Attitudinal Determinants of Turkish Diabetic Patients and Physicians About Ramadan Fasting

Ramadan as religious ritual: Experiences of Muslim people with Type 2 Diabetes in Türkiye regarding Ramadan

This study aims to determine the experiences of Muslim people with Type 2 Diabetes Mellitus (DM) about Ramadan in Türkiye. This phenomenological study was conducted with 30 Muslim people with Type 2 DM. The data were collected by holding in-depth individual interviews with a semi-structured interview form and analyzed using Colaizzi's seven-stage analysis and the MAXQDA-20 program. As a result, three main themes with 12 categories were determined as follows: (i) "the month of Ramadan and the meaning of fasting", (ii) "the effects of fasting", and (iii) "coping with difficulties". The participants stated that the month of Ramadan is one of the pillars of Islam and that it includes worshiping, finding peace, completing oneself in the religious sense, purifying oneself from sins, resting physically and spiritually, and appreciating the meaning of hunger, thirst, and blessings. However, some people reported that there was social pressure when they did not fast. Health professionals should provide people with DM with regular and safe training specific to Ramadan, establish support groups, and cooperate with religious officials (imams) to meet their religious demands.

Feelings, Difficulties and Attitudes in relation to Fasting: A Qualitative Study on Spiritual Coping Among Turkish Patients with Type 2 Diabetes

This study aims to reveal the feelings, difficulties, attitudes, and spiritual coping status of Turkish patients with Type 2 diabetes mellitus toward fasting during Ramadan. The sample of this descriptive qualitative study consists of 14 patients diagnosed with Type 2 diabetes. We determined two main themes and relevant sub-themes. The first was "the feelings and difficulties experienced due to diabetes mellitus" with the sub-themes of "negative emotions" and "difficulties in fasting." The second theme was identified as "religious and spiritual coping" with the sub-themes of "believing the disease comes from God," "having difficulty in adhering to disease-specific practices while fasting," and "feeling that fasting facilitates coping and provides relief." In conclusion, it was determined that the patients continued to fast despite the difficulties and that fasting facilitated coping and provided relaxation.

“I am my own doctor”: A qualitative study of the perspectives and decision-making process of Muslims with diabetes on Ramadan fasting

Background

Many Muslims with diabetes choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications. Patients are often reluctant to disclose fasting to their health care providers, and their needs regarding Ramadan are not met in consultations. For healthcare professionals to provide patient-centred care, it is important to gain more insight into patients’ decision-making process. This study therefore aims to explore how Muslims with diabetes decide whether to fast during Ramadan.

Methods

A qualitative study was conducted consisting of 15 focus groups with Muslims with diabetes within a constructivist paradigm. Convenience sampling was used. All focus groups were transcribed verbatim and analyzed using Braun and Clarke’s reflexive thematic analysis.

Results

Four themes were found to be important in the decision on whether to fast: (1) values and beliefs concerning Ramadan, (2) experiences and emotions concerning Ramadan, (3) the perception of illness, and (4) advice from health care professionals, imams and family. Many participants indicated fasting against medical advice and trusting their subjective assessments on whether they could fast. Moreover, three main stages in the decision-making process for eventually refraining from fasting were identified: (1) the stage where positive experiences with fasting dominate, (2) the stage where one encounters challenges but their determination to fast prevails and (3) the stage where one decides to refrain from fasting after experiencing too many physical difficulties with fasting.

Conclusions

Muslims with diabetes experience autonomy in their decisions on Ramadan fasting. The decision to refrain from fasting often resulted from a difficult and dynamic decision-making process and was often made after participants reached their physical limits. These findings highlight the importance of not only shared decision-making to empower patients to make well-informed decisions on Ramadan fasting but also pre-Ramadan diabetes education to help people with diabetes have a safe Ramadan.

