Review of Muslim Patient Needs and Its Implications on Healthcare Delivery

Abstract

Background:

In the rapidly changing environment of healthcare, striving toward health equity and providing patient-centered care is imperative to the patient’s experience. To achieve these goals, a comprehensive understanding of the diverse patient populations seeking these services, their needs, and the multitude of religious, cultural, and structural elements that impact their well-being is required. Muslim patients represent a considerable demographic, both in number and complexity of religious and cultural beliefs and practices. This scoping review examines the intersection of religion and cultural values with healthcare delivery in the context of the Muslim patient experience.

Objectives:

The objective of this review is to identify key concepts and challenges that impact the Muslim patient experience.

Search Methods:

The research databases Cochrane Library, OVID Medline, and PubMED were used to conduct a comprehensive systemic review of original, empirical peer-reviewed publications with the following search terms: “Muslim healthcare,” “Muslim patient,” and “Muslim experience.”

Selection Criteria:

Inclusion and exclusion criteria were used to narrow down articles to those that addressed Muslim patient needs and their healthcare experience.

Results:

A total of 21 articles met the criteria of this scoping review. Five central topics were identified during thematic analysis: Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning.

Conclusion:

This scoping review demonstrates that in order to provide patient-centered care addressing the unique needs of Muslim patients, religious and cultural values need to be explored under the frameworks of cultural humility and structural competency.

Introduction

In today’s increasingly diverse world, providing high-quality healthcare extends beyond mere clinical knowledge—it requires a deep understanding of patients’ cultural backgrounds, beliefs, and values. The astute clinician is able to recognize the impact these factors have on the patient’s healthcare experience and their long-term outcomes. Therefore, using the frameworks of cultural humility and structural competency become necessary as they involve a commitment to learning about patients’ values, understanding the downstream effects that influence health issues, and molding practices to meet these unique factors. These concepts are especially important when providing care to Muslim individuals (individuals who follow the religion of Islam)—a population representing nearly 2-billion people worldwide.

Leininger’s theory of cultural care emphasizes the importance of providing culturally sensitive care through acknowledging and addressing patients’ beliefs. ¹ One approach to delivering this multi-factorial care involves cultural humility—a process of self-awareness and ongoing learning about diverse cultures. Cultural humility serves as a useful framework for healthcare providers when working with all patients—particularly those from diverse backgrounds. Cultural humility emphasizes acceptance, curiosity, and reflection—all key components of effective healthcare delivery. ²

Structural competency, in turn, as defined by Metzl and Hansen, ³ is the ability to recognize that the clinical presentation of symptoms, attitudes, and diseases are the consequence of societal and institutional factors that then impact health outcomes. This framework addresses stigmatized identities and challenges healthcare providers to engage in healthcare delivery beyond the individual level of patient-interaction, into a more holistic approach. ³

Employing the principles of cultural humility and structural competency are especially important within the Muslim community. In fact, a qualitative study by Hasnain et al ⁴ specifically explored the healthcare experiences of Muslim women in Illinois. In this study, patients and healthcare providers completed separate questionnaires regarding their healthcare experience. They found an astounding 93.8% of the patients reported their healthcare providers did not understand their religious or cultural needs. ⁴ It is unsurprising, then, that upon questioning the healthcare providers in the same study, 83.3% reported encountering challenges when providing care to Muslim women. This demonstrates a shortcoming in the patient-physician relationship leading to ineffective healthcare delivery to Muslim patients.

In a comprehensive study involving 227 Muslim patients in the United States, inquiries were made regarding their encounters with discriminatory behaviors within healthcare settings. The findings revealed that 47.1% of respondents reported instances of exclusion or being ignored, 40% experienced challenges related to their Islamic dress, 26.4% encountered offensive verbal remarks, and 2.6% reported incidents of physical assault. ⁵ Compounding this, Shah et al ⁶ highlighted a concerning trend of discrimination experienced by female Muslim patients wearing hijabs (religious covering worn over the head) during cancer treatment visits. Respondents stated that they felt ignored by healthcare providers and encountered stereotypes such as being assumed to have abusive husbands or coming from backgrounds with limited English proficiency. ⁶ This prejudiced perception resulted in these women feeling as though they had been denied proper healthcare—emphasizing a critical issue that warrants attention and intervention within healthcare. These studies present a convincing narrative that the current system of healthcare delivery to Muslim patients in the US is flawed, contributing to an overall lack of trust in the healthcare system.

