SACM - Australia
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9648
Browse
52 results
Search Results
Item Restricted Evaluating Dispatcher-Assisted CPR: A Global Systematic Review and Observational Study in Asir, Saudi Arabia(Saudi Digital Library, 2025-06-17) Alshedidi, Ahmed Mohmmed; Zainab, AlqudahThis thesis evaluates the impact of Dispatcher-Assisted Cardiopulmonary Resuscitation (DACPR) on bystander CPR rates and patient outcomes following out-of-hospital cardiac arrest (OHCA). The first part is a systematic review of 17 studies from Asia, Europe, and North America, demonstrating increased bystander CPR and improved survival outcomes associated with DACPR. The second part is a retrospective observational study conducted in the Asir region of Saudi Arabia, which assessed call recognition, language-related delays, and early outcomes using linked dispatch and EMS data. Findings show that language and dispatcher qualifications influence recognition time and early survival indicators. The study highlights the need for improved training and multilingual protocols in Saudi EMS systems.9 0Item Restricted Shared decision-making during pregnancy and childbirth in Saudi Arabia: A mixed-methods study(Saudi Digital Library, 2025-07-13) Alruwaili, Tahani Ali; Fooladi, Ensieh; Crawford, KimberleyBackground Shared decision-making (SDM) is fundamental to quality pregnancy and childbirth, representing a collaborative approach between healthcare providers (HCPs) and women. In Saudi Arabia's obstetrician-led maternity care system, the implementation of SDM and the experiences of women and their husbands remain understudied, particularly in the context of unique cultural, religious, and healthcare factors. Aim To explore women’s and their husbands’ experiences of shared decision-making with healthcare providers during pregnancy and childbirth in Saudi Arabia. Methods The study employed a convergent parallel mixed-methods design guided by the Three-Talk Model for SDM, which conceptualises SDM as a process involving team talk, option talk, and decision talk. The quantitative strand involved a nationwide, online survey conducted between January and May 2023, targeting women aged 18 and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. Low to very low SDM and respect were defined as scores of ≤24 on the Mothers’ Autonomy in Decision-Making (MADM) scale and ≤49 on the Mothers on Respect Index (MORi), respectively. Using the same inclusion criteria, the qualitative strand conducted semi-structured interviews with women and husbands, recruited through convenient sampling from two maternity hospitals and social media. Interview data were analysed thematically and mapped onto the Three-Talk Model for SDM. Data from both phases were integrated during the interpretation phase to provide comprehensive insights into SDM experiences. Results The survey of 505 women revealed that 34.1% (95% confidence interval [CI], 29.6–38.9) reported low to very low SDM. Statistical analysis identified significant factors associated with low SDM, including seeing different obstetricians of a different gender at each visit (adjusted odds ratio [AOR] 2.0, 95% CI, 1.0–3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95% CI, 1.2–5.6), and having an instrumental vaginal birth (AOR 6.67, 95% CI, 1.6–28.1). A strong positive association emerged between low to very low SDM and reporting of low to very low respect (χ2 = 83.8173, p < 0.001). The qualitative data from 19 women and 5 husbands identified the following three major themes aligned with the Three-Talk Model: (1) Team Talk; communication and relationship building were limited by discontinuity of care, time constraints, language barriers, emotional readiness, and gender preferences; (2) Option Talk; information exchange highlighted the importance of clarity, despite reported insufficient details and perceived HCP biases towards intervention; and (3) Decision Talk; autonomy and SDM revealed varying levels of autonomy influenced by hierarchical healthcare structures, religious beliefs, and family involvement. Many participants mistook signing consent forms for engaging in SDM, indicating a gap in understanding of SDM processes. Participants’ experiences centred primarily on interactions with obstetricians, with minimal midwifery involvement. Conclusion The findings reveal challenges in implementing SDM within Saudi maternity care, including discontinuity of care, language barriers from non-Arabic-speaking obstetricians, gender preferences, and rigid institutional hierarchies. These findings highlight the need for healthcare reforms, including professional interpretation services, improved continuity of care, and exploration of midwifery-led models. Future maternity care policies should consider the complex interplay of religious beliefs and family dynamics when developing strategies to improve SDM in Saudi pregnancy and childbirth.24 0Item Restricted Enhancing Cardiac Arrest Management in Prehospital Settings in Saudi Arabia(Saudi Digital Library, 2025-06-02) ALSAHLI, MUSAAD; Bowles, Kelly-AnnAim: This study aimed to evaluate the current challenges and practices in managing out-of-hospital cardiac arrest (OHCA) in Saudi Arabia, with a focus on improving bystander intervention through cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. The research sought to assess public knowledge, attitudes, and barriers to CPR and AED utilization to provide evidence based recommendations for strengthening