Clinicians’ Perspectives on Caring for Muslim Patients Considering Fasting During Ramadan

  • Mohamed Ezzat Khamis AminEmail author
  • Ahmed Abdelmageed
Original Paper


This study explores clinicians’ perspectives on factors affecting care provided to Muslim patients who decide to fast during Ramadan. Semi-structured interviews were conducted with a purposeful sample of clinicians in Egypt (11) and the USA (10). Framework analysis was conducted through mapping data to constructs within social cognitive theory. Data were mapped into clinician’s belief in ability to care for those patients, belief in group’s ability to provide care, anticipated consequences of providing such care, knowledge, learning by observing other clinicians, cultural norms and perceived acceptability and prevalence of care provision, environmental barriers and opportunities, and communication approach.


Ramadan Islam Culture Social cognitive theory Qualitative 



We are very indebted to Dr. Betty Chewning for valuable methodological advice, Dr. Ahmed Osman, Dr. Mohammad Shoukry Newegy, Dr. Brian Henriksen, and Dr. Joshua Kline, for technical support in collection of data, Mrs. Eman ElNaggar, Ms. Marwa Farhat for transcription of data. We would also like to thank all clinicians who took the time to participate in the study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Abuelmagd, W., Hakonsen, H., Mahmood, K. Q., Taghizadeh, N., & Toverud, E. L. (2018). Living with diabetes: Personal interviews with Pakistani Women in Norway. Journal of Immigrant and Minority Health, 20(4), 848–853.CrossRefGoogle Scholar
  2. Ahmedani, M. Y., Hashmi, B. Z., & Ulhaque, M. S. (2016). Ramadan and diabetes: Knowledge, attitude and practices of general practitioners; a cross-sectional study. Pakistan Journal of Medical Sciences, 32(4), 846–850.Google Scholar
  3. Akhan, G., Kutluhan, S., & Koyuncuoglu, H. R. (2000). Is there any change of stroke incidence during Ramadan? Acta Neurologica Scandinavica, 101(4), 259–261.CrossRefGoogle Scholar
  4. Al Suwaidi, J., Bener, A., Hajar, H. A., & Numan, M. T. (2004). Does hospitalization for congestive heart failure occur more frequently in Ramadan: A population-based study (1991–2001). International Journal of Cardiology, 96(2), 217–221.CrossRefGoogle Scholar
  5. Ali, R., Siddiqui, H., Anjum, Q., Lohar, M. I., & Shaikh, S. S. (2007). Knowledge and perception of patients regarding medicine intake during Ramadan. Journal of the College of Physicians and Surgeons Pakistan, 17(2), 112–113.Google Scholar
  6. Amin, M. E., & Chewning, B. (2014). Community pharmacists’ knowledge of diabetes management during Ramadan in Egypt. International Journal of Clinical Pharmacy, 36(6), 1213–1221.CrossRefGoogle Scholar
  7. Amin, M. E., & Chewning, B. (2016). Pharmacist-patient communication about medication regimen adjustment during Ramadan. International Journal of Pharmacy Practice, 24(6), 419–427.CrossRefGoogle Scholar
  8. Aslam, M., & Healy, M. A. (1986). Compliance and drug therapy in fasting Moslem patients. Journal of Clinical and Hospital Pharmacy, 11(5), 321–325.Google Scholar
  9. Aydin, O., Celik, G. E., Onen, Z. P., Yilmaz, I., Ozdemir, S. K., Yildiz, O., et al. (2012). How do patients with asthma and COPD behave during fasting? Allergologia et Immunopathologia, 42, 115–119.CrossRefGoogle Scholar
  10. Bajaj, H. S., Abouhassan, T., Ahsan, M. R., Arnaout, A., Hassanein, M., Houlden, R. L., et al. (2019). Diabetes Canada position statement for people with types 1 and 2 diabetes who fast during Ramadan. Canadian Journal of Diabetes, 43, 3–12.CrossRefGoogle Scholar
