Levels Of Spiritual Well-being Research Articles

The interplay of spiritual health, resilience, and happiness: an evaluation among a group of dental students at a state university in Turkey

BackgroundDental education is one of the disciplines where students are most significantly affected psychologically. The aim of this study was to evaluate the relationship between spiritual health, resilience and happiness levels of dental students at a state university in Turkey.MethodsThis cross- sectional study included 212 students from the 3rd, 4th and 5th grades of the faculty of dentistry. A questionnaire consisting of 4 sections was used in the study. The sections of the questionnaire include students’ general and academic information, Turkish adaptations of the Spiritual Well-Being Scale, The Brief Resilience Scale, and the Oxford Happiness Questionnaire-Short Form. Data analysis was performed with IBM SPSS 25 package program. The Shapiro-Wilk test was used to assess the normal distribution of the data. The Mann-Whitney U test was preferred for comparisons between two categorical variables and one numerical variable. The Kruskal-Wallis H test was employed for comparisons involving two categorical variables and one numerical variable. The presence of a relationship between two numerical variables was examined using the Spearman test.ResultsIn terms of resilience and happiness scores, males had higher scores than females. It was determined that third graders scored higher than fifth graders in harmony with nature scores, and third graders scored higher than fourth graders in deregulation scores. There was a positive correlation between happiness, spiritual well-being and resilience; a negative correlation between happiness and anomie. There was no significant relationship between age and happiness scores. As a result of multiple linear regression to determine the factors affecting happiness; increases in spiritual well-being and resilience will lead to an increase in happiness levels.ConclusionThis study concluded that increased levels of spiritual well-being and resilience among a group of dental students would lead to increased levels of happiness. However, further research is needed to understand the relationship between mental health, resilience and happiness levels during dental education.

Spiritual well-being and associated factor among adult cancer patients in Hawassa University Comprehensive Specialized Hospital, Oncology Center, Hawassa, Ethiopia

Spiritual well-being and associated factor among adult cancer patients in Hawassa University Comprehensive Specialized Hospital, Oncology Center, Hawassa, Ethiopia

The Relationship Between Preparedness for Caregiving and Spiritual Well-Being in the Carers of Stroke Patients: A Case Study in Türkiye.

This study was conducted to determine the relationship between preparedness for caregiving and spiritual well-being in the carers of stroke patients. This descriptive and cross-sectional study was conducted with 130 primary carers of patients hospitalized with the diagnosis of stroke at the neurology clinic of a hospital. It was determined that the participants had moderate levels of preparedness for caregiving, they had high levels of spiritual well-being, and there was a positive significant relationship between these two variables. According to the regression analysis results, the spiritual well-being level of the participants was a predictor of their preparedness for caregiving (B: 0.144, p < 0.001). The results of this study demonstrated that the spiritual well-being of the carers of stroke patients is important in increasing preparedness for caregiving. In this context, to ensure that the carers of all stroke patients feel prepared for the caregiving process, it is recommended to evaluate their preparedness levels, support them in their preparation for their caregiving roles, and identify their spiritual needs.

The Investigation of Death Anxiety and Spiritual Well-Being Levels of Family Members of Patients Admitted to Intensive Care Unit.

This study aimed to investigate the death anxiety (DA) and spiritual well-being (SWB) levels of first-degree family members of patients hospitalized in the intensive care unit (ICU). The data of this descriptive correlational type of study were collected through a faceto-face interview and survey with 308 family members who came to visit family members treated in the ICU of a public hospital in the western province of Turkey. Results were analyzed with SPSS software version 22. The average Death Anxiety Scale (DAS) score of the family members is 7.99 (3.15), which is above the middle value (min/max; 0-15), and the average Spiritual Well-Being Scale (SWBS) score is 121.83 (12.91), which is relatively high (min/max; 29-145). A positive, weak, and significant correlation existed between DAS and SWBS mean scores (r=0.20; P<0.05). As a result, the DA levels of family members increase with the thought of losing their patients in the ICU. During this period, family members of patients need spirituality more than ever to cope with increasing DA. In this study, a positive and significant correlation was found between the DA levels and SWB levels of the family members. According to this result, as family members' DA increases, their spiritual needs also increase.

