Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study

Background: Physical inactivity is one of the major risk factors for non‑communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self‑reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017. Methods: This community‑based cross‑sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18–64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi‑square test and Cochran–Armitage tests. The Mann–Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level.Results: Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). “Perceived change in the amount of physical activity” was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27–7.26). Common facilitators of physical activity were “psychological wellbeing”(49.7%) and “prevent diseases”(46.8%). The greatest barriers to physical activity were “time limitation”(43.4%) and “high cost”(57.8%).Conclusion: This study revealed the physical activity level among Syrian refugees in Amman. The perceived facili‑tators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non‑refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers

A case analysis of partnered research on palliative care for refugees in Jordan and Rwanda

© 2021, The Author(s). Background: This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. Discussion: There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-maker’s research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. Conclusions: This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant

Población refugiada de origen sirio asentada en Jordania y sistema sanitario: explorando el acceso, las necesidades, las barreras y las estrategias de adaptación

Since the Syria crisis started, about one quarter of its population have fled to the neighbouring countries, mainly Turkey, Lebanon, and Jordan. Jordan has hosted more than 12% of the refugees from Syria and numbers are increasing. This increase in migration and refugee either due to long-lasting conflicts or ongoing economic crises has made the refugee movement a concern at global level and prompted hosting countries, as well as humanitarian organisations to respond to this alarming crisis. The study explores the access to and utilization of healthcare services among urbanized Syrian refugees in Jordan. Using the mixed method design, this phenomenon was studied among two refugees’ communities urbanized in central governorates. The study settings were selected conveniently, the participant sample for the quantitative part were randomly chosen while sampling was purposive for the qualitative part. A cross-sectional survey among 383 refugees aged 18 – 75 years old was conducted between November 2019 and January 2020. Participants answers were entered directly using on tablet using KOBO tool. Concurrently, in-depth semi-structured interviews were conducted among a subset of twenty participants. Data were analyzed with descriptive and thematic analysis, while quantitative data were analyzed with descriptive statistical analysis, qualitative data were transcribed and analysed using Braun and Clarke thematic analysis approach. Both dataset analyses identified a set of fragmented needs in relation to health needs and help seeking, such as emergency care, psychological-mental support needs, rehabilitation, disability, elderly care, childcare, women's care, and chronic disease care. The analysis of seeking behaviour found that primary awareness, beliefs, access policy, financial capacities and practice are the main drivers for health-seeking behaviours. The standard barriers quantified through quantitative assessment were cost, awareness, quality of services and discrimination. The qualitative assessment detected the same access barriers in addition to access policy, service availability, waiting time and distance. The standard adaptation strategies quantified by quantitative assessment were a theme in qualitative findings. These include seeking free services, delaying seeking care, reducing, or stopping the use of medication, using alternative medicine, borrowing money or use saving, and moving onward. However, the qualitative assessment also detected adaptation strategies included self-medication, collection donation, illegal labour, and prioritising between health and other livelihood needs. Four themes found under the impact of adaptation strategies include psychological and mental health consequences, compromise of other livelihood needs, deterioration of health status and legal consequences. The perceived needs, seeking behaviours, and experienced barriers with healthcare interacts with each other. Another contextual set-up, inform Syrian refugees’ healthcare utilization behaviours, drive adaptation strategies and result in a negative impact on refugee health status, but also may extend to another means of livelihood. The study’s findings may be relevant to the global responses to the refugee crisis. The hosting countries can use it to develop a balanced response regarding health interventions and policies to avoid negative consequences on refugees and host communities. Additionally, the third countries that received the secondary movement of refugees may use these findings to enhance support to host countries for better accommodation for refugees' needs and avoid unnecessary subsequent movements that pose additional global health and other risks.Tesis Univ. Granada

Impact of restricting access to health care services on Syrian refugees in Jordan: evidence from cross-sectional surveys

Publicación realizada en el marco de la investigación de tesis doctoral de Ibraheem Abu Siam, dirigida por María Rubio GómezPurpose – Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan. Design/methodology/approach – This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact. Findings – The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake. Originality/value – Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.UNHCR Jorda

A case analysis of partnered research on palliative care for refugees in Jordan and Rwanda

Abstract Background This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study’s main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. Discussion There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-maker’s research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. Conclusions This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant