Saudi Cultural Missions Theses & Dissertations
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Item Unknown Facilitators and barriers to the adoption of teledentistry in Saudi Arabia from the care providers' perspectives. A systematic review(Saudi Digital Library, 2025) Hakami, Amjad; Mohan, SarikaBackground: Teledentistry has emerged as a tool that holds great potential to enhance access, efficiency, and continuity of oral healthcare delivery. In Saudi Arabia, its adoption is important in the context of the health transformation programme and Vision 2030, in addition to the high prevalence of dental caries, especially among schoolchildren. Despite this potential, adoption is still limited. In this context, there is a need to systematically assess the factors influencing its adoption from the care providers’ perspectives. Objectives: This review aimed to systematically identify the facilitators and barriers to the adoption of teledentistry in Saudi Arabia, with the focus on the perception of dental care providers and dental students. Methods: A systematic review was conducted in accordance with PRISMA 2020 with narrative synthesis based on SWiM guidelines. PubMed, SCOPUS, Medline, Embase, and CINAHL databases were searched, covering publications up to 4th July 2025. The PICO framework was used to define the inclusion and exclusion criteria, and the CASP checklist was used to assess study quality. Data were synthesised using vote counting by direction of effect, categorising findings into facilitators and barriers. Results: After screening 156 records, 11 studies met the inclusion criteria. Study quality ranged from 7-11/11 based on the CASP checklist for cross-sectional studies. Key findings included facilitators such as improved access, efficiency and cost-effectiveness, communication and referral enhancements, educational benefits, and positive perception of technology. The key barriers were limited awareness and training, infrastructure and equipment reliability, privacy and data security, cost and financial issues, diagnostic accuracy, and the preference for in-person meetings. Conclusion: Teledentistry holds great potential, but its adoption is still limited in Saudi Arabia. Addressing the challenges that hinder adoption and empowering the facilitators that support it is important to ensure successful adoption. Improving infrastructure, enhancing training and integration into dental curricula, and strengthening regulatory frameworks are essential to ensure equitable adoption.12 0Item Unknown Developing a National Cybersecurity Threat Information Sharing Framework(Saudi Digital Library, 2025) Alkalabi, Waleed Abdulrahman; Morarji, Hasmukh; Simpson, LeonieCyber risks are increasing as industries undergo digital transformation. Therefore, employing advanced countermeasures to protect information assets against these risks is crucial. Cyber threat information sharing enables public, private, and government organisations to coordinate efforts to enhance national cybersecurity resilience. This is done by identifying, assessing, monitoring, and responding to newly discovered cyber threats. Allowing one organisation’s detection to become another’s prevention. Many developing and less developed countries in Africa, the Americas, Asia-Pacific, and the Arab states have not yet implemented national cybersecurity strategies and lack the necessary technologies to address cyber threats. Therefore, this study aims to promote cyber threat information sharing and facilitate the sharing of cyber threat information in developing countries. This thesis examines cyber threat information sharing practices in two case study countries: (i) Saudi Arabia and (ii) Australia. This thesis explores the challenges and benefits of cyber threat information sharing. It utilises them to successfully build a framework for implementing cyber threat information sharing in developing countries. This multiple case study approach investigates similarities and differences in cyber threat information sharing practices between a developed and a developing country to determine the optimal method for implementing cyber threat information sharing. This research presents a Multivocal Literature Review (MLR) to identify the barriers and incentives related to sharing cyber threat information. It then explores the most important factors for sharing cyber threat information in each case study country. This research conducts surveys with cybersecurity experts to determine critical success factors (CSFs) for cyber threat information sharing for each country. Then, the total interpretive structural modelling (TISM) technique was employed to build the relationships between the CSFs and develop a cyber threat information sharing model for each case study country. Finally, cybersecurity experts in the respective countries validated both developed models. The findings will be helpful for national authorities and cybersecurity professionals to successfully plan and implement effective national cyber threat information sharing practices. The developed TISM models can assist decision-makers in Saudi Arabia and Australia in implementing and improving current cyber threat information sharing practices.23 0Item Unknown The Role of AI Tools in Reshaping Barriers to Entrepreneurship: A Systematic Literature Review(Saudi Digital Library, 