J Relig Health

https://doi.org/10.1007/s10943-018-0634-y

ORIGINAL PAPER

Religiosity/Spirituality Matters on Plant-Based Local

Medical System

Ulysses Paulino Albuquerque1 • Washington Soares Ferreira Júnior2 •

Daniel Carvalho Pires Sousa1 • Rafael Corrêa Prota Santos Reinaldo1 •
André Luiz Borba do Nascimento1 • Paulo Henrique Santos Gonçalves1

Ó Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract Religiosity/spirituality can affect health and quality of life in myriad ways.
Religion has been present since the first moments of our evolutionary history, whether it is
understood as a byproduct or as an adaptation of our cognitive evolution. We investigated
how religion influences medicinal plant-based local medical systems (LMSs) and focuses
on how individual variation in the degree of religiosity/spirituality affects the structure of
LMSs. The knowledge of people about their medical systems was obtained through the
free-listing technique, and level of religiosity/spirituality was calculated using the
Brazilian version of the Brief Multidimensional Measure of Religiousness/Spirituality. We
employed a Generalized Linear Model to obtain the best model. Religiosity/spirituality is
predictive of structural and functional aspects of medicinal plant-based LMSs. Our model
encourages a discussion of the role of religion in the health of an individual as well as in
the structure of an individual’s support system. Religiosity/spirituality (and the dimensions
of Commitment and Religious and Spiritual History, in particular) act to protect structural
and functional elements of LMSs. By providing protection, the LMS benefits from greater
resilience, at both the individual and population levels. We suggest that the socialization
process resulting from the religious phenomenon has contributed to the complexity and
maintenance of LMSs by means of the interaction of individuals as they engage in their
religious observances, thus facilitating cultural transmission.

Keywords Ethnomedicine  Ethnobotany  Cultural evolution  Traditional

medical systems  Cognitive byproduct  Prosociality  Forgiveness  Health

& Ulysses Paulino Albuquerque

upa677@hotmail.com
1
Laboratório de Ecologia e Evolução de Sistemas Socioecológicos (LEA), Departamento de
Botânica, Universidade Federal de Pernambuco, Rua Prof. Moraes Rego, s/n, Cidade Universitária,
Recife, Pernambuco 50670-901, Brazil
2
Universidade de Pernambuco, Campus Petrolina, Rodovia BR 203, Km 2, s/n - Vila Eduardo,
Petrolina, PE 56328-903, Brazil

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Introduction

Scientists from a variety of fields have studied the phenomenon of religion, particularly as
it relates to physical and mental health. Various pieces of evidence suggest that involve-
ment with religion is positively associated with indicators of well-being (such as personal
satisfaction, happiness, positive effect and moral behavior) (Idler et al. 2003), whereas a
low degree of religiosity/spirituality bears some relation to indicators associated with
depression, suicide, and alcohol and drug abuse (Moreira-Almeida et al. 2006). It is unclear
why religiosity and spirituality act as foundational mechanisms that enhance certain
indicators of well-being and quality of life, which has led researchers to seek to understand
these processes (Aldwin et al. 2014). However, the relation between health and religion is
not simply one of logical cause and effect but instead one of complex interactions among a
variety of interrelated factors, such as gender, religious orientation (of the institutional
type) and the environment (see Fetzer 2003). Religion does seem to bear a direct relation to
individuals’ mental and biological well-being. Those who practice a religion have a series
of beliefs about God, ethics, human relations, life and death that are relevant to health
(Fetzer 2003), which appear to reduce depression and suicide rates (Moreira-Almeida et al.
2006) and to strengthen their ability to handle problems related to serious illness, such as
chronic heart conditions (Karademas 2010), stroke (Johnstone et al. 2008) and kidney
dysfunction (Lucchetti et al. 2011). Religion can also reinforce individuals’ self-esteem as
they confront situations or feelings in which they have little control, particularly regarding
stressful conditions, which is a concept that is a centerpiece of various models that are
useful in assessing psychological health (Idler et al. 2003).
Religion is also thought to provide social support to its practitioners. People who
practice a religion report higher levels of social connections, interpersonal contact and
practical or emotional support than non-religious people (Fetzer 2003), even among
members of the same religious group (Bradley 1995); in some cases, practicing a religion
often provides access to support and acceptance even to those people who are rejected by
society (Aydin et al. 2010). Religion thus offers a supportive environment in moments of
adversity, crises, suffering and sadness, reducing the negative impact of these emotions on
the mind and body (Moreira-Almeida et al. 2006).
Previous findings suggest that the influence of religion acts on various levels in the life
of an individual and in the social group to which he or she belongs. A view of religion as a
phenomenon that is important to humans leads to a host of questions, particularly about its
evolution. Religion has been present since the first moments of our evolutionary history,
whether it is understood as a byproduct or as an adaptation of certain cognitive features that
are no longer necessary to our social situation (for further discussion, see Bourrat 2015;
Voland 2009). Some scholars have interpreted religion in Darwinist terms in light of its
structuring role in many different societies (see Bourrat 2015). Along these lines, this role
of religion raises another question: how does religion affect local medical systems
(LMSs)?
LMSs consist of a set of culturally developed knowledge related to perceptions of
illness (their diagnosis, symptoms and causes) and their treatment strategies in a given
human group. Like religion, medical systems have a long evolutionary history and have
evolved in our species to meet our survival needs, particularly because they involve health
(Fabrega 1997; Ferreira Júnior et al. 2015). Thus, we can understand that although religion
and local ecological knowledge (LEK) may have taken different evolutionary paths in our
species, they share the same temporal stage of knowledge system development.

