Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Factors Impacting Secondary School Teachers’ Continuance Intention to Use Madrasati Platform in Saudi Arabia(Saudi Digital Library, 2016) Assiri, Fiasal; Wincenciak, Joanna; Morrison-Love, DavidDuring the rapid outbreak of the COVID-19 pandemic, most countries enforced stay-at- home policies, which led to an increase in distance working. Accordingly, e-learning was utilised to replace face-to-face education, with many educational organisations across the world switching to online teaching and learning. In Saudi Arabia (SA), the option for e- learning was not widely supported in public schools. The Ministry of Education (MoE) developed an online learning management system (LMS) named Madrasati to support the educational process during school closures. However, a large proportion of teachers chose to continue using Madrasati even after schools returned to face-to-face teaching, making it part of their post-pandemic approaches to teaching and learning. This study aims to investigate the reasons and motivations associated with the post-COVID-19 usage of Madrasati. This is of particular interest given that, internationally, LMSs such as Madrasati typically feature more prominently in further and higher education than they do in elementary and secondary school education. To thoroughly address the research question, this study adopts an explanatory sequential mixed-methods approach, wherein both quantitative and qualitative data were gathered in an organised sequence. First, a proposed model for a continued use of e-learning platforms was developed, primarily informed by the Decomposed Theory of Planned Behaviour (DTPB) and other relevant e-learning studies. In the first phase, a large-scale survey was conducted with 304 secondary school teachers in SA, who completed an online questionnaire. At this stage, Structural Equation Modelling (SEM) was applied to evaluate the proposed model, utilising two main techniques: the measurement model and the structural model. In the second phase, follow-up interviews were undertaken with 19 secondary school teachers, with a reflexive thematic analytical approach used to clarify the quantitative findings and to gain a deeper understanding of the rationale behind their decisions regarding the continuance of Madrasati use. The obtained results confirmed that the proposed model demonstrated a good fit with the quantitative data, verifying the validity and reliability of its instruments. The survey findings identified significant factors influencing teachers’ intentions to continue using Madrasati, including learning content quality, perceived usefulness, social influence, and self-efficacy. Most teachers demonstrated favourable attitudes towards the platform, with social influence—particularly from peers and students—emerging as a strong predictor of continuance intention. In contrast, qualitative data from the interviews revealed some concerns that could hinder the platform’s continued use, such as insufficient professional training, limited technical support, and inadequate internet infrastructure, particularly in rural areas. From an academic perspective, the proposed model may provide a useful tool for researchers in the field of technology adoption in education who wish to examine factors influencing the intention to adopt LMSs and technological platforms in diverse contexts. In addition, practical recommendations were presented to Saudi educational stakeholders and Madrasati’s developers to implement methods that could increase teachers’ motivation to continue using the platform.12 0Item Restricted The application of the Necessity-Concerns Framework in understanding inappropriate demand for antibiotics in upper respiratory tract infections and COVID-19 vaccine hesitancy(Saudi Digital Library, 2024) Almeshal, Nouf; Horne, Rob; Chan, Amy; Foot, HollyThe National Institute for Health and Care Excellence (NICE) Medicines Adherence Guidelines recommend personalised support to address both practical issues, enhancing patients’ abilities and perceptions that influence motivation to engage with, and adhere to treatment. The perceptions and practicalities approach (PaPA) operationalises key adherence-related beliefs through the Necessity-Concerns Framework (NCF). The NCF proposes that adherence is influenced by patients’ perceptions of their personal need for medication relative to concerns about adverse consequences. Studies across diseases, cultures, and healthcare systems have demonstrated the validity of the NCF in explaining variation in treatment engagement. This PhD thesis aims to examine the application of the NCF to address two behavioural challenges related to respiratory illnesses: vaccine hesitancy and demand for antibiotics to treat upper respiratory tract infections (URTIs). The research includes a scoping review of determinants influencing patients’ demand for antibiotics, a qualitative study involving patients with URTIs, a cross-sectional survey investigating beliefs about antibiotics and AMR, a review of COVID-19 vaccine hesitancy literature, a cross-sectional cohort survey examining differences in beliefs between COVID-19-vaccinated and unvaccinated individuals, and an exploratory analysis of the antecedents of beliefs about COVID-19 vaccine necessity and concerns. The scoping review identified