SACM - Australia
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9648
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Item Restricted Safe Return to Driving after Sustaining Road Traffic Injuries: Driver Assessment and Rehabilitation in Saudi Arabia(Monash University, 2024) Alhashmi, Doha Hassan; Oxley, Jennie; Fossey, Ellie; Lalor, AislinnBackground: In Saudi Arabia, motor vehicle crashes are a major cause of injury and disability. Rehabilitation is essential to reduce the severity and long-term disabilities resulting from road traffic injuries and to ensure successful reintegration of individuals into society. Occupational therapy plays a crucial role in this rehabilitation process. Since the occupational therapy profession is relatively new in Saudi Arabia, this thesis aimed to explore utilising occupational therapy services within post-crash rehabilitation and addressing safe return to driving. It also aimed to identify suitable interventions and policies that could enhance rehabilitation practices in the Saudi context. Methods: This research used a mixed methods approach involving quantitative and qualitative methods. Initially, a systematic review of methods to evaluate at-risk drivers was conducted. This was followed by two complementary studies: a quantitative observational retrospective cohort review and a descriptive qualitative study. The quantitative study used existing registry data from a Saudi major trauma centre. Data for 475 trauma registry patients was analysed using descriptive and regression analyses. Then qualitative semi-structured interviews with 13 occupational therapists explored their perspectives on post-crash rehabilitation practices and assessment of at-risk drivers. Data were analysed using reflexive thematic analysis. Results: The systematic review revealed the main approaches used internationally to assess at-risk drivers. Over two-thirds of the reviewed studies used on-road driving performance tests to ii determine driving competence independently or in combination with another method. The quantitative study data revealed that following RTIs, occupational therapy is utilised for several reasons and that the only significant predictor of occupational therapy referral (df=1, p=.049, CI=1.011- 75.27) was combined rehabilitation services use. The qualitative study identified themes highlighting the inaccessibility of post-crash rehabilitation due to multiple factors, including service centralisation and high demand. The rehabilitation pathway was described; there was also a lack of clarity on the occupational therapists’ role among other health professionals. Current limitations of rehabilitation services include insufficient experienced and specialised therapists, the predominance of the biomedical framework and the impairment focus in the current practice. The therapists in this study also reported their lack of knowledge and practical skills for driver assessment and rehabilitation practices, and their need for support and infrastructure to develop this practice area in Saudi Arabia. They also recommended the need for more research and engagement with stakeholders to establish this specialised practice area. Conclusions: This thesis highlighted the current practice challenges for rehabilitation following road traffic injuries in Saudi Arabia and emphasised the importance of a multidisciplinary approach in post-crash care. The thesis advocates a collaborative, participative approach to developing a driver assessment and rehabilitation policy by involving stakeholders, including at-risk drivers, healthcare professionals, and licensing authorities, so as to create a tailored and effective policy for Saudi Arabia. This is a crucial first step toward establishing a safe and sustainable practice framework that can enable therapists to 1) provide needed service to at risk drivers, 2) support at-risk drivers to resume driving safely and have meaningful and fulfilled lives, 3) protect all road users from preventable car crashes, and 4) alleviate the country’s burden from further road traffic injuries.9 0Item Restricted Unveiling the Digital Divide: Public and Private Spaces on Social Media in the Saudi Context(La Trobe University, 2024-05) Bahabri, Alaa Sultan; Bahfen, Nasya; McCarthy, BrigidThe emergence of social media has significantly altered the traditional boundaries between public and private, creating blurred spaces. As users around the world navigate these novel spaces, considerable research shows that they utilise various strategies to manage public and private. In the Saudi context, previous studies have shown that Saudis – influenced by Islamic privacy norms– tend to strictly segregate public and private spaces on social media using several strategies. Nonetheless, much of this research has primarily focused on users, with little attention paid to the influence of digital elements. This study investigates a common strategy of navigating public and private in the Saudi context, which is the segregation of public and private spaces across platforms. The study takes into account the influence of the platform’s interface and affordances. The study was conducted