Islamic moral reasoning and the use of prohibited medicines among Muslims: a qualitative study

Abstract Introduction Muslim patients often avoid medicines containing ingredients prohibited by their faith (haram), such as alcohol, gelatine, or porcine derivatives. While Islamic law permits exceptions based on necessity (darura) or biotransformation (istihala), the way these principles influence medication adherence and shape patient–healthcare provider (HCP) interaction is underexplored.1 Aim To explore how Muslims in the UK apply Islamic moral reasoning to medication adherence decisions involving medicines containing haram ingredients. Methods Muslim adults from diverse ethnic backgrounds were purposively sampled through mosque-based recruitment strategies, including post-Friday prayer announcements, poster advertisements, mosque-affiliated social media, and key informants. Semi-structured in-depth interviews were undertaken online through Zoom, exploring participants’ experiences of using or declining medicines they considered haram. Transcripts were analysed using Braun and Clarke’s reflexive thematic analysis (RTA), with themes constructed inductively.2 Interview development was informed by a prior scoping review and mosque-based public and patient involvement (PPI), within a qualitative, interpretive approach. Two co-authors independently coded a subset of transcripts to enrich the reflexive process, and feedback from face-to-face member checking allowed the final theme summaries to be refined and validated. Sampling was guided by information power and thematic depth in line with RTA; the study did not seek data saturation but focused on contextually situated theme development. Data interpretation was guided by the Necessity-Concerns Framework (NCF) and locus of control (LOC) theory. Results Thirteen adult Muslims with a range of ethnic heritages participated in the study. Four main themes were developed: (1) halal as worldview; (2) motivations for consumption; (3) minor illness or major disease; and (4) personalised care. These themes reflected how participants perceived illness severity, the semantic framing of ingredients, and the extent to which HCPs were viewed as trustworthy, culturally competent, and responsive to religious disclosure, all of which shaped adherence decisions. The rulings of darura (necessity) and istihala (biotransformation) were applied flexibly in chronic or life-threatening illnesses. Participants commonly avoided prohibited medicines for minor conditions, instead favouring complementary and alternative therapies perceived as natural and aligned with their religious beliefs. Conclusion Islamic moral reasoning influenced how participants engaged with medicines deemed haram. Supporting adherence requires pharmacy practice that incorporates religious literacy, responds to concerns about transparent labelling, and invites faith-sensitive communication. These steps may support patient-centred care by aligning religious and ethical reasoning with treatment decisions. In doing so, they may foster trust, enhance adherence, and support more equitable care for Muslim patients. Strengths of the study include its depth and reflexivity through RTA, as well as the use of member checking. However, transferability may be limited due to the sample being primarily mosque-based and from a single UK region.