Saudi Cultural Missions Theses & Dissertations
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Item Restricted An Exploration of the Acceptance of Telerehabilitation in Saudi Arabia: Physiotherapists' and Patients' Perspectives(University of Nottingham, 2024-01-29) Alanazi, Ahmed; Wharrad, HeatherBackground: Providing long-term treatment and monitoring for patients, especially those with neurological conditions, requires resources which are not always available. Consequently, finding innovative solutions that can ease the financial and physical burden of chronic conditions is essential. Telerehabilitation offers a potential solution to this challenge, and it was widely used during the COVID-19 pandemic, when face-to-face rehabilitation services could not be provided. However, despite its clinical effectiveness, previous studies suggest that its application may be impeded by users’ concerns, and an inadequate understanding of the practical implications of the discipline. The number of people with chronic disabilities in the Kingdom of Saudi Arabia (KSA) exceeds one million, and these patients require regular sessions with physiotherapists; however, accessing rehabilitation services can be difficult and costly, especially for those in rural or remote areas. Although telerehabilitation was used in the Saudi healthcare system before the pandemic, no formal framework to support its implementation exists and the potential barriers to its wider adoption in the country have not been clearly identified. As a result, this study explores the acceptance of telerehabilitation among physiotherapists and patients with neurological conditions in KSA and proposes a potential strategy for its nationwide implementation which takes account of the country’s large geographic area and its socio-religious context. Methods: This study adopts a pragmatic philosophical paradigm and employs the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) models to identify the factors which influence Saudi physiotherapists’ and patients’ acceptance of telerehabilitation. It also utilises Q methodology to gather and analyse the data, introducing a novel online approach to data collection in response to the limits on face-to-face engagement as a result of the pandemic. Results and discussion: The physiotherapist participants viewed telerehabilitation as beneficial, particularly for patients in rural or isolated areas, but they expressed concerns about data security, and the lack of training and technical support. The use of Q methodology enabled them to be categorised into three attitude-based groups: Advocates, who supported telerehabilitation for its cost-effectiveness; Pragmatists, who were open to healthcare technology but emphasised the need for better patient understanding of the uses of telerehabilitation; and Hesitants, who were uncertain and concerned about missing important clinical information. The patients with MS had varied perspectives, appreciating potential benefits, such as cost savings, but expressing concerns about data security and highlighting the lack of support from family and friends as a potential barrier. These patients were also categorised into three groups: Supporters, who recognised telerehabilitation's benefits but had concerns about a lack of suitable space at home and would prefer to be treated by a physiotherapist of the same gender; Rationalists, who accepted telerehabilitation's potential benefits but who thought more resources were required in order to accept it; and Resisters, who questioned its effectiveness over face-to-face rehabilitation. Barriers to telerehabilitation acceptance included the lack of facilitating conditions, such as training, guidelines, and equipment, individual differences such as age, gender knowledge, digital literacy, and medical conditions, and social influence, such as lack of support and encouragement from physiotherapists and family and friends to use telerehabilitation. These findings informed the development of a logic model for a strategy to implement telerehabilitation in KSA, which considers religious and cultural beliefs in KSA, and addresses the barriers identified above. The model sets out the desired outcomes, necessary inputs, and activities for physiotherapists, patients and healthcare services. It also lists the short-term, medium-term, and long-term outputs, the assumptions on which the model is based, and the external factors which might affect its implementation, including the rapid rate of social change in KSA. Conclusion: This study fills a gap in the literature by examining users' perceptions of telerehabilitation in KSA and identifying the barriers to its acceptance among two key stakeholders groups. The logic model contributes to society by outlining a strategy for the implementation of telerehabilitation in KSA, and, potentially, in other countries which share its cultural and religious values. The study also contributes to Q methodology by demonstrating an innovative method for online data collection and evaluating its effectiveness. In addition, the use of Q methodology in combination with the TAM and UTAUT models provides a methodology to assess user acceptance of healthcare technologies which could be used in other contexts. As such, the findings of this study are of immediate value to policy makers and healthcare providers in KSA, but they also have wider implications. Future research in the Saudi context should focus on the feasibility of the proposed strategy, including cost-benefit analyses and practical trials, and exploring perceptions in other rehabilitation fields, such as occupational and speech therapy.44 0Item Restricted Exploring the barriers and facilitators experienced by physiotherapists and patients with musculoskeletal conditions when using digital health interventions as a self-management approach in Saudi Arabia: a sequential explanatory mixed method study.