prehospital cardiac arrest response. Methods: A Quantitative approach was employed, combining a comprehensive literature review with a cross-sectional survey. The literature review analyzed peer-reviewed studies, national reports, and international guidelines on OHCA management in Saudi Arabia and comparable contexts. The survey, conducted online, included 229 Saudi residents aged 18 years or older, assessing demographics, CPR knowledge, AED awareness, willingness to act, and perceived barriers. Data were analyzed descriptively, and logistic regression identified factors influencing bystander willingness to perform CPR. Results: The survey revealed that while 70% of respondents expressed willingness to perform CPR, only 33% were very familiar with CPR steps, and 48% recognized AEDs. Key barriers included fear of causing harm (54%), legal concerns (31%), and reluctance to perform mouth-to-mouth ventilation (12%). Prior CPR training and exposure to awareness campaigns significantly increased willingness to act (OR = 2.4, *p* = 0.05). Urban-rural disparities were noted, with rural areas exhibiting lower awareness of CPR campaigns (20% vs. 33% in urban centers). Qualitative feedback emphasized the need for practical training, increased AED availability, and legal reassurance to encourage bystander action. Conclusion: The study highlights critical gaps in public preparedness for OHCA response in Saudi Arabia, including insufficient CPR knowledge, low AED awareness, and persistent cultural and legal barriers. To address these challenges, the study recommends integrating CPR training into school curricula, expanding AED deployment in public spaces, launching nationwide awareness campaigns, and implementing dispatcher-assisted CPR protocols. Strengthening community engagement and leveraging technology, such as volunteer responder apps, could further enhance the "Chain of Survival" and improve OHCA outcomes. These measures align with global best practices and offer a roadmap for reducing preventable deaths from cardiac arrest in Saudi Arabia.30 0Item Restricted Mapping the Fashion Entrepreneurship Ecosystem in Saudi Arabia: Impacts on Entrepreneurial Orientation and Business Performance of Micro, Small, and Medium Enterprises(RMIT University, 2025-03) Alharbi, Marwah; Tan, Caroline; Quintero Rodriguez, CarolinaThis thesis investigates the influence of the Fashion Entrepreneurship Ecosystem (FEE) on Entrepreneurial Orientation (EO) and Business Performance (BP) within fashion Micro, Small, and Medium Enterprises (MSMEs) in Saudi Arabia. The study adopts a mixed-methods explanatory design, integrating a quantitative survey with 223 fashion MSMEs and qualitative interviews with 15 ecosystem stakeholders. Drawing on the Resource-Based View (RBV), EO defined through innovativeness, proactiveness, and risk-taking, is conceptualised as a core intangible resource that mediates the relationship between external ecosystem elements and firm success. The quantitative phase employed Partial Least Squares Structural Equation Modelling (PLS-SEM) to test the direct and mediating effects of FEE on EO and BP. The results revealed that FEE has a significant positive impact on both EO and BP. EO also showed a strong direct effect on BP and partially mediated the relationship between FEE and BP. These findings underscore the strategic importance of EO in enhancing business outcomes and demonstrate the role of the ecosystem in shaping entrepreneurial capacities. The qualitative phase utilised thematic analysis to explore how fashion entrepreneurs and ecosystem actors experience and interpret the FEE. Key challenges identified include limited access to finance, insufficient entrepreneurial education, misaligned support structures, and persistent cultural stigma associated with fashion entrepreneurship. The study also highlights the mismatch between existing support services often designed for technology sectors and the specific needs of fashion startups. Additional barriers were found in rural accessibility, institutional support, and gendered constraints. Overall, the findings offer a context-specific understanding of the Saudi FEE and its role in shaping EO and BP. The research contributes theoretical insights into the RBV and EO literature and provides practical recommendations aligned with Vision 2030 to strengthen policy, education, and support mechanisms in Saudi Arabia’s creative economy.13 0Item Restricted An exploration of burnout in nurses working in intensive care in Saudi Arabia: An explanatory sequential mixed methods study(Saudi Digital Library, 2025-06-30) Altokhais, Abdulmajeed Saad; Principal supervisor, Professor Melanie Greenwood, and co-supervisor Dr Russell James.Nurses working in highly demanding and challenging environments, such as intensive care units, are prone to experiencing burnout compared to those in less demanding environments. In Saudi Arabia, the large number of nurses from other countries who work in intensive care contributes to the complexity of caring for critically ill people. Cultural complexity, high workloads and low morale may contribute to burnout in nurses, however how these factors affect nurse working in intensive care in Saudi Arabia is not well understood. Understanding these challenges, therefore, can help to mitigate burnout among nurses working in intensive care, improve patient outcomes, and assist recruitment and retention. This study aimed to investigate burnout among nurses working in