Saudi Cultural Missions Theses & Dissertations
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Item Restricted Development of physico-chemical and surface mechanical properties of a fast photo-polymerised resin-based composite(Saudi Digital Library, 2025-06-25) Thanoon, Halah; Watts, David CThe advancement of fast photo-polymerised resin-based composites (RBCs) offers promising potential for improving efficiency in restorative dentistry by reducing curing times while maintaining desirable mechanical properties. However, concerns regarding their thermal response, degree of conversion (DC), and long-term stability under different curing conditions and exposure to the oral environment necessitate further investigation. This thesis explores the conversion, thermography, physical-mechanical, and chemical characteristics of RBCs designed for rapid polymerisation, addressing their behaviour under various light-curing protocols and post-curing environmental conditions. The first experimental study examined the impact of laser, quad-wave, and conventional LED curing protocols on mean temperature rise (ΔT) and DC of both fast and conventional bulk-fill RBCs at 4-mm depth. Results showed that high-intensity short-exposure curing generated lower radiant energy but still achieved efficient polymerisation, particularly in fast-cure RBCs. Standard exposure times resulted in higher DC and ΔT, with a positive correlation observed between temperature rise and conversion efficiency. The findings underscore the role of optimised irradiation in enhancing polymerisation effectiveness while controlling heat generation. Building on this, the second study assessed the influence of polymerisation protocols on water sorption, solubility, and hygroscopic expansion over 120 d in distilled water. Fast-cure RBCs demonstrated lower water uptake and solubility compared to conventional bulk-fill composites, with minimal variation between 3 s and 20 s curing. In contrast, conventional RBCs exhibited increased water sorption and solubility under rapid polymerisation, suggesting a material-dependent response. These results highlight the stability of fast-cure RBCs in aqueous environments, reinforcing their suitability for clinical application. The final study focused on the effects of solvent storage on surface hardness and bulk viscoelastic properties. After 30 d in 75% ethanol/water and distilled water, all materials exhibited reduced hardness, particularly at the bottom surface, with ethanol exposure exacerbating these effects. Despite this, the fast-cure RBC maintained comparable viscoelastic performance to conventionally cured materials. The data suggest that filler composition significantly influences mechanical integrity, contributing to resistance against deformation under prolonged solvent exposure. This research provides valuable insights into the optimisation of light-curing protocols for enhancing the performance of RBCs designed for rapid polymerisation. By demonstrating their efficient polymerisation, reduced water sensitivity, and mechanical resilience, this work supports their clinical application, particularly in high-demand restorative procedures. The findings contribute to the refinement of material formulations and curing strategies, aiding in the development of durable and efficient RBCs for modern dental practice.5 0Item Restricted ON THE USE OF USER INTERFACE SPECIFIC DOMAIN GHERKIN IN BEHAVIOUR DRIVEN DEVELOPMENT(The University of Glasgow, 2025-05) Alshammari, Abdullah Farhan J; torer, Tim SThere has been a noticeable rise in the popularity of behaviour driven development (BDD) in the software industry. Gherkin is a popular language for describing system behaviours, since it uses simple natural language that can be understood easily by all those involved. Gherkin describes system behaviours as examples of how the system should behave in different scenarios. However, existing research has identified several challenges with current approaches to BDD and Gherkin. First, stakeholders struggle to express and negotiate requirements in Gherkin when they are expressed in terms of business domain concepts. Second, the automated acceptance tests associated with requirements expressed in business domain concepts require additional developer effort. Third, stakeholders find selecting an appropriate abstraction level