Faith-based medicine

Pratt Sharif

From left: Imam Sharif Mohamed, U faculty member Rebekah Pratt, Ph.D., and U researcher Nimo Ahmed discuss efforts to promote higher rates of cancer screening in the Somali community.

U researcher and local imam team up to use religion in the fight against cancer

Imam SharifSharif 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. Rebekah 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.”

What’s next

The next big next step for Pratt and Mohamed is to assess whether their work is influencing screening rates. They are currently applying for larger grants to look at these correlations and, ultimately, hope to test their messages with other audiences.

“First, we need to see if this work has an impact on screening,” Pratt explains. “If it does, this has got wonderful potential to be shared and disseminated across a number of communities.”

Already, local health systems have expressed interest in adapting Mohamed and Pratt’s messages to cervical and breast cancer screening programs and in using their approach to improve colorectal cancer screening rates among local Somalis. Mohamed also continues to work within his mosque to promote pro-screening messages.

“It’s quite exciting, because this is a low-cost intervention that really connects with the community,” Pratt says. “Our video messages can be shared and delivered in a clinic, in the community, or in the mosque. It’s got wonderful potential to make a big impact. That’s our hope.”

“Germinating the seed:” the impact of your philanthropy

When they started this work, neither Pratt nor Mohamed realized how quickly it would take flight. But one thing they both believe is that it wouldn’t have left the ground without Masonic support.

“This has given us the opportunity to germinate the seed of an idea and give it the space to grow. It’s been a wonderful investment,” says Pratt.

“Thank you for working with us and trusting us,” adds Mohamed. “This not only means a great deal to us, but most importantly, to the community as we help people become healthy.”

“And that kind of healthy is ultimately about saving lives,” Pratt says.

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Faith-based medicine