the intensive care setting and to establish the factors which lead to burnout and which promote well-being and resilience among those nurses in Saudi Arabia. An explanatory sequential mixed methods design was used, and the data collection occurred across two phases. The first phase of the study sought to understand factors that contribute to nurses experiencing burnout. Paper-based questionnaires were distributed to nurses working in intensive care units across four tertiary hospitals in Riyadh, the capital of Saudia Arabia. The questionnaire contained two sections included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)) scale used to explore the prevalence of burnout and the factors which contributed to the perception of burnout with the addition of participants’ demographic data and responses to the work characteristics questions. Data from the questionnaires were analysed using SPSS statistical software version 29. In Phase One, a total of 804 (80.4% response rate) nurses completed the questionnaire, with results indicating that more than half of the nurses experienced high levels of emotional exhaustion and depersonalisation, while more than half of those surveyed experienced moderate to low levels of personal accomplishment within the workplace. The analysis of demographic and work characteristic data, along with the MBI-HSS (MP) subscales, indicated that several factors may lead to burnout in nurses working within the intensive care setting. The demographic factors that contributed were gender, age, marital status, living arrangements, number of children, and nationality, while the work characteristics that contributed were work experience, type of intensive care, daily working hours, number of night shifts per month and number of patients per shift, attempts to maintain personal well-being, feeling stressed going to work, access to emotional support, feeling valued at work, salary satisfaction, and intention to leave. The findings from Phase One informed Phase Two, which used semi-structured interviews to delve deeper into and comprehend factors which led to nurses’ feelings of burnout and to identify their personal resilience against burnout. The interviews with consenting participants were undertaken online via Zoom or Microsoft Teams and analysed using a thematic analysis framework. In Phase Two, 20 semi-structured interviews were conducted with nurses who had completed the questionnaire and work in the intensive care setting. Three themes were identified from the thematic analysis: (i) “Being an intensive care nurse is challenging”; (ii) “The impact of the work upon me”; and (iii) “How I cope”. The first theme presented the nature of the work in intensive care settings in Saudi Arabia, highlighting the organisational challenges that participants encountered. The second theme reveals the physical, mental, psychosocial and professional impacts of working in intensive care in Saudi Arabia. The last theme captured the techniques participants used to cope with the challenges in the work environment. A pragmatic approach was used during data integration which influenced how this research was undertaken, presentation of the results and the structure of this thesis. Further, pragmatism helped explain the multiple realities that nurses encountered in their working environment in the intensive care setting in the cultural context of Saudi Arabia. The significant findings in this study are related to the unique cultural environment that exists in the nursing profession in Saudi Arabia and the interplay between the factors that contribute to and are protective against burnout. The contributing factors were the cultural and language challenges, which relied on nurses’ professional experience and adjustments to an altered scope of practice, and the protective factors, which included nurses’ capacity to build resilience, and how support systems created a complex dynamic that affected the participants’ performance and well-being. Whether nurses adapt or the environment adapts will be crucial in determining whether these nurses experience burnout or even leave the profession. Several recommendations stemming from this study are proposed to healthcare organisations, including policymakers, hospital leaders and nurse managers to improve work conditions in intensive care settings, which could potentially increase the adaptation to the work environment and, therefore, reduce burnout levels among nurses. In addition, it is crucial that stakeholders and hospital management understand the challenges that intensive care nurses encounter every day which impact their well-being as well as the quality of care. Policies and systems in hospitals, therefore, should be changed to help improve work conditions, which could potentially increase nurse retention and improve the quality of patient care.10 0Item Restricted Mapping the Fashion Entrepreneurship Ecosystem in Saudi Arabia: Impacts on Entrepreneurial Orientation and Business Performance of Micro, Small, and Medium Enterprises.