Introduction: Maternal morbidity remains a grand global health challenge with gestational hypertension (G-HTN) being one of the leading causes. Previous research found an association between low hypertension management among marginalized communities and the social determinants of health, especially among displaced populations, including refugees. Migration stressors are prevalent in refugees, but limited research describes how these experiences affect pregnancy. Little is known about refugee women’s experiences with G-HTN management, especially in countries of first asylum, such as Jordan, which hosts around 1.3 million Syrian refugees. This qualitative study offers an analysis of the multilevel barriers related to G-HTN management among refugee women living in Jordan in 2023.Methods: The study utilizes the social-ecological model of health to examine barriers to G-HTN management. We recruited a total of twenty community-dwelling Syrian refugee women with a history of or current G-HTN through a refugee community center in Jordan. Ten in-depth interviews and one focus group were conducted by a trained native-speaker research team. Interviews were conducted in Arabic, transcribed, translated, and coded using inductive thematic analysis. Results: At the personal level, participants expressed a general knowledge about G-HTN. On the interpersonal level, loss of social support emerged as a significant barrier. Many individuals were uncomfortable sharing their personal lives with current social networks, resulting in feelings of isolation when it came to asking for resources and expressing the need to receive extra guidance on self-management from providers. At the institutional level, barriers included healthcare costs and the absence of institutional support in providing blood pressure monitors. On the community level, cultural and societal expectations around reproduction, such as approval of contraception use, created stress, impacting their ability to manage their health. At the policy level, women noted the limited policies to allow refugee women to join the local workforce. Discussion: Like other chronic health conditions, G-HTN and its management are detrimentally influenced by the overall status of the healthcare infrastructure for refugees. Addressing barriers across the SEM would likely increase the effective management of G-HTN among refugee women in countries of first asylum.
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