SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Development and Feasibility of a Physiotherapist-Led Intervention to Increase Physical Activity Among Preschool Children: Using the Medical Research Council's (MRC) Guidelines for Developing Complex Health Service Interventions(Queen’s University Belfast, 2025) Alwalah, Mosfer; Heron, Neil; Donnelly, Michael; Alhusaini, AdelThesis Abstract Background: Insufficient physical activity (PA) in early childhood is a key risk factor associated with adverse health outcomes, including an increased risk of obesity. Early childhood represents an optimal period for implementing programmes and interventions aimed at promoting PA among young children. Despite the recognised importance of such interventions, many countries, including the Kingdom of Saudi Arabia (KSA), lack targeted programmes for preschool-aged children. Notably, most research in this field has been conducted in industrial countries, such as the United States and Australia, with mixed results regarding improvements in children’s PA levels, despite the documented health benefits of positive behaviour. Given that a significant proportion of preschool-aged children in the KSA attend childcare settings, these environments present a valuable opportunity to foster healthy lifestyle habits through interventions focused on behaviour modification. Consequently, this PhD project aims to develop, design, and implement a multi-component preschool-based intervention to promote PA among preschool children (aged 3–5 years) in the KSA. Methods: This PhD thesis presents the development and testing of the feasibility of a behaviour-change preschool intervention implemented in two Saudi preschool centres, guided by the MRC Guidelines for Developing and Evaluating Complex Interventions. There were four inter-related phases involved in this thesis. Phase 1 a systematic review was conducted to explore the correlation between behaviour change techniques (BCTs) and the effectiveness of interventions designed to enhance PA among young children. Phase 2 utilised a thematic analysis of data collected from focus groups (n=13) and interviews with key stakeholders (n=2), including teachers, classroom assistants, and principals. The results of the systematic review and the qualitative analysis were used to inform the development of the intervention. Phase 3 involved a trial (n=52) to evaluate the feasibility, appropriateness, and fidelity of a 10 week PA intervention and its evaluation for the target population and setting. Finally, Phase 4 comprised a process evaluation involving preschool staff and parents who participated in the post-intervention focus groups (n=10) and completed questionnaires (n=14). This phase assessed the acceptability of the intervention and gathered feedback on areas for improvement to inform the design of a further optimised intervention and future large-scale RCT. Results: The systematic review (Chapter 3) revealed a global scarcity of PA interventions targeting young children as well as the poor quality and design of existing interventions. The review provided insights into the most promising, effective, and commonly used BCTs including their candidature for being incorporated into future PA promotion interventions for young children . The analysis of data from focus groups and interviews with stakeholders ii (Chapter 4) pointed to three core themes or areas of programme design and development: (i) children’s motivation and (ii) barriers to engaging in PA, and (iii) factors that influence the implementation of a preschool-based multicomponent intervention. This results from the process of eliciting and analysing stakeholder input were used to refine key intervention components, tailor the intervention to suit specific preschool needs and capabilities and facilitate intervention adaptation to match the implementation setting. The feasibility of conducting a cluster randomised controlled trial (cRCT) of the intervention (Chapter 6) was tested within two public preschools in Saudi Arabia; one served as the intervention site and the other as the control. A total of 52 children and their parents participated in the study. In the intervention preschool, 27 participants received a 10-week behaviour change intervention, while the 25 participants at the control school continued with their usual physical activities. The intervention implemented in the preschool setting achieved a high-fidelity rate of 93.3%, compared to a lower fidelity rate of 74% in the home-based component. The recruitment response rates varied notably, with a cluster-level recruitment rate of 12% achieved across 112 centres and an individual-level recruitment rate of 36% among 143 children (mean age 4.16 years; 23 (44%) of whom were girls). The study experienced an attrition rate of 10%. Compliance rates exhibited variability across different measures: 90% for Body Mass Index (BMI) assessments, 71% for accelerometery, and 45% for questionnaire completion. At follow-up, the intervention group showed slight improvements in PA levels, decreases in sedentary times, and slight decreases in BMI as compared to the control group. Parents and teachers, including assistant teachers and