“It Makes a Difference!” Religion and Self-Assessed Health among Healthcare Support Professionals of Asian-Indian Origin

Abstract

Objective: Mixed evidence exists in the research examining the effects of religion on health outcomes. Due to the severity of health conditions experienced by immigrants and racial and ethnic minorities in the US during the COVID-19 pandemic, this research aims to examine the influence of religious involvement on self-assessed health among healthcare support professionals of Asian Indian origin living in the US. Method: The study used oral history narratives of phenomenological tradition, obtained through interviews of 16 healthcare support professionals of Asian-Indian origin and from three different religious backgrounds. The study cohort was made up of individuals residing in the greater Detroit and Lansing areas in Michigan. Findings: Although the narratives indicated that religious engagement plays a positive role in health outcomes among care professionals, simultaneously, it was found that religion-specific meaning intersects their immigration, settlement, family expectations, and work-related experiences in the US. Future research should extend the scholarship examining gender differences in the effect of religion on self-assessed health among healthcare support professionals of Asian-Indian origin.

1. Introduction

Existing research linking religion and health shows mixed outcomes (Berggren and Ljunge 2021; Koenig et al. 2012; Schieman et al. 2012; Idler 2014; Masters and Spielmans 2007; Ellison et al. 2001; Ellison and Lee 2010). A large body of empirical evidence links religion to positive health outcomes (Koenig et al. 2012; Schieman et al. 2012; Idler 2014), although some researchers have observed a negative effect of religion on health (Berggren and Ljunge 2021; Masters and Spielmans 2007; Ellison and Lee 2010). Using a sample of 5400 individuals from the European Social Survey who are born and living in the European countries, Berggren and Ljunge (2021) found that self-assessed religiosity is a predictor of bad health outcomes, specifically among immigrant mothers who attended church. In their seminal work including an extensive review, Koenig et al. (2012) investigated the conditions under which religion and spirituality (R/S) can affect physical and mental health outcomes. They found that religion, as a multidimensional construct, promotes mechanisms for coping with elevated stress. Koenig and colleagues found that 66% of the published articles reported a significant lowering of cortisol levels and an increase in health-promoting effects associated with (R/S). There is little to no evidence that religious involvement worsens stress-related diseases, although failure to seek medical attention early in the course of cardiovascular, metabolic, or malignant disorders is risky. In essence, R/S and seeking medical attention work well together.

In order to understand the role of religion among individuals, out of 100 articles on R/S and overall wellbeing reviewed by Koenig and colleagues, 80% reported higher scores on the measures of well-being among religious people compared to those who are not religious. The measures of well-being considered were life satisfaction, low anxiety levels, social support, happiness, positive affect, and high morale (Koenig et al. 2012). Weekly attendance at a religious service or ceremony was associated with a 37% increase in survival.

Research on religion and health in the US has primarily focused on the majority white Christian population; investigations related to racial and ethnic minorities are rare. Religion and health studies specific to South Asians or South Asian Indian healthcare professionals have been rarely conducted. This study adopts a grounded theory and social constructionist approach. To guide the research questions and potential findings, the study uses an intersectional framework consisting of multiple concepts, i.e., spirituality/religiosity, finding meaning in everyday life, and self-assessed health outcomes. In this research, I investigate how healthcare support workers of Asian-Indian origin narrate their experiences with religion and self-assessed health since their entry into the US as immigrants. Sociologist Peter Berger theorized that the juxtaposition of social and biographical facts constructs both the objective and subjective structures of meaning. This has a greater likelihood of happening to individuals who have the experience of coming into contact with people from many cultures and who have lived in many places. In the process of interacting with people with different ethnic and cultural backgrounds, an individual undergoes a recreation of the self. Berger’s theory is borrowed from the reconstruction process of his own life experiences. His theoretical paradigm charts the mechanisms of religious and human development across time and space, as his association with the sociology of religion refers to the prospects of religion and faith in an age of diversity and pluralism. The second issue of focus is how the modern world has made it possible to question the “obvious” (common sense rhetoric and its applications) and, in turn, create new realities based on interactions in everyday life.

Religion, as mediated through various social, economic, and political factors, has shaped patterns of immigration from India to the US (Kurien 2014). After the passage of the 1965 Immigration Act, the US opened its doors to immigrants from the global South. To address the issue of shortages of healthcare support workers in the US, huge numbers of healthcare-skilled individuals, including nurses, physical therapists, and others, emigrated from India to the US. The majority of the nurses who immigrated to the US were from Kerala, India (Hawkes et al. 2009; Khadria 2004) following the removal of the national origin quota law for immigrants in 1965. Next to the family reunification pathway to immigration, a significant number (i.e., 38%) of Asian-Indian immigrants entered and settled in the US because of employment (Batalova 2020). Global data show that Indian-trained nurses made up a significant share, i.e., 6%, of the overall workforce of nurses in the United States in 2016 (Walton-Roberts and Rajan 2020). Employment status and environment mediate immigrants’ experiences of health and wellbeing in their host nation.

This research is salient due to its different objectives: The founding father of the sociology of religion, Durkheim, theorized the inverse effects of religious solidarity on suicide rates when society was undergoing industrialization in Europe (Durkheim [1897] 1951). Critics of Durkheim’s religion and suicide theory found a more direct and independent association between religion and suicide rates (Stark et al. 1983). The present research, in addition to filling gaps in existing literature, advances the scope of religion and health scholarship with regard to the COVID-19 crisis and stress exposure among immigrant healthcare support practitioners. Additionally, it contributes to the literature on the intersection of human development with social processes of immigration, settlement, family dynamics, and health outcomes. Within the context of development, health resonates with biological, behavioral, and social dynamics. Further, these dynamics tie with physical, emotional, and cognitive growth. The study also contributes to policy development in healthcare organization.

During the unprecedented times of the COVID-19 pandemic, frontline and healthcare workers of immigrant origin have played a crucial role in promoting self-protection, patient protection, and crisis management. The pandemic has posed a threat to the quality of patient care, with increasing rates of hospitalization. During these times of crisis, health care support workers have remained the backbone of the health care services as societies undergo massive health changes. They were directly involved in diagnosing and treating COVID-19 patients. In effect, many were reported experiencing mental and other health and safety concerns (Que et al. 2020). Common emotions reported in research are fear, worry, sadness, shock, nervousness, and not feeling adequately trained for the situation or prepared to cope psychologically (Ladak et al. 2021). Additionally, COVID-19-specific patient care, disproportionate workloads, excessive media attention, shortages of PPE and medications, fear of contagion and contamination at home and work, and other related crises subjected healthcare workers to emotional and physical strain, trauma, and burnout (Deliktas et al. 2021; Chen et al. 2021).

