ICSA/OPR is Proud of Our Work with U of M Research and Masonic Charities to advance Faith
Based Medicine in the Muslim communities of Minnesota.

Sharif Mohamed has helped his congregants through a lot in his 20 years as imam at the Dar
Al-Hijrah Mosque in Minneapolis. But his work took an unexpected twist when he learned of
some of the stark health care disparities facing his community.
“Being a faith leader, especially in the Muslim community, carries a lot of responsibility,”
says Mohamed. “When people come to you for answers, you feel an obligation to learn more
about an issue and take action.”
Today, with Masonic pilot support, that’s just what Mohamed is doing. Together, he and U
faculty member Rebekah Pratt, Ph.D., are leveraging the community’s faith to promote good
health. And while some argue that religion can be a barrier to health care, they are using
individual and community belief systems as a powerful asset in the fight against cancer.

Troubling statistics

Over the years, Mohamed and Pratt, a member of the U’s Program in Health Disparities
Research,
have partnered on a number of projects related to health issues in the Somali community.
But in 2012, their work took on new focus when they learned of startling statistics for
breast
and cervical cancer screening among local Somali women.

“When we first started this work, these rates were terribly low,” says Pratt. “Some clinics
were
reporting that only 8 percent of eligible Somali women were getting mammograms and the rates
for
Pap smears weren’t much better.”

While there has been marginal progress, the statistics continue to lag. “Today, the
screening
rates for both breast and cervical cancer among Somali women in the Cedar-Riverside area of
Minneapolis are around 30 percent,” Pratt explains. “That’s massively less than what we see
in
the general population where rates range from 70 to 80 percent.”

In a community where cancer is all too prevalent, the need for early detection and
prevention is
more pressing than ever. East African women, for example, have the highest rates of cervical
cancer in the world. And the issue isn’t unique to cervical or breast cancer. Recently, the
rate
at one local clinic for colorectal cancer screening among Somali patients was only 8
percent.

Barriers to screening

Unfortunately, low rates of cancer screening in the Somali community are not new. “People
have been trying for a long time to make the statistics move, but haven’t had a lot of
success,” says Pratt. Reasons for foregoing screening are complex and varied.

For some, lack of health literacy and knowledge about cancer poses obstacles. For others,
especially first-generation immigrants, the approach to health care in their home country,
with less emphasis on prevention, gets in the way. “Back home in Somalia, we don’t see
doctors for preventive check-ups or screenings,” explains Mohamed. “You only go to the
doctor if you’re very sick and have obvious symptoms…people ask why they need to see a
doctor if they aren’t experiencing pain.”

But Pratt and Mohamed are most interested in faith-based reasons for foregoing screening.Over
the years, they and other researchers have found that misunderstandings of the Muslim faith
prevent many from getting screened for breast and cervical cancer, in particular. Some feel
it’s inappropriate to show their bodies to others, including medical providers and
especially those of the opposite sex. Others think that developing cancer is a matter of
fate and that screening is an attempt to bypass Allah or God’s will.

“When I hear the notion that faith is a barrier to cancer screening, it concerns me,” says
Mohamed. “It’s important to explore where this misunderstanding is coming from and specific
views on it.”

Turning barriers into assets

Misunderstandings can, at times, become ingrained into the belief systems of a community.
And
overcoming deeply held beliefs, which can include misinterpretations of faith, is easier
said
than done.

That’s why with Masonic support, Pratt and Mohamed tested the theory that religion is an
important asset, rather than a barrier, in promoting breast and cervical cancer screening
among
Somali women.

Together, guided by Mohamed’s expertise as an Islamic scholar and faith leader, they developed
messages based on the Muslim faith that offer support for preventive care, focusing on religious
concepts that address barriers to screening for breast and cervical cancer, in particular.

They then shared the messages with 30 local Somali women and 12 male religious leaders
during
workshops to learn more about attitudes and experiences around screening. The messages were
delivered by Mohamed via DVD and in person. After watching the clips and contributing to
larger
group discussions, the participants provided extensive feedback about their views on cancer
screening, whether the messages were influential, and whether they would consider getting
screened.

“Through our conversations, we found that religious messages, faith-based perspectives and
interventions, could actually be very powerful assets for health promotion and health
behavior
change,” Pratt says.

Improving views on cancer screening

The women and men participating in the workshops had overwhelmingly positive responses to
Mohamed and Pratt’s faith-based messages promoting breast and cervical cancer screening.

The messages gave those inclined to view screening positively increased confidence to engage
in
screening. Those who initially had reservations about screening indicated that the messages
had
meaningfully influenced their views. And of the 12 imams who received training, 11 committed
to
spreading pro-screening messages to their congregations.

“Our initial assumption was that the participants would be hesitant and not ready to discuss
topics like this,” Mohamed reflects. “But perhaps the atmosphere, the fact that we held
these
workshops in the mosque, helped people feel safe. Maybe they feel that if the mosque
promotes
this approach, it’s OK to talk. The community is ready to do more of this.”

By the people, for the people

For Pratt and Mohamed, a key ingredient to the success of their workshops is that they were
driven by the community.

By recognizing faith-based concerns within the community, crafting and sharing religious
reasons
for screening, and using culturally sensitive approaches such as separate workshops for men
and
women, Pratt and Mohamed were able to make real inroads.
“Sometimes if the community sees someone come in from the outside on projects like this,
there’s
a lot of hesitancy,” says Mohamed. “But when they see that they are writing the script, that
it
comes from them, we are successful.”

“When we develop our work to build on the strengths and assets of the community, the
community
shows up,” adds Pratt. “They’re super engaged and it’s because people are very much wanting
to
address these issues in a way that recognizes their values.”