2025) Alhubaish, Abdullah; Morlacchi, PieraThis dissertation investigates the role of artificial intelligence (AI) tools in reshaping barriers to entrepreneurship. While earlier research often presents AI as a simple enabler, this study adopts a more nuanced perspective, examining how AI removes, reconfigures, and introduces entrepreneurial constraints. A systematic literature review (SLR) of 79 sources published between 2015 and 2025—including 63 academic articles and 16 grey literature reports—was conducted using a structured coding framework. The review focused on how AI reshapes barriers, which applications drive these changes, its influence on business model innovation and product development, the risks of bias in large language models (LLMs), and the implications of divergent regulatory frameworks, as well as persisting gaps and future research directions. The analysis identifies a threefold dynamic. AI lowers traditional barriers such as high capital requirements, specialist expertise, and labor intensity; reconfigures entrepreneurial challenges by demanding new competencies in digital judgement, orchestration, and AI literacy; and introduces novel barriers, including algorithmic bias, regulatory fragmentation, and psychological pressures. Generative models and predictive analytics emerge as the most transformative applications, enabling ideation, prototyping, storytelling, and evidence-based decision-making. At a strategic level, AI accelerates business model innovation and iterative, data-driven product development, while raising concerns around ethics, intellectual property, and dependence on external infrastructures. This study contributes to knowledge by integrating academic and grey literature, reframing AI as a re-shaper rather than merely a remover of barriers and highlighting capability asymmetry and regulatory divergence as critical issues for research and practice. For entrepreneurs, the findings underscore the importance of AI literacy and responsible adoption as conditions for sustainable advantage. For policymakers, they emphasize the urgency of harmonized regulation and inclusive digital capacity-building. Overall, AI emerges as both an equalizer and a potential new gatekeeper in entrepreneurial ecosystems.26 0Item Restricted Barriers And Opportunities For Practising Creativity And Creative Teaching With Gifted Girls In Primary Schools In The KSA(University of Exete, 2024) Almasoudi, YasamiyanIn recent years, the Saudi educational system has witnessed significant changes and developments aimed at enhancing students’ performance by promoting creativity and nurturing creative and gifted students in primary schools. Encouraging creativity and creative teaching has become one of the basic goals of the Saudi Arabia’s Ministry of Education (MoE) with focus on teachers and students, which it evaluates through supervision of teachers and primary schools. However, recent research indicates the failure of many schools and institutions that sponsor gifted students to promote students' creative abilities, which would contribute to enhancing their talents. Accordingly, it is necessary to conduct research into this area of Saudi Arabian education to explore the perceptions of female teachers, supervisors and gifted female students about creativity and creative teaching with gifted students in girls' primary schools. This research responds to this need and aims to study and explore the perceptions of female teachers, supervisors and female gifted students about barriers and opportunities facing the promotion of creativity and creative teaching practices in Saudi Arabian girls' primary classrooms and current curricula. The study was conducted using the exploratory interpretive methodology. Interviews and focus groups, with analysis informed by a constructivist grounded theory approach, were used to obtain in-depth data to understand participants' responses from different perspectives. Data were collected in this study using semi-structured interviews with nine female teachers who teach classes that include female gifted students, and four female supervisors who supervise teachers of classes with female gifted students. Also, 14 female gifted students from public and private schools identified as gifted from the fourth to sixth grades in the girls’ primary level took part in three focus groups. Through these tools, a rich set of data was analysed to answer the research questions and objectives. The results of this study revealed that participants have clear concepts about creativity and its role in the classroom, whether for ordinary or gifted girls. Despite this, the participants pointed to a selection of barriers facing the promotion of creativity and creative teaching in girls’ primary schools. There was a lack of professional training that aims to develop female teachers for creative teaching and creative teaching practices, as well as dealing with gifted students, for teachers, in addition to a lack of time and resources in schools and the integration of female gifted students with many students in regular classes. On the other hand, teachers pointed to opportunities that enhance creativity among students, such as applying a set of practices to enhance creative teaching and learning strategies, cooperative learning, brainstorming, learning by playing and self-learning. The results of this study also revealed that