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COPYRIGHT 2000 JAI Press, Inc.
INTRODUCTION
A growing number of studies have examined the relationship between religion and health in late life (see Ellison and Levin 1998; Koenig 1994 for reviews of this literature). Viewed broadly, this literature suggests that elderly people who are more deeply involved in religion tend to enjoy better physical and mental health than older adults who are not as religious. Although a number of explanations have been offered for these intriguing findings, some researchers contend that it is especially important to consider the influence of prayer (Dossey 1993; Levin 1996). This is hardly surprising because scholars have argued for decades that prayer is the most important part of religion. This view is expressed in the classic work of William James (1902), who maintained that prayer is "... the very soul and essence of religion" (p. 365).
It is important to focus on prayer when studying older adults because there is some evidence that elderly people are especially likely to pray. More specifically, Koenig, Smiley, and Gonzales (1988) reported that virtually all (i.e., 95%) older adults pray. This is consistent with research by Poloma and Gallup (1991), who indicated that the proportion of elderly people who pray (91%) is higher than in any other age group.
Although the link between prayer and health appears promising (Levin 1996), researchers still have a great deal to learn. One of the foremost challenges involves fully specifying the content domain of this complex multidimensional construct. As Hood et al. (1996) pointed out, we still know little about the phenomenology of prayer, including the subjective experiences that people have during prayer as well as their perceptions of how God reacts to prayers.
The purpose of this article is to report findings from eight focus groups that were designed to explore the content domain of religion in late life. The article is divided into four sections. Prior quantitative work on the measurement of prayer is reviewed first. Following this, the use of focus groups for shedding light on the nature of prayer is discussed. The Methods section describes the methodology developed for this study, including subject recruitment, a brief demographic profile of the focus group participants, and an overview of how the focus groups were conducted. Finally, major insights into prayer that were gleaned from the focus group data are presented and discussed.
QUANTITATIVE MEASURES OF PRAYER
Researchers have typically followed one of three approaches to develop closed-ended survey questions about prayer. The most frequently used method consists of one or two items that ask study participants how often they pray (e.g., Levin, Taylor, and Chatters 1995). Although this information is essential, it doesn't reveal anything about the purpose, content, experiences, or expectations of the person who is praying. As a result, data obtained with this measurement strategy cannot provide a precise explanation for why prayer may be related to health outcomes.
Scales that assess religious coping responses represent the second way that prayer has been measured. Here, some investigators have taken a relatively simple approach that merely involves asking study participants whether they use prayer to help them deal with difficult times (e.g., Koenig et al. 1988). In contrast, other researchers have devised scales that gather more detailed information on the role of prayer in the coping process. The work of Pargament (1997) is especially noteworthy in this respect. In particular, he made an effort to assess the content of prayer (e.g., "begged for God's help") as well as the goal of prayer (i.e., "prayed or read the Bible to keep my mind off my problems"). There is little doubt that a major function of prayer is to help people cope effectively with stressful life events. However, there is more to prayer than this. Even a moment's reflection reveals that many people pray regardless of whether they are confronted by a stressor: Some offer prayers of thanksgiving,, while others may seek God's help for a loved one. Moreover, current measures of prayer as a coping resource have missed a good deal of contextual information. We don't know, for example, whether respondents feel that prayers for help during difficult times are always answered. Having this kind of information is important because problems may arise when researchers simply correlate requests for help with a health-related outcome in an effort to see if prayer is a successful coping strategy. Under these circumstances, investigators are, in effect, pooling subjects who feel their prayers are always answered with those who believe that requests for help are answered only some of the time, or only under certain conditions. If health benefits arise only when people believe that prayers are always answered, then ignoring beliefs about prayer will result in an underestimate of the relationship between prayer and health.
