Portraying Islam and Muslims in MEDLINE: a content analysis

Biomedicine and the treatment of difference in a Jerusalem emergency department

Biomedicine has played a key role in the dissemination of modern social norms, such as the emphasis on individual autonomy and the distinction between science and religion. This study examines the way the mostly-Jewish members of the medical staff at an emergency department of a Jerusalem hospital perceive Jewish ultra-Orthodox and Arab patients' behaviors vis-à-vis the existing biomedical norms. We analyzed participants' perceptions in terms of the social constructs they reveal, their meanings, and their implications. Semi-structured in-depth interviews were conducted with 24 staff members and were analyzed using content analysis. The staff described challenges in treating Arab and ultra-Orthodox patients, which they related to both groups' embeddedness in traditional "cultures" and collective identities. According to the participants, in both cases, the patients' cultural affiliations constrained their sense of individual autonomy and rationality. However, in the comparative analysis, two differences emerged. First, while both groups were perceived to diverge from modern norms of individual autonomy, in the case of Arab patients, these characteristics were presented as disruptive and potentially threatening to the hospital staff. By contrast, in the case of ultra-Orthodox patients, adherence to traditional and collective values was more likely to be represented as a risk to the patient, rather than to the staff. Second, staff were more likely to provide accommodations for ultra-Orthodox patients than for Arab patients. These accommodations were often described in the frame of "cultural competency." We suggest that divergences in how staff understood and responded to perceived cultural differences of each group reflect unequal impacts of structural determinants of health, including of political conflict. We recommend moving beyond the conceptual framework of cultural competency to strengthen the staff's structural competency, cultural and structural humility, and critical consciousness.

Pathways Through Early Psychosis Care for U.S. Youths From Ethnically and Racially Minoritized Groups: A Systematic Review

OBJECTIVE

The authors of this systematic review examined service utilization and outcomes among youths from ethnoracially minoritized groups after the youths initiated treatment for a psychotic disorder-that is, the youths' "pathway through care." Also examined were potential moderating variables in pathways through care for these youths at the clinic, family, and cultural levels. The goal was to describe methodologies, summarize relevant findings, highlight knowledge gaps, and propose future research on pathways through care for young persons from ethnoracially minoritized groups who experience early psychosis.

METHODS

The PubMed, PsycInfo, and Web of Science literature databases were systematically searched for studies published between January 1, 2010, and June 1, 2021. Included articles were from the United States and focused on young people after they initiated treatment for early psychosis. Eighteen studies met inclusion criteria.

RESULTS

Sixteen of the 18 studies were published in the past 5 years, and 11 had an explicit focus on race and ethnicity as defined by the studies' authors. Studies varied in terminology, outcomes measures, methodologies, and depth of analysis. Being an individual from an ethnoracially minoritized group appeared to affect care utilization and outcomes. Insufficient research was found about potential moderating variables at the clinic, family, and cultural levels.

CONCLUSIONS

Studies of pathways through care for persons from minoritized groups warrant further funding and attention.

Primary care Providers' approaches to cervical cancer screening in Muslim females

The utilization of the Papanicolaou (Pap) test and the human papillomavirus (HPV) vaccine has significantly decreased rates of cervical cancer and related mortality. Disparities in receiving these preventive screenings are scarcely studied in Muslim females. Our study explores primary care providers' (PCP) approaches to cervical cancer screening in Muslim females. We created a cross-sectional Qualtrics survey using convenience sampling of PCPs who perform Pap tests in central Ohio. Recruitment emails were disseminated via departmental email listservs. We had 200 analyzable responses and 78% of respondents reported having Muslim patients. Bivariate analysis was used to identify predictors of providers' approaches. Providers younger than 35 years obtained a sexual history from Muslim females less frequently, family medicine providers were more likely to obtain a sexual history from Muslim females, and gynecologists were more likely to offer the HPV vaccine to Muslim females. Providers who counseled patients about Pap tests (P<0.001) and HPV modes of transmission (P<0.004) were more likely to offer cervical cancer screening for Muslim females. Our findings suggested that providers' age and specialty may be predictors of proactive cervical cancer screening and prevention in Muslim females and that there is a gap between current guidelines and preventive clinical practices regarding the HPV vaccine and transmission counseling.