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In this article, we assess how religion influences LMSs. In contrast to approaches that
focus on the influence of religion on the health of an individual (particularly through self-
report), we assess whether and how religion affects the structure of a particular body of
knowledge (that is, whether it influences the formation of the knowledge base that indi-
viduals access for self-care) and also an individual’s capacity for addressing health
problems. Thus, our model makes it possible to discuss the role of religion not only in an
individual’s health but also in the structure of the individual’s operational support system.
Several studies have focused on information regarding the use of plants for medicinal
purposes in various social groups (see Albuquerque et al. 2013; Ferreira Júnior et al. 2013;
Santoro et al. 2015). Medicinal plants are part of LMSs and contribute to improving the
population’s health levels, fulfilling therapeutic needs by means of medicinal information
regarding treating regional illnesses (Casagrande 2000). In these systems, the influence that
religion and religious practices exert varies based on religious diversity, and the connection
between these aspects is nothing new. For example, in those religions that trace their roots
to Africa but that developed in Brazil, plants are often central to sacredness and religious
observance (Albuquerque 2001, 2014).
There is also evidence that a variety of factors—in addition to religion—can influence
the adoption of integrative and complementary medical practices, such as herbal medicine
(Loera et al. 2007). Our work focuses on how individual variation in the degree of reli-
giosity/spirituality affects the structure of medicinal plants based LMSs. Many of the
shortcomings reported in studies regarding the relation between health, religion and
spirituality are found in the ambiguity with which these terms are used (Campbell et al.
2010). For purposes of this study, our measure of religiosity is based on the concepts
underlying the creation of the Brief Multidimensional Measure of Religiosity/Spirituality
(BMMRS) (Idler et al. 2003), which combines several domains in a single measure.

Materials and Methods

Study Site and Participants

We conducted our study in a rural community in the municipality of Altinho (8°290 3200 S
and 36°030 0300 W), in the central region of the state of Pernambuco (located 161.1 km from
the state capital of Recife), in northeastern Brazil (Siqueira et al. 2012). The municipality
has an area of 454,484 km2 and a population of 22,535 inhabitants, of whom 9577 live in
rural locations. The climate is hot and semiarid (BSh in the Köppen classification), with
Caatinga (semiarid) vegetation, an average annual temperature of 23° and an average
annual rainfall of 622 mm (which is concentrated in the months of June and July) (Araújo
et al. 2008; Cruz et al. 2013; IBGE 2014).
The rural community of Carão (08°350 13.500 S and 36°050 34.600 W) is located 16 km
from the center of Altinho (Cruz et al. 2013); approximately 155 inhabitants live in 55
households, according to records in the only health clinic that attends to the basic medical
needs of the local population (March 2015). The local economy is based on subsistence
agriculture, with family farms growing corn, beans and cassava, in addition to engaging in
livestock farming, namely poultry, cattle and goats (Alencar et al. 2010). The region has no
basic sanitation system, and all local waste and garbage is dumped into open landfills. An
elementary school provides basic literacy and primary education, although students must
travel to the city of Altinho for more advanced education (Alencar et al. 2010). Regarding

