Abstract
BACKGROUND: Forced displacement has created widespread health disparities, with refugees experiencing disproportionate risks of chronic conditions like hypertension. In the United States, a limited understanding of how knowledge, attitudes, and practices (KAP) shape blood pressure (BP) outcomes continues to hinder equitable care. This study explores the relationship between KAP and BP control among Iraqi and Syrian refugees who resettled in the United States. METHODS: Iraqi and Syrian refugees (n = 95) with hypertension at a federally qualified health center in San Diego, California, participated in this study. They completed a survey in Arabic assessing KAP based on a scale validated in non-English speakers and were instructed to do home BP monitoring using digital cuffs for at least 3 days per week for 4 weeks. The outcome was BP control based on the American College of Cardiology (ACC) criteria, calculated from an average of home BP readings. Mixed-effect logistic regression was used to assess the relationship between each KAP quartile and BP control. KAP quartile was categorized into (poor, fair, good, excellent). RESULTS: Participants were 56% male, and the mean age was 58.8 (± 15.97) years. 86% were unemployed, 40% had at least a bachelor's degree, 63% had limited English proficiency, and only 3.6% had an annual income of ≥$35,000. Mean BP was 129/79 mmHg (SD systolic: 22.17 mmHg; SD diastolic: 11.15 mmHg). Scores were computed for each KAP sub-scale: knowledge (0-16), attitude (1-20), and practice (1-8). Knowledge 13.2 (± 2.37), attitude 14.6 (± 2.38), and practice 6.5 (± 1.17). Higher knowledge levels were associated with higher odds of BP control (OR 1.89, 95% CI 1.39-2.55). An inverse relationship was observed between attitudes and BP control: participants with "Fair" and "Good" scores had reduced odds of BP control (OR = 0.63, 95% CI: 0.52-0.77; and OR = 0.58, 95% CI: 0.45-0.75, respectively). CONCLUSIONS: These findings highlight the urgent need for culturally grounded health education and systems-level strategies that address both informational and perceptual barriers to BP control. Advancing health equity for refugee populations demands interventions that go beyond awareness, integrating trust-building, accessibility, and empowerment into chronic disease management.