The tools healthcare providers use when providing care should consider the values and beliefs of Muslim patients as well as the historical, political, and social bias against this community, in order to ensure culturally sensitive and effective healthcare delivery. As the Muslim patient population in the US continues to grow, existing literature on the unique healthcare needs of this patient population requires further review and analysis. However, the written works regarding the experience of Muslim individuals and their healthcare in the US is limited. This review aims to enhance our understanding of the importance of cultural humility and structural competency in delivering effective, patient-centered care.

The objective of this study is to examine the existing body of literature on health and well-being—with a focus on the unique experiences of Muslim patients in the United States. The research questions directing this review are:

• RQ1: What are the unique challenges Muslim patients face?

• RQ2: How do these challenges impact their health and well-being?

• RQ3: What implications do these challenges have on providing care using a cultural humility and structural competency framework?

By exploring the intersection of religion, cultural values, and healthcare delivery in the context of the Muslim patient in the United States, this review hopes to highlight central themes and challenges that emerge as well as opportunities for improvement in healthcare provided to Muslim communities. Ultimately, this scoping review aims to contribute to the ongoing efforts to advance the quality of care for Muslim patients and ensure that healthcare is delivered in a culturally sensitive and structurally aware manner.

Methods

Search Strategy

The methodological framework applied in this scoping review was developed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. ⁷ This systematic review was compromised of 5 stages:

• i. identifying a research question

• ii. identifying relevant literature

• iii. selecting literature within the inclusion criteria

• iv. identifying themes and trends

• v. reporting the results

A comprehensive systematic review of original, empirical peer-reviewed publications in the English language was performed. The following databases were utilized: Cochrane Library, OVID Medline, CINAHL, and PubMED were used with the following search terms: “Muslim healthcare,” “Muslim patient,” and “Muslim experience” (Supplemental Table 1). The search included all articles published from January 2000 to July 2022—the time in which the review was conducted. The following inclusion and exclusion criteria, listed below, were used to narrow down publications to those that directly addressed Muslim patient needs and their healthcare experience.

The inclusion criteria for this review was as follows

• Articles that focus on the Muslim-patient experience in the United States

• Randomized, non-randomized, descriptive, controlled, cohort, case-studies, cross-sectional, mixed method, and qualitative publications

• Articles that were published no earlier than the year 2000

• Articles that were original, empirical peer-reviewed publications

• Articles that were written in the English language

The exclusion criteria for this review was as follows

• Briefs, non-empirical papers, editorials, letters to the editor, newsletters, conference abstracts, and narrative publications

• Articles that did not meet the inclusion criteria

Data Extraction and Analysis

Data extraction involved reviewing titles, abstracts, and full text of identified publications to determine if they fit the inclusion criteria. This information was used to create a synthesis table on Microsoft Excel of all publications that met criteria. This table had the following categories: article title, author, journal, year of publication, sample size, research question, results, and conclusions. The “Remove Duplicates” function was utilized to ensure all publication entries were unique.

Data analysis involved a narrative approach to analyze and summarize findings. Thematic analysis was then used to identify central themes and trends across the selected literature.

Quality Assessment

The literature that met the inclusion criteria was assessed for clarity, methodology, and relevance to the research question using the associated quality assessment tools.

Bias Assessment

Reviewers in this study consisted of 7 medical students who identified as Muslim and come from diverse socioeconomic, cultural, political, and educational backgrounds. It is worth acknowledging, however, that as all reviewers in this study identified as Muslim, they brought perspectives that influence the interpretation of the literature. The initial screening of titles and abstracts, as well as the full-text review, was conducted individually by all reviewers. Efforts were made to ensure consistency through the training of reviewers, the use of pre-determined inclusion and exclusion criteria, and the use of a synthesis table. To address potential biases and serve as a cross-check, thematic analysis and review of all articles included in this study was completed separately by 2 reviewers on the team after the initial review.

Results

The initial search across all databases yielded 1507 articles; 47 duplicates were removed. Per the inclusion and exclusion criteria, 1353 articles were rejected during the screening of the title and abstract. Following the full-text screening, 82 articles were rejected; a total of 21 studies were found to satisfy the inclusion criteria for the review (Figure 1).

Figure 1.