through three phases of data collection and analysis. The first phase involved analysing social media platforms using a digital ethnography approach; the walkthrough methodology to demonstrate the platform’s interface and affordances of public and private space. The second phase focused on investigating users’ perspectives and behaviours related to public and private spaces across platforms using a questionnaire and interviews. Lastly, the third phase delved deeper into specific public and private spaces identified during the earlier phases through in-depth interviews and further analysis the online social norms of public and private space. This study argues that, as social media platforms blur the boundaries between public and private, the proliferation of social media has led Saudi users to heavily rely on segregating public and private spaces across these platforms, taking into account each platform's interface and affordances. This segregation reflects the Islamic notion of privacy, and it allowed users to reflect and facilitate their culture and social norms in the online space. The findings revealed that Saudis preferred platforms with default public or default private design, while they negotiate semi-public platforms. Twitter was favoured as a public space due to its default public interface design, while Snapchat’s was favoured as a private space. Conversely, Facebook’s semi-public nature was rejected due to perceived openness, leading to its designation as a niche network among Saudis. Instagram’s semi-public space was also negotiated and was used as a functional platform. Finally, TikTok was rejected due to the perception that it is not culturally appropriate. 5 Further analysis examined the social norms on Twitter and Snapchat, highlighting the differences in public and private interactions. The study found Twitter users exhibited cautious behaviour due to its public interface design, and presented a collective self, with either a serious or professional personas. In contrast, Snapchat provided a unique dynamic, particularly as older users were present on the platform, leading young users to create a more closed private space that differed from offline private circles. Overall, this research underscores the intricate interplay of culture, technology, and user behaviour in shaping Saudi Arabia’s digital landscape, emphasising the importance of considering both the cultural values and digital environments in understanding these dynamics for effective platform design and policymaking.14 0Item Restricted Reducing Type 1 Childhood Diabetes in Saudi Arabia by Identifying and Modelling Its Key Performance Indicators(Royal Melbourne Institute of Technology, 2024-06) Alazwari, Ahood; Johnstone, Alice; Abdollahain, Mali; Tafakori, LalehThe increasing incidence of type 1 diabetes (T1D) in children is a growing global health concern. Reducing the incidence of diabetes generally is one of the goals in the World Health Organisation’s (WHO) 2030 Agenda for Sustainable Development Goals. With an incidence rate of 31.4 cases per 100,000 children and an estimated 3,800 new cases per year, Saudi Arabia is ranked 8th in the world for number of T1D cases and 5th for incidence rate. Despite the remarkable increase in the incidence of childhood T1D in Saudi Arabia, there is a lack of meticulously carried out research on T1D in children when compared with developed countries. In addition, it is crucial to recognise the critical gaps in current understanding of diabetes in children, adolescents, and young adults, with recent research indicates significant global and sub-national variations in disease incidence. Better knowledge of the development of T1D in children and its associated factors would aid medical practitioners in developing intervention plans to prevent complications and address the incidence of T1D. This study employed statistical, machine learning and classification approaches to analyse and model different aspects of childhood T1D using local case and control data. In this study, secondary data from 1,142 individual medical records (359-377 cases and 765 controls) collected from three cities located in different regions of Saudi Arabia have been used in the analysis to represent the country’s diverse population. Case and control data matched by birth year, gender and location were used to control confounders and create a more robust and clinically relevant model. It is well documented that genetic and environmental factors contribute to childhood T1D so a wide range of potential key performance indicators (KPIs) from the literature were included in this study. The collected data included information on socioeconomic status, potential genetic and environmental factors, and demographic data such as city of residence, gender and birth year. Several techniques, such as cross-validation, hyperparameter tuning and bootstrapping, were used in this study to develop models. Common statistical metrics (coefficient of determination, R-squared, root mean squared error, mean absolute error) were used to evaluate performance for the regression models while for the classification models accuracy, sensitivity, precision, F