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the religious scenario, Carão has a small Catholic church and a small evangelical church.
The Catholic church opens weekly, every Sunday, and religious ceremony take place at
least once a month, with the visit of the priest of the town of Altinho for celebration. The
evangelical church can be considered more active, with cults held every Wednesday.
The local population uses plants that grow in the region as their primary method of
treating illnesses in the community, utilizing a rich and extensive pharmacopoeia (Alencar
et al. 2014; Araújo et al. 2012). The distribution of knowledge is heterogeneous, and age,
gender and occupation (Silva et al. 2011)—in addition to contact with the local vegetation
(Alencar et al. 2014)—influence this knowledge. Ferreira Júnior et al. (2011) found a
complex network of locally developed knowledge regarding the treatment of various types
of inflammation, with plants being selected based on their perceived therapeutic effec-
tiveness. Therefore, we believe that this rich model of local knowledge can tell us how
religion, which is another type of factor, may be shaping or influencing local ecological
knowledge.
We contacted the local leaders in Carão to discuss the research objectives, the proposed
activities and the development of an Informed Consent Form. Next, we visited the
households of the informants to explain the research objectives and procedures.
We collected data from 87 of the 102 current residents of the community, representing
85.29% of the study population. Our respondents consisted of 39 men and 48 women,
ranging in age from 18 to 88 years. Based on a list of medicinal plants obtained from
informants, we found a total of 118 popular names for medicinal plants and an average of
nine citations per free list. In addition, we counted 98 distinct therapeutic targets (illnesses
known to the population) and 903 information units (plant/therapeutic target) because a
plant can treat more than one type of illness. With regard to religious preference, we found
a large number of Catholics in our sample (88.5%), followed by evangelical Christians
(10.34%); notably, only one person claimed to have no religion (1.14%).

Procedures

Data were collected through two instruments: a free list to record the local ecological
knowledge regarding medicinal plants, and structured questionnaires to assess individual
levels of religiosity/spirituality. We also collected basic socioeconomic data for identifi-
cation purposes (name, age, identified gender, education level and marital status) from all
adults over the age of 18 who were interested in participating in the study.
To assess the popular knowledge of medicinal plants, we began collecting data using the
free list technique (see Albuquerque et al. 2014; Bernard 2006), asking each person
‘‘Which medicinal plants do you know?’’. When the list was complete, we recorded a list
of therapeutic targets for each plant, which can generally be understood as a symptom of an
illness (for example, red patches on the body) or a set of symptoms constituting a more
complex condition (for example, dengue) (Santoro et al. 2015). This procedure allowed us
to identify the medicinal resources known to each individual and their therapeutic
applications.
To identify the individual levels of religiosity/spirituality in the population, we used the
Brazilian version of the BMMRS, which was validated for the diverse religious and
spiritual context of the Brazilian population in general (Curcio et al. 2015). This ques-
tionnaire was developed in 1997–1998 by a working group financed by the Fetzer Institute
(see Fetzer 2003) to fill a methodological gap in research on the relationship between
religiosity and biological and mental health; this work aimed to develop a tool for ana-
lyzing the level of religiosity and spirituality in heterogeneous adult populations of various

