Saudi Cultural Missions Theses & Dissertations
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Item Embargo Healthcare Management for Children with Burn Injuries from the Perspectives of Parents/Carers: A Qualitative Systematic Review(Queen’s University Belfast, 2025) Albishi, Manal; McConnell, KarenBackground: Paediatric burns are a global public health concern, leading to physical, psychological and social consequences for affected children. Despite the challenges faced by parents and caregivers during the hospitalisation and recovery phases, their perspectives on healthcare management remain underexplored. Aim: This systematic review aimed to synthesise the perspectives of parents and carers concerning the healthcare management of their children with burn injuries. The findings aim to inform clinical practice, policy and future research to enhance family-centred care and improve outcomes for children with burn injuries and their parents. Methodology: A systematic search was conducted across five electronic databases: CINAHL, Medline, PsycINFO, Maternity & Infant Care, and ProQuest. Supplementary searches were conducted in Google Scholar. The inclusion criteria focused on qualitative studies exploring parents’ and carers’ perspectives on paediatric burn management. The search results were screened in Covidence by two reviewers independently. Data relating to the experiences of parents and caregivers on the healthcare management of paediatric burns were extracted by one reviewer. The quality of the included studies was assessed by one reviewer using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. A second reviewer checked 20% of the extracted data and quality appraisals. Data were then synthesised through thematic analysis by the method established by Thomas and Harden. Results: Fourteen studies were included in this review. The quality of the included studies ranged from six, indicating low quality, to ten, indicating high quality. Three main themes emerged: (i) parents’/caregivers’ perspectives on burn care challenges and support during hospitalisation and after discharge, highlighting barriers to and facilitators of parental involvement in their children’s treatment, non-professional support needs during hospitalisation, and financial, logistical and transition to home challenges; (ii) caregivers’ experiences of healthcare providers, showcasing both positive and negative experiences and gaps in communication and information needed for carers; and (iii) current and future concerns regarding the recovery and treatment of burn-injured children, including physical, psychological and social challenges. Conclusion: Effectively implementing family-centred care in paediatric burn care and incorporating social support are vital to address caregivers’ needs during hospitalisation and after discharge care. Improving healthcare providers’ communication skills, fostering a supportive environment for healthcare providers and integrating multidisciplinary care are essential to addressing parental challenges and optimising patient outcomes. Additionally, incorporating telehealth and parental feedback into care protocols can further enhance care delivery and collaboration among healthcare providers and caregivers, contributing to enhanced patient outcomes. Finally, cooperation among healthcare providers, policymakers and researchers is needed to bridge the gaps in paediatric burn management, improve outcomes, and support caregivers and burned children.Item Restricted Systematic Review of Asthma Exacerbations Impact on Children’s Quality of Life in Low-Income Countries and Lower-Middle-Income Countries(King's College London, 2024-09-25) Alrashed, Rana; Laurence, YokoBackground: Asthma is a major cause of morbidity and disability in children, especially in low-income countries and lower-middle-income countries (LICs and LMICs). This systematic review evaluates the impact of asthma exacerbations on the quality of life (QoL) of children and adolescents in LICs and LMICs. Methods: A comprehensive literature search was conducted in major medical databases, including PubMed, Medline, Embase, Global Health, and Cochrane Library. Studies involving children and adolescents aged 0-18 years residing in LICs and LMICs were included. The review considered a range of study designs, including cross-sectional studies, randomized controlled trials, systematic reviews, and meta-analyses. The quality of the included studies was assessed using the relevant Joanna Briggs Institute (JBI) checklists. Results: The review found seven relevant studies. The cross-sectional studies showed that poorly controlled asthma and frequent exacerbations have a significant negative impact on various aspects of children's QoL, including physical functioning, emotional well-being, and social interactions. The narrative review and meta-analysis supported these findings, emphasizing the considerable burden of asthma on the overall well-being of children in low-resource settings. The randomized controlled trial provided evidence that targeted interventions, such as comprehensive asthma education and management programs, have the potential to improve the QoL of affected children. Conclusions: This systematic review emphasizes the significant negative impact of asthma exacerbations on the quality of life of children in LICs and LMICs. Factors such as socioeconomic status, access to healthcare, and environmental exposures were identified as key determinants of the QoL in this population. The findings emphasize the urgent need for interventions and policies to address the challenges faced by children with asthma in LICs and LMICs and improve their overall well-being.5 0Item Restricted Ethical Implications of Social Media Marketing Targeting Children: A Case Study of YouTube's Influence on Consumer Behaviour.