Saudi Cultural Missions Theses & Dissertations
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Item Restricted How do Older Adults Experience Transition from Hospital and Adaptation to being Cared for at Home in Saudi Arabia?(Saudi Digital Library, 2026) Alharthi, Faisal; Tony, RyanAs global ageing accelerates and healthcare systems confront rising hospitalisation and readmission rates among adults aged 65 and older (WHO, 2021), the need for effective transitional care has become increasingly urgent. However, existing theories in gerontology and transitional care are predominantly shaped by Western perspectives, offering limited insight into how such care is understood and delivered in non-Western societies. This study addresses that gap by using Charmaz’s Constructivist Grounded Theory methodology to explore older adult transition care in Saudi Arabia. Data were collected through in depth, semi-structured interviews with thirty participants: twenty older adults (ten hospitalised and ten recently discharged), five family caregivers, and five nurses. A grounded theory was developed through iterative coding, constant comparative analysis and memo writing, culminating in the formulation of the Rebuilding and Reconnecting theory of older adult transition. This theory offers a culturally embedded, cyclical model of care transition in which older adults move between hospital and home. It challenges linear or unidirectional understandings of recovery by identifying four interrelated support systems, Faith, Family, Friends, and Formal care (the 4Fs) as central to sustaining or disrupting successful transitions. The theory places emphasis on relational engagement, spiritual meaning making, and cultural context as essential components of the care experience.16 0Item Restricted Development of a Behaviour Change Intervention for Deprescribing for Older People in Secondary Care in Saudi Arabia(Saudi Digital Library, 2026) Alenzy, Turkeah; Parsons, Carole; Barry, Heather; Alkahtani, SaadIntroduction Saudi Arabia’s ageing population is increasing, with rising multimorbidity and polypharmacy among older adults. This has contributed to potentially inappropriate medication use, increasing risks of adverse drug events, hospitalisation, and reduced quality of life. Deprescribing can reduce these risks, but evidence on its implementation in Saudi secondary care remains limited. This thesis aimed to provide a theory-based foundation for a behaviour change intervention to support deprescribing for older inpatients in Saudi hospitals, focusing on physicians, pharmacists, patients, and carers. Methods A mixed-methods design was conducted across four studies. Qualitative interviews explored physicians’ and pharmacists’ experiences of deprescribing, using topic guides informed by the Theoretical Domains Framework version 2 (TDF2). Determinants were prioritised and mapped to behaviour change techniques (BCTs). A modified nominal group technique used the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side effects and safety, and Equity) to refine and select BCTs. A cross-sectional survey using the revised Patients’ Attitudes Towards Deprescribing questionnaire assessed older inpatients’ and carers’ views. Finally, a scoping review applied the Behaviour Change Wheel to map hospital interventions to functions and BCTs. Results Key determinants included professional roles, team and hierarchical influences, patient and carer perceptions, concerns about negative outcomes, lack of guidance and documentation, resource constraints, interprofessional support, education, and recognition of benefits. These were linked to six TDF2 domains. Five BCTs were selected: ‘Information about others’ approval’, ‘Social support’, ‘Information about health consequences’, ‘Social comparison’, and ‘Salience of consequences’. Most older inpatients (88.1%) and carers (82.7%) were willing to deprescribe if recommended by a healthcare professional and wanted involvement in decision-making. Conclusion This thesis provides a theory-informed foundation for a feasible hospital-based deprescribing intervention in Saudi Arabia. The selected BCTs offer a practical basis for future intervention development, testing, and integration into routine hospital practice.8 0Item Restricted DETERMINATION OF CULTURAL DYNAMICS AFFECTING THE ADOPTION OF MOBILE HEALTH (M-HEALTH) APPLICATIONS BY THE ELDERLY POPULATION OF SAUDI ARABIA(Saudi Digital Library, 2026) Alshammari, Abdulaziz; GUDUR, RAGHAVENDRA REDDY; MASOUD, MOHAMMADIAN; SARVJEET, KAUR CHATRATHThis thesis investigates how socio-cultural, technological, personal, and demographic factors shape attitudes toward mobile health (mHealth) applications and their adoption by older adults in Saudi Arabia. Drawing on the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, and Hofstede’s cultural dimensions, it specifies and tests a model in which family support, social influence, cultural values, service attributes, perceived usefulness, security concerns, and interface and user experience predict attitudes toward mHealth and adoption. Demographic characteristics, including age, gender, education, living arrangement, and familiarity with technology, are examined as direct determinants of attitudes and adoption. A cross-sectional survey was administered through the Ministry of Human Resources and Social