Quality of Life in Patients With Well-Differentiated Thyroid Carcinoma After Total Thyroidectomy in Greece.

Well-differentiated thyroid cancer is among the most common types of endocrine cancer. Despite its increasing prevalence, the prognosis of thyroid cancer is rather good, with a five-year survival rate ranging between 80% and 90%, depending on the histological type. Not only the post-treatment complications and the side effects of the lifelong medicationbut also the possibility of a recurrence may have a negative impact on the patient's quality of life (QoL). The aim of this study is to investigate the impact of total thyroidectomy on the QoL of patients with well-differentiated thyroid carcinoma. A prospective study was performed in patients who underwent total thyroidectomy due to well-differentiated thyroid carcinoma in the Otolaryngology-Head and Neck Surgery Department at the University Hospital of Larissa, Greece. The QoL was evaluated based on the "Quality of Life (Thyroid Version)" questionnaire. One hundred patients participated in the study, with a mean age of 51.24±15.33 years. Of these, 63 (63%) were females and 37 (37%) were males. Social concerns, physical well-being, and psychological well-being presented a gradual positive alteration during the first 12 months after the surgery, with psychological well-being reporting the most significant progress of 15.3%. However, spiritual well-being appeared to decline over time. The younger patients progressively improved their physical, psychological, and mental well-being; however, the older patients showed an amelioration of their social skills. Female patients reported higher levels of spiritual well-being, whereas males developed better social skills. In the long term, total thyroidectomy can ameliorate patients' physical status, psychological well-being, and social concerns. However, it might have a negative effect on their mental health during the first 12 months postoperatively. In addition, QoL is directly influenced by demographic characteristics such as age and gender.

Spiritual well-being levels of formal and informal cancer caregivers in Turkish society and influencing factors: A comparative study

Purpose: This study aimed to compare the spiritualwell-being levels of formal and informal caregiversof cancer patients.Materials and Methods: This study using a crosssectional survey was conducted with formal (n=52)and informal caregivers (n=52), who met theinclusion criteria, were included in the sample. Thedata of the study were collected using web-based andself-reported questionnaires.Results: The scores of spiritual well-being in alldimensions of formal and informal caregivers are ata moderate level. There was a difference between informal and formal caregivers in the belief andpeace sub-dimension scores. Moreover, there was nodifference in total score averages of the spiritualwell-being scale. It was found that there was nostatistically significant difference between themaccording to age groups, gender, marital status,having a child, and income status.Conclusions: This study provides that the careprocess of cancer patients may affect the spiritualwell-being of formal and informal caregivers.Keywords: cancer, formal caregivers, informalcaregivers, spiritual well-being, oncology nursing

THE RELATIONSHIP BETWEEN COVID-19 FEAR, DEPRESSION, AND SPIRITUAL WELL-BEING IN UNIVERSITY STUDENTS

Spiritual values and spirituality are crucial in preventing mental issues such as depression and solitude in student life. In this descriptive research, we aimed to investigate the relationship between COVID-19 fear, depression and spiritual well-being in university students. It was a statistically significant difference between the department in which the students are educated and the total levels of the Spiritual Well-Being Scale (p&lt;0.05). As students' fear of COVID-19 increased, their psychological well-being scores decreased. Moreover, a statistically significant, moderate and negative relationship was observed between the COVID-19 fear scale and spiritual well-being levels (r=-0.495; p&lt;0.001). It was determined that the 2nd-year students of the First and Emergency Aid Program who attended their clinical practice had higher depression levels and lower spiritual well-being levels compared to other departments. It may be recommended that university students participate in appropriate psychosocial programs aimed at depression and factors that negatively affect their mental health and that these factors be taken into account in school curricula.

