American Muslim Engagement With Advance Care Planning: Insights From a Community Survey

Background and Objectives: Advance Care Planning (ACP) is a critical tool in advancing patient self-determination in health care delivery. Despite increasing research into racial/ethnic minorities' engagement with ACP in the US, studies on Muslim Americans are relatively scarce. We aimed to examine levels of ACP engagement among Muslim adults and measure associations between socio-demographic and religiosity characteristics and ACP engagement. Methodology: This was a survey study among Muslims attending mosque seminars in Chicago and Washington DC. Religiosity characteristics were assessed using a modified version of the Duke University Religion Index (DUREL) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured by the 4-item ACP Engagement Survey (4-ACPES) and 2 additional items covering ACP religious dimensions. Statistical analyses were performed using SPSS 28.0. Results: Out of 152 respondents, 56.2% to 72.6% were in the pre-contemplation stage of ACP across the 6 ACP items. Bivariate analyses showed that ACP engagement was correlated with participant age, ethnicity, duration of stay in the US and country of birth. Multivariable analyses demonstrated no association between religiosity characteristics and ACP engagement; independent predictors of ACP engagement were race/ethnicity (being South Asian), country of birth (born outside the US) and duration of stay in the US (longer years). Discussion/Conclusion: Our study suggests that American Muslims are largely unprepared to engage with ACP. Moreover, religiosity does not predict ACP engagement. We call for greater community outreach and educational programs that instill awareness and knowledge on the importance of ACP, and provide resources for tailored religiously-oriented conversations that assist individuals with ACP.

Muslims and End-of-Life Healthcare in Non-Muslim Majority Nations: A Systematic Literature Review

CONTEXT

As Muslim populations in non-Muslim majority nations grow and age, they will increasingly require culturally appropriate healthcare. Delivering such care requires understanding their experiences with, as well as preferences regarding, end-of-life healthcare.

OBJECTIVES

To examine the experiences, needs, and challenges of Muslim patients and caregivers with end-of-life, hospice, and palliative care.

METHODS

A systematic literature review using five databases (MEDLINE, Scopus, Web of Science, CINAHL, Cochrane Library) and key terms related to Islam and end-of-life healthcare. Papers were limited to English-language empirical studies of adults in non-Muslim majority nations. After removing duplicates, titles, abstracts, and articles were screened for quality and reviewed by a multidisciplinary team.

RESULTS

From an initial list of 1867 articles, 29 articles met all inclusion criteria. Most studies focused on end-of-life healthcare not related to palliative or hospice services and examined Muslim patient and caregiver experiences rather than their needs or challenges. Content analysis revealed three themes: (1) the role of family in caregiving as a moral duty and as surrogate communicators; (2) gaps in knowledge among providers related to Muslim needs and gaps in patient/family knowledge about advance care planning; and (3) the influence of Islam on Muslim physicians' perspectives and practices.

CONCLUSION

There is scant research on Muslim patients' and caregivers' engagement with end-of-life healthcare in non-Muslim majority nations. Existing research documents knowledge gaps impeding both Muslim patient engagement with end-of-life care and the delivery of culturally appropriate healthcare.

"I'm not Alone; He will be There for Me": A Mixed-Method Approach Exploring the Impact of Spousal Support on Mammogram Utilization and Health Beliefs

Regular mammogram screenings are effective for early breast cancer (BC) detection and decreased mortality rate. However, immigrant Muslim Arab women (IMAW) are less likely to adhere to these screenings although the rate of BC among IMAW is high. Recent studies have explored low mammogram screening rates among immigrant Muslim and/or Arab women from a limited perspective, overlooking the fact that husbands have an influence in IMAW's health behaviors toward cancer screenings. Thus, this mixed-method approaches were employed to (a) explore the association between spousal support and IMAW's health beliefs toward mammograms and their utilization, (b) to understand IMAW's experiences of spousal influence related to their mammogram use and health beliefs. The quantitative portion of the study, recruitment and data collection were conducted via online surveys in Arabic and English. Logistic regressions were used to explore relationships between perceived spousal support and IMAW's mammogram utilization and health beliefs. The qualitative portion of the study was conducted on a purposive sample of IMAW. A semi-structured interview guide in Arabic and English was used during one-on-one interviews. Arabic interviews were translated into English and transcribed by professionals. Interviews were analyzed by thematic analysis according to Braun and Clarke (2008). A total of 184 IMAW completed the survey with mean age of 50.4 (SD = 5.58, range = 45-60). Results revealed low mammogram screening rate among IMAW. Only 32.6% adhered to mammograms. Spousal support was positively associated with ever having obtained a mammogram and IMAW's adherence to mammogram. The 20 qualitative interviews, 16 in Arabic and four in English, produced rich description supporting results from the survey which includes, (a) types of spousal support, (b) impact of spousal support on participants' mammogram utilization and experience, and (3) impact of spousal support on participants' health beliefs toward mammograms. Findings from surveys and interviews show that a husband's support is positively associated with IMAW's mammogram utilization and health beliefs. Suggesting a new approach to integrate husbands in culturally appropriate interventions to increase mammogram screening rates among IMAW.

Relationships Between Religious Commitment, Workplace Experiences, and Professional and Psychological Outcomes Among U.S. Muslim Physicians

PURPOSE

To examine relationships between religiosity, workplace discrimination, religious accommodation, and related professional and psychological outcomes among US Muslim physicians.

METHOD

In 2021, the authors surveyed 264 physicians from 3 U.S.-based Muslim clinician organizations. Religious commitment, as measured by multiple items, was evaluated as a possible predictor of workplace discrimination and accommodation; job turnover; career satisfaction; workplace motivation; and belonging, burnout, and depression. Bivariate regression models were used to identify possible significant relationships between predictor and outcome variables. Predictors with meaningful bivariate analyses were included in separate multivariate regression models for each outcome.

RESULTS

Participants' mean age was 39.5 years (standard deviation, 10.03). Most were male (160/246; 65%), U.S.-born (146/244; 60%), completed medical school in the United States (190/243; 78%), and wore a beard/hijab (135/235; 57%). Participants identified as African American (40/247; 16%), Arab (55/247; 22%), South Asian (82/247; 33%), and White (70/247; 28%). Multivariate models demonstrated that religious importance was positively associated with discrimination from patients (odds ratio [OR] = 3.78; P = .02) and depression (OR = 5.36; P = .002), and negatively associated with prayer accommodation at work (OR = .20; P = .001). Engaging in congregational religious activities was negatively associated with discrimination from patients (OR = .64; P = .006) and job turnover (OR = .63; P = .02) and positively associated with accommodations for prayer (OR = 1.42; P = .008) and general religious identity accommodation (OR = 1.47; P = .01). Additionally, participant race and ethnicity were variably associated with these outcomes.

