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In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans' religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar's test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community's knowledge about the bioethical dimensions of EOLHC. [ABSTRACT FROM AUTHOR]

Objective: To assess Muslim physician experiences with religious discrimination and identify strategies for better accommodating Muslim identity in health care. Data Sources and Study Setting: Interviews were conducted with Muslim physicians from three US‐based Muslim clinician organizations between June and August 2021. Study Design: In‐depth, semi‐structured qualitative interviews used a phenomenological approach to describe experiences of religious discrimination and accommodation. A team‐based framework approach to coding was used to inductively generate themes from interview data. Data Collection/Extraction Methods: Physicians from the Islamic Medical Association of North America, American Muslim Health Professionals, and the US Muslim Physicians group were invited to participate using closed organizational listservs. Inclusion criteria sought English‐speaking, self‐identifying Muslims with current or past affiliation with a university hospital in the United States. Potential participants were segmented into groups based on responses to questions about perceived religious discrimination and accommodation. Purposive sampling was used to iteratively approach participants within these groups in order to capture a diverse respondent pool. Interviews stopped after thematic saturation was reached. Principal Findings: Eighteen physicians (11 women and 7 men; mean age: 41.5 [standard deviation = 12.91] years) were interviewed. Nearly all (n = 16) held Islam to be important in their lives. Three overarching themes, with several subthemes, emerged. Participants (1) struggled to maintain religious practices and observances due to unaccommodating organizational structures; (2) experienced religious discrimination, which, in turn, impacted their professional trajectories and, at times, their personal well‐being; and (3) believed that institutions could implement specific educational and policy interventions to advance the religious accommodation of Muslims in health care. Conclusions: Muslim physicians frequently encounter religious discrimination, yet there are concrete ways in which health care workplaces can better accommodate their religious needs and combat discrimination. To improve workforce diversity, equity, and inclusion, educational forums and policies that support the religious practices of physicians need to be established. [ABSTRACT FROM AUTHOR]

Introduction: Organ donation-related education is offered, and decisions are made at state Department of Motor Vehicles; however, little is known about Muslim Americans' attitudes toward these common practices. Research Questions: Are participants comfortable learning about deceased organ donation in the Department of Motor Vehicles setting? Are participants prepared to make deceased organ donation-related decisions at the Department of Motor Vehicles? Design: A survey of Muslim Americans attending an educational workshop at 4 mosques in two US cities. Primary study outcomes were self-reported (a) preparedness to make deceased donation-related decisions and (b) comfort with receiving organ donation education in the license renewal setting. We calculated Pearson product-moment correlations between these primary outcomes and participant characteristics including sociodemographic descriptors, religiosity and religious coping measures, and discrimination measures. Results: Most respondents indicated they were not prepared to make organ donation-related decisions at the Department of Motor Vehicles (79.6%). Preparedness did not vary by age, gender, country of origin or US residency duration, nor by religiosity, negative religious coping, or experiences of discrimination. However, higher scores on positive religious coping were associated with lower ratings of preparedness. A slight majority (58.9%) of respondents were comfortable receiving organ donation education. Conclusions: Muslim Americans are comfortable with learning about organ donation while at the Department of Motor Vehicles but are ill-prepared to make deceased donation-related decisions in the same setting. Further research is required to understand whether changes to the license renewal setting would improve decision-making outcomes in this population. [ABSTRACT FROM AUTHOR]

Attending to patient religion and spirituality (R/S) generates controversy. Some worry that because physicians lack formal religious training they may overstep their expertise, while others argue that physicians who are attentive to patient R/S provide higher quality of care. We aimed to describe American Muslim physicians' perspectives and practices regarding R/S discussions, and how physician characteristics correlate with these.A questionnaire including measures of religiosity, empathy, and attitudes and behaviors toward R/S, was randomly administered to Islamic Medical Association of North America members.More empathetic physicians were more likely to inquire about patients' R/S, share their own religious ideas and experiences, and encourage patients in their own R/S beliefs and practices (β =.44, p <.01). More empathetic physicians also had greater odds of encouraging discontinuation of futile life-sustaining interventions (OR 1.90, p <.05). Additionally, respondents with higher empathy had greater odds of encouraging patients at the end-of-life to seek reconciliation with God (OR 3.27, p <.001), and seek the forgiveness of those they have wronged (OR 2.48, p <.001).In the context of R/S diversity among the patient and provider population, enhancing physician empathy may be key to attending to the health-related R/S needs of patients. [ABSTRACT FROM AUTHOR]

