Saudi Cultural Missions Theses & Dissertations
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Item Restricted Behavioral Intentions Among Saudi Red Crescent Authority’s (SRCA) Active-Duty Paramedics Toward Seeking Psychological Help From Mental Health Professionals(Kent State University, 2025) Alsulami, Mohammed Ahmed; Laurie, M. Wagner; Kele, Ding; Deric, KenneParamedics are among the most vulnerable to mental health disorders. The nature of their profession places them in repeated exposure to unpredictable work-related stressors (e.g., motor vehicle mortalities). Such repeated exposures predispose paramedics to chronic stress and potentially to mental health disorders. The fear of being stigmatized by others, perceived as weak, or suffering career consequences are among the most common barriers that hinder their ability to consider help. The study adapted and further extended the TPB to (a) investigate the levels of attitude, subjective norms, perceived behavioral control, social and self-stigma, and intentions toward seeking help from mental health professionals among a sample of 184 paramedics in Saudi Arabia; (b) Compare those levels between paramedics with past help-seeking experiences and those without; and (c) Determine the most significant predictors of professional help-seeking intentions among active-duty paramedics in the Kingdom. Self-stigma has emerged as the strongest predictor of professional help-seeking intentions among SRCA paramedics. This significant finding highlighted the urgent need to proactively counter self-stigma within active-duty and future paramedics in Saudi Arabia. The findings provide a foundation for developing culturally sensitive interventions across individual, interpersonal, organizational, and policy levels to promote a supportive mental health culture within the EMS profession in the Kingdom.27 0Item Restricted Mental Health of Paramedicine Students in the United Kingdom and the Kingdom of Saudi Arabia(Saudi Digital Library, 2025) Alzahrani, Adnan Atiah; Johnson, Judith; Keyworth, ChrisResearch has shown higher mental health concerns among healthcare students, with paramedicine students experiencing particularly high levels of psychological distress due to exposure to traumatic incidents, high-pressure training environments, and demanding clinical placements. Unlike other healthcare professions, paramedicine students often encounter potentially traumatic events early in their training, yet they frequently suffer in silence without seeking appropriate support. There is limited research on paramedicine student’ mental health, especially from cross-cultural perspectives, and insufficient understanding of how to improve their wellbeing. This thesis aimed to deepen the understanding of mental health challenges faced by paramedicine students. This thesis presents five studies examining paramedicine students from the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). The first study was a systematic review and meta-analysis investigating the global prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) among paramedicine students. Building on these findings, the next two studies used semi-structured interviews to explore the causes of stress and poor wellbeing among paramedicine students (Study 2) and to investigate their preferences, barriers, and facilitators for accessing mental health support (Study 3). To quantify mental health outcomes and their predictors in cross-cultural settings, the fourth study used a cross-sectional survey design investigating burnout and depression rates, along with their associations with clinical experiences and psychosocial factors. The fifth study employed longitudinal survey methods to monitor changes in mental health outcomes over six months, examining how clinical exposure and perceptions of demand, control, and support influence wellbeing trajectories. Key findings This thesis revealed alarmingly high rates of mental health disorders among paramedicine students globally. The systematic review and meta-analysis (Study 1) found pooled prevalence rates of 56.4% for moderate anxiety, 34.7% for depression, and 17,9% for PTSD - all significantly higher than those reported among qualified paramedics and the general population. Regarding factors contributing to poor mental health, the cross-cultural qualitative analysis (Study 2) identified four key themes: exposure to potentially traumatic events during clinical placements; relationship and communication challenges with faculty, peers, and training supervisors; problematic programme atmosphere, including inadequate preparation and support; and career-related concerns about job prospects and professional acceptance. These themes were consistent across both cultural contexts, although with some variation in emphasis. The investigation of support preferences and access barriers (Study 3) revealed that students preferred tailored, culturally sensitive interventions rather than generic student support services. Three main preferences emerged: specialised support addressing paramedicine-specific challenges; privacy