patient demand as an important driver of unnecessary antibiotic prescriptions, influenced by factors that shape the perceived need for antibiotics and are associated with low concerns regarding their use. The qualitative study (n=32) identified determinants influencing perceived need for antibiotics (e.g., type and severity of symptoms) and concerns (e.g., frequent administration of antibiotics), impacting inappropriate demand for and unnecessary use of antibiotics. The cross-sectional study (n=1105) found that intention to request antibiotics was significantly predicted by beliefs about antibiotic necessity (β=0.475, p<0.001), and concerns (β=-.133, p<0.001). The COVID-19 vaccine hesitancy literature review was suggestive of the applicability of the NCF as an effective framework to understand and address this public health issue. The following cohort cross-sectional survey (n = 1012) reported that beliefs about vaccine necessity outweighed concerns about the vaccine and strongly predicted vaccination decisions [OR=1.616, 95% CI (3.001, 8.440)]. This research highlighted the adaptability of the NCF as a theoretical framework for comprehending inappropriate demand for antibiotics and COVID-19 vaccine hesitancy. The findings indicate the potential applicability of a reverse NCF approach in understanding and addressing inappropriate antibiotic demand. It further identified that COVID-19 vaccine hesitancy demonstrated patterns commonly observed in medication non-adherence, specifically characterised by low perceived necessity and increased concerns regarding treatment. The thesis findings potentially laid the foundation that the NCF can effectively inform the design of interventions targeting vaccine hesitancy and patients’ inappropriate demand for antibiotics in the management of URTIs.18 0Item Restricted The application of the Necessity-Concerns Framework in understanding inappropriate demand for antibiotics in upper respiratory tract infections and COVID-19 vaccine hesitancy(Saudi Digital Library, 2024) Almeshal, Nouf; Rob, Horne; Amy, Chan; Holly, FootThe National Institute for Health and Care Excellence (NICE) Medicines Adherence Guidelines recommend personalised support to address both practical issues, enhancing patients’ abilities and perceptions that influence motivation to engage with, and adhere to treatment. The perceptions and practicalities approach (PaPA) operationalises key adherence-related beliefs through the Necessity-Concerns Framework (NCF). The NCF proposes that adherence is influenced by patients’ perceptions of their personal need for medication relative to concerns about adverse consequences. Studies across diseases, cultures, and healthcare systems have demonstrated the validity of the NCF in explaining variation in treatment engagement. This PhD thesis aims to examine the application of the NCF to address two behavioural challenges related to respiratory illnesses: vaccine hesitancy and demand for antibiotics to treat upper respiratory tract infections (URTIs). The research includes a scoping review of determinants influencing patients’ demand for antibiotics, a qualitative study involving patients with URTIs, a cross-sectional survey investigating beliefs about antibiotics and AMR, a review of COVID-19 vaccine hesitancy literature, a cross-sectional cohort survey examining differences in beliefs between COVID-19-vaccinated and unvaccinated individuals, and an exploratory analysis of the antecedents of beliefs about COVID-19 vaccine necessity and concerns. The scoping review identified patient demand as an important driver of unnecessary antibiotic prescriptions, influenced by factors that shape the perceived need for antibiotics and are associated with low concerns regarding their use. The qualitative study (n=32) identified determinants influencing perceived need for antibiotics (e.g., type and severity of symptoms) and concerns (e.g., frequent administration of antibiotics), impacting inappropriate demand for and unnecessary use of antibiotics. The cross-sectional study (n=1105) found that intention to request antibiotics was significantly predicted by beliefs about antibiotic necessity (β=0.475, p<0.001), and concerns (β=-.133, p<0.001). The COVID-19 vaccine hesitancy literature review was suggestive of the applicability of the NCF as an effective framework to understand and address this public health issue. The following cohort cross-sectional survey (n = 1012) reported that beliefs about vaccine necessity outweighed concerns about the vaccine and strongly predicted vaccination decisions [OR=1.616, 95% CI (3.001, 8.440)]. This research highlighted the adaptability of the NCF as a theoretical framework for comprehending inappropriate demand for antibiotics and COVID-19 vaccine hesitancy. The findings indicate the potential applicability of a reverse NCF approach in understanding and addressing inappropriate antibiotic demand. It further identified that COVID-19 vaccine hesitancy demonstrated patterns commonly observed in medication non-adherence, specifically characterised by low perceived necessity and increased concerns regarding treatment. The thesis findings potentially laid the foundation that the NCF can effectively inform the design of interventions targeting vaccine hesitancy and patients’ inappropriate demand for antibiotics in the management of