Refugees are a subset of the population that suffer displacement and other stressors, and once they reach their new home country, medical conditions including hypertension can go undetected and untreated. However, research into this very topic began in February 2021. The study entitled “Perceptions, Knowledge, and Attitudes Towards Hypertension Management among Refugees in San Diego” is being carried out by Dr. Tala Al-Rousan, a founding faculty member at the Herbert Wertheim School of Public Health at the University of California San Diego, in partnership with Dr. Job Godino who leads the Laura Rodriguez Research Institute at the Family Health Care Centers of San Diego.
Throughout the program, participants are using Withings BPM Connect, a smart blood pressure monitor, as well as the Withings Data Hub, a cellular gateway used to collect measurements. The study is funded by The National Heart, Lung, and Blood Institute of the US National Institutes of Health. It aims to contribute to a relatively small body of literature surrounding the unaddressed global challenge of uncontrolled blood pressure in displaced populations including refugees and asylum seekers. The problem of hypertension among displaced peoples is even more prevalent as the numbers of refugees continue to increase due to higher rates of violence, natural disasters, and health inequities.
A specific goal of the project is to examine the feasibility of self-administered blood pressure monitoring through supportive healthcare infrastructure. The study hopes to show preliminary data that refugee patients can and prefer to take leadership over their hypertension management from where they are residing in combination with receiving guidance on medication titration plans from their healthcare providers.
In combination with BPM Connect, Drs. Al-Rousan and Godino’s teams collect patient data using Withings remote patient monitoring (RPM) solution. Both device and RPM help solve several pain points that participants may face such as interrupted healthcare access, economic hardship, language barriers, and varying levels of health literacy and numeracy. Regarding interrupted access, going to the doctor can be difficult for participants as some may have employment that does not allow for brief leave from work; since the device can be used at home, less time needs to be budgeted. BPM Connect also uses one button to take measurements which reduces potential language and use factors. Finally, any question of whether participants can access the internet has been assuaged using Withings Data Hub, a cellular gateway that requires no installation from users and securely connects retrieved data to the Withings RPM solution without requiring a smartphone or Wi-Fi.
The study includes 80 Aramaic and Arabic-speaking refugees with diagnosed uncontrolled blood pressure. Participants were recruited in consultation with ethnic community-based organizations in San Diego that serve refugees including Al Majdal Center and others. Multicultural and multilingual investigators with expertise in refugee health, digital health, epidemiology, and chronic disease prevention are involved in the team.
The study asks participants to measure their blood pressure three times a day every other day for four weeks. Qualitative interviews are being conducted before and after the intervention period to understand the levels of acceptability of remote monitoring and whether participants feel more in control, empowered, aware, and engaged in better quality healthcare. Questions on the role of social networks in health education and medication adherence are also asked about in this study.
“This project is revolutionary in that it is the first of its kind to be addressing the unmet need of uncontrolled blood pressure, a silent killer to millions all over the world, in one of the most understudied and underserved populations which is the refugee population.” — Dr. Al-Rousan
An observation the team has noted in the program are the results of two randomized groups — one that receives in-person education about how to use BPM Connect and the other that receives the same education virtually. The virtual education group has not only received the intervention smoothly but actually preferred it over in-person instruction which may be explained by fears of contracting COVID, or simply convenience and saving on transportation and other costs. Additionally, the use of the BPM Connect has extended beyond the intended four-week intervention period.
The ongoing pandemic has highlighted health disparities that vulnerable populations face. Drs. Al-Rousan and Godino hope that this study will show how innovative digital health solutions fit within patients’ feelings of acceptance while displaying that taking healthcare to marginalized people’s homes enables these populations to relate to their health providers, engage in healthier behaviors, and better manage chronic diseases.
The study is now in the end phase and results will soon be published. For questions, please contact Dr. Tala Al-Rousan. To find out more about how institutions are using BPM Connect and other connected health devices with the Withings Data Hub, you can visit Withings.com.