Survey in Azerbaijan on Ramadan: Report

This research was carried out in Azerbaijan, a nation with the most professed faith being Islam. For the most part, the Azerbaijani community professes Islam. As such, every year during the holy month of Ramadan, many will observe and fast.

Methodological Approach

I held focus group meetings to define and investigate the opinions of diabetes patients on Ramadan fasting. I was able to triangulate the information by using in-depth interviews and focus group conversations. Based on literature review, expert opinion, an interview topic guide was created and tested in my pilot research and topics were altered based on topics that arose during the interviews. The theme guide created on a variety of Ramadan fasting values including diet, self-management, values, and medication. Since most respondents were from the ethnic group of Azerbaijan, most interviews were performed in the Azerbaijani language. Interviews were performed in English where there was no concern about language barriers. During the interview sessions, general testing was used to promote questions (Can you explain further? What about your views on this? Can you explain further...). For clarification, follow-up questions were used, and respondents were encouraged to narrate as freely as possible.

A thematic method has been used to analyze all interviews. This technique permitted the information set to capture patterns of reactions. All the topics were inductively obtained from the information where the content of the transcribed information directs codes and theme growth. Data saturation evidence was determined when the information did not result in selective codes. Therefore, when saturation was attained, information collection was discontinued.

Participants

This research reports a mix-method study's qualitative outcomes. Participants were recruited if they were 18–75 years of age, diagnosed with diabetes for a minimum of 6 months, with the aim of fasting during Ramadan for at least 15 days. These respondents were sampled purposefully, depending on their gender and age group.

Timing and Place

Usually the interviews ranged from 15 to 30 minutes and were recorded and transcribed verbatim. These sessions were held at a moment and place that was convenient for participants and reimbursed to all participants for their moment and travel.

Limitations of the Study

There are some constraints to my research. First, my research was culturally specific and was carried out in an ethnic group that was mostly Azerbaijani. As such, these opinions may not represent other ethnic groups that have chosen to fast. Furthermore, I did not interview patients with diabetes who during Ramadan decided not to fast. Therefore, my research to the wider Muslim society may not be generalizable. As my interview was anonymous, against more objective measures such as blood glucose concentrations, I could not separately confirm the symptoms of hypoglycemia.

Ethical Consideration

To engage in this qualitative study, all respondents given informed consent.

Results

Most respondents were of Azerbaijani ethnicity, with 51.6 years of average age of respondents. The average diabetes length was 7.1 years. Most respondents are high school, unemployed and married. Results of this research recognized three primary topics: (1) Ramadan perception, (2) Ramadan side effects management, and (3) Ramadan diet control. By age, gender, and ethnicity, all respondents are recognized.

Theme 1: Perception of Ramadan:

Participants (32%) said they understood the difficulties facing Muslim during Ramadan fasting. Participants (28%) remarked that it is hard for those with diabetes to fast during Ramadan due to the medication system and lengthy periods without food. Participants (11 percent) also proposed that diagnosing diabetes during Ramadan influenced their social life as they felt more lethargic during this period. Some (7.5 percent) reported that they depended on their faith as a source of strength to overcome the difficulties of fasting, while others believed that their present predicament was a challenge from' Allah' and chose to acknowledge it. Respondents (26%) proposed that fasting was useful to their health during Ramadan. Some (3.7%) also proposed it's useful for general health as cholesterol and weight levels are lowered. However, one participant thought that there was no exceptional improvement in blood glucose control during Ramadan. One participant saw fasting as a matter of private decision but thought it reflected their desire to do so. Participants (9.4 percent) thought that periodic diabetes education provided by their clinicians was more than adequate in terms of education and felt that there was no need for additional education courses. Medication self-adjustment was prevalent among respondents to prevent hypoglycemia (17%). Often this involved lowering a dose or not entirely taking medication. Respondents (17 percent) frequently revealed how they reacted to fasting by adjusting the dosage of medication to prevent glycaemia, and this was typically achieved on the basis of their prior Ramadan fasting experience. Despite resistance from their physicians, one participant was insistent in changing their dosage. Before making any adjustment to his insulin dose in preparing for Ramadan, only one participant consulted his physician.

Theme 2: Managing side effects during Ramadan:

Participants (43%) reported having symptoms of hypoglycemia during the Ramadan month. Shakiness and fainting include recurring hypoglycemic symptoms experienced by respondents during Ramadan. Participants reported symptoms of lethargy and sleepiness (6 percent) when fasting. Side impacts from extended fasting raised concerns among one participant about how the workplace would view patients with diabetes. Participants (26 percent) reported being conscious of the symptoms of hypoglycemia and will generally break their speed to avoid escalation of symptoms. Some respondents (5.6%) took a wait-and-see strategy when breaking quickly and attempted to stay fasting for as long as necessary. In spite of hypoglycemic symptoms, some (5.6 percent) respondents continued to accelerate. Although there were prevalent hypoglycemic symptoms, respondents continued their daily operations including driving. Participants revealed fear of hypoglycemia (13 percent) and led to anxiety and binge eating before fasting to prevent daytime hypoglycemia. Other respondents (5.6%) saw that after a lengthy day of fasting, binge eating is needed to replenish their power.