Prior research shows that to cope with the present crisis, many healthcare workers turned to religion and spirituality (Htay et al. 2021; Shechter et al. 2020). Yet, the literature is limited. However, the increase in COVID-19 variants brought newer healthcare challenges to society. Therefore, understanding how religiousness is sought as an anchor to self-assess health outcomes among healthcare support professionals, has become more crucial than ever before. Additionally, the experiences of COVID-19 were more strenuous for healthcare support professionals of racial-ethnic minorities, yet research investigating, racial and ethnic minorities among immigrant population in healthcare during post-COVID-19 is rare; the rarity of research also extends to the Asian-Indian population working as support workers/professionals in healthcare. Evidence of self-assessed health outcomes is also in dearth, specifically with immigrants who entered the US as skilled healthcare professionals.

At the juncture of increasing demand for care work and rapid socio-structural changes in healthcare, this study aims to understand the relationship between religion and self-assessed health using the narratives from healthcare support professionals. The second aim of the research is to examine the relationship between religion and self-assessed health experiences of care professionals from immigrant, racial and ethnic minority groups using memory-based narratives. The objective of this study is to examine how religious involvement shapes self-assessed health outcomes among healthcare professionals of Asian-Indian origin. Self-assessed health is defined as a strong predictor of morbidity and mortality (Idler and Angel 1990; Jylhä et al. 1992). Religion and spirituality have marginal differences, but are often used as overlapping concepts. Spirituality is concerned with transcendental and theistic conceptions addressing ultimate questions about life’s meaning and purpose (Kent et al. 2020). Religion is a form of spirituality shared by a group of people, often with a common set of beliefs and practices. Religious involvement pertains to the behavior and practice determined by individual and collective interaction. Religious involvement can take up diverse characterization and manifestation involving attitudes and beliefs organized around personal, social, communal, and structural behaviors, yet it inspires a transcendental effect among believers (Idler and Angel 1990).

1.1. Religion and Social Determinants of Health

Religious involvement and its effect on health have been studied using different dimensions and processes of life. Religion and health have an intricate relationship with each other. Healthy people are more likely to get involved in religious practices (Idler 1987). When people are more religious, they tend to attend to religion more frequently. Research shows frequent attendance leads to good health outcomes, especially through indirect means, such as group socialization and group integration (Bradley et al. 2020). The presence of independent effect of religion on health is found among individuals with functional disabilities. The health-related barriers persuaded them to continue at-home religious practices when traveling to the communal religious attendance was challenging (Idler 1987). The influence of religiousness on functional disability and depression outcomes, as investigated by Idler (2014), showed a multidimensional interactional effect on health and wellbeing. The overall effect of religiousness (public and private involvement) accounted for a negative association with functional disability and psychological distress. Older men with functional limitations experienced barriers to public religious attendance, however religious consciousness did not forbid private practices (Idler 2014). As part of the collaborative project between religion and public health initiatives, Idler (2014) developed the logic of why religion should be adapted as a social determinant of health. Using the review of existing literature and case narratives, the concept of religion is described as possessing a social character and cannot be understood outside of the group of people who formed the in-group to practice the shared faith. Advancing a strong argument in favor of including religion as a social determinant of health, juxtaposed with the economic and political system, Idler argues that there are three ways of inclusion. The “invisible” and powerful effect of religion is submersed in faith-based collective practices such as social support, social cohesion, and social capital (Idler 2014). The role of religion affects an individual’s personal and private space (Kent et al. 2020). In tandem with the growing research on social determinants of health, over time, scholarship on health has broadened its definition to encompass a multidimensional construct of health (VanderWeele et al. 2019; Fisher 2011; Larson 1996). Although the definition of health has been debated, it is also viewed as multifaceted, including physical, psychological, and social experiences of individuals (Solhi et al. 2019). Existing research evidence shows self-assessed health is a reliable predictor of health outcomes (Idler and Angel 1990; Jylhä et al. 1992).

1.2. Religion and Health Outcomes

Considering religion and health studies are still in their infancy, researchers attempted to develop reliable and valid psychosocial factors by which religion is likely to impact health across different populations. Using 1998 General Social Survey data, (Idler et al. 2003) created multiple scales significantly associated with mental and physical health outcomes. These multiple evidence-based pathways were reported to have both positive and negative associations with mental and physical health. A review of multiple pieces of evidence is used to support the ten scales of religious engagement (Idler et al. 2003). Some of the indicators used in their review, religious affiliation, personal religious/spiritual history, and religious beliefs are associated with less cognitive disorder (Koenig et al. 1993; Benson 1996; Ellison 1994; Bowker 1970; Kaplan et al. 2006). Using NIMH Epidemiology catchment area survey Wave I and II among 18 years and older from Piedmont, North Carolina, (Koenig et al. 1993) found that religious variables (frequent church attendance and “born again” or change in life due to religion) among younger and middle-aged participants were associated with fewer anxiety disorders, agoraphobia, and generalized anxiety disorders. The regular church attendees also gained more social support which further lowered their anxiety levels. The extent of generalized anxiety disorder had a higher impact on middle-aged religious attendants over non-attendants. The religious variables had no association with anxiety among older people in this study. The negative association with mental and physical health was also noted (Ellison and Lee 2010). An analysis of the relationship between religious struggle measures and mental health outcomes among US adult data (General Social Survey) shows that when spiritual struggles occur, such struggles are associated with poorer mental health for most major segments of the adult population (Ellison and Lee 2010).

The positive and negative correlations of religion are associated with a myriad of health outcomes (Ellison and Levin 1998). In their review on establishing connections between religion and health, Ellison and Levin (1998) report various health outcomes (e.g., heart disease, hypertension, and other circulatory ailments, stroke, cancer, and gastrointestinal disease) including self-rated health and other forms of morbidity and mortality. Most of these studies have used western religion to examine its influence on health outcomes.

1.3. Role of Religion in Immigrant Communities

Immigrants are likely to be more religious than their US counterparts. Religion is likely to affect immigrant lives in a myriad of ways. Immigrants’ religious involvement tend to vary by religious orientation (Cadge and Ecklund 2006). Immediately after their arrival at the new destination, religion plays an important role in the immigrants’ reception and settlement process by the host nation (Foley and Hoge 2007; Kurien 2014; Yang and Ebaugh 2001). Religions in immigrant communities build social capital among their members (Kivisto 2014; Cadge and Ecklund 2006), provide social services, develop the “civic skills” of members, and shape immigrants’ identities (Foley and Hoge 2007; Yang and Ebaugh 2001). Studies have found a positive effect of religion on immigrants’ health (Allen et al. 2014; Cartwright 2021; Connor 2010; Jarvis et al. 2005; Montgomery et al. 2014). Positive religious coping found strong adherence to all age-appropriate screening among Latino populations in the US (Allen et al. 2014). Religious commitment showed a lower inclination to smoking among male Saudi Arabian college students (Almutairi 2016). In their research, Foley and Hoge (2007) identify four sets of variables when religious influence is examined on immigrants’ engagement in the wider society: First, the socio-economic profile of the immigrant group; second, differences in the organizational culture of the worshipping communities; third, differences in the culture of religious practice between worshipping at home or attending the congregation as a community; and fourth, religious values and the form of engagement. The existing evidence shows that there is cumulative effect of religion since the entry of the early European settlers in the US. The effect of overtime religious practices determined inequality in SES (Amin 2014; Yang and Ebaugh 2001) when immigrants, racial and ethnic populations were compared (Wilde et al. 2018).