the current curricula in the Kingdom of Saudi Arabia (KSA) help enhance creativity although they do not seem appropriate for gifted students. The results of this study provide a comprehensive understanding of the current landscape of creativity and creative teaching in one area of Saudi Arabia. They also provide valuable insights into the possibility of promoting a more creative and inclusive educational environment for all students, especially gifted girls. Therefore, in addition to its contributions to researchers and education professionals, this study is also valuable to educational policymakers in Saudi Arabia.12 0Item Unknown Equity and Access to Healthcare Services: A qualitative analysis of the maternity care experiences of Arab migrant women in Scotland(University of Dundee, 2025) Gashgari, Dawood; Symon, Andrew; Lee, ElaineBackground: Globally, migration has surged over the past two decades, with the UK emerging as the fifth top destination, hosting over 9.5 million foreign born residents (IOM, 2021). There has been a gradual increase in the number of new female migrants in the country. These trends emphasise the importance of meeting the maternity care access needs of new migrants, ensuring equitable access to services, and adapting these services to diverse cultures. This study’s initial scoping review mapped the literature about maternity care access experiences among newly arrived migrants in EU/EFTA countries. It identified limited studies about newly arrived migrant women in Scotland, a country experiencing population growth due to migration. Among migrant group that received little attention despite their numbers are newly arrived migrant women from Arab countries. Aim: To explore and describe the maternity care access experiences of newly arrived Arab migrant women who have given birth in Scotland, and for whom English is not their first language. Methods: A Qualitative Descriptive study was conducted using the Levesque et al. (2013) 5As access to healthcare framework. Twenty participants from various Arab countries and with different migration statuses were selected from Scotland’s four largest cities through purposive sampling strategy. In-depth semi-structured telephone interviews were conducted, focusing on their experiences. Thematic Analysis (TA) was employed to analyse the interviews. Findings: Participants reported varied experiences at different stages of maternity care, with more challenges than facilitators in accessing care. An overarching theme ‘Expectation and reality’ and four other themes were identified from the data. These are: 1) Perceived availability and appropriateness of maternity care; 2) Motivators and inhibitors when seeking maternity care; 3) Communication; and 4) Encounters with healthcare professionals. Discussion and Conclusion: The study highlights lack of familiarity and discrepancies between expected and actual care experiences, affecting experiences and perceptions of maternity services. Participants faced several challenges at both service and organisational levels, leading to criticism and resistance behaviours such as appointment avoidance and exaggerating conditions. The study shows how initial self-directed barriers could transform into motivators, and vice versa, which influenced participants’ decisions to seek, accept, or avoid care. It also identifies substantial communication barriers due to language difficulties and the inadequacy of interpretation services. This, along with a lack of tailored informational materials, significantly affected access to and understanding of maternity care services. Positive interactions with healthcare professionals fostered feelings of equality and welcome, while negative encounters often resulted in perceptions of discrimination. Recommendations include improving information provision and adopting women-centred, culturally sensitive practices to enhance maternity care for migrant women.17 0Item Unknown Readiness to expand the role of the nurses working in primary healthcare centres in Saudi Arabia to include prescribing: An exploratory descriptive qualitative study(Cardiff University, 2024) Albariq, Khloud Mohmmed; Albariq KhloudAbstract Introduction: Primary healthcare centres (PHCs) in Saudi Arabia are the first point of contact for patients across the country (Al Saffer et al., 2021). However, these PHCs face various accessibility challenges, including unequal distribution of PHCs and their services (Al-Sheddi et al., 2023), a shortage of medical professionals (Al Saffer et al., 2021), a lack of specialised services (Makeen et al., 2020), and long waiting times (Albarhani et al., 2022). One way to enhance accessibility, reduce waiting times, and alleviate various burdens on the healthcare system in Saudi Arabia is to grant nurses prescribing rights (Hibbert et al., 2017; Almotairy et al., 2023). However, Saudi research into the readiness to incorporate the prescribing role into nursing practice in PHCs is currently lacking. This study aims to investigate readiness to incorporate the prescribing role into nursing practice in Saudi PHCs. Methods: An exploratory and descriptive qualitative (EDQ) research was used as the chosen methodology. Twenty-five individual semi-structured interviews were thus conducted with participants who were divided into three groups: this gave ten nurses at the micro-level, five