Spirituality is a crucial but often a neglected aspect of health. Health care system needs to incorporate this significant aspect in both education and clinical practice. People need to be seen as a "Whole Person" in all dimensions. Connectedness with inner SELF and the universal consciousness, meaning making, finding the higher purpose of life and living in the Now, were some interesting themes emerged from the results of this research project to define people's spirituality.

2. “Spirituality” refers to:
Finding inner-self, meaning in life and
connections with the universal whole that
helps young adults with diabetes self-
reflect and transform within their journey.
Spirituality is an essential part of
patient-centred care.

3. Inner
SELF
Connected
-ness with
people
Connected
-ness with
the
universe
Spiritual
beliefs
Self-
awareness
Finding
meaning in
suffering
Self-
actualisation
Inner peace
Coping
Transformation

4. Explore spirituality in young adults with
diabetes.
Explore health professionals’ perspective about
spirituality and its integration into diabetes
care.
Investigate the relationship between spirituality
and coping in young adults with diabetes.
Investigate the relationships among
demographic variables and spirituality in young
adults with diabetes.
Use the information to develop an evidence-
based framework that could help HPs address
spiritual needs of young adults with diabetes.

5. Pilot study
Developing and validating
the questionnaires
( The SQ and the CQYAD)
Main study
Survey In-depth
interviews
Focus
groups

7.  Test-Retest with 20 young adults with
diabetes: no significant difference between
means of the two points test on the SQ. The
results of Wilcoxon Test for CQYAD caused to
removal of three items.
 Cronbach's alpha: for the SQ= 0.94
for the CQYAD= 0.75
 Factor analysis for the SQ with 160 young
adults from a general population: items
retained with factor loading ≥ 0.5

8. Coping Questionnaire for Young Adults with
Diabetes (CQYAD)
32 items in four sections:
1. Self-efficacy.
2. Diabetes-related coping behaviours.
3. Social-focused coping behaviours.
4. Avoidance coping behaviours.
Spirituality Questionnaire (SQ)
29 items and five sections:
1. Self-awareness.
2. Spiritual beliefs.
3. Spiritual practices.
4. Spiritual needs.
5. Open-ended questions

9. A) 100 young adults with diabetes aged 18-30
years recruited from the diabetes clinic of a
teaching hospital in Melbourne and the Reality
Check website. The participants completed the
CQYAD and the SQ.
B) 92 health professionals recruited through the
ADEA and completed the SQ.
Response rate: 57% for young adults with
diabetes
8% for health professional

10. In-depth interviews were conducted with 15 young
adults with diabetes who:
a) participated in the survey.
b) expressed their interest to participate by providing their contact
details for the researcher and returning the signed consent form.
Interviews were conducted through the open ended
questions about:
a) the core concept of spirituality.
b) the impact of spirituality on health, coping with difficult situations and
diabetes management.
c) Integrating spiritual aspects in health care.
Interview

11. Young adults with
diabetes
Five young adults with
diabetes who have
been interviewed,
participated in a focus
group discussion.
Diabetes educators
Six diabetes educators
who participated in the
survey.
Focus groups

12. Females adopted more spiritual practices (p< 0.01).
The higher the spirituality, the lower the HbA1c
(p<0.04), a significant relationship between lower
HbA1c and self-awareness (p<0.01).
Significant relationships between spirituality, and
higher education & shorter period of having diabetes.
Significant reverse relationship between HbA1c and
coping (p= 0.001), the higher the self-efficacy scores
the lower HbA1c (p=0.002).
Coping and spirituality were not significantly different
among people of various religions.
Coping was correlated with spirituality (p< 0.002).