(DE MONTFORT UNIVERSITY, 2024-09) Shabbaj , Ebraheem; Obey GM, PriscillaThe dissertation delves into the ethical considerations surrounding social media marketing aimed at children, specifically focusing on YouTube. Since YouTube has emerged as a key source of entertainment for children and a significant platform for advertisers, this study seeks to explore the impact of marketing strategies such as influencer marketing, branded content, and interactive ads on children's purchasing behaviour. The research aims to provide a comprehensive understanding of these marketing tactics using a mixed-methods approach involving content analysis of popular YouTube channels and surveys with parents. The findings indicate that YouTube marketing significantly shapes children's consumer behaviour, largely due to their relationships with influencers they perceive as friends. This makes children more receptive to ads that seamlessly integrate with their entertainment experiences. Moreover, the study highlights concerns about unclear advertising disclosures that many children struggle to comprehend. The research offers recommendations for policymakers, marketers, parents, and digital platforms. These suggestions include stricter regulations, more transparent advertising practices, improved parental guidance, and culturally sensitive content. The insights gleaned from this study contribute to the ongoing discourse about ethical marketing practices and lay the groundwork for future research aimed at protecting young audiences online.29 0Item Restricted Determinants of Traumatic Dental Injuries Among Adolescents in England A secondary analysis of the Children’s Dental Health Survey 2013(University College London, 2024-09) Asiri, Ali; Tsakos, Georgios; Blokland, AlexBackground: Adolescents are particularly vulnerable to traumatic dental injuries (TDI), which have a higher global prevalence in this age group. This study aimed to explore the associations between various demographic, clinical, behavioral, and socioeconomic risk factors with TDI among 12- and 15-year-old adolescents in England. Methods: This is a cross-sectional study and secondary data analysis of the Children’s Dental Health Survey 2013 (CDHS2013), using a nationally representative sample. A total of 2,126 adolescents were included after excluding cases with missing data (differences between the analytical sample and those with missing data were negligible). The analysis employed appropriate survey weights and examined demographic (age, sex, ethnicity), clinical (positive overjet, dental caries), behavioral (smoking, alcohol drinking), and socioeconomic factors (free school meals (FSM) eligibility , area deprivation, rural/urban classification) using multivariable logistic regression to model associations with TDI. Results: The overall prevalence of TDI in the sample was 10.98%. In the fully adjusted model, male adolescents were more likely to experience TDI compared to females (OR=0.64, 95% CI= 0.43-0.95). Adolescents who had never consumed alcohol had 37% lower odds of developing TDI (OR=0.63, 95% CI= 0.42-0.94). All other demographic and behavioral risk factors, as well as clinical and socioeconomic factors were not significantly associated with TDI. Conclusions: The study identified two key risk factors for TDI: being male and alcohol consumption. These findings highlight the importance of emphasizing on these risk factors while planning for preventive interventions and public health campaigns on TDI. Future research should adopt longitudinal designs to better assess the temporal relationship between these risk factors and TDI and include a broader range of variables for a more comprehensive understanding of TDI etiology.34 0Item Restricted The Association Between Head and Neck Injuries Requiring Medical Attention and Behavioural Problems Among 7- and 14-Year-Old Adolescents Living in the United Kingdom A Secondary Data Analysis of the UK Millennium Cohort Study (MCS)(University College London, 2024-09) AlRugaibah, Norah; Blokland, Alex; Sifaki, MariaBackground: Injuries are major public health problems that affect children’s lives. Behavioural problems have been linked to increased risk of injury incidence. However, few studies discussed the association between externalising and internalising behavioural problems and head and neck injuries among children and adolescents. Aim: This study aims to examine the association between head and neck injuries requiring medical attention and behavioural problems among 7- and 14-year-old youth living in the UK. Methods: A secondary analysis of data from the Millennium Cohort Study (MCS) was conducted using the fourth and sixth sweeps when the participants were 7 and 14 years old. The outcome indicated whether the child had sustained any head and neck injuries since the last survey. