A U OF M RESEARCHEr AND A LOCAL IMAM TEAM UP TO FIGHT CANCER
In his 20 years as imam at the Dar Al-Hijrah Mosque in Minneapolis, Sharif Mohamed has helped his congregants in many ways. But his work took an unexpected turn when he learned of some of the stark health disparities facing his community.
“Being a faith leader, especially in the Muslim community, carries a lot of responsibility,” he says. “When people come to you for answers, you feel an obligation to learn more about an issue and take action.”
That’s just what Mohamed is doing. Along with Rebekah Pratt, an assistant professor in the University of Minnesota Medical School’s Department of Family Medicine and Community Health, and support from Minnesota Masonic Charities, he is working with his community of faith to fight cancer.
Over the years, Mohamed and Pratt, a member of the Medical School’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 a new focus when they learned of startling statistics for breast and cervical cancer screening among local Somali women. “When we first started this work, those rates were terribly low,” Pratt says. “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.”
Although there has been marginal progress, the number of Somali women who get screened continues 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, according to Pratt. “That’s massively less than what we see in the general population, where rates range from 70 to 80 percent,” she says.
The issue isn’t unique to cervical or breast cancer. The rate for colorectal cancer screening among all Somali patients at one local clinic is only 8 percent. “People have been trying for a long time to make the statistics move, but haven’t had a lot of success,” Pratt says.
Reasons for foregoing screening are complex and varied. For some, lack of health literacy and knowledge about cancer are obstacles. For others, especially first-generation immigrants, the approach to health care in their home country gets in the way. “Back home in Somalia, we don’t see doctors for preventive check-ups or screenings,” Mohamed says. “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 about the Muslim faith prevent many women from getting screened for breast and cervical cancer, in particular. Some feel it’s inappropriate to show their bodies to medical providers—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’s or God’s will.
“When I hear the notion that faith is a barrier to cancer screening, it concerns me,” Mohamed says. “It’s important to explore where this misunderstanding is coming from.”
TURNING BARRIERS INTO ASSETS
With Masonic support, Pratt and Mohamed tested the theory that religion can be an important asset, rather than a barrier, in promoting breast and cervical cancer screening among Somali women.
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 screening.
Mohamed then shared those messages, via DVD and in person, with a group of 30 local Somali women and 12 male religious leaders. After watching the video and taking part in group discussions, the participants provided extensive feedback about their views on cancer screening and whether the messages were influential. The women also were asked whether they would consider getting screened after hearing the messages.
Both the women and men had overwhelmingly positive responses to the messages promoting breast and cervical cancer screening. Those who were already inclined to view screening positively said they felt more confident about it. Those who initially had reservations about screening indicated that the messages changed their view. Of the 12 imams who received training, 11 committed to spreading pro-screening messages to their congregations. All 30 of the women said attending the workshop made them more likely to have a mammogram or Pap screening in the next year.
“Our initial assumption was that the participants would be hesitant and not ready to discuss topics like this,” Mohamed says. “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, it’s OK to talk.
“Sometimes if the community sees someone come in from the outside on projects like this, there’s a lot of hesitancy,” he says. “But when they see that they are writing the script, that it comes from them, we are successful.”
Says Pratt: “When we build on the strengths and assets of the community, the community shows up. They’re super engaged, and that’s because people very much want to address these issues in a way that recognizes their values.”
When they started this work in 2016, neither Pratt nor Mohamed realized how quickly it would take flight. One thing they both believe is that it wouldn’t have gone anywhere without support from Masonic Charities.
“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,” Pratt says.
The next step is for Pratt and Mohamed to assess whether their work is influencing screening rates. They’re applying for larger grants to look at these correlations and hope to test their messages with other communities in Minnesota and beyond that are facing these challenges.
Already, local health systems have expressed interest in adapting Mohamed’s and Pratt’s messages to cervical and breast cancer screening programs and in using their approach to improve colorectal cancer screening rates among 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 of the video messages that 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.”
Lesley Schack is a contributor to Legacy magazine.
Promoting cancer screening
These are some of the messages U of M researcher Rebekah Pratt and imam Sharif Mohamed developed using Islamic principles to encourage screening.
On predestination (fate)
• Screening does not bypass predestination.
• Treatment is also predestined and is there to be taken.
On the role of modesty
• Modesty of the heart is as important as modesty of the body.
• It is more important to seek a doctor who has knowledge and confidence in the health at hand than a doctor of the same gender.
On cancer screening and treatment
• Prevention of disease is a faithful and religious thing to do.
• Prevention is better than cure.