<i>Coping</i> religioso-espiritual entre familiares de crianças que necessitam de cuidados contínuos e complexos: estudo de métodos mistos

Lima, Bruna Josiane de; Okido, Aline Cristiane Cavicchioli; Looman, Wendy Sue; Eduardo, Aline Helena Appoloni; Silva-Rodrigues, Fernanda Machado; Jardim, Fabrine Aguilar; Lima, Regina Aparecida Garcia

doi:10.1590/1980-220X-REEUSP-2025-0143en

person Bruna Josiane de Lima

schoolUniversidade Federal de São Carlos, Programa de Pós-Graduação em Enfermagem, São Carlos, SP, Brazil.

person Aline Cristiane Cavicchioli Okido

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil.

0000-0003-4309-5612

person Wendy Sue Looman

schoolUniversity of Minnesota Twin Cities, School of Nursing, Minneapolis, United States.

0000-0003-4608-4898

person Aline Helena Appoloni Eduardo

schoolUniversidade Federal de São Carlos, Programa de Pós-Graduação em Enfermagem, São Carlos, SP, Brazil.

0000-0003-1577-3383

person Fernanda Machado Silva-Rodrigues

schoolUniversidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.

0000-0002-8412-2333

person Fabrine Aguilar Jardim

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil.

0000-0002-0798-5987

person Regina Aparecida Garcia Lima

schoolUniversidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Ribeirão Preto, SP, Brazil.

0000-0002-0611-5621

Corresponding author: Aline Cristiane Cavicchioli Okido Avenida Bandeirantes, 3900, Vila Monte Alegre 14040-908 ” Ribeirão Preto, SP, Brasil
emailalineokido@eerp.usp.br

The manuscript was extracted from a dissertation titled “Coping religioso-espiritual entre familiares de crianças que necessitam de cuidados contínuos e complexos: um estudo misto”. Federal University of São Carlos, 2023.

ASSOCIATE EDITOR

Ivone Evangelista Cabral

Tabelas (5)

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Chart 1 Summary of the analytical process of qualitative data ” São Carlos, SP, Brazil, 2022.

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Table 1 Religious-spiritual coping of family members of children who need continuous and complex care (n = 51) according to the mean, standard deviation, minimum value, maximum value, median, and quartiles. São Carlos, SP, Brazil, 2022.

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Table 2 Effect of socio-demographic variables on religious-spiritual coping of family members of children who need continuous and complex care (n = 51), according to the simple linear regression model. São Carlos, SP, Brazil, 2022.

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Table 3 Effect of socio-demographic variables on religious-spiritual coping of family members of children who need continuous and complex care (n = 51) according to multiple linear regression model. São Carlos, SP, Brazil, 2022.

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Quantitative findings Qualitative findings Interpretation Mean of positive SRCOPE: 3.28Mean of negative SRCOPE: 1.82Ratio: 0.56 Family members described a greater use of positive strategies of religious-spiritual coping versus negative ones. They reported practices such as prayer, Bible reading, positive mentalization, and efforts to connect with God and/or access spirituality. Qualitative reports confirm the quantitative data of predominantly positive strategies. High score on “Positive position before God” (4.58) The thematic category “Believing in God strengthens me”: relief from suffering through faith in God” showed comments that characterize faith in God as the primary mechanism to face daily challenges of caring for a child who needs continuous and complex care. Qualitative topics are consistent with the high and moderate scores. Moderate scores for “Transformation of oneself and/or one’s life” (3.52) and “Offering to help another” (3.46) The thematic category “Transformation in ways of thinking, feeling, and interacting with others and oneself” includes the incorporation of charitable practices through emotional and material support for those in need. Low scores on “Actions in search of spiritual help” (2.35) and “Search for support from Clergy” (3.19) Family members reported distance from religious institutions due to care demands. Quantitative results align with lower institutional engagement. Higher negative SRCOPE score among younger family members (p = 0.014) Feelings of revolt at child’s birth or diagnosis, especially among younger parents. Reports of emotional distress at the time of diagnosis were consistent with the results of multiple linear regression model. Higher positive SRCOPE score among family members living with fewer people (p = 0.006) No qualitative data available to explain this result. -

