Saudi Cultural Missions Theses & Dissertations
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Item Restricted Healthcare in Crisis: Assessing Medication Adherence, Health Care Access, Telehealth Utilization, and Variations of Depression Treatment in the Era of COVID-19 for US Hypertensive Patients(Howard University, 2025) alharbi, Rehab; La’Marcus, WingateBackground: Coronaviruses (CoVs) are highly contagious viruses that cause respiratory and gastrointestinal illnesses. It disrupted global healthcare systems and affected access to care for chronic conditions like hypertension. It is a major risk factor for cardiovascular disease and a leading cause of death in the U.S. However, the pandemic shifted healthcare focus to COVID-19. Telehealth emerged as a critical tool for maintaining continuity of care. The pandemic also intensified mental health issues, such as depression. This study explores medication adherence, healthcare access, telehealth utilization, and depression treatment patterns among U.S. hypertensive patients during COVID 19. Methods: This cross-sectional analysis used secondary data from the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS).Outcomes included medication adherence among hypertensive patients, telehealth use, healthcare delay during the pandemic, and depression treatment variations in adults with both hypertension and depression. Descriptive statistics were utilized to describe patients’ characteristics, while logistic regression identified predictors of outcomes. Results: Medication adherence varied across antihypertensive classes, with ARBs having the lowest (53.4%) and beta-blockers having the highest (60.6%) levels of adherence. Older adults had lower adherence (adjusted odds ratio (AOR) = 0.87, p < 0.05) compared to younger adults (18-34). Whites were more likely to utilize telehealth than Blacks (AOR = 1.13, P = 0.05). Older individuals faced higher odds of delayed care, with those aged 50–64 having an (AOR = 1.19 ,p = 0.02), and v those aged 65 and above having an (AOR=1.29,p < 0.001). Additionally, Older adults aged 50–64 were more likely to receive depression treatment (AOR: 2.81, p < 0.001), and whites had 2 times higher odds of receiving depression treatment compared to blacks, with a p-value of 0.05. Those with poor physical health had the highest odds of receiving treatment (AOR = 5.99, p < 0.001), compared to those with excellent physical health status. Conclusions: The study highlights disparities in medication adherence, healthcare access, telehealth use, and depression treatment among hypertensive patients during COVID-19. Influenced by age, race, physical health, and gender. These findings highlight the need for policy interventions to improve access to chronic disease care.5 0Item Restricted Understanding the influence of ethnicity on medicines adherence(Newcastle University, 2025-05) Asiri, Rayah; Husband, Andy; Todd, Adam; Robinson-Barella, AnnaDiabetes is a significant global public health issue, resulting in serious and costly complications and reduced life expectancy. Adherence to prescribed medication is an essential component of diabetes management to obtain optimal outcomes. Understanding the factors influencing adherence is key to optimising adherence to antidiabetic medication. One factor that has yet to be studied in this context is ethnicity and given the increased incidence of diabetes in certain ethnic groups, it is important to establish if or how adherence to diabetes medication varies by ethnic group (Chapter 1). A systematic review of the existing quantitative literature was conducted to explore whether medication adherence to antidiabetic medications in people with diabetes varied by ethnicity (Chapter 2). Most of the included studies showed statistically significant disparities in adherence among different ethnic groups, with minority ethnic groups in high-income countries often reporting the lowest rates. A second systematic review (meta ethnography) was undertaken to synthesise the existing qualitative data to explore the barriers to and facilitators of adherence to antidiabetic medications experienced by people from minority ethnic communities in high-income countries (Chapter 3), revealing a gap in the literature concerning ethnicity-related factors from the perspectives of both minority ethnic communities and the majority within the context of socioeconomic deprivation. Chapters 4 and 5 detail two qualitative studies conducted in socioeconomically deprived settings in the United Kingdom and Saudi Arabia. The UK study (Chapter 4) explored the perspectives of people from South Asian and White British ethnic backgrounds in the North East of England. The results identified a range of barriers and facilitators, with some shared by both groups and others unique to the South Asian participants, including a preference for alternative medicine, certain religious-related beliefs and practices, social stigma associated with the condition, and unawareness of free prescription availability. The Saudi Arabian study (Chapter 5) involved participants from South Asian and Saudi Arabian backgrounds, highlighting a range of barriers and facilitators—some shared across both groups and others unique to each ethnic community. This research identified several factors influencing adherence, including ethnicity related and socioeconomic influences, as well as personal and healthcare system-related factors; these findings should inform the development of tailored interventions (Chapter 6).26 0Item Restricted Factors Associated with Antihypertensive Adherence in Patients Attending A Specialist Hypertension Service(University of Galway, 2024-07) Alhayrani, Hassan; Dennedy, MichaelAbstract This investigation explores the factors affecting antihypertensive medication adherence and focuses more on ADRs in patients receiving care at a dedicated hypertension clinic. Hypertension is a widespread health concern associated with significant cardiovascular implications, often necessitating pharmacological intervention. However, ADRs frequently compromise adherence to antihypertensive medications. This study is designed as a piece of secondary data analysis based on a cross-sectional study completed in 2021. The study utilized a quantitative research design. Data were collected by examining patient records, clinical assessments, and adherence monitoring, involving analysing pharmacy refill data and high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) analysis of urine samples. The study population comprised adults aged 18 and older who were diagnosed with hypertension and undergoing treatment at University College Hospital in Galway, Ireland. The study found no statistically significant overall impact of ADRs on medication adherence, although the use of diuretics approached statistical significance with a p- value of 0.084. Approximately 75% of patients reported adherence, while only 27% were confirmed adherent through mass spectrometry, indicating a