Saudi Cultural Missions Theses & Dissertations
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Item Restricted Evaluating Acceptance of Lateral Wedge Insoles for Knee Osteoarthritis in Saudi Arabia: A Mixed-Methods Study(University of Nottingham, 2024) Al Assiri, Abdullah; Loagn, PipBackground: Knee osteoarthritis (KOA) is a degenerative cartilage condition marked by inflammation and mechanical processes. In Saudi Arabia (SA), one in ten older individuals suffer from it. KOA often leads to pain, functional limitations, reduced daily activities, and diminished quality of life. For those with medial knee osteoarthritis, lateral wedge insoles (LWI) can alleviate knee pain and enhance function. While LWI offers biomechanical and symptomatic benefits, the perspectives of Saudi KOA patients and physiotherapists on its clinical use are not well-understood. In addition, there is limited research on gait modification treatment for other types of KOA, especially regarding facilitators and barriers in the Saudi context. Aims: This study aims to identify the suitability and acceptable use of the gait modification approach for reducing knee pain and enhancing functional ability among KOA patients in Saudi Arabia using a mixed methods approach. Methods & Findings: A sequential exploratory mixed-methods approach was employed for this evidence-based study, following the Medical Research Council's (MRC) Framework for Developing Complex Interventions. The research consisted of a systematic review and qualitative investigations, along with the development and testing of a feasibility study. The first component (Background, chapter 2) assesses the efficacy of various gait modification approaches on knee loading, pain, and function with KOA patients, with evidence from the Saudi healthcare system highlighted. Research goals and questions were set. The second component (Systematic reviews and meta-analyses, chapter 4) identifies the most effective gait modification approaches and their primary clinical outcomes during walking. The analysis revealed that most gait modification methods did not significantly reduce the KAM 1st peak in the short and mid-terms. However, the systematic review indicated that lateral stiffener shoes could reduce the KAM 1st peak in the short term, and re-gait training with toe-out positioning might significantly improve the KAM 2nd peak. Furthermore, in the short term, LWI significantly impacted both the KAM 2nd peak and the knee adduction angular impulse (KAAI). Despite these specific benefits, the overall effectiveness of gait modification in reducing knee loading was limited. Subsequently, the third section (Qualitative – chapter 5) utilised semi structured interviews and focus group discussions to grasp KOA patients' and physiotherapists' views on various gait modification techniques before adapting the LWI approach to the Saudi healthcare setting. This approach aimed to identify key features of gait modification and further understanding of stakeholders' knowledge, attitudes, and challenges in its application for KOA patients. The research indicated that implementing knee braces, canes, footwear and insoles was straightforward for patients and therapists, providing notable benefits and improving daily activities. Drawing from prior research, a feasibility study was designed, outlining the suggested LWI as a gait modification, implementation duration, outcomes, and satisfaction survey. The fourth component (Feasibility - chapter 7) evaluated the acceptability, tolerability, and feasibility of personalised LWI for KOA patients at a Saudi centre. This section implemented LWI as a gait modification, measuring recruitment, retention, adherence rates, the Numerical Rating Pain Scale (NRPS), the Osteoarthritis Index (WOAMC), and conducting satisfaction surveys for both patients and therapists. In the initial session, KOA patients were assigned LWI with baseline records, followed by self-reported outcomes, Then, at the 6th week, clinical outcomes (NRPS & WOAMC) were reassessed, and a survey was collected. Of the 21 KOA participants who consented for the quantitative analysis, 17 completed the final evaluation. The study achieved an 87.5% recruitment rate and an 81% retention rate after six weeks. However, it is important to note that comfort was an issue for some participants, as two withdrew citing insole discomfort. The compliance rate assisting at 5.47 hours/day, indicating a 71% adherence, which was below the targeted value. After six weeks, KOA participants showed significant improvements in the NRPS. A t-test revealed that these improvements were statistically significant (p = 0.007) with a large effect size (Cohen's d = 0.98). Similarly, the WOMAC results also demonstrated statistically significant improvements (p < 0.001) and large effect size (Cohen's d = 1.56). Seventeen KOA patients, who completed a survey, approved the LWI and expressed their satisfaction. They rated their satisfaction with the LWI application's clarity at 5 (extremely satisfied) and their symptoms improved satisfaction with the LWI at (64.7% - very satisfied). In the survey, KOA patients rated LWI as straightforward, well-tolerated and adverse-effect-free. The overall therapists’ satisfaction median was "Very satisfied," highlighting a positive response towards the practical skills enhancement provided by the insole, while the overall median for agreement items was "Agree," indicating a consensus among therapists on the insole's beneficial impact on their treatment routine. Given these results, the suitability of LWI in KOA recovery remains debatable. Conclusion: The LWI was viewed as a viable treatment option for KOA in the Saudi context. Both patients and physiotherapists had shown significant interest in this approach. The results of a six-week intervention highlighted its practical benefits, such as reduced knee pain and improved walking capability. Continuous support and guidance from physiotherapists contributed to high levels of adherence, contributing to maintaining activity levels. While LWI offered a promising option in KOA rehabilitation, its full potential remained unexplored. Factors like the current SA KOA clinical protocol, infrastructure difficulties, therapist expertise and LWI availability needed consideration. In the Saudi context, a follow-up trial was essential after this initial intervention to assess the programme's long-term viability and cost-effectiveness. Furthermore, Although the physiotherapists' satisfaction survey indicated that the LWI programme was debatable, the physiotherapy educators needed to integrate knowledge about assistive gait modification (LWI) into their academic and clinical programmes to enhance evidence-based practice.7 0Item Restricted Examining the Usage of Persuasive System Design to Drive Motivation for Learning Programming(RMIT, 2024-06) Alyounis, Essa Saleh A; Dick, Martin; Peszynski, KonradLearning to program is challenging, and