Abstract
BACKGROUND: Faith healing at Sufi shrines holds enduring cultural and spiritual significance in Pakistan. Despite advancements in biomedical healthcare, many individuals, particularly in rural and underserved areas, continue to seek healing through shrine-based practices. This persistence reflects a complex integration of spirituality with health-seeking behavior, influenced by cultural beliefs, socioeconomic constraints, and limited access to formal healthcare services. This study investigates the socio-demographic and economic factors influencing visitation to the Makhdoom Sakhi Syedi Mossani shrine, explores the motivations behind faith healing, and examines the ceremonial and symbolic practices employed in the healing process. METHODS: We used an exploratory qualitative design based on grounded theory principles. We conducted in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation with purposively selected shrine visitors. The FGDs and IDIs were conducted in the local language, Urdu, using a semi-structured interview guide and were audio-recorded with the participants' consent. Data collection continued until thematic saturation was achieved and was subsequently analyzed using NVivo software version 14. Data analysis was conducted using a consensual approach to identify themes and sub-themes. RESULTS: Ten IDIs and Four FGDs with a diverse group of participants, including native residents, visitors, devotees, caretakers, religious leaders, and key informants. This diversity allowed us to capture a well-rounded understanding of the phenomenon under investigation. Faith healing practices were found to be shaped by an interplay of factors, including low educational attainment, economic hardship, cultural belief systems, and distrust or inaccessibility of formal medical care. Participants frequently employed mixed treatment approaches, combining biomedical and spiritual practices. CONCLUSION: Shrine-based faith healing in rural Pakistan reflects a culturally embedded, pragmatic response to economic hardship, healthcare inaccessibility, and spiritual belief systems. Rather than opposing biomedicine, such practices represent adaptive strategies where spiritual and medical approaches coexist. These findings highlight the need for culturally responsive healthcare interventions that integrate spiritual worldviews with improved access to formal services. The study underscores the need for culturally responsive health interventions that respect traditional belief systems while promoting accessible and effective medical care, particularly for marginalized populations.