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Muslim communities as a resource for health promotion

Dr Sufyan Dogra shares his experiences of developing the Childhood Obesity Trailblazer Programme in Bradford
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Now it is an honour to be speaking, and I am really very much encouraged to see a timely debate on mental health and its relationship with kind of marginalised, disadvantaged communities and groups has started, and the University of Cardiff is taking a pioneering approach in that. So what we did, although not directly on mental health, but in a way connected with mental health, which was our our data from Born in Bradford, an organisation in which I work for the Bradford Institute for Health Research.
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So we learned that, for example, there are, there are lots of health inequalities and one example is that children who live with overweight and obesity and they happen to be of ethnic minority background, their prevalence of overweight and obesity in those children of South Asian region, for example, is 10% higher than the national average. Now, of course, if our problem is with kind of a phenomenal proportion and it’s prevalent in one community, then in order to address this issue, in order to tackle that health inequality, we have to make a special effort. An effort that is compatible, acceptable, feasible.
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And at the same time, it kind of does not demonise that community or it doesn’t put them kind of off from taking part actively into that solution for the health problem. So what we did, we tried to, we learned that children go to mosque and madrassa after school for a couple of hours on a daily basis. Now, if you have to deliver any health Promotion intervention, any kind of intervention that you want to kind of bring something good in the lives of people about their health and everyday life, what happens, it becomes very difficult because after school interventions are always difficult to plan and deliver.
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There is kind of a lot of things you have to think about bringing families and children together. Now, in Britain, if we look at kind of the way Muslim communities are organising their social lives and 24/7 going to mosque and madrassas, if you happen to be from South Asian background in particular, or any non-Arab speaking kind of background, then children have to go to those settings. So we started our research with this data that we had that 91% of South-Asian origin children who are of Islamic faith will go to a mosque or a madrassa.
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And we started our research from this kind of question, okay, how to use these spaces for health promotion, where we have a significant number of children and families? We saw this religious setting like a mosque or a madrassa, or a women’s circle to kind of study Islam. Or maybe if we can see a sports group or sports organisation that is connected with the religious setting, how to harness the potential of these settings where we have children, their families, their parents, community leaders, available as a captive audience on a daily basis. So what we learned is that the best way to engage with large numbers of children and adults is to work with religious settings.
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The question was how to do that. So we spent almost two to three years on understanding the engagement strategy. Now we learned that, okay, there are different ways of doing it. We connected the traditional, typical understanding in mainstream media, academia, researchers is oh, you know, if we want to deliver something through mosques and madrassas, we should go and talk to imams. Which is great because of course, the imam holds an influence. And then, you know, at the same time, Friday sermon is where we have lots of adults available in one religious space. But for delivery of a message, as one off, that is a great platform.
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But if you want to inculcate healthy behaviours or if you want to deliver something meaningfully on a long term best basis,
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approaching imams only wouldn’t work. And there are a variety of reasons for that. Poor imams, I mean, bless them, they have loads on their plate. They are doing a lot of things. And if you look at British mosques, they are organised as self, self, self-managing units. And these units are managed by a group of people who are regular attendees, congregation, and there is always a mosque management committee. You know, these people are extremely busy people. They have part time jobs or multiple jobs or daytime jobs, and then they come and they volunteer for the functioning of mosques. Some of them are full time paid staff as well, but only in big mosques and madrassas.
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So what goes unnoticed is the presence of those mothers and fathers and volunteers and staff who happen to be professional in certain capacities. For example, a person who might be a community health nurse, or a person who might be a doctor, or person who might be kind of a social care worker. And they also happen to be a regular namaazi, regular kind of person who is attending that mosque on daily basis. And they volunteer their time for their own children who are also attending same religious settings. Now, these people need to be approached through imams, through mosque management committee and I’ve not here like dismissing the role of imam or mosque management committee.
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But what I’m saying is for any particular health intervention, it is vital that we find the right people from within that mosque or madrassa. As a result, we end up organising a little community group that is targeted with a task and the task is to deliver certain behaviours on a regular interval or set up a service which then benefits people on the long term. Now, one way of doing it is that from external organisation like NHS, like Public Health England, or maybe any other mental health service or a charity comes and they do a session in the mosque and then this thing keeps going. But that is kind of a relationship of dependency between religious settings and service providers.
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What is more helpful and effective is if we empower, train and kind of educate and kind of, you know, familiarise people who are a regular part of mosques and madrassas with our health interventions. For example, if something needs to be done on mental health, that group of people, those men, women, families, children, if they know how this is done, they can do it themselves. And I’m not saying that they are doing specialised mental health services, but definitely we need an expert to be helping people. But there’s certain things that encourage healthy behaviours and because we have 91% of children available in these settings.
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So in childhood, if we encourage those healthy behaviours by providing scientific guidelines on healthy diet, physical activity and healthy sleeping patterns, which is a big issue in our communities, we can then ensure that children grew up with a positive experience of living a healthy life. And as a result, as a long term result of this kind of growing up experience, is that there is less health issues, physical or mental health related issues. Now, we learned that if you want to implement or deliver an intervention as a regular feature in a particular community, maybe for example, for one year, five years, three years, that doesn’t matter how long.
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Community people, imams, Islamic leaders, they informed us, basically, if you create some content a manualised toolkit maybe, or some information, some guidelines and these guidelines, information, a booklet, a manualised toolkit, must have scientific guidelines on one hand, at the same time Islamic narrative, like verses from Quran and Hadith and how these supplements and encourages believers to live a healthy life. And if that becomes available in the form of training sessions or workshops or maybe in the form of some kind of half day things, or a fun day sports day festival. And then those messages can be delivered on a sustainable basis for the longer in the long run.
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Now we developed a toolkit for the intervention that we were implementing, which was about childhood obesity. But then you use the same principle for other interventions for example, if you do mental health related service and familiarity, it’s very important that we find two or three volunteers who are eager and have interest, necessarily they do not have to be an imam or a member of mosque management committee. If they are, then that’s, that’s even better.
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But if they are not and they happen to be a member of the congregation, they live in the same neighbourhood, their expertise, their skills, their enthusiasm can be used by linking them with available services so that they can have training and then they can keep implementing. One important factor, I will stop after this, is that we must… so there has to be a kind of a, a system working in the background. Let’s not forget, these religious settings are run by volunteers. They do not have a permanent big source of income or funding in the background. Most of the people who are volunteers and staff in these settings happen to be like mostly from a working class background.
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So there is a lot of pressure on people. And if we expect them oh we come, we give you one message and you keep doing it for long term. That would be too much to ask and would be unrealistic. So to connect these settings with available funding sources from public sources are from private organisations or universities like, you know, academics and researchers and then give them training and then make a kind of partnership. So I will say we need to go one step ahead of engagement, which is involvement. And involvement begins when we start planning and designing any health promotion intervention, including mental health.
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And if people are part of planning and designing and co-production of any health intervention, then the chances are when they are trained and when they have resources, the success and acceptability of that particular health intervention will be huge and people will benefit more.

