Saudi Cultural Missions Theses & Dissertations
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Item Restricted Exploring Sex Differences in Physical Activity and Its Psychosocial and Environmental Determinants among College Students in Saudi Arabia.(Saudi Digital Library, 2026) Alharbi, Abdulaziz; LaJoie, A. ScottBackground: Although the importance of physical activity for health is well-established, engagement remains low among college students in Saudi Arabia, with a pronounced disparity between males and females. However, there is a lack of empirical research examining the unique psychosocial and environmental predictors of physical activity through a sex-stratified lens among Saudi college students. Purpose: This study had two primary aims: (a) to examine sex differences in total physical activity and its related self-efficacy, social support from family and friends, and environmental support; and (b) to identify the unique predictors of total physical activity among male and female college students in Saudi Arabia. Methods: A cross-sectional survey was employed with a sample of 540 college students recruited from one university in Eastern Saudi Arabia. Multivariate analysis of variance (MANOVA) was used to examine sex differences, and hierarchical multiple regression analyses, stratified by sex, were conducted to identify unique predictors of total physical activity. Results: The MANOVA was statistically significant (p < .001, ηp² = .058). Follow-up univariate ANOVAs revealed that males reported significantly higher levels of total physical activity (p = .009), self-efficacy (p = .006), social support from friends (p < .001), and environmental support (p = .012) than females. Among males, the final regression model explained 15% of the variance in total physical activity (p < .001), with self-efficacy (β = .15, p = .022), social support from friends (β = .14, p = .047), and gym attendance (β = .17, p = .011) emerging as significant predictors. Among females, the final model explained 13% of the variance in total physical activity (p < .001), with self-efficacy (β = .20, p < .001) and family social support (β = .16, p = .010) emerging as significant predictors. Conclusion: The findings highlight the importance of sex-specific approaches to address physical inactivity and related disparities among college students in Saudi Arabia. Interventions should focus on enhancing self-efficacy for both sexes while leveraging peer support for male students and family support for female students. A sex-specific intervention plan, informed by these findings and tailored to the local sociocultural context, is presented.23 0Item Restricted INSULIN RESISTANCE, BEHAVIORAL, AND PSYCHOLOGICAL PATHWAYS TO COGNITIVE AGING IN OLDER U.S. ADULTS(Saudi Digital Library, 2026) Alshayhan, Ali; Merchant, AnwarABSTRACT Introduction: Metabolic dysfunction, depressive symptoms, and physical activity are key and independent interrelated determinants of cognitive aging, yet the temporal ordering and causal pathways linking these factors remain incompletely understood. Specifically, metabolic dysfunction may act as both a risk factor for cognitive decline and as an exposure-induced mediator-outcome confounder when examining behavioral and psychological pathways. This dissertation used longitudinal data from the Health and Retirement Study (HRS) to examine the role of metabolic dysfunction, depressive symptoms, and physical activity in shaping later-life cognitive performance using advanced causal mediation methods. Methods: We analyzed nationally representative longitudinal data from U.S. adults aged 50 years and older participating in the HRS between 2014 and 2020. Metabolic dysfunction was indexed by the triglyceride-glucose (TyG) index derived from fasting biomarkers. Cognitive performance was measured using the validated 27-point Langa–Weir cognitive score. Aim 1 examined whether TyG predicted subsequent cognitive performance over 2 and 4 year follow-ups using multivariable regression incorporating survey weights. Aims 2 and 3 applied the Recanting Twins (RT) causal mediation framework using the crumble package in R to estimate path-specific effects on the additive scale in the presence of exposure-induced mediator-outcome confounding. Aim 2 examined the pathways linking physical activity (2014) to cognition through depressive symptoms and metabolic dysfunction (2016). Aim 3 examined pathways v linking depressive symptoms (2014) to cognition through physical activity and metabolic dysfunction (2016). Results: In aim 1, higher TyG levels were associated with poorer subsequent cognitive performance, with stronger and more consistent associations emerging over the longer 4-year follow-up. Continuous modeling detected modest short-term associations, whereas quartile-based differences were more consistent at longer follow-up among participants in the highest TyG quartile (Q4). In aim 2, physically active individuals had higher cognitive performance at both follow-ups. The largest contribution to the total effect (ATE:2018: 0.195 [95% CI: 0.19, 0.2]; 2020: 0.505 [95% CI: 0.476, 0.533] was the direct pathway from physical activity to cognitive performance independent of depressive symptoms and metabolic dysfunction (P1: A→Y, 2018: 0.122 [95% CI: 0.119, 0.126]; 2020: 0.366 [95% CI: 0.331, 0.400]), and the indirect pathways through depressive symptoms (P4: A→M→Y, 2018: 0.06 [95% CI: 0.029, 0.091]; 2020: 0.124 [95% CI: 0.09, 0.158]) were significant also at both follow-ups. The pathways involving metabolic dysfunction were only significant at the longer follow-up and were smaller in magnitude. The extent by which the exposure-induced mediator-outcome confounding component attributable to TyG index was not distinguishable from zero. In aim 3, elevated depressive symptoms predicted cognitive decline at both follow-ups (ATE:2018: -0.413 [95% CI: - 0.447, -0.379]; 2020: -0.733 [95% CI: (-0.756, -0.71]). The direct pathway independent of physical activity and metabolic dysfunction accounted for the largest portion of the total effect (P1: A→Y, 2018: -0.371 [95% CI: -0.380, -0.362]; 2020: -0.651 [95% CI: - 0.673, -0.629]). Also, the behavioral pathway through physical activity was significant at both follow-ups (P4: A→M→Y, 2018: -0.041 [95% CI: -0.0753, -0.007]; 2020: -0.062 vi [95% CI: -0.069, -0.056]). The metabolic pathways emerged only at the longer follow-up and were modest in magnitude. The exposure-induced mediator-outcome confounding component attributed to metabolic dysfunction was small but statistically significant. Conclusion: This dissertation demonstrates that metabolic dysfunction, depressive symptoms, and physical activity jointly shape cognitive aging through temporally evolving pathways. Metabolic dysfunction predicts later cognitive performance and plays a modest but increasingly detectable role in behavioral and psychological mediation pathways over longer follow-up and, in the depressive-physical activity-cognitive performance pathways, the TyG index representing the metabolic dysfunction acted as a an exposure-induced mediator-outcome confounding. Physical activity and depressive symptoms exerted strong direct behavioral and psychological effects on cognition, highlighting mental health and physical activity as key targets for intervention. These findings provide causal evidence that improving depressive symptoms, promoting physical activity, and addressing metabolic dysfunction may collectively contribute to preserving cognitive health in the aging population.4 0Item Embargo Women's Particcipation in Sport and Physical Activity in Saudi Arabia: An Intersectional Study(Saudi Digital Library, 2025) Bamuhair, Nouf; Giulianotti, Richard; Mason, CarolynneWomen’s participation in sport has been a globally debated topic. Despite the growing body of research and government initiatives aimed at increasing women’s mass participation in sport, limited empirical evidence has been provided on this issue through an intersectional lens. This gap in knowledge is especially relevant for Saudi Arabia as the nation is undergoing sociopolitical transformation, under the national Vision 2030 strategy, which seeks to promote women’s inclusion across various sectors, including sport. Thus, understanding the lived experiences of women’s sports become critical for generating knowledge which may in turn serve to enhance policies that promote the social inclusion of women. The overall aim of this research was to explore how Saudi women from different generations and social backgrounds experience sport participation; and to assess whether these experiences align with or diverge from the kingdom’s policy effort. Specifically, the study examines: (1) How does Saudi Arabia’s ‘Sport for All’ (SFA) policy enhance women’s participation in sport, and to what extent is it aligned with their lived experiences? (2) How do the sports participation experiences of different generations of Saudi women vary across different locations? (3) How can women’s participation in sport be increased in Saudi? To achieve this, semi-structured interviews were conducted with 30 women from diverse backgrounds (i.e. across different ages, social classes, and cities) in two major Saudi cities: Jeddah and Riyadh. The study employs an intersectional framework to analyse how gender, age, socioeconomic status, and location interact to shape women’s sport experiences. Alongside this, Bacchi’s (2012a) ‘What’s the Problem Represented to be?’ (WPR) framework was employed to critically examine SFA policy, comparing the policy’s representation of women’s sports participation with their real-life experiences. The findings highlight key themes that underpin or shape women’s experiences and involvements in sport, and these include culture factors, geographical differences, environmental barriers, financial limitations, perceptions of body image and prevailing social expectations, as well as education and political structures. A comparison between SFA policy objectives and women's experiences reveals key gaps. The policy marks a major step in acknowledging women as a distinct and targeted category, but policy needs to evolve to identify more specific targets and gender-sensitive strategies. This would cover the gap between policy aspirations and meeting the actual needs of various women. The research findings highlight this need to be move beyond viewing women as a homogeneous group, and instead to recognise the diverse perspectives, experiences