URTIs.4 0Item Restricted comparative study of the framing of COVID-19 by the BBC and Al Arabiya(University of Leicester, 2024) Shbber, Saud; Qian, GongThe COVID-19 pandemic required public service media (PSM) outlets to respond swiftly and adapt their communication strategies. This thesis examines how two major PSM organisations—BBC in the UK and Al Arabiya in Saudi Arabia—framed the COVID-19 crisis, focusing on eight key news frames identified in the study: human-interest, vaccination safety/hesitancy, war, commitment and transparency, uncertainty, economic consequences, government handling; criticism vs. firm state control, and authority-centric frames. This thesis uses corpus linguistic analysis (CLA) to assist the framing analysis process, building two corpora from tweets and the attached full news articles on X (formerly Twitter) from both outlets. This method allows for a detailed comparison of how COVID-19 was communicated in the different political, social, and media contexts of the UK and Saudi Arabia. The findings show that BBC’s coverage often highlighted public engagement, transparency, criticism and economic impact, while Al Arabiya focused more on government authority and firm state control. The thesis also tracks how these frames changed over time, noting both similarities and differences between the two outlets. Early coverage in both media focused on uncertainty and health risks but later shifted to issues such as vaccination, economic recovery, and government handling. However, the degree to which each outlet emphasised these frames varied, reflecting the differences in media landscapes and political environments. This change shows how PSM adapted their messages as COVID-19 progressed. This thesis offers new academic contributions by providing fresh insights into the role of PSM in risk communication and how PSM frames health crises and demonstrates the value of integrating CLA with framing analysis. It provides valuable lessons for policymakers on how to effectively manage public health messaging during future global emergencies.16 0Item Restricted A comparative study of the framing of COVID-19 by the BBC and Al Arabiya(University of Leicester, 2024) Shbeer, Saud; Qian, GongThe COVID-19 pandemic required public service media (PSM) outlets to respond swiftly and adapt their communication strategies. This thesis examines how two major PSM organisations—BBC in the UK and Al Arabiya in Saudi Arabia—framed the COVID-19 crisis, focusing on eight key news frames identified in the study: human-interest, vaccination safety/hesitancy, war, commitment and transparency, uncertainty, economic consequences, government handling; criticism vs. firm state control, and authority-centric frames. This thesis uses corpus linguistic analysis (CLA) to assist the framing analysis process, building two corpora from tweets and the attached full news articles on X (formerly Twitter) from both outlets. This method allows for a detailed comparison of how COVID-19 was communicated in the different political, social, and media contexts of the UK and Saudi Arabia. The findings show that BBC’s coverage often highlighted public engagement, transparency, criticism and economic impact, while Al Arabiya focused more on government authority and firm state control. The thesis also tracks how these frames changed over time, noting both similarities and differences between the two outlets. Early coverage in both media focused on uncertainty and health risks but later shifted to issues such as vaccination, economic recovery, and government handling. However, the degree to which each outlet emphasised these frames varied, reflecting the differences in media landscapes and political environments. This change shows how PSM adapted their messages as COVID-19 progressed. This thesis offers new academic contributions by providing fresh insights into the role of PSM in risk communication and how PSM frames health crises and demonstrates the value of integrating CLA with framing analysis. It provides valuable lessons for policymakers on how to effectively manage public health messaging during future global emergencies.17 0Item Restricted Adult Foster Homes in an Aging America: Trends, Effects, and Operational Challenges (2017–2023)(Oregon Health and Science University, 2024) Albalawi, Wafi; Chair, Paula Carder; Tunalilar, Ozcan; Messer, Lynne; Carlson, BryantBackground: As the aging U.S. population grows, the demand for long-term care services (LTCS) is rising. Adult Foster Homes (AFHs), small residential care settings providing personalized support for older adults, play a critical role in meeting this demand. However, limited research has focused on AFHs compared to other LTCS options. This dissertation examines Oregon’s AFH holistically by assessing home characteristics, resident’s status and health needs, and the experiences of operators, particularly during the COVID-19 pandemic. Methods: Utilizing data from the Oregon Community-Based Care study (2017–2023), this mixed methods research integrates quantitative trend analyses and qualitative content analysis. It explores three key aims: (1) identifying trends in residents' health conditions, service utilization, and medication use; (2) assessing associations between AFH characteristics and healthcare outcomes; and (3) capturing operators' perspectives on rewards