Religious leaders as partners in diabetes self-care promotion: opportunities and challenges from Imams' perspectives in Saudi Arabia

Background Type 2 diabetes mellitus (T2DM) poses a major public health challenge in Saudi Arabia, where effective management relies heavily on sustained self-care behaviors. Cultural and religious contexts strongly shape health behaviors, and Imams who hold significant moral authority and community trust may represent valuable partners in diabetes self-care promotion. However, little is known about Imams' perspectives on their potential role in this area. Methods A qualitative descriptive study was conducted using semi-structured, in-depth interviews with Imams in Saudi Arabia. 19 Imams were purposively recruited from urban and rural settings and interviewed face-to-face. Interviews explored perceptions of religious leadership roles, opportunities for supporting diabetes self-care, and perceived challenges and barriers. Interviews were audio-recorded, and transcribed verbatim in Arabic. The analysis was performed using inductive thematic analysis to identify key themes related to Imams' perspectives on diabetes self-care promotion. Results Five key themes emerged. First, Imams described their moral authority and community trust as a strong foundation for influencing health-related attitudes and behaviors. Second, participants identified multiple opportunities to support diabetes self-care through sermons, post-prayer talks, educational sessions, and individual counseling, particularly when health messages were framed within Islamic teachings. Third, substantial role ambiguity and lack of consensus existed regarding whether diabetes self-care promotion falls within Imams' professional responsibilities. Fourth, perceived barriers included limited health-related knowledge, concerns about credibility, anticipated congregant resistance, and skepticism about the effectiveness of behavior change efforts. Finally, participants highlighted the absence of institutional support, formal training, and structured collaboration with healthcare authorities as major constraints, despite general agreement that reinforcing adherence to medical advice aligns with their ethical role. Conclusions Imams in Saudi Arabia perceive both meaningful opportunities and significant challenges in engaging as partners in diabetes self-care promotion. While high levels of trust and social influence position Imams as promising contributors to culturally grounded health initiatives, role ambiguity, training gaps, and lack of institutional support limit their involvement. Structured training, clear role delineation, and formal collaboration between health and religious institutions may enable effective, faith-aligned strategies to support diabetes self-care and improve health outcomes.