Introduction: Detailed studies on the associations between religious beliefs and organ donation attitudes among religious minorities remain wanting. Although Muslims appear to have low rates of support for donation, how these behaviors relate to religious frameworks requires further investigation. Methods: We sought to explore the relationship between religious beliefs (Islam) and organ donation attitudes through focus groups with 43 Muslim women from 5 Chicago-area mosques. Purposive selection of mosques generated near-equal representation of Arabs, South Asians, and African Americans, as well as diversity in education and income. Using the theory of planned behavior as our conceptual framework, we expanded the traditional normative domain to include religiously informed beliefs. Findings: We found that the relationship between religious beliefs and Muslim attitudes toward organ donation is more complex than commonly perceived. Regarding the Islamic ethicolegal permissibility of organ donation, participants expressed a range of normative beliefs. Furthermore, participants voiced concerns beyond religious permissibility, including anxieties over modesty violations during the donation process, as well as concerns about purported black market organ trade and medical risks to donors. Discussion: Given that participants raised religious, societal, and biomedical concerns regarding organ donation, our findings suggest that effective educational programs should involve nuanced curricula that teach to the plurality of Islamic ethicolegal opinions and discuss transplantation processes within the United States. [ABSTRACT FROM AUTHOR]

Objective: Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.Methods: Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.Results: Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.Conclusions: Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening. [ABSTRACT FROM AUTHOR]

Background:  Invidious discrimination is unreasonable and unethical. When directed against patients, such discrimination violates the respect for persons at the heart of bioethics. Might such discrimination also be directed at times toward physicians themselves? Studies of workplace discrimination have largely focused on race and gender, with few examining whether religious identity attracts discrimination. Muslim physicians from diverse backgrounds comprise 5% of the U.S. physician workforce and, given the sociopolitical climate, may face anti-Muslim discrimination in the workplace. We assessed the prevalence of perceived religious discrimination and its association with measures of religiosity through a national survey of American Muslim physicians.Methods: A questionnaire including measures of religiosity, perceived religious discrimination, religious accommodation at the workplace, and discrimination-related job turnover was mailed to 626 Islamic Medical Association of North America members at random in 2013.Results: Two hundred fifty-five physicians responded (41% response rate). Most were male (70%), South Asian (70%), and adult immigrants to the United States (65%). Nearly all (89%) considered Islam as the most or a very important part of their life, and most (63%) prayed five times daily; 24% reported experiencing religious discrimination frequently over their career, and 14% currently experience religious discrimination at work. After adjusting for personal and practice characteristics, respondents for whom religion was most important had greater odds of experiencing religious discrimination at their current workplace (OR 3.9,p< .01). Sixteen respondents reported job turnover due to religious discrimination, of whom 12 rated religion as the most important part of their life.Conclusions:A significant minority of Muslim clinicians experience religious discrimination at work, and particularly those for whom their religion is most important. Further research is needed to undergird data-driven programs and policies that might reduce invidious, religion-directed discrimination in the health care workplace. [ABSTRACT FROM AUTHOR]

Background: Delayed care seeking is associated with adverse health outcomes. For Muslim women, delayed care seeking might include religion-related motivations, such as a preference for female clinicians, concerns about preserving modesty, and fatalistic beliefs. Our study assesses associations between religion-related factors and delayed care seeking due to a perceived lack of female clinicians. Materials and Methods: Surveys were distributed to Muslim women attending mosque and community events in Chicago. Survey items included measures of religiosity, religious fatalism, discrimination, modesty, and alternative medicine utilization and worship practices. The outcome measure asked for levels of agreement to the statement 'I have delayed seeking medical care when no woman doctor is available to see me.' Results: Two hundred fifty-four women completed the survey with nearly equal numbers of African Americans (26%), Arab Americans (33%), and South Asians (33%). Fifty-three percent reported delays in care seeking due to a perceived lack of female clinicians. In multivariate analysis adjusting for sociodemographic factors, higher religiosity (odds ratio [OR] = 5.2, p < 0.01) and modesty levels (OR = 1.4, p < 0.001) were positively associated with delayed care seeking. Having lived in the United States for >20 years (OR = 0.22, p < 0.05) was negatively associated with delayed care seeking. Conclusion: Many American Muslim women reported delays in care seeking due to a perceived lack of female clinicians. Women with higher levels of modesty and self-rated religiosity had higher odds of delaying care. Women who had lived in the United States for longer durations had lower odds of delaying care. Our research highlights the need for gender-concordant providers and culturally sensitive care for American Muslims. [ABSTRACT FROM AUTHOR]

