Spiritual care for older people living in the community: A scoping review

Abstract

Background

The population of older people should be supported to enjoy optimal quality of life. Health professionals should consider a range of interventions that support the older population to maintain their quality of life. One such interventional approach involves spiritual care.

Objective

To explore what is known about spiritual care approaches for older people living in the community.

Methods

Scoping review informed by Joanna Briggs Institute guidelines. Eight electronic databases were searched: CINAHL, Ageline, PubMed, ProQuest Nursing & Allied Health, PsycINFO, Scopus, Garuda, and Neliti. The review included quantitative and qualitative primary peer-reviewed research studies focusing on spiritual care interventions for older people living in the community published between 2011 and 2021 in English or Bahasa Indonesia. The search was uploaded into an electronic citation manager and imported into Covidence for screening.

Results

A total of 29 studies were included in the review. While the studies were conducted in five continents, most were reported from the Asian continent. Five key issues based on the outcome of interventions were found namely psychological, physical, spiritual, multidisciplinary approach, and social connection.

Conclusion

This scoping review identifies spiritual interventions conducted across many countries have been implemented for older people living in the community. Although there are review limitations and further research is needed, these spiritual interventions, both faith-based and non-faith-based, are identified as useful to support the well-being of older people.

Keywords:

• spiritual intervention
• aging
• spirituality
• health
• older adult
• community

Impact statement

What are the implications of this new knowledge for nursing care with older people?

• Nurses can use faith-based and non-faith-based spiritual interventions in the community, and health care services, to support other usual care interventions for older people.

• Supporting the person’s spirituality is an intervention identified to support the well-being of the aged.

How could the findings be used to influence policy or practice or research or education?

• More research regarding spiritual interventions is needed to enrich and guide nursing practice, education, and policy.

• The findings of this scoping review can be used to guide future research about spiritual interventions for older people living in the community.

Plain language summary

What is the context?

Health and quality of life of older people depends on several aspects including those of a spiritual nature. Health professionals are aware that this aspect is important, however, in practice may only be concerned with physical care.

What is new?

• Little is known about spirituality and spiritual care for community-dwelling older people to enhance their quality of life.

• Faith-based and non-faith-based interventions are identified to support spirituality for older people living in the community to improve their health status.

What does the review highlight?

We provide a comprehensive overview of spiritual interventions for older people applied worldwide. The review explores types of spiritual interventions, outcomes, and duration of interventions and also emphasises the need for further research regarding these interventions.

How the findings will influence the wider field?

Several spiritual interventions can be applied by older people without any specific skills such as some faith-based and non-faith-based interventions. Other interventions require specific skills in applying them with older people. Nurses and other health professionals should aware that improving quality of life of older people requires, not only consideration of physical aspects, but also understanding and application of spiritual interventions.

Background

The population growth of older people over 60 years old UNHCR (2021) is faster today when compared to the aging population in the past (WHO, 2021). As a normal life process, aging must synchronise with health status and quality of life. One dimension of quality of life, according to the World Health Organization (WHO)’s definition, is the spiritual aspect (Lima et al., 2020). Simply stated, spiritual and spirituality are essential especially for older people. Can Oz et al. (2022) describe that spirituality can have a significant impact on the lives of older people, providing an influence that helps them find meaning and overcome challenging situations. MacKinlay and Burns (2017) also emphasise that providing spiritual support to older persons can contribute to their experience of positive feelings and assist in their ability to manage stress. Spirituality has been identified as providing protection for the health and wellbeing of older people, protecting them from harmful effects of adverse life events (MacKinlay & Burns, 2017).

The term ‘spirituality’ is often described in relation to religion (Mauk & Scmidt, 2004). However, Richardson (2014) and Wattis et al. (2017) stated that spirituality can be experienced and expressed by religion in a multicultural society, but spirituality is different from religion. In fact, spirituality is more subjective, broader, and harder to evaluate than religion (Koenig et al., 2012).