Communicating with Clinicians on Fasting during Ramadan: The Patients' Perspective

Caring for millions of Muslim patients who decide to fast during Ramadan can be challenging for clinicians. Using a theory-guided approach, this study explores Muslim patients' perspectives on factors influencing communication with clinicians in relation to fasting during Ramadan. Semi-structured interviews were conducted with a sample of patients in Egypt (9) and the USA (8). Participants were purposefully sampled to assure variance in age, gender, education, decision to fast and ethnicity. Data emerging from narratives were mapped to constructs within the Linguistic Model of Patient Participation in Care (LMOPPC). Using framework analysis, iterative sampling and analysis continued until saturation. Drawing on LMOPPC, participants' narratives were mapped and clustered into patient participation and quality of care; predisposing factors (perceptions about fasting and its significance including sense of spiritual benefit when fasting and sense of guilt when not fasting, prior experiences including prior conversations with clinicians on fasting and experience of fasting while sick, patients' personality and locus of control, belief in the legitimacy of participation, motivations and perception of need to communicate with clinicians about fasting, provider verbal and nonverbal responses, and provider-patient rapport); and enabling factors (knowledge about the topic and repertoire of communicative skills, presence of companions during appointment, and timing of appointments). The LMOPPC framework provided insight into patients' perspectives on barriers and facilitators for communication with clinicians about fasting during Ramadan. It is important for stakeholders to consider those issues when implementing interventions aiming to adopt a concordant approach in providing care for this group of patients.

Perceptions among Muslims regarding fasting, medication use and provider engagement during Ramadan in the United States

BACKGROUND

Muslims with chronic diseases tend to fast during Ramadan, although Islam allows them not to fast. Therefore, understanding their perceptions and how they manage their health, especially as a minority population, is very important.

OBJECTIVE

To examine Muslims' (1) perceptions of fasting exemptions, (2) medication usage behaviour, (3) perceptions of relationships with healthcare providers and (4) factors impacting health management during Ramadan.

METHOD

This was a qualitative study employing four focus groups (two groups of women and two groups of men). Adult Muslims (aged 18 years or more) with chronic diseases were invited to participate. Participants were asked open-ended questions about their fasting ability, medication usage behaviours, healthcare access and collaboration with providers during Ramadan. Trained researchers conducted the focus groups interviews in both English and Arabic. Each focus group was recorded, and three investigators independently transcribed the data and extracted themes and categories. Coding terminology issues were resolved through discussion.

RESULTS

Twenty-five Muslims with chronic diseases (e.g., diabetes, hypertension, renal failure and anaemia) participated. The most prominent themes/subthemes were as follows: (1) fasting exemption (e.g., uncontrolled medical conditions), (2) fasting nonexemption (e.g., controlled medical conditions), (3) nonoral medication use during Ramadan, (4) healthcare provider involvement during Ramadan, and (5) factors impacting health management during Ramadan.

CONCLUSION

Muslim patients perceive fasting as an important religious practice, so they tend to self-modify their medication-taking behaviours. Educating pharmacists and other healthcare providers about Muslim culture, especially their strong desire to fast, may lead to Muslims better managing their medications and viewing pharmacists and other healthcare providers as knowledgeable healthcare providers.

Clinicians' Perspectives on Caring for Muslim Patients Considering Fasting During Ramadan

This study explores clinicians' perspectives on factors affecting care provided to Muslim patients who decide to fast during Ramadan. Semi-structured interviews were conducted with a purposeful sample of clinicians in Egypt (11) and the USA (10). Framework analysis was conducted through mapping data to constructs within social cognitive theory. Data were mapped into clinician's belief in ability to care for those patients, belief in group's ability to provide care, anticipated consequences of providing such care, knowledge, learning by observing other clinicians, cultural norms and perceived acceptability and prevalence of care provision, environmental barriers and opportunities, and communication approach.

Knowledge, Attitude and Practice Regarding Ramadan Fasting and Related Determinants in Patients with Type 2 Diabetes at a Saudi Diabetes Clinic

OBJECTIVE

This study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice.

METHODS

A total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21.

RESULTS

The mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p<0.041), education (OR: 0.068, 95% CI: 0.008,0.594, p<0.015) and family history (OR: 5.086, 95% CI: 1.095, 23.630 p<0.038) were identified as independent determinants of the total score.

CONCLUSION

Gender, Family history of diabetes and Education are determinants of knowledge, attitude and practice regarding fasting during Ramadan in the T2DM patients. A significant knowledge practice gap exists that necessitates further strengthening of the Pre-Ramadan education program for T2DM patients.