(Cardiff University, 2024-02-08) Sroge, Roaa; Carrier, Judith; Sparks, ValerieBackground: Musculoskeletal (MSK) conditions constitute a significant public health challenge due to their increasing incidence and potential severe negative impact on patients' quality of life. One recommended treatment is self-management, endorsed in MSK management guidelines, including the National Institute for Health and Care Excellence guideline (2021). Self-management for MSKs can be delivered via digital health interventions (DHIs), which is the term referred to as the delivery of healthcare and the translation of information, knowledge, and communication via digital technologies to help the individual manage their health and well-being. Purpose: The present thesis aims to determine and identify barriers and facilitators to recommending and using DHIs by MSK patients and physiotherapists in Saudi Arabia. Methods: This study used sequential explanatory mixed methods. A cross-sectional design utilised an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and cultural factors for two populations (MSK patients and physiotherapists). Eighteen users (11 physiotherapists and seven patients with different MSKs) were interviewed within seven physiotherapy departments. This study was conducted during the time period when the use of DHIs was made mandatory by the Ministry of Health (MOH). An audio recording, verbatim transcription, and English translation of the interviews were conducted. Descriptive analysis was used to interpret the quantitative data, and reflexive thematic analysis was used to analyse the qualitative data. Findings: The questionnaire was completed by 143 respondents (76 physiotherapists and 67 MSK patients). Regarding the patient's characteristics, the most common condition for patients was low back pain (LBP) 46.3% and arthritis 25.4 %, with the majority being chronic conditions (71.6 %). The experience level of utilising DHIs up to two months was common for physiotherapists and less than two months for patients. Almost 90% of patients received no training before using DHIs. Regarding the UTAUT framework, there were mixed views on the compatibility of DHIs with patients’ needs. However, both physiotherapists and patients agreed that DHIs improved their therapeutic relationships. Notably, both the physiotherapists and patients also had a substantial level of agreement about their intentions to use and expectations of using DHIs in the future. However, their rate of agreement was lower for using DHI regularly. Four themes were identified under thematic analysis, revealing the areas that support the utilisation of DHIs. Concepts reported within all four themes included aspects, such as perceived effectiveness, patients' willingness to use DHIs, cultural impact, and social influences. The study indicated that physiotherapists who used DHIs before the health delivery organisation deemed this type of delivery mandatory were likely to recommend DHIs to patients with MSKs. Conclusion: The study reveals that despite initials challenges, such as lack of training and mixed views on compatibility with patient needs, DHIs were viewed positively by both physiotherapists and patients for managing MSK disorders. Although there is a high agreement among physiotherapists and patients about their intentions and expectations to use DHIs in the future, efforts should be made to enhance their regular use in Saudi Arabia. Implications and recommendations: The study contributes both theoretical and practical implications. Concerning its theoretical contribution, it enriches the literature on DHIs by using the associated constructs of the UTAUT model. Its practical contribution offers valuable information to guide and support the implementation of DHI and training of public hospital physiotherapists and enhance MSK patients' awareness of the benefits of using DHIs. Having physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a potentially effective strategy to increase the use of this treatment method Further research is needed to provide insight into the barriers and facilitators that non-users of DHIs may encounter because the current study only included users of DHIs.35 0Item Restricted Exploring And Assessing The Level Of Physical Activity Among Physiotherapists In Saudi Arabia: A Cross-Sectional Survey(2023-03-06) Alnaji, Abdulelah Hussain; Phillips, NicolaBackground: Physical activity (PA) is an essential part of good health. There is considerable evidence of declining PA globally, including in the Kingdom of Saudi Arabia (KSA). One of the primary goals of physiotherapists is to advocate for a healthy lifestyle. Since physiotherapists act as healthy role models for their patients. However, there is a lack of information about PA among physiotherapists in KSA. Aim of the study: The current research aimed to explore the level of PA among physiotherapists in KSA and to understand the barriers to and facilitators of PA. Design: A cross-sectional survey. Methods: This study included 172 physiotherapists currently working in the KSA as citizens or residents, a large percentage of whom were male (71%; n: 122). Between 28 December 2022 and 2 February 2023, the investigator distributed an online form of the international physical activity questionnaire (short version) via various social media platforms such as Twitter and Facebook. Results: The study's findings demonstrate: (1) 9.3% (n = 16) of the study respondents did not engage in any PA; (2) the majority of the participants (90.7%, n:156) engaged in various intensities of moderate, vigorous, and a combination of moderate and vigorous PA; (3) more than half (61%, n: 105) of the respondents followed the international PA recommendations; (4) lack of time and work commitments were the most significant challenges that the participants faced when they engaged in PA; (5) motivation to improve health and losing or maintaining weight were the most notable facilitators for participating in PA among the participants. Conclusion: According to the results, a high percentage of physiotherapists in this study participated in PA. However, nearly 39% of study participants did not meet international PA recommendations. Thus, a study with large sample size is needed to improve the generalisability of the findings.13 0