CONCLUSIONS

This study demonstrates how religious identity may negatively associate with workplace experiences and well-being among U.S. Muslim physicians and highlights the buffering role of religious practice. It spotlights an urgent need for academic medical centers to ameliorate religious discrimination and implement workplace accommodation policies for Muslim physicians.

A Pilot Efficacy Trial to Educate Muslim Americans about the Islamic Bioethical Perspectives in End-of-Life Healthcare

In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans' religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar's test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community's knowledge about the bioethical dimensions of EOLHC.

Predictors of Perceived Discrimination in Medical Settings Among Muslim Women in the USA

Minority groups based on immigration status, gender, or religion often face discrimination in healthcare settings. Muslim women, especially those who wear hijab, are more likely to experience stereotyping and discrimination in and outside of healthcare, but little is known about the sociodemographic predictors of this discrimination. We examined sociodemographic factors and religiosity as predictors of discrimination in medical settings among Muslim American women. Muslim women (n = 254) were recruited from Muslim organizations in Chicago to self-administer a survey on perceived discrimination, religiosity, and sociodemographic characteristics. Many participants reported that they were treated with less courtesy than non-Muslims (25.4%) and that a doctor or nurse did not listen to them (29.8%) or acted as though they were not smart (24.3%). A multivariable regression model revealed that self-rated religiosity was negatively associated with discrimination. Race/ethnicity trended towards predicting perceived discrimination such that Arabs and South Asians reported less discrimination than African Americans. The current study sheds light on the important role of religiosity in shaping Muslim women's experiences in medical settings and points to the buffering effect of religiosity and the additive consequences of racial/ethnic identity in experiences of religious discrimination.

Organ Donation and the Dead Donor Rule: A Synopsis of Pressing Ethical Controversies and Practical Questions

OBJECTIVES

As a result of recent biomedical advancements, organ donation continues to save and enhance countless lives globally.Yet,the gap between the organ supply and demand persists, leading to approximately 17 people dying each day waiting for an organ transplant and another person being added to the transplant waiting list every 9 minutes. This gap persists, in part, because of ethical and practical concerns arising from ambiguities surrounding death determination before donation and the dead donor rule. In this study, we discuss challenges related to defining death in the context of organ donation, critical and tolerant views on the dead donorrule, and possible avenues by which some of the ambiguities and ethicaltensions related to organ donation may be resolved.

MATERIALS AND METHODS

We reviewed literature opinions and data pertaining to cultural and religious influences affecting societal attitudes toward death determination and organ donation and examined the future of deceased organ donation.

RESULTS

Cultural and religious influences affect societal attitudes toward death determination and organ donation. There is a plurality of views on the matter that may be assuaged to an extent by standardized death determination criterion that could be implemented globally or by identifying alternative therapies other than human organ transplant.

CONCLUSIONS

The debate regarding death and the acceptability of dead donor organs fortransplant does not have a straightforward solution, and efforts are needed to overcome social, cultural and religious objections.

Breast cancer screening among immigrant Muslim arab women in the United States: Analyzing relationships between beliefs, knowledge, spousal support and mammogram utilization

BACKGROUND

Regular mammogram screenings contribute to a decreased breast cancer (BC) mortality rate. Women from ethnic minorities in the United States, however, often underutilize mammogram screenings; in particular, immigrant Muslim Arab (IMAW) women have low mammogram screening rates.

OBJECTIVE

To explore the associations between mammogram utilization and (a) health and religious beliefs, (b) level of knowledge about mammograms, (c) health care provider (HCP) recommendations, and (d) spousal support.

METHODS

A cross-sectional study employed online data collection. An Arabic or English survey was completed by women who were 45 or older and married, had immigrated from Arab countries, and had no history of breast cancer. Logistic regression was conducted for data analyses.

RESULTS

Of the 184 Immigrant Muslim Arab survey participants, 86.6% reported having had at least one mammogram in their lifetime, and 32.6% adhered to mammograms. Ever having obtained a mammogram and adherence to mammograms were negatively associated with perceived mammogram barriers and positively associated with (a) spousal support, (b) level of mammogram knowledge, and (c) perceived self-confidence. Receiving (HCP) recommendation increased the likelihood of ever having obtained a mammogram. Finally, participants who reported higher levels of perceived mammogram benefits were more likely to have obtained a mammogram within the last 2 years compared to their counterparts.

CONCLUSIONS

IMAW have demonstrated low mammogram adherence rate.

IMPLICATIONS

Nursing clinicians and scholars must play a role in designing and implementing interventions to promote women adherence to mammograms. Involving husbands in these interventions may improve immigrant Muslim Arab women's mammogram adherence rates.

Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US

BACKGROUND

Discrimination negatively impacts physician career trajectories and well-being.

OBJECTIVE

Quantify perceived religious discrimination among US Muslim physicians and compare trends over time.

DESIGN/PARTICIPANTS/MAIN MEASURES

Two national surveys tabulated discrimination. The 2013 survey involved a mailed questionnaire to a random sample of 746 Islamic Medical Association of North America (IMANA) members, while the 2021 survey was administered online to subscribers of IMANA, American Muslim Health Professionals, and the US Muslim Physician network. Eligible participants had to be practicing US Muslim physicians, and English-proficient (the 2021 sample was further restricted to physicians in academic medicine). Questionnaires assessed experiences of religious discrimination and accommodation.

KEY RESULTS

In 2013, the 255 participants had a mean age of 52 years, were mostly male (70%), Sunni (91%), South Asian (70%), and adult immigrants (65%). In 2021, the 264 participants had a mean age of 39.5 years, were mostly male (65%) and Sunni (75%). In contrast to 2013, the majority were born in the USA (59%; p<0.01), and respondents were more diverse with 33% South Asians, 22% Arabs, and 16% African Americans. Greater proportions of the 2021 sample reported facing religious discrimination frequently in their career (24 to 53%; p<0.01), experiencing job turnover (7 to 32%; p<0.01), and having patients refuse their care (9 to 33%; p<0.01). A higher proportion of South Asians, Arabs, and participants under the age of 40 reported discrimination and job turnover in 2021 when compared to 2013. Higher proportions of South Asians and Whites reported being passed over for professional advancement and having patients refuse their care in 2021 relative to 2013.

CONCLUSIONS

Many American Muslim clinicians encounter religious discrimination at the workplace, and these experiences appear to be on the rise. Healthcare workforce diversity, inclusion, and equity programming should include a focus on accommodating the religious identities of physicians.

