Saudi Cultural Missions Theses & Dissertations
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Item 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 option18 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, PICS12 0Item Restricted Understanding the Factors Influencing the Acceptance and Adoption of Mobile Health Applications by Physicians during the COVID-19 Pandemic: The Case of Saudi Arabia(University of Technology Sydney, 2025-01) Alsahli, Sultan; Lam, Mary; Hor, Su-yin; Rogers, KrisBackground: The rapid evolution of mobile health applications has become increasingly crucial in enhancing healthcare delivery, particularly during the COVID-19 pandemic. Despite the critical role of these technologies, acceptance and adoption rates among physicians in developing countries, especially Saudi Arabia, have remained relatively low. This highlights the need to explore the determinants of their acceptance and adoption. Aim: This thesis aimed to investigate the key factors influencing Saudi physicians’ intentions toward using mHealth applications during the COVID-19 pandemic. Methods: This mixed methods research was conducted in three phases, each addressing specific objective and research question. In phase 1, a systematic review was conducted to present all available evidence of mHealth acceptance and adoption from the perspectives of physicians. Phase 2 applied a quantitative design based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model to investigate key factors influencing physicians’ behavioural intentions to adopt mHealth apps. Data were collected via an online survey and analysed using structural equation modeling. Phase 3 employed a qualitative design, exploring additional context-specific factors not accounted for by the UTAUT model through semi- structured interviews. The qualitative data were analysed using template analysis. Results: The systematic review identified technological, individual, and organizational factors affecting physicians’ acceptance of mHealth apps during the pandemic. The quantitative study found that performance expectancy, effort expectancy, social influence, and facilitating conditions significantly influenced physicians’ intention to use mHealth applications. Qualitative findings highlighted additional factors unique to the Saudi context, such as concerns about data privacy, patient engagement, compatibility with religious and cultural norms, and the impact of COVID-19 pandemic. These factors shaped physicians’ perceptions and adoption behaviours, emphasizing the need for tailored strategies to promote mHealth in Saudi Arabia. Conclusions: This thesis extends the UTAUT model by incorporating context-specific factors relevant to developing countries like Saudi Arabia during the COVID-19 pandemic. The findings emphasize the need for investments in infrastructure, targeted training programs, and policies that address both technological and cultural concerns. By fostering an environment that supports the integration of mHealth applications into routine practice, healthcare organizations can improve both healthcare delivery and patient outcomes during health crises and beyond. The study provides critical insights for policymakers and healthcare managers seeking to enhance the acceptance and use of mHealth technologies in similar global contexts. Future research should examine the perspectives of other healthcare workers and patients for a comprehensive understanding of mHealth adoption while also exploring its long-term impact on patient outcomes and healthcare professionals.26 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.45 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 disparities27 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.41 0Item Restricted The Cross-Section of Stock Returns and Factor Premiums in the Saudi Stock Market(Victoria University, 2024-04) Alshaikhmubarek, Asim; Seelanatha, Lalith; Kulendran, NadaThe recent reformation and globalisation of the Saudi stock market have underscored the necessity of investigating the patterns that drive market returns, with factor premiums and asset pricing models serving as crucial analytical tools for this purpose. Therefore, this study examines whether the Fama and French (2015) five-factor model (FF5FM) provides a better explanation for the cross-section of stock returns than the Fama and French (1992) three-factor model (FF3FM), and whether the factors utilised in these asset pricing models have a significant premium in the Saudi stock market. Furthermore, this study introduces a new factor, the Islamic premium, to the Fama and French asset pricing models and examines whether this factor has a significant premium or enhances the models’ ability to describe the variation in average returns. The research also investigates whether the recent global market integration has altered the significance of the factor premiums and the explanatory power of asset pricing models. Finally, to understand the market behaviour during crises, the impact of COVID-19 on stock performance and factor premiums is analysed. A one sample t-test is employed first to examine the significance of all factor premiums. Then, the GRS test for portfolio efficiency is used to compare the performance of the asset pricing models and to identify the most effective model based on the lowest GRS value. Then, this study divides the sample period into two subperiods – pre- and post-global integration – to assess the significance of the factor premiums (using a one-sample t-test) and the performance of the asset pricing models (using the GRS test) in each subperiod. Additionally, a two-sample t-test is conducted to ascertain any significant changes in the factor premiums, and robustness checks are performed using monthly/weekly returns and value-weighted/equal-weighted portfolios across all the methods applied in this study. Finally, panel regression analysis and the Wald test are used to examine the implications of COVID-19 on the performance of stocks in the market. This study finds that the value premium is the only factor that has a significant equity premium across all the examined portfolios. This indicates that future investors in the Saudi stock market could generate higher returns if they invest in stocks with a higher B/M ratio. However, the study also finds that the inverse of the investment premium is significant, which means the stocks with higher investment growth have a significant equity premium. This may be attributed