facilitators, found the intervention to be feasible to implement and beneficial. The findings from the fourth phase (process evaluation) (Chapter 7) provided a nuanced understanding about the facilitators and barriers to implementation. Key facilitators included the use of user-friendly materials and the intervention’s alignment with existing preschool curriculum, which aided seamless integration into daily routines. However, the implementation of the intervention faced challenges due to time constraints, spatial limitations within the preschool settings, and conflicts with existing policies. Despite the intervention materials being well-received and an appreciation for their clarity and visual appeal, time restrictions significantly affected parental engagement. Conclusion: The work contained in this thesis demonstrated that the intervention and trial procedures were feasible and acceptable for education providers, parents, and children in the Saudi preschool environment, contributing to the evidence base for PA interventions within this group. However, there were barriers to intervention delivery and engagement related to recruitment rates, compliance with completing outcome measures, and home environment acceptability that should be considered when designing a future cluster RCT.30 0Item Restricted Physical Activity Promotion in Saudi Arabia: The Potential and Challenges of Outdoor Exercise(Loughborough University, 2024-06-11) Albujulaya, Naif; Stevinson, Clare; Piggin, JoePhysical activity is a gateway to a healthier and more vibrant life, offering multiple physical and mental health benefits. Recent evidence suggests that engaging in outdoor exercise leads to many positive outcomes such as reducing stress, anxiety, & depression, providing Vitamin D and fostering social interactions and that extend beyond the boundaries of engaging in indoor exercise. In addition, the advantages of immersing oneself in nature are numerous and profound. Over the last two decades, research carried out in Saudi Arabia reveals that Saudis exhibit a concerning lack of physical activity. Despite efforts made in the field, there is still a lack of exploration into the factors that influence Saudi adults' involvement in outdoor exercise or strategies to enhance their participation. To fill this knowledge gap, the aim of this thesis is to investigate the possibilities of promoting outdoor exercise in Saudi Arabia. In order to gain a comprehensive understanding of all aspects related to the aim, three studies were conducted to address specific objectives. In the first study (in Chapter 3), the main objective was to analyse the Saudi government policy regarding the promotion of physical activity. This study employed the Comprehensive Analysis of Policy on Physical Activity framework to audit and assess the policy. Official reports and independent sources were examined to provide evidence on progress with implementing the policy objectives. In addition, semi-structured interviews were performed with policy-makers, policy-implementers and independent experts. The results indicated an evidence-based, ambitious policy with several objectives achieved. Greatest progress related to cultural change in permitting women’s sports and general physical activity attitudes and behaviour. Other goals, such as increasing female participation, have met barriers that have hindered progress. In the second study (in Chapter 4), the main objectives were to examine the barriers to exercise that face Saudis and understand the relationship between Saudis physical activity, outdoor environments and wellbeing. A representative sample of Saudi adults completed four standard scales: International Physical Activity Questionnaire - Short Form , Exercise Benefits/Barriers Scale, WHO (Five) Well-Being Index and short-form Nature Relatedness Scale. Additional questions related to physical activity contexts. The results of this study indicate that young adults perceive more barriers than other age groups such as challenges related to the exercise environment, time commitments and discouragement from family, and highlighted that males are more likely to exercise outdoors than females. Outdoor exercise and nature relatedness were significant independent predictors of wellbeing, as were social exercise and sporting activities. In the third study (in Chapter 5), the main objective was to explore in depth factors that influence physical activity, and specifically outdoor physical activity. Twenty-two semi- structured interviews with Saudi adults were conducted and qualitative content analysis was used to analyse the data. Key societal and environmental factors (e.g. discouragement from others, poor facilities, unsafe locations) negatively impacted exercise behaviour, particularly among women. Personal and societal factors were identified as motivations to exercise, such as health or mood improvement and active communities. The findings from the thesis indicate that several factors can impact engagement in outdoor exercise among Saudis. The major barriers included the significant lack of outdoor facilities and the weakness of the government's work towards enabling outdoor exercise. These barriers