significant discrepancy between self-reported adherence and objective measures. The findings underscore the necessity for robust methods to monitor and enhance adherence, particularly through minimizing ADRs and providing patient support tailored to demographic characteristics. Healthcare providers can develop more effective strategies to manage hypertension and improve patient outcomes by understanding the specific factors that influence adherence. The study aims to inform targeted interventions to optimize adherence and ultimately enhance the efficacy of hypertension management. This research highlights the critical need for personalized approaches in managing antihypertensive therapy, considering the varied impact of ADRs across different patient groups. The insights gained from this study could guide future research and clinical practices to better support patients in adhering to their prescribed medication regimens, thereby reducing the burden of hypertension-related complications.31 0Item Restricted An investigation of patients’ adherence to secondary preventive medications for stroke, and an exploration of the role of hospital pharmacists in the secondary prevention of stroke in the Kingdom of Saudi Arabia (KSA): A mixed method study(Saudi Digital Library, 2022-11-18) Alqahtani, Saeed; Jalal, Zahraa; Mason, Julie; Paudyal, VibhuBackground: A range of pharmacological treatments are supported by scientific data to lower the risk of stroke recurrence. However, it is known that non-adherence to secondary preventative medications is common amongst stroke patients, which negatively impacts patient outcomes. Understanding the factors that influence adherence and non-adherence can allow the development of interventions to promote adherence. In addition, evidence indicates that a variety of pharmacist interventions, particularly their role in increasing medication adherence among stroke patients, is able to enhance patient outcomes. This study aimed to investigate stroke patients’ adherence to secondary preventive medications and explore the role of the hospital pharmacists in secondary prevention and the management of stroke in the Kingdom of Saudi Arabia (KSA). Methods: A pragmatic, mixed-methods sequential exploratory study was conducted. Firstly, a systematic review and meta-analysis were performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to explore the role and outcomes of pharmacists’ interventions in relation to pharmaceutical care for the primary and secondary prevention of stroke. Secondly, a cross-sectional study was conducted with a convenient sample of Saudi stroke patients to measure patients’ adherence to medications prescribed for secondary prevention using a validated Arabic version of the Hill-Bone Medication Adherence Scale (HB-MAS) and multivariate linear regression. Following that, semi-structured interviews were conducted with a purposive sample of stroke patients who had been recruited in the previous cross-sectional study with the sub-optimal/optimal adherence groups. This qualitative study used the theoretical domains framework (TDF) and directed content analysis to explore the facilitators and barriers to medication adherence for the secondary prevention of stroke from the perspective of stroke patients. Finally, semi-structured interviews were performed with a purposive sample of Saudi hospital pharmacists to assess their experience and practice in the secondary prevention of stroke, with thematic analysis used to analyse the data. Results: The systematic review and meta-analysis included 31 studies; seven studies addressed the role of pharmacists in primary prevention and 24 in secondary prevention of stroke. The pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported statistically significant improvements in outcomes associated with medicines optimisation, risk factor modification, medicines adherence, and health-related quality of life (HRQoL) because of pharmacists’ input into patient care. Where measured, clinical outcomes in the secondary prevention of stroke (such as hospital readmission, thromboembolic events, and bleeding rates) were also improved. Importantly, meta-analysis of seven studies showed pharmacist intervention in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 minutes, odds ratio: 2.69 [95% confidence interval [CI]: 1.95-3.72]; p<0.001. The cross-sectional study showed that the level of stroke secondary preventive medications (SSPM) adherence was 72.3%, with a suboptimal adherence to SSPM. Males (224) showed suboptimal adherence (n= 170, 75.9%); more than females (119) (n=78, 65.5%), which was statistically significant (chi-square=4.15, p-value=.042). The average age was significantly higher in the group with suboptimal adherence (69.65 years) compared to the group with optimal adherence (64.33 years) and Mann–Whitney U (n optimal adherence=95, n suboptimal adherence=248) =2.165, p-value=0.03. Binary regression analysis revealed that per participant, the number of strokes (OR=1.779, 95% CI: 2.03 - 17.30, p-value=.001), and number of other medications used (OR=1.61, 95% CI: 1.26 - 2.05, p-value<.001) were significantly associated with suboptimal adherence. Numerous facilitators and barriers that influenced SSPM adherence were identified in the patient interview study. Fear of suffering another stroke, knowledge of SSPM, realisation of SSPM benefits in life expectancy and improving quality of life, family support, and establishing SSPM as a habit were identified as facilitators. On the contrary, SSPM barriers related to a lack of understanding regarding stroke and SSPM, forgetting to take medications, the ability for self-care and social influence, as well as certain religious beliefs. The pharmacist interview study found that most hospital pharmacists expressed good knowledge in regards to secondary stroke prevention. Additionally, most of the pharmacists recruited in the study were aware of the guidelines, such as the American Stroke Association (ASA) for the prevention and treatment of stroke. Some study participants stressed the need for adequate training and specialised stroke clinics within hospitals to effectively deal with stroke patients. Similarly, most of the participants outlined the lack of collaboration between the physicians. Many pharmacists were aware of their responsibility to improve patient medication adherence. Conclusion: This research study reveals certain factors that influence stroke patients’ adherence; and suggests possible solutions to increase stroke patients’ awareness of the importance of adhering to SSPM. Subsequently, the findings will provide future researchers and decision-makers with an extensive range of factors that might be considered when setting targets for interventions to improve adherence in the stroke population. Furthermore, this research can provide important recommendations regarding pharmacists and healthcare system roles in promoting medication adherence and seamless care of stroke patients.27 0