EVALUATION OF THE RELATIONSHIP BETWEEN SPIRITUAL WELL-BEING AND SURGICAL FEAR IN LIVER TRANSPLANT CANDIDATES

This study was conducted to evaluate the relationship between spiritual well-being and surgical fear in liver transplant candidates. This study is a cross-sectional study conducted with 124 liver transplant candidate patients admitted to a university liver transplant center. Personal Information Form, Spiritual Well-Being Scale (SWBS) and Surgical Fear Scale (SFS) were used to collect data. It was determined that the patients’ spiritual well-being was 24,59 ± 9,20 and their surgical fear was 40,11 ± 10,94. In the study, it was determined that there was a statistically negative correlation between the patients’ spiritual well-being and surgical fear (r=-0.248, p˂0.05). This study proved that liver transplant candidates with high levels of spiritual well-being have lower levels of surgical fear. For this reason, awareness of spiritual well-being should be developed in healthcare professionals and it is recommended that they provide healthcare services that provide moral and social support to patients.

Factors Affecting Death Anxiety in Patients Undergoing Open Heart Surgery: A Cross-Sectional Study.

After the operation, death anxiety of patients is affected by many factors. This study aims to investigate the factors affecting death anxiety of patients undergoing open heart surgery. A descriptive, cross-sectional study. Data were collected using the 'Introductory Information Form,' the 'Templer's Death Anxiety Scale,' and the 'Spiritual Well-being Scale.' This study was conducted with 313 intensive care patients. The mean scores of the patients on the "Death Anxiety Scale" were moderate (7.96 (4.28)). According to the study findings, age, gender, length of stay in the intensive care unit, and spiritual well-being were found to be important predictors of death anxiety (F (4,308) = 16.149, p < .001). Considering gender differences in nursing care, it is thought that the intensive care period will be shortened, the level of spiritual well-being will increase and death anxiety will decrease.

Investigation of the Relationship Between Spiritual Well-Being, Prenatal Stress and Attachment Level of Turkish Women Conceiving Spontaneously or with Assisted Reproductive Techniques.

The aim of the study is to examine the relationship between spiritual well-being, prenatal stress and attachment level of Turkish women conceiving spontaneously or with assisted reproductive techniques (ART). The comparative descriptive study type was conducted between November 2021 and June 2022 with 202 pregnant women, including 87 women conceiving with ART and 115 women conceiving spontaneously, who applied for routine prenatal care checkup in a state hospital in the west of Turkey. Both groups have a high level of spiritual well-being. Pregnant women in the ART group experience higher prenatal distress (9.6% for spontaneous, 12.6% for ART, p = 0.487) and low level of attachment (69.72 ± 7.98 for spontaneous, 66.24 ± 8.88 for ART, p = 0.006) compared to the other group. Additionally, as insufficient partner involvement in the prenatal process increases in pregnant women in both groups, prenatal attachment decreases. It is extremely important that midwives and nurses evaluate the spiritual well-being of pregnant women and provide holistic care in line with their spiritual needs.

The Power of Spiritual Well-Being: Its Relationship with Pain Intensity, Pain Management, and Pain Catastrophizing in Individuals with Chronic Pain

BackgroundChronic pain negatively affects human life. Chronic pain is multidimensional. Therefore, a multidimensional approach that focuses on the biologic, psychological, sociologic, and spiritual needs of patients is required in pain management. AimThis study was conducted to determine the relationship of spiritual well-being with the level of pain catastrophizing, pain intensity, and pain management in individuals with chronic pain. MethodsThe snowball sampling method was used in the research and the data were collected by individuals with ankylosing spondylitis and rheumatoid arthritis who had chronic pain via an online survey form. The study was completed between March and May 2023 with the participation of 399 people. The data of the study were collected using the Descriptive Characteristics Questionnaire, Pain Catastrophizing Scale, Three-Factor Spiritual Well-Being Scale, and Numerical Rating Scale. ResultsThere was a negative, high-level correlation between the spiritual well-being and the Pain Catastrophizing Scale and its subscales. At the same time, there was a negative, weak level correlation between the levels of spiritual well-being and the pain intensity. Spiritual Well-Being Scale scores differ according to the method used in pain management. Spiritual well-being and pain intensity explain 68% of the total variance in pain catastrophizing. ConclusionsThe results of this research show that there may be a relationship between increased spirituality and reduced perceptions of pain in this population.

Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic.

Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six (N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI (p's < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and trust-violation-related MI (p's < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history (p = 0.02) and self-compassion (p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees.

Effect of Psychoeducational Training Program on Coping Skills, Spiritual Well-being, and Levels of Anxiety among Patients with Generalized Anxiety Disorder

Context: Generalized anxiety disorder is one of the most common mental disorders that produce fear, worry, and a constant feeling of being overwhelmed. Spiritual well-being is a positive psychological factor linked to lower anxiety levels in GAD patients. One of the most important elements of having GAD is learning how to cope with persistent anxiety and physical symptoms.&#x0D; Aim: Evaluate the effect of the psychoeducational training Program on coping skills, spiritual well-being, and anxiety levels among patients with Generalized Anxiety Disorder.&#x0D; Methods: A quasi-experimental (pre/post-test) design was used. This study was carried out at the General Psychiatric Clinic of El Abbassia Psychiatric and Mental Health Hospital. The study involved 80 patients with generalized anxiety disorder. Data was collected over six months utilizing four tools. They were used for data collection: A Structured Interview questionnaire, a Coping Strategies Questionnaire, a Spiritual Well-being Scale, and a Beck Anxiety Scale.&#x0D; Results: The present study shows that more than half of patients with generalized anxiety disorder under study were in the age of &lt;30 years (57.5%) with a mean age of 24.5±8.33. While 28 % had satisfactory pre-program coping, this percentage increased to 52% post-program implementation. On the other hand, 63.7% of patients with generalized anxiety disorder understudy had low levels of spiritual well-being that decreased to 9% post-program. Also, more than half of 59% of patients had severe anxiety levels at pre-program; this percentage decreased to 21% post-program implementation with a statistically significant difference between coping skills, spiritual well-being, and anxiety level pre- and post-psychoeducational training. In addition, there was a highly statistically significant correlation between the total score of spiritual well-being, coping, and their total anxiety score during the pre/post-program implementation phase (P≤ 0.001).&#x0D; Conclusion: Psychoeducational training Program has a significant positive effect on improving coping skills, spiritual well-being, and levels of anxiety among patients with generalized anxiety disorder. Application of a psychoeducational nursing intervention can help patients with generalized anxiety disorder better understand the advantages of various spiritual pursuits and how to improve their spiritual well-being and coping skills.

Examining the Burden of Self-Blame Attribution Among Women With Cervical Cancer.

Background:Self-blame for past sexual behaviors or for the personal character may be associated with the development of cervical cancer. Purpose: Aims were to understand the burden of self-blame attribution (SBA) among women with cervical cancer by (1) examining relationships between SBA, psychological distress (PD), and spiritual well-being (SWB); (2) determining differences between behavioral (BSB) and characterological self-blame (CSB) attribution; and (3) describing associations between SBA and unwanted past sexual experiences. Methods: Women attending a cancer center in the southeastern United Stats (N = 106) completed an online survey including a demographic questionnaire and three instruments: (1) SBA for Cancer Scale; (2) Psychological Distress Subscale of the Psychological Adjustment to Cancer Scale-Self Report; and (3) Functional Assessment of Cancer Therapy-Spiritual Well-being. Results: Women with cervical cancer, 26-64 years of age, identified moderate levels of SBA, PD, and SWB. Relationships were found between PD, BSB and CSB, and unwanted sexual experiences. Significant inverse correlations between religious faith, BSB, unwanted sexual experiences, and SWB were noted. Unwanted sexual experiences were a significant predictor of SBA. Conclusion: SBA places women at risk for increased burden. Recognizing SBA in vulnerable cancer survivors is important to providing holistic nursing care.

