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 facilitators 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.

Psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda: burden and associations

Background

Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We studied the association between psychological distress and social support among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.

Methods

Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed in SPSS-version 22, and statistical significance was assumed at p < 0.05.

Results

Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress [F(2, 1011) = 47.91; p < 0.001], higher availability of social interaction [F(2, 1011) = 82.24; p < 0.001], lower adequacy of social interaction [F(2, 1011) = 54.11; p < 0.001], higher availability of social attachment [F(2, 1011) = 47.95; p < 0.001], and lower adequacy of social attachment [F(2, 1011) = 50.54; p < 0.001] than peers in urban settlements. Adequacy of social interaction significantly explained variations in psychological distress levels overall and consistently across settlements, after controlling for plausible confounders. Additionally, adequacy of social attachment significantly explained variations in psychological distress levels among refugees in rural settlements, after controlling for plausible confounders.

Conclusion

There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. To address psychological distress, Mental Health and Psychosocial Support Services (MHPSS) should focus on strategies which strengthen the existing social networks among refugees. Variations in social support are a key predictor of distress which should guide tailored need-adapted interventions instead of duplicating similar and generic interventions across diverse refugee settlements.

The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study

BACKGROUND

In Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health.

METHODS

We conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis.

RESULTS

Participant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one's right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run.

CONCLUSION

Comprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.

'He always thinks he is nothing': The psychosocial impact of discrimination on adolescent refugees in urban Uganda

Armed conflict causes massive displacement, erodes the social fabric of communities, and threatens the healthy development of a nation's future - its youth. Although more than half of the world's registered refugees under the age of eighteen currently reside in urban areas, research on the unique needs of and realities experienced by this population remain limited. In Uganda, as in many refugee-receiving countries, most regulated refugee protections and entitlements fail to extend beyond the confines of official settlements or camps. This dearth of support, in combination with few material resources, uncertain local connections, and little knowledge of the language, leaves refugee families vulnerable to the added burden of an unwelcome reception in cities. Drawing on qualitative data from a study conducted in March and April 2013 with Congolese and Somali adolescents, caregivers, and service providers in refugee settlements in Kampala, this manuscript explores the pervasive nature of discrimination against urban refugees and its effects upon adolescent well-being. Findings suggest that discrimination not only negatively impacts acculturation as youth pursue social recognition in the classroom and among neighborhood peers, but it also impedes help-seeking behavior by caregivers and restricts their ability to ameliorate protection concerns, thereby lowering adolescents' psychosocial well-being. Youth reported low self-worth, withdrawal from school, and an adverse turn toward street connections. Targeted and innovative strategies along with reformed policies that address the unique challenges facing urban refugees are paramount to ensuring that young people in this population experience greater protection, well-being, and future success.

A cross-sectional survey on gender-based violence and mental health among female urban refugees and asylum seekers in Kampala, Uganda

OBJECTIVE

To assess gender-based violence and mental health outcomes among a population of female urban refugees and asylum seekers.

METHODS

In a questionnaire-based, cross-sectional study conducted in 2010 in Kampala, Uganda, a study team interviewed a stratified random sample of female refugees and asylum seekers aged 15-59 years from the Democratic Republic of Congo and Somalia. Questionnaires were used to collect information about recent and lifetime exposure to sexual and physical violence, and symptoms of depression and post-traumatic stress disorder (PTSD).

RESULTS

Among the 500 women selected, 117 (23.4%) completed interviews. The weighted lifetime prevalences of experiencing any (physical and/or sexual) violence, physical violence, and sexual violence were 77.5% (95% CI 66.6-88.4), 76.2% (95% CI 65.2-87.2), and 63.3% (95% CI 51.2-75.4), respectively. Lifetime history of physical violence was associated with PTSD symptoms (P<0.001), as was lifetime history of sexual violence (P=0.014). Overall, 112 women had symptoms of depression (weighted prevalence 92.0; 95% CI 83.9-100) and 83 had PTSD symptoms (weighted prevalence 71.1; 95% CI 59.9-82.4).

CONCLUSION

Prevalences of violence, depression, and PTSD symptoms among female urban refugees in Kampala are high. Additional services and increased availability of psychosocial programs for refugees are needed.