This paper compares the discursive frames utilised by several national American Muslim organisations to craft an "Islamic" argument for healthcare reform via an expansion of health insurance coverage in the United States with Islamic ethico-legal opinions (fatwas) of U.S.-based jurists regarding the permissibility of purchasing health insurance. I analyse the differing ways in which these producers of "Islamic bioethics" material ground their arguments and draw on vocabulary from other discourses. The paper closes by reflecting upon the socio-political undercurrents that may contribute to the differences and disconnections between the ways in which these bioethics stakeholders produce their outputs and by arguing that further developing the field of Islamic bioethics will require concerted multidisciplinary engagements that clarify the distinctive nature of Islamic norms. [ABSTRACT FROM AUTHOR]

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Background: Interest and participation in global health activities among U.S. medical trainees has increased sharply in recent decades, yet the global health activities of physicians who have completed residency training remain understudied. Our objectives were to assess associations between individual characteristics and patterns of post-residency global health activities across the domains of health policy, education, and research. Methods: Cross-sectional, mixed methods national survey of 521 physicians with formal training in clinical and health services research and policy leadership. Main measures were post-residency global health activity and characteristics of this activity (location, funding, products, and perceived synergy with domestic activities). Results: Most respondents (73%) hold faculty appointments across 84 U.S. medical schools and a strong plurality (46%) are trained in internal medicine. Nearly half of all respondents (44%) reported some global health activity after residency; however, the majority of this group (73%) reported spending ≤10% of professional time on global health in the past year. Among those active in global health, the majority (78%) reported receiving some funding for their global health activities, and most (83%) reported at least one scholarly, educational, or other product resulting from this work. Many respondents perceived synergies between domestic and global health activities, with 85% agreeing with the statement that their global health activities had enhanced the quality of their domestic work and increased their level of involvement with vulnerable populations, health policy advocacy, or research on the social determinants of health. Despite these perceived synergies, qualitative data from in-depth interviews revealed personal and institutional barriers to sustained global health involvement, including work-family balance and a lack of specific avenues for career development in global health. Conclusions: Post-residency global health activity is common in this diverse, multi-specialty group of physicians. Although those with global health experience describe synergies with their domestic work, the lack of established career development pathways may limit the benefits of this synergy for individuals and their institutions. [ABSTRACT FROM AUTHOR]

Purpose: To examine relationships between religiosity, workplace discrimination, religious accommodation, and related professional and psychological outcomes among U.S. Muslim physicians., Method: In 2021, the authors surveyed 264 physicians from 3 U.S.-based Muslim clinician organizations. Religious commitment, as measured by multiple items, was evaluated as a possible predictor of workplace discrimination and accommodation; job turnover; career satisfaction; workplace motivation; and belonging, burnout, and depression. Bivariate regression models were used to identify possible significant relationships between predictor and outcome variables. Predictors with meaningful bivariate analyses were included in separate multivariate regression models for each outcome., Results: Participants' mean age was 39.5 years (standard deviation, 10.03). Most were male (160/246; 65%), were U.S.-born (146/244; 60%), completed medical school in the United States (190/243; 78%), and wore a beard/hijab (135/235; 57%). Participants identified as African American (40/247; 16%), Arab (55/247; 22%), South Asian (82/247; 33%), and White (70/247; 28%). Multivariate models demonstrated that religious importance was positively associated with discrimination from patients (odds ratio [OR] = 3.78; P = .02) and depression (OR = 5.36; P = .002), and negatively associated with prayer accommodation at work (OR = 0.20; P = .001). Engaging in congregational religious activities was negatively associated with discrimination from patients (OR = 0.64; P = .006) and job turnover (OR = 0.63; P = .02), and positively associated with accommodations for prayer (OR = 1.42; P = .008) and general religious identity accommodation (OR = 1.47; P = .01). Additionally, participant race and ethnicity were variably associated with these outcomes., Conclusions: This study demonstrates how religious identity may negatively associate with workplace experiences and well-being among U.S. Muslim physicians and highlights the buffering role of religious practice. It spotlights an urgent need for academic medical centers to ameliorate religious discrimination and implement workplace accommodation policies for Muslim physicians., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Background and Objectives: Advance Care Planning (ACP) is a critical tool in advancing patient self-determination in health care delivery. Despite increasing research into racial/ethnic minorities' engagement with ACP in the US, studies on Muslim Americans are relatively scarce. We aimed to examine levels of ACP engagement among Muslim adults and measure associations between socio-demographic and religiosity characteristics and ACP engagement. Methodology: This was a survey study among Muslims attending mosque seminars in Chicago and Washington DC. Religiosity characteristics were assessed using a modified version of the Duke University Religion Index (DUREL) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured by the 4-item ACP Engagement Survey (4-ACPES) and 2 additional items covering ACP religious dimensions. Statistical analyses were performed using SPSS 28.0. Results: Out of 152 respondents, 56.2% to 72.6% were in the pre-contemplation stage of ACP across the 6 ACP items. Bivariate analyses showed that ACP engagement was correlated with participant age, ethnicity, duration of stay in the US and country of birth. Multivariable analyses demonstrated no association between religiosity characteristics and ACP engagement; independent predictors of ACP engagement were race/ethnicity (being South Asian), country of birth (born outside the US) and duration of stay in the US (longer years). Discussion/Conclusion: Our study suggests that American Muslims are largely unprepared to engage with ACP. Moreover, religiosity does not predict ACP engagement. We call for greater community outreach and educational programs that instill awareness and knowledge on the importance of ACP, and provide resources for tailored religiously-oriented conversations that assist individuals with ACP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Minority groups based on immigration status, gender, or religion often face discrimination in healthcare settings. Muslim women, especially those who wear hijab, are more likely to experience stereotyping and discrimination in and outside of healthcare, but little is known about the sociodemographic predictors of this discrimination. We examined sociodemographic factors and religiosity as predictors of discrimination in medical settings among Muslim American women. Muslim women (n = 254) were recruited from Muslim organizations in Chicago to self-administer a survey on perceived discrimination, religiosity, and sociodemographic characteristics. Many participants reported that they were treated with less courtesy than non-Muslims (25.4%) and that a doctor or nurse did not listen to them (29.8%) or acted as though they were not smart (24.3%). A multivariable regression model revealed that self-rated religiosity was negatively associated with discrimination. Race/ethnicity trended towards predicting perceived discrimination such that Arabs and South Asians reported less discrimination than African Americans. The current study sheds light on the important role of religiosity in shaping Muslim women's experiences in medical settings and points to the buffering effect of religiosity and the additive consequences of racial/ethnic identity in experiences of religious discrimination., (© 2023. W. Montague Cobb-NMA Health Institute.)