1.4. Religion and Immigrant Health Outcomes

The effect of religion has been found across multiple levels of social institutions shaping the experiences that are directly or indirectly related to health outcomes. Lu et al. (2013) found that religion plays an essential part in immigrants’ lives when it shapes family experiences. Using qualitative interviews of married Chinese immigrant couples with one child, the research reports that despite experiencing challenges in maintaining an appropriate balance between religious involvement and family lives, the relationship remained strong among family members when the family recognized common goals. As immigrants tend to settle in the US, religion mitigates acculturative stress (Yeh and Inose 2002) and either assists or hinders acculturation for religious immigrants (Cartwright 2021; Kivisto 2014; Connor 2010) in the US. It serves as a belief system and agency of cultural practices, bridges social networks, assists with the formation of community, and expands social networks (Park et al. 2012) among immigrants. At the same time, religion can raise boundaries of discrimination, segregation, and linguistic barriers (Amin 2014; Foley and Hoge 2007). Religion helps maintain an added sense of ethnicity among some immigrant groups over others (Min 2010). Pyong Gap Min’s research shows that the nature of religious involvement among Hindus from India correlates with maintaining a stronger ethnic identity due to the characterization of Hinduism as “something different” from mainstream Protestant Christianity (Kurien 1998). Min’s (2010) study on Asian Americans in greater New York City compared Indian Hindu and Korean Protestant immigrants. The study found that these ethnic groups preserve their ethnicity through religion. More specifically, his focus was to investigate how non-congregation-based religions such as Buddhism and Hinduism have preserved their ethnicity through their religion. While Korean Protestants have been more successful in inheriting religion passing through their church, Indian Hindus have embraced their Indian identity and ethnic heritage through Hinduism. More Indian Hindus have transmitted ethnic identity to their next generation rather than religion. Min argues that non-congregational practices such as Hinduism, which also form small group and family practices outside of the temple, should not be minimized in their religious involvement.

In the context of immigrants and health, existing evidence shows that immigrants bring better health than their native-born counterparts (Abraido-Lanza et al. 1999; Akresh and Frank 2008; Markides and Coreil 1986; Markides and Eschbach 2011; Viruell-Fuentes and Schulz 2009). Many studies examined immigrant health behaviors and outcomes (Akresh 2007; Akresh and Frank 2008; Massey and Akresh 2006; Singh and Siahpush 2001; Yun et al. 2013). Research that used acculturation theory found mixed results on health (Diwan and Jonnalagadda 2002; Finch et al. 2004; Jasso et al. 2000; Jasso et al. 2005; Mui and Kang 2006; Salant and Lauderdale 2003; Wilkinson et al. 2005). Some found high levels of acculturation are correlated with better health outcomes, but others suggest the opposite. As acculturation is considered a time-dependent process among first-generation immigrants, Mui and Kang (2006) studied foreign-born older Asian immigrants aged 65+ using a survey method to examine the relationship between acculturation and depression. The study found that a wider acculturation gap is associated with a higher depression rate among the six subgroups of Asian immigrant elders in the sample. Among all six subgroups (Vietnamese, Japanese, Indians, Chinese, Filipino, and Korean), Vietnamese elders had the highest religiosity rate and poorest health condition and acculturation gap at the intergenerational level. Diwan and Jonnalagadda (2002) investigated the relationship between social integration and chronic disease among Asian-Indians that were 50 years or older from the Atlanta area. Using quantitative data analysis, they found that social integration measured by longer durations of stay in the US and less social support, were associated with poorer health outcomes. Despite the multiplicity of positive and negative effects of religion on health outcomes, the research in this area of scholarship is still in its infancy (Sternthal et al. 2012). Furthermore, the intersectional approach to examining self-assessed health outcomes intertwined with the role and status of employment and religious involvement among Asian-Indian healthcare support professionals has been rarely investigated, except for one study that examined Asian-Indians (Diwan and Jonnalagadda 2002).

2. Methods

The goal of this research is to investigate how memory-driven narratives explain the relationship between religious involvement and self-assessed health among healthcare support professionals of Asian-Indian origin. To do this investigation, I used the oral history narrative approach within the framework of phenomenology. These two traditions are not completely independent of each other. The characteristics of phenomenology related to the experience of the respondents permeate the boundaries of oral history, which is the memory-driven recollection of experiences (Kirby 2008). The significance of interconnecting these two methodologies highlights the importance of experience and memory-driven data extraction that has been used in nursing research to map the progress of psychotherapeutic utilization in the nurses’ lives (Golding and Hargreaves 2018). The advantages of using oral history narratives from a reflexive standpoint allow respondents to glean deeper insight into their lived experiences. Therefore, it is a more complex social and health phenomenon than conventional qualitative methods would indicate (Hernandez et al. 2017). In effect, the use of narrative inquiry in this study provided understanding through interpretation of the context, which may relate to unique human experiences. Furthermore, the integration of phenomenological inquiry into the interview process disentangles the complexity of meaning that exists in individual respondent’s experiences (Atkinson 2007; Bevan 2014; Patterson 2016). Aside from demographics, the core interview questions asked for this research pertain to describing memory-driven experiences with religious involvement since the time of entry into the US.

2.1. Participants

Sixteen healthcare support professionals participated in the oral history interviews. The participants were selected from the greater Lansing and Detroit areas. Once qualifying as a former immigrant gateway, Detroit experienced massive population loss or slow growth after the economic restructuring and shift to the service economy; “immigrants and refugees were sometimes the only sources of growth in population during the 1980s and 1990s” (Singer et al. 2008, p. 11). However, the rise in the service economy promoted the entry and settlement of skilled immigrants including in the suburbs/greater (Singer et al. 2008) metropolitan regions of Detroit and Lansing in Michigan. The selected research sites for most participants were from East Lansing, Haslett, and the greater Lansing areas. Only two respondents were recruited from the greater Detroit area.

