Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

Published:December 31, 2021DOI:



      We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women.


      A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test.


      Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50–59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test.


      The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.


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      1. Pew Research Center. A demographic portrait of muslim Americans. 2011. Available at:

        • Padela AI
        • Raza A
        American muslim health disparities: the state of the medline literature.
        J Health Dispar Res Pract. 2014; 8: 1
        • Attum B
        • Shamoon Z
        Cultural competence in the care of muslim patients and their families.
        Stat Pearls. 2018; (
        • Debnam KJ
        • Holt CL
        • Clark EM
        • et al.
        Spiritual health locus of control and health behaviors in African Americans.
        Am J Health Behav. 2012; 36: 360-372
        • Vu M
        • Azmat A
        • Radejko T
        • et al.
        Predictors of delayed healthcare seeking among American Muslim women.
        J Women's Health. 2016; 25: 586-593
        • Ahaddour C
        • Broeckaert B
        For every illness there is a cure”: attitudes and beliefs of moroccan muslim women regarding health, illness and medicine.
        J Relig Health. 2018; 57: 1285-1303
        • Shaheen M
        • Galal O
        Practices for early detection of breast cancer among Muslim women in Southern California.
        Ann Epidemiol. 2005; 15: 649
        • Padela AI
        • Murrar S
        • Adviento B
        • et al.
        Associations between religion-related factors and breast cancer screening among American Muslims.
        J Immigr Minor Health. 2015; 17: 660-669
        • Salman KF
        Health beliefs and practices related to cancer screening among Arab Muslim women in an urban community.
        Health Care Women Int. 2012; 33: 45-74
        • Zorogastua K
        • Sriphanlop P
        • Reich A
        • Aly S
        • Cisse A
        • Jandorf L
        Breast and cervical cancer screening among US and non US born African American Muslim Women. 4. AIMS Public Health, New York City2017: 78
        • Dallo FJ
        • Kindratt TB
        Disparities in vaccinations and cancer screening among US-and foreign-born Arab and European American non-Hispanic White women.
        Women's Health Issues. 2015; 25: 56-62
        • Eksheir S
        • Bowling J
        Perceived reproductive health needs among Muslim women in the southern US.
        McGill J Med. 2020; 18: 1-15
        • Inhorn MC
        • Serour GI
        Islam, medicine, and Arab-Muslim refugee health in America after 9/11.
        Lancet. 2011; 378: 935-943
        • Matin M
        • LeBaron S
        Attitudes toward cervical cancer screening among Muslim women: a pilot study.
        Women Health. 2004; 39: 63-77
        • Orgocka A
        Perceptions of communication and education about sexuality among Muslim immigrant girls in the US.
        Sex Educ. 2004; 4: 255-271
        • Shahawy S
        • Deshpande NA
        • Nour NM
        Cross-cultural obstetric and gynecologic care of Muslim patients.
        ObstetGynecol. 2015; 126: 969-973
        • Lofters AK
        • Vahabi M
        • Kim E
        • et al.
        Cervical cancer screening among women from muslim-majority countries in ontario, canada. cancer epidemiology.
        BiomarkPrev. 2017; : 1493-1499
        • Hammoud MM
        • White CB
        • Fetters MD
        Opening cultural doors: providing culturally sensitive healthcare to arab american and american muslim patients.
        Am J Obstet Gynecol. 2005; 193: 1307-1311
        • Mataoui FZ
        Correlates of Breast Cancer Screening in Arab Muslim Women Living in the United States: A Health Policy Study. (Doctoral dissertation.
        University of Massachusetts Boston, 2018
        • Padela AI
        • Vu M
        • Muhammad H
        • et al.
        Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.
        Psycho-oncol. 2016; 25: 1175-1182
        • Rajaram SS
        • Rashidi A
        Asian-Islamic women and breast cancer screening: a socio-cultural analysis.
        Women Health. 1999; 28: 45-58
        • Rousseau C
        • Hassan G
        • Moreau N
        • Thombs BD
        Perceived discrimination and its association with psychological distress among newly arrived immigrants before and after September 11, 2001.
        Am J Public Health. 2011; 101: 909-915
        • Lowe SR
        • Tineo P
        • Young MN
        Perceived discrimination and major depression and generalized anxiety symptoms: in Muslim American college students.
        J Relig Health. 2019; 58: 1136-1145
        • Martin MB
        Perceived discrimination of Muslims in health care.
        J Muslim Ment Health. 2015; 9: 41-69
        • Kira IA
        • Lewandowski L
        • Templin T
        • Ramaswamy V
        • Ozkan B
        • Mohanesh J
        The effects of perceived discrimination and backlash on Iraqi refugees’ mental and physical health.
        J Muslim Ment Health. 2010; 5: 59-81
        • Rivenbark JG
        • Ichou M
        Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey.
        BMC Public Health. 2020; 20: 31
        • Wamala S
        • Merlo J
        • Boström G
        • Hogstedt C
        Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden.
        J EpidemiolCommunity Health. 2007; 61: 409-415
        • Jasperse M
        • Ward C
        • Jose PE
        Identity, perceived religious discrimination, and psychological well-being in muslim immigrant women.
        Appl Psychol: An Int Rev. 2012; 61: 250-271
        • Padela AI
        • Gunter K
        • Killawi A
        • Heisler M
        Religious values and healthcare accommodations: voices from the American Muslim community.
        J Gen InternMed. 2012; 27: 708-715
        • Holt CL
        • Clark EM
        • Klem PR
        Expansion and validation of the spiritual health locus of control scale: factorial analysis and predictive validity.
        J Health Psychol. 2007; 12: 597-612
      2. U.S. Preventive Services Task Force. Breast cancer screening recommendations. 2016.Available at: Accessed Jan. 18, 2021.