Background: Regular mammogram screenings contribute to a decreased breast cancer (BC) mortality rate. Women from ethnic minorities in the United States, however, often underutilize mammogram screenings; in particular, immigrant Muslim Arab (IMAW) women have low mammogram screening rates., Objective: To explore the associations between mammogram utilization and (a) health and religious beliefs, (b) level of knowledge about mammograms, (c) health care provider (HCP) recommendations, and (d) spousal support., Methods: A cross-sectional study employed online data collection. An Arabic or English survey was completed by women who were 45 or older and married, had immigrated from Arab countries, and had no history of breast cancer. Logistic regression was conducted for data analyses., Results: Of the 184 Immigrant Muslim Arab survey participants, 86.6% reported having had at least one mammogram in their lifetime, and 32.6% adhered to mammograms. Ever having obtained a mammogram and adherence to mammograms were negatively associated with perceived mammogram barriers and positively associated with (a) spousal support, (b) level of mammogram knowledge, and (c) perceived self-confidence. Receiving (HCP) recommendation increased the likelihood of ever having obtained a mammogram. Finally, participants who reported higher levels of perceived mammogram benefits were more likely to have obtained a mammogram within the last 2 years compared to their counterparts., Conclusions: IMAW have demonstrated low mammogram adherence rate., Implications: Nursing clinicians and scholars must play a role in designing and implementing interventions to promote women adherence to mammograms. Involving husbands in these interventions may improve immigrant Muslim Arab women's mammogram adherence rates., (Copyright © 2023 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Discrimination negatively impacts physician career trajectories and well-being., Objective: Quantify perceived religious discrimination among US Muslim physicians and compare trends over time., Design/participants/main Measures: Two national surveys tabulated discrimination. The 2013 survey involved a mailed questionnaire to a random sample of 746 Islamic Medical Association of North America (IMANA) members, while the 2021 survey was administered online to subscribers of IMANA, American Muslim Health Professionals, and the US Muslim Physician network. Eligible participants had to be practicing US Muslim physicians, and English-proficient (the 2021 sample was further restricted to physicians in academic medicine). Questionnaires assessed experiences of religious discrimination and accommodation., Key Results: In 2013, the 255 participants had a mean age of 52 years, were mostly male (70%), Sunni (91%), South Asian (70%), and adult immigrants (65%). In 2021, the 264 participants had a mean age of 39.5 years, were mostly male (65%) and Sunni (75%). In contrast to 2013, the majority were born in the USA (59%; p<0.01), and respondents were more diverse with 33% South Asians, 22% Arabs, and 16% African Americans. Greater proportions of the 2021 sample reported facing religious discrimination frequently in their career (24 to 53%; p<0.01), experiencing job turnover (7 to 32%; p<0.01), and having patients refuse their care (9 to 33%; p<0.01). A higher proportion of South Asians, Arabs, and participants under the age of 40 reported discrimination and job turnover in 2021 when compared to 2013. Higher proportions of South Asians and Whites reported being passed over for professional advancement and having patients refuse their care in 2021 relative to 2013., Conclusions: Many American Muslim clinicians encounter religious discrimination at the workplace, and these experiences appear to be on the rise. Healthcare workforce diversity, inclusion, and equity programming should include a focus on accommodating the religious identities of physicians., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Background: More than 100,000 Americans with failing organs await transplantation, mostly from dead donors. Yet only a fraction of patients declared dead by neurological criteria (DNC) become organ donors., Discussion: Emergency physicians (EPs) can improve solid organ donation in the following ways: providing perimortem critical care support to potential organ donors, promptly notifying organ procurement organizations (OPOs), asking neurocritical care specialists to evaluate selected emergency department patients for death based on established neurologic criteria, participating in research to advance these developments, implementing automatic OPO notification technologies, and educating the professional and lay communities about organ donation and transplantation, including exploration of opt-out (presumed consent) organ recovery policies., Conclusion: With future improvements in organ preservation and DNC assessment, EPs may become even more involved in the donation process. EPs should support and engage in efforts to promote organ donation and transplantation., (Copyright © 2022 Elsevier Inc. All rights reserved.)