score and area under the curve were utilised as performance measures. Multiple linear regression (MLR), artificial neural network (ANN) and random forest (RF) models were developed to predict the age at onset of T1D for all children 0-14 years old, as well as for the most common age group for onset, the 5-9 year olds. To improve the performance of the MLR models, interactions between variables were considered. Additionally, risk factors associated with the age at onset of T1D were identified. The results showed that MLR and RF outperformed ANN. The logarithm of age at onset was the most suitable dependent variable. RF outperformed the others for the 5-9 years age group. Birth weight, current weight and current height influenced the age at onset in both age groups. However, preterm birth was significant only in the 0-14 years cohort, while consanguineous parents and gender were significant in the 5-9 age group. Logistic regression (LR), random forest (RF), support vector machine (SVM), Naive Bayes (NB) and artificial neural network (ANN) models were utilised with case and control data to model the development of childhood T1D and to identify its key performance indicators. Full and reduced models were developed to determine the best model. The reduced models were built using the significant factors identified by the individual full model. The study found that full LR had the highest accuracy. Full RF and SVM with a linear kernel also performed well. Significant risk factors identified as being associated with developing childhood T1D include early exposure to cow’s milk, high birth weight, positive family history of T1D and maternal age over 25 years. Poisson regression (PR), RF, SVM and K-nearest neighbor (KNN) were then used to model the incidence of childhood T1D, taking in the identified significant risk factors. The interactions between variables were also considered to enhance the performance of the models. Both full and reduced models were created and compared to find the best models with the minimum number of variables. The full Poisson regression and machine learning models outperformed all other models, but reduced models with a combination of only two out of three independent variables (early exposure to cow’s milk, high birth weight and maternal age over 25 years) also performed relatively well. This study also deployed optimisation procedures with the reduced incidence models to develop upper and lower yearly profile limits for childhood T1D incidence to achieve the United Nations (UN) and Saudi recommended levels of 264 and 339 cases by 2030. The profile limits for childhood T1D then allowed us to model optimal yearly values for the number of children weighing more than 3.5kg at birth, the number of deliveries by older mothers and the number of children introduced early to cow’s milk. The results presented in this thesis will guide healthcare providers to collect data to monitor the most influential KPIs. This would enable the initiation of suitable intervention strategies to reduce the disease burden and potentially slow the incidence rate of childhood T1D in Saudi Arabia. The research outcomes lead to recommendations to establish early intervention strategies, such as educational campaigns and healthy lifestyle programs for mothers along with child health mentoring during and after pregnancy to reduce the incidence of childhood T1D. This thesis has contributed to new knowledge on childhood T1D in Saudi Arabia by: * developing a predictive model for age at onset of childhood T1D using statistical and machine learning models. * predicting the development of T1D in children using matched case-control data and identifying its KPIs using statistical and machine learning approaches. * modeling the incidence of childhood T1D using its associated significant KPIs. * developing three optimal profile limits for monitoring the yearly incidence of childhood T1D and its associated significant KPIs. * providing a list of recommendations to establish early intervention strategies to reduce the incidence of childhood T1D.14 0Item Restricted Exploring Language Learning Strategies and Learners’ Identities Using WhatsApp Chats to Enhance the Learning of Arabic Grammar in Cooperative Learning Settings Online(The University of Queensland, 2024) Almutairi, Azizah; Smala, SimoneThis study investigates the innovative use of WhatsApp for teaching Arabic to international female students at Princess Nourah University in Saudi Arabia. Focusing on cooperative learning, it explores how WhatsApp interactions shape learner identities and support Arabic grammar learning. Guided by Norton’s theory of second-language learner identities and Johnson and Johnson’s cooperative learning model, the research examines identity shifts, cooperative strategies, and the negotiation of meaning in WhatsApp chats. Through chat analysis and interviews, the study offered insights into WhatsApp’s role in Arabic language acquisition and shed light on the broader role of social media platforms in the learning experiences of international higher education cohorts24 0Item Restricted Motivating and Supporting Medication Adherence Behaviour for Chronic Conditions: Persuasive design of a mHealth app.