and challenges during the pandemic. Results: Findings reveal high prevalence rates of dementia and polypharmacy among residents, with increasing medication use and stable trends in ADL needs. Family involvement significantly declined during the pandemic but showed partial recovery post-restrictions. Operators highlighted meaningful rewards, such as resident care and autonomy, alongside challenges like regulatory burdens and low Medicaid reimbursement rates. Conclusion: By highlighting the unique attributes, resident health needs, and operational challenges of AFHs in Oregon, this study brings critical attention to an often-overlooked long-term care option22 0Item Restricted Objective and Subjective Long-Term Cognitive Outcomes in COVID-19 Survivors Managed with ECMO: A Case Series(Royal Holloway, University of London, 2024) Alanazi, Abeer; Crabtree, AnnaCOVID-19 has been associated with significant health complications, including cognitive impairments, particularly among patients requiring intensive care interventions. A subset of these patients, especially those needing extracorporeal membrane oxygenation (ECMO), face heightened vulnerability due to prolonged Intensive Care Unit (ICU) stay and extended ECMO duration, placing them at an increased risk of developing post intensive care syndrome (PICS), a multifaceted condition that affects cognitive and psychological functions among other health- related domains. This study aims to investigate the cognitive screening outcomes and characteristics of cognitive impairments among COVID-19 survivors managed with ECMO, enhancing our understanding of cognitive outcomes in this high-risk group. Eighty-five COVID-19 patients who had been treated with ECMO were contacted after their ICU admission. The Telephone Montreal Cognitive Assessment (T-MoCA) was employed to detect cognitive impairment. Neuropsychological assessment was completed with ten survivors. A case series design was employed to characterise the cognitive profile of these ten COVID-19 survivors. The mean T-MoCA score for the 49 cohort was 16.20 (SD = 2.93), indicating cognitive impairment among COVID-19 survivors managed with ECMO. T-MoCA scores for the ten patients who completed neuropsychological assessments ranged from 10 to 19, with a mean score of 16.2 (SD = 2.94). The case series analysis demonstrated impairments across domains of attention, working memory, processing speed, and memory. Cognitive impairments are evident in COVID-19 survivors managed with ECMO, presenting cognitive profiles similar to those documented in acute respiratory distress syndrome (ARDS) patients (non-COVID-19). Key words: ICU, COVID-19, ECMO, Cognitive Impairment, PICS13 0Item Restricted Intensive Care Nurses' Experiences of Burnout During the COVID-19 Pandemic in Saudi Arabia: A Constructivist Grounded Theory Study(King's College London, 2024) Alzailai, Nawal; Xyrichis, Andreas; Barriball, LouiseBackground: Burnout amongst healthcare staff, particularly amongst intensive care unit (ICU) nurses, is a critical issue that intensified during the COVID-19 pandemic. Previous research, especially within the Saudi context, has identified significant levels of burnout in ICU nurses. However, a notable gap exists in the use of qualitative methodologies to deepen our understanding of ICU nurses’ burnout in the Saudi context. Moreover, comprehending the experiences of nurses who suffered from burnout during the pandemic, focusing on the factors that contributed to their stress, has been essential for identifying developmental needs and for shaping interventions aimed at mitigating burnout amongst nurses. Despite this, the existing literature lacks a reliable theory or model that adequately captures the phenomenon of burnout within highly demanding environments like ICUs, particularly under the unpredictable and greatly challenging circumstances of disasters. Aim: To construct a theory grounded in burnout experiences of ICU nurses in Saudi Arabia during the COVID-19 pandemic, intended to act as a foundation for future research that explores burnout in high-stress environments for nurses or other healthcare staff working in similar contexts. Methods: Building from one scoping review and one systematic review, a constructivist grounded theory design was employed for this study, as proposed by Charmaz (2014a). Conducted in four distinct adult ICU departments of a tertiary hospital in Saudi Arabia, the research involved 22 ICU nurses experienced in caring for COVID-19 patients and 10 decision-makers, recruited through initial purposive sampling and subsequent theoretical sampling until theoretical saturation was reached. Data were collected through semi-structured, in-depth interviews. Field notes and a reflexive methodological journal were maintained throughout the research process. Interviews were transcribed verbatim and translated into English where necessary. The analysis followed “Charmazian” principles, which include initial, focused and theoretical coding; constant comparison; theoretical sampling and sensitivity; memo writing; and diagramming. Ethical approval was secured from King’s College London and from the relevant Institutional Review Board in Saudi Arabia. Results: The theory generated by this investigation suggests burnout is a process, resulting from multiple interrelated factors within and beyond an