Having a Say in Research Directions: The Role of Community Researchers in Participatory Research with Communities of Refugee and Migrant Background

Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House ‘Refugee Recovery Framework’ to understand Community Researchers’ perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: ‘nothing about us without us’; ‘open the door’; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers’ presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation.

Muslim religiosity and health outcomes: A cross-sectional study among muslims in Norway

The aim of this study is to address the association between Muslim religiosity and health outcomes, and investigate if religious Muslims are more likely to be of disadvantage of health than non-religious Muslims. A cross-sectional study-design is used with a representative sample of Muslims in Norway including 2661 respondents in age 16 years-74 years from the "The Survey On Living Conditions Among Persons With An Immigrant Background 2016", conducted by Statistics Norway. Multivariate logistic regression analyses were conducted to investigate the relationship between Muslim religiosity and health outcomes. The health outcomes in focus are self-reported health, diabetes, cardiovascular diseases, neck and back illnesses, mental health problems, sleeping disorders, consumption of alcohol, and smoking. Association between Muslim religiosity and positive health outcomes were found. Smoking and alcohol consumption were negatively associated with Muslim religiosity. The findings suggest no evidence that religious Muslims are more likely than non-religious Muslims to be of disadvantage of health, and the study do not support the premise that Islam as a barrier to health. In addition, our findings suggest that Muslim religiosity might serve as a resource either predicting better health outcomes or that Muslim religiosity may be a factor that exists if good health is evident. As our findings cannot define any cause-effect relation between Muslim religiosity and health outcomes, given the cross-sectional design of the study, we emphasize the need of further research that investigates how Muslim religiosity is associated to health.

Conceptualising and addressing mental disorders amongst Muslim communities: Approaches from the Islamic Golden Age

Although Islam is the world's second-largest religion, there continues to be misconceptions and an overall lack of awareness regarding the religious and social worlds that make up the global Muslim community. This is particularly concerning when examining notions of mental ill-health, where a lack of cultural awareness, understanding, and sensitivity can impede adequate treatment. As a global religion, Islam is practiced within various cultural milieus, and, given the centrality of faith amongst Muslim communities, a conflation of religion and culture can occur when attempting to understand mental health paradigms. Whilst much of the discourse regarding Muslim mental health centres on cultural formulations, this article discusses how, historically, conceptualisations relating to medicine and mental health were ensconced within the particular medical paradigm of the day. Specifically, it considers the frameworks within which mental health and illness were understood within the medieval Muslim medical tradition and their relevance to contemporary debates in psychology and psychiatry. In sum, this paper seeks to demonstrate that cultural formulations of mental illness, often viewed as "Islamic", are distinct from historical Islamic approaches to mental health which employed contemporaneous medical discourse and which act as the reference marker for the emergent revivalist Islamic psychology movement seen today.

Cultural Sensitivity and Global Pharmacy Engagement in the Arab World

Objective. To create a resource on cultural sensitivity for schools and colleges of pharmacy that are currently engaged or considering future outreach opportunities in the Arab world. Methods. A literature review (2000-2018) of databases and Internet searches with specific keywords and terms were conducted. Authors who had experience in travelling to and hosting students and professionals from the Arab world and authors with local work experience in the Arab world were solicited. Results. General information about the Arab world, including unique aspects of individual countries, is presented. Stereotypes and misconceptions regarding the region and the people are discussed. Specific information about the government and infrastructure of each country, including their health care system is provided, with emphasis given to pharmacy education and practice in the region. In addition, recommendations for culturally sensitive engagement for pharmacy and other health care practitioners are discussed. Finally, recommendations for culturally sensitive engagement when hosting students and/or faculty members from the Arab world are also addressed. Conclusion. Global engagement between schools and colleges of pharmacy in the United States and those in the Arab world is increasing. For an enriching and fruitful engagement, sensitivity toward the cultural and clinical needs of the people, and in particular, the professionals of that region is critical.

