Saudi Cultural Missions Theses & Dissertations
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Item Restricted Understanding work participation in workers with lower limb osteoarthritis(The University of Queensland, 2024) Alyousef, Yousef Saleh; Smith, Michelle; Johnston, VenerinaAbstract Osteoarthritis (OA), particularly of the lower limb, is a prevalent health condition affecting people who are still participating in the workforce. People with lower limb OA typically experience joint pain, reduced mobility, muscle weakness and difficulties with ambulatory activities. These impairments can impact an individual’s life in several domains, including work participation. Research is scarce on the impact and management of lower limb OA in relation to work. This thesis aims to understand work participation in workers with lower limb OA using a range of indicators such as work status, work ability, productivity, absenteeism and presenteeism. This is accomplished through five studies presented across five chapters. Study 1 systematically reviewed the literature to explore work-related outcomes in individuals with lower limb OA compared to healthy controls. This review confirmed that the literature in this area is limited – seven studies were identified, two of which were included in a meta-analysis. No studies investigated work-related outcomes in individuals with foot or ankle OA. A meta-analysis revealed that individuals with lower limb OA were less frequently in paid employment than healthy controls (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies suggests that individuals with hip and knee OA have greater absenteeism and presenteeism and poorer functional capacity than healthy controls. To address gaps in the literature identified in the previous systematic review, Study 2 was a cross-sectional online survey that compared work-related outcomes and difficulty performing work in workers with (n=124) and without (n=106) lower limb OA. The survey included three validated scales of work-specific outcomes: the Work Ability Index (WAI), the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ), and the Work Role Functioning Questionnaire. We found that workers with lower limb OA have poorer work ability and productivity (p<0.001), and more difficulty with work scheduling demands and physical demands (p≤0.05) than healthy workers. There was no statistical difference in absenteeism or overall ability to meet work demands between workers with and without lower limb OA. Study 3 complemented the findings of Studies 1 and 2 by using semi-structured interviews to explore the perspectives of 22 workers with lower limb OA on difficulties they experienced at work, concerns they have about work, and strategies they use to manage at work. A thematic analysis identified six major themes related to participants’ experiences of working with lower limb OA: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three main themes were identified relating to strategies to remain at work: adjustments at work to help manage pain; regular strategies (e.g., changing positions and postures) to manage pain; and consulting healthcare professionals, but usually not specifically for work. This study identified challenges experienced by workers with lower limb OA that need to be addressed to help workers with OA to remain in the workforce. Based on the findings of Study 3, a cross-sectional online survey was conducted with Australian physiotherapists to explore their current management strategies when treating patients with lower limb OA, with the aim of determining how work concerns were addressed in their practice (Study 4). A total of 132 physiotherapists with at least two years of experience treating patients with lower limb OA completed the survey. The findings suggest that while the key interventions used by most Australian physiotherapists to manage people with lower limb OA are consistent with current clinical guidelines, most physiotherapists do not include activities to help people remain productive in the workforce. There is a need to better understand and address the lack of work support included in physiotherapy consultations with patients with lower limb OA. Study 5 conducted a systematic review and meta-analysis to determine the impact of interventions on work-related outcomes in workers with lower limb OA. Fourteen studies met the inclusion criteria, with seven studies included in the meta-analysis. The meta-analysis revealed no significant difference in employment status two or more years after surgical treatment (odds ratio: 3.47; 95% CI: 0.92, 13.14) or in work ability three months after non-surgical treatment (mean difference: 0.45; 95% CI: -1.11, 2.00) compared to pre-treatment among individuals with knee and/or hip OA. However, single studies reported positive changes post-treatment in absenteeism, work functioning and impact on work. This highlights the need for further research into work-specific interventions that address the unique challenges experienced by individuals with lower limb OA in the workplace. Overall, the findings from this thesis contribute to our understanding of work participation in workers with lower limb OA. The data provides