Saudi Cultural Missions Theses & Dissertations
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Item Restricted Shared decision-making during pregnancy and childbirth in Saudi Arabia: A mixed-methods study(Saudi Digital Library, 2025-07-13) Alruwaili, Tahani Ali; Fooladi, Ensieh; Crawford, KimberleyBackground Shared decision-making (SDM) is fundamental to quality pregnancy and childbirth, representing a collaborative approach between healthcare providers (HCPs) and women. In Saudi Arabia's obstetrician-led maternity care system, the implementation of SDM and the experiences of women and their husbands remain understudied, particularly in the context of unique cultural, religious, and healthcare factors. Aim To explore women’s and their husbands’ experiences of shared decision-making with healthcare providers during pregnancy and childbirth in Saudi Arabia. Methods The study employed a convergent parallel mixed-methods design guided by the Three-Talk Model for SDM, which conceptualises SDM as a process involving team talk, option talk, and decision talk. The quantitative strand involved a nationwide, online survey conducted between January and May 2023, targeting women aged 18 and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. Low to very low SDM and respect were defined as scores of ≤24 on the Mothers’ Autonomy in Decision-Making (MADM) scale and ≤49 on the Mothers on Respect Index (MORi), respectively. Using the same inclusion criteria, the qualitative strand conducted semi-structured interviews with women and husbands, recruited through convenient sampling from two maternity hospitals and social media. Interview data were analysed thematically and mapped onto the Three-Talk Model for SDM. Data from both phases were integrated during the interpretation phase to provide comprehensive insights into SDM experiences. Results The survey of 505 women revealed that 34.1% (95% confidence interval [CI], 29.6–38.9) reported low to very low SDM. Statistical analysis identified significant factors associated with low SDM, including seeing different obstetricians of a different gender at each visit (adjusted odds ratio [AOR] 2.0, 95% CI, 1.0–3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95% CI, 1.2–5.6), and having an instrumental vaginal birth (AOR 6.67, 95% CI, 1.6–28.1). A strong positive association emerged between low to very low SDM and reporting of low to very low respect (χ2 = 83.8173, p < 0.001). The qualitative data from 19 women and 5 husbands identified the following three major themes aligned with the Three-Talk Model: (1) Team Talk; communication and relationship building were limited by discontinuity of care, time constraints, language barriers, emotional readiness, and gender preferences; (2) Option Talk; information exchange highlighted the importance of clarity, despite reported insufficient details and perceived HCP biases towards intervention; and (3) Decision Talk; autonomy and SDM revealed varying levels of autonomy influenced by hierarchical healthcare structures, religious beliefs, and family involvement. Many participants mistook signing consent forms for engaging in SDM, indicating a gap in understanding of SDM processes. Participants’ experiences centred primarily on interactions with obstetricians, with minimal midwifery involvement. Conclusion The findings reveal challenges in implementing SDM within Saudi maternity care, including discontinuity of care, language barriers from non-Arabic-speaking obstetricians, gender preferences, and rigid institutional hierarchies. These findings highlight the need for healthcare reforms, including professional interpretation services, improved continuity of care, and exploration of midwifery-led models. Future maternity care policies should consider the complex interplay of religious beliefs and family dynamics when developing strategies to improve SDM in Saudi pregnancy and childbirth.24 0Item Restricted 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.15 0