Questioning the current public health approach to countering violent extremism

Since the start of the global War on Terror, governments have used the mental health system for counterintelligence purposes. A recent manifestation of this trend is the call from policymakers and mental health researchers to screen individuals at risk for violent extremism through the public health system. Civil rights organisations have raised alarms that Muslims are being disproportionately referred to law enforcement agencies and that Muslim communities are being selected for surveillance despite government assurances that violent extremism is not exclusive to any ideology. This commentary critically analyzes American policies and calls from mental health professionals to use the public health system for implementing initiatives that counter violent extremism. A close reading of such texts demonstrates a persistent concern with treating communities as vulnerable to extremism, prioritising law enforcement over scientific evidence in crafting policies, and breaking medical confidentiality of patients while not assuring immunity for mental health professionals involved in screening. A genuine engagement with public health provides alternatives that question the assumptions of such policies.

The experience and influence of social support and social dynamics on cardiovascular disease prevention in migrant Pakistani communities: A qualitative synthesis

OBJECTIVE

The objective of this research was to synthesise qualitative literature about the perceived influence and experience of social support, in relation to cardiovascular disease (CVD) prevention in migrant Pakistani communities.

METHODS

Articles were systematically reviewed, critically appraised, and analysed using an adapted meta-ethnography approach.

RESULTS

Sixteen qualitative studies on health behaviours related to CVD prevention were included.

FINDINGS

include four sub-themes under two substantive thematic areas that focus on: 1) family dynamics and 2) community dynamics influenced by discrimination. For members of the Pakistani community, gendered family dynamics and discrimination from outside and within community networks influenced behaviour change.

CONCLUSION

The authors of the synthesis developed multi-layered, contextualised interpretations of the care needs of an established multi-generational community. Future qualitative studies taking an intersectional approach to interpreting the role of social networks in migrant communities should take into account gender, identity, culture and faith.

PRACTICE IMPLICATIONS

Health care providers should focus on cultural awareness and sensitivity during consultations. In particular, general practitioners can benefit from the insight they gain from patient experiences, allowing for more appropriate recommendations.

Developing religiously-tailored health messages for behavioral change: Introducing the reframe, reprioritize, and reform ("3R") model

RATIONALE

As community health interventions advance from being faith-placed to authentically faith-based, greater discussion is needed about the theory, practice, and ethics of delivering health messages embedded within a religious worldview. While there is much potential to leverage religion to promote health behaviors and improve health outcomes, there is also a risk of co-opting religious teachings for strictly biomedical ends.

OBJECTIVE

To describe the development, implementation, and ethical dimensions of a conceptual model for religiously-tailoring health messages.

METHOD

We used data from 6 focus groups and 19 interviews with women aged 40 and older sampled from diverse Muslim community organizations to map out how religious beliefs and values impact mammography-related behavioral, normative and control beliefs. These beliefs were further grouped into those that enhance mammography intention (facilitators) and those that impede intention (barriers). In concert with a multi-disciplinary advisory board, and by drawing upon leading theories of health behavior change, we developed the "3R" model for crafting religiously-tailored health messages.

RESULTS

The 3R model addresses barrier beliefs, which are beliefs that negatively impact adopting a health behavior, by (i) reframing the belief within a relevant religious worldview, (ii) reprioritizing the belief by introducing another religious belief that has greater resonance with participants, and (iii) reforming the belief by uncovering logical flaws and/or theological misinterpretations. These approaches were used to create messages for a peer-led, mosque-based, educational intervention designed to improve mammography intention among Muslim women.

CONCLUSIONS

There are benefits and potential ethical challenges to using religiously tailored messages to promote health behaviors. Our theoretically driven 3R model aids interventionists in crafting messages that address beliefs that hinder healthy behaviors. It is particularly useful in the context of faith-based interventions for it highlights the ethical choices that must be made when incorporating religious values and beliefs in tailored messages.

The Islamic tradition and health inequities: A preliminary conceptual model based on a systematic literature review of Muslim health-care disparities

OBJECTIVE

The objective of this study was to identify mechanisms by which Islamic beliefs, values, and Muslim identity might contribute to health inequities among Muslim populations.

METHODS

A systematic literature review of empirical studies in Medline from 1980 to 2009 was conducted. The search strategy used three terms covering health-care disparities, ethnicity, and location to uncover relevant papers.