protection to safeguard academic and career prospects; and opportunities for peer socialisation and communication. Major barriers included mental health stigma from multiple sources, university environment factors, personal beliefs about help-seeking, operational challenges in accessing services, and concerns regarding professional competency assessments. The cross-sectional survey (Study 4) found significant differences between countries, with students from KSA reporting higher levels of depression but lower burnout scores compared to UK students. Clinical experiences, perceived psychological demands, and lower social support emerged as key predictors of poor mental health outcomes across both cultures. The longitudinal study (Study 5) indicated that mental health outcomes remained relatively stable over six months, with baseline scores being the strongest predictors of follow-up wellbeing. Nevertheless, perceived control and social support showed protective effects against mental health deterioration, while high psychological demands predicted poorer outcomes over time. Implications and conclusions This thesis demonstrates that paramedicine students face significant mental health challenges that exceed those of other healthcare student populations and qualified practitioners. The findings highlight the urgent need for specialised, culturally sensitive mental health interventions integrated into paramedicine curricula. Without targeted support addressing the unique stressors of paramedicine training - including early trauma exposure, demanding clinical environments, and professional identity development - these mental health issues may persist into professional practice, potentially impacting both practitioner wellbeing and patient care quality. The thesis offers the first comprehensive cross-cultural evidence base for developing evidence-informed interventions to support the mental health and wellbeing of this vital healthcare workforce during their formative training years23 0Item Restricted THE MEDITERRANEAN DIET, FOOD SECURITY, BEHAVIORAL AND PSYCHOSOCIAL FACTORS, AND MENTAL HEALTH SYMPTOMS AMONG COLLEGE STUDENTS(University of Florida, 2025) Alshahwan, May; Mathews, AnneCollege students are particularly vulnerable to mental health issues due to various biological and psychosocial factors, with a high prevalence of food insecurity (FI) being a significant concern. Previous research suggests that adhering to a Mediterranean diet (MedDiet) pattern may positively impact college students' health and mental well-being. This comprehensive research, encompassing cross-sectional, interventional, and longitudinal approaches, aims to investigate the effects of MedDiet adherence and FI on mental health symptoms (MHS) among college students. A cross-sectional study of first-year students (N=1,101) found low adherence to a MedDiet in 60.6%, and 25% experienced food insecurity. Approximately one-third reported moderate to severe depression and anxiety, with a moderate mean stress score of 25.8±9.3. There was an inverse association between MedDiet adherence and MHS (depression, anxiety, and stress) (beta = -0.08, p = 0.0007). FI was positively associated with MHS (beta = 0.12, p <.0001). No significant interaction was found between MedDiet adherence and FI on MHS. The intervention study was an 8-week Mediterranean-style diet educational intervention. Participants were randomly assigned to an intervention and education group (I & E; N=107) or an education-only group (E; N=110). At baseline, 43% had low MedDiet adherence, with mean Healthy Eating Index (HEI) and skin carotenoid status (SCS) scores of 61.9±11.6 and 345±107.8, respectively, with no significant differences between the groups. Post-intervention, the I & E group significantly improved MedDiet adherence, HEI, and SCS scores. Both groups experienced decreased depression and anxiety symptoms, with stress improving only in the I & E group. FI did not moderate the MedDiet-MHS relationship. Lastly, the longitudinal study covers four time points (2021-2024), (T1; N = 1,101), (T2; N = 493), (T3; N = 164), and (T4; N = 101). We found a cumulative high MedDiet adherence inversely correlated with MHS, while FI positively correlated with MHS over the years. The protective effects of MedDiet adherence on MHS were consistent across all food security levels. These findings highlight the critical need for early screening of MHS and FI among college students and may prompt university administrators to consider nutritional and food security interventions to promote student mental health and well-being.32 0Item Restricted Saudi Students’ Experiences Using Artificial Intelligence to Support Well-Being While Studying Abroad(University of Sheffield, 2024-09) Barhyem, Smer; Rowsell, JenniferThis desk-based study explores Saudi Students’ Experiences Using Artificial Intelligence to Support Well-Being while studying abroad. It focuses on their challenges to investigate how AI can address them, through a qualitative approach. Data were collected through secondary sources highlighting Saudi master's students' challenges studying abroad and the impact of AI on their well-being. The data were analyses by using thematic analysis to determine meaningful themes. The research discovers that AI can offer helpful solutions, by providing language support, promoting social integration, and offering mental health services. Despite the possible benefits, there are some concerns about ethical issues related to AI, such as privacy, breaches, and biases. This research seeks to encourage Saudi master's students to use AI by explaining how it offers multiple services and the impact on their well-being and suggesting some recommendations. These recommendations include the opportunity to Invest in AI support systems in the universities to enhance their language and encourage them to communicate with others and develop mental health support services, leading to starting the treatment quickly and offering academic support services. Additionally, by considering these recommendations universities can create supportive environments for Saudi master's students studying abroad, leading to improved well-being and academic success.26 0Item Restricted “What is the impact of gardening on the psychological health of adults? A scoping review.”(Exeter University, 2024-03-06) Alomiri, Abeer; Garsid, RuthRecently, there have been concerns that the prevalence of mental disorders has increased significantly, threatening the mental health of a large segment of the population. Therefore, there has been a call to improve the psychological health of the general population using non-pharmacological interventions (e.g., gardening and green spaces). Although several scoping reviews have examined the psychological outcomes of green spaces, there is a lack of scoping reviews that examine the psychological outcomes of gardening. Scoping reviews in this research area can be valuable because they identify potential methodological limitations, informing future research. Further, they can explore the scope of evidence, which can identify unanswered research questions. Therefore, this scoping review aimed to explore the scope of evidence as well as identify the methodological limitations in this research area in order to inform future research. The scoping review was guided by a framework developed by Arksey and O'Malley (2005). Different databases were used to access relevant studies, including Scopus, Medline, and the Web of Science Core Collection (WSCC). The search yielded 26 studies. Gardening can lead to a wide range of psychological outcomes, including a reduced risk of depression, with a higher effectiveness of community gardening in decreasing depression compared to individual/home gardening, a decrease in anxiety, mental resilience and relief from stress, escape, enjoyment, and relaxation, better cognitive performance, a sense of community and social relationships, and a greater sense of meaning of life, although there is a greater effect size in individualistic than collectivist cultures and an overly simplistic approach to the association between gardening and psychological outcomes. Further, there were several methodological limitations, such as limited use of objective measures (e.g., salivary cortisol levels, fMRI), a lack of use of the Core Outcome Sets (COS), a lack of studies with long-term follow-up, a lack of studies that examined the difference between doing the gardening activity and the mere presence of being at the gardening site, and a lack of studies from different countries (Africa, Asia, and South America). Limited studies examined the impact of mediators and moderators. Further, known facts were usually not taken into account. Researchers are advised to address these methodological gaps, as this will improve the quality of evidence in this emerging research area. Moreover, policymakers are advised to provide the required financial support to urban planners to increase the presence of gardens, as they can encourage local people to engage in gardening activities. Further, initiatives that introduce community gardening in public gardens can be adopted by local governments worldwide. Keywords: gardening, green spaces, psychological health, depression, anxiety, stress21 0Item Restricted INTERVENTIONS BOOSTING OPTIMAL MENTAL HEALTH AMONG ADULTS(Saint Louis University, 2023) Hawsawi, Samah; Schneider, Joanne KraenzleOptimal mental health is defined as a state where an individual feels good, functions well, copes with stressors, and contributes to the world. It is significant to individuals because it determines how individuals face adversity and make informed decisions. It also allows individuals to lead fulfilling and meaningful lives. Yet, it is estimated that only 20% of adults have optimal mental health and 1 in 5 adults experience mental health conditions. These data indicate the significance of using interventions to boost optimal mental health among adults. Evidence has indicated that identifying interventions that promote mental health and prevent mental health conditions might be significant in boosting mental health. The literature reveals