PSYCHOSOCIAL DETERMINANTS OF CARDIOVASCULAR HEALTH AMONG SYRIAN REFUGEES AT THE ZAATARI CAMP: THE SYRIANS IN CAMP HEART STUDY (SYNC-HEART)

Abstract

Background: Cardiovascular health (CVH) and its determinants are poorly understood among refugees who live in temporary settlements. This research investigates the prevalence of cardiovascular disease (CVD) risk factors and examines the association of psychosocial determinants and CVH among Syrian refugees residing at the Zaatari camp in Jordan. Methods: A convergent mixed-method design was used. Syrian refugees (N=218) were recruited using a convenience sample from the King Salman Humanitarian Aid and Relief Primary Health Center. A purposive sub-sample of 13 participants completed a focus group discussion. Descriptive, chi-square tests and linear regression analyses were used. The total CVH score was derived by averaging eight health metrics, resulting in a composite score from 0 to 100. Scores of 80+ indicate high CVH, 50-79 indicate moderate CVH, and <50 indicate low CVH. Thematic analysis was used for qualitative data, which was analyzed separately. Results were then triangulated to interpret the convergence and divergence of findings. Results: Participants scored low in diet diversity (50%), hypertension (61.8%), and obesity (49%). Males scored higher than females in body mass index (24.7%) and physical activity (70.3%), while females had higher scores in sleep (55.4%) and nicotine exposure (84.1%) (P <0.05). The total CVH score was 60.6 (±15.8), indicating that participants scored moderately well following the healthy guidelines. Higher household income (> $150 vs. < $50), the presence of vulnerable household members, no education, depression, and anxiety were associated with lower CVH. Technical education versus high school and below and employment were associated with higher CVH. Barriers to CVH include financial constraints, lack of structured daily activities, remote access to sports facilities, unhealthy living conditions, long waiting times for medical care, chronic stress, and traditional gender roles with limited employment opportunities. Facilitators included personal efforts to stay active, home gardening, community advocacy, interactions with healthcare workers, using the internet for health information, evolving gender roles, and intra-community support. Conclusion: Humanitarian organizations and stakeholders must implement interventions to improve diet, manage hypertension and obesity, and provide psychosocial support. Addressing these factors is vital for preventing further deterioration and promoting the overall well-being of CVH.