There is growing momentum to legalize medical cannabis across the United States. Positive public attitudes and permissive policies are based on growing anecdotal experiences and medical evidence that enumerate the health benefits of cannabis. Against this backdrop, Muslim stakeholders are (re)-evaluating their stance on the issue for Muslim patients who may benefit from such novel treatments, Muslim physicians who could incorporate the provision of cannabis into practices, and Muslim entrepreneurs who may seek to engage with the pharmaceutical and business aspects of the growing industry. Given this renewed interest, the Fiqh Council of North America (FCNA), a deliberative body comprised of Islamic jurists and medical consultants, examined the medical as well as religious evidence surrounding medical cannabis in order to furnish Muslim Americans with religious guidance. In 2018, they resolved that, while the use of intoxicating substances is proscribed by Islamic law, medical cannabis was permissible for Muslims to use with the following stipulations: Non-psychoactive preparations of cannabis are permitted to treat illnesses for which therapeutic effects of cannabis are certain, and psychoactive preparations are contingently permissible in cases of dire necessity. In this paper we first discuss the deliberative process and ethico-legal rationale brought to bear in furnishing the ruling, and then proceed to critically examine its conceptual gaps, practical limitations, and future implications. Clarifying the nuances around the religious permissibility of medical cannabis is important for Muslim patients and providers whose attitudes and behaviors may be informed by the ruling, as well for stakeholder groups within pharmaceutical and health policy circles who aim to address the needs of the global Muslim community that may stand to benefit from advances in medical cannabis research and therapeutics., Competing Interests: Declarations of Interest The authors declare that they have no competing interests., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Importance: The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown., Objective: To analyze whether President Trump's 2017 executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States" (known as the "Muslim ban" executive order) was associated with changes in health care utilization by people born in targeted nations living in the US., Design, Setting, and Participants: This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban-targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non-Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021., Exposures: Executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States.", Main Outcomes and Measures: Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses., Results: A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban-targeted nations (point estimate [SE], 3.41 [1.53]; P = .03)., Conclusions and Relevance: Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.