The U.S. Census Bureau (2020) estimates 117,783 Asian-Indians are living in the state of Michigan. The immigrants’ share of the healthcare support professionals, such as nurses, physical therapists, occupational therapists, and other assisting professionals is proportionally higher among the total number of health care professionals in the state of Michigan (Batalova 2020). Out of the total 65,515 Asian-Indians employed in different industries, 23.6% are employed in educational and healthcare industries (U.S. Census Bureau 2020). Multiple health centers and large-sized hospitals within the East Lansing, Lansing, and greater Lansing areas, including Sparrow, Sparrow Specialty, St Lawrence, McLaren Greater Lansing and Greater Detroit hospitals, and Ingham Regional Medical Center, employed Asian-Indian healthcare workers. All participants indicated that they are involved in their religious organizations, trust in the existence of God, or are inclined towards visiting religious organizations more frequently. Located in greater Lansing, Michigan, US, specific to their beliefs: Indian Hindus and Jains primarily worship at the Bharatiya Temple of Lansing located in Haslett; Indian Sikhs go to the Gurudwara located in Lansing; and Indian Christians hold their congregation at the Chapel, located in East Lansing. The demographic characteristics of the respondents’ sample is listed in

Table 1. Demographic Characteristics of the Healthcare professionals.

Characteristics of the Respondents	N = 16
Age	25–35 years = 6 36–46 years = 5 47–56 years = 2 57–66 years = 3 Mage = 44 years SDage = 12
Race/Ethnicity	Asian-Indian = 7 (43%) Asian-Indian (Naturalized American) = 8 (50%) Asian American (Native-born American) = 1 (6.25%)
Education	4 years of college and more = 2 4 years of college = 14
Gender	Men = 3 (18.7%) Women = 13 (81%)
Marital status	Married = 12 (75%) Unmarried = 1 (6%) Divorced = 1 (6%) Separated = 1 (6%) Widowed = 1 (6%)
Duration of stay in the US	31–35 years = 5 (38%) 26–30 years = 0 (0%) 21–25 years = 2 (12%) 16–20 years = 4 (31%) 11–15 years = 3 (19%) 6–10 years = 2 (12%) M years of stay = 22.25 SD years of stay = 9.7
Occupation	Nurses = 7 (44%) Physical Therapist = 6 (36%) Occupational Therapist = 1 (6%) Speech Therapist = 1 (6%) Audiologist = 1 (6%)
Religious Orientation	Hindu = 14 (88%) Christian = 1 (6%) Sikh = 1 (6%)
Citizenship/Visa status	Native-born = 1 (6.25%) Naturalized citizen = 8 (50%) Green card = 4 (25%) Employment visa (H1D/H1B) = 2 (13%) Student visa (F1) = 1 (6.25%)

.

2.2. Sampling Method

The participants were recruited using convenience and purposive sampling. According to Mutchnick and Berg (1996), a convenience sample could be easily available and chosen for appropriateness of fit. Additionally, this strategy is quick, inexpensive, and an excellent means to collect preliminary information for limited research questions (Mutchnick and Berg 1996; Berg 2001). My sample type was also purposive because, to select Asian-Indian nurses from the population, I made a preliminary field investigation in active religious organizations of Asian-Indians to seek key respondents. My sample is also snowball and criteria based. During my preliminary investigation, I located one initial key contact, a nurse, working for 15 years in the greater Lansing area, who introduced me to other Asian-Indian health care professionals. All healthcare professional contacts were actively involved in their respective religious organizations. To overcome gatekeepers, I devoted my weekends to volunteering at the temple as they needed; for two consecutive Sundays, I also visited the church. The volunteering sessions provided me with an opportunity to observe the interaction between the temple visitors with the priests. Using snowball sampling, during my visit to the church on one Sunday, the pastor of the church introduced me to a nurse and her family members present in that congregation. In a follow-up session, I was also invited to the private parties of this church held in one of their houses where the invitees were primarily church members of the same church. None of the respondents indicated that they are of Islamic origin. The author also visited the temple during major annual festivals and made contact with paraprofessionals using snowball sampling techniques.

2.3. Interviews

Each respondent was interviewed using multiple meeting sessions. To set up the meetings, initial contact with the respondents took place over the telephone. The meeting locations were chosen by the respondents, including either their own office space or at home. Each meeting was held for an hour, followed by the rescheduling of future meetings as needed to end the complete interview; respondents were allowed to talk without interruption unless the conversation rhythm and flow demanded a probe for organizational or clarification purposes. At the onset, respondents’ consent was taken for recording their narratives, along with having them sign a confidentiality form. Open-ended interviews were administered verbally as per their request; whenever any respondent wanted to read the questions on their own, the request was met accordingly. During the interview process, the expressions, gestures, and other non-verbal cues were also noted specific to the care professional. The core questions on religion and health presented to them were:

Q1. What is your religious background?

Q2. Describe how you decided to migrate? (Probe: Who was involved in the decision making, if any?)

Q3. Reflecting on your memory, describe how frequently you have attended your place of worship since the time you migrated to the US?

Q3. Based on your memory, describe how much involvement you have had with your place of worship since you migrated to the US?

Q4. Based on your memory, describe how it feels to stay involved in your place of worship?

(Probe: How would you describe your health status since you entered the US and if it has changed since you became involved in maintaining your culture and faith in the US)?

Religion and health-related expressions were meaningfully associated in the contexts where the narratives of the healthcare workers were about experiences of immigration, settlement, work environment, and acculturation questions.

3. Data Analysis

The interview responses were transcribed by a professional transcriber of non-Hispanic White origin. The transcriber was advised to note down any associated non-verbal cues (e.g., laughs, change in voice, or sound pitch) heard over the tape-recorded responses while transcribing.

The author open-coded the verbatim responses of the healthcare workers using the transcribed data. The codes were reviewed, revised, and recoded as needed by one full Professor of non-Hispanic African American background positioned at a large public research university in Michigan, US. The review allowed validity and reliability of the open codes using intercoder agreement. Codes were then analyzed, interpreted, and grouped by the themes (Appendix A). Multiple codes were used for a single excerpt of the interview data text. Although few in numbers, non-verbal cues were taken into consideration as well when verbatim data was used for coding and interpretation.

4. Results

4.1. Religiosity Intersects Immigration-Related Anxiety

Religion impacts everyday experiences, whether to a greater or smaller extent among immigrants’ decision-making (Maliepaard and Schacht 2018). Three themes were identified from healthcare professionals’ interviews: (1) A better future for the next generation; (2) better job opportunities for themselves; (3) achievement of higher socioeconomic status or upward socioeconomic mobility. Religiosity plays a crucial role in determining mental health, especially when immigration is sought as an opportunity. The perception of failure to migrate could lead to anxiety. One respondent recollected that immigrating to the US from the Middle East was an anxious process. A physical therapist, female, age 55, believes in Hinduism, and attends the temple, expresses her reliance on her faith as she secures her immigration documents.