when developing Gherkin scenarios can be challenging. To address these challenges, this thesis investigates the feasibility and efficiency of using user interface specific domain concepts for expressing requirements. This approach emphasises the expression of system behaviours in terms of user interface elements, such as buttons, text entry fields and so on. The intuition behind this approach is that the user interface represents a common ‘language’ for stakeholder discussion of requirements, that is independent of business specific concepts. The research followed an empirical methodology and used four different methods to evaluate the approach: multivocal literature review, design science, case studies, and laboratory experiment. First, a multivocal review of BDD and its best practices was undertaken to establish the prevailing understanding of Gherkin usage. Second, a framework that comprises standardised low level Gherkin scenario steps and the associated acceptance test functions was developed. The objective was to investigate the applicability of user interface domain specific Gherkin use in BDD. Third, three case studies were undertaken to improve and validate the design and implementation of the user interface domain specific Gherkin language and the automated acceptance test suites associated with it. The objective was to identify weaknesses in the design and implementation of the user interface specific domain Gherkin language. The results of the case studies suggest that using user interface specific domain concepts for communicating system requirements is feasible. Fourth, a controlled laboratory experiment was conducted to find out whether it is easier to comprehend and document scenarios written in user interface specific domain Gherkin than scenarios written in business domain Gherkin. The results indicate that non-software practitioners, who represent customers, found scenarios written in user interface specific domain Gherkin to be significantly easier to document than scenarios written in business domain Gherkin. Further, the results show that for the same group, scenarios written in user interface specific domain Gherkin were marginally easier to comprehend than scenarios written in business domain Gherkin. In addition, the results suggest that for software practitioners, scenarios written in user interface specific domain Gherkin were marginally easier to comprehend and document than scenarios written in business domain Gherkin.1 0Item Restricted Exploring Healthcare Professionals Perceptions and Experiences of Inter Professional Collaboration in Critical Care(Saudi Digital Library, 2025-06-03) ALMUTAIRI, ABDULLAH; McKinney, AidínAbstract Background: In high-pressure environments, interprofessional collaboration (IPC) in intensive care units (ICUs) is essential for effective patient care. However, collaboration between healthcare professionals is impeded by communication breakdowns, professional silos, and hierarchical practices. These barriers hinder the quality of care, leading to ineffective patient care. Team effectiveness and patient outcomes in critical care settings will improve if the barriers are addressed. Aim: This study aims to explore and synthesise healthcare professionals' perceptions and experiences regarding IPC in ICU settings Methodology: The systematic literature review was carried out on multiple academic databases such as PubMed, CINAHL, Scopus, and Web of Science. The review was based on qualitative studies published in the past decade, where each study was critically appraised using the CASP tool. A summary of data synthesised through thematic analysis following Braun and Clarke’s framework of developing key themes and information is provided. Results: Three main themes emerged in the review: fostering collaboration, barriers to effective collaboration, and impact on patient and professional outcomes. Each of them was further divided into two or three subsections to explore the topic further. Ineffective patient care was found to be due to poor communication, difference in terminologies, time pressures and role definition. However, interprofessional education (IPE) initiatives such as multidisciplinary teams and respect among team members promoted IPC. A practical approach to overcome these barriers and create a collaborative environment was found to be