Although it may be difficult to define spirituality, in the nursing literature spirituality is conceptualised as an effort to find purpose in life, connectedness, transcendence, and something more than religion (Caldeira et al., 2017; Cockell & McSherry, 2012). According to Wenham et al. (2021) a 2009 consensus conference defined spirituality as humanity’s search for meaning and purpose and how one connects to the moment, self, others, nature, and the significant or sacred. Spirituality is larger than religion, and non-believers can find purpose, meaning, reverence, and awe (McSherry, 2006). McSherry (2006) further states that the spiritual dimension can help people find harmony with the cosmos, seek answers to the infinite, and focus on the infinite when they are stressed, sick, or die. Similar to McSherry, O'Brien (2011) underlines that spirituality is a personal concept that involves an individual’s ideas about transcendence (God) or non-material elements of life and nature. They also believe that most spirituality descriptions include transcendence, mind-body-spirit connection, love, care, compassion, and a relationship with the Divine. Malone and Dadswell (2018) found that religion, spirituality, and/or beliefs can provide strength, comfort, hope, and a sense of community and belonging in older adults’ daily lives, suggesting spirituality and successful aging affect older individuals’ health and well-being. Spirituality is also a vital part of nursing care, supported in theory and validated in practice (Veloza-Gómez et al., 2017). Spiritual care can inspire optimism, closeness, and significance (MacKinlay & Trevitt, 2007). Recently Lepherd et al. (2020) and Mowat and O'Neill (2013) agreed that spiritual care can help older people develop spirituality and age successfully. Carr (2008) also acknowledges spiritual health and well-being can be promoted by spiritual care.

Spiritual care refers to caring activities and procedures that improve people’s spiritual well-being and performance as well as the quality of their spiritual life (Cavendish et al., 2003). According to Puchalski et al. (2009), spiritual care encompasses all the ways in which attention is paid to the spiritual dimensions of life. In another definition, spiritual care can be defined as the provision of assessment, counselling, support, and ritual in matters of a person’s beliefs, traditions, values, and practices enabling the person to access their own spiritual resources (Spiritual Health Association, 2021). According to the Spiritual Health Association (2021), spiritual care is essential in people’s lives because it can impact patient satisfaction, increase their trust in the health care team (William et al., 2011), and also can increase quality of care and quality of life (Marin et al., 2015). Further, spiritual care may benefit a people’s lives such as an increase in the individual’s capacity in making a decision or expressing their feelings freely. It also gives people a sense of meaning and of their inner framework (Spiritual Health Association, 2021). A research study conducted by the Spiritual Health Association reported that 87% of respondents’ comments indicated that receipt of spiritual care was a positive experience, and it met their needs. From all of these reported explanations, definitions and population data, studies about spiritual care or spiritual interventions and the older person are important to examine in order to guide nursing practice and ensure optimal wellbeing outcomes for older people.

To date, there are scoping reviews regarding spirituality in terms of the health practitioner perspective (Flanigan et al., 2019), spiritual care instruments (Nissen et al., 2020), and chronic illness (Roger & Hatala, 2018). However, no review articles have synthesised what is known about spiritual care for older people who live in the community. This scoping review sought to provide a summary and discussion of spiritual care for older people living in the community, specifically it aimed to explore what is known about spiritual care approaches for older people in the community, through the research question: What is known about spiritual care approaches for older people residing in the community?

Methods

Study design

A scoping review was selected for the review as it enabled a systematic approach while enabling broad exploration of existing research (Cooper et al., 2021). The review was conducted following The Joanna Briggs Institute methodology (Peters et al., 2020) and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) (Tricco et al., 2018).

Selection and extraction

The inclusion criteria were all studies that focused on older people living in the community and spiritual care approaches for older people. The review was limited to peer-reviewed quantitative, qualitative, and mixed methods studies published between 2011 and 2021 in English or Bahasa Indonesia. Discussion papers, editorial, literature reviews and syntheses were excluded. Electronic databases searched included CINAHL, PubMed, ProQuest Nursing Allied Health, PsyInfo, Scopus, Ageline, Garuda, Neliti using the search strings as tabled (See supplementary Table 1). Garuda and Neliti were selected for this project to obtain articles written in Bahasa Indonesia. Three members of the research team speak Indonesia and this allowed us to expand the search beyond English only. Two authors independently examined and analysed each article at all stages. Any discrepancy was examined by a third reviewer and the outcome discussed by the research team to achieve consensus. As per the guidance by Cooper et al. (2021), quality appraisal of included studies was conducted to enhance the review’s quality. This was undertaken using the appropriate CASP checklist (Critical Appraisal Skills Program, 2018a, 2018b, 2018c).