When I got married, my husband was in the Middle East, and I was in the Middle East for a while. Then, we decided that we want to move from Middle East because once we have children, we want to give them a better future. So, America was, at that time, prosperous for physical therapists; very prosperous. So, we thought, let us explore this. So, before having children we [planned to] migrate there so our children can have a better education. At the time we had the impression that America is the best country, so we thought that oh let us just go explore when we are young rather than send the children later for higher studies. It would be difficult to settle at a later age. When we moved we already had our 4 year old. So, we decided as a family, as a husband and wife, to come here. Additionally, we prayed about it as if like, oh! What a big deal [it is to immigrate to the US]! So, we were just going through everything about whatever they’re asking like stamping the visa and whatnot!

Immigration related anxiety increases the need to find support from religion.

4.2. Meaning of Religion in the Attainment of Migration

A majority of the professionals migrated to the US directly from India, except for one nurse and a physical therapist. The nurse, age 45, Christian, female, immigrated from Ireland. The physical therapist, age 50, Hindu, female, immigrated from the Middle East. The decision to migrate to the US consisted of both long-term and short-term goals for the healthcare support professionals. Based on the interviews with 16 healthcare professionals, the different reasons for emigrating to the US were exploring opportunities for socioeconomic prosperity (including entering the US with a student visa), to seek a better future for the next generation, outward personality and attitude (inclination towards seeking adventure and freedom), and migrating with immediate family members. Despite the multivariate sources contributing to the decisions to migrate, reliance on transcendental support had a significant impact on immigration success. The meaning of immigration was transformed into symbolic success in life when the new support professionals entered the US.

Like, we just were praying that everything goes well in immigration, and we get the visa, and everything just falls through! When I came, the first time, we were very excited.

To another respondent, the decision to migrate meant leaving family behind and winning the competition to acquire socioeconomic mobility or avoid skill mismatch.

I did not want to leave family. However, the agents kept on calling when I took and passed the exam by going to Sri Lanka. Sir [a Neurologist and family friend] persuaded me to come to the US. A lot of hiring was going on in the US. They [agents] called me all the time. I pick[ed], [when] an agent [who was] calling from the US. After I came to the US with my husband and two daughters, this agent sold us to another care agency. I did not know anything about green card.

Raj, [the agency] shows us our apartment building. All the nurses got the same apartment building. I asked Raj, when do I start the job? He said you have to pass the exam, first. It is through the commissioner of graduate foreign nursing services or something like that [makes a guess] and you have to take International English language exam or Toefl. I was shocked to hear this!

4.3. Religious Belief Intersects with the Anxiety of Settling at the Destination

None of the respondents reflected on settlement related anxiety due to their religious belief, except for one physical therapist. A male, age 45, immigrated from India, said

Yes, I was in my 20s when I first entered into Michigan, US. My wife who was my girlfriend at that time was involved in my decision making. My anxieties related to immigration in the US were mostly because of my low skills of speaking English, limited knowledge of Western culture, vegetarianism, and being Hindu. I was not sure how it was going to work out.

During the interview, the same physical therapist said that he now has his own practice and is very satisfied with his over $150,000 income. Another nurse who was raised in Johannesburg, South Africa and immigrated to the US during Apartheid, did not feel any structural barrier to her settlement because of her race or being Hindu. Her barriers were her unsupportive husband that overloaded her with work and stress. She relies on her faith to manage her responsibilities and choices that she made in life.

I came to the US in 1980. I, as a nurse wanted to give. Nursing is a very hard job, but every human being, I always knew, has existence of God in them. To do this job, I saw it as an opportunity from God. My husband was of no help. At home I had my children so I will take any abuse that will come to me as I did not want my children to see that I am depressed. My step son was getting married. I will work extra hour. Lived by my Bhagavat Gita. Almighty has chosen me for this job, and I also saw this service giving as an opportunity. So, I decided to marry my second husband who already had three children, and I did not have any children but decided to marry him thinking God wants me for this, so I will do it.

4.4. Religious Organization Intersects Ethnic Maintenance and Immigrants’ Emotion in the Host Country

All respondents across age, gender, and occupation expressed their feelings of happiness and sorrow when they discussed visiting or attending their specific faith organizations. Religion’s abstractness acquires social meaning when practiced as and manifested in organized ritualism. A significant number of respondents expressed their satisfaction with volunteering in their specific religious organization. Not being able to find a religious organization was associated with depression. Healthcare professionals of Indian origin attended their specific faith organizations— either in the local Temple, Gurudwara, or Church. A nurse, female, Hindu, age 65, said that the absence of a temple in East Lansing in her early years in the US was depressing. After getting married following arranged marriage rituals with a man (currently her husband), who is a graduate of a US university, she stayed in another state in the US for 4 years before moving to the greater Lansing area in 1989. Later, she took initiative to start a temple in the greater Lansing area, and eventually, accepted an administrative role in temple management. Now she organizes several festivities such as Sunday pujas, Shivaratri, Durga Puja, Basant Panchami (Holi), and the biggest of all the festivities, Diwali. She said that during Diwali, the temple is visited by more than a thousand people and there is an arrangement for Indian dinner. There are several occasions when Indian lunch and dinner are served throughout the year following different festivities. Engagement or volunteering in temple activities, as expressed by another nurse, reveals pleasure.

Over here, yes, I did put in a lot of effort. I have volunteered in the school, in the temple, not with the intention of this but it’s my nature and it’s my husband’s nature to help out. So, we have been very active in the temple group and we have gotten a lot of pleasure from it. Additionally, I think, just recently, my son and daughter mentioned that all our friends, who you made us be friends with when we were younger, helped us to be social now.

During the course of data collection, I volunteered on the weekends in the temple for one month and observed two priests that were involved in practicing rituals. After listening to the priests, I found that one priest immigrated to the US from the Southern part and the other from the Northern part of India. They both used the ancient language of Sanskrit to recite the mantras (chantings) as they offered flowers and prasad (fruits and milk) to the deities. The worshippers mostly wore Indian ethnic dresses while attending the temple. The Christian nurse stated that the pastor of her church is her family friend. The pastor advises the family, especially to her husband. She added that her husband never did any house work in India. In the US, he is compelled to spend more time in house work because she works outside. Additionally, her husband’s Indian degree in management does not transfer equally in the US. The pastor helped her husband fetch employment, assisted the family in buying their home, and extended a range of other social and psychological supports.

For my husband everything is about the church. The pastor saw me as a daughter. I am always in touch with them, and we all are from the same church. Without [him] he [her husband] felt like fish out of water. He was missing his parents and he saw his parents in the pastor. They told us what to do, what not to do, where to go, and not to go, everything! Every day they will talk.