Analysis method for literature selection using PRISMA.

A descriptive overview of the studies can be found in Supplemental Table 2. The studies were published between 2008 and 2022, and utilized various study designs, including qualitative (43%), quantitative (19%), mixed-method (5%), retrospective (9%), and cross-sectional (24%) methods to understand the healthcare experiences of Muslim patients in the United States. Due to the inclusion criteria, all studies were limited to those conducted in the United States. The demographic characteristics (race, age, gender, and geographical location) of the study populations varied widely across the included literature, reflecting the diversity of the Muslim population in the United States. The review identified diverse healthcare settings, including hospitals, clinics, and community healthcare centers. Additionally, some studies ventured into the Muslim community by going to mosques and community centers to question members on their healthcare experiences.

Nine qualitative studies were identified. Data was collected via focus groups and in-depth interviews. The studies averaged a score of 8.7 out of 10 on the Critical Appraisal Skills Program (CASP) qualitative checklist, indicating the high quality of the selected literature.

Nine cross-sectional studies were identified. Data was collected from medical records, using survey responses, or validated questionnaires. The studies averaged a score of 20.3 out of 22 on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, indicating the high quality of the selected literature.

Two retrospective studies were identified. Data was extracted from electronic medical records. The studies both scored a 10 out of 10 on the CASP cohort checklist, indicating high confidence in the results and the quality of the selected literature.

One mixed-method study was identified. Data was collected through survey responses and in-depth interviews. The study scored a 6 out of 7 on the Mixed Method Appraisal Tool (MMAT) indicating the high quality of the methodology and results.

Thematic analysis of the selected studies identified 5 overarching themes: Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning (Figure 2). These themes were synthesized to provide an overview of the current understanding in the literature, with specific attention to the challenges and complexities associated with the Muslim patient experience.

Figure 2.

Interpretation of studies. Five common themes were identified across the 21 articles deemed eligible for this scoping review.

Discussion

Throughout the course of this scoping review, several themes were identified to impact the experiences of Muslim patients. These themes include Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning. A common narrative that emerged among the analysis of these themes was the importance of healthcare providers recognizing and addressing challenges that Muslim patients face under the framework of cultural humility.

Ramadan and Fasting

Ramadan is the ninth month of the Islamic calendar and marks a time for reflection, gratitude, prayer, and community for those who practice. During Ramadan, Muslim adherents fast from sunrise to sunset, abstaining from food, drink, and any vices. Fasting during Ramadan is considered 1 of the 5 pillars of Islam and is compulsory for all healthy adults. ⁸ In the United States, it was found that about 80% of Muslim individuals fast during the month of Ramadan. ⁹ Therefore, developing an understanding of the impact on Ramadan and fasting on the Muslim patient experience is imperative.

Although fasting is not obligatory for individuals who are pre-pubescent, elderly, pregnant, or have chronic diseases, many of these individuals still choose to fast.^10,11 Little research has been done on the health impact of fasting for those individuals, yet a retrospective review of billing and electronic health record data in Massachusetts (n = 187 722) found that Muslim patients had higher numbers of primary care visits, hospitalizations, and emergency department visits when compared to non-Muslim patients during the month of Ramadan. ¹² Suggested reasons for the increase in healthcare utilization during Ramadan included exacerbations of chronic disease, disrupted medication schedules, and increased incidences of hypoglycemia—yet research has not been done to explore these potential causes.

Studies have shown that individuals with chronic diseases like diabetes, asthma, hypertension, and renal failure have been observed to alter their treatment plans or to discontinue their medications without first consulting with their healthcare providers.^13,14 In fact, a qualitative study of Muslim patients with diabetes by Myers et. al. found that individuals are less likely to communicate self-directed changes in medication-taking behaviors due to feeling vulnerable and poorly understood by their healthcare providers. ¹⁵ These changes in healthcare behaviors can have serious consequences on patient health and impact long-term health outcomes. In addition, a cross-sectional study done by Lou et al ¹⁶ within the University of Michigan Health System explored Muslim women attitudes on fasting during pregnancy. In this study, it was found that most participating patients reported not consulting their physicians on their decision to fast or abstain from fasting during pregnancy. ¹⁶ These studies highlight the numerous missed opportunities for crucial conversations between Muslim patients and their healthcare providers during the month of Ramadan. Not only do these missed opportunities pose health risks to Muslim patients who fast, they also set a barrier in the patient-physician relationship.

