Summary
A significant study reveals that Indonesian medical students hold generally positive perceptions of spiritual care, with gender emerging as the most important factor influencing these views. The research, published in Frontiers in Medicine, surveyed 470 medical students using a culturally adapted Muslim-context version of the Spirituality and Spiritual Care Rating Scale (SSCRS).
The study found that female students demonstrated significantly higher spiritual care perception scores than their male counterparts, scoring 76.59 compared to 75.12 on a 90-point scale. While age and academic year showed positive associations in initial analysis, only gender remained a significant predictor after controlling for other factors. Clinical-stage students achieved the highest scores (77.36), significantly outperforming first-year students (74.05), suggesting that clinical experience enhances appreciation for spiritual care.
The research identified five key domains of spiritual care perception: existential elements, religiosity, personalized care, spiritual care, and Muslim values. Gender differences were most pronounced in the religiosity and Muslim values domains, reinforcing the notion that women may be more attuned to emotional and spiritual aspects of patient care. The study highlights an urgent need for structured spiritual care education in medical curricula, as many healthcare professionals report inadequate training despite recognizing its importance.
These findings carry particular weight in Indonesia, a country where spirituality profoundly influences daily life and health-seeking behaviors. The authors recommend integrating spiritual care competencies into medical education and creating opportunities for reflection and interfaith dialogue to prepare future physicians for holistic, patient-centered practice.
Medical Students Show Positive Perceptions of Spiritual Care
New Indonesian study reveals gender differences in spiritual care attitudes among future doctors
Why Spiritual Care Matters in Modern Healthcare
Spiritual care has emerged as an essential component of holistic healthcare, addressing patients’ needs beyond physical symptoms. The concept of holistic health views human beings as integrated wholes, encompassing physical, psychological, social, and spiritual dimensions that interconnect and influence one another. From an Islamic perspective, spiritual care means understanding patients’ uniqueness according to their fitrah—their inherent human nature.
Research consistently demonstrates that spirituality and religiosity are associated with better psychological adjustment, reduced anxiety and hopelessness, and greater resilience among patients with chronic illness. Therapeutic communication plays a vital role in recognizing and responding to patients’ spiritual needs, promoting trust and facilitating patient-centered care.
Nevertheless, many patients still perceive that their spiritual care needs remain unfulfilled. Healthcare professionals often attribute this gap to limited knowledge and inadequate training in spiritual care. This challenge has prompted medical educators worldwide to examine how future physicians develop competencies in this crucial area.
The Indonesian Context: Spirituality as a Cultural Cornerstone
Indonesia, the world’s largest Muslim-majority nation, provides a unique setting for studying spiritual care perceptions. Indonesian society assumes spirituality as an essential aspect of life, particularly during sickness. Spiritual care can restore patients’ quality of life by providing comfort, strength, and compassion.
Despite this cultural backdrop, doctors often feel ill-equipped to address patients’ spiritual needs because of limited education on the subject. A study among Muslim nurses in Indonesia revealed that while most had cared for patients with spiritual needs, nearly all reported having no formal training in providing spiritual care. This gap between cultural expectations and professional preparation highlights the urgency of integrating spiritual care into healthcare education.
The Spirituality and Spiritual Care Rating Scale (SSCRS), originally developed in the United Kingdom, has been translated into Indonesian and culturally adapted to reflect Islamic values. This adaptation creates five distinct domains: existential element, religiosity, personalized care, spiritual care, and Muslim’s value.
The Study: How Future Doctors View Spiritual Care
Researchers at the University of Muhammadiyah Malang conducted a cross-sectional study involving 470 medical students from all academic years and clinical rotations. The study achieved a 62.67% response rate from the total student population of 750. Participants completed a self-administered questionnaire using the culturally adapted SSCRS, with scores ranging from 54 to 90.
The mean age of respondents was 20.7 years, with a range of 17 to 26 years. Female students constituted the majority (67.2%), reflecting the broader gender distribution in Indonesian medical education. Participants represented all academic levels, with first-year students (25.1%) and clinical rotation stage students (24.7%) comprising the largest groups.
Key Findings: The Gender Gap in Spiritual Care Perceptions
Overall Positive Perceptions
The mean total spiritual care perception score among all students was 76.11 out of 90, indicating generally positive views. This finding aligns with previous research among Turkish nursing students, which similarly reported good perceptions of spirituality and spiritual care.