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales of externalising and internalising behaviour. In the analysis both scales were dichotomised (10% highest scores) to discern those experiencing severe difficulties. Demographic, family, and socioeconomic factors were used as covariates. Weighted analysis using regression modelling was used to examine the associations between behavioural problems and head and neck injuries. Results: The prevalence of head and neck injuries for 7- and 14-year-olds were 9.35% and 6.23% respectively. Externalising behavioural problems at age 7 were reported for just under 10% of the children, and nearly 9% were reported to experience Internalising problems. At age 14, over 10% of the sample presented with externalising behavioural problems, and nearly 8% with Internalising behaviours. Children aged 7 years who presented with externalising difficulties had a significantly higher risk of head and neck injuries in the crude model (OR=1.41, 95%CI: 1.02–1.93). However, this association became non-significant after controlling for child characteristics. In the crude model, there was no difference in head and neck injury odds between children with internalising behavioural problems and their peers at age 7 (OR=1.00, 95%CI: 0.67–1.48). The association remained non-significant after subsequent adjustments. For 14-year-olds, those who with externalising problems appeared to have higher odds of head and neck injuries compared to their peers, although not statistically significant in the crude model (OR=1.25, 95%CI: 0.79–1.98) or after adjustments (final model: OR=1.27, 96%CI: 0.80 – 2.02). There was no difference between children aged 14 experiencing internalising difficulties and their peers in the crude model (OR=0.69, 95%CI: 0.35–1.36) or after adjustments (final model: OR=0.69, 96%CI: 0.36 – 1.32). Conclusion: This study indicated that children aged 7 with externalising behavioural problems were at higher risk for head and neck injuries. However, after adjusting for confounding factors, this association became non-significant. In early adolescence (age 14), such injuries were not significantly associated with externalising difficulties. Internalising problems showed no significant association with head and neck injuries in either age group.22 0Item Restricted The Knowledge of Autism Spectrum Disorder Among Male and Female Public Education Teachers in Jeddah, Saudi Arabia.(Nottingham Trent University, 0024-07) Alobaidi, Batool; Dillon, GayleThis study investigated teachers' knowledge of autism spectrum disorder (ASD) in Jeddah, Saudi Arabia, and examined what factors influenced the knowledge that teachers had. In Saudi Arabia, ASD is common but often diagnosed late (Hayat et al., 2019). This highlights the need to assess teachers' ASD knowledge, as they are well-positioned to notice signs of ASD. Understanding teachers' awareness can guide targeted training programs, improving early detection and support for students with ASD. Participants included 197 male and female teachers from public schools who completed the Autism Spectrum Knowledge Scale-General Population (ASKSG, 2019) and the Knowledge about Childhood Autism among Health Workers (KCAHW, 2008) scale. The findings revealed that participants demonstrated an average level of knowledge across both scales, scoring below average on the ASKSG but above average on the KCAHW, suggesting a potential gap in understanding ASD. Teachers with prior contact with individuals with ASD spectrum exhibited significantly higher ASD knowledge compared to those without such exposure, underscoring the impact of firsthand experience. Contrary to expectations, no significant differences in ASD knowledge were found based on gender, teaching experience, or school level taught between all educational levels, be it primary, secondary, or high school. The results aligned with previous regional studies (Alharbi et al.,2021; Otaif et al.,2019) documenting weak to moderate ASD knowledge among Saudi Arabian educators. Due to the findings from previous studies in Saudi Arabia until this study, which find that teachers' ASD knowledge has not improved, the study accentuates the pressing need for intensified and reinvigorated ASD training initiatives tailored to teachers, emphasising immersive, experiential learning modalities. By addressing the identified knowledge gaps and recognized limitations, further research efforts can help to provide a comprehensive understanding of teachers' knowledge of ASD. These studies will help to develop comprehensive and tailored programs to provide teachers with the knowledge needed to support children with ASD best.8 0Item Restricted Reducing Type 1 Childhood Diabetes in Saudi Arabia by Identifying and Modelling Its Key Performance Indicators(Royal Melbourne Institute of Technology, 2024-06) Alazwari, Ahood; Johnstone, Alice; Abdollahain, Mali; Tafakori, LalehThe