and challenges in their sport participation. The findings thus lead to the recommendations that addressing structural and socio-cultural barriers through inclusive policy development, shifts in public attitude, culturally responsive practice, and investment in accessible infrastructure are all essential to bridge the gap between policy intent and practical implementation. Ultimately, this research concluded that increasing women’s participation requires moving beyond one-size-fits-all policies. It calls for a strategy that integrates intersectionality, tackles socio-cultural limitations, and reflects women’s voices and aspirations in order to facilitate real social change.11 0Item Restricted Designing a Health Education Program about Physical Activities for Adult Diabetic Patients(Saudi Digital Library, 2025) ALSHURAYYAN, MAHDI; Abdelraouf, Samar ElhoseinyBackground: Diabetes is a growing chronic disease globally, including in Saudi Arabia. Although physical activity is vital for managing it, most Saudi adults with type 2 diabetes mellitus (T2DM) are inactive. This makes targeted health education programs crucial for encouraging exercise. Aim of study: This study aimed to design a health education program on physical activity for adult diabetic patients. Method: A descriptive cross-sectional survey with a Delphi round was conducted in Najran, Saudi Arabia. A convenient sample of thirty adult diabetic patients and a judgmental one of 12 expert panelists. Two tools for data collection: these belonged to adult diabetic patients, for five parts, and two parts for expert panelists. Results: The adult diabetic patients were urban Saudi nationals, with 43.3% being equal to or over 40 years old, with a mean age of 35.5 years. 55% are married, and 40% have university-level and professional jobs. As well, all experimenters were men and resided in urban areas. Seven were aged between 30 and 40 years, with a mean of 34.33 (SD = 5.50). Five held a master's degree, nine were nurses, and six were health educators and directors. Years of experience of 10 or more were among the nine. Conclusion: It is concluded that adult diabetic patients agreed that an effective health education program for physical activity must be patient-centred and practical. The program's design, content, and visual elements were evaluated and approved by both adult diabetic patients and the expert panelists, confirming a strong consensus that the program is well-designed and suitable for its target audience. Recommendations effectively promote physical activity among diabetic patients by implementing various health educational activities, integrating the designed program into healthcare services, and conducting further research.3 0Item Restricted PARENTS’ OPINIONS ON USING APPLIED BEHAVIOR ANALYSIS (ABA) TO INCREASE NEUROTYPICALLY DEVELOPING CHILDREN’S LEVEL OF PHYSICAL ACTIVITY(Oakland University, 2024) Faheem, Ahlam; Korneder, JessicaPhysical activity is important to reduce the risk of several diseases and in some cases death. Early childhood theorists stressed the importance of physical activity, lowering its cost, and rewarding physical movements. ABA interventions were an essential part of this paper because of its importance in altering the behavior and keeping the desired change even after the intervention. In general, parents and teachers’ motivations and engagement with children were the most effective way to increase physical activity in both ABA and ECE articles. Results of this research found that general knowledge of ABA is low and there is a need to increase ABA awareness and usage in the society before directing toward specific interventions. Finally, the cost of ABA interventions without insurance coverage is astronomical, yet all children have the right to receive behavioral treatments and live in an altered environment that ensure them the best overall development.10 0Item Restricted PARENTS’ OPINIONS ON USING APPLIED BEHAVIOR ANALYSIS (ABA) TO INCREASE NEUROTYPICALLY DEVELOPING CHILDREN’S LEVEL OF PHYSICAL ACTIVITY(Oakland University, 2024) Faheem, Ahlam; Korneder، JessicaPhysical activity is important to reduce the risk of several diseases and in some cases death. Early childhood theorists stressed the importance of physical activity, lowering its cost, and rewarding physical movements. ABA interventions were an essential part of this paper because of its importance in altering the behavior and keeping the desired change even after the intervention. In general, parents and teachers’ motivations and engagement with children were the most effective way to increase physical activity in both ABA and ECE articles. Results of this research found that general knowledge of ABA is low and there is a need to increase ABA awareness and usage in the society before directing toward specific interventions. Finally, the cost of ABA interventions without insurance coverage is astronomical, yet all children have the right to receive behavioral treatments and live in an altered environment that ensure them the best overall development.19 0Item Restricted The Effectiveness and Feasibility of Neuromuscular Electrical Stimulation after Fragility Fracture(University of Nottingham, 