RESULTS

A total of 171 articles were relevant based on titles and abstracts. Upon subsequent full-text review, most studies did not include religious identity or religiosity as explanatory variables for observed health disparities. Of 29 studies mentioning Islam within the text, 19 implicated Muslim identity or practices as potential explanations for health differences between Muslim and non-Muslim groups. These 19 studies generated six mechanisms that related the Islamic tradition, Muslim practices, and health inequities: (1) Interpretations of health and/or lack of health based on Islamic theology; (2) Ethical and/or cultural challenges within the clinical realm stemming from Islamic values or practices; (3) Perceived discrimination due to, or a lack of cultural accommodation of, religious values or practices in the clinical realm; (4) Health practices rooted within the Islamic tradition; (5) Patterns of health-care seeking based on Islamic values; and (6) Adverse health exposures due to having a Muslim identity.

CONCLUSION

While there is scant empirical research on Muslim health-care disparities, a preliminary conceptual model relating Islam to health inequities can be built from the extant literature. This model can serve to organize research on Muslim health and distinguish different ways in which a Muslim identity might contribute to the patterning of health disparities.

Islamic Religious Leaders in Israel as Social Agents for Change on Health-Related Issues

Islamic religious leaders (IRLs) have the potential to influence health education, health promotion, and positive health outcomes among their own communities. This study aims to examine the role and effectiveness of Arab Muslim religious leaders, in Israel, as social agents for change on health-related issues, focusing on reduction in infant mortality, prematurity, and congenital malformations attributed to consanguineous marriage. A self-administrated questionnaire was distributed to 127 IRLs, in 2012, to gain insights into practice, attitudes, and perceptions of IRLs toward their role as social agents for change on health-related issues. The results indicate that two-thirds (58%) of the surveyed IRLs have provided frequent advice on issues related to preventing infant mortality, congenital malformation, and prematurity over the past two years. Most IRLs indicated that they have keen interest in their communities' health matters (97%) and regard dealing with them as part of their job (85%). The study identified three enabling factors that had significant influence on the IRLs' attitude. These influences are: awareness and knowledge of the health issues, the perception that these issues and their impact on the community are part of their responsibility, and the empowerment they felt through the participation in the Ministry of Health (Northern Region Health Office) educational seminar series, in the year 2000. The main conclusion from this study indicates that IRLs are effective social agents for change and that the educational interventions can be a useful and effective strategy to encourage IRLs to cooperate with health providers and promote public health among their own communities.

Supporting Muslim Patients During Advanced Illness

Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1.6 billion adherents and approximately 3.5 million in the US alone. Patient-centered care requires health professionals to look past news headlines and unchecked social media so they can deliver high-quality care to all patients. This article explores areas of importance in the context of advanced illness for practitioners of Islam. These include the conditions needed for prayer, the roles of medical treatment and religious authority, the importance of modesty, the religious concordance of clinicians, the role of family in medical decision making, advance care planning, and pain and symptom management. Initial recommendations to optimize care for Muslim patients and their families, informed by the described tenets of Muslim faith, are provided for clinicians and health systems administrators. These include Islamic cultural awareness training for staff, assessment of patients and families to determine needs, health education and decision-making outreach, and community health partnerships with local Islamic institutions.

Examining the relationship between encouragement and health-related quality of life among Muslims

This study examines the relationship between encouragement and health-related quality of life (HRQOL) among a sample of American Muslims, in tandem with the potential mediating effects of depression and spirituality. To conduct this cross-sectional study, a model was developed and tested using structural equation modeling (SEM) with a community sample of Muslims (N = 284). The results indicate that encouragement has a direct, positive effect on HRQOL. Neither depression nor spirituality mediated the relationship between encouragement and HRQOL. Rather, both variables exhibited a direct, independent effect on HRQOL. In addition, spirituality exhibited an indirect effect on HRQOL through attenuating depression. The findings underscore the importance of encouragement as a pathway to enhance HRQOL among Muslims in post-9/11 America. The results also suggest that spirituality can play a significant role in fostering HRQOL among Muslims, both directly and indirectly by reducing the effects of depression on HRQOL.