14. Spirituality and coping in religious
and non-religious young adults with
diabetes

15. The relationship between spirituality and
coping using Kendall’s tau test
Spirituality
Coping
Correlation
Coefficient
& Sig.
Self-
awareness
Spiritual
beliefs
Spiritual
practices
Spiritual
needs
Spirituality
self-efficiency
τ 0.48 0.20 0.16 0.02 0.23
Sig. 0.000 0.007 0.03 0.748 0.001
Diabetes-
related coping
behaviours
τ 0.29 0.12 0.19 -0.00 0.10
Sig. 0.000 0.097 0.010 0.974 0.151
Social focused
behaviours
τ 0.17 0.22 0.10 0.18 0.22
Sig. 0.018 0.003 0.152 0.013 0.002
Avoidance
behaviours
τ -0.18 0.02 -0.09 -0.06 -0.03
Sig. 0.014 0.819 0.205 0.388 0.629
Coping
τ 0.40 0.21 -0.08 0.11 0.22
Sig. 00.000 0.006 0.254 0.124 0.002

16. Being in touch with inner self.
Meaning in life & sense of purpose.
Connectedness with other people,
nature and/or higher being.
Having a belief system.
Having a sense of inner peace and
balance.
Having positive attitude.
Connecting spirituality with religion.
Sense of self.
Meaning and purpose in life.
Having a belief system.
A sense of connection with a
‘greater being’, self, people, and
nature.
Having positive outlook.

17. Qualitative thematic analysis conducted to
explore:
 How young adults with diabetes defined
spirituality?
 How spirituality helped young adults with
diabetes cope with diabetes?
 Can spirituality be integrated into diabetes
care?

18. Sense of
SELF
Living in
the “now”
Knowing
my place in
the world
Relationship
with a higher
being

19.  Spirituality encourages you
deeper into ‘who you are’, and
‘where your attitude and
thoughts come from’, and then
you are actually going to see the
relevance of spirituality to your
life.
A young adult with diabetes

20. My spiritual thinking
is that we should live
in the ‘now’. I think
about the future but
live now.
A young adult with diabetes

21. Without Spirituality, there is little
point in looking after yourself. It
dictates how you live and
ultimately how you die.
It’s hard to thrive in your life
without spirituality.
A young adult with diabetes

22. Spirituality &
living with
diabetes
Why me?
Care of the whole
person
The diabetes
transformational
journey
Spirituality, an
essential
aspect of life
A need for
holistic care
-Listening
-Taking time
-Understanding
-Talking openly & honestly
-Discussing general things
-Considering the whole situation
-Showing respect for patient’s feeling
-Seeing the details
-Being sensitive to spiritual issues
Diabetes is
sometimes
frustrating
Networks for
support services
Communication
skills
State of
balance
Positive
attitude
Happiness
Model depicted from interviews with young adults with diabetes to show the relationship
between spirituality and coping

23. If you try to understand why you are here?
What you do with your life? What makes you
happy? What makes others happy? you bring
better things into your life; and once you bring
more happiness, you make better decisions
about your life and your health.
A young adult with diabetes

24. The theme diabetes journey concerned how
participants developed their inner self, which helped
them accept the diagnosis of diabetes and search
meaning in having diabetes during their journey.
Spirituality is only important to me in relation to
diabetes when it comes to thinking about ‘why me?’So I
need a reason for ‘why I got diabetes?’Then I would
tend to find an answer. I still might think maybe there is
a reason for it, that I don't know.
A young adult with diabetes
Diabetes journey

25. “Diabetes is a blessing to me....There have been good
things that happened as a result of diabetes like making
very good friends. I would never have done that if I
didn’t have diabetes”.
“For me [diabetes] is just a constant growth, it is
sometimes a negative thing, but you know it usually
is a positive growth”.

26. “Our health care system still has a long way to go. I think
that an "holistic" approach is very important”. An
interviewee
It's not just about control, about the personal behaviors, it's
about the whole situation that the person is in.
A young adult with diabetes
Sometimes health professionals don't see the everyday life; they
just see the HbA1c or the blood pressure or whatever. I think
health professionals who see the everyday life get a much better
picture and can have a lot more impact on things like HbA1c.
A young adult with diabetes
A need for holistic care

27. Body-mind-soul
and connections
to health
Diabetes, a
transformational
journey
A gap between
treating diabetes
& treating a
‘whole person’
Finding a
sacred space
Sense of self
Self- reflection
Connectedness
Diabetes-an
internal/external
part of self
Sense of balance
HPs & understanding
the diabetes journey
Social aspects of care-
lost in the medical
system
HPs’ reflection on
their own spirituality
Guidelines to help
HPs
Model depicted from focus group with young
adults with diabetes

