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Written by Laiba Husain and Yusra Shammoon

A person using a pulse oximeter

mosque1.jpgIt was 3pm when Muslim worshippers started streaming out from the weekly Jummah prayers, just like any other Friday afternoon. We were at the entrance of the Central Oxford Mosque, with our box of pulse oximeters, ready and waiting to hand them out to anyone who was interested.

By 3:15 every one of our oximeters was gone. Empty-handed, we were regretfully turning people in the queue away.

It was a promising start to our project – a small drive as part of a wider national initiative to support vulnerable populations in monitoring their oxygen levels at home. We had previously spoken to the Imam at COM about distributing free pulse oximeters at the mosque.

Who wouldn’t jump at a piece of free health tech? But why the mosque, you might say?

To answer these questions, let’s take a step back. We’ve spent over a year under the cloud of a pandemic, but we still have significant community spread of Covid-19. Certain populations are at much higher risk of developing the disease, and its complications, for example:

-           people who are over 65

-           those with comorbidities (e.g., diabetes, lung disease, heart disease)

-          people from minority ethnic groups

-          poorer individuals

Individuals falling into more than one of these groups are at correspondingly greater risk. Early oxygen therapy improves outcome in acute Covid-19, but many people who need it have “silent hypoxia” (i.e., no symptoms) which would require an oximeter to detect this.

In healthcare, oximeters are a bread-and-butter tool for monitoring, the thermometer for oxygen levels, if you will. However, unlike thermometers, oximeters had never previously been embraced as an essential home monitoring tool – information about them just hadn’t reached the public psyche. That is until the pandemic, which brought an explosion of media coverage and google searches around the device. However, for all the increased publicity, it remains uncertain whether this information has trickled down to the populations who would benefit the most.

There’s a lack of reliable statistics on home oximeter use, but reviewing remote covid monitoring studies and wider literature highlights challenges in home oximetry, which could be influencing patient uptake. These include:

-          technological literacy and access

  • possible barrier to using oximeters and accessing educational material

-          language barriers 

  • difficulty in accessing educational material and engaging with healthcare

-          appropriate education on using and interpreting oximeter results

  • ensuring patients know their target saturations, know to use CE accredited devices and are aware how to seek advice for abnormal results

-          access to healthcare

  • those who have easy access and are more willing to present to healthcare are more likely to be aware of oximeter benefits

 

This is important as groups such as the elderly, homeless, lower socio-economic classes and non-native language speakers may all be affected by the challenges above. In the context of Covid, we’ve already seen that these groups are at greater risk of poor health outcomes, which highlights the importance of proactively targeting them when trying to distribute oximeters.

This brings us to the mosque. 84% of the global population adheres to some religious faith, accounting for 5.8 billion people worldwide. Many of these individuals attend faith-based organizations as trusted entities within their communities. They provide spiritual refuge and renewal and have served as powerful vehicles for social, economic and political change. Within these organisations, religious leaders often wield a great deal of trust and thus influence over their respective communities.

We thought the Imam, as a respected figure from the central mosque, would be a good channel to spread the word about pulse oximetry in Oxford’s minority Muslim community. Although at first he didn’t know what a pulse oximeter was himself, after explaining the benefits and ease of the device, the Imam agreed to make an announcement at Friday prayer about our project.

Following his announcement, we observed the spark of interest in the mosque as people lined up to ask questions about the oximeter and receive their packets which included a free oximeter, instructional leaflet, survey and national guidance.

We later conducted 1-1 interviews with these individuals and qualitative analysis revealed the following themes: an initial lack of knowledge around what an oximeter is and what it can be used for; willingness to learn how to use pulse oximeters and take regular readings at home; enthusiasm and positivity around oximeters’ ease of use; a lack of preventive education around Covid and viruses in general in ‘hard to reach’ communities; and community platforms as a potential route to raise awareness on pulse oximetry benefits.

The interesting thing was that most of these people didn’t know what an oximeter was, but hearing the imam advocate for it made them jump at the chance to get one. Having then used the oximeters and seeing the benefits first-hand, they were then happily recommending them to other community members.

It just goes to show that the use of religious leaders—trusted and well-respected figures in minority groups have the capacity to influence healthcare promotion and engagement on a communal scale and we wanted to leverage just that in our study. Especially in the Asian Muslim minority group, where cultural and linguistic competency can hinder access to health education, partnering with faith-based organizations can help health care organisations and their communities expand access to primary and preventative health care.

Community events such as Friday Mosque prayer announcements can be a valuable platform to provide information to members of the community on important topics including vaccinations, pulse oximetry, and general health advice.

These initial qualitative findings complement research into the remote monitoring of patients with coronavirus symptoms. It is known that patients with serious coronavirus symptoms often do not go to hospital early enough, and this can negatively impact patient outcomes. Promoting general public knowledge of pulse oximetry monitoring can mean those with rapid deterioration and silent hypoxia are more likely to be identified and can get the help they need as quickly as possible. Reaching at risk groups, like minority ethnic individuals, can be facilitated through the leveraging of faith-based organisation wherein leaders like imams have the capacity to facilitate positive changes in health education in their local communities. Religious and faith-based organizations have an incredible capacity to act as catalysts for health care and should be considered an important partner in health-systems strengthening and assuring equity of access to healthcare in many communities.

The lessons learnt from collaborating with faith-based organisations can also be applied to disseminating health education through other community networks. Making use of trusted figures, existing community support systems (from shelters to social clubs and groups) and word-of-mouth spread could all be valuable tools in enfranchising more challenging to reach communities.

The full report on this preliminary scoping study can be downloaded by clicking here.

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.

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