effective leadership. Effective leadership was found to address these barriers and create an organizational culture that would enhance quality patient care in ICUs. Conclusion: Improving IPC in ICUs is possible by addressing communication barriers and time pressures, defining roles, applying regular multidisciplinary team (MDT) rounds, and developing IPE programmes and incorporating them into healthcare training and policy development. These recommendations are needed to improve patient care and team dynamics and, therefore, lead to better clinical outcomes in ICUs.3 0Item Restricted Synthesis and Characterisation of Asymmetric Perylene-based Supramolecular Polymers(University of Bristol, School of Chemistry, Bristol Doctoral College, 2025-06-17) Alharbi, Helal S M; Faul, Charl F J; Arthur, ChrisSupramolecular polymers (SMPs) are a unique class of materials where highly directional and reversible non-covalent interactions link the monomers. Owing to the reversibility of non-covalent interactions, SMPs exhibit significantly dynamic behaviour, enabling them to display various properties such as self-healing, processability, and stimuli-responsiveness. The ability to control the self-assembly behaviour of these functional molecules offers pathways for optimising their properties and structures for targeted applications. Perylene diimides (PDIs) have attracted considerable interest for their increasing prominence as building blocks in the construction of SMPs through solution-based self-assembly. PDIs feature a variety of appealing properties, including optoelectronic properties, that enable the investigation of their self-assembly, thermal and photochemical stability, N-type semiconductivity, and facile chemical modification. Asymmetric PDIs, which bear unique substituents at each imide position, are considered an essential subgroup within PDI derivatives owing to their substantial synthetic versatility. Despite the promising properties of asymmetric PDI derivatives, there have been limited studies on tuning their self-assembly behaviour and morphology, especially in terms of variation of the hydrophobic-hydrophilic balance by introducing asymmetric hydrophilic and hydrophobic chains. The work described in this thesis explores the formation of SMPs based on asymmetric PDIs and investigates the effects of variation of asymmetric hydrophilic and hydrophobic substitution on the properties of the resulting SMPs. A series of asymmetric PDI derivatives were synthesised with modifications of the amide linker, long alkyl and oligo (ethylene glycol) (OEG) chains at the imide position. Tetrahydrofuran/water (THF/H2O) mixtures were found to be an optimal system to induce the self-assembly behaviour of these asymmetric PDI derivatives; the behaviour of these new systems was monitored by recording ultraviolet-visible (UV/Vis) spectra and analysing changes in absorbance intensity. Temperature-dependent UV/Vis studies yielded thermodynamic parameters for the self-assembly process and revealed a transition in the supramolecular polymerisation mechanism due to variations in asymmetric hydrophilic and hydrophobic substitutions. Detailed transmission electron microscopy (TEM) and atomic force microscopy (AFM) investigations revealed the formation of different nanofiber-based supramolecular structures, demonstrating a potential strategy for controlling the supramolecular architecture of asymmetric PDIs. Overall, this thesis provides insights into the influence of asymmetric hydrophilic and hydrophobic substitutions on the self-assembly and supramolecular polymerisation of PDIs. The strategies developed in this work may offer potential pathways for controlling self-assembly behaviour and tailoring material properties, thereby contributing to the broader design of functional supramolecular polymers.9 0Item Restricted Investigating Pathological Remodelling in Metabolic Stress-Induced Heart Failure(Saudi Digital Library, 2025-06-17) Samman, Sultan; Wang, Xin; Zi, MinBackground Metabolic syndrome, comprising obesity, type 2 diabetes mellitus, and hypertension, is strongly associated with mitochondrial dysfunction, a major pathogenic mechanism in the progression of heart failure (HF). Emerging evidence suggests that elevated accumulation of trimethylamine N-oxide (TMAO) contributes to mitochondrial dysfunction, thereby exacerbating HF development. However, the underlying mechanisms by which TMAO promotes mitochondrial dysfunction and HF remain unclear. Aims: 1. Establish and optimise mouse models of HF that replicate the characteristic features of human heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) induced by metabolic stress. 