increasing incidence of type 1 diabetes (T1D) in children is a growing global health concern. Reducing the incidence of diabetes generally is one of the goals in the World Health Organisation’s (WHO) 2030 Agenda for Sustainable Development Goals. With an incidence rate of 31.4 cases per 100,000 children and an estimated 3,800 new cases per year, Saudi Arabia is ranked 8th in the world for number of T1D cases and 5th for incidence rate. Despite the remarkable increase in the incidence of childhood T1D in Saudi Arabia, there is a lack of meticulously carried out research on T1D in children when compared with developed countries. In addition, it is crucial to recognise the critical gaps in current understanding of diabetes in children, adolescents, and young adults, with recent research indicates significant global and sub-national variations in disease incidence. Better knowledge of the development of T1D in children and its associated factors would aid medical practitioners in developing intervention plans to prevent complications and address the incidence of T1D. This study employed statistical, machine learning and classification approaches to analyse and model different aspects of childhood T1D using local case and control data. In this study, secondary data from 1,142 individual medical records (359-377 cases and 765 controls) collected from three cities located in different regions of Saudi Arabia have been used in the analysis to represent the country’s diverse population. Case and control data matched by birth year, gender and location were used to control confounders and create a more robust and clinically relevant model. It is well documented that genetic and environmental factors contribute to childhood T1D so a wide range of potential key performance indicators (KPIs) from the literature were included in this study. The collected data included information on socioeconomic status, potential genetic and environmental factors, and demographic data such as city of residence, gender and birth year. Several techniques, such as cross-validation, hyperparameter tuning and bootstrapping, were used in this study to develop models. Common statistical metrics (coefficient of determination, R-squared, root mean squared error, mean absolute error) were used to evaluate performance for the regression models while for the classification models accuracy, sensitivity, precision, F score and area under the curve were utilised as performance measures. Multiple linear regression (MLR), artificial neural network (ANN) and random forest (RF) models were developed to predict the age at onset of T1D for all children 0-14 years old, as well as for the most common age group for onset, the 5-9 year olds. To improve the performance of the MLR models, interactions between variables were considered. Additionally, risk factors associated with the age at onset of T1D were identified. The results showed that MLR and RF outperformed ANN. The logarithm of age at onset was the most suitable dependent variable. RF outperformed the others for the 5-9 years age group. Birth weight, current weight and current height influenced the age at onset in both age groups. However, preterm birth was significant only in the 0-14 years cohort, while consanguineous parents and gender were significant in the 5-9 age group. Logistic regression (LR), random forest (RF), support vector machine (SVM), Naive Bayes (NB) and artificial neural network (ANN) models were utilised with case and control data to model the development of childhood T1D and to identify its key performance indicators. Full and reduced models were developed to determine the best model. The reduced models were built using the significant factors identified by the individual full model. The study found that full LR had the highest accuracy. Full RF and SVM with a linear kernel also performed well. Significant risk factors identified as being associated with developing childhood T1D include early exposure to cow’s milk, high birth weight, positive family history of T1D and maternal age over 25 years. Poisson regression (PR), RF, SVM and K-nearest neighbor (KNN) were then used to model the incidence of childhood T1D, taking in the identified significant risk factors. The interactions between variables were also considered to enhance the performance of the models. Both full and reduced models were created and compared to find the best models with the minimum number of variables. The full Poisson regression and machine learning models outperformed all other models, but reduced models with a combination of only two out of three independent variables (early exposure to cow’s milk, high birth weight and maternal age over 25 years) also performed relatively well. This study also deployed optimisation procedures with the reduced incidence models to develop upper and lower yearly profile limits for childhood T1D incidence to achieve the United Nations (UN) and Saudi recommended levels of 264 and 339 cases by 2030. The profile limits for childhood T1D then allowed us to model optimal yearly values for the number of children weighing more than 3.5kg at birth, the number of