The third approach to the measurement of prayer is exemplified by the research of Poloma and Gallup (1991). This is perhaps the best work on the measurement of prayer that is available to date and is impressive for two reasons. First, the researchers devised survey measures of four specific types of prayer: ritual, petitionary, conversational, and meditative (see also Hood, Morris, and Harvey 1993). Second, Poloma and Gallup (1991) developed five indicators to measure prayer experiences. Included in this brief index are items that assess whether study participants feel the presence of God during prayer, or whether they believe they receive an answer to their prayers.
The items that assess the experience of prayer represent an especially promising development. But they may not go far enough. This limitation is best illustrated by turning to some of the findings in the Poloma and Gallup (1991) study. These investigators reported that only 15 percent of their study participants believed they regularly received answers to prayers. In contrast, 27 percent reported they never received answers to prayers, and another 25 percent said they only got an answer once or twice. We need to know more about how and when people feel their prayers are answered. For example, do people believe that prayers are more likely to be answered if they are presented in a certain way, or do they believe that one should ask for some kinds of things, but not others?
In addition to the limitations that have been discussed so far, there is a larger and more generic problem that is shared by all of the measurement approaches reviewed here. In particular, none of the scales on prayer have been devised specifically for older adults. Instead, the origins of the items are either unknown, or they have been developed with samples consisting only of younger people. There are at least three reasons why researchers need survey measures of prayer that have been developed for elderly people. First, as noted earlier, older adults pray more often than younger people. If we want to learn more about prayer, then focusing on people who are most likely to pray represents a good place to start. Second, research consistently reveals that physical health problems are more likely to arise in late life. This is especially true with respect to chronic health problems (Rowe and Kahn 1998). If prayer really affects health, then it makes sense to evaluate this relationship with measures that have been designed specifically for those who are most likely to be at risk. Third, a number of researchers argue that the nature and meaning of religion changes as people grow older. This idea is reflected in a discussion of "a mature faith" (Koenig 1994). Although somewhat hard to define, a mature faith involves developing a deeper, more intimate, and more personal relationship with God that is based, in part, on successfully meeting many of life's challenges. It seems reasonable to assume that the nature and content of prayer should change if one's relationship with God changes in the manner proposed by Koenig (1994). A central premise in the present study is that the best way to develop sound measures of a mature faith is to turn to older adults themselves, and learn more about how they perceive and practice prayer.
FOCUS GROUPS AND QUANTITATIVE SURVEY ITEM DEVELOPMENT
Focus groups provide an excellent way to address the limitations discussed above. By allowing older adults to talk freely in groups while minimizing the influence of the researchers' prior assumptions on the content of their discussions, focus groups provide an opportunity for more direct access to prayer as it is practiced and experienced by the average older person. Listening while focus group participants share and compare their experiences with prayer gives researchers a better understanding of the participants' perspective. Because the ultimate goal of this project is to create a closed-ended survey instrument, hearing elders' own experiences and views about prayer helps insure that our questionnaire covers the topics that are important to the respondents themselves. The group interviews are, therefore, especially useful for uncovering broad themes and content areas that reflect the ways that elders themselves think about and practice prayer.
Another major advantage of working in a group context is that we can observe and record the words and phrases that older adults use with each other when discussing prayer. Hearing the language that respondents use is especially useful for crafting good closed-ended survey items because it insures that the questions we ask are phrased in ways that make sense to study participants (Morgan 1997).
METHODS
Study Participants
In an effort to ensure that we captured the way the typical older person thinks about prayer, we followed a more quantitative survey sampling approach that relies instead on simple random probability sampling. Even so, as discussed below, we modified the traditional random probability sampling approach slightly to insure that a diverse range of older adults were included in our focus groups.
The sampling frame for this study consisted of all older adults residing in Washtenaw County, Michigan who were contained in the Health Care Finance Administration (HCFA) Medicare Beneficiary Eligibility List. This list contains the name, address, sex, and race of virtually every person in Washtenaw County. It should be emphasized that elderly people are included in this list even if they are not currently receiving Social Security benefits. Even...
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