(University of Wollongong, 2024-03) Altuwayrib, Saleh Abdulqader; Win, Khin Than; Freeman, MarkArthritis requires long-term treatment and lifestyle management to manage symptoms and prevent disease progression. Medication adherence behaviour is essential for managing arthritis. However, the adherence rates for arthritis patients are often low due to factors like lack of motivation, forgetfulness, and limited knowledge about the condition. Mobile health applications (mHealth apps) emerged as a promising solution to support patient adherence by providing users with personalised, accessible, and interactive features that promoted medication management. Educational features that enable users to access health information can improve user awareness about the condition, reminder features can assist users from forgetting to take medication and motivational features like rewards and social support can be tailored to motivate and engage users. This thesis focuses on the motivational design of mHealth apps to support medication adherence behaviour for chronic arthritis conditions. The thesis addresses the gaps in existing mHealth apps for arthritis and medication adherence, which often fail to involve patients in the design process or address the specific barriers to adherence they encounter. The research question of this study is: What are the key design features of a motivational mobile health app that can promote medication adherence among chronic arthritis patients in Saudi Arabia? The thesis has several objectives to answer this research question, which include exploring the arthritis patients' needs, designing a mHealth app prototype, and evaluating the usability of the mHealth app among Saudi arthritis patients. This research adopts qualitative research methods, starting with a scoping review of medication adherence apps for different chronic health conditions, interviews with health care providers (HCPs), and online focus group discussions with chronic arthritis patients across Saudi Arabia. Interpretivism is used to understand adherence behaviour barriers, facilitators, and user needs and preferences to ensure the user-centric design process. Additionally, the research embraces pragmatism in the design and evaluation process through 3 design cycles that follow the six-design science research methodology (DSRM) steps. The selection of user requirements considers the theoretical framework adopted combining three components of the IMB model: information, motivation, and behavioural skills. Motivation aspects consider the intrinsic motivation that can be satisfied according to Self Determination Theory. The principles of persuasive design are considered to ensure that the app motivates users and supports health behaviour change. The user research, design, and evaluation resulted in an interactive mHealth app prototype tailored to the needs and preferences of Saudi arthritis patients. The evaluation steps in each cycle identified usability problems, and areas for improvements, confirmed user acceptance, and validated the features and content with HCPs. Therefore, user-evaluation in the final cycle showed high user satisfaction among arthritis patients in Saudi Arabia. The research highlights the potential of mHealth apps to engage users and support adherence behaviour by satisfying their needs, simplifying medication management, empowering users to monitor their arthritis, engaging users with the local arthritis community, and enabling users to access credible content and supportive services that aim to support patient adherence. Future work will focus on the app’s development, evaluate the app’s effectiveness, and explore scalability options to make the app accessible to a broader population of Arabic arthritis patients.36 0Item Restricted An evaluation of the Rashaka Initiative: a school-based obesity intervention in Makkah City, Saudi Arabia(University of Technology Sydney, 2024-03) Banany, Mohammed; Sibbritt, David; Gebel, KlausBackground: Childhood overweight and obesity are public health issues worldwide. In Saudi Arabia, in 2016/2017 the Rashaka Initiative, a national school-based, multicomponent, weight-related intervention, was launched to decrease the prevalence of obesity among students by 5% within five years. Neither the development stage of the initiative nor its implementation has been evaluated to explore its processes and outcomes. Aim: This study was aimed at evaluating the implementation of the Rashaka Initiative in intermediate and secondary schools in Makkah City, Saudi Arabia, covering both process and outcome. To this end, the following objectives were pursued: (1) to develop an evaluation framework that can be used to assess the processes and outcomes of the initiative, (2) to determine whether there was a change in students’ body mass indices (BMIs) during the implementation period, and (3) to explore the knowledge and attitudes of the Rashaka stakeholders regarding the perceived barriers and facilitators of implementation in their schools. Methods: This retrospective study, conducted after the implementation