collectively impact individuals, making them develop a habit of engaging in indoors exercise. On the other hand, engaging in outdoor exercise during childhood, particularly among Saudi males, and seeking health benefits from physical activity are the most noticeable factors that can promote or facilitate outdoor exercise. Knowledge obtained from this thesis can potently help organisations and the Saudi government as a valuable foundation for designing effective interventions and policy modifications to gain the additional benefits of engagement in outdoor exercise.44 0Item Restricted The Feasibility of Pulmonary Rehabilitation in Patients with Interstitial Lung Diseases Including Patients with Combined Pulmonary Fibrosis and Emphysema(2023-08-14) Alsomali, Hana; Ward, ChrisIntroduction: Interstitial lung diseases (ILD) are characterized by interstitial inflammation or fibrosis, leading to impaired gas exchange, shortness of breath, decreased exercise tolerance, and reduced quality of life. Combined pulmonary fibrosis and emphysema (CPFE) is the co-existing presence of pulmonary fibrosis and emphysema. Data describing the experience of tailored pulmonary rehabilitation program (PRP) in people with ILD is rare and in particular in patients with CPFE are lacking. This PhD aimed to determine the characteristics and prognosis of patients with CPFE in a United Kingdom cohort, and to assess the feasibility of inspiratory muscle training (IMT) as part of a PRP for patients with ILD including patients with CPFE. Methods: A five-year retrospective single centre study was conducted at the regional ILD clinic. Then a feasibility study with a randomized controlled trial design was conducted Patients were randomized into intervention group IMT + PRP and a control group PRP only. The IMT was performed using POWERBreathe® twice daily. The PRP consisted of one session a week for 6-8 weeks. Results: Retrospective study showed that 203 patients with CPFE were diagnosed. Mean age and Body Mass Index (BMI) for patients with CPFE were 72 years (SD = 8.7), and 28.1 kg/m² (SD = 4.4) respectively. Median survival time for patients with idiopathic pulmonary fibrosis (IPF) subtype CPFE n= 93 was 3.2 years (2.1-4.2).. Kaplan Meier analysis showed statistically significant differences between Gender at birth-Age-Physiology (GAP) stages with a p-value of 0.012 in patients with IPF subtype CPFE. PRP had an attendance and completion rates of mean of 87% and 64% respectively. No side effects were reported during the study. The maximum inspiratory pressure (MIP) improved in all participants. Conclusion: Patients with CPFE were relatively old, majority male, with a history of smoking, and had poor prognosis. The GAP index and staging system demonstrated prognostic capability in patients with IPF subtype CPFE. At least half the patients with CPFE were not referred to PRP, indicating low referral rates. A tailored PRP program was feasible and well received in patients with CPFE, indicating that this was a viable and beneficial treatment option for patients with CPFE where therapeutic options are limited.5 0Item Restricted Exploring And Assessing The Level Of Physical Activity Among Physiotherapists In Saudi Arabia: A Cross-Sectional Survey(2023-03-06) Alnaji, Abdulelah Hussain; Phillips, NicolaBackground: Physical activity (PA) is an essential part of good health. There is considerable evidence of declining PA globally, including in the Kingdom of Saudi Arabia (KSA). One of the primary goals of physiotherapists is to advocate for a healthy lifestyle. Since physiotherapists act as healthy role models for their patients. However, there is a lack of information about PA among physiotherapists in KSA. Aim of the study: The current research aimed to explore the level of PA among physiotherapists in KSA and to understand the barriers to and facilitators of PA. Design: A cross-sectional survey. Methods: This study included 172 physiotherapists currently working in the KSA as citizens or residents, a large percentage of whom were male (71%; n: 122). Between 28 December 2022 and 2 February 2023, the investigator distributed an online form of the international physical activity questionnaire (short version) via various social media platforms such as Twitter and Facebook. Results: The study's findings demonstrate: (1) 9.3% (n = 16) of the study respondents did not engage in any PA; (2) the majority of the participants (90.7%, n:156) engaged in various intensities of moderate, vigorous, and a combination of moderate and vigorous PA; (3) more than half (61%, n: 105) of the respondents followed the international PA recommendations; (4) lack of time and work commitments were the most significant challenges that the participants faced when they engaged in PA; (5) motivation to improve health and losing or maintaining weight were the most notable facilitators for participating in PA among the participants. Conclusion: According to the results, a high percentage of physiotherapists in this study participated in PA. However, nearly 39% of study participants did not meet international PA recommendations. Thus, a study with large sample size is needed to improve the generalisability of the findings.13 0