the dropout and pass rates in programming courses have remained an issue for several decades. Many students experience difficulties in gaining the necessary programming skills. Hence, students in programming courses need to be motivated to maintain the required effort to develop programs. The current problem is that not all students—in particular, non-computer-science majors—have the same motivation or interest to pursue programming as part of their studies. Therefore, there is a need to keep students motivated while they pursue programming activities. Accordingly, this research aimed to examine the impact of applying persuasive system design (PSD) principles to develop the instructional design of a programming course in order to improve students’ motivation for learning programming. This study followed the design science research (DSR) methodology by adapting Peffers et al.’s (2007) model to develop the instructional design for an introductory online programming course, into which it incorporated PSD principles. The programming course was deployed in a free Canvas account and covered the fundamental topics in introductory programming. Mixed methods were employed for data collection, encompassing pre-test and post-test assessments, log-system analysis and semi-structured interviews with voluntary participants to assess the influence of the course design on their motivation. First, a Programming Motivation Questionnaire, adapted from the Science Motivation Questionnaire-II, was used to measure their motivation before and after they took the designed programming course. This adapted questionnaire consists of five subscales: intrinsic motivation, career motivation, self-efficacy, self-determination and grade motivation. Second, a thematic analysis was conducted to identify the themes that emerged from the interviews. The results showed that the intervention had a positive impact on the participants’ motivation. Analysis of data from the 89 participants completed pre- and post-questionnaires revealed a significant enhancement of their motivation level (from a mean of 3.62 and median of 3.96, respectively, to a mean of 4.08 and median of 4.28, respectively). Further, a Wilcoxon signed-rank test revealed a statistically significant increase in motivation after taking this course, with a medium effect size. Moreover, the thematic analysis identified various themes, which supported the quantitative results. The themes identified that the effects of the course on the participants’ experience, such as motivation, encouragement, self-efficacy and satisfaction, were prevalent among the 10 interviewees. Thus, this research contributes to the literature that addresses issues surrounding learning programming. It provides an alternative solution to stimulate students’ motivation and avoid increasing instructors’ workload. This study also reveals the role of various PSD principles in developing the instructional design and the impact of an instructional design decision on students’ motivation. Future research should examine the application of PSD in traditional courses in higher education. Conducting the study during an academic semester will provide a more comprehensive understanding of how PSD influences the motivation of students from various domains.82 0Item Restricted An Exploration of the Suitability of Pharmacy Education in Saudi Arabia to Prepare Graduates to Meet Healthcare Needs: a Mixed-Methods Study(2023-08-01) Alfaifi, Salihah Hadi; Bridges, Stephanie; Arakawa, NaokoThe key role of pharmacists within the health system, particularly in optimising safe, responsible and effective use of medicines, underpins the demand for a highly skilled and competent workforce. Therefore, developing the capacity of pharmacists to attain and maintain essential competencies relevant to the population’s health needs is required to ensure a high standard of patient care, thereby helping to improve patient and population health. In Saudi Arabia, little evidence exists regarding the assessment of national educational programmes’ structure and outcomes. Moreover, no national competency framework exists for pharmacists in any sector or stage of practice. In the absence of such core quality elements to inform pharmacy education assessment and development, the extent to which pharmacy schools in Saudi Arabia prepare competent pharmacists to address societal needs from pharmacy services is unclear. Therefore, this study aimed to explore the extent to which pharmacy education can prepare competent pharmacists to address the healthcare needs for pharmacy practice in Saudi Arabia. An exploratory sequential mixed methods research design was used to address the aim of this study in three phases: individual interviews and focus groups were employed with a purposively selected sample of pharmacy policy makers, pharmacists and the public to explore societal healthcare needs and the roles required of pharmacists to meet those needs; a national online survey of pharmacists and an online nominal group consensus method of pharmacy experts were used to identify competencies considered essential to develop a profession-wide national foundation level competency framework; and a case study in which curriculum mapping of two purposively selected Doctor of Pharmacy (PharmD) curricula was used to assess the extent to which the current pharmacy programme in Saudi Arabia meets the identified competencies of the developed national competency framework. Based on qualitative and quantitative analyses of societal healthcare needs, pharmacists’ roles, core competencies and curricular contents within the local context of Saudi Arabia, findings showed that there is a mismatch between initial education and real practice needs and expectations. While the country’s current needs from pharmacists are to optimise health system capacity and increase access to primary care services and medicines expertise in community pharmacies, the study indicated local education is product-oriented with a focus of curricular content and experiential training opportunities in most schools on preparing future pharmacists for hospital pharmacy practice. The study also identified several gaps between current initial education programmes and the competencies required to practise the expected roles, suggesting that current initial education might not prepare the students sufficiently to provide the full range of quality pharmaceutical services as per the country’s pharmacy practice needs. The study provided a new understanding of graduates’ readiness to practise as per the country’s pharmacy practice needs, the quality of educational programmes and pharmacists' professional development opportunities in Saudi Arabia. Findings maybe used to inform the development of competency-based education and maximise graduates’ capacity to deliver and develop pharmaceutical services effectively to best meet societal healthcare needs in Saudi Arabia.44 0