Effects of a Culturally Adapted Spiritual Care Nursing Intervention on Anxiety and Infection-Prevention Practices among Hajj Pilgrims: A Randomized Controlled Trial

Abstract

Objective: To evaluate the effects of a culturally adapted spiritual care nursing intervention on anxiety and infection-prevention practices among Hajj pilgrims.

Methods: This parallel-group, two-arm randomized controlled trial was conducted during the Hajj season of 1446 AH (2025) and included 120 adult Hajj pilgrims who were randomly allocated in a 1:1 ratio to an intervention group receiving culturally adapted spiritual care plus usual Hajj health education (n=60) or a control group receiving usual Hajj health education alone (n=60). Anxiety and infection-prevention practices were assessed at baseline and after the intervention. Between-group differences in outcome changes were evaluated using baseline-adjusted analysis, with effect sizes and 95% confidence intervals reported.

Results: Baseline anxiety and infection-prevention practice scores were comparable between groups. Following the intervention, anxiety decreased from 8.8 ± 3.2 to 3.1 ± 2.8 in the intervention group, compared with a reduction from 9.0 ± 3.3 to 6.6 ± 3.8 in the control group. The between-group difference in mean change was −3.48 points (95% CI: −4.38 to −2.58; p<0.001; Cohen’s d=−1.43). Infection-prevention practice scores increased from 67.3 ± 7.5 to 79.7 ± 10.1 in the intervention group and from 68.7 ± 10.6 to 71.6 ± 11.6 in the control group. The between-group difference in mean change was 9.57 points (95% CI: 7.39–11.75; p<0.001; Cohen’s d=1.63). Baseline-adjusted analyses confirmed significant intervention effects for both outcomes.

Conclusion: Culturally adapted spiritual care nursing produced substantial improvements in anxiety and infection-prevention practices among Hajj pilgrims. Integrating culturally congruent spiritual care with routine Hajj health education may strengthen holistic nursing support and health-promoting behaviors during pilgrimage.