healthcare professionals and employers with a deeper understanding of the difficulties people with lower limb OA experience at work and highlight the lack of evidence for interventions to maximise work participation in this population.27 0Item Restricted Facilitators and Barriers for Breastfeeding among Working Women in Saudi Arabia(University of Newcastle, Australia, 2024-07-23) Aldossary, Alanoud; Cummins, Allison; Prussing, ElysseBackground: Breastfeeding is an essential method of infant feeding that provides many health advantages for both the infant and the mother. Despite the World Health Organization (WHO) and United Nations Children's Fund espousing the benefits of breastfeeding for up to two years of age, returning to paid employment after the baby is born is one of the main reasons that women stop breastfeeding. There are barriers and facilitators for breastfeeding women who return to paid employment in many countries. However, there is scant information about the facilitators and barriers for breastfeeding women returning to work in Saudi Arabia. Furthermore, there is no information from the perspectives of the women, their co-workers and employers, and healthcare providers. Aims: This research explored the facilitators and barriers of breastfeeding as perceived by Saudi women in paid employment. To contextualise Saudi women’s experiences, current workplace policies related to breastfeeding and their operationalisation in the local workplace environment were examined. Also, the experiences of co-workers, line managers and employers have been sought to assess the position of workplace culture in supporting women to continue breastfeeding. Finally, the views of healthcare professionals who work with childbearing women were sought to increase understanding of the roles healthcare workers and healthcare services play in supporting women to initiate and continue breastfeeding after returning to paid employment. Methods: A mixed-methods design was conducted. The qualitative strand of this study explored the facilitators and barriers towards breastfeeding as perceived by women in paid employment, their co-workers, and line managers or employers. Data were collected by oneto-one interviews, transcribed and translated from Arabic to English. Thematic analysis was undertaken through the lens of the theory of planned behaviour to arrive at the themes and subthemes. The quantitative phase has two arms. Arm I examines the resources and spaces available in the workplace to support breastfeeding practices. The settings were in Dammam in the Eastern Province of Saudi Arabia and comprised two government sector locations: Imam Abdulrahman bin Faisal University (IAU) and Maternity and Children Hospital (MCH), and two private sector locations: Alfaisliyah School and Almana General Hospital. Data were collected via direct observation of current workplace policies, and current breastfeeding spaces and resources available to support breastfeeding women in their work environment. Arm II vi explores the role of nurses and midwives in supporting women to initiate and continue breastfeeding after returning to paid employment. A total of 123 nurses and midwives agreed to participate and complete the survey. Data were collected via the participants’ survey completions. Online surveys were conducted using SurveyMonkey and paper surveys were collected by the main researcher. Result: The study showed that immediate family members such as mothers, sisters and grandmothers are important social networks to support breastfeeding women after return to paid employment, and that the woman’s husband plays a critical role in the woman’s continuation of breastfeeding. In addition, healthcare professionals (nurses and midwives) were sources of information for women. However, the perception of breastfeeding support was influenced by aspects such as the knowledge and skills of the healthcare professionals (nurses and midwives). This study showed that workplaces are lacking facilities, such as private rooms with a clean sink and refrigerators, to allow breastfeeding women to express breast milk and to store the milk. In addition, this study found that the 70 days of maternity leave was not enough to achieve the goal of breastfeeding and the WHO recommendation of exclusive breastfeeding for six months. Finally, the findings from this study showed the challenges facing breastfeeding women after return to paid employment due to the fact that the private and government sectors might not have sufficient resources to accommodate the needs of breastfeeding women after return to paid employment. Significance of research: The findings from this research have the potential to increase knowledge regarding the factors that facilitate or hinder Saudi women’s decision to initiate breastfeeding and to continue breastfeeding on return to paid employment. Additionally, understanding of Saudi healthcare workers’ current skills and knowledge base related to breastfeeding may be increased. It is conceivable, therefore, that results from this research can support the development of policies and practices that will facilitate breastfeeding initiation and duration rates among Saudi working women.55 0