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ages and various religious and non-institutionalized spiritual traditions (Idler et al. 2003).
Based on its objectivity in analyzing these measures, it has been translated, validated and
used by researchers around the world (see Bodling et al. 2013; Capanna et al. 2013; Harris
et al. 2008; Masters et al. 2009; Mokuau et al. 2001; Yoon and Kim 2015).
The questionnaire validated for the Brazilian context consists of 38 questions that ask
about 11 religious/spiritual dimensions of the informants. According to Idler et al. (2003),
the dimensions and the general meaning of each are as follows: (A) Daily spiritual
experiences (DSE), consisting of six questions that seek to identify spiritual feelings and
experiences that individuals may have during their daily lives, whether in the company of
others or in moments of solitude, but outside of participation in religious services;
(B) Values/beliefs (VB), consisting of two questions that are designed to assess one of the
central features of religiosity in the cognitive dimension, i.e., belief in a divine protector
and caring about the well-being of others; (C) Forgiveness (F), consisting of three ques-
tions designed to assess the individual’s ability to forgive, to see things from another
person’s perspective, to sympathize with their weaknesses and to look beyond their mis-
takes; (D) Private religious practices (PRP), consisting of five questions that aim to assess
the frequency of non-institutional or informal religious practices that the individual per-
forms during his/her life, whether alone or with family, indicating their commitment to
religious messages or rituals; (E) Religious/spiritual coping (RSC), consisting of seven
questions designed to evaluate how prone a person is to handle problems that arise in life
using religious/spiritual support; (F) Religious support (RS), consisting of four questions
designed to identify how much support individuals feel they have from their religious
community when they need assistance or social or emotional support; (G) Religious/
spiritual history (RSH), consisting of three questions that aim to assess whether the
individual has experienced a deep, life-changing religious or faith experience; (H) Com-
mitment (C), consisting of three questions designed to analyze how religious faith and
spiritual beliefs are expressed through an individual’s behavior; (I) Organizational Reli-
giosity (OR), consisting of two questions covering an individual’s involvement with the
public institutional activities of their religion, such as attending religious meetings, whe-
ther inside or outside a sacred physical space; (J) Religious preference (RP), which seeks to
identify which religion an individual currently practices; and, finally, (K) Overall self-
ranking of Religiosity/spirituality (OSR), consisting of the final two questions on the
questionnaire, which asks that individuals assess their own level of religiosity and
spirituality.

Data Analysis

We used several measures to represent LMSs. For each participant, we counted the fol-
lowing: (1) the richness of medicinal plants cited; (2) the number of therapeutic targets,
which is equivalent to the number of illnesses that might be treated using the medicinal
plants cited; and (3) the number of use citations, including the number of ‘‘plant ? ther-
apeutic target’’ combinations, which involves counting more than one use for the same
plant (for example, Plant 1—Therapeutic target 1; Plant 1—Therapeutic target 2; Plant 1—
Therapeutic target 3; Plant 2—Therapeutic target 1). We chose these measures because
medicinal plants and illnesses are important components of the structure of medical sys-
tems, and therefore, the more people know about these components, the greater their ability
to maintain their health independently using the LMS (Ferreira Júnior et al. 2013). In
addition, the combination of ‘‘Plant ? Target’’ shows how versatile a person’s knowledge

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is regarding the treatment of illnesses (in terms of the number of combinations), which is
another important component of a person’s ability to maintain their health independently.
To estimate the religiosity/spirituality of each participant, we began with a set of
different dimensions of religiosity/spirituality (Curcio et al. 2015) and calculated each
individual’s specific index of religiosity/spirituality for each dimension and for the overall
index of religiosity/spirituality. Although the specific index consists of a measure of
religiosity limited to a particular dimension, the overall index combines the values for each
dimension addressed. Although the questionnaire included 11 dimensions, we disregarded
the ‘‘Religious preference’’ dimension during the analysis because the study did not aim to
evaluate, e.g., differences between religions. Thus, specific indices were calculated for the
10 remaining dimensions, with a minimum value of 0 (if no features of this dimension of
religiosity were observed) and a maximum of 10 (if the individual displayed maximum
scores for each feature of this dimension of religiosity). The overall index of religiosity/
spirituality was calculated by summing the specific indices for each dimension, and
because the value for each specific dimension could vary from zero to 10, the overall index
could range from zero to 100. The method and approach used to calculate the overall and
specific indices of religiosity/spirituality in this study are not part of the original work that
developed the BMMRS-p questionnaire (Idler et al. 2003). However, we chose to apply
this procedure to create a proxy, that is, an estimator for these variables.
To assess which of the 10 dimensions of religiosity/spirituality (the predictor variables)
generate the models that best explain variations in the richness of medicinal plants, ther-
apeutic targets, and use citations (response variables), we employed a Generalized Linear
Model (GLM) with a Poisson distribution, followed by a stepwise regression, to obtain the
best model based on the AIC (Akaike Information Criterion). The most explanatory models
were those with the lowest AIC value. All tests were performed in R software version 3.2.4
revised (R Core Team 2016), and all results with values of p \ 0.05 were considered
significant.