of the Rashaka Initiative, was completed in three phases. In phase I, a conceptual framework called the school-based weight-related intervention evaluation framework (SWIEF) was developed by integrating some elements of the program evaluation framework used by the US Centers for Disease Control and Prevention (CDC) with the components of a logic model. In phase II, secondary data from the Rashaka Initiative were analysed. Phase III was a cross-sectional exploration of the Rashaka stakeholders’ knowledge and attitudes as well as what they perceive as facilitators and barriers to implementing the intervention at their schools. Results: The comprehensive literature review yielded a published systematic review (Banany et al. 2024, Systematic Reviews). This systematic review found 11 school-based weight-related intervention studies in the six Gulf Cooperation Council countries (GCC). Despite the methodological limitations of some of these studies, there is preliminary evidence of the possible benefits of school-based interventions on students' weight and associated lifestyle factors in these countries. A review of the literature also facilitated the development of the SWIEF. The analysis of the secondary data revealed a significant reduction in BMI (p<0.001) across schools that participated in the Rashaka Initiative over two school years (2016/17 and 2018/19). However, this reduction was not associated with the school environmental factors attributed to the initiative. The study findings found that students’ BMIs decreased more considerably in girls’ and intermediate schools than in boys’ and secondary schools (p<0.001 and p=0.031, respectively). The cross-sectional study indicated that significantly better knowledge of risk factors and interventions for childhood obesity was exhibited by female Rashaka stakeholders (vs their male counterparts), stakeholders who completed tertiary education (vs those with lower education levels) and stakeholders engaged in the initiative for more than two years (vs participants who joined more recently) (p<0.001, p<0.007 and p<0.033, respectively). School health counsellors had more positive attitudes towards children’s health and weight than principals (p<0.008). Significantly more favourable attitudes towards the Rashaka intervention were also found among female stakeholders (p<0.011) and those with better knowledge of the initiative’s objectives, components, activities, and outcomes (p<0.049). Among the stakeholders, 73% perceived collaboration with different government and private sector institutions as the most common facilitator of the Rashaka implementation at their schools, while 69% perceived a lack of time as the main barrier. Conclusions: Addressing childhood obesity is a public health priority that requires substantial efforts from all relevant key stakeholders in Saudi Arabia. The evidence derived in this thesis revealed that the Rashaka Initiative has yet to satisfy its objectives. Future studies should be more rigorous, theory-based, and holistic to tackle obesity among school students. Evaluations of school-based obesity interventions should use control groups, validated and reliable measures and rigorous data analysis. Long-term monitoring of the implemented interventions is highly recommended for their improvement and sustainability.27 0Item Restricted Enabling Citizens’ Participation to implement Smart Sustainable Cities for Saudi Vision 2030(University of New South Wales Sydney - UNSW, 2024-08-18) Alamoudi, Abood Khaled; Abidoye, Rotimi Boluwatife; Lim, Benson; Lam,Terence YatThe emerging technologies and a focus on producing better urban environments, the smart sustainable cities (SSC) concept carries a lot of recognition among governments and societies. Aspirations for smart cities are heightened by citizens' participation in decision-making, even though citizens' participation isn't adhered to under current policies and governance. Smart cities have been labeled in recognition of these advantages by several cities around the world. Globally, citizen engagement has been acknowledged in urban development and decision-making; however, no evaluations of empowerment's impact have been conducted to compare it against other factors. SSC variables will be identified in this thesis, and more importantly, factors that contribute to implementing SSC will be ranked, categorized, and discussed in terms of engaging citizens, empowering them, and enabling them to participate in the urban development of SSC. This thesis aims to develop a citizens' participation framework by combining qualitative and quantitative methods, identifying additional stakeholder management measures (SMM), and explaining how SMM is positively correlated with citizen participation levels (CPLs) as well as smart sustainable city outcomes (SSCOs). In the conceptual framework, three main components are identified: Smart Sustainable Cities Outcomes (SSCO) based on SMM, Community Participation Recruitment (CPR), and Future Saudi Cities Program (FSCP) based on Saudi Vision 2030 and Saudi government policy. To achieve smart sustainable city outcomes, all of these components must be present. SSCs