Biomedical and religious knowledge affects organ donation attitudes among Muslims. We tested the effectiveness of mosque-based, religiously tailored, ethically balanced education on organ donation among Muslim Americans. Our randomized, controlled, crossover trial took place at 4 mosques randomized to an early arm where organ donation education preceded a control educational workshop or a late arm with the order reversed. Primary outcomes were changes in biomedical (Rotterdam Renal Replacement Knowledge Test living donation subscale, R3KT) and religious (Islamic Knowledge of Living Organ Donation, IK-LOD) living kidney donation knowledge. Statistical analysis employed a 2 (Treatment Arm) X 3 (Time of Assessment) mixed-method analysis of variance. Of 158 participants, 59 were in the early arm and 99 in the late arm. A between group t test comparison at Period 1 (Time 1 - Time 2), demonstrated that the early arm had a significantly higher mean IK-LOD (7.11 v 5.19, P < .05) and R3KT scores (7.65 v 4.90, P < .05) when compared to the late arm. Late arm participants also had significant increases in mean IK-LOD (5.19 v 7.16, P < .05) and R3KT scores (4.90 v. 6.81, P < .05) postintervention (Time 2-Time 3). Our novel program thus yielded significant kidney donation-related knowledge gains among Muslim Americans (NCT04443114 Clinicaltrials.gov)., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Introduction: Studies around the world demonstrate that Muslim attitudes toward organ donation are closely tied to religion, but also that Muslim publics suffer from a lack of detailed knowledge about the Islamic perspectives on organ donation. Consequently, organ donation professionals and stakeholders are increasingly addressing knowledge gaps in the Muslim community through educational interventions. Yet, a measurement of Islamic knowledge of organ donation, and thereby the efficacy of such education, is not available., Research Question: To present the development and psychometric evaluation of the Islamic Knowledge of Living Organ Donation scale, designed to measure knowledge of the Islamic ethicolegal stances, and their underlying rationale, regarding living organ donation., Methods: Items were developed based on a review of Islamic juridical perspectives on organ donation, addressed knowledge gaps pervading Muslim communities, and pilot tested. The scale was statistically validated and psychometrically analyzed with a sample of 158 mosque-going Muslims in the United States., Results: The 9-item Islamic Knowledge of Living Organ Donation scale was found to be reliable (Cronbach α: 0.86), unidimensional, independent of religiosity, and predictive of social attitudes toward organ donation., Discussion: The survey can be used to validly assess Islamic knowledge of living organ donation among Muslim communities in research, educational, and clinical settings.

Background: We sought to evaluate how Muslim allied healthcare professionals view death by neurologic criteria (DNC)., Methods: We recruited participants from two listservs of Muslim American health professionals to complete an online survey questionnaire. Survey items probed views on DNC and captured professional and religious characteristics. Comparative statistical analyses were performed after dichotomizing the sample based on religiosity, and Chi-squared, Fisher's exact tests, likelihood ratios and the Kruskal-Wallis test were used to assess differences between the two cohorts., Results: There were 49 respondents (54%) in the less religious cohort and 42 (46%) in the more religious cohort. The majority of respondents (84%) believed that if the American Academy of Neurology guidelines are followed and a person is declared brain dead, they are truly dead; there was no difference on this view based on religiosity. Less than a quarter of respondents believed that outside of organ donation, mechanical ventilation, hydration, nutrition or medications should be continued after DNC; again, there was no difference based on religiosity of the sample. Importantly, half of all respondents believed families should be able to choose whether an evaluation for DNC is performed (40% of the less religious cohort and 60% of the more religious cohort, p = 0.09) and whether organ support is discontinued after DNC (49% of both cohorts, p = 1)., Conclusions: Although the majority of allied Muslim healthcare professionals we surveyed believe DNC is death, half believe that families should be able to choose whether an evaluation for DNC is performed and whether organ support should be discontinued after DNC. This provides insight that can be helpful when making medical practice policy and addressing legal controversies surrounding DNC.

Background To advance the literature on religiously-tailored interventions and on Muslim cancer screening disparity research, we report on a behavioral intervention that used religiously-tailored messages to address salient mammography-related barrier beliefs. Methods We crafted specific, religiously-tailored messages and designed a two-session, peer-led, mosque-based educational program to deploy them. t-tests assessed pre- and post-intervention changes in mammography knowledge, intention to obtain mammography, and levels of agreement with mammography-related barrier and facilitator beliefs, while ordered logistic regression models assessed predictors of change. Results 58 women participated, 29 who were South-Asian and 18 Arab. Mean mammography knowledge increased post-intervention. Participants' overall mean agreement with facilitator beliefs trended upward and there was a significant decrease in agreement with the belief "Breast Cancer Screening is not important because God decides who will get cancer," Discussion Religiously-tailored messages provide an opportunity for addressing barriers to preventive health in a theologically consonant way.

Background: Research demonstrates that the attitudes of religious physicians toward end-of-life care treatment can differ substantially from their nonreligious colleagues. While there are various religious perspectives regarding treatment near the end of life, the attitudes of Muslim physicians in this area are largely unknown., Objective: This article attempts to fill in this gap by presenting American Muslim physician attitudes toward end-of-life care decision-making and by examining associations between physician religiosity and these attitudes., Methods: A randomized national sample of 626 Muslim physicians completed a mailed questionnaire assessing religiosity and end-of-life care attitudes. Religiosity, religious practice, and bioethics resource utilization were analyzed as predictors of quality-of-life considerations, attitudes regarding withholding and withdrawing life-sustaining treatment, and end-of-life treatment recommendations at the bivariate and multivariable level., Results: Two-hundred fifty-five (41% response rate) respondents completed surveys. Most physicians reported that religion was either very or the most important part of their life (89%). Physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette. Physicians who were more religious had higher odds of viewing withdrawal of life-sustaining treatment more ethically and psychologically challenging than withholding it and had lower odds of agreeing that one should always comply with a competent patient's request to withdraw life-sustaining treatment., Discussion: Religiosity appears to impact Muslim physician attitudes toward various aspects of end-of-life health-care decision-making. Greater research is needed to evaluate how this relationship manifests itself in patient care conversations and shared clinical decision-making in the hospital.

