The COVID-19 pandemic has disproportionately impacted refugee, migrant, and immigrant (RIM) communities. This crisis is shaped by various social, economic, and cultural factors, including religious practices, which can significantly influence RIM community responses to the pandemic and acceptance of vital health services such as vaccines. Faith-based approaches to health interventions, particularly involving mosques and including religious leaders, have proven to be instrumental in reaching and positively impacting Muslim communities in the context of COVID-19 mitigation.
During the COVID-19 pandemic, the International Rescue Committee (IRC) offices in Sacramento and Atlanta sought to foster meaningful engagement with local Muslim communities and better understand their thoughts related to COVID-19 vaccines so they could develop culturally responsive and effective mitigation strategies. The IRC discovered: access barriers such as transportation, English language and low literacy; community concerns, such as misinformation about the vaccine’s impact on their health or vaccine induced infertility, that were circulating on social media and within the community; and religious concerns such as the halal or haram status of vaccines and vaccination during Ramadan (whether to take it before breaking the fast or after). Both offices used the following five approaches to address these multifaceted hurdles while keeping cultural and religious sensitivity at the forefront.
Approach 1: Foster a Sense of Security and Belonging in Community Spaces
Mosques hold significance as communal hubs where Muslim communities, particularly newcomers in a new country, come together for various religious activities. These spaces become essential for building connections, fostering a sense of belonging, and engaging with fellow Muslims during prayers and other religious events. According to an IRC Sacramento team member, when utilizing community spaces like mosques for health promotion, individuals are more likely to perceive the engagement as beneficial rather than an intrusive intervention. Both offices developed and disseminated culturally appropriate COVID-19 health communication campaigns, participated in religious events with the local mosque during Ramadan, and collaborated with their local imams to encourage vaccinations and provide education.
Approach 2: Provide Linguistically Accessible and Culturally Appropriate Communication
Health education material such as the NRC-RIM fact sheets and flyers containing crucial updates and information about COVID-19 were in various accessible languages such as Dari, Pashto and Farsi and local imam’s provided suggestions on the material content and helped review the material to make sure it was culturally appropriate before it was disseminated. During the pandemic, the office developed Ramadan calendars that included health messaging, including COVID-19 information. The calendars were distributed at the Mosque during Ramadan with the assistance of the imam. According to the coordinator, the materials were well-received due to the relevant information including hours of fast-breaking along with critical health messages.
Teams in Atlanta worked with the local mosques to set up tables after Friday prayers and other services, offering education and vaccinations while involving the imam in community engagement. During Ramadan, the Atlanta office collaborated closely with a respected and well-known imam, creating impactful videos and materials in which he addressed concerns from the perspective of Quranic verses, emphasizing the vaccine's alignment with Islamic beliefs. These videos, primarily shared on YouTube, were well-received by the community and garnered interest from other partners and community-based organizations (CBOs), leading to requests for their use. The involvement of the imam and the dissemination of these materials played a vital role in addressing prevalent myths and concerns within the community. This collaborative approach demonstrated by these two offices added a layer of trust and relationship-building with the local religious leaders, strengthening their engagement with the community during the challenging times of the pandemic.
Approach 3: Utilize Gender-Sensitive Approaches
While their efforts proved fruitful, challenges emerged in reaching females at the Sacramento office due to mosque segregation. To address this, the office involved the imam and left flyers/fact sheets with the imam to give out to female members of the mosque, as well as obtaining the imam's permission to leave flyers in the female's section at the mosque. As a result, the community's response to receiving and requesting information on COVID-19 mitigation strategies was positive. The Sacramento health coordinator observed, "A lot of people were coming [and] people asked for more flyers saying, ‘I need another flyer for my mom or cousin.’ Or, ‘Do you have any specific flyer for youth and pregnant women?" According to the team, the number of people willing to vaccinate increased due to their faith-based and gender-sensitive approach to tackling vaccine hesitancy.
The Atlanta team also took a gender-sensitive approach by ensuring female and male team members and vaccinators were present during community events. Staff coordinated with the mosque administrative staff to ensure adherence to mosque protocols, including dress code considerations for female team workers and identifying appropriate protocols such as taking off their shoes. As a result of listening to and adapting to the preferences of the Muslim community, the Atlanta team reflected that a sense of trust, ownership, and involvement was fostered.
Approach 4: Involve Team Members with a Shared Linguistic and Cultural Background
The IRC Sacramento Health Coordinator emphasized building trust as a crucial component of their health promotion approach. To achieve this, they recognized the significance of representation within the health promotion team and that trust was more naturally cultivated by having employees who are part of the communities they serve. In addition, the ability to converse with community members in their native language allowed for a deeper level of understanding and engagement. Introducing himself as a person with a medical background and a Muslim, the coordinator created an immediate rapport, allowing community members to feel more comfortable approaching him with questions and seeking information. When hesitant about the vaccine, the coordinator reflected, "I would tell them that I am Muslim, and my kids also got the vaccine." This personal connection made the health information more relatable and reinforced the community's confidence in the health promotion efforts. Through this approach, the health coordinator successfully built bridges of trust, establishing a solid foundation for effective health promotion within the Muslim communities. The coordinator shared, "They knew that they were receiving the right information from the right person in the right way."
Approach 5: Invest in Building Long-term Trust
In addition to ensuring the health interventions were culturally and linguistically appropriate, both teams understood the need to build and maintain trust by creating authentic connections within the community. For example, the IRC Sacramento outreach team stressed the importance of getting to know communities of faith, actively listening to their needs, and fostering long-term relationships, especially with new arrivals. They understood that service providers can build a foundation of trust and familiarity through proactive face-to-face connections before implementing a health intervention. This approach nurtures a collaborative spirit where health initiatives are more accepted among the broader community.
The IRC Atlanta office also recognized the significance of consistency and trust in their approach. The team understood the importance of identifying trusted faith leaders whose endorsement carries weight among the community. Therefore, the team ensured relationships remained strong with the religious leaders and solid partnerships were established with the mosques. To bolster the community's confidence in the health initiatives, the team ensured familiar faces were present during the outreach events. Staff worked closely with the mosques to adapt to their scheduling needs when planning vaccination events. Remaining flexible and responding to the preferences of the religious leaders and mosque administration demonstrated adaptability and fostered trust and engagement. Furthermore, the involvement of male and female teams showed respect for religious beliefs and contributed to their success in promoting health and COVID-19 mitigation within the Muslim communities.
In summary, both teams implemented adapted health interventions that were linguistically, culturally, and contextually informed. By prioritizing trust-building, inclusivity, and a deep understanding of cultural nuances, the IRC Atlanta and Sacramento teams successfully navigated hesitancies and delivered impactful health interventions. Fostering a sense of ownership among community members was a key principle applied as an Atlanta team member reflected, "We made them feel like it [the health programming] was for them and from them". This proactive and community-oriented approach, combined with culturally sensitive strategies, ensured that Muslim communities served by IRC Atlanta and Sacramento received accurate health information to make informed decisions during the height of the pandemic.
According to feedback from an Atlanta office staff member, they observed that employing these practices in partnership with Mosques and religious leaders led to a noticeable increase in the number of individuals expressing interest in vaccination, seeking information, and getting vaccinated. They noted that "from 5-10 people vaccinating at our vaccination locations, the numbers increased to 100 and 150". Furthermore, the office's faith-based COVID-19 mitigation strategies exemplify the power of cultural sensitivity and community collaboration. By respecting religious practices, involving faith leaders, and delivering tailored messaging, they effectively engaged with the Muslim communities and contributed to a more robust pandemic response.