2. Investigate the role of TMAO-induced mitochondrial dysfunction in HF progression. 3. Examine the combined effects of palmitic acid (PA) and TMAO in cardiomyocytes. 4. Test the therapeutic potential of ZLN005 in restoring mitochondrial function under metabolic stress. 5. Assess the effect of TMAO on intracellular calcium (Ca²⁺) handling in cardiomyocytes. Methods: Wild-type mice were divided into three experimental groups: (1) a control group fed a standard chow diet (CHOW group); (2) a group fed a high-fat diet (HFD) combined with nitric oxide synthase (NOS) inhibition using N^ω-nitro-L-arginine methyl ester hydrochloride (commonly known as L-NAME), administered via drinking water, to induce hypertension (HFD+L-NAME group); and (3) a group fed a modified Western diet (MWD), consisting of a standard Western diet (WD) supplemented with TMAO, in combination with L-NAME (MWD+L-NAME group). Cardiac structural and functional changes were evaluated at weeks 5 and 25, alongside histopathological and mitochondrial assessments. In vitro, the effects of combined TMAO and PA exposure on reactive oxygen species production, fatty acid (FA) metabolism, and mitochondrial function were assessed in H9C2 cardiomyocytes. In addition, the impact of TMAO on intracellular Ca²⁺ handling was investigated. Results The HFD+L-NAME group exhibited features consistent with human HFpEF, including left ventricular (LV) hypertrophy, fibrosis, diastolic dysfunction, and moderate mitochondrial abnormalities. In contrast, the MWD+L-NAME group displayed more pronounced LV hypertrophy, fibrosis, and systolic dysfunction. This group also showed decreased ATP production and severe mitochondrial dysfunction, characterised by morphological alterations, reduced fatty acid oxidation capacity, and downregulation of mitochondrial regulatory genes, closely mirroring human HFrEF. In H9C2 cells, co-exposure to TMAO and PA induced oxidative stress, disrupted FA metabolism, promoted lipid accumulation, and impaired mitochondrial function, while ZLN005 mitigated these effects. Furthermore, TMAO dysregulated intracellular Ca²⁺ handling. Conclusions: TMAO exacerbates mitochondrial dysfunction and contributes to HF progression. The MWD+L-NAME model may serve as a valuable preclinical tool for studying HFrEF and its underlying mechanisms. Moreover, targeting mitochondrial dysfunction with ZLN005 shows promise as a therapeutic strategy to improve HF outcomes.19 0Item Restricted Association between Friendship Quality and Subjective Wellbeing in Adolescents: Social Network Analysis and Investigation of Moderators(Saudi Digital Library, 2025-06-11) Alsarrani, Abdullah Abdulaziz; Garcia, Leandro; Hunter, Ruth; Dunne, LauraBackground: Adolescence is a crucial stage in the development of wellbeing. Recent global trends show a decline in various wellbeing indicators among adolescents. One factor that influences this is peer relationships, which become more important during this stage. Friendships at school form a major part of adolescents’ social lives and may have a strong effect on their wellbeing. This thesis explores both cross-sectional and longitudinal associations between school friendship quality and different dimensions of subjective wellbeing among adolescents. It also examines how behavioral homophily may influence these relationships. Methods: A multi-staged approach was adopted, beginning with a systematic review of 43 studies examining the association between friendship quality and subjective wellbeing (Chapter 2). Two cross-sectional analyses were conducted (Chapter 4) to investigate the relationship between friendship quality and subjective wellbeing among adolescents aged 13–18 years in Northern Ireland. Finally, a two-wave longitudinal social network study (Chapter 5), using the same dataset, was carried out to examine how friendship quality and the maintenance of friendships over time influence students’ subjective wellbeing. Multilevel models with network effects assessed the impact on three outcomes: overall subjective