Religious Practices and Patient Compliance

03-23-2007 | Categories:

Culture-Ethnicity

Impact of Theology on Adherence To Treatment

Source:
Bashir Qureshi, FRCGP, Diabetes in Ramadan J R Soc Med. 2002 October; 95(10): 489–490.

Managing Diabetic Patients Practicing Devotional Fasting and Other Religious Behaviors

This article centers on pragmatic clinical tips on the medical management of diabetic Muslims celebrating Ramadan.

Devoted healthy Muslims commemorate the revelation of the Holy Quran by Allah to the Prophet Mohammed by fasting in the month of Ramadan every year. Ramadan lasts for 29 or 30 days, depending on the sighting of the moon. While continuing their daily occupation without time off, fasting Muslims abstain from food, liquids, tobacco, sexual activity and medication (oral, inhaler or injection) from sunrise to sunset. However, the sick, the pregnant and nursing mothers and children are exempt; moreover, if a fasting person becomes ill, he or she is allowed to end the fast in the day. Ramadan directly influences the control of diabetes because of the month-long changes in meal times, types of foods, use of medication and daily lifestyle.

A brief summary of the relevant customs of Ramadan is followed by “Ten Points Towards Improving Diabetes Care In Muslim Patients.”¹ These examples from that list are representative:

#4 ‘Human insulin’ may be misunderstood by the patient as signifying manufacture from human flesh or pancreas, leading to non-compliance. Some non-westernized Asian and African Muslims do not understand diabetes as western people do. Explain that ‘human’ simply means ‘akin to human’

#5 In Ramadan, a person with type 2 diabetes can take a sulphonylurea at the end of the fast, with the evening meal started within 30 minutes. Advise not to miss the sehri (before sunrise) meal so as to avoid hypoglycaemia later in the day. Repaglinide (NovoNorm) can be particularly useful, since it need only be taken when a meal is eaten, therefore no change in drug therapy will be required in Ramadan. A meal must be eaten within 15 minutes

Other recommendations are less specific to diabetes or Ramadan; Point #8, for example, advises that:

Medical advice is sometimes ignored for religious reasons. Occasionally a devoted Muslim will say, ‘Allah will protect me’. He or she may not fear death or may even want to die so as to meet the Creator. Counsel the patient by saying ‘to see the doctor and comply with treatment is Prophet Mohammad’s sunnat (precedent)’. To refuse would be a sin

Commentary

While this article focuses on a relatively narrow audience, clinicians with limited knowledge of Muslim practices who are providing care for diabetics who are followers of that religion, its readily apparent implications regarding compliance extend far beyond the treatment of a given disease or methods for dealing with those who conform to a single set of theological doctrines. The message to healthcare professionals is clear:

Only by acquainting themselves with the religious and cultural practices of their patients can healthcare providers anticipate and develop insight into potential conflicts between adherence to treatment and adherence to theological obligations and offer those patients the counsel and information necessary to maintain both their faith and their health.

Footnotes