that flourishing is a promoter of good mental health because it cultivates positive characteristics that decrease the risk for mental conditions; and compassion fatigue is a challenging factor to mental health because it impairs individuals’ ability to deal with stressors. Therefore, the focus of this dissertation was to identify interventions that alleviate compassion fatigue symptoms and improve flourishing among adults. We conducted two meta-analyses to identify interventions that promote flourishing among adults. We coded data from prior studies including source, method, intervention, and participant characteristics. We analyzed data using the random-effects model and used Hedge’s g to estimate effect size. We examined publication bias and heterogeneity. We conducted a moderator analysis to examine the effects of moderator variables. In addition, to explore interventions that alleviate compassion fatigue, we conducted an integrative review using Whittemore and Knafl method and analyzed data using thematic analysis. Our results from three manuscripts revealed that physical activity and mindfulness interventions are two distinct approaches that offer pathways to flourishing and can alleviate compassion fatigue among adults, but they operate through distinct mechanisms and approaches. Through the moderator analysis, we identified some moderator variables that influenced the effect sizes including, the type of intervention and a priori power calculations. Overall, physical activity and mindfulness practices, while different, can complement each other in a holistic approach to enhancing overall mental health, which can be explored through future research.56 0Item Restricted Workplace Factors Associated with Psychological Effects in Paramedics, A systematic Review and Meta- Analysis(Saudi Digital Library, 2023-10-13) Zahran, Rahaf; Brad, MetcalfThis systematic review and meta-analysis study aims to assess the correlation between workplace factors and psychological effects on paramedics. A search of four databases found 1794 papers, from which 31 were deemed eligible from the years 2000 to 2023. Their methodological quality was assessed using the Critical Appraisal Skill Program (CASP, 2018) tool and the Strengthening the Reporting of Observational Studies in Epidemiology (STOBE) guidelines to help in assessing cross-sectional studies. The results give the overall effect size with an OR=1.65 and a P<0.001, indicating statistical significance for the first forest plot. Similarly, forest plot 2 demonstrates an overall effect size with a correlation r= 0.29 and a P<0.001, also indicating statistical significance. In summary, this review found a small and positive correlation in reported odds ratio studies. For Pearson correlation r reported studies, a moderate and positive correlation were found linking psychological effect to workplace factors in paramedics. The limitation of this study included research published in English and variation in reporting results in the studies. The findings will inform future research and help policymakers, healthcare organizations, and practitioners in developing strategies to support paramedics' mental health and enhance quality of care.24 0Item Restricted The role of child and parental factors on parents feeding practices in a clinical population of children with poor growth(Saudi Digital Library, 2023-10-15) Almaatani, Dina; Bandsma, Robert H J; Van Den Heuvel, MetaFailure to thrive (FTT) is a symptom of inadequate nutrition and growth. Parental feeding practices are important determinants in shaping weight and eating behaviors in children during a sensitive period of physical and cognitive development. The feeding interaction is a bidirectional relationship between the caregiver and the child and informed by different contextual factors such as family, parental and/or child characteristics. Responsive feeding has been found to promote children’s interest in feeding, as well as their awareness of hunger and satiety cues. This dissertation aims to explore parental beliefs and feeding practices in a clinical population of children with poor growth, as well as the contextual factors that influence parental feeding practices in this population. First, a systematic review and meta-analysis was conducted in order to synthesize the current literature examining association between parents’ stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. Second, a clinical study with cross-sectional design was conducted among a clinical population of children with poor growth to examine the correlation between maternal concern about child weight or perceived feeding difficulties and feeding practices, and to investigate the role of child temperament and maternal mental health in a clinical population of children with poor growth. The findings from the two projects, showed that both general and parenting stress were associated with non-responsive feeding styles. Furthermore, higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive feeding practices. Both child temperament and maternal mental health influenced