Titles and abstracts of the 5289 articles were downloaded into a citation manager and imported into Covidence software for screening. Following removal of duplicates (n = 404), 4885 were screened by titles and abstract for relevance. Of the 136 articles examined by full-text review, 29 articles were eligible for this review. The PRISMA diagram (Page et al., 2021) outlines these steps in this literature search, see Figure 1.

Figure 1. Prisma diagram.

Study characteristics including article citation, country of origin, study design and method, sample, key findings, limitations, recommendations, and characteristics of the spiritual intervention were tabled (see Supplementary data, Table 2).

Results

Of the 29 included studies included in the review, 20 reported quantitative designs, such as cluster randomised design (Anderson & Pullen, 2013; Frew et al., 2015; Johnson et al., 2020; McCarthy et al., 2015), cross-sectional (Aw et al., 2019; Ho et al., 2019; Mahlo & Windsor, 2021), experimental (Sabir et al., 2016; Yu et al., 2014), quasi-experimental study (Arnata et al., 2018; Lai et al., 2018; Sabir et al., 2016), observational (Barkan et al., 2016; Mukherjee, 2016; Siddarth et al., 2014), and pre-post study (Bartholomaeus et al., 2019; Friedman et al., 2017; Friedman et al., 2019; Ilmi et al., 2016). Qualitative methods were reported in seven studies. Those studies that used qualitative methodology included hermeneutic phenomenology (Adams et al., 2014), case study (Wahyuliarmy, 2016; Yasumoto & Gondo, 2021), phenomenology (Hamilton et al., 2013; Parra et al., 2019; Petrovsky et al., 2020; Reis & Menezes, 2017), and ethnographic design (Matsunobu, 2018). There were two studies that employed mixed methods (Chippendale & Boltz, 2015; Johansson & Björklund, 2015). A majority of the studies (n = 13) were conducted in the United States of America. Three studies each were conducted in Australia and, Indonesia, two in each of Japan and Singapore and one conducted in Brazil, China, Hong Kong, India, New Zealand, and Sweden.

Type of interventions

There were three main groups of interventions; faith-based interventions (n = 7) non-faith-based interventions (n = 14) and interventions that reported a combination of the two (n = 6).

Faith-based interventions included spiritual interventions based on a religion (Bopp et al., 2012), a faith-based education programme (Frew et al., 2015), perception regarding religio-spirituality (Mukherjee, 2016), religious song (Hamilton et al., 2013), choral singing (Petrovsky et al., 2020), Spiritual Emotional Freedom Technique (SEFT) therapy (Arnata et al., 2018; Wahyuliarmy, 2016), and reading the Bible and praying the rosary (Mukherjee, 2016; Reis & Menezes, 2017). Countries where these seven studies were implemented comprised the United States (n = 3), Indonesia (n- = 2) and one each in India and Brazil (see Supplementary data, Table 3).

This review identified 14 non-faith-based interventions. This grouping refers to any activities or interventions not related to a religious institution or activity. Interventions included in this grouping included music for life (Matsunobu, 2018), life story work (Lai et al., 2018), domestic gardening practice (Adams et al., 2014), state of mindfulness (Mahlo & Windsor, 2021), Mindfulness-based Stress Reduction (MBSR) therapy (Barkan et al., 2016; Parra et al., 2019), occupational therapy and lifestyle intervention (Johansson & Björklund, 2015), psychoeducational approach to transcendence and health (PATH) (McCarthy et al., 2015), arts engagement (Ho et al., 2019), Lighten UP! Program (Friedman et al., 2017; Friedman et al., 2019), living legend programme (Chippendale & Boltz, 2015), community wellbeing and resilience programme (Bartholomaeus et al., 2019), attachment-focused integrative reminiscence (Sabir et al., 2016), the community for successful aging (ComSA) programme (Aw et al., 2019), and community-based social innovation (CBSI) (Yasumoto & Gondo, 2021). Countries where these interventions were implemented included the United States (n = 7), Japan and Singapore (n = 2), and one each in Australia, Hong Kong, and Sweden.