  11. Bandura, A., & National Inst of Mental Health. (1986). Prentice-Hall series in social learning theory. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  12. Bener, A., Hamad, A., Fares, A., Al-Sayed, H. M., & Al-Suwaidi, J. (2006). Is there any effect of Ramadan fasting on stroke incidence? Singapore Medical Journal, 47(5), 404–408.Google Scholar
  13. Bowen, G. A. (2008). Naturalistic inquiry and the saturation concept: a research note. Qualitative Research, 8(1), 137–152.CrossRefGoogle Scholar
  14. Delbanco, T. L. (1992). Enriching the doctor-patient relationship by inviting the patient’s perspective. Annals of Internal Medicine, 116, 414–418.CrossRefGoogle Scholar
  15. Gaborit, B., Dutour, O., Ronsin, O., Atlan, C., Darmon, P., Gharsalli, R., et al. (2011). Ramadan fasting with diabetes: An interview study of inpatients’ and general practitioners’ attitudes in the South of France. Diabetes and Metabolism, 37(5), 395–402.CrossRefGoogle Scholar
  16. Gale, N., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Health Services Research, 14(1), 117.Google Scholar
  17. Habib, A. G., Shepherd, J. C., Eng, M. K., Babashani, M., Jumare, J., Yakubu, U., et al. (2009). Adherence to anti retroviral therapy (ART) during Muslim Ramadan fasting. AIDS and Behavior, 13(1), 42–45.CrossRefGoogle Scholar
  18. Hakonsen, H., & Toverud, E. L. (2012). Cultural influences on medicine use among first-generation Pakistani immigrants in Norway. European Journal of Clinical Pharmacology, 68(2), 171–178.CrossRefGoogle Scholar
  19. Hassanein, M., Al-Arouj, M., Hamdy, O., Bebakar, W. M. W., Jabbar, A., Al-Madani, A., et al. (2017). Diabetes and Ramadan: Practical guidelines. Diabetes Research and Clinical Practice, 126, 303–316.CrossRefGoogle Scholar
  20. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.CrossRefGoogle Scholar
  21. Ilkilic, I., & Ertin, H. (2017). Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan. Medicine, Health Care and Philosophy, 20(4), 561–570.CrossRefGoogle Scholar
  22. Jaber, D., Albsoul-Younes, A., & Wazaify, M. (2014). Physicians’ knowledge, attitude and practices regarding management of medications in Ramadan. Eastern Mediterranean Health Journal, 20(1), 56–62.CrossRefGoogle Scholar
  23. Kumar, N., & Jivan, S. (2007). Ramadan and eyedrops: The Muslim perspective. Ophthalmology, 114(12), 2356–2360.CrossRefGoogle Scholar
  24. Langford, E. J., Ishaque, M. A., Fothergill, J., & Touquet, R. (1994). The effect of the fast of Ramadan on accident and emergency attendances. Journal of the Royal Society of Medicine, 87(9), 517–518.Google Scholar
  25. Mir, G., & Sheikh, A. (2010). ‘Fasting and prayer don’t concern the doctors… they don’t even know what it is’: Communication, decision-making and perceived social relations of Pakistani Muslim patients with long-term illnesses. Ethnicity and Health, 15(4), 327–342.CrossRefGoogle Scholar
  26. Mygind, A., Kristiansen, M., Wittrup, I., & Norgaard, L. S. (2013). Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark. International Journal of Clinical Pharmacy, 35(2), 281–288.CrossRefGoogle Scholar
  27. Noon, M. J., Khawaja, H. A., Ishtiaq, O., Khawaja, Q., Minhas, S., Niazi, A. K., et al. (2016). Fasting with diabetes: A prospective observational study. BMJ Global Health, 1(2), e000010.CrossRefGoogle Scholar