(RMIT University, 2025-03) Alharbi, Marwah; Tan, Caroline; Quintero Rodriguez, CarolinaThis thesis investigates the influence of the Fashion Entrepreneurship Ecosystem (FEE) on Entrepreneurial Orientation (EO) and Business Performance (BP) within fashion Micro, Small, and Medium Enterprises (MSMEs) in Saudi Arabia. The study adopts a mixed-methods explanatory design, integrating a quantitative survey with 223 fashion MSMEs and qualitative interviews with 15 ecosystem stakeholders. Drawing on the Resource-Based View (RBV), EO defined through innovativeness, proactiveness, and risk-taking, is conceptualised as a core intangible resource that mediates the relationship between external ecosystem elements and firm success. The quantitative phase employed Partial Least Squares Structural Equation Modelling (PLS-SEM) to test the direct and mediating effects of FEE on EO and BP. The results revealed that FEE has a significant positive impact on both EO and BP. EO also showed a strong direct effect on BP and partially mediated the relationship between FEE and BP. These findings underscore the strategic importance of EO in enhancing business outcomes and demonstrate the role of the ecosystem in shaping entrepreneurial capacities. The qualitative phase utilised thematic analysis to explore how fashion entrepreneurs and ecosystem actors experience and interpret the FEE. Key challenges identified include limited access to finance, insufficient entrepreneurial education, misaligned support structures, and persistent cultural stigma associated with fashion entrepreneurship. The study also highlights the mismatch between existing support services often designed for technology sectors and the specific needs of fashion startups. Additional barriers were found in rural accessibility, institutional support, and gendered constraints. Overall, the findings offer a context-specific understanding of the Saudi FEE and its role in shaping EO and BP. The research contributes theoretical insights into the RBV and EO literature and provides practical recommendations aligned with Vision 2030 to strengthen policy, education, and support mechanisms in Saudi Arabia’s creative economy.6 0Item Restricted Analysing Existing Saudi Arabian University Admission Criteria for Accounting Programs(Victoria University, 2025) Alboty, Yazeed; Farley, Alan; Yang, HelenThis research was motivated by the significant role played by effective admission criteria in predicting academic performance, particularly in Saudi Arabian accounting programs. The primary objective of this research is to investigate the appropriateness of Saudi Arabian university admission criteria for undergraduate and postgraduate accounting programs. First, for the bachelor accounting program, this research aims to explore how well existing admission criteria—which test different dimensions of prior knowledge—predict academic performance of accounting students based in Saudi Arabia. It evaluates the validity of the High School Grade Point Average (HSGPA) and College Entrance Exam (CEE)—that is, the General Aptitude Test (GAT) and Achievement Test (AT)—to predict student performance in the Preparatory Year Program (PYP), along with first-year core courses in the accounting program and First Year Grade Point Average (FYGPA) and overall Grade Point Average (GPA) of students at the end of the degree. It also examines how the business college PYP predicts performance in the first year, and overall student GPAs at the end of the degree. The role of gender as a moderator in these relationships is considered. This investigation is based on prior knowledge theory (PKT), which is characterised as a multidimensional, hierarchical entity comprised of various types of knowledge and skills. Tied to the above, for the Master of Accounting program, this research aims to evaluate how effectively one admission criterion predicts the relative academic performance of accounting students in Saudi Arabia. Specifically, it examines the impact of English language proficiency—as measured by International English Language Testing System (IELTS) scores—on the relative performance of Saudi Master of Accounting students in more versus less conceptually oriented accounting courses. This investigation is informed by cognitive load theory (CLT), which addresses the challenge of processing complex cognitive tasks with multiple interactive information elements. The findings demonstrated that when used as sole predictors, the explanatory variables (HSGPA, GA, and AT) all had statistically significant positive correlations with the dependent variables related to predicting academic performance. Multiple regression analyses indicated that HSGPA was the strongest incremental predictor of academic performance, whereas GAT was the weakest, showing no significant incremental predictive power in most cases. This study demonstrates that HSGPA is the strongest predictor of both short- and long-term college outcomes in particular accounting disciplines. Further, the results consistently imply that the individual courses and GPA of the PYP in the business college have predictive value for academic performance. Additionally, the results indicate that gender does moderate the relationship between admission criteria and PYP and academic performance, which is significant in many cases. Last, the results show that English language proficiency measured by the IELTS alone has no significant direct effect on the relative academic performance of Saudi accounting students. Several implications can be drawn from this research for stakeholders and policy makers. It raises questions about the continued use of GAT score as an entry criterion and strongly supports gender-based differential entry criteria. In addition, it provides insight into the efficacy of the PYP.9 0Item Restricted A framework to adopt construction 4.0 in the Kingdom of Saudi Arabia: Impact of Institutional Pressures, Ambidexterity