Development to adults aged 60 years and over who use national mHealth services, yielding 354 valid responses. Data were analyzed using partial least squares structural equation modelling. Adoption was operationalized through reported frequency and duration of use, range of features, and health tasks completed. The results show that technological and personal factors underpin positive attitudes, which are positively associated with adoption. Socio-cultural and demographic conditions contribute additional variation in adoption and highlight groups who may require tailored support. The findings offer design and policy guidance for strengthening sustained engagement with mHealth among older Saudis.13 0Item Restricted Exploring the Influence of Culture on Adherence to Physical Activity Guidelines Among Older Adults with diabetes mellitus and/or chronic kidney disease in KSA: A mixed methods study(Saudi Digital Library, 2026) Alrashidi, Lamya; Gillian, Prue; Iseult, WilsonBackground: Physical activity (PA) is essential for managing chronic conditions such as diabetes mellitus (DM) and chronic kidney disease (CKD), particularly among older adults. In the Kingdom of Saudi Arabia (KSA), limited data exist on the PA behaviours of this population or the cultural and contextual factors that influence them. This study employed a sequential explanatory mixed-methods design to assess PA levels and explore the cultural dynamics influencing PA adherence among older adults with DM and/or CKD in Ha’il City. Methods: A sequential explanatory mixed methods design was employed in three phases. Phase 1 consisted of a scoping review to examine the influence of culture on physical activity behaviours among older adults with chronic diseases. Phase 2 involved a quantitative cross-sectional survey of 256 older adults using the Arabic version of the Physical Activity Scale for the Elderly (PASE-A). Descriptive, bivariate, and multivariable regression analyses were conducted to explore associations between physical activity and sociodemographic and clinical variables. Phase 3 comprised qualitative dyadic interviews with 15 older adults and their informal caregivers. Thematic analysis, guided by the Social-Ecological Model (SEM), was used to interpret the findings and contextualise the quantitative results. Results: PA levels among older adults in Ha’il with DM and/or CKD were low relative to published international reference values, with a mean PASE score of 30.6 (SD = 41.9). Household activity contributed to overall physical activity scores among a subset of participants, particularly women; however, household physical activity was unevenly distributed, with more than half of participants reporting no household activity. Participants with CKD were less active than those with DM, and longer disease duration was associated with lower PA levels, while higher educational attainment was positively associated with PA engagement. Qualitative findings identified multiple barriers to PA, including chronic illness, fatigue, restrictive cultural norms equating ageing with rest, gender-based mobility constraints, family overprotection, inadequate infrastructure, and extreme climatic conditions. Key facilitators included family encouragement, medical advice, social companionship, and increased awareness of PA benefits. Conclusion: This study demonstrates that PA among older adults with DM and/or CKD in KSA is limited and shaped by an interaction of individual, interpersonal, community, and societal influences. Multi-level interventions that address cultural norms, strengthen family and caregiver support, and improve community and environmental resources are needed to support sustainable PA engagement and improved health outcomes in this population. Keywords: Physical activity, Older adults, Diabetes mellitus, Chronic kidney disease, KSA, Mixed-methods, Cultural factors, Caregivers, Social Ecological Model16 0Item Restricted Nutrition for Health and Wellbeing in Community Dwelling Older Adults(University of Newcastle, 2024) Alghamdi, Maryam; Chojenta, Catherine; Burrows, TracyPrior research has suggested that culinary nutrition programs are effective in improving the dietary intake and overall health of older adults. Delivering these programs online has been proposed as possible and present promising results. These programs often promote healthy-eating patterns in relation to the program’s aim and can be based on various dietary patterns. Considering the recognition of the Mediterranean diet (MedDiet) as a healthy-eating pattern for older adults and the successful adherence in non-Mediterranean populations, there is a need for innovative and cost-effective programs to provide older adults with evidence-based culinary nutrition education based on the MedDiet that include an online component. This PhD project employed a multimethod design to develop a culinary and nutrition-focused masterclass that provides education on the MedDiet, including step-by-step guidance to facilitate adopting this dietary pattern among older adults. To address the purpose of this research, the thesis (1) conducted a synthesis of current culinary and nutrition programs for older adults published to 2022, (2) qualitatively analysed workshop discussions to explore older adults’ use and motivations to join online courses, (3) used a participatory action