and their complex nature can be more effectively implemented by utilizing the proposed framework from a conceptual and practical perspective.80 0Item Restricted EVALUATION OF A WHATSAPP-DELIVERED DIABETIC SELF-MANAGEMENT EDUCATION PROGRAM FOR PEOPLE WITH TYPE 2 DIABETES: A MIXED METHODS STUDY(The University of Newcastle, 2024-06-07) Yaagoob, Esmaeel; Regina, Lee; Chan, Sally; Stubbs, MichelleDiabetes is a severe chronic health and potentially devastating medical condition that has increased in prevalence over the past few decades to constitute a significant public health challenge of the twenty-first century. Inadequate diabetes management can result in severe complications, including cardiovascular diseases and strokes, impacting the quality of life. Effective self-management is crucial, with individuals making daily decisions related to their diabetes care. Diabetes self-management education and support (DSMES) provides people with type 2 diabetes mellitus (T2DM) the necessary knowledge, skills, and confidence to manage their condition. It has been found that increasing individual knowledge regarding disease and its complications has significant benefits in compliance with treatment and decreasing complications associated with diabetes. Traditionally, such programs are conducted via face-to-face group sessions. However, there are challenges in accessing face-to-face programs due to factors such as geographic location and travelling distances. In regions where digital technology and social media are pervasive, there is potential to increase innovative delivery methods such as social media platforms to provide accessible and flexible DSMES, thereby reaching a wider audience and improving health outcomes for individuals with T2DM. Considering the widespread use of WhatsApp in Saudi Arabia, online delivery of the DSMES may serve as a viable platform to decrease the burden and impact of living with T2DM. All research in this thesis was conducted in Saudi Arabia using a mixed-methods experimental design to examine the effectiveness of DSMES delivered via WhatsApp for people with T2DM. There are three phases in this study. In Phase One, a qualitative descriptive study was conducted using semi-structured phone interviews. The objective of this phase was to gain an in-depth understanding of the experiences and perceptions of people with T2DM regarding diabetes self-management. Insights from this phase guided the development of the teaching materials for the online diabetes self-management education program implemented in Phase Two. In Phase Two, a randomised controlled trial (RCT) was conducted. The objective of the RCT study was to evaluate the effectiveness of the WhatsApp-based DSMES in enhancing self-efficacy and diabetic knowledge (primary outcomes), as well as evaluating its impact on glycemic control (HbA1c), health-related quality of life (HRQoL), and levels of anxiety and depression (secondary outcomes). Subsequently, the third phase was a process evaluation to explore the experiences of people with T2DM who participated in the newly developed WhatsApp-based DSMES. In Phase One (qualitative interviews), nineteen (n=19) participants were recruited from the diabetes centres located within Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia. Themes generated from the qualitative analysis included knowledge deficit regarding disease management and its complications, difficulties in coping with the disease, adjusting to lifestyle changes and coping mechanisms influenced by a blend of culture and religion. Participants shared their experiences in accessing diabetic services via social media. Data generated from Phase One were used to develop an intervention that was tailored to the specific needs and experiences of people with T2DM in Saudi Arabia, as identified through the qualitative inquiry. The intervention was developed based on self-efficacy theory and aimed to enhance the self-management skills of people with T2DM through a structured educational delivered via WhatsApp. Common outcomes of WhatsApp-based DSMES for people with DM is to increase motivation to modify behaviours, adopt healthier lifestyles and adhere to prescribed medications. The educational content of the WhatsApp-based DSMES included general diabetes care information, signs and symptoms of diabetes, pathophysiology, aetiology, diet therapy, exercise, and other self-care behaviours. The intervention was delivered over six weeks, with each week focusing on a specific topic related to diabetes management. Participants received text messages, photos, and videos through a WhatsApp group, and were encouraged to interact, share experiences, and ask questions. The educational sessions were designed to take about one hour per week, and participants indicated their engagement by sending a thumbs-up emoji or the word "done" after reviewing the weekly content. In Phase Two (RCT), 80 participants were recruited from the diabetes centres at Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia were randomly assigned into intervention (n=40) and control groups (n=40). The intervention group received a 6-week intervention via WhatsApp, while