ATLANTA -- A religiously sensitive educational effort designed to address barriers to mammography for Muslim women increased the women's perceived likelihood of getting the breast screening and their eventual receipt of mammograms, according to results of a study presented at the 10th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held here Sept. 25-28.
"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," said the study's lead author, Aasim Padela, MD, MSc, director of the Initiative on Islam and Medicine, associate professor of medicine in the Section of Emergency Medicine, and an associate investigator of the Comprehensive Cancer Center at the University of Chicago. "We wanted to see if we could engage these women within the framework of their faith to encourage them to obtain mammograms."
Padela said that previous research has shown that about 50 percent of Muslim-American women get mammograms every two years, compared to 67 percent of all American women. The U.S. Preventive Services Task Force recommends that women between ages 50 and 74 get mammograms every two years; younger women are encouraged to consider risk factors and decide with their doctors when to begin receiving mammograms.
Padela and colleagues conducted focus groups and interviews with women from Muslim organizations, seeking to learn about their beliefs about mammography. They then designed a curriculum and messages for a series of health education classes to be held in Chicago-area mosques. They recruited peer educators from the mosques, and taught them messages to use in conjunction with talks from physicians and breast cancer surgeons. Finally, they surveyed participants before the classes, then again immediately afterward, six months after the classes, and one year after the classes.
Padela said the researchers identified numerous "barrier beliefs" that prevented Muslim women from getting mammograms. For example, many believed that God controls diseases and cures, so screening would not be beneficial. Also, 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, Padela explained.
The research team designed interventions that considered these religious ideas while still communicating the importance of mammography screening. For example, Padela said, the peer educators told the women that while 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.
To reframe the women's feelings about modesty, Padela said, "We reflected with them that while maintaining modesty is critically important, it is not the ultimate value. 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."
At the six-month follow-up interviews, 20 of 47 participants (42 percent) had already obtained a mammogram. Overall, the women reported being significantly more likely to get a mammogram than they had been before the classes.
"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."
Padela said the study's primary limitation was its small size. Also, because the participants were regular attendees at their mosques, they may have been more religious than the Muslim population as a whole and, as such, these findings may not be applicable to the broader Muslim population.
Padela declares no conflicts of interest.
Reducing Muslim mammography disparities: Outcomes from a religiously tailored mosque-based intervention. Aasim Padela, Sana Malik, Shaheen Nageeb, Monica Peek, Michael Quinn. university of chicago, Chicago, IL.
Objective: To describe the design of, and participant-level outcomes related to, a religiously-tailored peer-led group education program that addressed mammography-related barrier beliefs of American Muslims.
Methods: Using community-engaged research methods including a multi-disciplinary community advisory board, we identified and then intervened upon barrier beliefs impeding mammography screening among American Muslim women. Phase 1 of the project involved focus groups and interviews with an ethnically-diverse group of women aged 40 and older sampled from Muslim organizations to identify salient behavioral, normative and control beliefs regarding mammography. Phase 2 entailed interviews with the same target population to elicit ideas about intervention design. CAB members and staff used these data to design the curriculum and messaging for a religiously-tailored mosque-based intervention involving peer-led group education classes. Peer educators were recruited and trained from mosques and were religious and ethnically concordant with the target intervention population. The classes involved facilitated discussions and guest-led didactics covering religion and health and mammography. Survey data from group education participants was collected pre-intervention, post-intervention, 6 months post-intervention, and one year post-intervention. Survey instruments recorded changes in mammography intention, likelihood, confidence and resonance with barrier and facilitator beliefs.
The structural elements and messages of the classes tackled barrier beliefs in at least one of 3 ways (i) Reprioritizing- introducing another religious belief that has greater resonance with participants such that the barrier belief is marginalized, (ii) Reframing the belief within a religious worldview such that it is consistent with the health behavior desired, and (iii) Reforming- using a religious scholar to provide "correct" interpretations of religious doctrine.
Results: 52 Muslim women (mean age = 50 yrs) that had not had a mammogram in the past two years of which 18 were of Arab descent and 27 South Asian participated in the two-session course. The pre- and post- self-reported likelihood of obtaining a mammogram increased significantly following the intervention (p=0.03) as did breast cancer screening knowledge (p=0.0002). Greater resonance with facilitator beliefs significantly predicted positive likelihood changes (OR 1.31, p=.003). Participants with higher negative religious coping (OR = 1.33, p=0.04) and greater resonance with facilitator beliefs (OR = 1.44, p = 0.00) had higher odds for having an intention to get a mammogram post the class, while those with higher religiosity (DUREL, OR = 0.72, p= 0.01), and more resonance with barrier beliefs (OR= 0.72, p= 0.01) had significantly lower intentions. At six months follow-up, 42 % (n= 20/47) of participants had obtained a mammogram and 7.7 % (n=4) were lost to follow up.
Conclusion: Our pilot mosque-based intervention involving religiously-tailored messages delivered through peer-led classes demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms post-class, and over 40% of participants eventually obtained a mammogram within 6 months of the classes.
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