Predictors and barriers for the management of non-communicable diseases among older Syrian refugees amidst the COVID-19 pandemic in Lebanon: A cross-sectional analysis of a multi-wave survey
Authors: McCall Stephen J. , Khoury Tanya El , Salibi Noura , Zeid Berthe Abi , Haddad Maria El , Alawieh Marwan F. , Abdulrahim Sawsan , Chaaya Monique , Ghattas Hala , Sibai Abla 
Published: April 2022

AbstractImportanceOlder Syrian refugees have a high burden of non-communicable diseases and economic vulnerability.ObjectiveThis study aimed to develop and internally validate a predictive model of the inability to manage non-communicable diseases (NCDs) in older Syrian refugees, and to describe barriers to adherence to NCD medication.DesignA nested cross-sectional study within a longitudinal study.SettingLebanon.PopulationSyrian refugees aged 50 years or older residing in Lebanon who self-reported having hypertension, diabetes, history of cardiovascular disease (CVD) or chronic respiratory disease (CRD).MethodsAll households with refugees aged 50 years or older who received humanitarian assistance from a non-governmental organization were invited to participate in a study examining the impact of COVID-19 on older Syrian refugees. Data were collected through telephone surveys between September 2020 and January 2021. The study outcome was self-reported inability to manage hypertension, diabetes, CVD or CRD. Predictors of inability to manage any NCD were assessed using a logistic regression models. The model was internally validated using bootstrapping techniques, which gave an estimate of optimism. The optimism-adjusted discrimination and calibration of the model were presented using C-statistic and calibration slope (C-slope), respectively.ResultsOut of 3,222 older Syrian refugees, 1,893 reported having at least one NCD including 43% who had hypertension, 24% diabetes, 24% history of CVD, and 11% CRD. There were 387 (20%) participants who were unable to manage at least one of their NCDs. Predictors for inability to manage NCDs were age, non-receipt of cash assistance, household water insecurity, household food insecurity, and having multiple chronic diseases. The model’s adjusted C-statistic was 0.65 (95%CI:0.62-0.67) and C-slope was 0.88 (95%CI:0.73-1.03). The prevalence of non-adherence to medication was 9% and the main reasons were unaffordability of medication (41%) and the belief that they no longer required the medication after feeling better (22%).ConclusionsThis study identified that the predictors of inability to manage NCDs among older Syrian refugees in Lebanon are mainly related to financial barriers, which aids the targeting of assistance and interventions. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to medication and healthcare.Key pointsQuestionWhat are the predictors and barriers to managing NCDs as an older Syrian refugee in Lebanon?FindingsThis nested cross-sectional study assessed the predictors and barriers to managing any NCD, which included hypertension, diabetes, history of cardiovascular disease and chronic respiratory disease. Predictors included age, no cash assistance, household water insecurity, household food insecurity and having multiple chronic diseases. Primary reasons for not taking medications were unaffordability of the medication and belief medication was no longer required.MeaningContext-appropriate assistance is required to overcome financial barriers and enable equitable access to healthcare and medication required to manage NCDs.