Understanding the Muslim Community From a PT-Specific Lens
By the year 2040, Muslims are projected to become the second largest religious group in the U.S. (Pew Research Center, 2018). Currently, the Muslim population faces health inequities, part of which stem from discrimination and a lack of religious accommodation in clinics.
Given the growth rate of the Muslim population, it is inevitable that the proportion of Muslim patients requiring physical therapy will similarly grow. Physical therapists and physical therapist assistants must therefore equip themselves with information that will help them to best address the needs of this population.
If health care practitioners fail to understand the sociocultural influences of a patient's condition, they may fail to successfully treat that patient. According to three published studies, Ethnicity & Disease: "Provider Factors Affecting Adherence: Cultural Competency and Sensitivity" (2009); Health Affairs: "Cultural Competence and Health Care Disparities: Key Perspectives and Trends" (2005); and Medical Care: "Physician Communication and Patient Adherence to Treatment: A Meta-Analysis" (2009), when patients perceive poor communication and a lack of congruency between their goals, values, and experiences, and those of their health care providers, patients may be more likely to delay care, be nonadherent, and distrust the health care system.
Today, Muslims in the U.S. may feel unwelcome in clinics that are not culturally competent in addressing their needs in the context of religion, as reported in a 2012 study published in the Journal of General Internal Medicine: "Religious Values and Healthcare Accommodations: Voices From the American Muslim Community." Patients should not have to educate health care providers who may not be aware of their faith requirements, but clinicians should ask the patient for guidance when needed. This way it creates an opportunity to ensure that their needs are met. It's important for PTs and PTAs to educate themselves about the needs of their patients who identify as Muslim to ensure that patient-centered care remains our profession's priority.
I chose to address this topic because I am a bridge between two worlds. I am both a devout Muslim woman and a second-year physical therapy student at Wayne State University.
I pursued physical therapy as a career in part due to the health needs of my community. Too many stories have come up about how fellow Muslims did not feel comfortable, accommodated, or accepted in clinical settings. In order to better care for Muslim patients, a basic awareness of their values and experiences is necessary.
Although we cannot say that every Muslim practices Islam the same way, there are certain behavioral trends in religious practice that PTs and PTAs should be aware of in order to provide the best care. Based on my experiences, I have compiled a few key considerations for therapists who directly influence patient care: modesty customs and the concept of spiritual activities of daily living.
At this point, I think that it is appropriate to mention that accommodation of different customs and traditions, be they of religious origin or otherwise, is not tantamount to endorsement of those customs and traditions.
As professionals, our role is to meet patients with our expertise in order to fulfill their needs and improve their health. This expertise should not conform to a single value system; rather, it should be adaptable to meet the needs of any patient who seeks our aid.
With this in mind, and considering the diversity of our patient populations, it is important for PTs and PTAs to create opportunities for patients to share their cultural needs instead of leaving it up to patients to find an appropriate moment to interject.
Since it may not be obvious that someone is Muslim, a few ways to ensure that any patient's religious values are met are to ask before an evaluation, "Is there anything my team and I can do to make you more comfortable?" or "Are there any religious, ethnic, or cultural values that you would like me to know about prior to beginning treatment?" These statements can serve as general additions to all patient interviews and are inclusive enough to apply to all patients.
Modesty is a general ruling for both men and women in Islam. This includes both being alone with a person of the opposite sex as well as concealing one's body parts. However, in a health care setting, health needs supersede those of modesty. Therefore, it is permissible for men and women to expose body parts in such settings.
In general, a Muslim patient will prefer to be treated in a private area by a therapist of the same sex. Most clinics are already equipped to fulfill these needs, as most have private spaces or curtains to draw around treatment tables. If these are not readily available, portable privacy screens may be purchased to serve the same purpose.
Although Islam has rulings of modesty, it is flexible toward the health needs of Muslims. In the rare instance in which no accommodations can be made, the health needs of Muslim patients supersede modesty, and it is permissible to proceed with care if the patient consents. However, PTs and PTAs should try as best as possible to make their patients comfortable during treatment; this is true for all religious affiliations. After all, an act as simple as keeping a door closed or a curtain drawn is truly appreciated by any patient in maintaining privacy and dignity.
Spiritual activities of daily living (ADLs).
One concept that is notably absent from physical therapy dialogue is the impact of health problems on spiritual or religious practices, such as kneeling in prayer. I have come to think of these as spiritual ADLs. Before getting into the specifics for the Muslim population, spiritual ADLs may be introduced into conversations with a simple question that may apply to people of all backgrounds. For example, while inquiring about difficulties with ADLs during an evaluation, a therapist may ask, "Are there any spiritual or religious activities in your daily life that have been affected by your symptoms?" This would open the door to patients sharing their customs, ranging from religious prayers to meditation.
For Muslims specifically, prayer and ablution (wudu) are spiritual ADLs of utmost importance. Muslims have five prayers that are interspersed throughout the day. The first is prayed before sunrise and the last is prayed in the night. From a PT perspective, the aspects that are most important for rehabilitation are the physical movements required for a successful prayer. The image below highlights the common positions of prayer and should serve as a baseline awareness of the movements required. It is also important for PTs and PTAs to recognize that some of these movements may be unattainable to patients, and they can be modified.
For example, patients who cannot pray standing may pray seated. There are countless modifications that can be made based on an individual's movement capacity. If faced with this, PTs and PTAs may discuss these issues with their patients and work together to modify the motions of prayer to suit patients' current abilities and future goals. In case of doubts, patients can be encouraged to speak about the permissibility of specific modifications with local religious leaders.
Another key consideration is wudu, or ablution. Wudu is the practice of cleaning and purifying the body with water in preparation for prayer. It entails cleaning the hands, mouth, nose, face, forearms, hair, ears, and feet. Once again, the important part for PTs to recognize are the movements required to complete wudu. As long as the body parts are washed, body position does not matter. Therefore, if patients identify wudu as an area of struggle, PTs may work with them to understand what difficulties are experienced and to brainstorm ways to make the task easier.
Although I can do a great deal to help my community, I cannot address everyone. The physical therapy community must contribute to this process. Islam is a religion that respects health and encourages health-seeking behaviors. Having health care providers who have awareness of Islamic values allows Muslim patients to better improve their health.
This article provides a basic awareness of religious and cultural considerations for the Muslim population in health care settings from a PT-specific lens. Its implementation serves as a step forward in inclusivity and cultural competency and brings us closer to achieving the APTA vision of transforming society by optimizing movement to improve the human experience.
APTA is committed to fostering a culture of diversity, equity, and inclusion within our community. This is a journey and that journey needs your perspective and support. If you have ideas to increase diversity and promote equity and inclusion, email us at email@example.com.
Bana Odeh, SPT, is a student at Wayne State University and a member of the Michigan Physical Therapy Association's Diversity, Equity, and Inclusion Committee. You can connect with Bana at firstname.lastname@example.org.