Factors Associated with Suboptimal Adherence to Hypertensive Medications Among Syrian Refugees – Cross-Sectional Study at the Zaatari Camp, Jordan

OBJECTIVE: This study aimed to assess the level of medication adherence and associated factors among Syrian refugees with hypertension in Jordan. METHODS: This cross-sectional study included 180 randomly selected Syrian refugees diagnosed with hypertension residing in Zaatari camp, Jordan. The Adherence to Refills and Medications Scale (ARMS) was used to assess adherence to antihypertensive medications. Additional data were collected on sociodemographics, therapy-related factors, patients' behaviors and knowledge of hypertension disease and therapy, and health system-related factors. Multivariate linear regression was used to assess the association between adherence scores and other variables. RESULTS: The mean (SD) of ARMS scores was 15.7 (2.9). Based on ARMS scores, 22.8% of patients were adherents and 77.2% were non-adherents. Multivariate analysis showed that newly initiated therapy (≤2 years) and illiteracy were both strong predictors of lower adherence with p < 0.001 and p = 0.012, respectively. Other variables that were significantly associated with lower adherence included discontinuation of antihypertensive medications due to side effects (p = 0.032), reporting irregular availability of free antihypertensive medications dispensed by non-governmental organizations (NGOs) (p = 0.024), and dissatisfaction with health services (p = 0.022). CONCLUSION: Suboptimal adherence to antihypertensive medications remains a substantial unmet need among Syrian refugees with hypertension. As illiteracy appears to have a negative impact on adherence levels, educational interventions that promote medication adherence and favorable health behaviors through auditory and visual aids are needed to better reach and engage people with limited literacy skills. Strengthening the pharmaceutical supply chain at various levels is strongly recommended to respond quickly to changes in demand and prevent an indirect negative impact on adherence levels.