individual’s working environment. This process occurs in three dynamic stages affected by the coping and supportive resources that the nurse has used/received. The core category that emerged, ‘we fought and now we need to be healed’, encapsulates the essence of the nurses’ experiences with perceived burnout and their vital need for recovery and support. This finding led to the development of the BuRN-ICU19 model, a comprehensive framework representing the ICU nurses’ experiences with burnout during the COVID-19 pandemic and informed by results from two fundamental reviews: a scoping review and a systematic review. Conclusion: This thesis offers novel insights into the experiences of burnout among ICU nurses in Saudi Arabia during a disaster situation. It highlights the critical need for targeted interventions and policy reforms to alleviate burnout in, improve the well-being of and effectively support ICU nurses in demanding situations. The BuRN-ICU19 model presents a valuable framework for future research and practical application in ICU nursing, with potential implications extending beyond the Saudi context.56 0Item Restricted THE RELATIONSHIP BETWEEN ECONOMIC ENVIRONMENT, NURSING HOMES BOUNDARIES, THROUGHPUTS, AND OUTPUTS IN THE MIDWEST PRE- AND POST-COVID 19(University of Wisconsin-Milwaukee, 2024-12) Bahkali, Ali M; Kibicho, JenniferBackground: Nursing homes are among the most prevalent healthcare facilities serving individuals aged 65 and older. With 14,817 facilities currently operating across the United States and housing over 1.3 million residents, these institutions play a critical role in long-term care. The Centers for Medicare & Medicaid Services (CMS) regulates and surveys nursing homes and issues deficiency citations and penalties for non-compliance. Despite their importance, the relationship between the economic environment of older adults and key aspects of nursing home operations and characteristics remains insufficiently explored. This study investigates the relationship between economic environment, nursing home boundaries (i.e., market share and number of beds), throughputs, and outputs to address this gap. Methods: This quantitative research was guided by General Systems Theory (GST) and utilized secondary data from 2,916 nursing homes located across 493 counties in six Midwestern states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. The study focused on two distinct periods, 2017-2019 (pre-COVID) and 2021-2023 (post-COVID). Data analysis was conducted using the Multiple-Indicator-Multiple-Causes Structural Equation Modeling (SEM-MIMIC) Approach. Results: The Economic environment was associated with both the demand for (-0.238, p<0.001) and quality of care (-13.029, p<0.01) in nursing homes across certain states. Evidence of distributional cost-effectiveness emerged in facilities with higher proportions of female residents (-0.609, p<0.001) and in rural areas (-0.151, p<0.001), though not in facilities with varying resident acuity levels. Additionally, a negative relationship was observed between facility size and quality outputs (-0.799, p<0.001). The findings also suggest that nursing homes adapt and improve by learning from past experiences, and that their quality outputs are influenced by the political landscape. The state of Illinois showed significant outcomes on most of the results. Conclusion and Policy Implications: Individual median income and household rent burden among individuals aged 65 and older were associated with nursing home operations. Further research is needed to explore gender, socioeconomic, and operational disparities28 0Item Restricted Evaluating Reported Patient Perspectives of Teledentistry Use for Dental Care Provision During the COVID-19 Pandemic in Saudi Arabia: A Scoping Review(University of Exeter, 2024) Althabit, Thabet; Carrieri, DanieleBackground: The COVID-19 pandemic significantly impacted dental services, increasing interest in teledentistry as an alternative. In Saudi Arabia, dental clinics' temporary closure in March 2020 made teledentistry crucial for maintaining dental care. Despite advanced technology, teledentistry use was low. Understanding patient perspectives is key to improving its adoption. Objective: This review synthesizes evidence on patient perspectives, satisfaction, and perceived outcomes of teledentistry during the COVID-19 pandemic in Saudi Arabia to guide future strategies and research. Methods: Following a scoping review methodology, we searched multiple databases from 2020 to 2024, identifying studies involving Saudi patients using teledentistry during the pandemic. Data were extracted and analyzed thematically. Results: Eleven studies from 2020 to 2023 were included. Key themes were accessibility, convenience, patient satisfaction, and security concerns. Teledentistry improved access and reduced costs, with high satisfaction for minor issues. However, data privacy concerns and limitations in handling complex cases were noted. Conclusion: Teledentistry offered significant benefits during the pandemic, enhancing accessibility and patient satisfaction for minor issues. Yet, managing complex cases and ensuring data security remain challenges. A hybrid model of teledentistry and in-person visits is recommended. Further research on long-term effects, cost-effectiveness, and data security is needed.59 0