'Somali? Muslim? Hey, you already got me': Acceptability of Islamic Problem-Solving and Stress Management Techniques in Adapted Problem Management Plus (PM+) Intervention Among Somali Muslim Women

Abstract

Background: Somali Muslim women in King County face significant mental health challenges, with PTSD prevalence of 33-80% and high rates of depression and anxiety. Cultural gaps between Western therapeutic approaches and Islamic healing paradigms create barriers to accessing mental health services. This study examined the acceptability of Islamic adaptations integrated into Problem Management Plus (PM+) among Somali Muslim women.Methods: A sequential exploratory mixed-methods study was conducted with 10 Somali Muslim women who participated in culturally adapted PM+ sessions. Islamic adaptations included incorporating du'as with breathing exercises, using Prophet Muhammad's problem-solving approaches, framing stress management within Islamic concepts, and aligning activities with prayer times. Data collection included interviews and a 7-item acceptability survey. Qualitative data were analyzed using systematic coding based on detailed operational definitions for 3R strategies (Reframing, Reprioritizing, Reforming) and implementation outcomes (acceptability, appropriateness, feasibility, sustainability). Results: Participants demonstrated high acceptance: 9/10 strongly agreed with acceptability items, 8/10 with appropriateness items, and 7/10 with feasibility items. Three themes emerged: Religious Familiarity and Recognition, Integration of Religious Coping with PM+ Techniques, and Community Implementation considerations. Participants described Islamic adaptations as creating "powerful combinations" that enhanced rather than replaced evidence-based techniques. Conclusions: Islamic integration significantly enhanced acceptability of evidence-based mental health interventions among Somali Muslim women. The enhancement model, where religious practices amplify rather than compromise therapeutic effectiveness, offers a promising approach for culturally responsive mental health care in refugee communities.