and Organizational Resources on Intention to Adopt(University of Newcastle, 2025) Alyami, Abdullah; Thayaparan, Gajendran; Marcus, Jefferies; Tanvi, NewazConstruction 4.0 is the construction industry’s response to Industry 4.0, a technological revolution to adopt innovative methodologies and modern technologies to boost productivity and efficiency in modern workplaces. Construction 4.0 is driven partly by an accelerated pace of urbanization, the resulting heightened demand within the construction industry, and the construction industry’s reputation for lack of modernization. It marks a paradigm shift characterised by the integration of digital technologies, automation, real-time data, and artificial intelligence across all stages of the construction lifecycle. The extant literature suggests that Construction 4.0 adoption is influenced by organizational resources (technology, people, process, and education), ambidexterity (exploration and exploitation), and institutional pressures (normative pressure, memetic pressure, and coercive pressure). The predominant discourse of existing studies on the implementation of Construction 4.0 have focused on its impact on work procedures, project completion times, quality, and safety measures, despite the significant influence of organizational resources, ambidexterity, and institutional pressures on the successful adoption of Construction 4.0. Less attention has been paid to how internal organisational factors and external institutional forces interact to shape the strategic intent to adopt Construction 4.0 technologies. This study addresses this gap by investigating the influence of three critical constructs: organisational resources (technology, people, processes, education and training), organisational ambidexterity (exploration and exploitation capabilities), and institutional pressures (coercive, normative, and mimetic) on the intention to adopt Construction 4.0 within the Saudi construction industry. Hence, this study investigates the influence of organizational resources, ambidexterity, and institutional pressures on the adoption of Construction 4.0 in the Kingdom of Saudi Arabia. Ultimately, the study has developed a framework for implementing Construction 4.0 in the Saudi construction industry. This research developed a theoretical model proposing eighteen (18) hypotheses, based on theories related to strategic resources (Resource-Based View), strategic flexibility (ambidexterity), and institutional pressures (institutional theory) to understand their impact on Construction 4.0 adoption. A comprehensive literature review was conducted, and a conceptual model was developed to measure the influencing factors. A quantitative research methodology was adopted, underpinned by a positivist paradigm. Data was collected through a questionnaire completed by 261 professionals in construction organizations in Saudi Arabia. Structural Equation Modelling (SEM) was adopted to test the hypotheses, examine the relationships between variables, and validate the conceptual model. The results of the SEM confirmed 13 of the 18 hypotheses, revealing that institutional pressures significantly influence exploration orientation. This orientation, in turn, positively impacts key organizational resources—particularly human capital, education and training, and processes—needed for the adoption of Construction 4.0. The intention to adopt C4.0 was found to be most strongly influenced by the development of these organizational resources. Moreover, the study identified five dominant adoption pathways that integrate external institutional forces and internal strategic capabilities. These pathways offer a nuanced understanding of how adoption dynamics unfold in practice, especially in contexts undergoing rapid socio-economic transformation. These findings offer theoretical and practical contributions. Theoretically, it advances the discourse on digital transformation in construction by integrating three organizational theories into a single explanatory model. The integration of organizational theories provides a deeper understanding of Construction 4.0 adoption dynamics. Empirically, it provides evidence-based insights specific to the Saudi Arabian context, an emerging market undergoing rapid reform aligned with Vision 2030. Practically, the study offers an empirically validated framework tailored to the Saudi construction context, which can inform decision-makers, policy developers, and construction professionals seeking to enhance productivity through digital transformation in alignment with national strategic ambitions.16 0Item Restricted SHATTERED PERCEPTIONS: HOW NEGATIVE NEWS TRUMPS DESTINATION IMAGE IN CONFLICT-RIDDEN REGIONS(Queensland University of Technology, 2024) Moathen, Wael; Wang, Di; Beatson, AmandaThis research investigates the causal effect of negative news media on destination image formation in conflict-ridden regions, addressing a critical gap in tourism literature. Destination image is pivotal in tourists’ decision-making processes and overall destination competitiveness. In conflict-ridden regions like the Middle East, negative news coverage can significantly impact these perceptions, potentially deterring visitors and affecting tourism economies. Despite the recognised importance of news media as an autonomous agent in image formation, limited empirical research has examined its causal effects, particularly in conflict- ridden areas. This study aims to comprehensively