SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Exploring the barriers and facilitators experienced by physiotherapists and patients with musculoskeletal conditions when using digital health interventions as a self-management approach in Saudi Arabia: a sequential explanatory mixed method study.(Cardiff University, 2024-02-08) Sroge, Roaa; Carrier, Judith; Sparks, ValerieBackground: Musculoskeletal (MSK) conditions constitute a significant public health challenge due to their increasing incidence and potential severe negative impact on patients' quality of life. One recommended treatment is self-management, endorsed in MSK management guidelines, including the National Institute for Health and Care Excellence guideline (2021). Self-management for MSKs can be delivered via digital health interventions (DHIs), which is the term referred to as the delivery of healthcare and the translation of information, knowledge, and communication via digital technologies to help the individual manage their health and well-being. Purpose: The present thesis aims to determine and identify barriers and facilitators to recommending and using DHIs by MSK patients and physiotherapists in Saudi Arabia. Methods: This study used sequential explanatory mixed methods. A cross-sectional design utilised an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and cultural factors for two populations (MSK patients and physiotherapists). Eighteen users (11 physiotherapists and seven patients with different MSKs) were interviewed within seven physiotherapy departments. This study was conducted during the time period when the use of DHIs was made mandatory by the Ministry of Health (MOH). An audio recording, verbatim transcription, and English translation of the interviews were conducted. Descriptive analysis was used to interpret the quantitative data, and reflexive thematic analysis was used to analyse the qualitative data. Findings: The questionnaire was completed by 143 respondents (76 physiotherapists and 67 MSK patients). Regarding the patient's characteristics, the most common condition for patients was low back pain (LBP) 46.3% and arthritis 25.4 %, with the majority being chronic conditions (71.6 %). The experience level of utilising DHIs up to two months was common for physiotherapists and less than two months for patients. Almost 90% of patients received no training before using DHIs. Regarding the UTAUT framework, there were mixed views on the compatibility of DHIs with patients’ needs. However, both physiotherapists and patients agreed that DHIs improved their therapeutic relationships. Notably, both the physiotherapists and patients also had a substantial level of agreement about their intentions to use and expectations of using DHIs in the future. However, their rate of agreement was lower for using DHI regularly. Four themes were identified under thematic analysis, revealing the areas that support the utilisation of DHIs. Concepts reported within all four themes included aspects, such as perceived effectiveness, patients' willingness to use DHIs, cultural impact, and social influences. The study indicated that physiotherapists who used DHIs before the health delivery organisation deemed this type of delivery mandatory were likely to recommend DHIs to patients with MSKs. Conclusion: The study reveals that despite initials challenges, such as lack of training and mixed views on compatibility with patient needs, DHIs were viewed positively by both physiotherapists and patients for managing MSK disorders. Although there is a high agreement among physiotherapists and patients about their intentions and expectations to use DHIs in the future, efforts should be made to enhance their regular use in Saudi Arabia. Implications and recommendations: The study contributes both theoretical and practical implications. Concerning its theoretical contribution, it enriches the literature on DHIs by using the associated constructs of the UTAUT model. Its practical contribution offers valuable information to guide and support the implementation of DHI and training of public hospital physiotherapists and enhance MSK patients' awareness of the benefits of using DHIs. Having physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a potentially effective strategy to increase the use of this treatment method Further research is needed to provide insight into the barriers and facilitators that non-users of DHIs may encounter because the current study only included users of DHIs.35 0Item Restricted Self-Management Interventions To Improve Mobility In The Community Post-Stroke(Saudi Digital Library, 2023-05-18) Sahely, Ahmad; Rosewilliam, SheebaIndividuals’ lives after stroke are affected by multiple levels of disability. Appropriate rehabilitation services can help them to regain their functions and improve their quality of life. In the UK and other developed countries, there has been a tendency toward the early supported discharge from hospital after a stroke with the aim of providing care at home after discharge. However, stroke survivors’ needs after discharge from the hospital have been unmet as the health care services lack sufficient resources. Self-management strategies have been developed to help stroke survivors improve their self-efficacy and independence and play an active role in their rehabilitation process. The efficacy and appropriateness of self-management as an additional component to the current practice have been examined in several contexts, but there has been limited research around self-management strategies to improve mobility after stroke. The overarching aim of this thesis was to develop, implement, and test the feasibility of a self- management (SM) intervention to improve functional mobility for stroke survivors in the community. Chapter 1 (the introduction) provides a background of the research problem and the knowledge to practice gap. It demonstrates the prevalence, impact, and management of stroke with focus on mobility rehabilitation as a main physical impairment. It also discusses the gap in current practice regarding the delivery of optimum amount of therapy and the role of SM in bridging the gap and facilitating the recovery of stroke survivors. Chapter 2 demonstrates the philosophical stance taken by the researcher to select the appropriate methodology for each stage of this research work. It shows the advantages of applying different methods to address the specific objectives of the thesis. Chapter 3 includes a systematic review of the evidence about specific SM interventions that can be applied for the rehabilitation of mobility post-stroke. A new intervention was then developed in consultation ii with senior clinicians and stroke patients to adapt the use of evidence to a local context of stroke rehabilitation within the West Midlands. In study 2 (chapter 4). A qualitative exploratory study was carried out during the Covid-19 pandemic exploring needs and experiences of stroke patients and NHS therapists who worked with stroke patients with a special focus on the utility of self-management strategies post discharge. This study found four main themes that described the modifications in the care system because of the pandemic, impact on the stroke survivors at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. The findings from the study contributed to the modification of the intervention developed to integrate technology and promote remote strategies for self-management. Study 3 (chapter 5), aimed to evaluate feasibility of implementation, to explore participants’ perspectives about the acceptability, practicality, and fidelity of the new intervention and to scope out methodological feasibility of a future randomised control trial of the new self-management intervention for mobility following stroke (SIMS). A mixed-methods study design was carried out including a feasibility randomised control design and focus groups to collect data. The study recruited 24 participants (14 males: 10 females; age range (36-87 years)) into both the intervention and control groups. The study findings showed that it was feasible to recruit participants from hospital and community, but the rate was low due to effects of the COVID-19 pandemic. Randomisation and blinding were successful. Retention rate was 83% at 3 months and 79.2% at 6 months assessments. Adherence to the intervention varied mainly due to post stroke fatigue, COVID-19 and the impact of mood changes. It was feasible to deliver the intervention online with no serious events related to the study. Focus groups discussed participants’ motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in walking outcomes, facilitators and challenges for self-management, and suggestions for improvement. Lastly, chapter 6 provides a summary of findings and discussion points about the key findings from all three studies included in this thesis work.23 0