nursing supervisors and five managers at the meso-level, and five policymakers at the macro-level. The collected data was then analysed using reflexive thematic analysis (RTA). Findings: Six key themes emerged from the data analysis. These were improving primary healthcare services, nurse-doctor partnership prescribing, educational preparation, acceptance of the nurse prescribing role, establishing the legality of the nursing prescribing practice, and readiness of primary healthcare centres. Conclusion: Implementing the nurse prescribing role in PHCs services has the potential to improve PHC services through enhancing accessibility and reducing waiting times. A nurse-doctor partnership prescribing approach may be implemented, in which nurses and physicians share prescribing responsibilities while doctors remain responsible for diagnosis. However, nurses’ general lack of pharmacological knowledge is a major obstacle, requiring additional focus on educational preparation. Another potential barrier could be a lack of acceptance of the nurse prescribing role among patients, doctors, and nurses. Several changes are thus necessary to existing systems, including the introduction of clear legislation and regulations and ensuring the readiness of PHCs to smooth the implementation of the NP role.28 0Item Unknown Development and Evaluation of an Educational Resource to Promote Skin-to-Skin Contact between Mother and Neonate in Saudi Arabia(The University of Newcastle, 2024-12) Hawsawi, Abeer; Fernandez, Ritin; Mackay, Maria; Alananzeh, Ibrahim; Al Mutair, AbbasIntroduction Skin-to-skin contact is crucial for both the baby and the mother for a better health outcome but the low practice rate in Saudi Arabia is a national concern. Consequently, there was an urgent need to develop an educational intervention to improve the uptake of skin-to-skin contact. Therefore, this study aimed to develop and evaluate the effectiveness of educational resources to promote skin-to-skin contact in Saudi Arabia. Methodology and methods A multi-method design, grounded in the Knowledge to Action framework, included a scoping review, surveys, and a clinical controlled trial followed by a mixed-methods approach incorporating semi-structured interviews and surveys. The educational resources, available in both English and Arabic, consisted of a pamphlet, a PowerPoint presentation, and a short video. These resources were developed through co-creation, involving healthcare providers, mothers, and university researchers. An online consensus development conference involving 14 participants ensured the cultural and linguistic appropriateness of the resources. A total of 383 participants were recruited from two Saudi hospitals (control, n=192 and intervention, n=191) using a convenience sampling method to test the effect of the educational resource. Data analysis Data were collected using online surveys before and after the educational intervention. Semi structured interviews with eight mothers in the intervention group further explored their experiences with the intervention. The data were analysed using SPSS version 29. Descriptive and inferential statistics, including Chi-square and T-tests, were used to compare outcomes between the control and intervention groups. A p-value of <0.05 was considered statistically significant. Qualitative data from interviews were analysed using thematic analysis. Results The online consensus development conference effectively guided the development and implementation of the educational intervention. The rates of correct skin-to-skin practice and breastfeeding within an hour after birth were significantly higher in the intervention group. Mothers reported a highly positive experience with the educational intervention. Conclusion The online consensus development conference facilitated the design and implementation of an effective intervention, significantly improving adherence to optimal skin-to-skin and early breastfeeding practices, with high maternal satisfaction.30 0Item Unknown Perceived Barriers and Facilitators by Critical Care Nurses and The Impact of Cultural Variations Between Nurses and Patients on End-Of-Life Care at Intensive Care Units(University of Cincinnati, 2024-10-18) Alali, Khairayah; Smith, Carolyn R.Background: Due to the complexity of medical conditions in the intensive care unit (ICU), mortality rates are typically high in most hospitals. End-of-life care (EOLC) begins when curative treatments are no longer beneficial, shifting the focus to comfort and quality of life for patients and families. Despite EOLC being a standard part of ICU management, healthcare professionals encounter complexities and uncertainties when transitioning from life-saving treatments to comfort-focused care. Additionally, EOLC in the ICU is influenced by the cultural backgrounds of both nurses and patients. The nursing culture in Saudi Arabia reflects a diverse workforce, with a significant reliance on expatriate nurses from various countries, leading to cultural and language differences that can influence EOLC. Objectives: To explore the perceived barriers and facilitators of critical care nurses in providing EOLC in intensive care units, how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients. Method: The study employed a qualitative descriptive method, utilizing semi-structured interviews that were conducted