Saudi Cultural Missions Theses & Dissertations
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Item Restricted Access to Care, Structural Barriers, and Recovery Identity in Mental Health and Substance Use Disorder Treatment(Saudi Digital Library, 2025) Alnashri, Yahya; Becker, David J; Dantzler, John; Giannouchos, Theodoros V; Jaiswal, Jessica; Sen, BisakhaSubstance use disorders (SUDs) remain one of the most pressing public health and economic challenges in the United States, with growing recognition that recovery is a multidimensional process shaped by clinical, social, and structural factors. This dissertation explores recovery at the levels of health policy, population, and experiential levels to assess gaps in access to recovery support services, identify patterns and predictors of recovery identity, and highlight the lived experiences of individuals with opioid use disorder. First, we evaluated whether state Medicaid expansion under the ACA (2010–2019) was associated with changes in the availability of consumer-run peer support services in mental health treatment facilities, based on data from the National Mental Health Services Survey (N-MHSS). Through a staggered difference-in-differences (DiD) design, we found no significant post-expansion increase in peer support offerings, suggesting that insurance coverage expansion alone did not lead to growth in recovery-oriented service integration. Second, we estimated the prevalence and predictors of self-identified recovery among U.S. adults reporting lifetime substance use problems, using pooled data from the 2021–2023 National Survey on Drug Use and Health (NSDUH). We found that approximately three-quarters of individuals with lifetime substance use problems identified as being in recovery or recovered. Recovery identity was associated with a variety of demographic, psychosocial, and behavioral characteristics, including rural residence, religious involvement, lower income, public insurance, having a chronic health condition, co-occurring mental health recovery and those who reported reduced substance use during the COVID-19 pandemic. Third, through semi-structured interviews (n=26) with adults living with opioid use disorder in Alabama, we explored how they define recovery and navigate structural and social barriers to accessing care. Thematic analysis identified recovery as “rebuilding a normal life” across housing, employment, relationships, and well-being; persistent logistical obstacles (financial hardship, insurance instability, transportation) and pervasive stigma undermined treatment engagement despite recognition of MOUD’s lifesaving role In conclusion these papers underscore that recovery is shaped by more than individual behavior; it reflects the broader health policy landscape, social support systems, and lived experiences. Policymakers and practitioners must address structural and relational barriers to improve equitable access to recovery-oriented care.8 0Item Restricted Influence of Participation in the BPCI-A Initiative on 30-Day Heart Failure Unplanned Readmission Rates Among U.S. Hospitals(University of Texas Health Science Center at Houston, 2025) Balhareth, Ibrahim Ali; Linder, StephenBackground: The Bundled Payments for Care Improvement Advanced (BPCI-A) initiative incentivize participating hospitals if they achieved less than the target spending amount for the selected condition and penalizes them if they exceeded the target. The BPCI-A program aims to enhance care quality and reduce spending. One of the quality measures targeted by BPCI-A is hospital readmissions. Heart failure is one of the leading causes of hospital readmission effectiveness of BPCI-A in reducing cardiac-related readmissions, particularly for heart failure, and the influence of hospital characteristics on program outcomes remain uncertain. This series of studies comprehensively evaluated the impact of BPCI-A on heart failure readmission rates. Methods: First, a scoping review was conducted to synthesize the existing literature on hospital characteristics, BPCI-A participation, and associated readmission outcomes, specifically focusing on cardiac care. Subsequently, a second study utilizing a propensity score matching (PSM) with national hospital-level datasets compared the baseline characteristics and readmission outcomes between hospitals participating in the program and a matched group of their counterparts that never participated in the program. Lastly, a retrospective matched-cohort study was conducted to validate the findings from the second study by evaluating whether participation in the BPCI-A program influenced 30-day heart failure readmissions, including subgroup analyses by hospital size, ownership, and teaching status, using weighted regression modeling and interaction analyses. Results: The scoping review revealed limited effectiveness of BPCI-A in reducing cardiac-related readmissions broadly, emphasizing existing disparities among hospitals. Empirical findings from Journal Article 2 demonstrated significant baseline differences: BPCI-A hospitals were larger, urban, teaching-oriented, and for-profit institutions. Post-matching analyses indicated a modest but significant association between BPCI-A participation