title: Health is a spiritual thing: perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan.
abstract: OBJECTIVE
  To explore perspectives of health care professionals and female Somali and Bangladeshi Muslim women on practices related to fasting during Ramadan, the impact of fasting on health and the role of health professionals during Ramadan.
  
  
  METHODS
  A cross-sectional qualitative study was conducted. Two culturally specific focus groups were conducted with six Somali and seven Bangladeshi Muslim women who observed Ramadan and lived in an inner-city neighbourhood of Toronto, Canada. Individual semi-structured interviews were conducted with 22 health care professionals practicing in this inner-city area (three of whom were Muslim). Data were analysed using thematic qualitative analysis.
  
  
  RESULTS
  Both Muslim women and health care professionals recognised the spiritual significance of the Ramadan fast. Muslim participants considered the fast to be beneficial to health overall, whereas health care professionals tended to reflect on health concerns from fasting. Many health care professionals were not fully aware of fasting practices during Ramadan and some found it challenging to counsel patients about the health effects of fasting. Muslim women expressed disagreement regarding which medical interventions were permitted during fasting. They generally agreed that health care professionals should not specifically advise against fasting, but instead provide guidance on health maintenance while fasting. Both groups agreed that guidelines developed by the health care and faith communities together would be useful.
  
  
  CONCLUSIONS
  There are a variety of health beliefs and observances among female Muslim Somali and Bangladeshi women and a range of knowledge, experience and opinions among health care professionals related to fasting during Ramadan and health. Overall, there is a need for improved communication between members of the Muslim community and health professionals in Canada about health issues related to fasting during Ramadan. Strategies could include published practice guidelines endorsed by the Muslim community; patient education materials developed in collaboration with health and religious experts; or further qualitative research to help professionals understand the beliefs and observances of Muslim people.
authors.affiliation: Department of Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Rubini
authors.initials: R
authors.lastname: Pathy
authors.forename: Kelsey E
authors.initials: KE
authors.lastname: Mills
authors.forename: Sharon
authors.initials: S
authors.lastname: Gazeley
authors.forename: Andrea
authors.initials: A
authors.lastname: Ridgley
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001459:Bangladesh / Q000208:ethnology; D003430:Cross-Sectional Studies; D005215:Fasting / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006304:Health Status; D006693:Holidays; D006801:Humans; D007407:Interviews as Topic; D007514:Islam; D008875:Middle Aged; D009864:Ontario; D024382:Professional Role; D012998:Somalia / Q000208:ethnology; D029181:Spirituality; D014505:Urban Population