Results

Religiosity/spirituality is predictive of structural and functional aspects of medicinal plant-

based LMSs (Table 1). When we broke our measure down into its different dimensions,
religious/spiritual history was the explanatory variable with the greatest weight for richness
of knowledge of medicinal plants and the number of use citations, whereas commitment
best explains the richness of therapeutic targets. Although the other variables in the model
(such as forgiveness) do not have the required significance values, the model’s explanatory
power is lost when they are removed from the model.

Discussion

Although the scientific literature has emphasized the ways in which global change and
sociocultural and environmental changes at the local level are generally harmful to LEK
(Inta et al. 2013; Reyes-Garcı́a et al. 2013; Vandebroek et al. 2004), our findings indicate
that religiosity/spirituality can protect structural and functional elements of medicinal
plant-based medical systems. By protecting LEK, the LMS can benefit from greater
resilience at both the individual and population levels (Ferreira Júnior et al. 2013; Santoro

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Table 1 The set of models that best explain the relationship between religiosity/spirituality and knowledge
of medicinal plants, selected from the GLM analysis according to AIC value
Response Model with Predictor variables Explanatory model
variables all the selected by stepwise
predictor regression
variables

Richness of AIC = 528.93 Forgiveness(F), AIC = 519.52 Estimate z value p

medicinal Religious/spiritual F 0.05286 1.794 0.07
plants history (RSH),
Organizational RSH 0.03401 2.592 0.009
Religiosity (OR), OR 0.03162 1.735 0.08
Overall self-ranking OSR - 0.02671 - 1.59 0.11
(OSR)
Therapeutic AIC = 474.02 Religious support (RS), AIC = 465.7 Estimate z value p
targets Religious/spiritual RS 0.034 1.726 0.0844
cited history(RSH),
Commitment (C), RSH 0.02663 1.688 0.0914
Overall self-ranking C 0.06836 2.488 0.0128
(OSR) OSR - 0.03012 - 1.456 0.1453
Use AIC = 575.14 Forgiveness (F), AIC = 566.29 Estimate z value p
citations Religious/spiritual F 0.04119 1.489 0.1366
history (RSH),
Organizational RSH 0.02751 2.242 0.025
Religiosity (OR) OR 0.02885 1.782 0.0747

Significant relationships are given in bold

et al. 2015). By strengthening the structural elements of the system (the richness of
medicinal plants and therapeutic targets, for example), religiosity/spirituality increases
LMSs’ capacity to withstand disturbances that might affect the way in which people treat
their health problems. Thus, it might produce greater flexibility in the therapeutic response
to a medical problem (Ferreira Júnior et al. 2015). Our LEK proxies are measures of the
information circulating in the system at the individual level, which does not mean that this
information translates into practical healthcare actions (a variable we did not assess).
However, it is reasonable to assume that an individual becomes more capable of applying
his/her knowledge when required, as his/her knowledge increases.

The Effect of the Commitment Dimension

The commitment dimension explains a greater richness of therapeutic targets. The more
that people attend religious services, the more they add to their knowledge of health risks
(illnesses and symptoms) that are circulating in their community and that require attention.
The previous literature has used different terms for this variable, such as ‘‘social inte-
gration’’ or ‘‘religious attendance,’’ but these measures are basically established by the
frequency with which people attend church activities. Hummer et al. (1999) found that the
frequency with which individuals engage in religious services is associated with an
increase in life expectancy, and this finding is consistent across age, gender and race/
ethnicity and for all major causes of death. Furthermore, this finding is supported by a
meta-analysis that also identified a significant association with lower mortality (McCul-
lough et al. 2000). Several other health benefits have been attributed to commitment, such
as reduced depression (Cole-Lewis et al. 2016) and anxiety (Koenig et al. 1993); increased