Career Satisfaction and Burnout among American Muslim Physicians

Background  Career satisfaction and burnout among physicians are important to study because they impact healthcare quality, outcomes, and physicians' well-being. Relationships between religiosity and these constructs are underexplored, and Muslim American physicians are an understudied population. Methods  To explore relationships between career satisfaction, burnout, and callousness and Muslim physician characteristics, a questionnaire including measures of religiosity, career satisfaction, burnout, callousness, and sociodemographic characteristics was mailed to a random sample of Islamic Medical Association of North America members. Statistical relationships were explored using chi-squared tests and logistic regression models. Results  There were 255 respondents (41% response rate) with a mean age of 52 years. Most (70%) were male, South Asian (70%), and immigrated to the United States as adults (65%). Nearly all (89%) considered Islam the most or very important part of their life, and 85% reported being somewhat or very satisfied with their career. Multivariate models revealed that workplace accommodation of religious identity is the strongest predictor of career satisfaction (odds ratio [OR]: 2.69, p  = 0.015) and that respondents who considered religious practice to be the most important part of their lives had higher odds of being satisfied with their career (OR: 2.21, p  = 0.049) and lower odds of burnout (OR: 0.51, p  = 0.016). Participants who felt that their religion negatively influenced their relationships with colleagues had higher odds of callousness (OR: 2.25, p  = 0.003). Conclusions  For Muslim physicians, holding their religion to be the most important part of their life positively associates with career satisfaction and lower odds of burnout and callousness. Critically, perceptions that one's workplace accommodates a physician's religious identity associate strongly with career satisfaction. In this era of attention to physician well-being, the importance of religiosity and religious identity accommodations to positive career outcomes deserves focused policy attention.

Muslim American physicians' experiences with, and views on, religious discrimination and accommodation in academic medicine

OBJECTIVE

To assess Muslim physician experiences with religious discrimination and identify strategies for better accommodating Muslim identity in health care.

DATA SOURCES AND STUDY SETTING

Interviews were conducted with Muslim physicians from three US-based Muslim clinician organizations between June and August 2021.

STUDY DESIGN

In-depth, semi-structured qualitative interviews used a phenomenological approach to describe experiences of religious discrimination and accommodation. A team-based framework approach to coding was used to inductively generate themes from interview data.

DATA COLLECTION/EXTRACTION METHODS

Physicians from the Islamic Medical Association of North America, American Muslim Health Professionals, and the US Muslim Physicians group were invited to participate using closed organizational listservs. Inclusion criteria sought English-speaking, self-identifying Muslims with current or past affiliation with a university hospital in the United States. Potential participants were segmented into groups based on responses to questions about perceived religious discrimination and accommodation. Purposive sampling was used to iteratively approach participants within these groups in order to capture a diverse respondent pool. Interviews stopped after thematic saturation was reached.

PRINCIPAL FINDINGS

Eighteen physicians (11 women and 7 men; mean age: 41.5 [standard deviation = 12.91] years) were interviewed. Nearly all (n = 16) held Islam to be important in their lives. Three overarching themes, with several subthemes, emerged. Participants (1) struggled to maintain religious practices and observances due to unaccommodating organizational structures; (2) experienced religious discrimination, which, in turn, impacted their professional trajectories and, at times, their personal well-being; and (3) believed that institutions could implement specific educational and policy interventions to advance the religious accommodation of Muslims in health care.

CONCLUSIONS

Muslim physicians frequently encounter religious discrimination, yet there are concrete ways in which health care workplaces can better accommodate their religious needs and combat discrimination. To improve workforce diversity, equity, and inclusion, educational forums and policies that support the religious practices of physicians need to be established.

Increasing Solid Organ Donation: A Role for Emergency Physicians

BACKGROUND

More than 100,000 Americans with failing organs await transplantation, mostly from dead donors. Yet only a fraction of patients declared dead by neurological criteria (DNC) become organ donors.

DISCUSSION

Emergency physicians (EPs) can improve solid organ donation in the following ways: providing perimortem critical care support to potential organ donors, promptly notifying organ procurement organizations (OPOs), asking neurocritical care specialists to evaluate selected emergency department patients for death based on established neurologic criteria, participating in research to advance these developments, implementing automatic OPO notification technologies, and educating the professional and lay communities about organ donation and transplantation, including exploration of opt-out (presumed consent) organ recovery policies.

CONCLUSION

With future improvements in organ preservation and DNC assessment, EPs may become even more involved in the donation process. EPs should support and engage in efforts to promote organ donation and transplantation.

Muslim Americans' Views on Making Organ Donation Decisions in the Department of Motor Vehicles Setting

Introduction: Organ donation-related education is offered, and decisions are made at state Department of Motor Vehicles; however, little is known about Muslim Americans' attitudes toward these common practices. Research Questions: Are participants comfortable learning about deceased organ donation in the Department of Motor Vehicles setting? Are participants prepared to make deceased organ donation-related decisions at the Department of Motor Vehicles? Design: A survey of Muslim Americans attending an educational workshop at 4 mosques in two US cities. Primary study outcomes were self-reported (a) preparedness to make deceased donation-related decisions and (b) comfort with receiving organ donation education in the license renewal setting. We calculated Pearson product-moment correlations between these primary outcomes and participant characteristics including sociodemographic descriptors, religiosity and religious coping measures, and discrimination measures. Results: Most respondents indicated they were not prepared to make organ donation-related decisions at the Department of Motor Vehicles (79.6%). Preparedness did not vary by age, gender, country of origin or US residency duration, nor by religiosity, negative religious coping, or experiences of discrimination. However, higher scores on positive religious coping were associated with lower ratings of preparedness. A slight majority (58.9%) of respondents were comfortable receiving organ donation education. Conclusions: Muslim Americans are comfortable with learning about organ donation while at the Department of Motor Vehicles but are ill-prepared to make deceased donation-related decisions in the same setting. Further research is required to understand whether changes to the license renewal setting would improve decision-making outcomes in this population.

Designing academic career trajectories: identifying internal assets and evaluating external challenges

When I joined the Society of Behavioral Medicine's Mid-Career Leadership Institute in 2016, I was at an academic crossroads where my motivation to pursue a research career was waning. Specifically, I was challenged in obtaining funding for my unique research focus, and by the loss of institutional mentors and sponsors. In this commentary, I describe how I utilized components of the SBM Leadership Institute, specifically executive coaching and peer mentorship, as well as introspection to identify career trajectories that align with my internal motivations, as well as acknowledge dynamics in my scholarship area and at my institution. By specifying several concrete possibilities for career advancement that are both personally meaningful and institutionally practical, I have been better able to focus my scholarly pursuits and seek out leadership positions. In general terms, the leadership institute helped me to evaluate my own internal assets (e.g., skills and passions), to critically examine trends in my area of scholarship, and to delineate alternative career pathways. In my view such periodic introspection and evaluation is critically important for maintaining a fulfilling academic career.

