An integrated physical and mental health awareness education intervention to reduce non-communicable diseases among Syrian refugees and Jordanians in host communities: A natural experiment study

Tara M Powell; Shang-Ju Li; Yuan Hsiao; Michelle Thompson; Aseel Farraj; Mariam Abdoh; Rami Farraj

doi:10.1016/j.pmedr.2021.101310

An integrated physical and mental health awareness education intervention to reduce non-communicable diseases among Syrian refugees and Jordanians in host communities: A natural experiment study

Prev Med Rep. 2021 Jan 7:21:101310. doi: 10.1016/j.pmedr.2021.101310. eCollection 2021 Mar.

Authors

Tara M Powell¹, Shang-Ju Li², Yuan Hsiao³, Michelle Thompson², Aseel Farraj⁴, Mariam Abdoh⁴, Rami Farraj⁵

Affiliations

¹ University of Illinois, School of Social Work 1010 West Nevada Street, University of Illinois Urbana-Champaign, 61801, United States.
² Americares, 88 Hamilton Avenue, Stamford, CT 06902, United States.
³ Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195-3340, United States.
⁴ Royal Health Awareness Society, Jordan.
⁵ King Hussein Medical Center, Jordan.

Abstract

The Syrian crisis has had a devastating impact on displaced populations and among host communities in neighboring countries such as Jordan. Many of these individuals are at risk for non-communicable diseases (NCD) and mental health disorders, yet do not have access to services designed to manage or prevent these conditions. The purpose of this study was to examine the efficacy of a non-communicable disease (NCD) awareness educational intervention and an integrated NCD and mental health education intervention on reducing cardiovascular disease (CVD) risk among Jordanians and displaced Syrians. This natural experiment study was conducted in three health centers in Irbid, Jordan with 213 Syrian participants and 382 Jordanians. Participants were assigned to one of three study conditions: the Healthy Community Clinic (HCC), a non-communicable disease educational intervention; the HCC with added mental health awareness sessions; standard healthcare. CVD risk factors were assessed at baseline, 12 and 18 months. The HCC education group yielded significant improvements in three CVD risk factors including: body mass index (BMI) -1.91 (95% CI: -2.09, -1.73); systolic blood pressure (SBP) -12.80 mmHg (95% CI: -16.35, -9.25); and diastolic blood pressure (DBP) -5.78 mmHg (95% CI: -7.96, -3.60) compared to standard care. The HCC-mental health treatment arm also demonstrated significant improvements in BMI, SBP, and DBP compared to standard care. Significant improvements in fasting blood glucose -20.32 (CI: -28.87, -11.77) and HbA1c -0.43 (-0.62, -0.24) were also illustrated in the HCC-mental health treatment arm. The HCC-mental health group sustained greater reductions in CVD risk than the HCC education group at 18-months. This study is among the first to our knowledge illustrating an integrated health and mental health educational intervention can reduce CVD risk among Syrian refugees and Jordanians. Continued investment and research in CVD prevention interventions is needed to enhance health, reduce costs, and have lasting benefits for conflict-affected individuals and communities.

Keywords: Cardiovascular disease; Intervention; Mental health; Refugee.