wellbeing, psychological wellbeing, and moods and emotions. Behavioral homophily in tobacco use, alcohol use, and physical activity was also tested as a moderator. Results: The review found consistent cross-sectional associations between friendship quality and wellbeing. Cross-sectional analyses confirmed these patterns, with more variation in moods and emotions. Longitudinal findings showed that improved friendship quality enhanced wellbeing, while persistent ties had mixed effects. Behavioral homophily moderated these relationships in behavior-specific ways. Conclusion: High-quality friendships support adolescent wellbeing, while friendship stability presents a more complex picture. These findings stress the need for school-based interventions that foster meaningful peer relationships and consider shared behaviors within friendship networks.11 0Item Restricted Quality of life, disability, health behaviours and recovery among women living with mental illness in Saudi Arabia: A mixed methods study(Saudi Digital Library, 2025) Almalki, Ibtihal; Inder, Kerry; Alqudah, Muhammad; O'Brien, Tony; Inder, KerryBackground Research on women with mental illness in Saudi Arabia is limited with the voices of these women not heard. Quality of life, disability and recovery are critical concerns for these women. Healthy lifestyle behaviours and their life experiences are not known. Aim To explore the experiences of women hospitalised with mental illness and to examine the quality of life, level of disability, health behaviours and personal recovery of women living with mental illness in Saudi Arabia. Methods A convergent mixed methods research design was conducted in two Saudi government-funded mental health hospitals in the cities of Taif and Jeddah in the Kingdom of Saudi Arabia. Face-to-face in-depth semi-structured interviews were used to collect qualitative data. For quantitative data, a cross-sectional survey administered three standardised and validated instruments to measure quality of life, disability and recovery: the World Health Organization Quality of Life Brief Version questionnaire, the World Health Organization Disability Assessment Schedule 2.0, and a Questionnaire about the Process of Recovery. Demographic characteristics, clinical information and health behaviours were collected from medical records and by self-report. Data were collected simultaneously and analysed separately. Qualitative data were analysed thematically. Quantitative data were summarised descriptively, and linear and logistic regression techniques were used to determine factors associated with quality of life, disability and recovery. Results from both methods were integrated and discussed to gain a comprehensive understanding of the research phenomenon with researcher reflexivity. Findings and results Individual interviews were undertaken with 19 women hospitalised with mental illness. Four major themes emerged: lived experiences with mental illnesses, the voice of recovery, lifestyle and wellness, and knowledge and understanding. The cross-sectional survey was administered to 201 women. There was a higher proportion of married women and women who were housekeepers from Taif, while there was a high proportion of single women and more highly educated women from Jeddah. Health behaviour characteristics indicated that many women were either overweight or obese and did not engage in physical activity. Final adjusted regression models revealed several key findings. Recent diagnoses with mental illness and unemployment status resulted in lower quality of life scores. Lack of exercise resulted in lower physical health and psychological health. Being single resulted in lower social relationships and environment domains, while being married resulted in lower scores for physical and psychological health domains. Married or widowed women who were recently diagnosed with a mental illness, unemployed women, women with no formal education, or who never exercised were more likely to have higher disability levels. Recent diagnosis, being younger, married or widowed, unemployed, not engaging in activity and having poor sleep resulted in lower recovery levels. This integrated approach demonstrates that face-to-face interviews can reveal deeper, context-specific factors influencing the quality of life and recovery and underscores the necessity of