Bioethical insights from the Fiqh Council of North America's recent ruling on medical cannabis

There is growing momentum to legalize medical cannabis across the United States. Positive public attitudes and permissive policies are based on growing anecdotal experiences and medical evidence that enumerate the health benefits of cannabis. Against this backdrop, Muslim stakeholders are (re)-evaluating their stance on the issue for Muslim patients who may benefit from such novel treatments, Muslim physicians who could incorporate the provision of cannabis into practices, and Muslim entrepreneurs who may seek to engage with the pharmaceutical and business aspects of the growing industry. Given this renewed interest, the Fiqh Council of North America (FCNA), a deliberative body comprised of Islamic jurists and medical consultants, examined the medical as well as religious evidence surrounding medical cannabis in order to furnish Muslim Americans with religious guidance. In 2018, they resolved that, while the use of intoxicating substances is proscribed by Islamic law, medical cannabis was permissible for Muslims to use with the following stipulations: Non-psychoactive preparations of cannabis are permitted to treat illnesses for which therapeutic effects of cannabis are certain, and psychoactive preparations are contingently permissible in cases of dire necessity. In this paper we first discuss the deliberative process and ethico-legal rationale brought to bear in furnishing the ruling, and then proceed to critically examine its conceptual gaps, practical limitations, and future implications. Clarifying the nuances around the religious permissibility of medical cannabis is important for Muslim patients and providers whose attitudes and behaviors may be informed by the ruling, as well for stakeholder groups within pharmaceutical and health policy circles who aim to address the needs of the global Muslim community that may stand to benefit from advances in medical cannabis research and therapeutics.

Health Care Utilization Before and After the "Muslim Ban" Executive Order Among People Born in Muslim-Majority Countries and Living in the US

IMPORTANCE

The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown.

OBJECTIVE

To analyze whether President Trump's 2017 executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States" (known as the "Muslim ban" executive order) was associated with changes in health care utilization by people born in targeted nations living in the US.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban-targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non-Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021.

EXPOSURES

Executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States."

MAIN OUTCOMES AND MEASURES

Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses.

RESULTS

A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban-targeted nations (point estimate [SE], 3.41 [1.53]; P = .03).

CONCLUSIONS AND RELEVANCE

Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.

Muslim American physicians' views on brain death: Findings from a national survey

Background

Biotechnology has introduced a new physiological state, "brain death," that continues to attract controversy and confusion. While variability in diagnostic criteria for, and physician practices regarding, "brain death" has been studied, few studies examine physicians' normative views on the significance of "brain death" and how religiosity implicates these views.

Objective

The objective is to assess how Muslim physicians' views on death, and how their religiosity and acculturation, associate with their perceptions of "brain death."

Methods

A randomized national sample of 626 American Muslim physicians completed a mailed questionnaire assessing sociodemographic characteristics, religiosity, and views about death. Measures of religious practice and acculturation were analyzed as predictors of physician views at the bivariate and multivariable levels. In conducting the multivariate analysis, P-values less than 0.05 were deemed statistically significant.

Results

Two-hundred and fifty-five respondents completed the survey (41% response rate). Most participants agreed that death is the irreversible cessation of cardiac and respiratory function (90%), while half agreed or disagreed with other definitions of death, such as loss of personhood or the equivalence of cardiopulmonary and neurological criteria for death. Physicians who scored higher on the religious practice scale had significantly lower odds of agreeing with the statement; "brain death" signifies the departure of the soul from the body [odds ratio (OR) = 0.57, 95% confidence interval (CI): 0.33-0.98]. Those who were born in the US, or immigrated to the US as a child, had greater odds of viewing death as the irreversible loss of personhood and consciousness [OR = 3.52, 95% CI: 1.62-7.63].

Conclusion

Physician characteristics such as religiosity and acculturation appear to influence their views on what constitutes death and how it should be diagnosed. In our sample of Muslim physicians, there appears to be significant reservation toward equating neurological and cardiopulmonary criteria to determine death and disquiet regarding the meaning of "brain death" in general.

Informing American Muslims about living donation through tailored health education: A randomized controlled crossover trial evaluating increase in biomedical and religious knowledge

Biomedical and religious knowledge affects organ donation attitudes among Muslims. We tested the effectiveness of mosque-based, religiously tailored, ethically balanced education on organ donation among Muslim Americans. Our randomized, controlled, crossover trial took place at 4 mosques randomized to an early arm where organ donation education preceded a control educational workshop or a late arm with the order reversed. Primary outcomes were changes in biomedical (Rotterdam Renal Replacement Knowledge Test living donation subscale, R3KT) and religious (Islamic Knowledge of Living Organ Donation, IK-LOD) living kidney donation knowledge. Statistical analysis employed a 2 (Treatment Arm) X 3 (Time of Assessment) mixed-method analysis of variance. Of 158 participants, 59 were in the early arm and 99 in the late arm. A between group t test comparison at Period 1 (Time 1 - Time 2), demonstrated that the early arm had a significantly higher mean IK-LOD (7.11 v 5.19, P < .05) and R3KT scores (7.65 v 4.90, P < .05) when compared to the late arm. Late arm participants also had significant increases in mean IK-LOD (5.19 v 7.16, P < .05) and R3KT scores (4.90 v. 6.81, P < .05) postintervention (Time 2-Time 3). Our novel program thus yielded significant kidney donation-related knowledge gains among Muslim Americans (NCT04443114 Clinicaltrials.gov).

Engaging Muslim Americans for Research on Community Health: Lessons Learned from a PCOR Capacity-Building Program

BACKGROUND

Although racially, ethnically, and socioeconomically diverse, American Muslim communities share a religious worldview that contributes to similar health and health care behaviors. Yet, this "Muslim" dimension largely overlooked in health disparity research and intervention programs. As such, Muslim community leaders have few opportunities to participate in, and shape, research that addresses religion-related factors impacting Muslim community health outcomes.

OBJECTIVES

We initiated a community-engaged, capacity-building program to develop a cohort of Muslim community leaders equipped with the knowledge and intention to participate in Muslim community-relevant, patient-centered outcomes research (PCOR).

METHODS

By means of a learning institute and webinars, we implemented tailored education focused on research methods, strategies for studying the religious dimensions of health behavior, PCOR tools, and skills for mosque engagement to a cohort of diverse Muslim community leaders. This cohort further participated in a consensus-building activity to identify Muslim community health priorities, and developed project proposals to tackle community health issues. Finally, we convened a national, multistakeholder conference to connect Muslim health researchers and discuss PCOR approaches to combating Muslim health disparities.