In fact, when Lou et al ¹⁶ asked participants what physician characteristics would make them more comfortable discussing healthcare decisions and religious practices, study respondents noted that the most important characteristics desired in a physician included being respectful of Islamic beliefs and possessing knowledge about Ramadan. Therefore, while having a basic understanding of cultural practices is beneficial, it is crucial to approach conversations around fasting behaviors with humility and a desire to better understand individual preferences and beliefs. Only then can providers create an environment of transparency and shared decision-making in the healthcare setting.

Provider understanding of Ramadan as a religious holiday, as well as the possible impacts on the Muslim patient experience, is imperative to providing patient care. In fact, a study by Stockbridge et al ¹⁷ on strengthening tuberculosis protection for Muslim refugees showed the impact of culturally humility in healthcare. Prior to the implementation of an after-dusk home delivery of latent tuberculosis infection regimens, Muslim patients had lower rates of therapy completion than non-Muslim patients during the month of Ramadan. However, after implementation of this program, these rates were comparable to non-Muslim patients, providing evidence for the impact of cultural humility in Muslim patient care. ¹⁷ This study provides a great example of the role of cultural humility in healthcare. Through understanding how religious practices can impact Muslim individuals’ life—and health—behaviors, providers can work to provide care in a culturally sensitive manner. This, in turn, allows Muslim patients the opportunity for equitable care.

Gaining a better understanding of Islamic beliefs, therefore, may present an opportunity for improved communication and partnership between Muslim patients and their healthcare providers. Furthermore, future studies exploring the impact of Ramadan on the Muslim patient experience can open doors to utilizing cultural humility as a framework for physician education—perhaps allowing for better Muslim patient comfort and communication with their providers. It is the responsibility of healthcare providers to approach patient conversations with an emphasis on shared decision-making in order to address healthcare challenges that arise from cultural and religious practices.

Barriers in the Patient-Physician Relationship

The patient-physician relationship is the foundation upon which healthcare delivery takes place. Therefore, it is unsurprising that this relationship assumes particular significance for the health and well-being of Muslim patients. Strong physician-patient relationships are multifactorial and built on respect, trust, empathy, and cultural humility. Time and time again, research has demonstrated that patients who trust their physicians are more likely to adhere to treatment plans and report higher levels of satisfaction.^{18 -21} Among Muslim patients, within the patient-physician relationship, healthcare providers encounter the convergence of religious beliefs and healthcare. It goes without saying that understanding the role of religion in healthcare—for example, fasting during Ramadan, as discussed above—is essential.

Building and maintaining trust between patients and healthcare providers is integral for optimal patient outcomes and experiences. However, research has shown that trust in the healthcare system is reduced in underrepresented groups when compared to their White counterparts. ²² This is applicable to members of the Muslim community who may be less willing to participate in healthcare due to a lack of trust and perceived discrimination. ²³ Compounding this, Padela et al ²⁴ found that decreased trust in the healthcare system may contribute to worse health inequities within the Muslim community. Working to address this barrier can be particularly nuanced and is something healthcare providers should take into consideration when working with Muslim patients.^25,26

For Muslim patients, a healthcare provider’s ability to actively look for and incorporate cultural niceties, religious values, and practices is crucial. A study looking at HPV and influenza vaccine behavior among Muslim women found that Muslim women have significantly lower rates of HPV and influenza vaccination when compared to their White counterparts and other underrepresented groups. They found that improving this disparity required an understanding of the values of Muslim patients and improved communication on the part of the provider. ²⁷ Similarly, a study surveying the experiences of Muslim cancer survivors found that engaging the Muslim community required an understanding of the culture of the study population, including values, norms, language, and preferences—all of which were crucial for the success of their research. ²⁸ Another study looking at breastfeeding practices among African American Muslims found that outreach initiatives that weaved together Islamic perspectives with healthcare education positively influenced breastfeeding attitudes and rates in this population. ²⁹ These studies highlight the importance of healthcare providers developing a basic understanding of the belief system of Muslims to provide culturally-sensitive healthcare grounded in evidence.