Objective: To describe the design of, and participant-level outcomes related to, a religiously tailored, peer-led group education program aimed at enhancing Muslim women's mammography intention., Method: Using a community-engaged approach and mixed methods, we identified and addressed barrier beliefs impeding mammography screening among Muslim American women. Our religiously tailored, mosque-based, peer-led intervention involved facilitated discussions and expert-led didactics conveying health-related religious teachings, and information about the benefits and process of mammography. Barrier beliefs were addressed through reframing, reprioritizing, or reforming such beliefs. Participant surveys were collected preintervention, postintervention, 6 months postintervention, and 1 year postintervention. These measured changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs., Results: A total of 58 Muslim women (mean age = 50 years) that had not had a mammogram in the past 2 years participated in the two-session program. Self-reported likelihood of obtaining a mammogram increased significantly ( p = .01) and coincided with a positive trend in confidence ( p = .08). Individuals with higher agreement with barrier beliefs preintervention had lower odds for positive change in likelihood (odds ratio = 0.80, p = .03), while those who were married had higher odds for positive change in likelihood (odds ratio = 37.69, p = .02). At 1-year follow-up, 22 participants had obtained a mammogram., Conclusion: Our pilot mosque-based intervention demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms, and increased their mammography utilization, with nearly 40% obtaining a mammogram within 12 months of the intervention., Impact: Our conceptual model for religiously tailoring messages, along with its implementation curriculum, proved effective in enhancing the likelihood and receipt of mammograms among Muslim American women. Accordingly, our work advances both the theory and practice of faith-based interventions and provides a model for addressing Muslim women's cancer screening disparities.

Trust in physicians and the healthcare system underlies some disparities noted among minority populations, yet a descriptive typology of different types of trust informing healthcare decisions among minority populations is limited. Using data from 13 focus groups with 102 American Muslims, we identified the types and influence of trust in healthcare decision-making. Participants conveyed four types of trust implicating their health-seeking behaviors-(I) trust in allopathic medicine, (II) trust in God, (III) trust in personal relationships, and (IV) trust in self. Healthcare disparity research can benefit from assessing how these types of trust are associated with health outcomes among minority populations so as to inform intervention programs that seek to enhance trust as a means to improve community health.

Background: American Muslims are understudied in health research, and there are few studies documenting community-based participatory research (CBPR) efforts among American Muslim mosque communities., Objectives: We highlight lessons learned from a CBPR partnership that explored the health care beliefs, behaviors, and challenges of American Muslims., Methods: We established a collaboration between the University of Michigan and four Muslim-focused community organizations in Michigan. Our collaborative team designed and implemented a two-phase study involving interviews with community stakeholders and focus groups and surveys with mosque congregants., Lessons Learned: Although we were successful in meeting our research goals, maintaining community partner involvement and sustaining the project partnership proved challenging., Conclusions: CBPR initiatives within mosque communities have the potential for improving community health. Our experience suggests that successful research partnerships with American Muslims will utilize social networks and cultural insiders, culturally adapt research methods, and develop a research platform within the organizational infrastructures of the American Muslim community.

Background: Religion-rooted beliefs and values are often cited as barriers to organ donation among Muslims. Yet how Islamic religiosity relates to organ donation attitude among Muslims is less studied., Methods: Using a community based participatory research approach, we recruited adults from mosque communities to self-administer a questionnaire assessing levels of Islamic religiosity, attitude toward deceased organ donation, and sociodemographic descriptors., Results: Of the 97 respondents, there were nearly equal numbers of men and women. Over a third were Arab American (n=36), and nearly a quarter were either South Asian (n=23) or African American (n=25). Respondents viewing difficulties in life as punishment from God had a decreased odds of believing deceased organ donation to be justified (OR 0.85, P<0.05). Other measures of Islamic religiosity, such as intrinsic religiosity, positive religious coping and one related to following Islamic ethical guidelines, were not associated with organ donation attitude. Arab Muslims were more likely to believe deceased organ donation to be justified than South Asian or African Americans (OR 7.06, P<0.05). Sociodemographic descriptors including age, sex, and country of origin, as well as self-reported health and trust of the American health-care system, were not significantly associated with attitude toward deceased organ donation., Conclusion: Higher levels of intrinsic religiosity or adherence to Islamic ethics do not appear to associate with negative attitudes toward deceased organ donation. Negative religious coping appears, however, to be related to lower rates of believing deceased organ donation to be justified. Future studies with larger samples that incorporate additional measures of religiosity can further clarify relationships between religiosity and organ donation attitude among Muslim communities.