28. Some health professionals purely come in with ‘I
want to see your HbA1c’, ‘I will check your blood
pressure’, and ‘thanks for coming’, and ‘thanks
anyway for going’! You know, I think that there is a
very big GAP with people who purely just treat the
"condition" and not the "person".
A young adult with diabetes from FG

29. Spirituality helps me to be able to monitor my
diabetes. So, for me it is very much connected [to
diabetes management]. I certainly do recognise that
if I don't have the balance, if I am out of balance,
then I am one of those who suffers and it happens
ALL THE TIME.
A focus group participant
Having positive attitude towards diabetes and
confident to manage diabetes

30. Make a
connection with
the patient
Addressing
spirituality in
care
Providing
support services
Reflection on
‘self’ & ‘personal
performance’
Exploring
patients’ life
journey
Incorporating
spirituality
into care plan
Improving
communication
with patients
Creating an
appropriate
space & time
Drop-in centre Support groups
Model depicted from focus group with diabetes educators
indicating how spirituality can be incorporated into

31. Creating an appropriate space & time
You can’t address issues like spirituality if you are watching the
clock and stopping in 10 minutes. If you expect someone to
share their inner thoughts you cannot do it in 10 minutes. I think
that’s why the GPs fail; it’s not the fault of the GP’s, it’s the fault
of the system. A health professional
“….You have to make the priorities.”
A diabetes educator

32. Reflection on ‘self’ and ‘personal
performance
Many health professionals spend less and less time
enhancing their own connections.
A diabetes educator
There are a lot of times I walked out of a session and just go
‘Oh God, that did not work well’and they came back the
following week and nothing has changed, so, how can I
change it and what would make that person take the step to
change things and feel better.
A diabetes educator from focus group

33. Using a triangulated method enabled the researcher to
collect a wealth of detailed opinions and perspectives
about spirituality and its impact on coping and health.
The focus group with young adults with diabetes in phase
three enabled the researcher to confirm the data obtained
from the previous phases and her interpretation of the
data.
Using valid and reliable questionnaires.
The low response rate and the small number of
participants in the focus groups.

34. Spirituality needs to be incorporated into diabetes management
and
HPs need to emphasise the psychosocial and spiritual aspects of
diabetes care during routine consultations.
Changes may need to be made in diabetes clinics programs and
service delivery to enable the spiritual aspects of care to be
addressed; e.g. being flexible about time and the number of
appointments, providing “drop-in centres” and “young adult support
groups”.
The spirituality questionnaire (SQ) could be used in routine health
assessment.
Health professionals’ competence to provide holistic care needs to
be considered by educators and employers.

35. Implications
Spirituality and holistic care need to be included undergraduate
and post-graduate education programs more overtly; and
methods of developing HPs’ competence to provide holistic
care can be considered in such education programs.
The evidence-based framework to explore spirituality could be
used in the further research to explore spirituality in people
with other chronic conditions.
More emphasis on the spiritual aspects of care in overall health
care settings is needed.

36.  Spirituality was associated with better coping, higher spirituality
and lower levels of HbA1c in young adults with diabetes.
 Spirituality helped young adults with diabetes cope with diabetes
through a process of finding meaning in diabetes, personal
growth, and transformation.
 The study found similar perspectives about spirituality among
young adults with diabetes and health professionals that
encompasses inner self, self-actualisation, finding meaning in life
and connectedness ; however, young adults with diabetes
indicated that health professionals did not provide holistic care.
 Important suggestions emerged from the interviews and focus
groups to help HPs address spirituality in diabetes care. These
included improving communication skills and providing support
services.

37.  My supervisor, Trisha Dunning.
 All staff at the School of Nursing, Deakin University for
their kind support, especially Bodil Rasmussen for
facilitating the focus group with young adults with
diabetes.
 The ADEA for supporting diabetes educators recruitment.
 Reality Check website for supporting people with
diabetes recruitment.
 The people who participated in the study.

38. AND all who taught me how to love and touch
the beauty of life.