How Different Student Groups View Spiritual Care
| Student Group | Average Score (out of 90) | Is This Score Higher or Lower? | Is the Difference Meaningful? |
|---|---|---|---|
| By Gender | |||
| Female students | 76.59 | Higher | YES – Women have significantly more positive views |
| Male students | 75.12 | Lower | |
| By Academic Year | |||
| First year | 74.05 | Lowest | YES – Experience matters |
| Second year | 76.30 | Higher | |
| Third year | 76.65 | Higher | |
| Fourth year | 76.75 | Higher | |
| Clinical stage | 77.36 | Highest | First-year vs. clinical is the biggest gap |
| By Age | |||
| Older students | Slightly higher | Weak connection | Age has very little practical effect |
What this table tells you: Higher scores mean students have more positive views about spiritual care. Female students and those with more clinical experience tend to have more positive views. Age makes almost no difference.
Gender: The Only Consistent Predictor
Female students demonstrated significantly higher spiritual care perception scores than males in the study. Researchers explain this finding by noting that women tend to focus more on emotional and affective aspects in patient care, whereas men often emphasize physical aspects. This pattern aligns with broader research suggesting women may be more capable of sharing feelings and emotions.
In multivariate analysis, gender remained the only significant predictor of total spiritual care perception scores. The regression equation showed that being female increased spiritual care scores by approximately 1.46 points. Gender differences were most pronounced in the “Religiosity” and “Muslim’s Value” domains, suggesting that cultural and religious dimensions of spiritual care resonate more strongly with female students.
Academic Year: Experience Matters—But Indirectly
Students in clinical rotation stages achieved the highest mean scores (77.36), significantly outperforming first-year students (74.05). Scores increased progressively across academic years, suggesting that clinical exposure and academic instruction enhance appreciation for spiritual care.
However, after multivariate analysis, academic year no longer showed a significant independent effect. This indicates that the relationship between academic year and spiritual care perceptions may operate through other factors, such as increased patient contact, mentorship, or cumulative learning experiences.
The Five Building Blocks of Spiritual Care (And Who Scores Higher)
| Domain Name | What This Measures (Simple Explanation) | Do Women Score Higher? | What This Tells Us |
|---|---|---|---|
| Existential Element | Understanding life’s meaning and purpose | No | Men and women view this similarly |
| Religiosity | How important religious beliefs and practices are | YES | Women feel religion matters more in care |
| Personalized Care | Tailoring care to each patient’s individual needs | No | Both genders value this equally |
| Spiritual Care | Direct spiritual support and interventions | No | Both genders value this equally |
| Muslim’s Value | Islamic cultural and religious values in healthcare | YES | Women are more attuned to Islamic values |
What this table tells you: The biggest gender differences appear in areas related to religion and Islamic values. Women seem more connected to the religious and cultural aspects of spiritual care.
Age: A Weak but Positive Link
A weak positive correlation emerged between age and spiritual care perception scores. This finding aligns with studies showing that older individuals tend to have slightly better perceptions of spiritual care, possibly because more life experience enables deeper understanding of spiritual dimensions in healthcare.
However, the correlation coefficient of 0.153 indicates a very weak relationship, and age did not remain significant in multivariate analysis. Other demographic characteristics, such as race, ethnicity, and religion—which were not examined in this study—may play larger roles.
Why Gender Differences Matter for Medical Education
The consistent finding that women demonstrate stronger spiritual care perceptions raises important questions for medical education. Research in Brazil similarly found that female medical students placed greater importance on assisting patients with relaxation and stress-reduction activities. This pattern suggests that addressing gender differences in spiritual care education could improve training outcomes for all students.
The study’s authors note that women’s tendency toward emotional and affective focus may make them more receptive to spiritual care training. However, male students should not be neglected. Targeted educational interventions could help bridge this gap, ensuring all future physicians develop competence in holistic patient care.
The Gap Between Recognition and Training
While medical students demonstrate positive perceptions of spiritual care, a significant gap persists between recognition and training. Studies in Brazil reveal that although 84% of medical students recognize the importance of knowledge about spirituality, 93% report no academic exposure to the topic. Furthermore, 97% agree that addressing spirituality enhances the doctor–patient relationship.