Muslim women’s healthcare was a particular area of focus in the articles found in this review. This is not surprising given that Muslim women’s needs also include gender-specific health concerns in addition to cultural values and religious beliefs. Understanding and respecting these unique needs is crucial for providing comprehensive and equitable care. A second study by Hasnain et al ³⁰ looking at the healthcare experiences of Muslim women found 93.8% of participants reported their healthcare providers did not understand their religious or cultural needs. This study found that improving care for this patient population as well as strengthening the patient-physician relationship required (i) provider education on religious and cultural beliefs, (ii) increased shared-decision making opportunities, (iii) addressing communication barriers, and (iv) patient education on navigating the healthcare system. ³⁰ Another study focusing on Muslim women and factors that contributed to delayed healthcare seeking found that the lack of female clinicians was a significant hindrance to care for 53% of participants. In providing care to Muslim women, taking gender-concordant care into account when possible is key to ensuring trust and comfort. ³¹ Simpson et al ³² in a study looking at Muslim women’s experiences with healthcare providers in a rural setting, found that to increase patient satisfaction, providers must be sensitive to cultural differences, emphasize patient rights, and guide them on navigating the U.S. healthcare system, and female health exams. Providing care to Muslim women requires understanding the complexities of incorporating religious and cultural values within healthcare delivery and underscores the significance of healthcare providers’ awareness and sensitivity.

The patient-physician relationship is the basis of healthcare delivery to all patients, including Muslim ones. It encompasses concepts ranging from cultural humility, trust, and sensitive communication to the navigation of complex cultural and religious values and practices. Throughout this scoping review, it has become increasingly apparent that the power of this dynamic between physician and patient is crucial in molding the experiences and long-term health outcomes within Muslim communities.

Trauma and Perceived Discrimination

According to the United Nations Refugee Agency, there are over 108 million individuals who have been forcibly displaced worldwide. A large proportion of these individuals come from majority Muslim countries such as Syria (6.5 million), Palestine (5.9 million), and Afghanistan (5.7 million). While reasons for displacement may range from war, political instability, and mass violence, it is essential that healthcare providers consider the impact of this trauma on health and well-being for the Muslim population. ³³ These global conditions have resulted in the United States seeing an influx of Muslim immigration. Over the past decade, about 36% of refugees admitted to the United States identified as Muslim. ³⁴ Limited studies, however, exist exploring the impact on the refugee experience on patient well-being. Furthermore, following the 9/11 attacks, numerous studies have shown heightened discrimination against Muslims in the US.^23,35,36 The increasing number of Muslims in the US, as well as the unique factors that shape their experience in the country, make exploring the intersectionality of trauma, perceived discrimination, and health imperative when addressing Muslim patient well-being.

A study asking teenage and young adult Muslim participants to record the frequency in which they felt that they were discriminated against due to their religion found that 84% of these individuals ages 12 to 18 years reported experiencing at least 1 act of discrimination in the last 12 months. This value was higher among the older age cohort, ages 18 to 25 years, with 88% of individuals reporting that they experienced some form of discrimination within the year. ³⁷ Perceived discrimination can have an impact on individual health. In fact, previous evidence has shown a link between discrimination and well-being, with perceived discrimination found to be associated with 1.86 times higher odds of mental health problems. ³⁸ Furthermore, in a study with Muslim college students, acculturative stress and perceptions of discrimination was shown to have an indirect effect on depression and anxiety symptoms. ³⁹ Despite increasing evidence highlighting the foregoing challenges, little research has been done on the impact of perceived discrimination on Muslim individuals with respect to their health and well-being. Provider knowledge of factors such as perceived discrimination that make Muslim patients more vulnerable to mental health challenges, however, is invaluable.

In a study focused on children of West African immigrants, a positive correlation was found between (i) trauma and PTSD symptoms of parents and (ii) externalized behavior of their children—demonstrating the long-lasting impacts of trauma on subsequent generations. ⁴⁰

This also, however, demonstrates the importance of provider awareness of potential transgenerational immigration impact when caring for their patients.

Sheikh et al, ⁴¹ more generally explored the role of trauma and perceived discrimination on Muslim individuals in the United States. This study utilized surveys focused on the impact of social connectedness on post-traumatic cognitions of forcibly displaced Muslim persons. About 88% of participants who identified as Muslim refugees reported religion as the basis of discrimination against them. Higher perceived discrimination was significantly associated with stronger negative post-traumatic cognitions (P < .001). ⁴¹ There was also found, however, a strong association of higher social connectedness with lower post-traumatic cognitions (P < .001), suggesting the protective impact of social connection. ⁴¹ Collectively, these studies show how trauma and perceived discrimination can manifest as negative impacts on well-being in youth and adult populations.