CONCLUSIONS

A multi-modality capacity-building program can cultivate grassroots motivation and skills for addressing the religious dimensions of health challenges through mosque communities. Yet, for such efforts to translate into specific initiatives strategic partnerships between research funders, health care systems, and mosque community leaders is needed. Our experience suggests that holistic approaches to Muslim health concerns are desired by community members, and that, therefore, discussions and consensus-building projects should incorporate a variety of stakeholders.

The impact of religiously tailored and ethically balanced education on intention for living organ donation among Muslim Americans

We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre-post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P < .0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P < .0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P < .0001). Mean change in likelihood to encourage a loved one, a co-worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P = .0035, 0.23; SD ± 0.82, P = .0021, 0.33; SD ± 0.79, P < .0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01-1.41, P = .03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96-0.998, P = .03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08-0.60, P = .003). Our intervention appears to enhance living kidney donation-related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114].

The Development and Validation of the Islamic Knowledge of Living Organ Donation Knowledge Scale for Measuring Organ Donation Knowledge Among Muslim Communities

Introduction:

Studies around the world demonstrate that Muslim attitudes toward organ donation are closely tied to religion, but also that Muslim publics suffer from a lack of detailed knowledge about the Islamic perspectives on organ donation. Consequently, organ donation professionals and stakeholders are increasingly addressing knowledge gaps in the Muslim community through educational interventions. Yet, a measurement of Islamic knowledge of organ donation, and thereby the efficacy of such education, is not available.

Research Question:

To present the development and psychometric evaluation of the Islamic Knowledge of Living Organ Donation scale, designed to measure knowledge of the Islamic ethicolegal stances, and their underlying rationale, regarding living organ donation.

Methods:

Items were developed based on a review of Islamic juridical perspectives on organ donation, addressed knowledge gaps pervading Muslim communities, and pilot tested. The scale was statistically validated and psychometrically analyzed with a sample of 158 mosque-going Muslims in the United States.

Results:

The 9-item Islamic Knowledge of Living Organ Donation scale was found to be reliable (Cronbach α: 0.86), unidimensional, independent of religiosity, and predictive of social attitudes toward organ donation.

Discussion:

The survey can be used to validly assess Islamic knowledge of living organ donation among Muslim communities in research, educational, and clinical settings.

Causes and Means of Healing: An Islamic Ontological Perspective

Healthcare practitioners are increasingly aware that patients may utilize faith-based healing practices in place of conventional medicine based on their spiritual and/or religious understandings of health and illness. Therefore, elucidating the ontological understandings of patients utilizing such religion-based treatments may clarify why patients and clinicians have differing understandings of 'who' heals and 'what' are means for healing. This paper describes an Islamic ontological schema that includes the following realms: Divine existence; spirits/celestial beings; non-physical forms/similitudes; and physical bodies. Ontological schema-based means of healing include conventional medicine, religion-based means (e.g., supplication, charity, prescribed incantations/amulets), and active adoption of Islamic virtues (e.g., reliance on God [tawakkul] and patience [sabr]). An ontological schema-based description of causes and means of healing can service a more holistic model of healthcare by integrating the overlapping worlds of religion and medicine and can support clinicians seeking to further understand and assess patient responses and attitudes toward illness and healing.

When can Muslims withdraw or withhold life support? A narrative review of Islamic juridical rulings

When it is ethically justifiable to stop medical treatment? For many Muslim patients, families, and clinicians this ethical question remains a challenging one as Islamic ethico-legal guidance on such matters remains scattered and difficult to interpret. In light of this gap, we conducted a systematic literature review to aggregate rulings from Islamic jurists and juridical councils on whether, and when, it is permitted to withdraw and/or withhold life-sustaining care. A total of 16 fatwās were found, 8 of which were single-author rulings, and 8 represented the collective view of a juridical council. The fatwās are similar in that nearly all judge that Islamic law, provided certain conditions are met, permits abstaining from life-sustaining treatment. Notably, the justifying conditions appear to rely on physician assessment of the clinical prognosis. The fatwās differ when it comes to what conditions justify withdrawing or withholding life- sustaining care. Our analyses suggest that while notions of futility greatly impact the bioethical discourse regarding with holding and/or withdrawal of treatment, the conceptualization of futility lacks nuance. Therefore, clinicians, Islamic jurists, and bioethicists need to come together in order to unify a conception of medical futility and relate it to the ethics of withholding and/or withdrawal of treatment.

The Moral Status of Organ Donation and Transplantation Within Islamic Law: The Fiqh Council of North America's Position

BACKGROUND

Muslim communities tend to hold more negative attitudes toward organ donation than other communities. These views, in part, reflect the diverse views of Islamic scholars who debate the conditions under which donation and transplantation is morally licit. In December 2018, the Fiqh Council of North America (FCNA) weighed in on the US context of donation and transplantation through an Islamic ethico-legal verdict (fatwa).

METHODS

Between 2016 and 2018, FCNA members engaged in multidisciplinary research using conventions of collective Islamic moral deliberation. They examined rulings on organ donation and transplantation issued by Islamic jurists and juridical councils abroad, convened with organ donation and transplantation professionals and stakeholders including families and patients, and consulted medical and bioethics experts.

RESULTS

FCNA judges organ donation to be morally permissible from the perspective of Islamic law and ethics, subject to several conditions. These include first-person authorization, that donation occur either while living or after circulatory declaration of death, harm to the donor is minimized, reproductive organs are not donated, among others. Organ transplantation, in general, was also deemed licit.

CONCLUSIONS

FCNA's verdict uniquely addresses American contexts and has several clinical practice implications. By sharing their perspective with academic and professional stakeholders, the council aims to provide nuanced guidance for assisting Muslims in making informed choices regarding these procedures and further societal dialogue on the ethics and practices of donation and transplantation.

Producing Parenthood: Islamic Bioethical Perspectives & Normative Implications

Biomedicine has opened up new possibilities for parenthood. Once resigned to remaining childless or pursuing adoption, infertile couples can now pursue options such as gamete donation, in-vitro fertilization, and uterine transplantation, as well as surrogacy. Muslim thinkers have viewed these strategies with both promise and caution given new types of kinship and parenthood result. By drawing upon leading medical fiqh academy resolutions this paper critically analyses Islamic normative views on the production of parenthood. We start with an overview of the Sunni rulings on gamete donation, gestational surrogacy and uterus transplantation, and the rationale and scriptural sources that undergird these moral assessments. Next, we discuss the contested relational bonds in light of larger discussions on genetics and the preservation of lineage. Finally, we comment on how scientific data, social imaginaries, and empirical gaps impact Islamic normativity regarding the production of parenthood so as to inform more holistic Islamic bioethical assessments.