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individual well-being (Ellison 1991) and physical health (Campbell et al. 2010); and
reduced heart problems, hypertension and rates of substance abuse (Mueller et al. 2001).
What must be explored and elucidated is how this dimension of religiosity/spirituality
operates to exert these positive effects on different health indicators, as well as on our
findings. On the one hand, Campbell et al. (2010) suggest that this variable is associated
with social support. By intensifying his/her participation in religious services, an individual
would be exposed to more instances of social support by the members of his/her religious
community. However, these variables turned out not to be correlated in his own study,
which obviously diminishes the strength of this interpretation. Alternatively, we suggest
that commitment provides opportunities for social learning in which people can exchange
experiences and socialize information. This conceptualization would explain, for example,
the effect on the richness of information about diseases because individuals would
exchange information about events they had experienced or witnessed.

The Effect of the Religious/Spiritual History Dimension

Our findings show that RSH is a predictor of the richness of medicinal plants that an
individual knows, as well as of the possible therapeutic combinations for which they can be
used. The measures included in the RSH dimension provide a snapshot of an individual’s
involvement with a religion over the course of his/her life, particularly regarding life-
changing religious/spiritual experience(s). For this reason, some researchers argue that this
dimension measures the intensity of an individual’s religious experience (Fetzer 2003).
However, as with the Commitment dimension, little is known about the mechanism by
which the RSH dimension influences various aspects of health.
Some studies note that these events may have a positive effect on health, particularly
with regard to emotional disorders, although it is not possible to establish a causal rela-
tionship. Koenig et al. (1993) observed that the incidence of anxiety and social phobia were
lower among those individuals who considered themselves to have been ‘‘born again’’ after
a profound religious/spiritual experience. Jones et al. (2015) found a correlation between
having had a positive spiritual experience and a perception of good mental health, whereas
having had negative spiritual experiences was correlated with a perception of having
poorer overall health and an increased perception of pain.
In other cases, the relationships observed are more difficult to understand. One clinical
study found that the proportion of patients who reported having experienced some reli-
gious/spiritual event that increased their faith varied based on their clinical condition.
However, it is difficult to establish the relationship of such an event with the severity of a
clinical condition, as cancer patients and stroke patients were more likely to indicate that
they had never experienced an event that increased their religious faith, whereas patients in
primary care or undergoing treatment for spinal cord injuries and head trauma were more
likely to report having experienced this type of event (Campbell et al. 2010).
The relationship between religiosity and symptoms of depression also appears to be
quite complex. In spite of having observed an association between certain religious indices
(such as loss of faith, negative religious coping and endorsing negative support from the
religious community) and the incidence and severity of depression in adolescents, Dew
et al. (2010) suggested that it was not religion as such that was influencing these psy-
chological disorders but instead the absence of social support. In this sense, belonging to a
religion or to a better structured family might contribute to better social support and
prevent depression. Social support seems to be a recurring explanation for the effects of
different dimensions of religiosity/spirituality.

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We suggest that RSH and commitment may be correlated dimensions. Individuals who
have had some type of profound life-changing religious experience can increase their
engagement in religious activities and/or encourage others to become more involved
because such events tend to exemplify the ‘‘efficacy’’ of a particular religion (see Teas
2010). As we have suggested, commitment may lead to a greater frequency of social
transmission events, during which individuals would be more likely to share their expe-
riences, including how to handle health-related problems. In summary, we suggest that
these dimensions together would increase the potential for social transmission of infor-
mation regarding medicinal plants. When considering the two dimensions of religiosity,
however, commitment favors knowledge of therapeutic targets while religious history
favors knowledge of medicinal plants. We have not yet been able to assess these different
responses in the LMSs because the mechanisms regulating these differences remain
unknown.