Theme 3: Diet control during Ramadan:

Participants (11 percent) mentioned when questioned about their diet during Ramadan that there were difficulties in regulating diet because they wanted not to be alienated from family members and colleagues. An insulin participant discovered it hard to regulate their consumption of food. Maintaining family relationships was one of the primary factors for respondents to compromise on their blood glucose-controlled diet based on medication.

Discussion

This research reports a large-scale qualitative analysis of the view and perception of the participant during Ramadan on diabetes management. Overall, respondents regard Ramadan optimistically and consider fasting to be useful to their health and well-being. The research also provides information on how patients change their drugs and deal with the adverse effects of fasting including hypoglycemia. This opinion resonates with earlier published research by Patel et al as well as Robinson and Raisler reporting comparable results from their focus group research. Findings from interviews with our focus group obviously show that changing diet is a significant area of concern for respondents who are fasting during Ramadan. Studies have shown that control of diet during the month of Ramadan is a significant factor in regulating glucose concentrations. However, our results show that, for fear of hypoglycemia, most patients are nervous and afraid to fast during this era. As a consequence, respondents eat big amounts of food, believing that this will result in avoiding hypoglycemia and replenishing their power after lengthy hours of fasting.

Participants ' tendency to self-adjust drugs among quick participants is worrying. Before changing his medication in preparing for Ramadan, only one participant (1.9 percent) consulted his doctor. Most respondents demonstrated a high degree of autonomy with regard to their decision making and did not consult their physicians when changing their medication. Possible reasons for not seeking advice from physicians include the inconvenience of seeking advice, medication adjustment based on previous experiences, fear of not being told to speed up, and perceived absence of comprehension by physicians.

Discussions with Imams (Muslim religious leaders) disclosed that while the Quran exempts those who are ill from fasting, practitioners are encouraged to fast during Ramadan when the fasting act does not hurt the person. The Imams also stressed, however, that practitioners should prioritize the guidance given by their doctor / healthcare professional on their capacity to fast during Ramadan. The person is needed to pay “Fidyah,” a spiritual gift to their spiritual bodies, in case an person is unable to fast owing to their disease.

Some practical tips provided by the Imams to Muslim practitioners who are worried about being stigmatized because they are not pious in their faith include receiving from their doctor a formal letter of recommendation or even an official letter of exemption from the religious office. They also proposed some cooperation between healthcare teachers and the local mosque to provide diabetes education in order to better educate their supporters before fasting during Ramadan.

A latest study discovered that Ramadan-focused education is an efficient instrument during Ramadan to guarantee patient safety as it can bridge the knowledge gap by acknowledging patients ' spiritual requirements. Our research indicates, however, that most respondents are not open to any instructional initiative. Several new strategies could be introduced to enhance participants in diabetes schooling. For example, educational materials could be developed through collaboration between health care professionals and religious authorities, including insights and endorsement from religious community and imams. Furthermore, these educational materials can be put in religious facilities or mosques to enable simple access to data for Muslim with diabetes who choose fasting. Alternatively, health care practitioners in these religious groups can teach spiritual leaders on diabetes leadership during Ramadan and share this newly imparted understanding with their supporters before Ramadan.

Conclusion

Religion is a profoundly private matter, and it is hard to assess its effect on disease. Especially for those who are sick, it offers hope and strength, which is why many with diabetes still choose to meet their religious commitments to fast during Ramadan despite having difficulty abstaining from food and suffering from symptoms of bad control of diabetes. Participants indicated in our research that their faith in God gives them power when fasting during Ramadan to overcome difficulties. In order to guarantee excellent glycaemic control during Ramadan, it is essential for health care professionals to create open communication with their clients. One challenge, however, is to define these patients as some healthcare professionals want to prevent the stereotypical strategy such as excluding certain ethnic groups or generalizing that all Muslims will be fasting during Ramadan. Training and recruiting other healthcare practitioners such as nurses and pharmacists to assist in diabetes management during Ramadan may be a feasible strategy to improve patient’s knowledge on safe fasting practices should they choose to fast. Furthermore, caregivers can also be involved in creating a dialog with patients by constructing relationships and empowering patients, which can help to establish a more satisfying encounter when articulating data about secure fasting.

In short, the findings of this research indicate the significance of fasting in Muslim patients in Ramadan. Muslim diabetes patients have an optimistic perspective to quickly decide during Ramadan and think that the time has come to improve relationships with friends and families Healthcare professionals need to know why people with diabetes continue to fast and cooperate with religious groups and academics during Ramadan.