virtually through Zoom. Purposeful sampling techniques and a homogeneous sampling approach were used to recruit participants. Open-ended questions were used from an interview guide to prompt the critical care nurses to share their viewpoints and experiences. Results: The exploration of the perceived barriers and facilitators of critical care nurses during EOLC for terminally ill patients in the ICU revealed three main themes: (a) EOLC barriers, (b) EOLC facilitators, and (c) suggestions to improve the EOLC and overcome barriers. The exploration of how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients revealed five main themes: (a) cultural practices and traditions of patients & families, (b) cultural competence during EOLC, (c) culturally competent nursing care decisions and actions (d) challenges in providing culturally competent nursing care, and (e) suggestions to improve cultural competence. Conclusion: This study identified barriers to EOLC, including family acceptance, understanding of EOLC, unrealistic expectations, over-involvement, poor policy awareness, staffing shortages, high workloads, care continuity, and insufficient training. Nurses showed a strong commitment to respecting patients' cultural and religious practices but faced challenges in delivering culturally competent care. Recommendations include better family education, clear communication, integrating EOLC training into nursing education, addressing language barriers, implementing advance directives, and fostering a collaborative team environment with adequate resources and flexible visiting hours. These steps can enhance the quality and compassion of EOLC.58 0Item Unknown Developing an Evidence-Based Educational Framework to Support the Trauma Care Competencies of Intensive Care Unit Nurses in Saudi Arabia(King’s College London, 2024-02) Almarhabi, Maha Ahmed; Philippou, Julia; Cornish, Jocelyn; Raleigh, MaryBackground The management of trauma patients in intensive care units (ICU) has a significant impact on patients’ survival and outcomes. Trauma care during this phase is complex, and care management requires skilled and knowledgeable nurses to deliver competent care and improve patient safety and outcomes. To ensure the delivery of competent care within the high-tech and constantly changing ICU practice, continuous and in-service education/training are needed. Research on trauma care education beyond emergency in critical care environments is scarce, especially in contexts that have a workforce with diverse educational backgrounds. Overarching aim To develop an educational framework that informs the basis of and/or theoretically drives interventions for supporting ICU nurses' trauma care competencies, meeting the needs of a mixed-culture workforce context in Saudi Arabia. Design and Methods The study was guided by the Medical Research Council (MRC) framework for developing complex interventions and consisted of three phases, drawing upon the development stage of this framework: Phase 1 involved a systematic review and meta-analysis that examined the effect of educational interventions on trauma ICU nurses' competence. Additionally, a review of educational learning theories was also completed to base the educational framework development on established theoretical ground. Phase 2 consisted of the main study, which was an exploratory multiple embedded case study design that incorporated three hospitals from two different regions within the Kingdom of Saudi Arabia. Key informants or stakeholders were members of the nursing workforce recruited from the adult intensive care units (ICUs). Data were collected through semi-structured interviews complemented by documentary reviews of trauma-related education syllabi, competencies, and care protocols. This was to provide an in-depth understanding of the local context, practice, and education needs in ICU trauma care and to explore the factors influencing nurses’ in-service education in Saudi Arabia. This followed by, Phase 3 involved stakeholders' focus groups aimed at refining the initially developed education framework based on interview data and reaching an agreement on the optimal implementation of in-service education across various ICU settings in Saudi Arabia. The datasets from interviews and focus groups were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis. Findings In phase 1, the systematic review demonstrated the positive effect of trauma care education interventions on nurses’ competence. However, this review identified limited interventions primarily focused on managing traumatic brain injury (TBI) patients. Additionally, the findings are weakened by the absence of theoretical frameworks that go beyond simply delivering and measuring the impact of interventions. Such frameworks should encompass a deeper understanding of context, practice, educational needs, and components, including education format and delivery methods. The absence of these elements limits their generalisability. (Published paper 1) In phase 2, sixty-eight multinational nursing key informants—clinical staff, clinical educators, nurse managers and leaders—were included from the three hospitals. The findings were conceptualised into main categories comprising a number of major themes and subthemes. The first category provides an extensive contextual exploration of trauma care and education