A Mosque-Based Qualitative Study on American Muslim Women's Organ Donation Beliefs

INTRODUCTION

Detailed studies on the associations between religious beliefs and organ donation attitudes among religious minorities remain wanting. Although Muslims appear to have low rates of support for donation, how these behaviors relate to religious frameworks requires further investigation.

METHODS

We sought to explore the relationship between religious beliefs (Islam) and organ donation attitudes through focus groups with 43 Muslim women from 5 Chicago-area mosques. Purposive selection of mosques generated near-equal representation of Arabs, South Asians, and African Americans, as well as diversity in education and income. Using the theory of planned behavior as our conceptual framework, we expanded the traditional normative domain to include religiously informed beliefs.

FINDINGS

We found that the relationship between religious beliefs and Muslim attitudes toward organ donation is more complex than commonly perceived. Regarding the Islamic ethicolegal permissibility of organ donation, participants expressed a range of normative beliefs. Furthermore, participants voiced concerns beyond religious permissibility, including anxieties over modesty violations during the donation process, as well as concerns about purported black market organ trade and medical risks to donors.

DISCUSSION

Given that participants raised religious, societal, and biomedical concerns regarding organ donation, our findings suggest that effective educational programs should involve nuanced curricula that teach to the plurality of Islamic ethicolegal opinions and discuss transplantation processes within the United States.

Using the Maqāṣid al-Sharī'ah to Furnish an Islamic Bioethics: Conceptual and Practical Issues

The field of Islamic bioethics is currently in development as thinkers delineate its normative content, ethical scope and research methods. Some scholars have offered Islamic bioethical frameworks based on the maqāṣid al-Sharī'ah, the higher objectives of Islamic law, to help advance the field. Accordingly, a recent JBI paper by Ibrahim and colleagues describes a method for using the maqāṣid al-Sharī'ah to provide moral end-goals and deliberative mechanisms for an Islamic bioethics. Herein I highlight critical conceptual and practical gaps in the model with the hopes of fostering greater discussion about how maqāṣid al-Sharī'ah frameworks may fit within Islamic bioethics deliberation.

Study Protocol for ‘Informing American Muslims about Organ Donation (I AM a LD)’

Background: American Muslims tend to hold more negative attitudes towards organ donation than other American populations, and these attitudes are contributed to by gaps in biomedical and religious knowledge. As a result, there is significant need for religiously-tailored health education on organ donation within this community. Thus our study sought to test the effectiveness of a mosque-based, religiously-tailored health education program that addressed biomedical and religious knowledge gaps regarding living organ donation amongst Muslim Americans. Methods: A randomized, controlled, cross-over trial of religiously-tailored educational workshops held at four mosques in Washington D.C. and Chicagoland. Mosques are randomized into early and late intervention arms and participants are recruited at worship services and other mosque events. The primary study outcomes are changes in biomedical and religious knowledge regarding living organ donation. Secondary outcomes include change in procedural knowledge about the process and types of living organ donation, beliefs regarding organ donation, and religious knowledge regarding end-of-life care. Funding and Ethics: This study is supported by a grant from the U.S. Human Services Health Resources and Services Administration and received ethics approval from the University of Chicago’s Biological Sciences Division Institutional Review Board.

Empathy and Attending to Patient Religion/Spirituality: Findings from a National Survey of Muslim Physicians

Attending to patient religion and spirituality (R/S) generates controversy. Some worry that because physicians lack formal religious training they may overstep their expertise, while others argue that physicians who are attentive to patient R/S provide higher quality of care. We aimed to describe American Muslim physicians' perspectives and practices regarding R/S discussions, and how physician characteristics correlate with these. A questionnaire including measures of religiosity, empathy, and attitudes and behaviors toward R/S, was randomly administered to Islamic Medical Association of North America members. More empathetic physicians were more likely to inquire about patients' R/S, share their own religious ideas and experiences, and encourage patients in their own R/S beliefs and practices (β = .44, p < .01). More empathetic physicians also had greater odds of encouraging discontinuation of futile life-sustaining interventions (OR 1.90, p < .05). Additionally, respondents with higher empathy had greater odds of encouraging patients at the end-of-life to seek reconciliation with God (OR 3.27, p < .001), and seek the forgiveness of those they have wronged (OR 2.48, p < .001). In the context of R/S diversity among the patient and provider population, enhancing physician empathy may be key to attending to the health-related R/S needs of patients.

Genethics and Human Reproduction: Religious Perspectives in the Academic Bioethics Literature

The successes of the human genome project and genomics research programs portend great potential to improve upon health and enhance life. As scientific advancements continue, bioethicists and policy makers deliberate over the social and ethical implications of genetic and genomic technologies and information (ggT/I). The application of ggT/I to human reproduction raises conceptual and moral questions about being human and the links between offspring, parents, and society. Given ggT/I's ability to significantly affect the biological constitution of humans and future human generations thinking through such issues is fundamental to ethical and policy analysis. By means of a systematic literature review and accompanying content analysis, this paper highlights the dominant ethical concerns raised within recent bioethics discourse over the use of ggT/I for human reproduction. Based on these findings it aso offers a framework through which, and demarcates where, religious perspectives can add value to genethics debates and policy deliberation.

The Development and Validation of a Modesty Measure for Diverse Muslim Populations

This paper reports on the multi-phase development of an English-language modesty measure for use among Muslim populations. The process yielded a 10-item measure that has high levels of internal consistency reliability (Cronbach's α of 0.83), and has acceptable discriminant and predictive validity. Specifically although our modesty measure for Muslim women was found to be significantly correlated with measures of positive and negative religious (Islamic) coping, it was not significantly correlated with religious practice-based religiosity (discriminant validity). Further logistic modeling revealed higher modesty levels positively associated with forgoing mammography because of concerns about lack of same-sex providers (predictive validity).

Assessing Relationships Between Muslim Physicians’ Religiosity and End-of-Life Health-Care Attitudes and Treatment Recommendations: An Exploratory National Survey

Background:

Research demonstrates that the attitudes of religious physicians toward end-of-life care treatment can differ substantially from their nonreligious colleagues. While there are various religious perspectives regarding treatment near the end of life, the attitudes of Muslim physicians in this area are largely unknown.

Objective:

This article attempts to fill in this gap by presenting American Muslim physician attitudes toward end-of-life care decision-making and by examining associations between physician religiosity and these attitudes.

Methods:

A randomized national sample of 626 Muslim physicians completed a mailed questionnaire assessing religiosity and end-of-life care attitudes. Religiosity, religious practice, and bioethics resource utilization were analyzed as predictors of quality-of-life considerations, attitudes regarding withholding and withdrawing life-sustaining treatment, and end-of-life treatment recommendations at the bivariate and multivariable level.

