Developing a Religiously-Tailored Mammography Intervention for American Muslims
Generally mistaken for a small homogenous group, American Muslims are many and diverse. Because of this diversity, and because national health care surveys and databases typically do not collect religious affiliation data, there is limited data on aggregate American Muslim breast cancer outcomes; what is known is based on ethnic group data and community surveys. Ethnic group data suggest that Muslim women present with breast cancer at a younger age, with more advanced disease, and with worse morphological features than other groups, making breast cancer an important health challenge for the community. 
Muslim community surveys evidence mammography rates lower than the 75% national average and the Healthy People 2020 goal of 81%.  For example, community surveys among the Chicago Muslim community note biennial mammography rates of 44 and 52%,  and California study reported a rate of 54%.
The project began by seeking to understand how religion impacts screening behaviors and attitudes towards mammography in an ethnically and racially diverse group of Muslim women. This knowledge was, in turn, mobilized towards the design of a religiously-tailored, peer-led group education workshop conducted in mosques.
The purpose of developing these workshops is to empower the Muslim community to make informed decisions by:
- Filling critical gaps in knowledge about how Islam influences cancer screening behaviors
- Providing a model for how to partner with mosque communities to conduct a culturally-tailored mammography promoting program.
This study is a collaboration between the Initiative on Islam and Medicine at the University of Chicago and the Council of Islamic Organizations of Greater Chicago with support from the American Cancer Society.
This project was supported by a Mentored Research Scholar Grant (MRSG-14-032-01-CPPB) from the American Cancer Society, an Institutional Research Grant (no. 58-004) from the American Cancer Society, and a Cancer Center Support Grant (no. P30 CA14599) from the National Cancer Institute. Data warehousing was supported by the REDCap project at the University of Chicago, managed by the Center for Research Informatics, and funded by the Biological Sciences Division and the Institute for Translational Medicine CTSA Grant (UL1 RR024999).
Breast cancer is the second leading cause of cancer death among American women, and screening mammography is a proven method to reduce mortality from this cancer. In 2015 while 65.3% of U.S. women above 40 had a mammogram, lower rates were observed among racial and ethnic minorities. Muslim women have low rates of mammography.
Community surveys reveal:
- 37% of women (n=254) in the Chicago area had not obtained a mammogram in the last 2 years
- 42% of Arab women (n=365) from Detroit reported not having a mammogram every 1-2 years
Developing Religiously Tailored, Evidence-Based Health Education for Muslim American Women
Community Partnership Building
- Council of Islamic Organizatons of Greater Chicago
- Muslim Women Resource Center
- Arab American Family Services
- Compassionate Care Network
- Phase 1: Community Surveys
- Phase 2: Mosque-based Focus Groups
- Phase 3: Key Informant Interviews
Tailored Intervention Design and Deployment
- Caring for Body & Soul Workshops
- Group Education Manual – Replication Guide
- 2 half-day sessions were held at Muslim Education Center and Orland Park Prayer Center
- Peer-educators and guest lecturers, including a religious scholar and female physician, delivered didactics and facilitated discussion sessions on: breast cancer, mammography screening guidelines, religion and health, accessing resources for breast cancer screening
Methods for Addressing Barrier Beliefs: The 3R Model
Reframe: “switch train tracks”
- Keep the belief intact but change the way one thinks about it so it is consonant with the desired health behavior
- Normalizes the barrier belief
Reprioritize: “show them a better train”
- Introduce a new belief and create higher valence for it than the barrier belief
- Normalization of the barrier belief is optional
Reform: “breakdown the train carriage”
- Negate the barrier belief by demonstrating its faults by appealing to authority structures
Of the 58 participants in workshop:
- Demographics 35% of participants were of Arab decent
- 52% of participants were of South Asian decent
- 37% of participants annual income was below poverty level
- 27/58 participants had NOT had mammogram in the past 2 years.
- 29/58 participants had NEVER had a mammogram
Within 1 year after this workshop:
- 22 participants (38%) had received a mammogram within one year of the classes
- Changing Mammography-Related Beliefs Among American Muslim Women: Findings from a Religiously-Tailored Mosque-Based Intervention.
Community members who are interested in replicating these workshops in your mosque can use our Replication Toolkit as a guide to learn more about the study design and logistical plannings to coordinate the workshops.
We wanted to assess the acceptability and feasibility of using sermons for health promotion in American Muslim mosque communities by deploying a tailored sermon in two mosque communities. Our study demonstrates that theologically-framed health messaging is acceptable within sermons in American Muslim mosque communities and underscores the potential utility of mosque sermons for health education programs and for health behavior interventions in American mosques. Below are sample sermons delivered in our study.