a holistic approach to the mental health care of women with mental illness. The interviews revealed significant challenges related to stigma, social isolation and the impact of educational background on participants’ lives, which were less apparent in the quantitative component. The survey data provided a better understanding of potentially modifiable factors to impact quality of life, disability and recovery. Both data sources aligned with the Connectedness, Hope, Identity, Meaning and Empowerment framework revealing a shared emphasis on the five key aspects of personal recovery. Conclusion This thesis uniquely explores the experiences of women with mental illness in Saudi Arabia focusing on their quality of life, disability, health behaviours and recovery providing valuable insights and implications for enhancing support and care for women. This study provides new insights into their experiences and significantly advances the understanding of women’s challenges and perspectives. Delivering recovery-based practices and advocacy programs for community and mental health professionals is recommended. Incorporating counselling services into healthcare policies, enhancing community-based support, and improving nursing practices are critical. Advancing mental health education and addressing stigma through public awareness are crucial to building a more inclusive and supportive society. Future research should focus on understanding the mental health needs of women with mental illness, addressing socio-cultural barriers to help seeking, and reducing stigmatisation and discrimination. Including more women from this vulnerable group in research allows their voices to be heard.47 0Item Restricted آليات تعزيز العلاقات الاجتماعية بين الأطباء والمرضى: دراسة ميدانية بمستشفي الملك خالد في منطقه نجران بالمملكة العربية السعودية(Saudi Digital Library, 2025) ال سالم , صالح; أ.د أبوريه , سوزانآليات تعزيز العلاقات الاجتماعية بين الأطباء والمرضى: دراسة ميدانية بمستشفي الملك خالد في منطقه نجران بالمملكة العربية السعودية. جهة الدراسة: جامعة حلوان – كلية الآداب – قسم علم الاجتماع. هدفت الدراسة الى التعرف على اليات تعزيزالعلاقة الإنسانية بين الأطباء والمرضى في مستشفى الملك خالد بمنطقة نجران كما هدفت الى تقييم العلاقة الإنسانية الحالية بين الأطباء والمرضى في المستشفى.وتقييم فاعلية الممارسات والأليات الحالية لتعزيز العلاقة بين الأطباء والمرضى في المستشفى، وايضاً تحليل العوامل المؤثرة في تشكل العلاقة الإنسانية بين الأطباء والمرضى في المستشفى وتقديم مقترحات عملية لتحسين العلاقة بين الأطباء والمرضى وتعزيز التواصل والثقة بينهما. وتكونت عينة الدراسة من 300 مريض من المرضي المترددين على مستشفي الملك خالد بمنطقه نجران بالمملكة العربية السعودية، كما تضمنت العينه (100)طبيب من مستشفي الملك خالد بمنطقه نجران بالمملكة العربية السعودية.وقد اوضحت نتائج الدراسة ان العلاقة بين الطبيب والمريض جوهر العملية العلاجية، وتؤثر بشكل كبير على نتائج العلاج ورضا المريض يرى المرضى أن العلاقة الجيدة مع الطبيب مبنية على عدة عوامل رئيسية منها التعاطف، توفير الوقت الكافي والمشاركة في اتخاذ القرارات، الثقة، التواصل والتفاهم والاحترام. وتظهر نتائج الدراسة بوضوح أن المرضى يقدرون بشكل كبير الجوانب الإنسانية في العلاقة مع الطبيب، مثل التعاطف والاحترام والتواصل الفعال. كما يرون أن المشاركة في اتخاذ القرارات وتوفير الوقت الكافي من العوامل الأساسية لبناء علاقة قوية ووثيقة. اظهرت نتائج الدراسة أن الأطباء يرون أن جميع الأبعاد التي تم قياسها ذات أهمية عالية، ولكنهم يختلفون في ترتيب أولوياتهم ومن جانبهم ايضا ، يدرك الأطباء أهمية بناء علاقات إيجابية مع مرضاهم، ولكنهم يواجهون العديد من التحديات التي تعيقهم عن تحقيق ذلك ضغط العمل، نقص الموارد، التعامل مع توقعات المرضى غير الواقعية، التنوع الثقافي.ومن خلال تحليل نتائج الدراسات المختلفة، يتضح أن هناك تلاقي كبير بين وجهات نظر المرضى والأطباء، فكلاهما يدرك أهمية الاحترام، والتواصل والتفاهم، والثقة، والمشاركة في اتخاذ القرارات، وتوفير الوقت الكافي للمريض، والتعاطف. ومع ذلك، هناك بعض الفجوات التي يجب العمل على سدها، مثل التحديات التي يواجهها الأطباء في توفير الوقت الكافي لكل مريض وتلبية احتياجاتهم.1 0Item Restricted الأخطاء النحوية والصرفية للمتعلمين في وحدة تعليم اللغة العربية للناطقين بغيرها في جامعة الطائف وطرق علاجها(Saudi Digital Library, 2025) بن صديق، عزيزة; السليماني، عبد اللههدفت هذه الدراسة إلى تحديد الأخطاء النحوية والصرفية الشائعة للمتعلمين في وحدة تعليم اللغة العربية للناطقين بغيرها في جامعة الطائف، وجوانب ضعفهم في ذلك، والوصول إلى الأسباب المؤدية إلى حدوث تلك الأخطاء، مع تقديم الحلول والطرق المناسبة لعلاج هذه