The third grouping was the combination of faith-based and non-faith-based interventions. This grouping is where the literature reported the inclusion of multiple interventions or multiple approaches. There were six articles that reported a combination of interventions. Articles reported a worship community (Reid, 2018), Community of Voices (COV) choir programme (Johnson et al., 2020), Physical Activity with Spiritual Strategies (PASS intervention) (Anderson & Pullen, 2013), ILMI SpaRe (a combination of interventions that included memory training, physical exercise, spiritual interventions of listening to murattal (reciting Quran) and to spiritual song) (Ilmi et al., 2016), yoga/tai chi (Siddarth et al., 2014), and the Dejian mindfulness-based intervention (DMBI) (Yu et al., 2014). These combinations of faith-based and non-faith-based interventions were implemented in four countries: the United States of America (n = 3), and one each in China, Indonesia, and New Zealand.

The intersection of faith-based interventions and non-faith-based interventions is outlined in Figure 2.

Figure 2. The intersection of faith-based interventions and non-faith-based interventions.

Programme leader and duration of interventions

The majority of studies identified in this review was reported as being facilitated by researchers or were government or community group led. When the programme leader was a researcher, these articles tend to report the duration of the intervention was over a short period of time (Barkan et al., 2016; Bartholomaeus et al., 2019; Chippendale & Boltz, 2015, 2018; Friedman et al., 2017; Friedman et al., 2019). The government or community group led interventions were reported to occur over a longer period i.e. 3–6 months (Aw et al., 2019; Bartholomaeus et al., 2019; Reid, 2018; Yasumoto & Gondo, 2021).

Reports of the duration of the spiritual intervention were varied. Five studies reported the intervention was implemented over a short term i.e. less than three months (Barkan et al., 2016; Bartholomaeus et al., 2019; Chippendale & Boltz, 2015, 2018; Friedman et al., 2017; 2019). Two articles reported the duration of their implementation between three to six months (Anderson & Pullen, 2013; Aw et al., 2019). Other studies do not report the duration of the intervention (Arnata et al., 2018; Johansson & Björklund, 2015; Johnson et al., 2020; Mukherjee, 2016; Petrovsky et al., 2020; Reid, 2018; Siddarth et al., 2014; Wahyuliarmy, 2016; Yasumoto & Gondo, 2021).

Duration of follow-up post-interventions

There was variability in the duration in follow-up of the programme participation post the interventions. Almost half of the studies did not report how long the follow-up of the programme participant occurred post-intervention (Adams et al., 2014; Arnata et al., 2018; Ho et al., 2019; Ilmi et al., 2016; Mahlo & Windsor, 2021; Matsunobu, 2018; Reid, 2018; Wahyuliarmy, 2016). Other articles reported follow-up of participants between three to six months post-intervention (Barkan et al., 2016; Frew et al., 2015; Friedman et al., 2017; Friedman et al., 2019; Johansson & Björklund, 2015; Johnson et al., 2020; Lai et al., 2018; Parra et al., 2019; Yasumoto & Gondo, 2021).

Outcome of spiritual interventions

The spiritual interventions varied with their outcome measures. These measures could be classified into psychological, physical, spiritual, social connections, and multi-dimensional outcomes. Reported health outcomes included improving adaptive capacity (Adams et al., 2014; Aw et al., 2019), cognitive impact (Barkan et al., 2016; Friedman et al., 2017; Johnson et al., 2020; Parra et al., 2019), acceptance of older people’s condition (Barkan et al., 2016; Friedman et al., 2017; Parra et al., 2019), reducing loneliness and personal growth (Barkan et al., 2016; Friedman et al., 2017; Johnson et al., 2020; Parra et al., 2019), optimism and resilience (Bartholomaeus et al., 2019), reducing depression level, anxiety, and somatic symptoms (Friedman et al., 2017; Ilmi et al., 2016; Reid, 2018; Sabir et al., 2016; Siddarth et al., 2014), improving mental well-being (Ho et al., 2019; Lai et al., 2018; Parra et al., 2019; Petrovsky et al., 2020; Yasumoto & Gondo, 2021), affective well-being (Lai et al., 2018; Mahlo & Windsor, 2021; Petrovsky et al., 2020), awareness of thought emotion and change attitudinal foundation (Aw et al., 2019), behavioural change (Frew et al., 2015; Sabir et al., 2016; Siddarth et al., 2014), independence and self-esteem (Johansson & Björklund, 2015), peace and overcoming adversity (Reis & Menezes, 2017), preventing anger (Siddarth et al., 2014), and reducing stress level (Yu et al., 2014).

