoga and Naturopathy, Hyderabad, India.
authors.forename: S
authors.initials: S
authors.lastname: Lakshmi
authors.affiliation: Central Research Institute of Unani Medicine, Hyderabad, India.
authors.forename: B K
authors.initials: BK
authors.lastname: Ansari
authors.affiliation: National Institute of Siddha Medical Sciences, Chennai, India.
authors.forename: R S
authors.initials: RS
authors.lastname: Ramaswamy
authors.affiliation: J.S.P.S Govt. Homeopathic Medical College, Hyderabad, India.
authors.forename: Rajender A
authors.initials: RA
authors.lastname: Reddy
authors.affiliation: HELP Foundation of Omaha, Omaha, NE, USA.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tribulato
authors.affiliation: HELP Foundation of Omaha, Omaha, NE, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Agarwal
authors.affiliation: Goa University, Bambolim, Goa, 403001, India.
authors.forename: Jagadish
authors.initials: J
authors.lastname: Bhat
authors.affiliation: B.R.K.R. Govt. Ayurvedic Medical College, Hyderabad, India.
authors.forename: Namburu
authors.initials: N
authors.lastname: Satyaprasad
authors.affiliation: Central Research Institute of Unani Medicine, Hyderabad, India.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Sweekaar-Upkaar Rehabilitation Institute for Handicapped, Osmania University, Hyderabad, 500007, India.
authors.forename: Pasupuleti Hanumantha
authors.initials: PH
authors.lastname: Rao
authors.affiliation: National Institute of Mental Health and Neuro Sciences, Bangalore, India.
authors.forename: Pratima
authors.initials: P
authors.lastname: Murthy
authors.affiliation: University of Airlangga, Surabaya, Jawa Timur, Indonesia.
authors.forename: Kuntaman
authors.initials: K
authors.lastname: Kuntaman
authors.affiliation: Duke University Medical Center, Durham, NC, USA.|King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Harold G
authors.initials: HG
authors.lastname: Koenig
authors.affiliation: Federal University of Juiz de Fora, Avenida Eugênio do Nascimento s/n - Aeroporto, 36038330, Juiz de Fora, MG, Brazil.
authors.forename: Alessandra L G
authors.initials: AL
authors.lastname: Lucchetti
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel / Q000208:ethnology; D001938:Brazil; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D007214:Indonesia; D008297:Male; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D012068:Religion and Medicine; D029181:Spirituality; D011795:Surveys and Questionnaires
keywords: Medical education; Physician attitudes; Religion and medicine; Spirituality