4.5. Religion Mediates Immigrants’ Intergenerational Family Expectations and Mental Health

The practice of arranged marriage is still prevalent in India. Several healthcare workers expressed that they will remain uninvolved in who their children select as their partners. However, three nurses said they want their children to marry someone from the same religious affiliation. Using a melancholy voice, one nurse expressed that she wished her son had never married a girl from a different faith. Her primary concerns were that a family member of a different religion “does not fit well.” The nurse expressed disappointment in her daughter-in-law for ignoring her or her son’s religion. The daughter-in-law, however, requires her son’s company when visiting her religious organization. Her perceptions of religious rejection transform into her poor health outcomes. This respondent, a nurse, female, age 46, living and employed in greater Lansing for approximately 15 years, expressed her disappointment with her son’s marriage outside of Asian-Indians and Hindu religion.

I want my sons to go through an arranged marriage. However, my elder son got married to a non-Hispanic White girl. [Probe: what is her religion?] She is Christian. We told him we prefer an Indian girl [for him]. [Probe: Hindu?], yes! However, if [But,] she is in love and we do not want to make him unhappy. He started college here [Michigan State University], he was 18 or 19 here. He finished all his schooling in India and here, he went directly to [college]. He went for his Masters [out of state]. We were thinking that he did not finish his Ph.D. because of this marriage.

The same respondent indicated that while they could comfortably approach Asian-Indians for help, however, most of the assistance received came from their White neighbors.

The nurse with the Christian background, female, age 45, came to Detroit, Michigan in 1990, said that her daughter “must marry a Christian, even if he is affiliated with a different church.” Similarly, the healthcare professional of the Sikh faith expressed disappointment that due to work overload, single parenting of two children, and her recent moving into a new house barring her own attendance, and her children’s involvement in Gurudwara. Engaging in a tone of loss, the care worker exclaimed, I cannot do it much! “Not as active as I would like to get involved in Sabbath. Further, her positive intention toward her children’s bonding with the Gurudwara was highlighted in her exchange

I would like to get more involved and get the kids more involved. When I was in school, I went to a Sikh school, so I used to sing Shabbat I used to play the harmonium and I have plans that my kids are going to sing Shabbat pretty soon, if not this January then probably by next December and planning to have all three of us get more involved. [Probe: Do you feel worried that if you get more involved in the Gurudwara or with Shabbat that someone may think that your kids should be brought up a certain way or better in a different way?].

No, because I think I am the best person to take care of them

[Probe: When did you move into your new house?] On Diwali. Wanted to move here on Diwali! Moving into a new house on the day of religious festivity, such as Diwali is considered auspicious in Hinduism. In India, Diwali is celebrated as a religious holiday. Diwali, the festival of lights, is the day when Ram (the God) returned to his home/kingdom with his wife and younger brother after he rescued his wife by killing Ravana (the demon).

A nurse practitioner, age 35, female, mother of a 2-year-old daughter, immigrated in 1981 with her parents to Michigan. She expressed her intergenerational religious/ethnic maintenance with passion and aspirations.

I find particularly the traditions of the pujas are important and beautiful and something that I want my daughter to do for her entire life. I think there are some things…Indian cooking is like…even though I’ve eaten it my entire life, I think it’s like the most delicious cooking in the world. However, I would love my daughter to be…I guess I want her to…If I ever pass on a legacy, then I guess I want this. My daughter looks American; she has very light skin. She has dark eyes and dark hair but she has light skin. She will be thought of as an American her whole life. This is [the only Indian] legacy I pass on if I died today. You know, I would want her to feel like…connected…have an identity with her Indian culture. Despite all the forces in society that are going to make her feel more American at times than anything else. I guess I just never want her to feel ashamed or…I want her to feel proud of that background, and I want her…have an appreciation for the traditions of the pujas, the food, the saris, the singing, the dancing. All these things I did not appreciate until my adulthood; that have a huge impact on who I am. Additionally, you know, provide my cultural background. I want it to be her cultural background too.

4.6. The Resurgence of Religiosity, Religious resiliency, and Self-Assessed Health

Although healthcare professionals expressed self-motivation towards religious involvement, one physical therapist emphasized that his inclination toward religiosity is additionally determined by multiple factors; immigration status, experiences of colorism, and racism in the US have reinforced religiosity within him. The physical therapist, a male, age 47, who first came to Michigan from New Delhi, India, goes deeper into his memory and reflects that his religious values were shaped starting at age of 14. His house in India was located next to a temple and the contact between him and his sacred space instilled the value of religiosity from an early age. Despite having an early religious socialization, he was uncertain whether religion means a “time waste.” After he migrated to the US, he reconfirmed to religiosity. This is when he felt that he started to experience emotional clarity. He expressed his feelings with reverence for religious engagement.

It makes a difference! My days go much better when I seek support from the power of God. I feel deep!

4.7. Religion, Socioeconomic Status, and Self-Rated Health

All respondents, except one, indicated high socioeconomic status (SES). The expression of the narratives on self-assessed health was epitomized with positive emotions.

Religion has enhanced my economic prosperity. My perception is and it could only be my perception; you get closer to yourself or deep into yourself or to religion and spirituality when either you are in deep trouble, in misery, and all that. Second, when all your physical and materialistic needs are fulfilled, and you have a comfortable life. Then, you feel now what? What is the meaning of life? I worked more hours in India than here. So, I took one hour out of those extra hours every day to devote to meditation and prayer. Doing this for the past 20 years, a lot of hours went into it. It made a difference! So, I think it all depends on the perception. This path that I chose, I think I like it! Absolutely! being closer to mother nature, closer to silence, closer to the city where there is a temple, I cannot pinpoint one thing, it is the wholeness that provides a sense of prosperity.

A respondent who was recruited at a Hindu (Durga Pujo) ceremonial gathering, and later interviewed over facetime, indicated belonging to a middle-class status. She said that at the age 35 she is still paying off her college loans. She is also a second-generation (2.5 generation) Asian-Indian. Regardless, she feels overjoyed to attend the Bengali religious ceremonies, such as Durga Pujo (worshiping Goddess of protection as believed in the state of West Bengal, India) in the greater Detroit area.

4.8. Religion in the Workplace Intersects with Patient Care and Self-Health

In regard to job satisfaction, healthcare support workers largely concurred that compared to the physicians, they work more closely with the patients. For instance, an exchange from the narrative adds, “being a physical therapist, I work closely with the patients unlike a physician; life [as a therapist] is good!”

Responses from two physical therapists differed from others. One therapist expressed frustration over religion-related communication at the workplace during patient care.

I am very religious-minded. There are some patients of mine, and they talk about religion. I hate when my patients say to live a life as a Christian. I, sometimes, not always, rather say, hey my religion is not worse than yours.