approach to co-design the education content and Mediterranean-style recipes of the masterclass with older adults and (4) presented a reflection on the experience of conducting the co-design virtually and the impact of using this approach with older adults. The synthesis of existing research revealed limited research regarding programs designed specifically for the older adult population. Among the few programs, only four involved older adults in the development phase. The scoping review also identified that existing culinary nutrition programs had limited online components, no program was offered fully online and none provided MedDiet education to the non-Mediterranean older population. Through workshops and qualitative analysis, it was determined that older adults were interested in online courses and have had successful learning experiences with large variations in digital skills between research partners and people within their communities. Following on from the initial phases of work, a co-design approach using multimethods identified older adults’ needs and preferences, which determined the key elements of a MedDiet culinary nutrition masterclass. Specifically, educational content was developed and input to inform the structure and format of the masterclass. In addition, recipes were sought and optimised for diet quality. The outcome is a book that includes culinary nutrition education, Mediterranean-style recipes and links to a series of videos, led by partners’ decisions. Reflecting on the online co-design identified difficulties and highlighted the positive impact of the co-design approach on partners, suggesting that it can be considered in future co-design research with older adults.25 0Item Restricted Discrimination and Multimorbidity among older adults(King's College London, 2024-08) ALFAKHRI, KHALED; Sabbah, WaelAim: This study aims to investigate the relationship between racial discrimination and multimorbidity among American older adults, and whether discrimination mediates the relationship between socioeconomic factors and health outcomes. Methods: Participants in this study who were 65 years of age or older were drawn from the 2022 Behavioural Risk Factors Surveillance System (BRFSS) database. This study included 44,029 participants. Multimorbidity was defined as the presence of two or more chronic conditions, including stroke, heart attack, angina, cancer, asthma, arthritis, depression, chronic pulmonary disease, diabetes, and kidney disease. Racial discrimination was measured through self-reported experiences of being treated differently based on race. Socioeconomic factors (income and education level) and behavioural factors (smoking, alcohol consumption, physical activity) were considered. Negative binomial regression models were used to examine the association between racial discrimination and multimorbidity, adjusting for potential confounders. Results: The analysis revealed a significant association between experience of racial discrimination and multimorbidity (Rate Ratio [RR] = 1.13; 95% Confidence Interval [CI]: 1.05- 1.21). Socioeconomic factors such as lower income and education levels were also significantly associated with higher multimorbidity risk, however no evidence of discrimination experience partially mediating the association. Conclusion: Understanding the impact of racial discrimination on multimorbidity highlights the importance of addressing social determinants of health. This study underscores the need for targeted interventions to mitigate health inequalities among older adults, particularly those facing racial discrimination.Item Restricted Assessment of low-intake dehydration in hospitalised older people and the role of Bioelectrical Impedance Spectroscopy(University of Southampton, 2024-06-27) Alsanie, Saleh; Wootton, Stephen; Lim, Stephen; Ibrahim, KindaBackground: Older people are susceptible to low-intake dehydration, which is often not recognised and can result in significant morbidity through falls, constipation, delirium, respiratory and urinary tract disorders, and even death. Identifying low-intake dehydration at hospital admissions is challenging, leading to treatment delays and poor outcomes. Aims: To examine the factors underlying the identification of low-intake dehydration in older people admitted to Medicine for Older People (MOP) wards at University Hospital Southampton NHS Trust and to explore the feasibility of performing a study whereby bioelectrical impedance analysis (BIA) might be used alongside existing hydration risk screening tools in identifying low-intake dehydration in older people admitted to hospital. Methodology: A narrative review of the role of water in the body and the consequences of dehydration was carried out. This was followed by a sequential explanatory mixed-methods study involving quantitative service evaluation of recognition of dehydration in MOP wards and qualitative staff interviews to determine barriers and facilitators of hydration care and examine the factors influencing the routine assessment and diagnosis of dehydration in MOP wards. This led to a systematic review of the literature on the role of BIA in detecting low-intake dehydration. Finally, a study was conducted to examine the feasibility of conducting measurements of hydration status in hospitalised older patients using the existing