Differences in the Spiritual Welfare Levels of the Elderly Who Have Spouses and Without Spouses

Introduction: Most of the elderly who have spouses have a high level of spiritual well-being, but some also have moderate and low levels of spiritual well-being. This is also experienced by the elderly who do not have a life partner, some have moderate and low levels of spiritual well-being, but some also have high levels of high spiritual well-being. Purpose: this study aims to determine the difference in the spiritual well-being of the elderly who have a spouse and without a spouse. Place of Research: Rejosari Health Center Working Area. Methods: This study used a quantitative design using a comparative study method. The approach used was cross sectional. Results: There is no difference in the level of spiritual well-being of the elderly who have a spouse and without a spouse (Sig. (2-tailed) = 0.228, 0.05). Conclusion: There is no difference in the level of spiritual well-being of the elderly who have spouses and those without spouses. Suggestion: Future researchers can examine the factors that affect the spiritual well-being of the elderly with or without a spouse.

Investigating the Spiritual Well-Being of Employee Nurses in the Hospitals of Birjand University of Medical Sciences in 2022

Background: In recent decades, spiritual well-being has gained fundamental importance in many healthcare environments. Spiritual well-being is important information about healthcare needs, allowing people to deal with mental stress. Objectives: The present study aimed to determine the spiritual well-being of nurses working in Birjand University of Medical Sciences hospitals in 2022. Methods: In this cross-sectional study, 354 nurses working in the hospitals of the University of Medical Sciences in Birjand City in 2022 were selected by proportional stratified random sampling, and they completed the questionnaire related to demographic information and the standard questionnaire of spiritual well-being. Data were analyzed by SPSS v26 software and ANOVA with Tukey's post hoc test, Pearson correlation, and chi-square at 0.05 significant level. Results: The mean age of the nurses participating was 35.76 ± 7.29 years, and the mean total score of nurses' spiritual well-being was 180.55 ± 16.95. Most of the people in the field of communication with God (78.5%), self (58.8%), others (75.1%), and nature (78.5%), and the total score (52%) were in the medium level of spiritual well-being. There was a significant direct correlation between all dimensions of spiritual well-being (P &lt; 0.001). Also, there was a statistically significant relationship between the mean score of spiritual well-being and age, employment status, and workplace hospital (zage = 7.76; z employment = 18.95; z workplace = 18.62; P &lt; 0.05). Conclusions: Considering that the nurses were medium in terms of spirituality and spiritual well-being, it is suggested to hold educational workshops to improve the level of spiritual well-being of nurses.

Spiritual Well-Being and Death Anxiety: A Cross-Sectional Study Among Iranian Patients With Acute Coronary Syndrome.

Acute coronary syndrome (ACS) patients experience a tremendous psychological burden, typically in the form of death worry due to acute medical conditions and the possibility of mortality. The unfavourable conditions of ACS patients cause them to reconsider the meaning of life and their spiritual well-being. This study evaluated the association between death anxiety and spiritual well-being in a total of 241 ACS patients in Shahroud, northeast of Iran. The data were collected using the Templer Death Anxiety Scale, and the Spiritual Well-being Scale by convenience sampling method. All patients indicated a high degree of death anxiety, and roughly half reported a moderate level of spiritual well-being. There was a significant and direct correlation between death anxiety and spiritual well-being levels. Older age, single status, and non-smoking were other predictors of good spiritual well-being. A multidisciplinary health team should identify and implement approaches to promote spiritual well-being and reduce mental suffering.