understand how negative news shapes destination image, the underlying mechanisms of this effect, and potential moderating factors. Study One establishes the main effect of negative news on destination image through a 2 (within-subjects: Time [before news story, after news story]) × 2 (between-subjects: News Frame [thematic, episodic]) × 4 (Countries [Turkey, Saudi Arabia, Dubai, Qatar]) experimental design. Analysis of variance (ANOVA) reveals that negative news significantly decreases destination image for the featured location and, to a lesser extent, other destinations in the region. The study demonstrates the robustness of this effect across different news frames, providing initial evidence for the pervasive impact of negative media coverage on regional perceptions. Study Two replicates and extends these findings using a 2 (Story type: negative v. ordinary) × 2 (Connotation: negative v. neutral) × Continuous prevention focus, between- participants experimental design. Through mediation analyses, it identifies perceived risk and negative emotions as significant mediators in the relationship between negative news and destination image. Additionally, moderation analysis reveals that prevention focus moderates the effect of negative news on perceived risk, with high prevention-focused individuals being more susceptible to negative news effects. Study Three further confirms these results and examines the impact across different travel arrangements using a 2 (Story type: negative v. ordinary) × 2 (Travelling arrangements: independent traveller v. all-inclusive packaged travellers) between-participants experimental design. The findings demonstrate that the negative effect of news persists for both independent iv Chapter 1: Introduction and package travellers, challenging assumptions about the risk-mitigating potential of all- inclusive packages in conflict-ridden destinations. Theoretically, this research makes several important contributions. It provides the first causal evidence of the negative effect of news media on destination image formation in conflict-ridden regions, addressing calls for more rigorous methodologies in this area. Identifying perceived risk and negative emotions as mediators advances understanding of the psychological mechanisms underlying this effect. Further, the research extends the application of regulatory focus theory in tourism contexts by demonstrating its relevance to news processing and destination perceptions. This research fills a significant geographical gap in tourism studies by examining an under-researched geographical region, thereby enhancing the global relevance of tourism scholarship and providing valuable insights for both academic discourse and practical tourism management. Practically, the findings offer valuable insights for destination marketing organisations in conflict-ridden regions. The research underscores the need for proactive media monitoring and rapid response strategies to counteract negative coverage. It highlights the importance of addressing both cognitive (perceived risk) and affective (negative emotions) components in image management efforts. The findings related to prevention focus suggest the need for tailored marketing approaches that consider individual differences in risk sensitivity. In conclusion, this research comprehensively examines how negative news media influences destination image formation in conflict-ridden regions. Establishing causal relationships, identifying underlying mechanisms and exploring moderating factors advances both theoretical understanding and practical strategies in destination marketing. As global tourism continues to navigate geopolitical challenges and media dynamics, these insights offer crucial guidance for managing destination perceptions in complex environments.22 0Item Restricted Developing and Assessing the Effectiveness of a Web-based Breastfeeding Educational Resource on Exclusive Breastfeeding Rate among Saudi Women(University of Wollongong, 2024-09) Alahmed, Salma; Frost, Steve; Meedya, Shahla; Fernanadez, Ritin; Win, Khin; Almutair, AbbasBackground Breastfeeding is not only a very cost-effective way of feeding a baby, but it is also associated with multiple health benefits for both mothers and infants. Henceforth, the World Health Organization highly recommends early initiation of breastfeeding within an hour after birth, followed by exclusive breastfeeding for up to six months. However, the rates of early initiation of breastfeeding and exclusive breastfeeding vary around the world, and in some countries, they are well below the WHO targets. Similarly, in Saudi Arabia, the rate of early initiation of breastfeeding ranges from 26.3% in the Northern region to 62.7% in the Southern region. Furthermore, the rate of exclusive breastfeeding at six months after birth varies from 19.2% to 28%. Despite national efforts to promote breastfeeding, a decline in breastfeeding practices has been recorded, coinciding with increased use of infant formula. Introducing formula milk during hospital stays in Saudi Arabia is common practice. Several misconceptions about body shape, the safety of colostrum, and breastmilk insufficiency, coupled with rapid economic growth, have contributed to this decline and early breastfeeding cessation, even though Saudi women are offered breastfeeding education during pregnancy. Therefore, there was a need to develop an online educational intervention to motivate Saudi women to breastfeed