hospital screening tool for dehydration and BIA measurements. Results: Most older patients admitted were at moderate to severe risk of developing dehydration. The service evaluation of hydration care provision showed good compliance with completing the initial hydration assessment. However, follow-up of patients at severe risk via 24-hour fluid balance charts needed improvement. Nursing and medical staff were aware of the importance of assessing hydration status but faced challenges in the diagnosis and management of dehydration. The proposed design for a study exploring the concurrent validity of the current screening tools and bedside measurements of BIA, its implementation and conduct was shown to be both feasible and acceptable to patients and staff and generated high-quality impedance measurements at the bedside alongside routine clinical care. Clinical demographics and directly measured impedance values of resistance, reactance, phase angle and impedance ratio were obtained in 25 patients reflected both age and hydration state but did not significantly correlate with risk categorisation of dehydration based on the established screening tools. Conclusion: Identifying older people admitted to hospitals who are at risk of or have low-intake dehydration requires continued vigilance, adherence to screening and assessment, and continued oversight within ordered systems and processes. Continued service improvement and staff training are needed, together with objective measures of hydration status, such as bioelectrical impedance, which may be used to improve clinical decision-making and care. Further studies are required to determine the reliability and validity of BIA in detecting low-intake dehydration compared with pre-existing objective measures such as serum osmolality, as well as its cost-effectiveness and evaluability in clinical practice.Item Restricted Body Weight and Mortality Risk in Community-Dwelling Older Adults(Monash University, 2024-02-21) Alharbi, Tagrid Abdullah; Owen, Alice; Freak Poli, Rosanne; Ryan, Joanne; Gasevic, DanijelaBackground: Overweight and obesity, generally defined by body mass index (BMI) ≥ 25 kg/m² or large waist circumference (abdominal obesity), is increasingly prevalent among older adults worldwide, however studies of excess weight and the link with mortality risk in older adults have reported mixed findings. Weight change may be a better indicator of mortality risk in older individuals, but large community-based longitudinal studies of older individuals are needed. Aims: To systematically review the association between weight change and all-cause mortality risk in adults aged ≥ 65 years, and to examine the association of weight status, abdominal obesity and weight change with the risk of mortality in community-dwelling older adults aged ≥ 65 years. Methods: A systematic review and meta-analysis conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to examined the evidence that weight change (loss, gain and fluctuation, measured by weight or BMI) is associated with all-cause mortality. Secondary data analysis was performed using longitudinal data on community-dwelling individuals from the ESPIRIT (France, N=2,017) and ASPREE/ALSOP sub-studies (Australia, N=14,853). The association of self-reported weight loss, objectively measured weight change (loss and gain), weight status, and abdominal obesity with all-cause mortality over a 17-year follow-up period in the ESPIRIT study was explored using Cox proportional-hazard regression. To broaden understanding of the association between BMI in early (at age 18 years) and later (age ≥70 years) adulthood, and their impact on later-life mortality (over a median of 4.7 years in the ASPREE/ALSOP sub-study), Cox proportional-hazard regression was applied. Furthermore, the socio-demographic, lifestyle, and clinical characteristics associated with change in weight status between early (age 18 years) and late (age ≥ 70 years) adulthood were identified. Results: From the systematic review, weight change, particularly weight loss, was found to be associated with a 59% increased risk of mortality compared to stable weight. Longitudinal data analyses found that abdominal obesity was linked to a 49% increased mortality risk compared to non-abdominal obesity, but being overweight was associated with a 20% decreased risk compared to a normal BMI. Self-reported weight loss of >3 kg at baseline was associated with a 52% increase in mortality risk for men only; but both men and women with ≥ 5% objectively measured weight loss had a 24% increased risk of all-cause mortality. Obesity at 18 years, but not in older age, was associated with a 35% increased risk of mortality in later life. Compared to participants with a normal BMI, obesity at both early adulthood and later life was associated with 99% increase in the risk of all-cause mortality. Obesity in early and/or late adulthood was also associated with a higher risk of adverse clinical risk characteristics. Conclusion: Weight change and weight status are important predictors of mortality risk in older adults. These results highlight the importance of healthcare providers monitoring weight in older adults to detect weight loss at it is early stages, enabling more effective interventions aimed at maintaining stable weight and reducing risk of premature mortality.54 0