This pattern extends globally. A study among healthcare students in Brazil found that most believed spirituality is important for their training (74.8%) and patient care (84%), yet only 48.5% had any contact with the theme during their education. Similarly, a review of medical student perceptions found that while most recognize spirituality’s importance, they express low preparedness to address it in clinical settings.
Islamic Spiritual Care: A Distinctive Framework
Islamic spiritual care represents a distinctive approach based on religious values derived from the Qur’an and hadith—the primary sources of authority in Islam. This framework includes practices such as muraqabah meditation, a technique grounded in Islamic values that has shown effectiveness in helping patients experiencing depression and anxiety.
The study’s use of a culturally adapted SSCRS reflects recognition that spiritual care cannot be separated from cultural and religious contexts. The “Muslim’s Value” domain, where gender differences emerged, captures this cultural dimension. Previous research among Indonesian nurses similarly found that perceptions of spiritual care are embedded within Islamic cultural frameworks.
Practical Implications: Training Future Physicians
Integrate Spiritual Care Into Medical Curricula
The study’s findings underscore the urgent need for structured spiritual care education in medical training. Despite students’ positive perceptions, many feel unprepared to address patients’ spiritual needs. Medical schools should develop curricula that include both theoretical knowledge and practical skills for spiritual assessment and intervention.
A Brazilian study found that elective disciplines and structured approaches, such as the FICA model (Faith, Importance/Influence, Community, Address/Action), improved students’ confidence and empathy. Similarly, reflection-based learning has shown promise in increasing student awareness of spiritual care, though its effectiveness depends on factors such as clinical experience, peer learning, and appropriate facilitator feedback.
Consider Gender Differences in Training Design
Given the consistent gender differences in spiritual care perceptions, educators should consider developing targeted approaches for different groups. Female students may benefit from advanced training that builds on their strengths, while male students might need additional support in developing emotional and spiritual competencies.
However, the study’s authors caution against overgeneralizing. Not all women will score high, nor all men low. Gender should be viewed as one factor among many, including personal spirituality, cultural background, and educational exposure.
Promote Interfaith Dialogue and Cultural Competence
In multicultural healthcare settings, understanding diverse spiritual perspectives is essential. Muslim-majority healthcare environments face unique challenges in adapting spiritual care models to Islamic contexts. Educators should create platforms for interfaith dialogue and positive information exchange about different spiritual traditions.
Collaboration between medical schools, religious leaders, and healthcare institutions can help bridge gaps between cultural expectations and professional preparation. This approach aligns with recommendations for creating social contexts that promote positive intergroup interactions in healthcare settings.
Limitations and Future Research Directions
The study’s generalizability is limited by its single-institution design and focus on one Indonesian medical faculty. Future research should include multiple institutions across diverse cultural and geographical settings. Additionally, the study employed a self-report questionnaire, which carries inherent response bias risks.
The authors recommend future studies using mixed methods, including qualitative approaches such as interviews and focus groups, to capture the lived experiences of medical students learning about spiritual care. Longitudinal research could examine how perceptions evolve throughout medical education and into professional practice.
Future studies should also explore other potentially influential factors not examined in this research, including ethnicity, prior spiritual training, personal religious beliefs, and clinical specialty preferences. This broader perspective could help educators design more effective and inclusive spiritual care curricula.
Conclusion: A Call to Action for Medical Education
This study provides compelling evidence that Indonesian medical students recognize the importance of spiritual care, but significant gaps remain between perception and preparation. Gender emerges as a consistent predictor of spiritual care perceptions, suggesting that medical educators should consider demographic factors when designing training programs.
The authors conclude that integrating spiritual care education into medical curricula is essential for preparing future physicians to meet patients’ holistic needs. This integration should include theoretical foundations, practical skills training, and opportunities for reflection and interfaith dialogue.
As healthcare increasingly embraces biopsychosocial-spiritual models, the development of spiritual care competencies cannot remain an afterthought. The findings from this Indonesian study contribute to a growing global recognition that spirituality matters in healthcare—and that medical education must evolve to prepare physicians who can address this vital dimension of human health.
Reference: Prihanti GS and Firmansyah FH (2026) Medical students perceptions of spiritual care. Front. Med. 13:1802023. doi: 10.3389/fmed.2026.1802023 Link to original article
