Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
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Item Restricted Knowledge, Attitudes, and Behaviors of School Nurses Regarding Their Role in Childhood Obesity Prevention in Saudi Private Elementary Schools(ProQuest, 2023) Alharbi, Abdullah; Colin, Jessie M.Background: School age children are expected to have a normal body mass index which is commensurate with their age group. The prevalence of childhood obesity and overweight is increasing in alarming rates in developing countries, with the highest rate in the Middle East region. School nurses’ involvement in childhood obesity prevention practices will benefit children and their families in managing the epidemic of childhood obesity. However, there is no research addressing the role of school nurses in Saudi Arabia in preventing and managing childhood obesity. Purpose: The purpose of this qualitative study was to explore the critical factors that influence school nurses’ knowledge, attitudes, and behaviors regarding childhood obesity prevention in Saudi private elementary schools. Philosophical Underpinnings: The grounded theory is based within the constructivist paradigm and has philosophical underpinnings of symbolic interactionism and pragmatism. Methods: This study was conducted using Charmaz's constructivist grounded theory approach. Semi-structured interviews were conducted to collect data from 11 school nurses from private elementary schools in Saudi Arabia. Data from the interviews were analyzed according to Charmaz’s analytical process. Theoretical sampling was used to saturate developed categories. A focus group interview was conducted with three experts in the research topic to confirm the generated theory. Results: A conceptual theoretical framework was developed from the rich data collected from the research participants. Three categories (Struggling, Avoiding, Competing Priorities) and a core category (Lacking Support) emerged to support the basic social process Jumping Hurdles: A Pathway to Professional Growth. Conclusions: The study findings may be used to guide nursing education, practice, research, and health and public policy. The conceptual theoretical framework developed in this study can help in understanding the critical factors influencing school nurses’ knowledge, attitudes, and behaviors regarding their role on childhood obesity prevention. Understanding these critical factors can help enhancing school nurses’ role in childhood obesity prevention.17 0Item Restricted Lunchtime purchasing habits and physical activity in school children and their links to obesity(Saudi Digital Libaray, 2023-12-14) Albalwi, Fatmah Abdualrzg; Speakman, JohnThe prevalence of childhood obesity has raised concerns, with factors such as declining physical activity (PA) levels and poor food habits being suggested as contributors. Previous studies relied on self-reported data from children, liable to potential bias and errors. To address these limitations, my research adopted validated methodological approaches to explore the impact of PA and the school food environment on children's BMI. My study accurately measured height and weight , calculating BMI percentiles. Accelerometers were employed to track PA changes from early Primary 2 to later Primary 7 stages. These measures allowed a more precise assessment of their influence on BMI and blood pressure (BP). Additionally, a novel approach of observing students' lunch purchasing behaviour directly over a year, without direct questioning, revealed insights into eating habits beyond schools. Four studies were undertaken. The first analysed various school lunch choices' association with BMI using data from the Health Behaviour in School-aged Children (HBSC) and the National Diet and Nutrition Survey (NDNS). None of the lunch types correlated with BMI in either dataset. The second study investigated the influence of food outlets around secondary schools on pupils' lunch choices, I found only the percentage of cafés and bakeries significantly affected food and drink buying patterns. The third study explored the contribution of energy and fat intakes from various lunch sources to total intake and BMI. Though a weak relationship initially emerged, further analysis accounting for socioeconomic status and ethnicity, no association was found. Fast-food outlets accounted for 23% of energy intake. Lastly, the fourth study, part of the Scottish Lifestyle Organised Sport and Health (SLOSH) project, examined over six years changes in PA's association with BMI and (BP). No significant links were found between PA levels and either BMI percentile or blood pressure, despite an overall reduction in activity levels.18 0Item Restricted Effectiveness of childhood obesity prevention interventions in the Middle East. A systematic review(Saudi Digital Library, 2023-11-28) Alsaadi, Ghadeer; Papadaki, AngelikiIntroduction Childhood obesity is considered a critical health concern in the Middle East due to its escalating prevalence and adverse impact on the community. To address this epidemic, this review aims to assess the effectiveness of school-based interventions conducted in the Middle East on obesity- related outcomes, physical activity levels, and dietary habits and evaluate the interventions’ cost-effectiveness analyses where data are available. Methods This systematic review conducted an electronic comprehensive search on the 2nd of June, 2023, using the databases PubMed, Embase, Medline, and Web of Science. School-based interventions, both single and multi-component, utilising a randomised control trial study design, implemented among primary school-aged children or adolescents aged 4-19 years old, assessing (BMI, body fat percentage, waist circumference, physical activity levels, or dietary habits) as the intervention’s targeted outcomes, and conducted in the Middle East were included in this review. Results Seven RCTs were examined in this review, of which five had dietary and physical activity components; one was a dietary intervention, and the last was a physical activity intervention. All assessed RCTs effectively reported at least one positive finding of the school-based intervention on the targeted outcomes. Post- intervention between-group differences were found in the likelihood of changing to normal weight status, improved nutritional quality, increased physical activity levels, and reduced weight. Additionally, intervention groups reported physical activity levels increase, dietary habits improvement, a reduction in the likelihood of being overweight or obese, a reduction in BMI Z-score, and a reduction in waist circumference. Post-intervention self-efficacy and nutritional knowledge increased in the intervention groups (p<0.001), which