الأخطاء. واتبعت الدراسة المنهج الوصفي التحليلي، حيث يقوم على وصف الصعوبات واستقراء الأخطاء النحوية والصرفية وتحديدها وتحليلها، باستخدام الاستبانة كأداة لجمع البيانات؛ للحصول على تصور حول الصعوبات التي تواجه طلاب الوحدة، وتحليلها عن طريق نماذج كتابية، بإجراء اختبار لطلاب المستوى الرابع، ومعرفة أنواع تلك الأخطاء وأسباب الوقوع فيها، ومن ثم تحقيق أهداف الدراسة للوصول إلى النتائج المرجوة. وقد توصلت الدراسة إلى مجموعة من النتائج، أبرزها: أن الأخطاء النحوية والصرفية التي يقع فيها متعلمو اللغة العربية الناطقون بغيرها تعود إلى مجموعة من العوامل، كالتداخل بين اللغة الأم واللغة الهدف، والجهل بالقواعد وقيودها، وقلة الممارسة، وطرق التدريس، وعدم كفاية التدريبات التطبيقية. كما بيّنت النتائج أن مشكلات المتعلمين ليست في الفهم النظري، بل في التطبيق العملي، وأن هذه المشكلات قد تتناقص تدريجيًا مع كثرة الممارسة، وتقدم المتعلم في المستويات التعليمية للغة. وقد أوصت الباحثة بضرورة تصميم مناهج دراسية تراعي الأخطاء الشائعة. وتقديم الدروس النحوية والصرفية بطريقة مترابطة ومنطقية، مع تجنب الفصل بينهما، وتعزيز الممارسة العملية لتثبيت المفاهيم.13 0Item Restricted Barriers and Facilitators to Uptake of Cardiac Rehabilitation Following Percutaneous Coronary Intervention in Saudi Arabia(Saudi Digital Library, 2025-06-17) Almoghairi, Ahmed Mohammed A; Duff, Jed; O'Brien, JaneBackground Cardiovascular disease remains the foremost cause of mortality and a major contributor to morbidity globally, with coronary heart disease being particularly prevalent across populations. In the Kingdom of Saudi Arabia, cardiovascular disease accounts for approximately 45% of all deaths, with coronary diseases as the leading cause. Treatment for coronary diseases typically involves lifestyle modifications and medications to manage symptoms. However, when these are insufficient, percutaneous coronary intervention is employed to restore blood flow to the heart muscle. Even with these interventions, patients who do not alter their lifestyle post procedure remain at high risk for recurrent cardiac events and rehospitalisation imposing tremendous burdens on health systems. Thus, effective post-discharge care is crucial, particularly through cardiac rehabilitation programs. Despite their proven benefits and cost-effectiveness, these programs are globally underutilised due to multiple barriers at the patient, clinician, and healthcare system levels. In the Kingdom of Saudi Arabia, the paucity of research further limits understanding of adherence to secondary prevention measures and barriers to the uptake of cardiac rehabilitation among patients with coronary heart disease. This backdrop sets the stage for this study to explore the country’s understudied areas of cardiology care. Aim This research project aims to identify the difficulties and opportunities in providing cardiac rehabilitation services to patients with coronary heart disease following percutaneous coronary intervention in cardiac centres across Saudi Arabia. Methods This PhD thesis employed a multiphase methodological approach beginning with conducting a systematic scoping review using the Joanna Briggs Institute methodology to identify effective interventions to promote uptake of cardiac rehabilitation (objective 1). This review systematically searched seven online databases for English-language articles published in the last decade, extending until October 2024. Reviewers independently assessed eligibility, and data extraction followed the Template for Intervention Description and Replication and PRISMA guidelines. The subsequent phase utilised a cross-sectional survey employing computer-assisted telephone interviews to collect insights from Saudi patients with coronary disease who underwent revascularisation at the Prince Sultan Cardiac Center in Riyadh and were clinically eligible for cardiac rehabilitation (objective 2). The study collected data from patients one-month post-procedure and aimed to evaluate their adherence to secondary prevention behaviours and identify their challenges when enrolling in cardiac rehabilitation programs. The further phase involved an observational cross-sectional study that distributed an online survey to cardiologists and cardiology fellows across Saudi Arabia (objective 3). This questionnaire was disseminated during the Saudi Heart Association's annual conference in October 2023 and extended through various social media platforms. It assessed participants' self-reported