for a longer duration. Saudi Arabia has a deep-rooted cultural heritage based on the Islamic religion, and its main language is Arabic. Hence, the cultural and linguistic aspects of the educational intervention were considered important determinants of its successful implementation. Aim The aim of this program of Higher Degree Research (HDR) was to develop and assess the effectiveness of a Web-based Breastfeeding Educational Resource (WEBBER) on exclusive breastfeeding rate during the hospital stay until one month after birth. Method The multi-method study was carried out in three phases to address the research aim. In the first phase, a systematic review was conducted to collect evidence-based information. The content of the website was based on the knowledge gaps identified in the systematic review, the WHO recommendation and the Milky Way app. In the second phase, the content of the website was finalised through a consensus development conference involving local stakeholders from the participating hospital in Saudi Arabia and university researchers. Participants of the Consensus Development Conference were asked to give feedback before the meeting, and changes were made to the content accordingly. The meeting was conducted on Zoom, and polling was used to indicate whether consensus was reached about the content, images and layout. The Persuasive System Design model informed the framework of the website development phase. The third phase was divided into two stages. In the first stage, a quasi-experimental study with a before and after intervention design was used to assess the effectiveness of the Web-based breastfeeding educational resource in promoting breastfeeding practices. An online survey was conducted to collect information about the breastfeeding practices during a hospital stay and at one month after birth before (Standard Care group) and after (Intervention group) giving access to the website. In the second stage, a semi-structured interview was undertaken to explore women’s experiences using the website. The interview was digitally recorded and transcribed verbatim using the Otter application before translating into English. The quantitative data was analysed using R language for statistical computing. A log-binomial regression model was used to adjust for any confounding factors that were identified. The qualitative data was analysed using content and thematic analysis. Results A total of sixteen studies were included in the systematic review. Data from ten studies that reported on breastfeeding knowledge demonstrated that 42.3% to 82.3% of Saudi women had good knowledge. However, several gaps in knowledge were identified including managing breastfeeding challenges. A meta-analysis of seven studies that reported on attitudes showed that most Saudi women hold positive attitudes towards breastfeeding. However, around 40% of women believed that formula milk was as healthy as breastmilk, and 59.4% believed that formula feeding was more convenient. The literature review was crucial in developing the content of the website. After making changes to the content based on feedback received from the members of the Consensus Development Conference, 100% agreement about the content, layout and images was achieved during the meeting. This confirmed the cultural and linguistic appropriateness of the content of the website, which was successfully developed using the Persuasive Systems Design model. Findings from the quasi-experimental experimental demonstrated an almost three times increase in the rate of exclusive breastfeeding at one month after birth in the intervention group that was given access to the website. Several predictors of exclusive breastfeeding were identified, including intention to breastfeed for six months or more, baby not receiving pre-made infant formula, and unemployment status of the women. Thematic analysis of the data from the semi-structured interview revealed three themes, including “Satisfying,” “Helpful,” and “Motivational.” Participants found the website “satisfying” due to its “Accessibility,” “Visual attraction,” “User-friendliness,” “Informative content,” “Trustworthiness,” and “Uniqueness.” They qualified the website as being helpful because it was perceived as a “Problem solver,” “Supportive,” and “Confidence booster.” The four sub-themes associated with “Motivational” were “Motivation to continue breastfeeding,” “Preparedness for managing breastfeeding challenges,” “Facilitating the continuation of breastfeeding,” and “Enhancement of intention to Breastfeed for a longer period.” Overall, the women’s experience of using the website was very positive. Conclusion This program of Higher Degree Research (HDR) has demonstrated the effectiveness of the Web-based Breastfeeding Education Resource in improving the exclusive breastfeeding rate during the hospital stay until one month after birth in Saudi Arabia. The Consensus Development Conference facilitated the engagement with local stakeholders, who ensured the cultural and linguistic appropriateness of the evidence-based content derived from the systematic review, WHO and Milky Way App. The Persuasive Systems Design model was successfully employed in developing the website, which was confirmed by the positive feedback from breastfeeding women who felt more motivated to breastfeed. This study has demonstrated that a women-centred online breastfeeding educational intervention can improve breastfeeding practices in Saudi Arabia.19 0