served as potential mediators. Conclusion Overall, findings from this review support the promising effects of school-based interventions on improving obesity-related outcomes, physical activity levels, and dietary habits. Further studies should be conducted to confirm the findings while measuring the intervention’s cost-effectiveness analysis.17 0Item Restricted Health behaviours and childhood obesity among refugee families with young children(2023-04-30) Maha, Alsubhi; Peters, Sarah; Epton, Tracy; Goldthorpe , JoannahChildhood obesity represents a leading public health issue over the last decade, with a progressive rise reported in the prevalence of obesity among children living in low socioeconomic status in developing countries as well as groups of ethnic minorities. A high prevalence of obesity is also reported amongst refugee children who move to developed countries, where they often live in low income families. Poor health consequences associated with childhood obesity, include hypertension, insulin resistance, orthopaedic problems, and low quality of life. Refugees and their families commonly face complex physical and psychological challenges, exacerbated by their low income status, after resettlement in a new environment, which can undermine their health and put them at higher risk of being overweight or obese. Every year there are increased numbers of refugee families resettled in developed countries. This posing a very serious challenge to the governments of host countries, especially as these vulnerable populations face challenges that can affect their health, there is still a noticeable lack of research on refugee children's health behaviours and obesity. To address this health issue, it is essential to understand the challenges they face and how they affect their obesity-related behaviours. In particular, it is essential to identify the key factors related to health behaviours and childhood obesity among refugee children. This would inform the development of a culturally informed weight management intervention that supports appropriate nutrition and the prevention of obesity and associated disease in this population. Objectives: The overall aim of this thesis was to understand the factors influencing obesity behaviours in refugee children settled in developed countries, and to develop a theoretically informed intervention to address key health behaviours that impact on refugee children obesity. Methods: These research objectives were addressed through a series of four studies. Firstly, a systematic review that synthesised the literature to identify the factors that influence health behaviours related to obesity in refugee families with young children after their resettlement in the developed countries. The second was a qualitative study (N=27), that built on the review, to investigate refugee parents’ experiences and perspectives regarding the health behaviour changes (i.e. changes in diet, levels of physical activity) of their young children. The third study developed an intervention (Be healthy) informed by the Behaviour Change Wheel and based on findings from the first two studies, as well as Public patients involvements (PPI) and stakeholder involvement. The final study (N=23), that aimed to refine the intervention through assessing its acceptability to the targeted population. Findings: The data synthesis process revealed, several factors that influence the health behaviours of children. Several factors contributed to unhealthy food choices, including poor food literacy, increasing availability of unhealthy foods, and decreasing availability of healthy foods. There were multiple factors linked to overconsumption of food, including temptation from increased variety and abundance of food that is greater than in their home countries, as well as reacting to previous food insecurity by overeating while food was available. There were several factors related directly to physical activity, including poor weather, labour saving devices, and lack of value given to sporting activities. The review also revealed the parental practices that influence the health behaviours of children, especially those aged 2 to 10 years. The results suggested a need to understand further the role that parents have in influencing the health behaviours and weight trajectories of children following resettlement. Finding from qualitative interviews revealed that parents face substantial changes to their lifestyle and personal context, including restricted living space, restricted neighbourhood/community and inclement weather. These environmental differences required parents to adjust their roles and practices around their own and their children’s eating habits. These changes influenced refugee children’s health behaviours. Of particular concern to parents were increased sedentary behaviour and consumption of unhealthy snacks. Parent's beliefs about relevant health behaviours included cultural beliefs regarding body shape, perception that the new environment is restricted and unsafe and issues with knowledge about and trust in, the food in the host country. These beliefs have influenced the parents and their children’s diet and level of physical activity, shaping the ways that they interact with their new living environment. These findings suggest targeting these behaviours in tailored interventions may improve the health of refugee children. Using the COM-B model and Theoretical Domains Framework to guide the behavioural diagnosis, findings suggested that behaviour changes should be targeted at Psychological Capability, Physical Opportunity, Reflective Motivation and Social Opportunity. This resulted in the design of a four-week family-based intervention, “Be healthy”, that targeted snacking and sedentary behaviours. The final study found that the intervention was acceptable. Parents had a positive attitude towards attendance and perceived that the programme was effective in motivating and initiating behaviour change. Suggested changes to further refine the “Be healthy” intervention that more positive experiences and solutions be shared, more photos be included in the booklet to enhance accessibility, and improvements be made to the referral process in order to make potential participants more aware of the level of difficulty. Conclusion: Children in refugee families are at risk of increased sedentariness and unhealthy snacking post-settlement. An intervention targeted at parents that takes into account their complex and unique challenges, as well as their cultural background, is acceptable. Future research should determine the effectiveness of “Be healthy” within this setting using a randomised controlled trial, with feasibility studies being required to determine its transferability to other contexts.11 0