Initial codes	Intermediate codes	Thematic categories
Believing in a God strengthens me. It renews our strength every day. God is our refuge and our fortress, always.	Faith helps to face daily problems
God represents everything in our lives. Without God and Jesus Christ, I am nothing. Without Him, I would not be here today.	God at the center
Mentalizing Heartfelt clamoring. Praying. Prayers and supplications.	Strategy to connect with God and access spirituality	“Believing in a God strengthens me”: relief from suffering through faith in God
There are moments when we think we are alone and that we will not succeed I cry like every human being. There are days when we are down. I got weak. It made me angry.	Moments of weakness
The child came to improve me as a person. I would never be the person I am today if God had not given them to me. I try to police myself to be better	Reflection of their attitudes
Loving your neighbor, exercising charity, Inside an NGO helping mothers Helping people with psychological support, giving attention and care,	Offering to help another	Transformation in ways of thinking, feeling, and interacting with others and oneself
I am not a church person; I created my church inside my house. I don’t cling to any religion; I cling to God. God, Jesus is above any religion. I am not a 100% religious person. I stopped going to churches, but I have much faith in God.	Giving new meaning to religion and/or religious institutions
I am thankful God has trusted me to care for, love, and protect them. Everything has a purpose. I trust in Him.	Gratitude to God
If God wants to take them, I will accept it. If they had already accomplished his mission, they could leave. They no longer needed to suffer. This will one day come to an end.	Acceptance of terminality	Gratitude to God and trust in divine purposes
Believing in miracles. They will be a totally normal child. For God, nothing is impossible.	Hope for improvement

Variables	Mean	SD	Min.	Q1	Median	Q3	Max.
Indices
Positive SRCOPE	3.28	0.51	2.03	3.03	3.32	3.65	4.00
Negative SRCOPE	1.82	0.63	1.00	1.40	1.73	2.07	3.93
Total SRCOPE	3.73	0.40	2.75	3.51	3.83	3.96	4.49
Negative SRCOPE/positive SRCOPE ratio	0.56	0.22	0.25	0.43	0.50	0.61	1.23
Positive factors
Factor P1 - Transformation of oneself and/or one’s life	3.52	0.79	1.77	3.16	3.67	3.94	4.88
Factor P2 - Actions in search of spiritual help	2.35	0.98	1.0	1.8	2.4	2.8	4.8
Factor P3 - Offering to help another	3.46	0.93	1.4	3.0	3.4	4.2	5.0
Factor P4 - Positive position before God	4.58	0.61	1.8	4.3	4.8	5.0	5.0
Factor P5 - Search for support from Clergy	3.19	0.89	1.0	2.75	3.25	4.0	4.75
Factor P6 - Active surrender through God/religion/spirituality	4.08	0.90	1.67	3.67	4.33	5.0	5.0
Factor P7 - Quest for spiritual knowledge	2.98	0.93	1.0	2.33	3.0	3.66	5.0
Negative factors
Factor N1 - Negative reappraisal of God	1.52	0.85	1.0	1.0	1.0	1.8	5.0
Factor N2 - Negative position before God	2.55	0.99	1.0	2.0	2.33	3.0	5.0
Factor N3 - Dissatisfaction with Clergy	1.47	0.95	1.0	1.0	1.0	1.37	4.75
Factor N4 - Negative reappraisal of meaning	2.00	1.05	1.0	1.0	1.67	2.66	4.67

