To fast or not to fast during the month of Ramadan? A comprehensive survey on religious beliefs and practices among Moroccan diabetic patients

Figures & data

Table 1 Characteristics of the recruited sample

Parameter	Value
Age (years)	45.39±15.74
Gender (number, %)
Male	83 (41.3%)
Female	118 (58.7%)
Family status (number, %)
Married	138 (68.7%)
Not married	63 (31.3%)
Educational level (number, %)
Primary	95 (47.3%)
Secondary	75 (37.3%)
Tertiary	31 (15.4%)
Type of disease (number, %)
Diabetes	135 (67.2%)
Diabetes with cardiovascular complications	12 (6.0%)
Diabetes and hypertension	48 (23.9%)
Diabetes and other chronic disorders	6 (3.0%)
Occupation (number, %)
Not working/unemployed	59 (29.4%)
Working	142 (70.6%)
Number of fasting days	22.98±8.53

Table 2 The items of the ad hoc questionnaire, designed and developed to investigate Ramadan fasting as well as other religious beliefs and practices

Number	Item
Ramadan fasting beliefs and practice subscale
1	I think that Ramadan fasting is a cure for my illness, even though my doctor and my spiritual guide have advised me not to fast
2	I am embarrassed when I have to break the fast of Ramadan in front of people.
3	I do not openly break the fast of Ramadan.
4	I am afraid that I will have problems with others if I do not fast during the month of Ramadan.
5	I consider fasting in Ramadan, despite my illness, increases closeness to God.
6	I do not think that the first obligation to fast is to carefully listen to doctor’s advice.
7	I feel that I can fast because my illness and/or my age have not yet reached an advanced stage.
8	I think that whoever dies while fasting, even though it would not be permissible to fast for him/her (eg, due to sickness), is in the order of the martyrs with God.
9	I think that I can openly break the Ramadan fast only with my family and people with whom I have an intimate relationship.
10	I am afraid that I will be at risk of dying during the Ramadan fasting.
11	I am at risk of complications or of death because of fasting as I do not adhere to the doctor’s advice.
12	I accept to increase the symptoms of the disease during fasting in the month of Ramadan.
13	I believe that preserving religion is more important than self-preservation.
14	I think the doctor’s advice not to fast is not binding.
15	I consider the position of medicine which allows me not to fast contrary to the Shariah (Islamic law).
16	I would feel guilty if I would follow the shuyukh, fuqahā, a’immah (spiritual guides/leaders)’s advice, who have permitted me not to fast.
17	I feel bad when I break the fast.
18	When I break the fast, I feel that others are looking at me with contempt.
19	I think that the permission of the shuyukh, fuqahā, a’immah (spiritual guides/leaders) for me not to fast during the month of Ramadan is not obligatory.
20	I do not accept that a person breaks the fast in front of me while I am still fasting.
Religious beliefs and practice subscales
21	I try to pray all my prayers in the mosque.
22	I am committed to praising and making supplications, after every prayer.
23	I am committed to reading the Qur’an on a daily basis.
24	I abide by honesty and integrity in dealing with all people.
25	I consider that Islam is the true religion that should be observed in all its teachings and precepts.
26	I consider my sickness to be from God in order to strengthen my faith.
27	I think that God is the healer alone and there is no need for medicine.
28	I think that my life and my health are entirely in God’s hands and are not influenced by whether or not I take drugs.
29	I believe that the Qur’an will heal all physical diseases.
30	I believe that the righteous are engaged in reciting the Qur’an and doing supplication, without having the need for taking medication.
31	I believe that it is faith in Islam that relieves my suffering from disease.
32	I think that Islam is the main reason I do not believe in suicide.
33	When the pain of the disease is overwhelming, there is nothing more powerful and effective than the prayer.
34	I believe that faith positively affects both my mental and physical health.
35	I can only get sick or worse with medication.
36	I am worried when God does not respond to my call for healing.
37	When I have to face a problem in my life, I think it is a penalty for a bad deed I have committed.
38	I consider the teachings and precepts of Islam to be inspiring and guiding my daily behavior.
39	I think the problems we are experiencing in this age are because of the distance from Islam.
40	I believe that Islam is the path of salvation and eternal happiness.