Several interventions had a positive impact on older people’s health physically such as improving sleep quality (Arnata et al., 2018; Friedman et al., 2017; Parra et al., 2019; Yu et al., 2014), body strength, balance and walking speed (Aw et al., 2019; Johnson et al., 2020; Yu et al., 2014), reducing blood pressure (Parra et al., 2019; Siddarth et al., 2014; Yu et al., 2014), stimulating body coordination (Aw et al., 2019), and also lowering fatigue levels (Siddarth et al., 2014).

Several interventions were found to affect older people’s spiritual state. Several components of older people’s spiritual state were affected such as life satisfaction (Aw et al., 2019; Friedman et al., 2019; McCarthy et al., 2015), spiritual satisfaction (Ho et al., 2019; Reid, 2018; Yasumoto & Gondo, 2021), purpose and meaning in life (Chippendale & Boltz, 2015), and overall spiritual well-being (Ho et al., 2019; Reid, 2018). In terms of social benefits, these interventions had significant impact on social connections: improved social function and interpersonal support (Ho et al., 2019), belonging to the group (Johansson & Björklund, 2015), marital relationships (Parra et al., 2019), perceived social isolation (Bartholomaeus et al., 2019), sharing music with others (Matsunobu, 2018), and community cohesiveness (Yasumoto & Gondo, 2021). Finally, multidimensional impact was found to provide benefits for older people such as quality of life (Hamilton et al., 2013; Ho et al., 2019; Mukherjee, 2016; Parra et al., 2019; Petrovsky et al., 2020), level of wellbeing (Bartholomaeus et al., 2019), and maintenance of health and longevity (Reis & Menezes, 2017).

Discussion

This scoping review sought to explore what is known about spiritual care approaches for older people residing in the community. Twenty-nine studies with 26 different spiritual interventions implemented in 11 countries and represented five continents were identified. Findings suggest several interventions can be implemented to benefit older people in all components of health aspects such as psychological health, physical health, spiritual health, social connection, and multi dimensions.

The number of spiritual interventions was broadly reported in the studies included in this review, and can be divided into three groups based on if they were underpinned by religion or non-religion or a combination of faith-based and non-faith-based interventions. Faith-based intervention comprised several interventions that focused on activities based on belief/religion such as education program, religious activities (reading bible, reciting Koran, zikr, praying the rosary, etc). These types of interventions impact specifically spiritual health and psychological health. However, this review additionally found that implementing spiritual intervention for older people can enhance older people’s health status whether psychologically or spiritually, can encounter problems for health professionals in the health service centres. Hence, there is a need to examine health professionals’ perceptions of spirituality and spiritual care in delivering treatment to older people. Koenig et al. (2012) explain that spirituality/religiosity can benefit older people’s meaning of life, wellbeing, connectedness, hope, and peace. Kaplan and Kaplan (2021) also emphasise that religion is one strategy to overcome stress and can impact physical and health conditions. In addition, personal spirituality can affect older people’s physiological and psychosocial well-being (O'Brien, 2011). Spirituality can effect significantly end-of-life care, such as chronic kidney disease problems, therefore O'Brien (2011) believes spiritual care can help people discover meaning and purpose in later life (Moura et al., 2020).

An example of the impact of spirituality/religiosity/spiritual care can be seen in some spiritual interventions such as mindfulness, meditation-relaxation, and religious activities (e.g. reciting Koran, prayer and zikr). It can confer an effect by reducing depression (Ilmi et al., 2016), adapting to stress (Perez-Blasco et al., 2016), reducing sleep disturbances in older people (Black et al., 2014). In addition, research regarding meditation-relaxation as a spiritual intervention conducted by Lindberg (2005) found that meditation and spiritual practices can lead to significant social and emotional benefits if social isolation is a problem. The most popular intervention in this study is mindfulness as the main intervention in several studies identified. In order to measure effectiveness of mindfulness interventions, more investigation is needed.