2024) Alqurashi, Helal; Robinson, Katie; Gladman, John; Gordon, Adam; Masud, Tahir; Piasecki, MathewFrailty, the vulnerable state seen in older people due to the cumulative effects of ageing and disease, is characterised by loss of muscle mass and muscle strength (sarcopenia). Older people living with frailty are prone to falls and fragility fractures, which necessitate hospital admission, resulting in further muscle loss and eventually leading to further disability. Rehabilitation exercise can reduce these consequences but is not always possible or adequate due to factors such as pain and fatigue. An alternative or additional technique is Neuromuscular Electrical Stimulation (NMES), which stimulates muscle contractions via an electrical stimulus applied to the skin overlying the muscles. The aim of this PhD thesis was to investigate the feasibility and efficacy of NMES on neuromuscular function in patients after fragility fracture. To explore the evidence regarding the effectiveness of NMES in hospitalised patients, I conducted a systematic review and meta analysis. This is reported in Chapter 2. Across the 42 identified papers, NMES was proven to be safe, albeit with a small incidence of minor discomfort. The meta-analysis revealed that NMES had a small effect on muscle strength (moderate certainty) (SMD = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life. However, the effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. These findings showed that NMES may be a promising intervention for rehabilitation after fragility fracture. I then contributed to and took over the management of a feasibility study of NMES in patients admitted to hospital due to fragility fractures. The main results of this are reported in Chapter 3. The aim of the study was to evaluate the feasibility and effectiveness of NMES in patients with fragility fractures. The objectives included assessing the willingness and ability of patients to receive NMES, examining compliance and acceptability of NMES treatment, and identifying recruitment parameters and suitable outcome measures for a randomised clinical trial with clinical outcomes. The study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants’ homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. NMES was applied to quadriceps and tibialis anterior muscles for 30 minutes, 3 days/week. Sessions were progressed to achieve 60 minutes, 5-7 day/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months. The findings showed that 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. 53% achieved the target of 24 NMES sessions. 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs. It became clear during the feasibility study that hospital-based NMES was unlikely to be feasible, but that NMES might be more feasible if home-based NMES. In view of the limited use of this technique in fragility fracture patients at home, I utilised an action research iv approach to optimise the use of NMES in this group and setting whilst the feasibility study continued. The findings of this and those of semi structured interviews of participants reported in Chapter 4. The observational process highlighted issues related to the stimulation of tibialis anterior muscle, which could be overcome. Themes identified through interview included acceptability, safety, practicality, user experience, training, and support, and how and when. This sub-study reinforced the findings of the quantitative aspect of the feasibility study, confirming the safety and acceptability of NMES. In summary, my literature review has indicated that NMES is a potentially useful treatment to prevent and reverse the muscular consequences of hospitalisation for fragility fracture. Furthermore, the feasibility study has shown that trials of NMES in fragility fractures are feasible, albeit in a minority of mildly frail fragility fracture patients with little premorbid disability. I have argued that such trials should use home-based, self-administered NMES, and should consider this intervention as an adjunct to, rather than a replacement of, a rehabilitation programme. Additionally, the findings derived from this thesis serve as valuable insights for designing future randomised controlled trials, which is a necessary step before NMES becomes a routine part of clinical care.20 0Item Restricted Exploring the Challenges and Opportunities Involved in Increasing Physical Activity among Children and Young People in Saudi Arabian Schools(The University of Sheffield, 2024-05) Alalawi, Abdullah; Goyder, Elizabeth; Blank, LindsayBackground: The growing global burden of noncommunicable diseases, exacerbated by insufficient physical activity (PA), is a significant health issue in the Kingdom of Saudi Arabia (KSA). Cultural and environmental factors limit opportunities for PA, especially among school children in urban areas. Aim: This study explores the challenges and opportunities for school-based PA to inform future interventions among schoolboys aged 13 to 15 years in KSA. Methods: Systematic reviews assessed international and Arabic country-specific evidence for school-based PA interventions. Qualitative data were collected through semi-structured interviews with 16 school staff, seven parents and workshops with 37 students in two contrasting schools one