Whether through perceived discrimination or the transgenerational impact of forced displacement, the negative association between the challenges faced by the Muslim community and health and well-being is clear. These considerations pose a unique set of challenges to healthcare providers when caring for their Muslim patients. Awareness of these patterns can impact provider understanding of their Muslim patients and can set the framework of preventative care. Recognizing the impact that transgenerational trauma and perceived discrimination can have on Muslim patients allows healthcare workers to be better informed in the care they provide. It also allows for the utilization of proactive and protective measures.

More methodically rigorous studies, however, exploring the impact of trauma and perceived discrimination on Muslim patient health is needed. More specifically, future studies should further explore the intersectional nature of trauma and perceived discrimination, the transgenerational impact, and potential interventions that can combat these factors. Potential study ideas include incorporating longitudinal designs to explore the effects of parent refugee trauma and assess potential impacts on future generations’ health and well-being. Moreover, protective factors need to be further explored in order to inform supportive systems—such as healthcare providers—on impactful ways to help refugees and subsequent generations.

Mental Health Awareness and Stigma

In a study published in 2021, Muslim individuals were 2 times more likely to attempt suicide compared with respondents from other faith traditions, as well as atheist and agnostic respondents. ⁴² This information, combined with the unique mental health risk factors that Muslim individuals in the US face such as racism, xenophobia, and Islamophobia, make it clear that addressing mental health with the Muslim community is a topic that needs to be further explored.

In a population-based study exploring the prevalence, correlates, and impact of psychological disorders on Muslim individuals, it was found that while they had a similar prevalence of psychiatric disorders as their non-Muslim peers, they were less likely to seek out professional intervention. ⁴³ While a variety of factors likely play a role in the delay or absence of seeking care among the Muslim population, mental health education has been found to make an impact on perception and willingness to utilize resources. A study conducted by Mushtaq et al ⁴⁴ explored this idea. This study aimed to assess perception of mental health in Muslim Americans by looking at survey responses of those individuals before and after a mental health symposium. This event was held by faith leaders and mental health professionals and included 3 primary elements: (i) personal narratives from Muslim patients, (ii) a panel of Muslim mental health providers, faith leaders, and a Muslim youth coordinator, and (iii) a presentation held by a Muslim mental health professional with formal training in Islam. ⁴⁴ These elements were intentionally selected due to previous studies showing that Imams—Islamic faith leaders—play an integral role in shaping community attitudes. ⁴⁵

In the survey administered prior to the symposium, respondents reported that they were not as inclined to speak to a medical professional about their mental health challenges and were less likely to take psychotropic medications. There was, however, a significant increase in respondent willingness to take psychotropic medications following intervention, demonstrating the impact of mental health education on changing perceptions and behaviors. ⁴⁴

In a study exploring mental health in a Somali population, Michlig et al ⁴⁶ notes that Somali refugees have an increased risk of common mental health disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD). The authors likened this increased risk with other refugee populations. As previously noted, a large proportion of forcibly displaced individuals worldwide are from majority Muslim countries. A previous literature review on mental health challenges in immigrants and refugees shows that challenges unique to these populations may contribute to an increased risk of mental health concerns. Specific challenges include communication difficulties due to cultural and language differences, the impact of culture in shaping perceptions toward mental health diagnosis and treatment, and differences in family dynamics as it relates to intergenerational conflict and adaptation. ⁴⁷ These unique stressors make mental health awareness in the population—as well as provider understanding of challenges that immigrants and refugees face—especially necessary. Particular focus should be paid to educating future healthcare workers on frequently unacknowledged topics within the mental health sphere in the Muslim community such as the refugee and immigrant experience and traumatic events such as forced migration.

Studies included in this scoping review found that multiple factors including perceived racism, acculturation, cultural knowledge, educational levels, health literacy, refugee status, and general stigma of mental health played a significant role in hindering Muslim patients from seeking mental healthcare.^44,47 These factors should be considered by healthcare providers when discussing mental health care to their Muslim patients and can be achieved by basic training and exposure. With the growing population of Muslim individuals in the US over the past decade, there is an increasing need for health literacy initiatives targeted toward biopsychosocial healthcare for the Muslim population. Future studies should further explore the nuances of mental health perception within Muslim communities. This understanding can be leveraged in the development of culturally sensitive interventions and campaigns to raise awareness in these communities.

