The impact of religious beliefs on adherence to medication in the Muslim population: a systematic scoping review
Authors: Ali B , Nazar Z , Barnes N , Rutter P 
Published: April 2022

Abstract

Introduction
Factors influencing medication adherence are well-established, however, how religious beliefs influence medication adherence is less well researched. In the Islamic faith, strict dietary laws exist. It arguably prohibits certain animal derived, and alcohol-based foodstuff both in the diet as well as in medicines. Religiously Prohibited Medicines (RPMs) are medicines that contain ingredients, active or otherwise, proscribed by Islam’s canonical texts (1). Potential circumstances exist where Muslim patients avoid RPMs thus presenting a possible dilemma for patients and healthcare professionals involved in their care.

Aim
To scope the literature and summarise the reported influence of religious beliefs on adherence to RPMs in the Muslim population and highlight gaps for further research.

Methods
A systematic scoping review methodology advocated by the Joanna Briggs Institute was employed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (2). The protocol was registered with the Open Science Framework. Boolean operators AND and OR combined with truncation and phrase searches were used to search PubMed, Medline, Scopus and EBSCO (CINAHL, IPA, PsycINFO). MeSH terms were used where appropriate. Filters included, studies published in English from inception until November 2020. Grey literature sources included OpenGrey, EThOS and ZETOC. Reference lists from included studies were also hand-searched. All study designs were considered for inclusion. Eligible studies included investigations involving any stakeholder regarding the influence of RPMs on medication adherence amongst Muslims. Two reviewers independently screened the titles, abstracts and full papers, with a third reviewer consulted in cases of non-agreement. Two reviewers independently performed data extraction. A narrative approach to data synthesis was employed, in which two reviewers independently identified themes that aligned with the research question.

Results
15 articles were included, published between 2001-2019, 13 of which were conducted in the UK. Studies included seven cross-sectional surveys, one qualitative study, four practice papers, three case reports and one unpublished report. Most studies investigated healthcare practitioners’ awareness and knowledge of religious-factors influencing medication-adherence (n=13). These studies revealed that level of exposure to diverse populations and cultural competence training were of most significance. Some studies explored market availability of RPM alternatives with recommendations for clearer labelling on packaging and reference sources (n=2). Two case reports detailed accounts where Muslim patients prescribed RPMs resulted in non-adherence. Key themes identified that addressed the research question included: 1) ethical dilemmas; 2) sources of information; 3) cultural competence; 4) biological to synthetic sourcing.

Conclusion
The strength of this review is that it is the first to explore the influence of religious beliefs on adherence to RPMs and provides an overview of the existing literature. The review identified two case reports demonstrating the possible risks RPMs pose to medication-adherence, however, the lack of studies exploring this field restricts the understanding of the topic, limiting the research. Furthermore, only English published articles were included. Studies provided evidence that further training of healthcare professionals in cultural competence and awareness of RPMs, may facilitate the necessary support to deliver culturally-sensitive care to Muslim patients. However, multi-stakeholder perspectives of RPMs, and evidence-based strategies to address their potential negative implications, remains largely unexplored and warrants further research.

References
(1) Sattar SP, Ahmed MS, Madison J, Olsen DR, Bhatia SC, Ellahi S, et al. Patient and physician attitudes to using medications with religiously forbidden ingredients. Ann Pharmacother. 2004;38(11):1830–5.
(2) Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467–73.