"I am my own doctor": A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

The influence of religiosity on food choice among British Muslims: A qualitative study

Background: Religiosity is known to have a socio-cultural influence on food choice. However, to date, research exploring the influence of Islam on food selection has almost exclusively focused on fasting during Ramadan and has not explored the influences of Islam on everyday food choices among Muslim people. Aim: This qualitative study explored the influence of Islamic religiosity on everyday food choices among Muslim people. Methods: Thirty-two adult participants residing in the United Kingdom (n = 16 faith leaders and n = 16 lay Muslim people) were recruited from three Sunni mosques, and data was collected using semi-structured interviews. The data was analysed using reflexive thematic analysis and a constant comparison method was applied to draw out similarities and differences between faith leaders and lay Muslim people. Results: The results revealed that Islamic religiosity had an influence over food choice with two main overarching themes 1) Demonstrating religious obedience through food choices and, 2) Spheres of influence on food choice; and five sub-themes 1a) Trusting in familiar food providers, 1b) Verification of halal authenticity, 1c) Seeking purity within food, 2a) The Prophet Muhammed (Peace Be Upon Him) as a role model for food choice and, 2b) Islamic jurisprudence. Conclusion: These findings provide important insights into the influence of Islam on food choice and could be used support the design of faith-informed dietary interventions among Muslim people. Further research is required to examine the role of faith-informed dietary intervention in the Muslim community.

First-Time Usage of SGLT2 Inhibitors in Patients With Type 2 Diabetes Who Are Fasting Ramadan: Efficacy and Safety

Introduction: Ramadan fasting claims a necessary role in the management of diabetes. Many people with Type 2 diabetes insist on fasting during the holy month of Ramadan, which represents a challenge to their physicians to provide balance between preventing hypoglycemia or diabetic ketoacidosis (DKA) and good control of hyperglycemia with its short- and long-term complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a glucose-lowering therapy for Type 2 diabetes, which are generally well tolerable but may carry the risk of dehydration and hypoglycemia particularly during the long fasting hours. The study aimed to assess the efficacy and safety of the use of SGLT2i for the first time during Ramadan fasting. Methods: This prospective cohort study was carried out on 61 Egyptian Muslim patients, aged ≥ 18 years old, both sexes, with Type 2 diabetes mellitus (T2DM), prepared to fast during Ramadan, and treated with SGLT2i for the first time as a supplementary to metformin or another oral hypoglycemic drug. The dose of SGLT2i started after Iftar time. During and 6 weeks after Ramadan, evaluations were conducted. Results: Glycated hemoglobin (HbA1c), blood pressure (systolic and diastolic), and creatinine were significantly lower after Ramadan than at the beginning of Ramadan. The estimated glomerular filtration rate (eGFR) was significantly higher after Ramadan than at the beginning of Ramadan. Hypoglycemia, dehydration, and DKA did not occur in any patient. There was a significant negative correlation between age and HbA1c (r = -0.267, 95% CI: -0.48 to -0.05; p = 0.037) and eGFR (r = -0.684, 95% CI: -0.79 to -0.54; p < 0.001) after Ramadan, while there was no correlation between the duration of DM and HbA1c before and after Ramadan. HbA1c was significantly lower after Ramadan than during Ramadan in patients with ischemic heart disease (IHD), hypertension (HTN), peripheral neuropathy (PN), and chronic kidney disease (CKD) (p < 0.05). Conclusions: SGLT2i is effective and safe during Ramadan fasting with a significant reduction in HBA1c, blood pressure, and creatinine and a significant elevation of eGFR. Trial Registration: ClinicalTrials.gov identifier: NCT06370247.

Improving cultural humility in pharmacy education: A focus on diabetes management during religious fasting

BACKGROUND

Cultural humility is an increasingly important focus of healthcare education, aiming to equip students with the tools they need to provide care to diverse groups of people. There is a growing need for healthcare providers to understand Islamic religious practices that influence heath decision-making, especially religious fasting during Ramadan. However, there are limited efforts in pharmacy curriculums to address this. The objective of this project is to describe a cultural humility activity focusing on increasing students' confidence in managing patients' diabetes medications during religious fasting.

METHODS

A case-based activity was delivered within a pharmaceutical skills lab. Pre- and post-activity surveys assessed self-efficacy in student's confidence in communication, creating therapeutic plans, and identifying challenges and opportunities in the context of Ramadan fasting. Confidence was rated on a five-point Likert scale. Paired t-tests were used to compare mean confidence scores before and after the activity.

RESULTS

A total of 56 of 63 students completed the survey. The results showed improvements in confidence across all areas: initiating conversations about medication management (mean change +1.11 [0.20]; t = 5.475; P < .0001), developing therapeutic plans (mean change +1.29 [0.19]; t = 6.822; P < .0001), identifying challenges (mean change +1.02 [0.20]; t = 5.136; P < .0001), and recognizing opportunities (mean change +1.07 [0.20]; t = 5.318; P < .0001).

CONCLUSION

This study demonstrated a successful activity designed to increase cultural humility in future pharmacists for the purpose of delivering high quality healthcare to diverse patient groups. To address disparities in pharmacists' ability to deliver culturally mindful care to Muslim populations, additional activities should be designed incorporating this topic into curricula.