deliveries by older mothers and the number of children introduced early to cow’s milk. The results presented in this thesis will guide healthcare providers to collect data to monitor the most influential KPIs. This would enable the initiation of suitable intervention strategies to reduce the disease burden and potentially slow the incidence rate of childhood T1D in Saudi Arabia. The research outcomes lead to recommendations to establish early intervention strategies, such as educational campaigns and healthy lifestyle programs for mothers along with child health mentoring during and after pregnancy to reduce the incidence of childhood T1D. This thesis has contributed to new knowledge on childhood T1D in Saudi Arabia by: * developing a predictive model for age at onset of childhood T1D using statistical and machine learning models. * predicting the development of T1D in children using matched case-control data and identifying its KPIs using statistical and machine learning approaches. * modeling the incidence of childhood T1D using its associated significant KPIs. * developing three optimal profile limits for monitoring the yearly incidence of childhood T1D and its associated significant KPIs. * providing a list of recommendations to establish early intervention strategies to reduce the incidence of childhood T1D.24 0Item Restricted An evaluation of the Rashaka Initiative: a school-based obesity intervention in Makkah City, Saudi Arabia(University of Technology Sydney, 2024-03) Banany, Mohammed; Sibbritt, David; Gebel, KlausBackground: Childhood overweight and obesity are public health issues worldwide. In Saudi Arabia, in 2016/2017 the Rashaka Initiative, a national school-based, multicomponent, weight-related intervention, was launched to decrease the prevalence of obesity among students by 5% within five years. Neither the development stage of the initiative nor its implementation has been evaluated to explore its processes and outcomes. Aim: This study was aimed at evaluating the implementation of the Rashaka Initiative in intermediate and secondary schools in Makkah City, Saudi Arabia, covering both process and outcome. To this end, the following objectives were pursued: (1) to develop an evaluation framework that can be used to assess the processes and outcomes of the initiative, (2) to determine whether there was a change in students’ body mass indices (BMIs) during the implementation period, and (3) to explore the knowledge and attitudes of the Rashaka stakeholders regarding the perceived barriers and facilitators of implementation in their schools. Methods: This retrospective study, conducted after the implementation of the Rashaka Initiative, was completed in three phases. In phase I, a conceptual framework called the school-based weight-related intervention evaluation framework (SWIEF) was developed by integrating some elements of the program evaluation framework used by the US Centers for Disease Control and Prevention (CDC) with the components of a logic model. In phase II, secondary data from the Rashaka Initiative were analysed. Phase III was a cross-sectional exploration of the Rashaka stakeholders’ knowledge and attitudes as well as what they perceive as facilitators and barriers to implementing the intervention at their schools. Results: The comprehensive literature review yielded a published systematic review (Banany et al. 2024, Systematic Reviews). This systematic review found 11 school-based weight-related intervention studies in the six Gulf Cooperation Council countries (GCC). Despite the methodological limitations of some of these studies, there is preliminary evidence of the possible benefits of school-based interventions on students' weight and associated lifestyle factors in these countries. A review of the literature also facilitated the development of the SWIEF. The analysis of the secondary data revealed a significant reduction in BMI (p<0.001) across schools that participated in the Rashaka Initiative over two school years (2016/17 and 2018/19). However, this reduction was not associated with the school environmental factors attributed to the initiative. The study findings found that students’ BMIs decreased more considerably in girls’ and intermediate schools than in boys’ and secondary schools (p<0.001 and p=0.031, respectively). The cross-sectional study indicated that significantly better knowledge of risk factors and interventions for childhood obesity was exhibited by female Rashaka stakeholders (vs their male counterparts), stakeholders who completed tertiary education (vs those with lower education levels) and stakeholders engaged in the initiative for more than two years (vs participants who joined more recently) (p<0.001, p<0.007 and p<0.033, respectively). School health counsellors had more positive attitudes towards children’s health and weight than principals (p<0.008). Significantly more favourable attitudes towards the Rashaka intervention were also found among female stakeholders (p<0.011) and those with better knowledge of the initiative’s objectives, components, activities, and outcomes (p<0.049). Among the stakeholders, 73% perceived collaboration with different