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.

Economic globalization and advances in technology have made it more feasible and even necessary to develop international research collaborations in global public health. Historically, collaborations in global research described in the literature have been mostly "North-South" collaborations in which the more developed "North" country works together with a developing "South" country to conduct research in the latter. This type of collaboration has for the most part, represented unequal partnership and rarely left behind a lasting impact. Recently, the opportunity for a new kind of international research partnership has emerged in which the host country has significant financial resources, but relatively limited expertise in research Methodology or techniques and research implementation.  This type of collaboration features a relative equalization of power between the international partners. The purpose of this paper is to describe the process of building a successful research collaboration between a team in the United States and a team in Qatar, a rich Arabic nation in Gulf. We present a case study that provides an overview of our own project focused on the development of a culturally and linguistically adapted health care quality instrument for Qatar, discussing many of the benefits and challenges we encountered during each phase of instrument development. We present recommendations for researchers seeking sustainable and equitable partnerships with the Arab World.

The recent enactment of the Patient Protection and Affordable Care Act (ACA) of 2010, and the ongoing debate over reform of the U.S. health care system, raise numerous important ethical issues. This article reviews basic provisions of the ACA; examines underlying moral and policy issues in the U.S. health care reform debate; and addresses health care reform's likely effects on access to care, emergency department (ED) crowding, and end-of-life care. The article concludes with several suggested actions that emergency physicians (EPs) should take to contribute to the success of health care reform in America., (© 2012 by the Society for Academic Emergency Medicine.)

Background: Patient satisfaction is related to the perception of care. Some patients prefer, and are more satisfied with, providers of the same gender, race or religious faith. This study examined emergency medical provider attitudes towards, as well as patient and provider characteristics that are associated with, accommodating such requests., Methods: A survey administered to a convenience sample of participants at the 2007 American College of Emergency Physicians Scientific Assembly. The nine-question survey ascertained Likert-type responses to the likelihood of accommodating patient requests for specific provider types. Statistical analyses used Wilcoxon rank-sum, Wilcoxon signed-rank and Cochran's Q tests., Results: The 176 respondents were predominantly white (83%) and male (74%), with a mean age of 42 y. Nearly a third of providers felt that patients perceive better care from providers of shared demographics with racial matching perceived as more important than gender or religion (p=0.02). Female providers supported patient requests for same gender providers more so than males (p<0.01). Provider race, practice location, type and duration did not significantly affect the level of accommodation. When requesting like providers, female patients had higher accommodation scores than male patients (p<0.001), non-whites than whites (p<0.05), with Muslim patients (male or female) most likely to be accommodated (p<0.01)., Conclusion: Accommodating patient requests for providers of specific demographics within the emergency department may be related to provider characteristics. When patients ask for same gender providers, female providers are more likely to accommodate such a request than male providers. Female, non-white and Muslim patients may be more likely to have their requests honoured for matched providers.

In an increasingly diverse patient population, language differences, socioeconomic circumstances, religious values, and cultural practices may present barriers to the delivery of quality care. These obstacles contribute to the health care disparities observed in all areas of medical care. Increasing cultural competence has been cited as part of the solution to reduce disparities. The emergency department (ED) is an environment where cultural sensitivity is particularly needed, as it is often a primary source of health care for the underserved and ethnic and racial minorities and a place where high patient volume and acuity place the provider under demanding time pressures, yet the emergency medicine (EM) literature on health care disparities and cultural competence is limited. The authors present three clinical scenarios highlighting challenges in providing equitable emergency care to minority populations. Using these cases as illustrations, three processes are proposed that may improve the quality of care delivered to minority populations: 1) increase cultural awareness and reduce provider biases, enabling providers to interact more effectively with different patient populations; 2) accommodate patient preferences and needs in medical settings through practice adjustments and cultural modifications; and 3) increase provider diversity to raise levels of tolerance, awareness, and understanding for other cultures and create more racially and/or ethnically concordant patient-physician relationships.