Experiences of fasting during Ramadan in British Muslims: Psychological, social and health behaviours

Ramadan is a month-long religious festival observed by Muslim worldwide, characterised by intermittent fasting. This qualitative study addressed the need to understand how fasting is experienced by Muslims residing in Western cultures, aiming to inform policies that create a more supportive environment. Practicing Muslims, both men and women, were recruited in the North of England in the United Kingdom (UK). Data were collected by individual interviews (N = 7) and focus group discussion (N = 4) and then analysed using Social Ecological Theory as a framework. Fasting was managed at the individual level through instrumental food choice and eating practices, and by adapting sleep routines. Disrupted sleep routines posed a challenge for those who had to adhere to Western working schedules, leading to perceived detriments to cognitive function and mood. The sense of belonging associated with Ramadan was seen as a motivating factor for fasting. Breaking the fast (Iftar) was marked by social activity and the availability of traditional fried foods. Participants identified the wider Western culture and environment as challenging for those who are fasting. These findings imply a need for policies that enable flexible working practices for Muslims during Ramadan.

Correction: "I am my own doctor": A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

[This corrects the article DOI: 10.1371/journal.pone.0263088.].

Digitising diabetes education for a safer Ramadan: Design, delivery, and evaluation of massive open online courses in Ramadan-focused diabetes education

AIMS

Ramadan-focused diabetes education is critical to facilitate safer Ramadan fasting amongst Muslim people living with diabetes. We present the design, delivery, and evaluation of two parallel massive open online courses (MOOCs) in Ramadan-focused diabetes education for people with diabetes and HCPs.

METHODS

Two Ramadan-focused diabetes education MOOCs were developed and delivered for Ramadan 2023: one for HCPs in English, and another for people with diabetes in English, Arabic and Malay. A user-centred iterative design process was adopted, informed by user feedback from a 2022 pilot MOOC. Evaluation comprised a mixed-methods evaluation of pre- and post-course user surveys.

RESULTS

The platform was utilised by people with diabetes and their family, friends and healthcare professionals. Overall, a total of 1531 users registered for the platform from 50 countries, 809 started a course with a 48% subsequent completion rate among course starters. Qualitative analysis showed users found the course a user-friendly and authoritative information source. In the HCP MOOC, users reported improved post-MOOC Ramadan awareness, associated diabetes knowledge and ability to assess and advise patients in relation to their diabetes during Ramadan (p<0.01).

CONCLUSIONS

We demonstrate the potential of MOOCs to deliver culturally tailored, high-quality, scalable, multilingual Ramadan-focused diabetes education to HCPs and people with diabetes.

Review of Muslim Patient Needs and Its Implications on Healthcare Delivery

BACKGROUND

In the rapidly changing environment of healthcare, striving toward health equity and providing patient-centered care is imperative to the patient's experience. To achieve these goals, a comprehensive understanding of the diverse patient populations seeking these services, their needs, and the multitude of religious, cultural, and structural elements that impact their well-being is required. Muslim patients represent a considerable demographic, both in number and complexity of religious and cultural beliefs and practices. This scoping review examines the intersection of religion and cultural values with healthcare delivery in the context of the Muslim patient experience.

OBJECTIVES

The objective of this review is to identify key concepts and challenges that impact the Muslim patient experience.

SEARCH METHODS

The research databases Cochrane Library, OVID Medline, and PubMED were used to conduct a comprehensive systemic review of original, empirical peer-reviewed publications with the following search terms: "Muslim healthcare," "Muslim patient," and "Muslim experience."

SELECTION CRITERIA

Inclusion and exclusion criteria were used to narrow down articles to those that addressed Muslim patient needs and their healthcare experience.

RESULTS

A total of 21 articles met the criteria of this scoping review. Five central topics were identified during thematic analysis: Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning.

CONCLUSION

This scoping review demonstrates that in order to provide patient-centered care addressing the unique needs of Muslim patients, religious and cultural values need to be explored under the frameworks of cultural humility and structural competency.

Management of diabetes during Ramadan: an update for Russian-speaking doctors

Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.

Qualitative exploration of Australian Muslim patients' perceptions and experiences surrounding medication management during Ramadan

ObjectiveTo explore Australian Muslim patients' perceptions and experiences surrounding medication management practices during Ramadan.MethodsThis was a qualitative exploration of the views and experiences of Muslim patients who were hospitalised during or shortly prior to Ramadan 2021. Data comprised comments obtained from a cross-sectional telephone or face-to-face questionnaire about medications and Ramadan fasting at a tertiary-referral hospital in Melbourne, Australia. A purposeful criterion sampling approach was employed for participant recruitment. Data were analysed using thematic analysis. Data were coded inductively and subthemes and themes were developed via an iterative process.ResultsComments were provided by 88 patients born in a wide range of countries and with a variety of medical and surgical co-morbidities. Themes identified included interpretation of Ramadan fasting, altering medications to facilitate fasting, perceptions about healthcare professionals and health knowledge. Many patients altered their medications to facilitate Ramadan fasting and there was considerable variability in interpretation of what breaks the fast. Patients' perceptions and previous experiences with healthcare professionals determined whether they sought advice about managing their medications during Ramadan or dismissed advice and/or self-managed their medications, sometimes inappropriately.ConclusionsThis exploration of Australian Muslim patients found diverse views and experiences around medication practices during Ramadan - past relationships with healthcare professionals influenced this practice. As there are ramifications for physical, spiritual and family wellbeing, it is imperative that healthcare professionals partner with their Muslim patients to optimise their medication management and health outcomes for Ramadan.