to investors’ potential overreaction to positive news, such as investment growth, and herding behaviour. The study further finds that Fama and French’s FF5FM generally outperforms FF3FM, particularly when using factors constructed from the 2 × 3 sort. Conversely, when employing factors from the 2 × 2 sort, the Islamic premium notably enhances the explanatory power of FF5FM and FF3FM. The study finds evidence that the size effect started to reappear in the market after global integration. More substantial evidence shows that the value premium emerged following changes in market demographics. On the other hand, the inverse of the investment premium was significant before global integration but has disappeared since then. These findings show that after market reforms, investors in the Saudi market have made more informed investment decisions and paid more attention to factor premiums. The study also found that the best asset pricing model for describing variation in the cross-section of stock returns differed before and after the global market integration. From 2018 onward, incorporating Islamic premiums have improved the explanatory power of the Fama and French asset pricing models. Additionally, value-weighted portfolios always give higher returns than equal-weighted portfolios. This could be due to the poor performance of smaller stocks and higher exposure to larger stocks in value-weighted portfolios. Finally, there is evidence that Islamic and less profitable stocks performed poorly compared to non-Islamic and more profitable stocks during the COVID-19 crisis, most likely due to liquidity challenges. Most firms experienced a revenue decline during COVID-19, particularly stocks with low profitability, as they already had cash flow issues. However, the limited financial sources available to Islamic stocks compared to non-Islamic stocks worsened their liquidity position and made them more vulnerable.12 0Item Restricted Analyzing the Spread of COVID-19 Misinformation on Twitter: Patterns, Impact, and Countermeasures(Auckland University of Technology, 2024) Abokhanjar, Hissah; Li, Weihua; Wang, XiaodanTwitter, as a significant information hub during the pandemic, has facilitated the rapid spread of accurate updates and false narratives, contributing to the ‘infodemic.’ This study investigates the most common types of COVID-19 misinformation spread on Twitter and examines their impact on public perception and behavior. By analyzing a substantial dataset of COVID-19-related tweets, the research identifies recurring misinformation themes, including erroneous claims about the virus’s origin, prevention strategies, treatments, and vaccine efficacy. Prominent misinformation types include theories falsely attributing the virus’s origin to human engineering or intentional release, unproven prevention methods like natural remedies, and misleading treatment options, such as the promotion of unapproved drugs. Additionally, vaccine-related misinformation, including baseless claims about vaccine safety, side effects, and hidden agendas, contributed significantly to public skepticism and hesitancy. The study explores how these misinformation narratives influenced public attitudes and behaviors, revealing that exposure led to increased vaccine hesitancy, reduced compliance with public health guidelines, and the widespread acceptance of conspiracy theories. These effects complicated public health efforts and deepened social and political divisions, further impeding effective pandemic management. The findings highlight the urgent need for strategies to counter misinformation and promote accurate public health information, especially during global crises. Public health authorities, social media platforms, and educators must collaborate to enhance information literacy, improve content moderation, and develop targeted interventions. These efforts are crucial to mitigating the spread and impact of misinformation, thereby safeguarding public health and trust in scientific expertise.27 0Item Restricted THE RELATIONSHIP BETWEEN ESG AND FINANCIAL PERFORMANCE OF UK FTSE 250 LISTED FIRMS.(University of Sussex, 2024-09) Alhuqayl, Nouf; Hawas, AmiraIn this dissertation, the relationship between the Environmental, Social and Governance (ESG) principles in relation to the financial performance of FTSE 250 companies pre-and during COVID-19 was studied. Utilizing data from Bloomberg and to conduct regression panel models with fixed and random effects, a Hausman test was performed in order to choose the most effective model. The study reveals that ESG including its sub-dimension exhibit minimal influence on financial outcomes pre-pandemic with only slight improvements noted during the pandemic. The data corroborates the assertion that despite virtually no clear monetary advantages of ESG integration is seen at once, its contribution keeps increasing over time. The study emphasizes the complexities of ESG impacts and the need for companies to tailor their ESG strategy to specific operational and economic settings in order to maximize advantages. This study contributes to the nuanced understanding of ESG integration and encourages more research into its long-term effects in various businesses and regulatory situations.13 0Item Restricted THE RELATIONSHIP BETWEEN ESG AND FINANCIAL PERFORMANCE OF UK FTSE 250 LISTED FIRMS.(University of Sussex, 2024-09) Alhuqayl, Nouf Khalid; Hawas, AmiraIn this dissertation, the relationship between the Environmental, Social and Governance (ESG) principles in relation to the financial performance of FTSE 250 companies pre-and during COVID-19 was studied. Utilizing data from Bloomberg and to conduct regression panel models with fixed and random effects, a Hausman test was performed in order to choose the most effective model. The study reveals that ESG including its sub-dimension exhibit minimal influence on financial outcomes pre pandemic with only slight improvements noted during the pandemic. The data corroborates the assertion that despite virtually no clear monetary advantages of ESG integration is seen at once, its contribution keeps increasing over time. The study emphasizes the complexities of ESG impacts and the need for companies to tailor their ESG strategy to specific operational and economic settings in order to maximize advantages. This study contributes to the nuanced understanding of ESG integration and encourages more research into its long-term effects in various businesses and regulatory situations.10 0