Religiously tailored education increases mammography use in Muslim women
A religiously tailored educational effort increased receipt of mammograms among Muslim American women, according to study results presented at American Association for Cancer Research Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Research showed only 50% of Muslim American women get mammograms every 2 years — in concordance with U.S. Preventive Services Task Force guidance — compared with 67% of all American women, Aasim I. Padela, MD, MSc, director of the Initiative on Islam and Medicine, associate professor of medicine in the section of emergency medicine, and associate investigator at Comprehensive Cancer Center of University of Chicago, said in a press release.
“Routine mammograms have helped significantly reduce mortality from breast cancer, but we know that some religious and cultural beliefs discourage Muslim American women from getting mammograms,” Padela said. “We wanted to see if we could engage these women within the framework of their faith to encourage them to obtain mammograms.”
Padela and colleagues used community-engaged research methods to identify and design a religiously tailored education program to address beliefs that create mammography-related barriers among Muslim American women.
In the first phase of the study, researchers conducted focus groups and interviews with an ethnically diverse group of women aged 40 and older from Muslim organizations to identify relevant behavioral, normative and control beliefs about mammography.
The researchers identified numerous “barrier beliefs” that prevented Muslim women from getting mammograms. For example, many women believed that God controls diseases and cures, so screening would not be beneficial. In addition, because the Islamic faith places a high priority on modesty, many Muslim women may feel discomfort exposing their bodies for mammograms or having male practitioners.
The second phase of the study included additional interviews with the same target population to prompt ideas for intervention design.
The researchers then designed curriculum and messaging for a religiously tailored, mosque-based intervention involving a two-session series of peer-led health education classes.
Researchers recruited peer educators from mosques and trained them to lead classes involving facilitated discussions and guest-led didactics regarding religion, health and mammography.
For example, peer educators explained that although God may control disease, religious teachings also stress that women must be good “stewards” of their bodies, so it is important to obtain information about one’s health, Padela said.
“We reflected with them that while maintaining modesty is critically important, it is not the ultimate value,” he added. “Religious scholars note that if no option is available, mammography can be performed by a male technician. However, we also shared that most centers have female staff.”
The researchers surveyed participants before the classes, and then immediately, 6 months and 1 year after the classes.
Before the classes, 52 Muslim American women (mean age, 50 years) — 18 of whom were of Arab descent and 27 of South Asian descent — reported they had not had a mammogram in the past 2 years.
At the 6-month follow-up interviews, 42% of women had already obtained a mammogram. Four participants (7.7%) were lost to follow-up.
The likelihood of obtaining a mammogram (P = .03) and knowledge about breast cancer screening (P = .0002) increased significantly following intervention. Greater resonance with facilitator beliefs appeared to significantly predict positive likelihood of change (OR = 1.31; P = .003).
Women with higher negative religious coping (OR = 1.33; P = .04) and greater resonance with facilitator beliefs (OR = 1.44) appeared more likely to report having an intention to get a mammogram following the class.
Adversely, those with higher religiosity (OR = 0.72; P = .01) and more resonance with barrier beliefs (OR = 0.72; P = .01) had significantly lower intentions.
“It’s a challenge to frame healthy behaviors within the context of religious beliefs and cultural values,” Padela said. “But we believe that by engaging with such deeply held aspects of identity, we can meet people where they are and encourage them to uphold their beliefs in a way that also benefits their health.” – by Kristie L. Kahl
Padela A, et al. Abstract C03. Presented at: American Association for Cancer Research Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 25-28, 2017; Atlanta.
Disclosure: Padela reports no relevant financial disclosures.