Faith and Meaning Drive Health Volunteers: New Study Reveals What Motivates Iran’s Unpaid Health Workers

In a finding that could reshape how health systems recruit and retain their volunteer workforce, researchers in Iran have discovered that religious belief is a stronger predictor of volunteer motivation than spiritual well-being itself. The study, conducted among 324 health volunteers in the city of Saveh, provides some of the first evidence from a religiously oriented, non-Western society that institutional religiosity and personal spiritual health—two constructs often conflated in the scientific literature—each contribute independently to what drives people to serve their communities without pay.

The research, published in the journal Heliyon, focused on a distinctive group within Iran’s primary health-care infrastructure: Women Health Volunteers, community members who collaborate with primary health-care centers on a voluntary, unpaid basis. These volunteers undergo basic health training and assist health professionals in delivering health promotion and prevention initiatives within their neighborhoods. Their responsibilities typically include educating families on healthy lifestyles, improving maternal and child health outcomes, encouraging chronic disease self-management, and bridging the gap between community members and primary care services. As these activities are unpaid and community-oriented, health volunteers represent an essential pillar of organized volunteerism within the Iranian primary health system.

To understand what motivates these volunteers, the research team drew on the Functional Approach to Volunteerism proposed by Clary and Snyder, a framework that holds individuals engage in volunteer activities because volunteering serves different psychological functions. These include the expression of values, social interaction, understanding, career development, enhancement, and protective motives. From this perspective, religiosity and spiritual health may be particularly relevant to the values function, as both constructs are associated with altruistic beliefs, meaning in life, and concern for the welfare of others. The framework is also consistent with Self-Determination Theory, which suggests individuals are more likely to engage in sustained prosocial behaviors when those behaviors satisfy intrinsic needs for meaning, relatedness, and personal fulfillment.

The study was designed as an analytical cross-sectional, non-experimental investigation conducted in 2025 in Saveh city. The final sample size was determined to be 345 participants initially enrolled, calculated using G*Power software based on a linear multiple regression model. Assuming a small-to-moderate effect size, a significance level of 0.05, a statistical power of 90 percent, and six predictors—religiosity, spiritual health, age, gender, education level, and marital status—the minimum required sample size was estimated at 181 participants. To account for potential incomplete questionnaires and improve statistical precision, a larger sample was recruited. Of the 345 health volunteers initially enrolled, 324 respondents with complete data were included in the final analysis.

Simple random sampling was employed after obtaining approval from the relevant ethics committee. A list of all registered health volunteers in Saveh was collected in collaboration with Saveh University of Medical Sciences, health centers, health bases, and pre-hospital emergency services. After assigning a unique numerical code to each individual on this list, a random number table was utilized to ensure random selection and minimize bias. Each number extracted from the table was matched with the assigned numerical code of the volunteers, and if a match occurred, that individual was selected as a final participant. Questionnaires were administered in two formats: online, completed by 165 respondents, and paper-based in person, initially distributed to 180 respondents, of which 21 incomplete questionnaires were excluded, yielding a final paper-based total of 159. Respondents were not randomly assigned to the two modes of data collection; rather, the mode of completion was determined by participants’ accessibility and personal preference. The researchers compared the main study variables across the two formats using the Mann–Whitney U test and found no statistically significant differences.

Three validated instruments were used to collect data. The Volunteer Functions Inventory, developed by Clary and colleagues, assesses the motivations underlying volunteering across six subscales: Protective, Values, Career, Social, Understanding, and Enhancement. The validated Persian version used in this study contained 29 items, with the total possible score ranging from 29 to 203. The Religiosity Questionnaire, based on the work of Glock and Stark, gauges individuals’ religious beliefs and attitudes across four dimensions—belief, emotional, consequential, and ritual—yielding a total score range of 0 to 104. The Spiritual Well-Being Scale developed by Paloutzian and Ellison is a 20-item self-report instrument assessing two dimensions of spiritual health: religious well-being and existential well-being, with a total score range of 20 to 120. In the present study, Cronbach’s alpha coefficients indicated acceptable reliability for all three instruments, with the Volunteer Functions Inventory reaching 0.98, the Religiosity Questionnaire 0.93, and the Spiritual Well-Being Scale 0.88.

The results revealed a significant positive correlation between the total score of volunteer functions and both spiritual health and religiosity. The correlation between volunteer functions and spiritual health was 0.26, while the correlation with religiosity was notably stronger at 0.40. Respondents with higher spiritual health and religiosity exhibited higher levels of volunteer functions. Furthermore, a significant positive correlation was observed between spiritual health and religiosity themselves, at 0.48. The majority of respondents demonstrated moderate levels of spiritual health and religiosity: 67.9 percent fell into the moderate category for spiritual health, and 70.1 percent for religiosity. The mean age of respondents was 29.87 years, with 63.9 percent female, 53.1 percent married, and 52.2 percent holding a bachelor’s degree.

Multiple linear regression analysis showed that, after controlling for socio-demographic variables including age, gender, education level, and marital status, both spiritual health and religiosity independently and significantly predicted the total volunteering function score. Spiritual health was positively and significantly associated with volunteering functions, with an unstandardized coefficient of 0.402 and a p-value of 0.021. Religiosity emerged as an even stronger positive predictor, with an unstandardized coefficient of 0.801 and a p-value below 0.001. Among the socio-demographic variables, only education level showed a significant negative effect, such that higher educational levels were associated with significantly lower volunteering function scores. In contrast, age, gender, and marital status were not significantly related to volunteering functions. The final regression model accounted for approximately 21 percent of the variance in volunteering function scores, and the overall model was statistically significant.