Spiritual Therapy in Coping with Cancer as a Complementary Medical Preventive Practice

There are many of methods of treating cancer. However, the concept of curing the cancer is beyond our current knowledge. Some patients who have the cancer may seek an alternative manner of curing their disease. Alternative medicines, such as spiritual and complementary therapy, are able to cure the cancer and, at the least, are safe. Research on the importance of spirituality in cancer care has mainly been performed in geographically heterogeneous populations. The results are limited to these specific religious-cultural contexts and enlightened by contributions from ethnicity and religion. This article focused on the religiousness and spiritual support of cancer patients from diverse and heterogeneous groups around the globe. An electronic search of peer-reviewed articles was systematically performed to obtain the relevant literature with the CINAHL, PsycINFO, and PubMed databases. The keywords included religion, cancer, illness, psychotherapy, and spiritual and alternative treatment/therapies. The inclusion criteria for the reviews were that the documents were original quantitative research and published in English. Articles that were not directly relevant to the present objective were excluded. The present outcome of these review resources suggest that it may be helpful for clinicians to address spirituality, particularly with regard to prevention, healing, and survival of cancer patients. This article indicates that it may be useful for clinical oncologists to be informed of the prevalence of the use of spiritual medicine in their specialized field. In addition, patients should routinely be asked about the use of spiritual medicine as part of every cancer patient's evaluation.

A Bicultural Researcher's Reflections on Ethical Research Practices With Muslim Immigrant Women: Merging Boundaries and Challenging Binaries

Bicultural researchers are well positioned to identify tensions, disrupt binaries of positions, and reconcile differences across cultural contexts to ensure ethical research practices. This article focuses on a bicultural researcher's experiences of ethically important moments in research activities with Muslim immigrant women. Three ethical principles of respect, justice, and concern for welfare are highlighted, revealing the implications of binary constructions of identity, the value of situated knowledge in creating ethical research practices, and the need to recognize agency as a counterforce to oppressive narratives about Muslim women.

Strong, female and Black: Stereotypes of African Caribbean women’s body shape and their effects on clinical encounters

The aim of this article is to explore how tendencies to stereotype minority ethnic groups intersect with lay discourses about them in ways that can reproduce cultural prejudices and reinforce inequalities in access to services and health outcomes. Drawing upon Black feminist and cultural studies literature, we present a theoretical examination, the stereotypes of the Black woman as ‘mammy’ and ‘matriarch’. We suggest that the influence of these two images is central to understanding the normalisation of the larger Black female body within African Caribbean communities. This representation of excess weight contradicts mainstream negative discourses of large bodies that view it as a form of moral weakness. Seeking to stimulate reflection on how unacknowledged stereotypes may shape clinical encounters, we propose that for Black women, it is the perception of strength, tied into these racial images of ‘mammy’ and ‘matriarch’ which may influence when or how health services or advice are both sought by them and offered to them. This has particular significance in relation to how body weight and weight management are/are not talked about in primary care-based interactions and what support Black women are/are not offered. We argue that unintentional bias can have tangible impacts and health outcomes for Black women and possibly other minority ethnic groups.

Research Misconduct: The Peril of Publish or Perish

There is a spurt of interest in research productivity in the Gulf Cooperation Council (GCC) to lay the foundation for national development. From a global perspective, increased research productivity could conceivably be accompanied by an exponential increase in research misconduct (RM). Inevitably, erroneous or falsified data will be expected to adversely affect public health by misleading policy makers and clinicians alike into embarking on health policy and allocation of resources that are byproducts of RM. This will contribute significantly to the emerging crisis of confidence of the public in the integrity of scientific research. For a long time, RM has been considered only as plagiarism or data fabrication and falsification. However, the concept of RM nowadays encompasses more and, in this review, we discuss its possible implications in emerging economies, such as those of the GCC countries. We suggest that GCC countries ought to consider implementing remedial and punitive policies to deal with RM.