Other Dimensions of the Models: Forgiveness

Although it was not significant in any of the three models, forgiveness is one of the
dimensions that weakens all the correlations found if it is removed from the model,
particularly the relationship of the richness of medicinal plants and the types of treatment
associated with each (the plant/therapeutic target relation). In a general sense, the act of
forgiving relates to an individual’s capacity to see a situation from another person’s per-
spective, to sympathize with their weaknesses and to look beyond their faults (Idler et al.
2003). Several religious institutions posit that the act of forgiveness is their central phi-
losophy, and understanding how forgiveness operates may help us understand the asso-
ciation between religiosity/spirituality and increased health and well-being (Webb et al.
2012, 2013).
Several studies have confirmed the influence of forgiveness on improved physical and
mental health. For example, patients characterized by higher levels of forgiveness had
fewer problems related to intense physical pain, anger and psychological distress (Carson
et al. 2005). Low blood pressure rates are correlated with high levels of forgiveness (Idler
et al. 2003), and conversely, people who had difficulty forgiving God showed high levels
of anxiety and depression (Exline et al. 1999). In our study, forgiveness may be acting to
maintain relations and contact between individuals, which results in the maintenance of
networks involving social interaction. In other words, individuals who forgive tend to be
more sociable and empathetic, which would facilitate the transmission of knowledge.

An Evolutionary Interpretation of Our Findings

The processes that gave rise to the phenomenon of religion and the question of whether or
not it is adaptive in nature have been the subject of wide-ranging debate (see Bourrat 2015;
Voland 2009). Recently, it has been suggested that the religious phenomenon may be at the
origin of human socialization. Evidence suggests that cultural evolution stimulated by
competition among human groups favors the emergence of beliefs in supernatural
divinities and rituals, which became ever more effective at promoting commitment and
solidarity among individuals within the group and at supporting cooperation on a large
scale (Atran and Henrich 2010). Thus, we propose that the process of socialization, which
might have resulted from the religious phenomenon, has contributed to the complexity and
maintenance of LMSs by encouraging interactions among individuals promoted by reli-
gious activities. In this sense, when considering that religion and medical systems play

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important roles in the evolutionary history of our species (Bourrat 2015; Fabrega 1997),
from the perspective of cultural evolution, our findings indicate that these two knowledge
systems are currently evolving together. Future studies may investigate the evolutionary
dynamics involving the interaction of religion and medical systems.
As a clue to understanding these dynamics, several studies have shown that individuals
acquire information essentially through processes of cultural learning, which may undergo
biases as they are transmitted (Mesoudi 2015). These processes of social transmission may
be biased by context, the status of whom they are learned from, relatives, and many other
factors. Individuals may prefer to learn from people who they choose based on various
traits, such as perceived prestige and success, in addition to the content of the information
(see Mesoudi 2011). If we are correct, our findings suggest an important hypothesis to be
investigated in the future: The combination of a set of religious dimensions favors the
development of transmission biases associated with the informational content (the
knowledge of medicinal plants, which may be linked to referential religious experiences)
and with the context of the transmission (the religious environment), favoring the spread
and acceptance of new information that is perceived as valid.

Limitations of Our Study

Our study has certain limitations that should be taken into consideration. First, the sample
was small and consisted entirely of people of Christian faiths, with a high predominance of
Catholics. If, on the one hand, this feature allows us to discuss how the structure of this
particular religion influences the life experiences of its practitioners, it does not make it
possible to generalize our data to practitioners of other religions. The small sample size
could not be avoided, as we assessed more than 70% of the adult population. This scenario
merely limits the generalization of our findings but does not invalidate its conclusions. In
addition, the study focused on a rural community and, as Yoon and Lee (2006) emphasize,
such communities are typically characterized by low population density, difficulty of
movement, few medical facilities and essential services, low educational levels, and higher
levels of poverty and mortality. This focus may have influenced our results because such
factors may contribute to intensifying the effects of religious institutions. Finally, although
the BMMRS questionnaire assesses different levels of an individual’s religious/spiritual
sphere in a fairly objective manner, the analytical dimensions may suffer from overlapping
meanings among different people, which is one of the main limitations of this instrument in
assessing religion (Idler et al. 2003).

Funding Contribution of the INCT Ethnobiology, Bioprospecting and Nature Conservation, certified by
CNPq, with financial support from FACEPE (Foundation for Support to Science and Technology of the
State of Pernambuco).

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