Results:

Two-hundred fifty-five (41% response rate) respondents completed surveys. Most physicians reported that religion was either very or the most important part of their life (89%). Physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette. Physicians who were more religious had higher odds of viewing withdrawal of life-sustaining treatment more ethically and psychologically challenging than withholding it and had lower odds of agreeing that one should always comply with a competent patient’s request to withdraw life-sustaining treatment.

Discussion:

Religiosity appears to impact Muslim physician attitudes toward various aspects of end-of-life health-care decision-making. Greater research is needed to evaluate how this relationship manifests itself in patient care conversations and shared clinical decision-making in the hospital.

Acceptability of Friday Sermons as a Modality for Health Promotion and Education

Our objective was to assess the acceptability and feasibility of using sermons for health promotion in American Muslim mosque communities by deploying a tailored sermon in two mosque communities. With input from a community advisory board and resident imams, sermons communicated four health-related themes: (i) good health is a grant from Allah, (ii) one's body is trust and must be cared for, (iii) trusting in God's plan does not preclude taking actions to care for oneself, and (iv) community members are caretakers of one another. Self-administered, post-sermon questionnaires asked attendees about the acceptability of the sermon and the sermon-giver, and to identify survey themes. Data analyses involved descriptive statistics and regression modeling to assess variance in acceptability across race/ethnicity and gender. Of the 235 respondents, the majority found the sermon content acceptable and desired to hear health-based sermons more often (72 and 67% respectively). There were no significant differences in acceptability of sermon or sermon-giver by gender or race/ethnicity. Our study demonstrates that theologically-framed health messaging is acceptable within sermons in American Muslim mosque communities. This study underscores the potential utility of mosque sermons for health education programs and for health behavior interventions in American mosques.

The Problem of Female Genital Cutting: Bridging Secular and Islamic Bioethical Perspectives

Recent events, including the arrest of physicians in Michigan, have renewed bioethical debates surrounding the practice of female genital cutting (FGC). The secular discourse remains divided between zero-tolerance activists and harm-reduction strategists, while Islamic bioethical debates on FGC similarly comprise two camps. "Traditionalists" find normative grounds for a minor genital procedure in statements from the Prophet Muhammad and in classical law manuals. "Reformers" seek to decouple FGC from Islam by reexamining its ethico-legal status in light of the deficiencies within narrations ascribed to the Prophet, the health risks posed by FGC, and contemporary perspectives on human rights, and thereby delegitimize the practice. This paper argues that alignment between secular and Islamic views can be found in a harm-reduction strategy by demonstrating that the impetus to reduce harms is found within Prophetic statements on FGC. From an Islamic ethico-legal standpoint, it is justified to acknowledge the permitted status of FGC procedures that do not harm-in other words, the ritual nick-and at the same time the prohibited status of procedures that lead to credible medical and psychological harms. Bringing these multiple perspectives and data points into conversation forges a common ground to delegitimize and eradicate harmful genital procedures among Muslim communities.

Are Emergency Medicine Residents Prepared to Meet the Ethical Challenges of Clinical Practice? Findings from an Exploratory National Survey

BACKGROUND

Although the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine require clinical ethics education in residency training, instruction varies widely. We assessed the educational preparedness of trainees in emergency medicine to address ethics challenges common to their field.

METHODS

The survey assessed two outcomes: 1) knowledge of specific ethical challenges and 2) perceived educational preparedness, across five ethics areas: 1) informed consent and decisional-capacity assessment, 2) surrogate decision making, 3) interpretation of advanced directives, 4) withdrawing and/or withholding life support, and 5) presumed consent for emergency treatment. Clinical vignettes, revised through expert panel review and pilot testing, were utilized to evaluate these areas. The final instrument was administered via Web link to emergency medicine residents and recent graduates through adverts within Emergency Medicine Residency Association and Society for Academic Emergency Medicine (SAEM) newsletters and social media platforms. Additionally, targeted e-mails through the Council of Residency Directors in Emergency Medicine, the Clerkship Directors of Emergency Medicine, and the SAEM Ethics Committee listservs encouraged survey distribution. Analyses involved one-way analysis of variance for overall knowledge scores and chi-square tests for categorical outcomes. Multivariable regression models tested associations between respondent characteristics and outcomes.

RESULTS

There were 302 participants of which 34% reported having a dedicated ethics module within their residency curriculum. The mean (±SD) knowledge score was 59.7% (±12.8%); assessing decisional capacity was the most difficult topic for respondents as only 1% both correctly addressed the general issue and identified the correct plan of action. Participants having a dedicated ethics module perceived themselves better prepared, although there was no association between having a dedicated ethics module and knowledge scores.

CONCLUSIONS

Gaps in clinical ethics knowledge appear prevalent among emergency medicine trainees, and few programs have dedicated ethics modules. Greater study is needed to understand and remedy clinical ethics knowledge shortfalls.

The Essential Dimensions of Health According to the Maqasid al-Shariʿah Frameworks of Abu Ishaq al-Shatibi and Jamal-al-Din-ʿAtiyah

Contemporary Muslim thinkers have shown increasing interest in the higher objectives of Islamic law, maqaṣid al-shariah for reasons of utility and flexibility. Inductively derived from scriptural source-texts and the inherited legal canon, the maqasd have proven to be useful in interfaith dialogue and in addressing modern contexts because they are rationally accessible and can incorporate knowledge coming from the natural and social sciences as well as the humanities. In this paper, I examine the maqasid for applicability to the healthcare context. Specifically, I will describe the maqaṣid formulae of Islamic scholars Abu Ishaq al-Shatibi and Jamal-al-Din-ʿAṭiyah (Gamal Eldin Attia) and use them to generate theoretical models of the essential dimensions of human health. During my analyses of these authors’ frameworks, I will examine their views on how the maqaṣid are discovered, and on focus on their discussions regarding the preservation of human life and intellect. I will also compare the relative relevance of their models to modern biomedicine in terms of their “openness” to data coming from the health sciences and in light of contemporary knowledge about the determinants of health.

Abstract 5273: Outcomes from a religiously tailored intervention to enhance mammography uptake among American Muslims

Objective: Describe outcomes of a religiously-tailored peer-led group educational intervention addressing mammography-related barrier beliefs of American Muslims.