in Saudi Arabia. Two interrelated themes relevant to trauma emerged from the data analysis: (i) care practice and (ii) education practice. The trauma care practice highlighted the limited competencies and education support in trauma care, as well as the perceived challenges and educational needs of nurses. The trauma education practice described the staff learning behaviours, supervision practices and in-service education systems in the participants’ settings. These findings were also supported by reviewing the relevant documents. (Published paper 2) In phase 3, the focus groups agreed with the insights provided by the interviewees and suggested a number of ways in which they could help create a favourable environment for nurse training and sustain nurses’ motivations. Based on findings from phases 2 and 3, a main category presented the education content that ICU nurses need to form the trauma ICU education framework. Stakeholders wanted in-service education by subject experts characterised by: (i) relevant educational content; (ii) a range of educational techniques; and (iii) flexible delivery and format. Moreover, a category addresses the factors that enable and inhabit the successful implementation of the education framework in the studied context. Nurses identified factors that encouraged them to participate in this in-service education, including adequate planning, sufficient resources, and a supportive work environment, whilst heavy workloads, scheduling issues, cost, and low-quality training and educators, balancing of life and wellbeing hindered their participation. (Published paper 3) Conclusion The PhD study presented in this thesis systematically developed a novel and evidence-based in-service education framework that has not been investigated before in the Saudi Arabian context or globally. It constitutes a unique and significant contribution to the body of knowledge regarding the understanding of theory and practice in multicultural nursing workforce education within complex clinical environments. It is anticipated that the framework will yield positive benefits in staff educational training due to its novel methodological approach, combining an exploratory multiple-case study and an empowering education model, underpinned by the MRC development stage, which was successful in developing this context- specific framework. The developed in-service education framework is set to undergo feasibility testing at the post-doctoral level. The use of multiple cases can enhance the transferability of the developed education framework; however, it is necessary for researchers in other contexts to evaluate its adaptability, feasibility and effectiveness. The engagement of key clinical stakeholders in the ICUs, along with thorough consideration of context and practice, is a significant element for the development of the educational framework. Therefore, to enhance the quality, efficiency and feasibility of trauma care in-service education, it is essential to ensure that educational content is highly relevant and motivating for individuals, while also considering the impact of various organisational factors operating in local clinical settings that can influence nurses' in-service and continuing education.19 0Item Restricted Exploring the Barriers to Physical Activity During Pregnancy in Saudi Arabia: A Systematic Review(Swansea University, 2024-09-30) Alhussain, Maha; Ikpeme, MoBackground: Engaging in regular physical activity (PA) during pregnancy is crucial for improving maternal and fetal health outcomes. Activities range from light exercises, like walking, to more structured moderate-intensity activities. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend pregnant women engage in at least 150 minutes of moderate-intensity PA per week, yet global adherence rates, particularly in Saudi Arabia, remain low due to various barriers. Methods: A comprehensive literature search was conducted across six databases, including Embase, Web of Science, Medline, PubMed, ASSIA, and APA PsycInfo. The review focused on studies addressing barriers to PA among pregnant women in Saudi Arabia. The SPICE framework guided the search strategy, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Results: Out of 1,138 studies identified, five were included in the final review. Key barriers identified included sociodemographic factors such as age, education, and number of pregnancies. Cultural beliefs and lack of knowledge were significant barriers, with many women believing exercise could harm their pregnancies. Social influences, particularly family discouragement, and environmental factors, such as lack of access to safe exercise facilities, further hindered PA. Additionally, women cited fatigue, lack of time, and motivation as major personal barriers to engaging in regular exercise during pregnancy. Conclusion: The review identified several barriers that prevent pregnant women in Saudi Arabia from engaging in regular PA. Cultural beliefs, social norms, and limited knowledge about the benefits of PA contribute to these challenges. Environmental factors and personal barriers like fatigue and time constraints also play a significant role in reducing PA levels during pregnancy. Addressing these barriers through education and access to resources may help improve PA participation rates and enhance maternal health outcomes.10 0