Saudi Cultural Missions Theses & Dissertations
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Item Restricted Investigating opportunities to provide behaviour change conversations to promote child oral health in non-dental settings(University of Manchester, 2024) Alshammari, Dalil; Peters, Sarah; Goldthorpe, Joanna; Coupe, NiaBackground: In 2022, almost a quarter of 5-year-old children in England had at least three untreated teeth with deep tooth decay. This is partly due to limited access to dentists, suggesting a need for additional ways to support children's oral health. Therefore, this PhD project sought to investigate opportunities to provide behaviour change conversations (BCC) to reduce children's oral health problems in early years settings (EYS). Method: The thesis aim was addressed through three stages using a mixed-method approach. In the first stage, a secondary analysis was conducted of electronic records of children referred to general dental anaesthesia in northwest England for tooth extraction. In the second phase,14 parents and 11 EYS staff were interviewed to explore their views regarding delivering and receiving messages to promote children's oral health. Sampling of participants sought to include those from varied backgrounds and 8 (57%) of parent interviews were conducted in Arabic. A systematic approach was developed to ensure accurate translation of non-English data, which preserved cultural and linguistic nuances during analysis. In the final stage, the behaviour change wheel approach was used to design an intervention to address the barriers and challenges identified in the previous stages. Results: Stage one revealed that despite an increased need, there were 90% fewer referrals to general anaesthesia during lockdown than in the corresponding period in the previous year. These findings indicate the need to explore the potential for non-clinical settings to address children’s oral healthcare. Stage two revealed that parents have limited awareness of oral health activities in EYS. They acknowledged that EYS staff could influence children's oral health behaviours, but identified several limitations, such as staff credibility. EYS staff recognised the need to address child oral health yet viewed the inclusion of oral health activities as overwhelming and reported how they avoid difficult conversations about oral health with parents. In response to the challenges of translating non-English data, a framework consisting of six stages was developed to ensure accurate translation and to guide researchers through the translation process. In stage three, the ToothTalk toolkit intervention was developed to facilitate communication between EYS staff and parents regarding children's oral health. This comprised a booklet for staff with information and behaviour change techniques to support their conversations, and an accompanying parents’ interactive workbook. Conclusion: The thesis provides timely and important evidence to support the existing rollout and proposals for expanding oral health practice at EYS in England, which may have potential also for other geographical localities. It found that oral health is considered a delicate conversation where staff need training to develop the necessary communication skills and confidence to initiate and hold tooth-kind conversations. Parents need support to trust and engage more in these conversations. The ToothTalk intervention was developed to address the identified barriers, which aim to increase the frequency and quality of oral health-related discussions initiated by EYS staff with parents. Further research is necessary to evaluate its effectiveness and acceptability in the EYS context. As well as its potential to be tailored to other contexts both within the four nations of the UK, and beyond.17 0Item Restricted mHealth technology-mediated patient engagement model: A mHealth asthma management app in Saudi Arabia as a case study(University of Wollongong, 2024-04-24) Almutairi, Nawaf; Win, Khin Than; Vlahu-Gjorgievska, ElenaPatient engagement is currently considered the cornerstone of a revolution in healthcare for its positive impact on health outcomes, health behaviors and healthcare costs. Patient engagement focuses on providing consumers with personalized care through knowledge, skills, and confidence. The healthcare domain has adapted health information technology (HIT) to improve consumer health, as consumer health informatics is a new field designed to engage consumers by providing health information. Globally, there appears to be a rise in mobile health (mHealth) applications and technology related to health behavior. Thus, giving such mHealth applications to chronic disease patients could boost their engagement by helping them understand and improve their health conditions, sustain their health improvements, and respond to changes in their behaviors. However, there are some indications of a decrease in chronic patients’ engagement with mHealth applications, and their effectiveness has been considered low in quality. Additionally, the developed mHealth applications have not incorporated behavior change theories, often resulting in designs that lack a theoretical foundation. Consequently, there has been little use of behavior change theories to increase patient engagement. Prior studies have noted that there is room for improvement, mostly regarding mHealth applications that facilitate patient engagement. Each mHealth application should be designed in a way that is valuable to the relevant stakeholders. Nevertheless, most of the mHealth applications have not involved all relevant stakeholders in the design and development phases and thus have not considered some important aspects such as human values and ethics. Therefore, this research aims to develop a mHealth technology-mediated patient engagement model; and to design and develop a mHealth management application for patients with chronic conditions. This research adopted a design science research paradigm to answer the research question by achieving its aims and objectives. The design science research methodology (DSRM) steps were followed to guide this design science research. Thus, the entry point of this research is problem-centered initiation—an initial literature review was conducted and directed by the problem of this research to present meta-requirements. Then, a systematic literature review and meta-analysis were conducted to develop a conceptualized design model. The developed model aimed to provide persuasive engagement features of the mHealth application for patients with chronic conditions. Asthma as a chronic disease in Saudi Arabia was chosen in this research as a case study to examine the artifact in depth in a business environment. A value-sensitive design (VSD) approach was employed to identify all the relevant stakeholders and their values and translate them into design requirements for a mHealth asthma management application. Semi-structured interviews were conducted after all the relevant stakeholders had been identified. The identified design requirements were mapped into the persuasive system design (PSD) model to design the prototype and develop the application. During this research, an online survey was conducted in this research to validate the proposed conceptual design model and the identified design requirements by evaluating the app’s content and functionality. The researcher posted online advertisements across social media platforms inviting asthma consumers to participate in the research. The online survey comprised 18 items to evaluate usability, perceived persuasiveness, and the user’s intention to continue using the app. The researcher adopted the mHealth app usability questionnaire (MAUQ) as well as validity testing of the modified MAUQ (m-MAUQ) was conducted in this study. The internal consistency for the total variables was high, as indicated by Cronbach’s alpha values above 0.7, which signifies good reliability. Then the m-MAUQ was pilot-tested with 12 asthma consumers before conducting the empirical study. Further, usage data of the application was collected through system log i files to evaluate asthma user engagement. This design science research showed four DSR cycle outcomes. The systematic literature review and meta- analysis results identified 11 persuasive design features that showed patient engagement-related outcomes, including increasing self-management skills, self-efficacy, medication adherence, clinical condition improvement, increasing awareness, and health behavior improvement. Behavior change techniques (BCTs) were combined with the identified persuasive design features. Then, the conceptualized design model was developed, which comprises the identified persuasive features of the mHealth application design that capture BCTs and facilitates engagement-related outcomes. An artifact was identified as a mHealth asthma management application, and Saudi Arabia was identified as a case study for this DSR research. Healthcare professionals were identified as indirect stakeholders, and asthma consumers were identified as direct stakeholders. The stakeholders identified nine values for the mHealth asthma management application: Safety, Awareness, Credibility, Usability, Accessibility, Autonomy, Competence, Relatedness, and Connectivity. These values were translated to 59 design requirements and then were mapped into 19 persuasive design features. This research’s results indicated that the developed conceptualized design model could influence the engagement of patients with chronic diseases toward changing their behavior. The findings indicated that identified persuasive engagement of mHealth applications have various patient engagement-related outcomes. This study’s findings demonstrated that the identified stakeholders' values and design requirements could be considered valuable contributions to the mHealth asthma management applications design and content creation. The evaluation of the “My Asthma” application indicated that the asthma consumers were satisfied with the app's content and functionality and overall perceived the app’s persuasiveness. They stated that it was well-organized, visually aesthetic and user-friendly. Further, the evaluation indicated that asthma consumers intend to continue using the app. Finally, the research provided its findings’ implications and recommendations for future research.19 0