The duration of the interventions identified in these articles was generally short term i.e. less than three months or between three and six months. No article identified an ongoing intervention or maintenance strategies to support the participants to continue with the interventions implemented. In addition, duration of follow up of study participants varied. No studies had intervention with follow up for more than six months. In contrast, interventions with follow up between 3 to 6 months, comprised nine type of interventions that were reported as conducted by researchers. A study conducted by Rothman et al. (2009) found that habit could be formed by action intensively. It can be seen in his study regarding diet and activity behaviours that needs a repetition activity in 32 weeks to loss 3.8 kg body weight. In this research it was also explained over 24-months of follow-up period was suggested to maintain the habits developed from programme participation. Gardner et al. (2012) and Gardner et al. (2020) outline a chance of forming a good habit need 2–3 months of working effort. Wood and Neal (2016) and (Riggott, 2016) identify three steps to form healthy new habits: repetition activities, stable clues that trigger habit formation, and positive rewards. Wood and Neal (2016) emphasise that to create a good habit, six-months action to sustain this activity is needed.

The variability in health outcomes between studies makes comparisons difficult. Outcome measures identified in this review can be categorised as physical, psychological, spiritual, and intangible. Physiological measures were reported including personal growth, optimism, adaptive capacity, mental health, depression, anxiety, self-esteem, adaptive resilience, self-acceptance, and stress. Physical determinants reported varied from sleep quality, mobility, balance, walking speed, blood pressure, lower body strength, fatigue, drugs addiction. Spiritual outcomes identified as meaning in life, sense of purpose, satisfaction of life, spiritual well-being. Belonging to the group, sense of communities, marriage relationship grouped as social connections outcomes. Lastly, there were some health benefits than cannot be classified into the group above. Similar to these impacts found in this review, some studies also show that spiritual interventions such as faith-based interventions (Onyishi et al., 2021), faith-based education programme (Hosseini et al., 2016), and religious activities (Hosseini et al., 2016). The studies found that those interventions can impact on gene expression in breast cancer patients (Hosseini et al., 2016), patients’ quality of life suffering cancers (Bożek et al., 2020), patients’ systolic blood pressure, body weight, and fasting plasma glucose (Moeini et al., 2012).

This review has highlighted areas where there is a need for further research in order to better understand the implementation of spiritual interventions for older people in the community. While there are many identified limitations, challenges, and recommendations for supporting those interventions, the spiritual interventions reported had a positive impact for older people’s health such as raising awareness of their mental health, improving physical health, enhancing spiritual health, improving health behaviours, and finally in elevating quality of life. Only a small number of studies were found that described whether spiritual interventions had a spiritual benefit and a social benefit. There is a need for research seeking to understand health professionals’ perceptions in implementing spiritual interventions with older people.

This scoping review has some limitations that need to be recognised. It sought to explore what is known about spiritual care for older people residing in the community. Only English and Indonesian language studies were included and, while the review was broad, some relevant studies may have been omitted. Three studies were reported in Bahasa Indonesia, this limit may be caused by databases in use in this country that this review has not captured. Most included studies were implemented in the Asian region, although no studies were reported to have been conducted in Europe or the United Kingdom which may limit the generalisability of these findings to other settings. This review has been able to classify interventions into two distinct categories of faith based and non-faith-based spiritual interventions. In addition, there is an intersection between these two categories to account for the varied and many approaches that the literature reports.

Conclusion

To conclude, this review identified various spiritual interventions that can impact the health status and overall quality of life of older people. In general, interventions based on faith and those not based on religious beliefs were carried out for different durations. Interventions were found to positive impacts on bodily, psychological, or spiritual well-being. The findings of this study suggest that spiritual interventions can be implemented for older people at both community and family levels. Nevertheless, there are various interventions that require specialised skills, which can be carried out by nurses employed in community health services. Therefore, community nurses play an important part in educating older people about suitable interventions that can be adopted at both the community and family levels. The implementation of spiritual interventions has many health benefits in improving older people’s quality of life, however there were some challenges in delivering interventions. Further research is needed to explore specific interventions for spiritual and psychological outcomes as the main objective and to measure the duration of the effect.

Acknowledgements

Furthermore, we want to acknowledge Dr. Sue Gilbert, senior librarian at La Trobe University, for her support and assistance in designing the search strategy.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental data for this article can be accessed at https://doi.org/10.1080/10376178.2024.2310260.

Additional information

Funding

This PhD study is supported by ‘Beasiswa Kemenag-LPDP’ (Ministry of Religious Affair Republic of Indonesia-Indonesia Endowment Fund for education) MORA-Kemenag RI.