Culture and religious beliefs in relation to reproductive health

An increasing number of contemporary research publications acknowledge the influence of religion and culture on sexual and reproductive behavior and health-care utilization. It is currently hypothesized that religious influences can partly explain disparities in sexual and reproductive health outcomes. In this paper, we will pay particular attention to Muslims in sexual and reproductive health care. This review reveals that knowledge about devout Muslims' own experience of sexual and reproductive health-care matters is limited, thus providing weak evidence for modeling of efficient practical guidelines for sexual and reproductive health care directed at Muslim patients. Successful outcomes in sexual and reproductive health of Muslims require both researchers and practitioners to acknowledge religious heterogeneity and variability, and individuals' possibilities to negotiate Islamic edicts. Failure to do so could lead to inadequate health-care provision and, in the worst case, to suboptimal encounters between migrants with Muslim background and the health-care providers in the receiving country.

Adapted behavioural activation for the treatment of depression in Muslims

BACKGROUND

Incorporating religious beliefs into mental health therapy is associated with positive treatment outcomes. However, evidence about faith-sensitive therapies for minority religious groups is limited.

METHODS

Behavioural Activation (BA), an effective psychological therapy for depression emphasising client values, was adapted for Muslim patients using a robust process that retained core effective elements of BA. The adapted intervention built on evidence synthesised from a systematic review of the literature, qualitative interviews with 29 key informants and findings from a feasibility study involving 19 patients and 13 mental health practitioners.

RESULTS

Core elements of the BA model were acceptable to Muslim patients. Religious teachings could potentially reinforce and enhance BA strategies and concepts were more familiar to patients and more valued than the standard approaches. Patients appreciated therapist professionalism and empathy more than shared religious identity but did expect therapist acceptance that Islamic teachings could be helpful. Patients were generally enthusiastic about the approach, which proved acceptable and feasible to most participants; however, therapists needed more support than anticipated to implement the intervention.

LIMITATIONS

The study did not re-explore effectiveness of the intervention within this specific population. Strategies to address implementation issues highlighted require further research.

CONCLUSIONS

The adapted intervention may be more appropriate for Muslim patients than standard therapies and is feasible in practice. Therapist comfort is an important issue for services wishing to introduce the adapted therapy. The fusion of conceptual frameworks within this approach provides increased choice to Muslim patients, in line with policy and research recommendations.

Religion and disparities: considering the influences of Islam on the health of American Muslims

Both theory and data suggest that religions shape the way individuals interpret and seek help for their illnesses. Yet, health disparities research has rarely examined the influence of a shared religion on the health of individuals from distinct minority communities. In this paper, we focus on Islam and American Muslims to outline the ways in which a shared religion may impact the health of a racially, ethnically, and socioeconomically diverse minority community. We use Kleinman's "cultural construction of clinical reality" as a theoretical framework to interpret the extant literature on American Muslim health. We then propose a research agenda that would extend current disparities research to include measures of religiosity, particularly among populations that share a minority religious affiliation. The research we propose would provide a fuller understanding of the relationships between religion and health among Muslim Americans and other minority communities and would thereby undergird efforts to reduce unwarranted health disparities.

Mothers' online message board questions about parenting infants and toddlers

AIM

To report a study conducted to explore childrearing concerns through an analysis of online parenting message boards managed by popular parenting magazines. Background.  Increasingly, mothers appear to be turning to the Web for childrearing advice and support. However, no previous studies have examined the childrearing concerns of mothers of infants and toddlers through the analysis of online message board postings.

DESIGN

Ethnographic content analysis methods were used to analyse the online postings.

METHODS

A total of 120 messages posted in 2007 by mothers of 0-2 year olds on the websites of two best-selling parenting magazines in the United States were submitted to ethnographic content analysis. Each message pertained to one or more of six childrearing domains: Feeding/Eating, Sleep, Development, Discipline, Toilet-Training and Mother-Child Relationships.

RESULTS

Questions and pleas for support were most prominently centred on feeding/eating and sleep issues. Mothers expressed concerns about when and how their children should begin to sleep and eat independently. In addition to the themes specific to particular domains, across-domain themes were identified involving mothers' parenting stress, questioning of advice from families/paediatricians and worries that children were not developing normally.

CONCLUSION

Online forums have become a space where mothers can openly describe their own negative emotions towards parenting and ask questions or gain reassurance to resolve mixed messages about how one should rear infants and toddlers. Paediatric nurses should be aware that mothers are confused about conflicting messages, especially in the domains of sleeping and eating. Reviewing parenting message boards occasionally would give nurses continuing insight into common parenting concerns.