In this video, Dr Sufyan Dogra (Principal Research Fellow at the Bradford Institute for Health Research) shares his experiences of developing the Childhood Obesity Trailblazer Programme (COTP) in Bradford.

This project was funded by the Department of Health and Social Care in the UK and managed by the Local Government Association. See the link below for further information on COTP.

Dr Dogra draws out recommendations from COTP around co-producing health promotion and intervention activities with Muslim communities. He suggests that those seeking to work with Muslim communities through mosques, should engage congregants as well as imams and go beyond mosque management committees. Dr Dogra found that Muslim communities included informed, well-educated, and enthusiastic people who could be engaged to promote better health, including mental health, in their social networks and communities.

Those who seek to work with mosques should be aware that the people working within these settings are often volunteers, often with other demands on their time. Sufyan recommends that those who seek to work with mosques should focus on building long-term collaborative relationships that are based on mutual trust and understanding, and that do not unduly burden volunteers from the mosque community.

CCGs commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed for diverse local populations and ensuring that they are provided. In their recent report, the Lantern Initiative, a grassroots mental health charity for Muslims, make the following recommendations for CCGs around improving support for Muslim mental health:

  • CCGs should commission research which accesses the expertise already held within communities, this research needs to start addressing more complex mental health needs of the Muslim community
  • create funding schemes and mentorship programmes within the NHS that genuinely work together in co-creating training and service provision with Muslim experts in the field
  • create long term sustainable funding streams for community groups working in Muslim mental health; incorporate an autonomous model where individuals and grassroots organisations have a voice in the decision-making processes in relation to service design and delivery
  • consider alternative career entry routes, whilst maintaining standards, as an alternative to existing roles governed by established accreditation bodies which hold problematic structural and systemic alienation and racism concerns.

(The Lantern Initiative et al. 2021)

Signpost

News article: Born in Bradford: Mosques and madrassas have huge potential to help prevent child obesity. Telegraph and Argus, 4th June 2021.

Childhood Obesity Trailblazer Programme.

For more information on Clinical Commissioning Groups (CCGs) see the NHS website.

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Understanding Muslim Mental Health

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