the control group received usual care. The primary outcomes measured included UK-Diabetes Management Self-Efficacy Scale (DSMES-UK) and the Diabetes Knowledge Test2 (DKT2). The secondary outcomes measured included glycaemic blood test (HBA1C), the Hospital Anxiety and Depression Scale (HADS), and Diabetes Quality-Of-Life scale (DQOL). These outcomes were assessed at three time points: baseline, immediate post intervention at 6th week and two months after the intervention at 12th week. Findings at 6- and 12-week time points showed significant improvement in DSMES-UK and DKT2 in the intervention group compared to the control group. No significant difference in secondary outcomes was observed in HbA1c, total HADS, total DQoL, T0 to T1. In Phase Three (process evaluation), twenty-three (n=23) participants from the intervention group were recruited. Those who had previously consented during Phase Two and had indicated their willingness to share their experiences of the intervention were invited to participate in semi-structured phone interviews. Qualitative analysis found the participants expressed positive feedback surrounding the acceptability, flexibility, and relevance of the intervention content along with elements of cultural inclusion of the WhatsApp-based program. The participants also supported that the 6-week WhatsApp-based DSMES intervention enhanced a healthy change in lifestyle choices. They offered recommendations for enhancing the WhatsApp-based DSMES including more interactive and real-time features, the inclusion of allied health professionals for specialized support, the involvement of family members, and the integration of the program into standard diabetes care practices. These suggestions could increase the WhatsApp-based DSMES effectiveness, engagement, and overall impact on diabetes management. Findings of this study highlighted the positive effects of a WhatsApp-based DSMES on self-efficacy and diabetic knowledge of people with T2DM. Findings also provided feasibility data for the delivery of an evidence-based social media intervention to achieve optimal diabetes control, health outcomes, and quality of life for people with T2DM within communities. Findings further demonstrated DSMES was easily accessible, flexible, and assisted participants in modifying their behaviours to adopt a healthier lifestyle. By incorporating social media and culturally specific needs into DSMES, we can enhance health outcomes for people with T2DM and alleviate disease burden. Healthcare providers and policymakers may improve health outcomes for people living with T2DM by implementing the delivery of DSMES via social media platforms such as WhatsApp. Future research should focus on multicentre clinical trials with longer follow-up periods to investigate the long-term and cost-effectiveness of WhatsApp-based DSMES. Future studies should also explore the perspectives of diabetes educators and nurses and the readiness of healthcare centres to implement such online educational interventions. Expanding the scope to include a family-centred approach may lead to more sustainable interventions to promote self-management skills for people living with T2DM within communities.31 0Item Restricted Factors Influencing Parents' Decision-Making to Complete Childhood Immunisation in the Eastern Province of Saudi Arabia: A Mixed Methods Design(University of Newcastle, 2024-07-22) Alabadi, Marwa; Pitt, Victoria; Newton, Phillip; Aldawood, ZakariyaIn pursuit of a healthier and more resilient society, childhood vaccination and immunisation programmes have emerged as powerful allies in combating infectious diseases and protecting public health. Surveillance data from the Saudi Ministry of Health show that the Kingdom’s large-scale immunisation programme has significantly reduced the mortality and morbidity of target diseases among children. Similar to other countries, Saudi Arabia continues to face the challenge of inconsistent vaccination uptake across its population due to several reasons. The exact prevalence of these factors and their relationship to vaccination compliance in Saudi Arabia are not well understood. Furthermore, the controversy surrounding the risks and benefits of childhood vaccinations has led parents to question its safety. To build upon the understanding of parental decision-making concerning health-protective behaviours, this research study followed several steps. Firstly, a comprehensive systematic literature review was conducted to identify and analyse existing research on parental compliance with childhood immunisation in Saudi Arabia, highlighting key factors influencing compliance rates. Secondly, this research study employed two research methodologies (mixed methods)— quantitative and qualitative methods—to identify the factors that contribute to parents' decision-making regarding completing Saudi Arabia's National Childhood Vaccination Programme. The quantitative approach in Phase 1 surveyed 353 parents attending one of the 27 primary health care (PHC) centres in Qatif, located in the Eastern Province of Saudi Arabia. The quantitative results identified several factors that positively or negatively