What has been used to improve patients’ spiritual health in primary care: A realist review

Abstract

Abstract Background Spiritual health is a vital aspect of holistic health linked to improved outcomes, yet little is known about approaches used in primary care to support this dimension of wellbeing. Objectives To identify which interventions have been used to improve patients’ spiritual health in primary care, and what works, for whom, and in which contexts. Methods A qualitative realist review was registered with PROSPERO and conducted in line with RAMESES standards. Systematic database searches were completed in May 2024 and June 2025. Iterative analysis and synthesis were informed by discussions with professionals to situate findings within real-world practice contexts. Results Five European interventions were identified, each offering person-centred, listening-based support to address spiritual or existential concerns. These services operated in small, motivated pockets of practice rather than as routine provision. Validated outcome measures showed improvements in emotional wellbeing, but none directly assessed spiritual health. Most interventions followed a chaplaincy model adapted from hospital care and faced barriers to wider implementation: limited funding, workforce pressures, and inconsistent referral pathways. Conclusion Spiritual health interventions can provide valuable holistic support within primary care, but current provision is fragmented, locally driven, and often unsustainable. Improving timely referrals, increasing practitioner confidence, and reducing stigma surrounding spiritual health are priorities. A social asset-based approach may complement existing practice by equipping primary care staff to recognise spiritual need and connect patients with community organisations. Further research is required to determine the acceptability, effectiveness, and scalability of chaplaincy and alternative asset-based models of spiritual care within primary care.