knowledge, attitudes, and practices regarding cardiac rehabilitation and determined impediments to their referral practice. Participants were required to have a minimum of six months of clinical experience managing patients with coronary disease post-percutaneous coronary intervention. The final phase involved a qualitative study using an interpretive descriptive approach, featuring recorded semi-structured interviews with key decision-makers in cardiology care within Saudi Arabia (objective 4). It aimed to identify the health system level challenges and potential enablers for the uptake of cardiac rehabilitation in the country. The analysis of these interviews was structured around the updated Consolidated Framework for Implementation Research, which guided the identification of themes. Results The scoping review highlighted that home-based cardiac rehabilitation internationally led to higher patient engagement and adherence to secondary prevention post interventions and effectively overcame several challenges at patient and health system levels. The observational study in phase two included 104 post-procedures Saudi patients with coronary diseases and showed a concerning prevalence of cardiac risk factors and significantly low adherence to secondary prevention measures, with only 10.6% being referred to cardiac rehabilitation. The most-cited barriers to enrolment in cardiac rehabilitation by included patients were inadequate program endorsement by cardiologists, absence of communication with cardiac rehabilitation care providers, and geographic distance to the service site. The subsequent survey involving 106 cardiologists revealed that, while they were knowledgeable about cardiac rehabilitation services and their benefits for patients following interventions, there was notable uncertainty regarding the quality of local services. This ambiguity, combined with unclear patient pathways and the limited availability of programs in practice areas, contributed to the reluctance of cardiac specialists to recommend these programs to their eligible patients. The last research examination interviewed nine policymakers and revealed systemic issues such as insufficient facilities, lack of cardiologists’ knowledge about cardiac rehabilitation, and shortage of qualified staff. This thesis recommends strategic improvements for consideration by the national healthcare system in Saudi Arabia to facilitate broader and successful implementation of cardiac rehabilitation programs. These reforms incorporate revising patient discharge protocols, enhancing the education and training of clinicians on cardiac rehabilitation, implementing effective referral systems, and ensuring equitable expansion of services across all regions. It also advocates for the adoption of innovative models of cardiac rehabilitation such as home-based and telerehabilitation programs, the development of supportive cardiac rehabilitation policies and regulations, and the engagement of higher authorities to drive these transformative changes. Conclusion This PhD thesis thoroughly examines effective interventions for cardiac rehabilitation delivery and identifies home-based models as effective alternatives to the underutilised traditional programs. It reveals critical findings pinpointing low adherence to secondary prevention measures and enrolment in cardiac rehabilitation programs among Saudi patients with coronary heart disease following percutaneous coronary intervention, primarily due to inadequate healthcare professional support and limited program accessibility. It indicates a significant knowledge practice gap in cardiologists within Saudi Arabia which affected the nationwide endorsement of cardiac rehabilitation. It uncovered systemic challenges necessitating urgent national reforms to boost program capacity, enhance healthcare professionals’ understanding of cardiac rehabilitation, and attract qualified personnel to the services. The integrated insights from the conducted studies significantly improve the understanding of cardiac rehabilitation utilisation within Saudi Arabia and similar contexts, laying a foundation for ongoing research to design, refine, test and implement innovative cardiac rehabilitation models, and encourage more international collaborative efforts for comparative studies of these innovative models.16 0