influenced the completion of childhood immunisation. Parents with positive attitudes, social norms, perceptions towards immunisation, and those working in private companies were more likely to immunise their children. On the contrary, living in an apartment building, walking to primary healthcare centres (PHCs), waiting longer at PHCs, and having higher knowledge of immunisation were negatively associated with the completion of childhood immunisation. The qualitative approach in Phase 2 applied thematic analysis to 20 parents interviewed who attended PHC centres in Qatif. The findings demonstrated that there were social (e.g., family influence, peer pressure) and ecological (e.g., healthcare accessibility, public policy) factors influencing childhood immunisation and immunisation hesitancy among parents in Saudi Arabia. This research resulted in three key recommendations: 1) implementing tailored educational campaigns to address parental concerns and misconceptions about vaccines; 2) improving accessibility to vaccination services, particularly in remote areas, by enhancing healthcare infrastructure and mobile clinics; and 3) fostering community engagement through partnerships with local leaders and organizations to promote the importance of immunisation. These recommendations aim to enhance immunisation programmes and overcome barriers to compliance. Therefore, this research contributes to the literature and informs the Saudi National Childhood Immunisation Programme about factors contributing to childhood immunisation hesitancy, helping to address a critical healthcare issue.9 0Item Restricted Factors Influencing Parents' Decision-Making to Complete Childhood Immunisation in the Eastern Province of Saudi Arabia: A Mixed Methods Design(University of Newcastle, 2024-07-22) Alabadi, Marwa; Pitt, Victoria; Newton, Phillip; Aldawood, ZakariyaIn pursuit of a healthier and more resilient society, childhood vaccination and immunisation programmes have emerged as powerful allies in combating infectious diseases and protecting public health. Surveillance data from the Saudi Ministry of Health show that the Kingdom’s large-scale immunisation programme has significantly reduced the mortality and morbidity of target diseases among children. Similar to other countries, Saudi Arabia continues to face the challenge of inconsistent vaccination uptake across its population due to several reasons. The exact prevalence of these factors and their relationship to vaccination compliance in Saudi Arabia are not well understood. Furthermore, the controversy surrounding the risks and benefits of childhood vaccinations has led parents to question its safety. To build upon the understanding of parental decision-making concerning health-protective behaviours, this research study followed several steps. Firstly, a comprehensive systematic literature review was conducted to identify and analyse existing research on parental compliance with childhood immunisation in Saudi Arabia, highlighting key factors influencing compliance rates. Secondly, this research study employed two research methodologies (mixed methods)— quantitative and qualitative methods—to identify the factors that contribute to parents' decision-making regarding completing Saudi Arabia's National Childhood Vaccination Programme. The quantitative approach in Phase 1 surveyed 353 parents attending one of the 27 primary health care (PHC) centres in Qatif, located in the Eastern Province of Saudi Arabia. The quantitative results identified several factors that positively or negatively influenced the completion of childhood immunisation. Parents with positive attitudes, social norms, perceptions towards immunisation, and those working in private companies were more likely to immunise their children. On the contrary, living in an apartment building, walking to primary healthcare centres (PHCs), waiting longer at PHCs, and having higher knowledge of immunisation were negatively associated with the completion of childhood immunisation. The qualitative approach in Phase 2 applied thematic analysis to 20 parents interviewed who attended PHC centres in Qatif. The findings demonstrated that there were social (e.g., family influence, peer pressure) and ecological (e.g., healthcare accessibility, public policy) factors influencing childhood immunisation and immunisation hesitancy among parents in Saudi Arabia. This research resulted in three key recommendations: 1) implementing tailored educational campaigns to address parental concerns and misconceptions about vaccines; 2) improving accessibility to vaccination services, particularly in remote areas, by enhancing healthcare infrastructure and mobile clinics; and 3) fostering community engagement through partnerships with local leaders and organizations to promote the importance of immunisation. These recommendations aim to enhance immunisation programmes and overcome barriers to compliance. Therefore, this research contributes to the literature and informs the Saudi National Childhood Immunisation Programme about factors contributing to childhood immunisation hesitancy, helping to address a critical healthcare issue.23 0