(Probe: Do they know you are not a Christian?) Yeah. They do know that and then I politely tell them, well what does your religion say? Does it say there is one God? They say, “yeah”, then, I tell them, that is exactly what my religion says. Additionally, I love that quote by Rumi, one of the poets, there are a million ways to kneel and kiss the ground. So, if it’s somebody I am having a good conversation with I might go and explain myself, why I feel and how I feel. Additionally, sometimes they’re accepting and sometimes they’re not. Sometimes they still say, hey, the only way is through Jesus. I think, well that is your narrow-mindedness, I respect your religion and I would hope you respect mine.

4.9. Religious Attendance, Private Practice, and Self-Assessed Health Narratives

Nurses and physical therapists expressed positive and healthy feelings about staying closer to and involved in the temple. A female nurse in her 50s said that “it feels great to be involved and attend to faith every weekend.” A final-year nursing student expressed that her routine attendance at the temple depends on her availability after work, and the distance between the temple and her house. She preferred practicing religion at home. On a weekend in October, she was interviewed in a greater Detroit high school, when she was actively involved in celebrating Durga Pujo (worshiping Goddess of protection, which is considered a major festivity in the state of West Bengal, India) with her community. Her life as an immigrant started with her parents from Louisiana when she was 3 years old. Later, she moved to Michigan with her husband, a professor at a state university in Michigan. She adds,

No, not at all engaged religiously here on regular basis. When I was in India, I would do more than what I would do here religiously. However, I would like to have it here too, but they do have it here, but I do not get to go all the time. It’s not everywhere like in India. However, I am pretty content with what I get to do over here. It’s no particular thing that I would not be able to do here. If I want to, I can do it. [probe: Do you try to go to the temple more frequently?] Not at all. I just worship at home; I just pray at home that is it.

The self-assessed health outcomes among nurses mostly ranged from fair to good. Healthcare professionals resonated with excellent mental health condition largely when they continue to stay active religiously. Some noted variations in physical health outcomes; specifically, when they were diagnosed with diabetes and arthritis. However, with their physiological knowledge, they concurred that some arthritis comes with aging. The nurse who has diabetes said that her immediate family members are diabetic, therefore it is not a surprise for her. A physical therapist expressed weight gain with longer stay in the US. Yet, he greatly appreciated his health with a sense of liberation, happiness and good outcomes. One respondent summarized her health status as follows:

Mentally I feel a lot healthier than before. I feel liberated. Physically I feel I was much better when I came here, and I’ve gained lots of pounds now and I want to work out. As a physical therapist, I know how deconditioned I am. Sometimes it becomes hard to tell someone to strengthen their core when your core is so flabby. So yeah, I am not on the healthy side physically. Emotionally, mentally I am on the healthier side compared to what I was before. I have been fortunate to have no major health issues.

5. Discussion and Conclusions

In this study, I examined how healthcare support professionals of Asian-Indian origin describe the relationship between their religious involvement and self-assessed health. Based on 16 interviews with healthcare support professionals, the findings show that healthcare support professionals reveal a positive attitude towards and deeper affiliation with religious belief and involvement. The evidence from the narratives highlights a protective and positive influence of religion on self-assessed health among healthcare professionals of Asian-Indian origin. Even the respondents who mentioned having a chronic disease, such as diabetes or arthritis, justified the illness due to family or aging problems.

Decision to migrate is a multidimensional process. During the decision making period, migrants are challenged with a wide spectrum of social and interactional complexities. For instance, considering to migrate can arise from involuntary and voluntary situations. Migration can be a driving force to seek freedom or it can rather arise from structural selection over agency formation. Findings from this study show that respondents were both active and passive regarding the prospect of immigrating to the US. While some professionals were concerned about leaving their immediate and extended families behind, others viewed migrating to the US as prospective opportunity for the self and intergenerational socioeconomic mobility. The decision to migrate among healthcare professionals involves a conscious thought process that intersects with emotional and legal status. Even though the professionals in this study were legal immigrants, nonetheless they faced anxiety due to uncertainties involved in legality of immigration, which confirms that immigration is a complicated selective process. To cope with immigration-related anxiety, they seek transcendental support through religiousness (Koenig et al. 1993). Koenig et al. (1993) note that people turn to religiousness to calm anxiety when they experience significant stressors, resource deprivation, and powerlessness. The highest level of anxiety was found among the age group that did not participate in any form of religious practice. Existing evidence states that the effects of dynamic or life-changing factors that elevate stress and anxiety motivate people to turn to religion for comfort and relief (Koenig et al. 1993). Migration as a multidimensional process entails a variety of pre-migration and post-migration social and emotional responses that this study locates among healthcare professionals. Similarly, Montgomery et al. (2014) generalizes that thrust of pre-migration harm and uncertainties are found among all types of immigrants.

As immigrants enter into the host country, their life remains fraught with the challenges of settlement and integration. This research finds that skilled immigrants such as healthcare professionals brought aspiration and hope for upward mobility from their country of origin, India. This research finds that religion mediates with immigrants’ border crossing to enter into the US the same way it determines pathways to integration, acculturation, or assimilation into the host society. As most healthcare professionals were religiously involved, their ways of adjusting to the host society and desire to either assimilate or selectively assimilate intersected with religious beliefs. Respondents assert that the maintenance of ethno-religiosity, mostly among Hindus, has boosted their sense of self-acceptance, growth in the knowledge of patient care, and construction of self-development. The care professional of Christian faith reflects that she never experienced any barriers to her growth and recognition at her workplace. In fact, her supervisor expressed more empathy towards her and her responsibilities increased over time, which accorded to her upward mobility. She further notes that her relationship with her supervisor was met with astonishment from her co-workers.

In this study, the findings from religious involvement and US adaptation contradict prior research on Muslim immigrants. In their research on Muslim immigrants, Maliepaard and Schacht (2018) discuss the role of Islam in the social integration of Muslim immigrants. Their research findings indicate that being closer to Islam, the religion of the ethnic origin among the study cohorts, is associated with greater co-ethnic integration. When healthcare professionals aim to immigrate to the US, one of the primary reasons for coming to the US is to access better opportunities. There is more opportunity in mainstream US society because of the wide distribution of resources than co-ethnics. Co-ethnic integration may pave downward socioeconomic mobility among professionals, causing frustration and anxiety. Skilled immigrants experience higher anxiety and stress due to co-ethnic-related factors. Immigrants’ skills brought from their origins do not fully transfer into the US and may cause barrier to integration.