        • Noor SR
        • Noor N
        • Haq MM
        Breast cancer in Muslim countries: risk reduction strategies.
        J Adv Med Med Re. 2016; : 1-11
        • Padela AI
        • Peek M
        • Johnson-Agbakwu CE
        • Hosseinian Z
        • Curlin F
        Associations between religion-related factors and cervical cancer screening among muslims in greater chicago.
        J Low Genit Tract Di. 2014; 18: 326-332
        • Kwok J
        • Atencio J
        • Ullah J
        • et al.
        The perceived ethnic discrimination questionnaire—community version: validation in a multiethnic asian sample.
        Cultur Divers Ethnic Minor Psychol. 2011; 17: 271
        • Holt CL
        • Clark E
        • Klem PR
        Expansion and validation of the spiritual health locus of control scale: Factorial analysis and predictive validity.
        J Health Psychol. 2007; 12: 597-612
        • Downey RG
        • King CV
        Missing data in Likert ratings: a comparison of replacement methods.
        J G Psychol. 1998; 125: 175-191
        • Abu-Ras W
        • Azhar S
        Practice with arab american families.
        in: Congress EP González MJ Multicultural perspectives in working with families. Eds. Springer Publishing Company, New York2005
        • Azhar S
        Islamic processes of managing grief and loss.
        in: Counselman-Carpenter B Redcay A Working with Grief, & Traumatic Loss: Theory, Practice, Personal Reflection & Self-care for Clinicians. Eds. Cognella Publishing, San Diego2019
        • Al-Azri MH
        • Al-Awisi H
        • Al-Rasbi S
        • Al-Moundhri M
        Coping with a diagnosis of breast cancer among Omani women.
        J Health Psychol. 2014; 19: 836-846
        • Harandy TF
        • Ghofranipour F
        • Montazeri A
        • Anoosheh M
        • Bazargan M
        • Mohammadi E
        Muslim breast cancer survivor spirituality: coping strategy or health seeking behavior hindrance?.
        Health Care Women Int. 2010; 31: 88-89
        • Jafari N
        • Farajzadegan Z
        • Zamani A
        • Bahrami F
        • Emami H
        • Loghmani A
        Spiritual well- being and quality of life in Iranian women with breast cancer undergoing radiation therapy.
        Support Care Cancer. 2013; 21: 1219-1225
        • Siegler IC
        • Feaganes JR
        • Rimer BK
        Predictors of adoption of mammography in women under age 50.
        Health Psychol. 1995; 14: 274
        • Dai Y
        • Cook OY
        • Yeganeh L
        • Huang C
        • Ding J
        • Johnson CE
        Patient-reported barriers and facilitators to seeking and accessing support in gynecologic and breast cancer survivors with sexual problems: a systematic review of qualitative and quantitative studies.
        J SexMed. 2020; 17: 1326-1358
        • Tackett S
        • Young JH
        • Putman S
        • Wiener C
        • Deruggiero K
        • Bayram JD
        Barriers to healthcare among Muslim women: a narrative review of the literature. 69. In Women's Studies International Forum, Pergamon2018: 190-194
        • Mitchell J
        • Lannin DR
        • Mathews HF
        • Swanson MS
        Religious beliefs and breast cancer screening.
        J Women's Health. 2002; 11: 907-915
        • Achour M
        • Azmi IB
        • Isahak MB
        • Nor MR
        • Yusoff MY
        Job stress and nurses well-being: prayer and age as moderators.
        Community Ment Health J. 2019; 55: 1226-1235
        • Padela AI
        • Zaidi D
        The Islamic tradition and health inequities: a preliminary conceptual model based on a systematic literature review of Muslim health-care disparities.
        Avicenna J Med. 2018; 8: 1-13
        • Walton PhD DP
        • Maria L
        • Akram RD
        • Hossain BB
        Health beliefs of muslim women and implications for health care providers: exploratory study on the health beliefs of muslim women.
        Online J Health Ethics. 2014; 10: 5
        • Islam N
        • Patel S
        • Brooks-Griffin Q
        • et al.
        Understanding barriers and facilitators to breast and cervical cancer screening among Muslim women in New York City: perspectives from key informants.
        SM J Community Med. 2017; 3: 1-14
        • Yosef AR
        Health beliefs, practice, and priorities for health care of Arab Muslims in the United States.
        J Transcult Nurs. 2008; 19: 284-291
      3. Mohamed B Diamant J. Black Muslims account for a fifth of all U.S. Muslims, and about half are converts to Islam. Pew Research Center2019. Available at:

        • Nageeb S
        • Vu M
        • Malik S
        • Quinn MT
        • Cursio J
        • Padela AI
        Adapting a religious health fatalism measure for use in Muslim populations.
        Plos One. 2018; 13e0206898
      4. Padela AI, Nageeb S, Vu M, Quinn MT. The development and validation of a modesty measure for diverse muslim populations. J Relig Health 201;58:408-25.