Psychometric properties of the Functional Assessment of Chronic Illness Therapy--Spiritual Well-being (FACIT-Sp) in an Arabic-speaking, predominantly Muslim population

OBJECTIVE

This study determined the psychometric properties of the Arabic Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) Version 4 and explored associations between its three factors (Peace, Meaning, and Faith) and health-related quality of life (HrQoL) among Arab patients with cancer.

METHODS

A total of 205 Arabic-speaking, study-eligible cancer patients who were in treatment at the King Hussein Cancer Center, Amman, Jordan, completed the FACIT-Sp scale.

RESULTS

Cronbach's alpha reliability coefficients suggest that the Arabic FACIT-Sp is reliable and that moderate to strong correlations among subscales suggest validity. Correlation analyses showed that the 12-item Spiritual Well-being scale was associated with Social (r = 0.45, p = 0.01) and Functional Well-being (r = 0.48, p = 0.01). Hierarchical multiple regressions revealed that the Peace factor added 7.5% and the Meaning factor 3.8% to the prediction of HrQoL (p < 0.001). Faith did not significantly contribute to the unique prediction of HrQoL. Correlation analyses revealed that Peace was most prominently associated with the HrQoL subscale of Functional Well-being (r = 0.53, p = 0.01).

CONCLUSIONS

This first study of Arabic-speaking, predominantly Muslim Jordanian cancer patients using the FACIT-Sp indicates that it is a psychometrically sound instrument for detailed assessment of the spiritual well-being of Arabic-speaking cancer patients. The three-factor model appears to allow for discrimination among factors that are most highly associated with different aspects of HrQoL.

The role of imams in American Muslim health: perspectives of Muslim community leaders in Southeast Michigan

American Muslims are a diverse and growing population, numbering nearly 200,000 in Southeast Michigan. Little empirical work exists on the influence of Islam upon the healthcare behaviors of American Muslims, and there is to date limited research on the roles that imams, Muslim religious leaders, play in the health of this community. Utilizing a community-based participatory research (CBPR) model through collaboration with four key community organizations, we conducted semi-structured interviews with 12 community leaders and explored their perceptions about the roles imams play in community health. Respondents identified four central roles for imams in healthcare: (1) encouraging healthy behaviors through scripture-based messages in sermons; (2) performing religious rituals around life events and illnesses; (3) advocating for Muslim patients and delivering cultural sensitivity training in hospitals; and (4) assisting in healthcare decisions for Muslims. Our analysis also suggests several challenges for imams stemming from medical uncertainty and ethical conflicts. Imams play key roles in framing concepts of health and disease and encouraging healthy lifestyles outside of the healthcare system, as well as advocating for Muslim patient needs and aiding in healthcare decisions within the hospital. Healthcare partnerships with these religious leaders and their institutions may be an important means to enhance the health of American Muslims.

Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands

Background

Migration and ethnic minority status have been associated with higher occurrence of common mental disorders (CMD), while mental health care utilisation by non-Western migrants has been reported to be low compared to the general population in Western host countries. Still, the evidence-base for this is poor. This study evaluates uptake of mental health services for CMD and psychological distress among first-generation non-Western migrants in Amsterdam, the Netherlands.

Methods

A population-based survey. First generation non-Western migrants and ethnic Dutch respondents (N = 580) participated in structured interviews in their own languages. The interview included the Composite International Diagnostic Interview (CIDI) and the Kessler psychological distress scale (K10). Uptake of services was measured by self-report. Data were analysed using weighting techniques and multivariate logistic regression.

Results

Of subjects with a CMD during six months preceding the interview, 50.9% reported care for mental problems in that period; 35.0% contacted specialised services. In relation to CMD, ethnic groups were equally likely to access specialised mental health services. In relation to psychological distress, however, Moroccan migrants reported less uptake of primary care services (OR = 0.37; 95% CI = 0.15 to 0.88).

Conclusion

About half of the ethnic Dutch, Turkish and Moroccan population in Amsterdam with CMD contact mental health services. Since the primary purpose of specialised mental health services is to treat "cases", this study provides strong indications for equal access to specialised care for these ethnic groups. The purpose of primary care services is however to treat psychological distress, so that access appears to be lower among Moroccan migrants.