The demographic analysis revealed additional patterns. A weak but significant association was found between age and religiosity, suggesting that religiosity increases with age—a trend consistent with some studies observing an increase in religiosity in later life stages, which may be linked to accumulated life experiences and a heightened search for meaning during these periods. Women exhibited significantly higher levels of religiosity and spiritual health compared to men, and married respondents showed significantly higher levels of religiosity than single respondents. These differences may be influenced by gender-related socialization patterns, gender roles, and participation in religious social networks, while marital status may enhance engagement with religious and spiritual values through increased family responsibilities and social integration. However, the researchers noted that although these differences were statistically significant, the magnitude of associations was relatively small to moderate rather than strong.

The finding that higher education levels were associated with lower levels of spiritual well-being, religiosity, and volunteer functions warrants careful interpretation. The researchers suggested this pattern may reflect differences in how individuals with varying educational backgrounds engage with religion and spirituality. Secularization theory has often been used to explain this association, suggesting that higher education and modernization may expose individuals to broader worldviews and critical thinking perspectives, which can be accompanied by a gradual decline in traditional religious involvement. However, this relationship is not universal and appears to be context-dependent, influenced by cultural setting, measurement approaches, and individual differences. The correlation coefficients ranged from approximately negative 0.11 to negative 0.19, indicating weak but consistent trends that warrant further investigation rather than strong causal or deterministic interpretations.

The researchers acknowledged that spiritual health and religiosity overlap conceptually, and that this overlap might influence the observed relationships. While related, these two concepts are distinct: spiritual health generally refers to a broad sense of meaning, connection, and existential well-being, whereas religiosity is more about how closely someone follows religious beliefs, rituals, and practices. Previous research has shown that although these areas are correlated, they are generally considered distinct constructs capturing different aspects of people’s inner lives and behaviors. The instruments utilized in this study are grounded in established theory and have been validated as measuring distinct constructs, which mitigates the risk of confounding. The magnitude of the observed associations is consistent with prior empirical reports, suggesting the results do not arise solely from conceptual overlap. Nonetheless, some shared variance is inevitable when studying closely related psychosocial concepts, and future research could benefit from using more precise or multidimensional measures to more clearly differentiate between spiritual health and religiosity.

Several limitations constrain the interpretation of these findings. Owing to the cross-sectional design, causal inferences cannot be drawn; as data were collected at a single point in time, only associations—not causal relationships—between religiosity or spiritual health and volunteering can be inferred. Social desirability bias remains a potential concern, as respondents may overreport religious devotion owing to its socially valued status, though anonymity mitigated this risk. Additionally, socioeconomic status and prior volunteer experience were not assessed and therefore could not be included as covariates in the regression models. These variables are known to be associated with both religiosity and volunteering behavior, and their omission could potentially confound the observed associations. Several secondary bivariate analyses were also conducted without formal adjustment for multiple comparisons, meaning the possibility of Type I error inflation cannot be completely excluded.

The cultural context of these findings deserves particular attention. In individualistic countries like the United States, Canada, and Australia, volunteering is often driven by personal goals such as learning new skills, self-development, and career growth. In contrast, in collectivist societies like India, Japan, and China, motivation tends to come from ethical and social values, such as supporting the community, sharing responsibility, and following religious norms. The researchers cautioned that care is warranted when generalizing these findings to culturally different populations. Within the specific context of a religiously oriented society like Iran, however, the results suggest that religious beliefs, practices, and broader dimensions of spiritual well-being may contribute meaningfully to volunteer functions. Prior research has also emphasized that combining religion with active spiritual practices—like prayer, meditation, gratitude, and quiet reflection—has a stronger effect on volunteering than simply following religious doctrines, and that the social side of religiosity, such as joining collective rituals and being part of religious communities, is especially powerful in motivating volunteer behavior.

Looking forward, the researchers recommend longitudinal and prospective studies to clarify the direction and mechanisms of the relationships between spiritual and religious dimensions and volunteering behavior. Future research should also incorporate comprehensive measures of socioeconomic background and volunteer history to better isolate the unique contributions of religiosity and spiritual health to volunteer functions. The results indicate that demographic factors, particularly educational level, may be associated with differences in volunteer functions and should be considered in future research and program development. For health systems in Iran and similar contexts that depend heavily on volunteer networks to deliver community health services, understanding these motivational foundations could prove essential for sustaining the volunteer workforce upon which primary care delivery increasingly relies.

Subject of Research: Associations between religiosity, spiritual health, and volunteer functions among community health volunteers in Iran

Article Title: Religiosity, spiritual health, and volunteer functions among health volunteers in Saveh, Iran: A cross-sectional study

Article References: Arab, F., Khademi, S., & Saeedi, M. (2026). Religiosity, spiritual health, and volunteer functions among health volunteers in Saveh, Iran: A cross-sectional study. Heliyon, 12(16), Article e45585. https://doi.org/10.1016/j.heliyon.2026.e45585

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45585

Keywords: religiosity, spiritual health, volunteer functions, health volunteers, Iran, cross-sectional study, volunteer motivation, primary health care, Women Health Volunteers, community health, psychology of religion, Heliyon