government and private sector institutions as the most common facilitator of the Rashaka implementation at their schools, while 69% perceived a lack of time as the main barrier. Conclusions: Addressing childhood obesity is a public health priority that requires substantial efforts from all relevant key stakeholders in Saudi Arabia. The evidence derived in this thesis revealed that the Rashaka Initiative has yet to satisfy its objectives. Future studies should be more rigorous, theory-based, and holistic to tackle obesity among school students. Evaluations of school-based obesity interventions should use control groups, validated and reliable measures and rigorous data analysis. Long-term monitoring of the implemented interventions is highly recommended for their improvement and sustainability.55 0Item Restricted Predictors Associated with The Success Rate of Dental Procedures Performed on Children Treated Using Oral Conscious Sedation(Rutgers the State University of New Jersey, 2024) Alagl, Haifa; Caceda, Jorge H.Purpose: The purpose of this study was to describe, and compare the survival rate of dental procedures performed on healthy children using oral conscious sedation and to determine if age, recalls post treatment, distance traveled, and type of dental insurance were associated with the success rate of dental procedures. Methods: Dental records of 457 healthy children ages 36-60 and 61-84 months who had dental procedures performed using oral conscious sedation (OCS) by postdoctoral students of the Department of Pediatric Dentistry & Community at Rutgers School of Dental Medicine between the years 2014-2021 were retrieved from the Axium electronic health records and analyzed using the Cox Regression Model. Number of recalls, type of insurance, and distance travelled were recorded and analyzed in relation to the survival rate of dental procedures. Results: Stainless steel crowns and composite restorations showed the highest success rate when compared to strip crowns and pulpotomies (p=<0.00). Age, number of recalls, type of insurance, and distance travelled were not statistically significant in relation to the success rate of dental procedures. A significant difference was found when the type of insurance and distance travelled were compared for the recall and no recall groups. Conclusions: The COX regression model showed that age, recall visits, type of dental insurance, and distance were not statistically significant in relation to the success or failure rate of dental procedures. Stainless steel crowns and composite restorations showed the highest success rate. The type of dental insurance and distance travelled were found to be statistically significant in relation to recall and no recall groups.12 0Item Restricted Childhood Obesity and Weight Stigma: A Public Health Nutrition Approach(University of Glasgow, 2024-04-20) Abuznada, Salma; Combet, Emilie; Garcia, AdaPoor understanding of obesity, its causes and consequences contribute to weight-related stigma in the UK. Children’s understanding of obesity shapes their views and perceptions towards obesity as a disease, body image, and weight stigma behaviours. Exploring children’s and adolescents’ knowledge, perceptions and views of obesity, weight stigma, and nutrition is essential to establishing effective health promotion programmes that cater to young people’s needs, understanding and perspectives. Successful programmes also need continuous monitoring and evaluation, which are currently lacking in the UK. Perceptions and views around obesity among the public vary in different cultures and among healthcare professionals. These different perspectives lead to debates on defining, managing and treating obesity. Weight stigma research in adults tends to focus on weight stigma due to the poor understanding of obesity both among the public (especially women of white ethnicity) and healthcare professionals rather than children and adolescents. This thesis uses systematic reviews and a mixed-methods approach to explore weight stigma across the age spectrum, including children, adolescents and adults. Furthermore, the research investigates children’s and adolescents’ views on obesity and nutrition knowledge. Study 1 systematically reviewed existing observational, quantitative and qualitative studies focusing on the sources, frequency and implications of weight stigma on children’s and adolescents’ mental health, well-being and eating behaviours. The Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) were followed for study selection, screening and data extraction. Synthesis Without Meta-Analysis (SWiM) guidelines were applied to report the synthesis and results. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of the included studies. Twenty observational studies were included in the final text analysis. Synthesised evidence highlighted that bullying and victimisation play a fundamental role in developing and perpetuating weight-related stigma. Weight-related bullying was correlated with participants’ low self-esteem. Most of the included studies (N=15/20) were of fair quality (average score 5 to 8), although two were of poor quality (average score 0 to 4), and most of the quality criteria were not met. One of the main gaps identified during the literature search in Study 1 was children and adolescents were poorly represented in the studies, with an overemphasis on white adult women. After identifying existing gaps in the literature (e.g., the overemphasis on recruiting white women), Studies 2, 3 and 4 were developed to explore underrepresented groups and gain a deeper understanding of their views and opinions of obesity and weight stigma. Children’s and adolescents’ views and opinions of obesity and nutrition knowledge were explored in Study 2, using a cross-sectional questionnaire and phone interviews. The questionnaire was structured in six sections, exploring sociodemographic characteristics, anthropometric measurements, views and perceptions of obesity, nutrition knowledge, general health, and eating habits and lifestyle. Online interviews followed a narrative focusing on obesity knowledge and experience, obesity perception and the relationship between nutrition and obesity. Study 2 recruited a total of n=317 participants, 54% boys, 72% White/British, with a median age of 16 years (interquartile range (IQR) 15- 18). There was an overall lack of understanding of obesity and its causes and consequences. There was also a lack of consensus and agreement about whether obesity is a sign of disease, a disease, or merely a body shape. There was agreement that obesity can be a personal responsibility (median=4: likely, IQR 3: neutral – 4: likely). Food knowledge was low, with 83% correctly answering three questions or fewer out of six. Although participants reported and believed that they knew what obesity was, most participants linked obesity to body image and placed the responsibility of having obesity on the individuals or their parents. This can lead to increased stigmatising behaviours and isolation of children and adolescents with obesity. Proper education about obesity is imperative to help support children in understanding the general concepts behind obesity’s complexity as a disease. Study 3 used a cross-sectional questionnaire and phone interviews to explore weight stigma and its implications on weight stigma attitudes and body image perceptions in children. In Study 3 (n=667, 62% boys, 70% White/British, median age 16 years (IQR 15-18)), 50% of participants who experienced weight stigma had a BMI ≥30 kg/m². Almost two-thirds of participants who experienced weight stigma (n=259) said it happened at local community places (e.g., clubs, during extracurricular activities) (n=149, 58%). Over a quarter (n=67,26%) reported that it was extremely harsh. Participants who self-reported having obesity (n=214) experienced more weight stigma (n=114, 53%) than those who believed they have overweight (n=87, 41%) or underweight (n=13, 6%). More than half of the sample (n=408, 61%) were dissatisfied with their body image. Most participants who self-reported having obesity were dissatisfied with their body image, demonstrating a significant relationship between self-reported weight problems ‘underweight, overweight, obesity’ and body image satisfaction levels ‘dissatisfied, neutral and satisfied’". In summary, unsurprisingly, most participants who reported weight stigma had a BMI ≥30 kg/m2. Interestingly, more boys than girls who reported experiencing weight stigma believed there was weight stigma in society. To better understand the contribution and impact of childhood lived experiences of weight stigma on adult perceptions and beliefs around overweight and obesity, Study 4 employed similar methods to Study 3. In Study 4 (n=738, 52% men, 76% White/British, 39% BMI ≥30 kg/m2, median age=26 years (IQR=24-31)), less than a quarter of participants had experienced weight stigma as children (n=154, 21%). More women (n=108/154, 70%) experienced weight stigma during childhood than men (n=46/154, 30%, p≤0.001). Participants were mostly undecided about whether obesity is a disease (median=3: undecided, IQR=1: strongly disagree – 3: undecided). Experiencing weight stigma in childhood was positively associated with parents reporting their children’s weight stigma experiences. Parents dissatisfied with their body image (n=62) were more likely to be dissatisfied with their children’s body image (n=23/62, 37%) than satisfied (n=17/62, 24%). Understanding and awareness of obesity are essential in developing public health strategies and health education programmes that are child-oriented and specific to children and adolescents regarding location and intervention tools. The findings in this thesis highlight the negative impact of weight stigma on children and adolescents' physical and mental health. Moreover, a poor understanding of obesity was evident in this research. The work of this research is beneficial in informing programs explicitly targeting the gaps explored and found. This thesis attempts to improve the knowledge of public and academic domains in elements surrounding perceptions, views, and attitudes regarding obesity and weight stigma, the reasonings behind perceptions, and strategies to address obesity stigmatising behaviour.18 0
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