Table 3 Descriptive statistics of each item of the questionnaire

Item	Mean	SD	Skewness		Kurtosis
			Statistics	Standard error	Statistics	Standard error
Item 1	2.408	1.401	0.510	0.172	−1.159	0.341
Item 2	3.005	1.512	0.079	0.172	−1.459	0.341
Item 3	3.189	1.471	−0.189	0.172	−1.364	0.341
Item 4	2.960	1.236	−0.052	0.172	−0.902	0.341
Item 5	3.323	1.323	−0.287	0.172	−1.035	0.341
Item 6	3.015	1.290	−0.268	0.172	−0.965	0.341
Item 7	3.045	1.369	−0.200	0.172	−1.171	0.341
Item 8	3.458	1.253	−0.689	0.172	−0.486	0.341
Item 9	3.229	1.333	−0.427	0.172	−0.962	0.341
Item 10	2.940	1.160	0.098	0.172	−0.739	0.341
Item 11	2.756	1.275	0.072	0.172	−1.085	0.341
Item 12	2.761	1.205	0.020	0.172	−0.896	0.341
Item 13	3.020	1.277	−0.096	0.172	−1.058	0.341
Item 14	2.985	1.447	−0.004	0.172	−1.300	0.341
Item 15	3.110	1.431	−0.029	0.172	−1.387	0.341
Item 16	2.990	1.490	0.036	0.172	−1.401	0.341
Item 17	3.144	1.343	−0.354	0.172	−1.035	0.341
Item 18	3.124	1.449	−0.229	0.172	−1.324	0.341
Item 19	2.896	1.369	−0.152	0.172	−1.256	0.341
Item 20	2.960	1.438	−0.133	0.172	−1.411	0.341
Item 21	3.189	1.181	−0.225	0.172	−0.454	0.341
Item 22	3.547	1.034	−0.128	0.172	−0.480	0.341
Item 23	3.587	0.956	−0.408	0.172	0.237	0.341
Item 24	3.821	0.817	−0.380	0.172	0.012	0.341
Item 25	3.995	0.935	−0.731	0.172	0.377	0.341
Item 26	3.965	0.897	−0.772	0.172	0.786	0.341
Item 27	3.672	1.073	−0.564	0.172	−0.235	0.341
Item 28	3.725	1.169	−0.669	0.172	−0.241	0.342
Item 29	3.826	1.084	−1.005	0.172	0.755	0.341
Item 30	3.537	1.109	−0.673	0.172	0.060	0.341
Item 31	3.622	1.143	−0.781	0.172	0.109	0.341
Item 32	3.692	1.079	−0.565	0.172	−0.249	0.341
Item 33	3.791	1.066	−0.750	0.172	0.075	0.341
Item 34	3.627	1.125	−0.523	0.172	−0.335	0.341
Item 35	3.328	1.154	−0.491	0.172	−0.437	0.341
Item 36	3.313	1.177	−0.501	0.172	−0.443	0.341
Item 37	3.323	1.217	−0.508	0.172	−0.554	0.341
Item 38	3.721	1.180	−0.735	0.172	−0.193	0.341
Item 39	4.020	1.049	−1.065	0.172	0.682	0.341
Item 40	4.110	1.085	−1.286	0.172	1.112	0.341

Table 4 Reliability statistics for each item of the questionnaire

Item	Scale mean if item deleted	Scale variance if item deleted	Corrected item-total correlation	Squared multiple correlation	Cronbach’s alpha if item deleted
Item 1	131.310	493.300	0.627	0.724	0.905
Item 2	130.720	487.147	0.670	0.803	0.904
Item 3	130.545	497.727	0.524	0.688	0.906
Item 4	130.770	506.238	0.476	0.595	0.907
Item 5	130.400	496.231	0.614	0.715	0.905
Item 6	130.720	512.806	0.340	0.663	0.909
Item 7	130.685	497.654	0.568	0.743	0.906
Item 8	130.265	507.824	0.439	0.689	0.908
Item 9	130.505	503.980	0.477	0.552	0.907
Item 10	130.790	529.182	0.070	0.594	0.912
Item 11	130.970	545.919	−0.223	0.448	0.916
Item 12	130.960	523.164	0.175	0.481	0.911
Item 13	130.695	505.650	0.472	0.529	0.907
Item 14	130.740	498.274	0.523	0.633	0.906
Item 15	130.620	490.116	0.663	0.780	0.904
Item 16	130.730	488.681	0.657	0.702	0.904
Item 17	130.580	496.948	0.591	0.695	0.906
Item 18	130.605	497.306	0.538	0.590	0.906
Item 19	130.825	499.030	0.545	0.672	0.906
Item 20	130.770	505.957	0.405	0.545	0.908
Item 21	130.535	498.642	0.647	0.766	0.905
Item 22	130.180	511.877	0.455	0.624	0.908
Item 23	130.135	513.303	0.462	0.673	0.908
Item 24	129.900	517.668	0.428	0.529	0.908
Item 25	129.735	511.040	0.529	0.600	0.907
Item 26	129.755	514.387	0.469	0.632	0.908
Item 27	130.055	512.314	0.427	0.677	0.908
Item 28	130.000	510.221	0.429	0.646	0.908
Item 29	129.895	518.265	0.300	0.480	0.909
Item 30	130.190	514.054	0.376	0.533	0.908
Item 31	130.100	515.849	0.329	0.533	0.909
Item 32	130.035	516.305	0.342	0.569	0.909
Item 33	129.935	514.322	0.388	0.547	0.908
Item 34	130.105	515.089	0.351	0.395	0.909
Item 35	130.395	519.486	0.255	0.484	0.910
Item 36	130.415	525.128	0.143	0.563	0.911
Item 37	130.390	517.124	0.285	0.488	0.910
Item 38	130.010	511.105	0.408	0.626	0.908
Item 39	129.695	512.022	0.449	0.591	0.908
Item 40	129.610	510.862	0.453	0.472	0.908

Table 5 Multivariate regression analysis

Parameter	Nonstandardized coefficients		Standardized coefficients	T	Sig.
	B coefficient	SD	Beta coefficient
Constant	38.141	4.303		8.865	0.000
Gender	1.319	1.183	0.076	1.115	0.266
Age	−0.077	0.046	−0.142	−1.658	0.099
Family status	1.928	1.494	0.105	1.290	0.198
Educational level	1.049	1.646	0.045	0.637	0.525
Occupation	1.116	1.324	0.060	0.843	0.400
Diabetic complications and comorbidities	−3.505	1.263	−0.194	−2.775	0.006
Fasting and religious beliefs and practices	−0.074	0.025	−0.199	−2.917	0.004