Improvement of Spiritual Well-Being in Students Experiencing Quarter Life Crisis through Solution-Focus Brief Therapy

Postgraduate students are defined as individuals who continue their studies at the master’s level at a tertiary institution, both public and private or an institution that is equivalent to a tertiary institution. This adult development phase is the phase that has the lowest level of spiritual well-being compared to other developmental phases where individuals do not have spiritual beliefs that can be used as a coping mechanism to overcome problems, especially problems experienced during the quarter-life crisis phase. This study aimed to determine the effect of a solution-focused brief therapy (SFBT) intervention on the spiritual well-being of postgraduate students experiencing a quarter-life crisis. This research is very important for groups of young adults who experience quarter-life crises to help provide information and skills in dealing with quarter-life crises. The research method used is quasi-experiment. Based on the results of the research that has been done, brief solution-focused therapy is proven to be able to improve the spiritual well-being of postgraduate students who are experiencing a quarter-life crisis. Increased spiritual well-being gives graduate students more positive self-assessments and reduces anxiety so that their quarter-life crisis rate decreases. Based on the description, it can be concluded that short therapy focused on solutions improves the spiritual well-being of postgraduate students experiencing a quarter-life crisis. Subjects who were given brief therapy focused on solutions felt changes in themselves, and complaints such as low self-esteem, pessimism, and anxiety could be resolved. The decrease in these complaints made the subject more optimistic so that the quarter-life crisis could be resolved.&#x0D; &#x0D; Received: 17 May 2023 / Accepted: 20 June 2023 / Published: 5 July 2023

Corelation of Spiritual Well-Being and Stress Level in College Students: A Correlational Study

Background: Students often experience stress with varying intensity. Spiritual well-being is considered to have a role in controlling student stress levels. But there are many students who experience stress even though they already have good spiritual well being.Objective: This study aims to explore the correlation between spiritual well-being and stress levels in college students.Methods: This a cross-sectional l study involved 104 students. The sample was selected using an accidental sampling technique. The independent variable of this study was the students' level of spiritual well-being, while the dependent variable was the level of student stress. Data collection uses the Spiritual Well Being Scale Questionnaire and Hassless Assessment Scale for Students in College questionnaires which have been tested for validity and reliability. This research’s results were analyzed using the SPSS application with the Spearman Rho test. Most of the respondents had spiritual welfare in the high category, namely 82.7%. Most of the stress levels experienced by students were at a mild stress level (63.5%).Results: The study found a significant correlation between spiritual well-being and stress level among collge student (p = 0.000 ) with a correlation coefficient of -0.392.Conclusion: This study indicates that there is a significant relationship between spiritual well-being and stress levels in college students, with a weak correlation level and a negative correlation direction, this means that students who have high spiritual well-being have a lower probability of stress.

Spiritual Well-Being and Psychological Distress among Muslims During COVID-19: An Empirical Analysis

The impact of COVID-19 becoming more serious for most of the people as they are facing challenges in sustaining their financial and emotion stability. Muslims find it even more difficult due to the distractions to perform worship in the mosque during the previous period of Movement Control Order (MCO). The objectives of this study were (1) to examine the level of spiritual well-being and the level of depression, anxiety and stress among Muslims during previous MCO.; (2) To test the relationship between spiritual well-being and psychological distress among Muslim people during previous MCO. This was a non-experimental quantitative research involving 133 respondents of Muslim people who lived in Terengganu, Malaysia during previous MCO. A set of survey questions consisting of demographic information, the Spiritual Well-Being Scale (SWBS) and the Clinical Scale for Depression, Anxiety and Stress (DASS-21) were used in this study. Mean descriptive statistics were used to see the level of spiritual well-being and depression, anxiety and stress of the respondents, and correlation analysis was employed to identify the relationship between spiritual well-being and psychological distress among respondents. The findings show that the level of spiritual well-being as well as depression, anxiety and stress among Muslims in Terengganu during previous MCO was at moderate level. There was a negative relationship between spiritual well-being and depression, anxiety and stress (r= -0.103, n=131, p<0.01). This indicates that Muslim people in Terengganu during previous MCO were not much affected from the psychological aspect nor spiritual well-being. However, indeed spiritual well-being play it roles in controlling the depression, anxiety and stress even though many constraints had to be faced such as the limitation of spiritual activities in the mosque and so on. It is recommended for future research to examine deeper through mixed methods including observation and interview, especially involving older respondents.