		Positive SRCOPE			Negative SRCOPE			Total SRCOPE			Negative SRCOPE/positive SRCOPE ratio
Variables	Categories	Beta (SE)	p	R²	Beta (SE)	p	R¹	Beta (SE)	p	R²	Beta (SE)	p	R²
Kinship	Mother (ref.) Other family members	– -5.27 (4.16)	0.211	0.0317	– -7.17 (4.09)	0.086	0.0589	– 2.38 (4.21)	0.575	0.0065	– -4.04 (4.19)	0.339	0.0186
Family’s age	Continuous variable	0.06 (0.14)	0.674	0.0036	-0.34 (0.13)	0.014	0.1177	0.33 (0.14)	0.019	0.1065	-0.33 (0.13)	0.018	0.1095
Religion	Catholic (ref.) Evangelical Other	– -4.53 (6.11) -6.46 (6.71)	0.463 0.342	0.0246	– 4.86 (6.14) 3.44 (6.74)	0.433 0.612	0.0163	– -6.21 (5.86) -9.19 (6.44)	0.296 0.162	0.0520	– 6.79 (6.00) 7.46 (6.59)	0.265 0.265	0.0398
Education	Elementary school (ref.) High school Higher education	– -6.66 (7.28) -2.35 (7.51)	0.365 0.756	0.0285	– 2.67 (7.23) -3.53 (7.47)	0.713 0.638	0.0390	– -5.81 (7.23) 0.21 (7.47)	0.425 0.978	0.0412	– 5.46 (7.20) -1.31 (7.44)	0.453 0.861	0.0491
Marital status	With partner (ref.) No partner	– -1.87 (5.29)	0.726	0.0025	– -1.68 (5.28)	0.752	0.0021	– 1.18 (5.29)	0.824	0.0010	– -1.62 (5.29)	0.761	0.0019
Occupation	Selfemployed (ref.) Signed contract Household/wage earner Unemployed	– -6.45 (5.55) 0.51 (5.84) 0.71 (9.72)	0.251 0.930 0.942	0.0520	– -0.72 (5.49) -1.44 (5.78) 15.85 (9.61)	0.896 0.804 0.106	0.0722	– -3.51 (5.46) 2.95 (5.75) -14.36 (9.56)	0.524 0.610 0.140	0.0834	– 4.16 (5.33) -3.40 (5.61) 18.39 (9.33)	0.440 0.548 0.055	0.1276
Family income	Continuous variable	-0.08 (0.14)	0.573	0.0065	-0.29 (0.14)	0.037	0.0860	0.19 (0.14)	0.182	0.0361	-0.24 (0.14)	0.094	0.0563
Residents in the household	Continuous variable	-0.44 (0.15)	0.006	0.1581	0.30 (0.15)	0.056	0.0788	-0.51 (0.15)	0.001	0.2088	0.42 (0.15)	0.008	0.1460

Variables		Beta (SE)	p	Partial R²
Positive SRCOPE	Residents in the household	-0.44 (0.15)	0.006	0.1581
Negative SRCOPE	Family’s age	-0.34 (0.13)	0.014	0.1177
Total SRCOPE	Residents in the household	-0.51 (0.15)	0.001	0.2088
Negative SRCOPE/positive SRCOPE ratio	Residents in the household	0.42 (0.15)	0.008	0.1460

Quantitative findings	Qualitative findings	Interpretation
Mean of positive SRCOPE: 3.28 Mean of negative SRCOPE: 1.82 Ratio: 0.56	Family members described a greater use of positive strategies of religious-spiritual coping versus negative ones. They reported practices such as prayer, Bible reading, positive mentalization, and efforts to connect with God and/or access spirituality.	Qualitative reports confirm the quantitative data of predominantly positive strategies.
High score on “Positive position before God” (4.58)	The thematic category “Believing in God strengthens me”: relief from suffering through faith in God” showed comments that characterize faith in God as the primary mechanism to face daily challenges of caring for a child who needs continuous and complex care.	Qualitative topics are consistent with the high and moderate scores.
Moderate scores for “Transformation of oneself and/or one’s life” (3.52) and “Offering to help another” (3.46)	The thematic category “Transformation in ways of thinking, feeling, and interacting with others and oneself” includes the incorporation of charitable practices through emotional and material support for those in need.
Low scores on “Actions in search of spiritual help” (2.35) and “Search for support from Clergy” (3.19)	Family members reported distance from religious institutions due to care demands.	Quantitative results align with lower institutional engagement.
Higher negative SRCOPE score among younger family members (p = 0.014)	Feelings of revolt at child’s birth or diagnosis, especially among younger parents.	Reports of emotional distress at the time of diagnosis were consistent with the results of multiple linear regression model.
Higher positive SRCOPE score among family members living with fewer people (p = 0.006)	No qualitative data available to explain this result.	-

[1] Legend: SD - standard deviation; Min. - minimum value; Max. - maximum value.

Coping religioso-espiritual entre familiares de crianças que necessitam de cuidados contínuos e complexos: estudo de métodos mistos

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