the use of pressure feeding. Therefore, a review into current policies regarding parents’ mental health screening in a pediatric setting was conducted. The review suggests a lack of clear guidelines and recourse in order to support parents’ mental health screening in a pediatric setting. These findings provide a novel insight into the role of both the child and parents factors on parents’ beliefs and feeding practices. A better understanding of this relationship may provide pathways that could support and improve the clinical management of children with poor growth.17 0Item Restricted Factors Influencing Physical Activity Among U.S. Adults With Chronic Health Conditions: Mediation And Moderation Analyses(Saudi Digital Library, 2023-03-09) Alqahtani, Sami; Fontaine, KevinThe prevalence of chronic health conditions (CHCs) is rising across all age groups, genders, and racial/ethnic groupings, making them the main cause of death globally. The majority of CHCs deaths occur in middle-to-low-income countries, although they are also a significant health issue in developed countries. A higher risk of developing CHCs is linked to physical inactivity. Global societies are experiencing increased prevalence of CHCs, which are directly assoicated with rising healthcare costs, workforce attendance, productivity challenges, and academic success. However, increased exercise and physical activity (PA) are linked to lower odds of developing CHCs. In fact, regular PA can help reduce the risk of developing at least 20 CHCs and help with the management of these conditions. However, only 1 in 4 adults in the United States (US) meet the current PA recommendations for aerobic and muscle-strengthening activities. In addition even fewer individuals with CHCs meet current PA recommendations. To that end, the current dissertation explores factors influencing the relationship between CHCs and PA status among US adults to address this important research gap via three independent studies. In the first study (Chapter 2), and as a first step, we wanted to present an updated estimate of American adults' with CHCs adherence to the current Centers of Disease Control (CDC) recommendations for PA based on the presence or absence of CHCs using a nationally representative data (BRFSS). Specifically, we estimated the prevalence of US adults with self-reported CHCs who meet the current PA recommendations according to their sociodemographic characteristics, number of CHCs, and type of CHCs. Additionally, we identified important research gaps and proposed recommendations for future studies. Briefly, we found that only 18% of US adults with self-reported CHCs met the PA recommendations for both aerobic and muscle-strengthening, and almost 35% did not meet both PA recommendations. Another important finding is that the prevalence of American adults who do not adhere to both PA recommendations increases as the number of CHCs increases. Furthermore, after examining each CHC independently, it was found that American adults with COPD had the highest prevalence of not meeting the PA recommendations for both aerobic and muscle-strengthening exercise. In the second study (Chapter 3), we conducted two mediation analyses to test whether mental health status and then separately physical health status mediate the relationship between self-reported CHCs and self-reported PA status. Specifically, the inverse odds weighting approach (IOW) was used to estimate the total effect, the direct effect, the indirect effect, and the percent of effect related to mediation in weighted logistic regression models. Our analysis of BRFSS data showed lower odds of PA, poorer mental health, and poorer physical health among American adults with CHCs. Most importantly, we found that the relationship between CHCs and PA is due, in part, to the influence of CHC on poorer mental and physical health, which, in turn, influences physical inactivity, supporting our hypotheses. In the third study (Chapter 4), five weighted logistic regression models were performed to examine the relationship between CHCs and PA. Tests of moderation were conducted by including an interaction term between CHCs and each substance use variable (binge drinking, tobacco smoking, smokeless tobacco, marijuana, and polysubstance). We found that individuals who reported having CHCs and individuals who are current tobacco smokers had statistically significant lower odds of being physically active. CHCs management has risen to the forefront of modern medicine as our population ages, and medical costs continue to rise. Hence, there is a need for more research that prioritize CHCs preventative and mitigating strategies, such as PA behavior promotion. The findings from this dissertation may guide clinicians, public health professionals, policymakers, and researchers to better understand the factors that might influence the relationship between PA and CHCs. This information will help design more effective and evidence-based PA promotion interventions and policies aiming to help American adults (with or without CHCs) to be more physically active.13 0