Journal of Vocational Nursing Vol. 4, No. 1 (2023): 82-86 EFFECTS OF DHIKR ON SPIRITUALITY AND CORTISOL LEVELS AMONG PATIENTS WITH HEART FAILURE: A PILOT STUDY Fanni Okviasanti 1 , Suhartono Taat Putra 2 , Abu Bakar 3 , Ah Yusuf 3 1 Faculty of Vocational Studies, Universitas Airlangga, Indonesia 2 Faculty of Medicine, Universitas Airlangga, Indonesia 3 Faculty of Nursing, Universitas Airlangga, Indonesia Research Report A B S T R A C T Introduction: Depression and anxiety are common comorbid conditions in patients with heart failure (HF). Spirituality was found to have a positive impact on patients’ mental health status. However, whether the spiritual practice affects physiological modulation is still questionable. Therefore, this study aimed to analyze the effect of dhikr as spiritual practice on spirituality and cortisol levels among patients with HF. Methods: A quasi- experiment was used in this study. A sample size of 18 respondents consists of 9 respondents of the control group and 9 respondents of the treatment group. Dhikr intervention was conducted in three meetings with an interval of two days during patients’ hospitalization. Spirituality was measured using a spirituality questionnaire, whereas the cortisol levels with venous blood sampling, measured by the enzyme-linked fluorescent immunoassay (ELFA) method. Statistics analysis in this study was using t- Test for spirituality, Mann Whitney and Wilcoxon Sign Rank Test for cortisol level with a significance level of α<0.05. Results: The results showed that dhikr improves the spirituality of HF patients (p=0.000) and decreases the level of cortisol (p=0.015) significantly. Dhikr interventions appears to strengthen spirituality in patients with HF by improving stress perception which further modulates the adaptive stress response in the form of decreasing cortisol levels. Conclusions: Dhikr could be one of the spiritual nursing interventions to improve spirituality and stress hormonal modulation in patients with HF. A R T I C L E I N F O Received May 10, 2023 Accepted May 11, 2023 Online May 31, 2023 *Correspondence: Fanni Okviasanti *Email: fanni.okviasanti@vokasi.unair.ac.id Keywords: Cortisol Levels, Dhikr, Heart Failure, Spirituality INTRODUCTION Heart failure (HF) is a global burden disease that affects more than 26 million people worldwide (Savarese & Lund, 2017). The estimated prevalence of HF throughout Asia is 1.26% to 6.7% (Benjamin et al., 2017). Meanwhile, the prevalence of this disease in Indonesia based on having been diagnosed by a doctor is 0.13%, and based on symptoms is 0.3% (Research and Development Board Ministry of Health Republic of Indonesia, 2013). Depression and anxiety are comorbids that are often experienced by HF patients (Aburuz, 2018; Aggelopoulou et al., 2017; Chapa et al., 2014). The prevalence of depressive events ranges from 23.8-67% in hospitalized patients and around 16.7-70% in outpatients (Chapa et al., 2014). Meanwhile, the prevalence of anxiety ranges from 11-70%. This prevalence is 4-5 times higher than in the general population (Aburuz, 2018). Depressive and anxiety states cause HF patients to have a low self-acceptance response to illness. This results in a worsening disease prognosis, death, and a high incidence of readmission to the hospital (Smith, 2010; Song et al., 2009). In addition, depressed HF patients are at the highest risk of experiencing treatment nonadherence which causes a decrease in health status and is significantly associated with a higher mortality rate (Wu et al., 2013). Therefore, early detection and appropriate management of depression and anxiety is very important. Dhikr is known to have a positive impact on peace of mind. Preliminary studies conducted on four HF patients showed that patients who practiced dhikr verbally, heart, and Journal of Vocational Nursing www.e-journal.unair.ac.id/JoViN/ Volume 4, Number 1, May 2023