  28. Ozkan, S., Durukan, P., Akdur, O., Vardar, A., Torun, E., & Ikizceli, I. (2009). Does Ramadan fasting increase acute upper gastrointestinal haemorrhage? The Journal of International Medical Research, 37(6), 1988–1993.CrossRefGoogle Scholar
  29. Padela, A. I., Gunter, K., Killawi, A., & Heisler, M. (2012). Religious values and healthcare accommodations: Voices from the American Muslim community. Journal of General Internal Medicine, 27(6), 708–715.CrossRefGoogle Scholar
  30. Patel, N. R., Kennedy, A., Blickem, C., Rogers, A., Reeves, D., & Chew-Graham, C. (2015). Having diabetes and having to fast: a qualitative study of British Muslims with diabetes. Health Expectations, 18(5), 1698–1708.CrossRefGoogle Scholar
  31. Pathy, R., Mills, K. E., Gazeley, S., Ridgley, A., & Kiran, T. (2011). Health is a spiritual thing: Perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan. Ethnicity and Health, 16(1), 43–56.CrossRefGoogle Scholar
  32. Peeters, B., Mehuys, E., Van Tongelen, I., Van Bever, E., Bultereys, L., Avonts, D., et al. (2012). Ramadan fasting and diabetes: An observational study among Turkish migrants in Belgium. Primary Care Diabetes, 6, 293–296.CrossRefGoogle Scholar
  33. Peterson, S., Nayda, R. J., & Hill, P. (2012). Muslim person’s experiences of diabetes during Ramadan: information for health professionals. Contemporary Nurse, 41(1), 41–47.CrossRefGoogle Scholar
  34. Pew Forum on Religion & Public Life. (2011). The future of the Global Muslim Population: Projections for 2010–2030. Washington, District of Columbia: Pew Research Center Forum on Religion and Public Life.Google Scholar
  35. Pinelli, N. R., & Jaber, L. A. (2011). Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. Journal of Pharmacy Practice, 24(2), 211–215.CrossRefGoogle Scholar
  36. Rasheed, A. A., Rashid, Y. A., Pirzada, F. T., Haroon, F., Jabbar, A. A., & Rahim, A. (2017). Knowledge, attitude and perceptions of Muslim cancer patients regarding cancer treatment during Ramadan: Results from a tertiary care hospital Karachi. Journal of the Pakistan Medical Association, 67(8), 1144–1150.Google Scholar
  37. Reeves, S., Albert, M., Kuper, A., & Hodges, B. D. (2008). Why use theories in qualitative research? British Medical Journal, 337, a949.CrossRefGoogle Scholar
  38. Robinson, T., & Raisler, J. (2005). “Each one is a doctor for herself”: Ramadan fasting among pregnant Muslim women in the United States. Ethnicity and Disease, 15(1 Suppl 1), S1-99–S1-103.Google Scholar
  39. Salti, I., Benard, E., Detournay, B., Bianchi-Biscay, M., Le Brigand, C., Voinet, C., et al. (2004). A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: Results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care, 27(10), 2306–2311.CrossRefGoogle Scholar
  40. Savas, E. (2018). Attitudinal determinants of turkish diabetic patients and physicians about Ramadan fasting. Journal of Religion and Health, 57(1), 47–56. Scholar
  41. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.CrossRefGoogle Scholar
  42. Topacoglu, H., Karcioglu, O., Yuruktumen, A., Kiran, S., Cimrin, A. H., Ozucelik, D. N., et al. (2005). Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department. International Journal of Clinical Practice, 59(8), 900–905.CrossRefGoogle Scholar
  43. Zeeneldin, A. A., & Taha, F. M. (2012). Fasting among Muslim cancer patients during the holy month of Ramadan. Annals of Saudi Medicine, 32(3), 243–249.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of PharmacyBeirut Arab UniversityBeirutLebanon
  2. 2.College of Pharmacy, Natural and Health SciencesManchester UniversityFort WayneUSA

Personalised recommendations