Abstract C03: Reducing Muslim mammography disparities: Outcomes from a religiously tailored mosque-based intervention
Authors: Padela Aasim , Malik Sana , Nageeb Shaheen , Peek Monica , Quinn Michael 
Published: February 2019

Abstract
Objective: To describe the design of, and participant-level outcomes related to, a religiously tailored peer-led group education program that addressed mammography-related barrier beliefs of American Muslims.
Methods: Using community-engaged research methods including a multidisciplinary community advisory board, we identified and then intervened upon barrier beliefs impeding mammography screening among American Muslim women. Phase 1 of the project involved focus groups and interviews with an ethnically diverse group of women aged 40 and older sampled from Muslim organizations to identify salient behavioral, normative, and control beliefs regarding mammography. Phase 2 entailed interviews with the same target population to elicit ideas about intervention design. CAB members and staff used these data to design the curriculum and messaging for a religiously tailored mosque-based intervention involving peer-led group education classes. Peer educators were recruited and trained from mosques and were religious and ethnically concordant with the target intervention population. The classes involved facilitated discussions and guest-led didactics covering religion and health and mammography. Survey data from group education participants were collected pre-intervention, post-intervention, 6 months post-intervention, and one year post-intervention. Survey instruments recorded changes in mammography intention, likelihood, confidence, and resonance with barrier and facilitator beliefs.
The structural elements and messages of the classes tackled barrier beliefs in at least one of 3 ways: (i) Reprioritizing--introducing another religious belief that has greater resonance with participants such that the barrier belief is marginalized; (ii) Reframing the belief within a religious worldview such that it is consistent with the health behavior desired; and (iii) Reforming--using a religious scholar to provide “correct” interpretations of religious doctrine.
Results: 52 Muslim women (mean age = 50 yrs) who had not had a mammogram in the past two years, of whom 18 were of Arab descent and 27 South Asian, participated in the two-session course. The pre- and post-self-reported likelihood of obtaining a mammogram increased significantly following the intervention (p=0.03), as did breast cancer screening knowledge (p=0.0002). Greater resonance with facilitator beliefs significantly predicted positive likelihood changes (OR 1.31, p=.003). Participants with higher negative religious coping (OR = 1.33, p=0.04) and greater resonance with facilitator beliefs (OR = 1.44, p = 0.00) had higher odds for having an intention to get a mammogram post the class, while those with higher religiosity (DUREL, OR = 0.72, p= 0.01), and more resonance with barrier beliefs (OR= 0.72, p= 0.01) had significantly lower intentions. At six months' follow-up, 42% (n= 20/47) of participants had obtained a mammogram and 7.7% (n=4) were lost to follow-up.
Conclusion: Our pilot mosque-based intervention involving religiously tailored messages delivered through peer-led classes demonstrated efficacy in improving Muslim women's self-reported likelihood of obtaining mammograms post-class, and over 40% of participants eventually obtained a mammogram within 6 months of the classes.
Citation Format: Aasim Padela, Sana Malik, Shaheen Nageeb, Monica Peek, Michael Quinn. Reducing Muslim mammography disparities: Outcomes from a religiously tailored mosque-based intervention [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C03.