members of minority communities, we deeply understand the challenges in getting health care. As a community advocacy organization, the Utah Muslim Civic League is uniquely positioned to bridge the gaps in care for underserved communities. We design programs and resources to empower Muslims as engaged citizens and respond to their Muslims’ concerns.
I (Wagma) joined the Utah Muslim Civic League as a program associate and the head of their Public Health Committee in 2020. In addition to programs targeting mental health issues, domestic violence, and Covid education, we’ve also set up five vaccination clinics. My parents are immigrants from Afghanistan, and I saw how even though my mom was highly educated, she was treated very differently when she went for health care. She didn’t feel heard, and she always came home feeling like nobody would listen to her, and that really broke trust because she didn’t feel a connection with a provider. When we moved to Utah, I started hearing these microaggressions and blatant racism, so I chose a career in medicine to help people in return; to stand up and be an advocate. What I see is that those patients who feel that they are heard by their providers are more willing to immunize.
I (Luna) founded the Utah Muslim Civic League in order to engage in civic and charitable activities. Providing service means providing well-being for the community. Muslims make up between 1-2.5% of the American population, and most people think of Muslims as an Arab-majority, wealthy kind of community. But if you look at the data, you’ll see that one-third of Muslims are Black Americans. Their barriers completely outweigh what the general public usually experiences. My goal is to engage people in the civic process and influence policy. When the pandemic hit, it completely interrupted people’s lives and jobs. If we want to affect policy change, we need to understand what is really going on at a grassroots level, and we need to meet them where they are.
Misinformation, language and access: Factors influencing vaccine hesitancy in Muslims
We have seen how disinformation and conspiracy theories convince people not to get a Covid-19 vaccine. In an underrepresented community like the Muslim community, there are also added layers of isolation, including lack of education and language barriers.
For minority patients who speak English as a second language, providers struggle to clearly communicate the benefits of the vaccine or may not be able to understand and address a patient’s questions. They may brush off the person’s concerns, even inadvertently, leaving them unable to build trust. When patients feel heard and get good information, they often become comfortable with vaccination.
Poverty is also a significant barrier. They may not have the privilege of time or the resources to do their own research. They rely on information from family and friends in their community, who may also be misinformed.
There is a third issue as well (unrelated to vaccine hesitancy), which is access to care. Many people who do want a vaccine cannot get one because of structural barriers. For example, vaccination sites located in places that are difficult to access without reliable transportation. Sites that are so far away that the person cannot take time off work to travel there when it’s open. Information on how and where to get the vaccine that is not available in their native language.
All of these barriers add up, and we as health care providers must meet people where they are to provide the best care.
Who communicates matters: Building trust to vaccinate
To build trust and bring the Covid-19 vaccine to the Muslim community in Utah, we started Project Shifa. Shifa means health and healing in Arabic. It starts with providing data-driven information to the community, as well as policy makers. Instead of forcing individuals to represent an entire community, we came together collectively to address and create shared pathways of education and serving the community. We put together a team with varied experience—physicians, paraprofessionals—to inform, learn, and synthesize information about health disparities in our community. It was also important that team members were compassionate and cared about serving this population.
Next, we reached out to local community leaders to directly communicate with different groups of people and to understand their concerns. We asked “What are your concerns? What is causing hesitancy?” For example, we reached out to imams (Muslim religious leaders) to discuss specific challenges in their community. I (Luna) spent hours speaking to imams about the efficacy and importance of vaccination and its sequential positive impact on the community. We target communities to understand their specific issues, and then answer them through their channels. For example, one of our public health committee members, Lejla Ramic, who is also a University of Utah Nurse Educator, helped facilitate and conduct discussions with the Bosnian community.
Our outreach included:
Zoom meetings and events
Social media outreach through WhatsApp, Facebook, and Instagram
Building networks of professionals behind the scenes
Conducting one-on-one meetings with leaders and community members
These ongoing conversations and outreach efforts helped us connect with people and increase the number of vaccinations. Its been one-on-one conversations that have made the difference and the change with offline influencers. We’ve found that men are much easier to access and find in our community, and it's women, those working two jobs and taking care of families, that we need to develop networks to address. It's about creating a circle of trust.
How to build trust and help patients feel heard
Helping underrepresented minority patients get the care they need is also something that individual providers can do. To build trust with your patients:
Take time to listen. Ask open-ended questions and give them space to talk about their own beliefs, ideas, and concerns. Say things like, “Tell me in your own words, what is going on today, how do you feel?”
Formulate a plan together. Avoid telling patients what to do; instead work with them to create a care plan that meets their medical needs and addresses their concerns. Then ask, “How do you feel about this plan? Are you comfortable with it? Tell me about the concerns that you have.”
Give ownership back to patients. Building trust means allowing patients to share in their care decisions, instead of having the attitude that we, as providers, know what is best.
Address your own biases. Providers might not know everything about a person’s culture, and that is okay. But it is imperative for everyone in health care to take a step back and address biases. I’ve seen that one negative interaction can deter someone from seeking medical care in the future, so every interaction counts. As a Muslim woman who has grown up in the United States, I (Wagma) definitely have more privileges than the newly arrived members to the community, but it’s a matter of recognizing those and putting ourselves in a patient's shoes to see how we can help.
Trust-building means that we all need to get uncomfortable. It takes guts, and it takes more listening than speaking. Sometimes we need to look beyond the immediate medical concerns to see the bigger picture. For example, a Muslim patient observing Ramadan will be fasting from sun up to sun down. You can help them understand vaccine safety when fasting.
The patient might not mention these things to you, so spending extra time getting to know them and being sensitive to their culture and beliefs can help you take these factors into account.
"Trust-building means that we all need to get uncomfortable. It takes guts, and it takes more listening than speaking. "
There is still work to do
With programs like Project Shifa we are making progress, but there is still a lot of work to do. The first set of vaccination sign-ups were the easy ones, especially if we made it easy to come to the mosque or refugee center. Now, there are still many more that need to be vaccinated.
We’re constantly pushing, creating new materials, and improving. We are a small organization, but at the end of the day we really punch above our weight. We’re committed to developing resources to help the Muslim community, and help the broader community be educated about Muslims.