Consistent with the prior findings on anxiety, Ellison et al. (2014) emphasize two types of religious adherence to cope with anxiety. Those who are secure and observant of God (prays frequently) experience more healthy outcomes in coping with anxiety than those who are unresponsive (distant) followers of God. Immigrants’ context of reception plays a major role in the ways immigrants’ socio-religious resettlement advance in the host society. The freedom and extent to which religion can be practiced by its members vary by the context (Connor 2010). The characteristic of the immigrant-receiving environment, whether it is more open to the religious pluralism or assimilation effects the experiences of immigrants’ settlement. Contrary to the assumptions of classical assimilation (that promotes complete removal of ethnic traits), Connor’s (2010) study advance in-depth understanding of race, class, and religion that potentially determine the extent of “otherness” between immigrants and host populations. Similarly, the combination of race, class and religion plays a significant role in the lives of the healthcare practitioners included in this study. The participants’ narratives were concerned with their settlement-related stress. Although, Connor’s study in the context of reception and immigrants’ outcomes (positive or negative) is focused on Muslim immigrants, yet, the study findings apply to the individuals of different religious orientations. In this study, the integration of healthcare professionals is complicated by the intersection of context of reception, race, language, and religious affiliation.

Examining the relationship between inherited traits, socially learned practices, and extent of support, recent research by Bradley et al. (2020) finds that individuals who attend regular or weekly religious services in groups are more likely to gain social support. Individual determinants, such as different personality traits among extroverts and introverts, do not determine social support and integration. The religious organizations serve as co-ethnic and emotional spaces of support (Bradley et al. 2020). The effect of religion, independent of the congregational or non-congregational nature of its practice, supports the formation of collective orientation that healthcare support professionals of Hindu faith confirmed in this study. In his study, Min (2010) claims that Hinduism as part of the Vedic culture is a non-congregational practice. Due to its ritualistic nature, Hindu temples employ priests (Brahmins), who are considered the liaison between followers of the faith and supreme God; this priestly class has historically commanded over the construction of the means to reach God. Cumulative socializations have shaped the role status of this group.

My research also finds that intergenerational expectations are impregnated with religiosity. The healthcare professional of Sikh faith awaits with hope and compassion to procure the Gurudwara that she embraced as a young child. She remembers her role as a Sabbath attendee and expects the same from her children. During the interview, her tone was reflexive of subjective symbolization surrounding the meaning of being a Sikh. She accounts for her workload, unsupportive husband, complicated interaction with the spouse, and single parenting as barriers to frequent religious involvement. These barriers inhibit her ability to balance between her religious and parental responsibilities toward her children. This finding resonates the prior research on ethno-religious cohesion and parental practices among religious minorities of Sikh faith settled in the Lansing community. Moving beyond family, the community inculcates ethnic and religious practices among their children and encourages glorification of their racial and cultural orientation. Specific to Sikhism practiced in the Lansing area, a collective social force of aged members of the community established the Gurudwara (Sikh temple) to provide institutional support for ethno-religious maintenance among their children. The gratification of being a Sikh is shown using community participation through sharing their food and culture with people outside of Sikhism (Rana et al. 2019). Similar findings have also been noted in my research among Hindu parents’ expectations of their children that concerts with Min (2010); Hindu parents’ desire to teach their children about Hinduism is juxtaposed with instilling lessons on ethnic heritage and identity. The purpose of attending a Hindu temple is multifold including the glorification of God and the worship of God. Yet, these religious antecedents are enveloped with the interactional meaning-making of “constructing the self” among healthcare professionals. As reflected by the parlance: “it makes a difference” or “I feel peace of mind” evinces the use of religion to cope with personal difficulties (Min 2010, p. 112).

Similar to past research, the self-assessed health narratives among healthcare professionals indicated weight gain (obesity) with the longer duration of stay in the US (Akresh 2007). The other poor health conditions were multiple chronic illnesses; diabetes, arthritis, and family or work-related stress. During the early years of their entry into the US, some respondents experienced adaptation and acculturation related stress and anxiety; this condition waned away for more than 80% of the respondents as they progressed in their socioeconomic status. A non-significant proportion of respondents confirmed to milder forms of mental health issues such as chronic frustration and stress due to work and family reasons. This finding significantly confirms that immigrants have several cause-specific mortality advantages (Singh and Siahpush 2001) after entry; yet, longer duration of stay in the US influence their chronic illnesses and poor outcomes of health (Abraido-Lanza et al. 1999; Akresh and Frank 2008; Markides and Coreil 1986; Markides and Eschbach 2011; Viruell-Fuentes and Schulz 2009).

The majority of care professionals’ experiences with immigration, settlement, employment, and other day-to day life are personified by religion. The experiences of care professionals related to immigration, settlement, family-related expectations, and interactions with patients in the US carry significant meaning intersecting with religion; religious involvement, religious affiliation, religious belief, and religious attendance. The religious involvement among healthcare professionals formed a transcendental connection with the phenomenon of life. This overall finding syncs with Berger’s (1967) theory of “infusion of sacred and profane” or “the cosmos of both transcendent and man-made” which gives “events of life and death a spiritual significance (Idler et al. 2003, p. 333).”

The self-narratives regarding religion and health reproduce religious intersectionality with a myriad of experiences related to immigration, settlement, family-related expectations, patient-care interaction, and self-narrated health outcomes across time and space. The presence of religion is evident in the everyday lives of the immigrants, whether they pertain to big or small phenomena. Healthcare professionals who made decisions to migrate to the US assigned transcendental significance to successful crossing of the complicated socio-political boundaries after entering the US. This finding confirms the existing literature on religion and immigration that found religio-political factors are associated with the emigration of religious groups, especially, Sikhs and Christians from India (Kurien 2009). Consistent with the prior studies, this research found evidence of pre-migration anxiety among skilled immigrants (Montgomery et al. 2014) conciliated by religious beliefs. Even with their high skills and socioeconomic status, religion was intervened by them as a coping mechanism to offset migration, race, and ethnic specific structural barriers. Despite their Asian-Indian origin, respondents from all three different religious backgrounds associated meaning with their everyday experiences borrowing from their faith (Berger 1967). The findings from this research signify that religion have a wide range of possibilities for human development depending upon how individuals and groups involve religion in their everyday lives. This research findings recommend that public health and health and human service policies should consider cultural and religious backgrounds of diverse groups in the US.

6. Limitations

Findings from this research show significant outcomes of religion and health, regardless of the religious diversity among the respondents. The gender distribution in this research sample had more women than men. Evidence of disproportionate distribution of men and women exists among nurses, physical therapists, and other healthcare support workers due to traditional gender socialization patterns. Women are more likely to be employed as care workers in the US healthcare system. Similarly, research shows that women are more likely to have religious involvement than men (Jasso et al. 2000), irrespective of religious affiliation. The conditions related to gender differences in the work place may impact the findings in this research. Due to the small sample size, the findings of the research could be skewed towards religious involvement among respondents. Despite study limitations, this research makes an important contribution to religion and health, immigration studies, healthcare, and healthcare professional scholarships. Future research will consider the relationship between religion and gender health outcomes.