private and one public sector in Jeddah City, KSA. Follow-up interviews were conducted with a total of nine school staff members at both schools. Results: Review evidence identified promising interventions for increasing PA in schools including The Daily Mile, active breaks, active desks, and multi-component programmes. In Arabic countries, interventions focusing on PA, nutrition, and education showed potential to increase PA and decrease BMI. Primary research revealed that PA among adolescents is influenced by multiple factors. Individual-level motivators included enjoyment, competition, and health benefits, while barriers comprised academic pressures and sedentary preferences. Interpersonally, variable support from parents, friends, and teachers impacted PA levels. Organisationally, the school environment, facilities, and policies affected PA availability. Community-level insights indicated broader societal and policy interventions, including adapting international programmes to local contexts. Conclusion: This study underscores the need for a multi-dimensional approach to enhance PA among adolescents in Jeddah. Stakeholders should pilot and adapt effective international PA interventions, address school resource disparities, increase PA time in the curriculum, and enhance parental awareness about PA’s importance. These measures are crucial for creating an environment that supports PA to improve public health and enhance youth well-being in KSA.25 0Item Restricted Vision 2030 and Sports Policy in Saudi Arabia: Shaping National Development and Global Impact(Loughborough University, 2024-09) Turkistani, Saleh; Piggin, JoeThis study examines the evolution of Saudi Arabia’s sports policy under Saudi Vision 2030, focusing on three key areas: physical activity, sports infrastructure, and the hosting of sports mega-events (SMEs). The research aims to explore how these policies have developed to support economic diversification, enhance quality of life, and position Saudi Arabia as a global sports hub. Employing a qualitative approach, the study uses policy and documentary analysis guided by the Interpretative Policy Analysis (IPA) framework, along with concepts of soft power and nation-branding. The findings reveal that initiatives such as the Quality-of-Life programme (QOLP) and the Sports for All Federation (SFA) have effectively increased sports participation, particularly among women, while significant investments in sports infrastructure have facilitated community engagement and prepared the Kingdom to host major international events. Hosting SMEs, framed as part of Saudi Arabia's nation-branding strategy, is shown to contribute to economic growth and international recognition. This study highlights the interconnected nature of physical activity promotion, investment in sport infrastructure, and major event hosting, illustrating how sports policies are vital to achieving the objectives of Saudi Vision 2030. The research offers insights for policymakers, sports management professionals, and academics on the potential of sports as a tool for national development and global influence.353 0Item Restricted Exploring the Barriers to Physical Activity During Pregnancy in Saudi Arabia: A Systematic Review(Swansea University, 2024-09-30) Alhussain, Maha; Ikpeme, MoBackground: Engaging in regular physical activity (PA) during pregnancy is crucial for improving maternal and fetal health outcomes. Activities range from light exercises, like walking, to more structured moderate-intensity activities. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend pregnant women engage in at least 150 minutes of moderate-intensity PA per week, yet global adherence rates, particularly in Saudi Arabia, remain low due to various barriers. Methods: A comprehensive literature search was conducted across six databases, including Embase, Web of Science, Medline, PubMed, ASSIA, and APA PsycInfo. The review focused on studies addressing barriers to PA among pregnant women in Saudi Arabia. The SPICE framework guided the search strategy, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Results: Out of 1,138 studies identified, five were included in the final review. Key barriers identified included sociodemographic factors such as age, education, and number of pregnancies. Cultural beliefs and lack of knowledge were significant barriers, with many women believing exercise could harm their pregnancies. Social influences, particularly family discouragement, and environmental factors, such as lack of access to safe exercise facilities, further hindered PA. Additionally, women cited fatigue, lack of time, and motivation as major personal barriers to engaging in regular exercise during pregnancy. Conclusion: The review identified several barriers that prevent pregnant women in Saudi Arabia from engaging in regular PA. Cultural beliefs, social norms, and limited knowledge about the benefits of PA contribute to these challenges. Environmental factors and personal barriers like fatigue and time constraints also play a significant role in reducing PA levels during pregnancy. Addressing these barriers through education and access to resources may help improve PA participation rates and enhance maternal health outcomes.10 0