and reduced heart failure readmissions (4.1 percentage points lower, p<0.001). Confirmatory analyses from Journal Article 3 validated these results, showing a 4.2 percentage-point reduction in readmissions associated with participation, with substantial heterogeneity by hospital characteristics. Small, public, and non-teaching hospitals benefited disproportionately from participation. Conclusion: Participation in BPCI-A is modestly associated with lower heart failure readmission rates, especially among hospitals historically disadvantaged by resource constraints. However, BPCI-A alone appears insufficient to eliminate persistent disparities or achieve substantial reductions universally. Future bundled payment policies must be tailored to hospital contexts, address under-resourced institutions by providing targeted support to enhance equity and effectiveness in reducing heart failure readmissions.32 0Item Restricted A Review and Appraisal of Saudi Arabia’s Health and Oral Health Strategies(University College London (UCL), 2024-08) Alanazi, Alanoud; Tsakos, Georgios; Heilmann, AnjaAbstract Background: Oral health is a critical component of overall health, yet oral diseases like dental caries and periodontal diseases remain prevalent globally, including in Saudi Arabia. Despite their preventability, these conditions contribute significantly to the disease burden. Saudi Arabia's Vision 2030 aims to reform healthcare, including oral health, aligning with global health initiatives such as the WHO's Global Oral Health Action Plan (2023–2030). Aims: This study aims to review and evaluate Saudi Arabia's health and oral health strategies, assessing their design, implementation, and alignment with global health policies. The goal is to identify strengths, gaps, and opportunities for enhancing policy effectiveness within the context of Vision 2030. Methods: The study employs the Health Policy Triangle (HPT) framework to analyse key health policies in Saudi Arabia. Document analysis was used to systematically identify and evaluate relevant policies, focusing on the interaction between policy content, context, processes, and actors. Results: The analysis revealed that Saudi Arabia has made strides in aligning its health policies with global standards, particularly in tobacco control, sugar taxation, and water fluoridation. However, gaps still need to be in fully integrating oral health into primary healthcare and in systematically evaluating these policies. Conclusion: While progress has been made, Saudi Arabia's health policies would benefit from a more integrated and comprehensive approach to oral health. Enhancing policy coherence, improving access to care, and strengthening monitoring mechanisms are crucial for aligning with global health standards and achieving Vision 2030's objectives. Future efforts should focus on bridging identified gaps and fostering innovation through public-private partnerships to improve oral health outcomes in the Kingdom.39 0Item Restricted Evaluating the trends and determinants of patient experience in primary health care in Saudi Arabia(Tsinghua University, 2024-06-25) Alqarni, Waleed; Richardson, SolThe Saudi Arabian healthcare system, with its emphasis on primary health care (PHC) as the cornerstone of health service delivery, is undergoing significant transformations to enhance healthcare quality and accessibility. This study investigates patient satisfaction within PHCs across Saudi Arabia, recognizing its critical role in evaluating healthcare quality and informing policy and practice improvements. This thesis aims to explore the determinants of patient satisfaction in Saudi Arabian PHCs from January 2022 to December 2022. It seeks to identify overall satisfaction levels, analyse trends across various patient demographics and regions, and assess the impact of the COVID-19 pandemic on patient satisfaction. The study employed a descriptive analysis approach, utilizing patient satisfaction surveys and multivariable regression analysis. Data were collected on patient satisfaction scores, demographics (age, gender, nationality), and different regions within PHCs. The study also examined the relationship between patient satisfaction and healthcare delivery aspects, such as provider communication, waiting times, empathy, and cleanliness of facilities. The findings indicate that patient satisfaction within Saudi PHCs varies significantly across different demographics and regions. Key factors influencing patient satisfaction include provider communication, waiting times, and facility cleanliness. The COVID-19 pandemic has also notably impacted patient satisfaction, reflecting the challenges, and we hypothesize that adjustments in healthcare delivery are the cause of change in satisfaction during this period. Understanding the key determinants of patient satisfaction in PHCs is essential for improving healthcare delivery in Saudi Arabia. The study highlights the need for targeted interventions to address the identified factors influencing patient satisfaction. Enhancing the patient experience in PHCs can contribute to the overall improvement of the healthcare system in Saudi Arabia, aligning with the goals of Vision 2030 for health sector transformation.23 0