Awareness of Advanced Care Planning

End-of-life care varies from household to household due to differences in social, cultural, religious, and personal practices; it requires cultural competence and humility from healthcare providers when caring for Muslim patients. For example, Islam preaches the idea that experiencing illness is a test from Allah (God). Therefore, individuals suffering from illness, as well as the families who care for them, are believed to be rewarded by Allah. ⁴⁸ Furthermore, practicing Muslims believe that incurable illnesses and their faith is in the hands of Allah. ⁴⁹ These beliefs may influence how Muslim patients and families view death, as well as advanced care planning (ACP). Muslim patient’s needs extend beyond the technical medical interventions provided by their healthcare team and is nuanced by the patient’s social, cultural, and spiritual needs, especially in ACP.

Historically, there has been low engagement from racial and ethnic underrepresented populations, individuals with low socioeconomic status, immigrants, and non-English speakers in advanced care planning (ACP). ⁵⁰ Muslim Americans were found to have a low rate of ACP engagement when compared to the US national rate. ⁵⁰ In fact, in a cross-sectional descriptive study exploring Muslim participant engagement in ACP across the United States, it was found that almost half (46.6%) of participants had never heard of ACP. Moreover, only about 15% of participants had signed official ACP documents. ⁵⁰ Possible barriers to Muslim patient engagement in ACP include distrust in the healthcare system, access to care, and health literacy. ⁵¹ With a growing aging Muslim population, it is projected that there will be about 570,000 Muslim American seniors by the year 2030. ⁵⁰ As a complex and sensitive topic, ACP needs to be personalized and discussed in a manner most relevant to the patient and their beliefs.

In an interventional education study aimed at teaching palliative care physicians basic end-of-life care for Muslim patients, pre-surveys revealed that the physicians lacked knowledge in not only end-of-life care in Islam, but also in fundamental Islamic practices. ⁵² After an interventional lecture given by a Muslim chaplain, post-surveys showed a significant improvement in that knowledge. This study is a prime example of the impact informational sessions can make in physicians’ level of understanding regarding their patients. However, implementation of this newly acquired knowledge is necessary in a clinical setting in order to determine improvement of patient-provider interactions as they revolve around end-of-life care. Future studies should aim to achieve this cohesiveness by not only addressing the gap in knowledge on the healthcare providers’ part, but also how information can be exchanged between physicians and patients regarding these sensitive topics.

This discussion highlights several key themes that impact the healthcare experience of Muslim patients. It is apparent that providers must practice cultural humility and develop an understanding of the unique health and wellness needs of Muslim patients. Through an understanding of the themes highlighted in this review, healthcare providers can provide patient-centered care and truly culturally sensitive care that considers the needs of a Muslim patient.

Limitations

There are a couple of limitations in this project to be mentioned. While the Bias Assessment section of this manuscript highlighted measures taken to minimize biases, it is possible that the cultural backgrounds and experiences of research members resulted in biased interpretation and analysis of the literature. Furthermore, there exists a wide range of databases from which articles in this scoping review could have been identified. The research team utilized a total of 4 databases; these databases were selected by the team as they were believed to provide comprehensive and extensive coverage of the research topic, however there is a possibility that other relevant articles were not included in the search. Moreover, during the screening phase, 4 articles were excluded as they were not retrievable. Compounding this, the Muslim population is diverse—making it challenging to capture the full scope of healthcare experiences. It is therefore difficult to generalize the Muslim patient experience based on a small set of study reviewed. Additionally, this review focused on the healthcare experiences of Muslim patients in the US, therefore limiting application and transferability of conclusions to a wider global context.

Conclusion

The 5 themes identified in this review—Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning—represent challenges that Muslim patients face in their healthcare. This scoping review highlights the importance of familiarizing and exposing providers to Islamic practices and the Muslim patient experience, particularly in the aforementioned contexts. This will promote long-term trust and build rapport between the patient and physician and has the potential to improve overall health outcomes. The hope is that this scoping review contributes to the existing literature to aid in providing a better understanding on the vital role cultural humility plays in healthcare, especially in the context of providing care to Muslim patients.