Methods: We used focus groups and interviews with a diverse group of Muslim women aged 40 and older to identify salient behavioral, normative and control beliefs regarding mammography. We used these data to design the curriculum and messaging for a mosque-based intervention involving peer-led group education. A novel model for religious tailoring was developed to address barrier beliefs by reframing, reprioritizing, and/or reforming belief structures. Peer educators were recruited/trained from mosques to match the ethnic composition of target population. The classes involved facilitated discussions and guest-led didactics covering religion and health, and mammography guidelines. Survey data was collected pre-, post, 6 months, and one-year post-intervention which captured changes in three primary outcome variables (1) perceived mammography intention, likelihood, confidence, (2) breast cancer knowledge and (3) receipt of mammograms. Resonance with barrier and facilitator beliefs was also measured.

Results: Fifty-eight Muslim women who had not had a mammogram in the past two years participated. Mean age was 50 years, with 29 being South Asian and 18 being of Arab descent. With respect to changed intention/likelihood/confidence pre-post there was a significant increase in mean perception of likelihood to obtain a mammogram (0.29, P = 0.01). Mammography knowledge also significantly increased following the intervention (p = 0.0002). Importantly, 22 participants received a mammogram at one-year follow-up. With respect to belief structures, a marginally significant increase was observed in level of agreement with mammography facilitator beliefs (p = 0.08) post-intervention. Although overall level of agreement with the outcome variable of mammography barrier beliefs did not change following the intervention (p = 0.94), there was a significant decrease in agreement with the specific belief in fatalism (p = 0.03). Multivariable models demonstrated that higher levels of agreement with fatalistic beliefs at baseline was significantly associated with a lower odds of increased mammography knowledge following the intervention (OR = 0.73), while higher religiosity at baseline was significantly associated with higher odds of increased mammography knowledge following the intervention (OR = 1.90).

Conclusion: Our mosque-based intervention involving religiously-tailored messages and peer-led classes demonstrated efficacy in behavioral change by improving Muslim women's self-reported likelihood of obtaining mammograms and having 38% of participants obtained a mammogram within a year.

Citation Format: Aasim I. Padela, Sana Malik, Shaheen Nageeb, Stephen Hall, Fatema Mirza, Monica Peek, Michael Quinn. Outcomes from a religiously tailored intervention to enhance mammography uptake among American Muslims [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5273.

Jewish, Christian and Muslim theological perspectives about xenotransplantation

BACKGROUND

This paper is based on a theological symposium presented at the International Xenotransplantation Association's 14th Congress held in Baltimore, MD, September, 2017.

METHODS

The information explores the Jewish, Christian and Muslim theological perceptions and perspectives about cross-species (ie pig-to-human) organ transplantation, the genetic alterations required in the organ-source pig, and their potential to influence individual acceptance of the procedure.

RESULTS/CONCLUSIONS

This work should not be considered as the ultimate word about individual theological views, but rather as part of an ongoing conversation that will hopefully lead to wider consideration and exploration of these issues as xenotransplantation science advances towards clinical trials.

Reducing Muslim Mammography Disparities: Outcomes From a Religiously Tailored Mosque-Based Intervention

OBJECTIVE

To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention.

METHOD

Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs.

RESULTS

A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram.

CONCLUSION

Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention.

IMPACT

Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.

Developing religiously-tailored health messages for behavioral change: Introducing the reframe, reprioritize, and reform ("3R") model

RATIONALE

As community health interventions advance from being faith-placed to authentically faith-based, greater discussion is needed about the theory, practice, and ethics of delivering health messages embedded within a religious worldview. While there is much potential to leverage religion to promote health behaviors and improve health outcomes, there is also a risk of co-opting religious teachings for strictly biomedical ends.

OBJECTIVE

To describe the development, implementation, and ethical dimensions of a conceptual model for religiously-tailoring health messages.

METHOD

We used data from 6 focus groups and 19 interviews with women aged 40 and older sampled from diverse Muslim community organizations to map out how religious beliefs and values impact mammography-related behavioral, normative and control beliefs. These beliefs were further grouped into those that enhance mammography intention (facilitators) and those that impede intention (barriers). In concert with a multi-disciplinary advisory board, and by drawing upon leading theories of health behavior change, we developed the "3R" model for crafting religiously-tailored health messages.

RESULTS

The 3R model addresses barrier beliefs, which are beliefs that negatively impact adopting a health behavior, by (i) reframing the belief within a relevant religious worldview, (ii) reprioritizing the belief by introducing another religious belief that has greater resonance with participants, and (iii) reforming the belief by uncovering logical flaws and/or theological misinterpretations. These approaches were used to create messages for a peer-led, mosque-based, educational intervention designed to improve mammography intention among Muslim women.

CONCLUSIONS

There are benefits and potential ethical challenges to using religiously tailored messages to promote health behaviors. Our theoretically driven 3R model aids interventionists in crafting messages that address beliefs that hinder healthy behaviors. It is particularly useful in the context of faith-based interventions for it highlights the ethical choices that must be made when incorporating religious values and beliefs in tailored messages.

Framing the Mind-Body Problem in Contemporary Neuroscientific and Sunni Islamic Theological Discourse

Famously posed by seventeenth-century French philosopher René Descartes, the mind-body problem remains unresolved in western philosophy and science, with both disciplines unable to move convincingly beyond the dualistic model. The persistence of dualism calls for a reframing of the problem through interdisciplinary modes of inquiry that include non-western points of view. One such perspective is Islamic theology of the soul, which, while approaching the problem from a distinct point of view, also adopts a position commensurate with (substance) dualism. Using this point of convergence as a conceptual starting point, we argue that bringing into dialogue contemporary neuroscientific, philosophy of mind, and Sunni Islamic theological discourses may provide a fruitful way of reframing the age-old mind-body problem. This paper provides an overview of how these three discourses have approached the issue of the mind-body (-soul) problem. Juxtaposing these three discourses, we hope, may ignite further scholarly dialogue and investigation.

Muslim women's perspectives on designing mosque-based women's health interventions-An exploratory qualitative study

Mosques could serve as a promising setting for health interventions. However, little empirical data are available to guide the development of mosque-based health interventions, especially for women. We aimed to assess Muslim women's views on effective strategies for mosque-based educational interventions to promote women's health. A sample of Muslim women of diverse ethnicity and race was recruited from mosques in Chicago to participate in semi-structured interviews. In interviews, nineteen participants (aged 41-67 years) discussed characteristics of the imam and peer educator, aspects of the intervention modality, and content of health messaging that would be effective in mosque-based health programs. Participants reported that imams should have health-related knowledge to deliver to be successful, while peer educators should be respected women, educated in both religion and health. Sermons and group education classes were believed to be modalities that could reach a large portion of the community for discussions of women's health issues. Participants also suggested that sermons should use scriptural sources to convey the importance of women's health. Participants supported imam-led sermons and peer-led educational classes as effective strategies to promote women's health. Our study results speak to strategies for leveraging religious concepts to promote health among Muslim women.