Saudi Cultural Missions Theses & Dissertations
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Item Restricted NURSING INFORMATICS COMPETENCY AND EFFECTIVE CLINICAL DECISION-MAKING AMONG NURSES IN SAUDI ARABIA(Saudi Digital Library, 2025) ALRUWAILI, SABIRIN; Al Osta, MohammadABSTRACT Introduction: Clinical Decision-Making (CDM) is among the essential skills in the nursing profession that affect the outcomes of provided care. Nurses utilize various resources to achieve optimal care outcomes, including nursing informatics tools and skills, where nurses’ competencies play a vital role. Aim: To examine the relationship between nursing informatics competency and the levels of clinical decision-making skills among nurses in Saudi Arabia. Methods: A descriptive correlational design with convenience sampling methods was used to conduct the current study. A self-report questionnaire that consists of questions about demographic characteristics, the Nursing Informatics Competency Assessment Tool (NICAT), and the Clinical Decision-Making in Nursing Scale (CDMNS). Data were collected between May and July 2024 using online Google Forms from registered nurses at three governmental hospitals in Saudi Arabia. Results: 160 registered nurses participated in the study. The results show that nurses in Saudi Arabia were “proficient” in their nursing informatics competencies with total scale average (M=110.5, SD ±24.3), and have a perceived “medium” level in their effective clinical decision-making with total average score (148.6, SD ±32.0). Moreover, there was a statistically significant strong linear relationship between nursing informatics competency and perceived levels of clinical decision-making (r=.734, p<.001). However, nursing informatics competency was the sole statistically significant predictor (β=0.7, p<.001) of their perceived level of clinical decision-making. Conclusion and Implications: The study presented the critical role of nursing informatics competency in clinical decision-making among nurses. The results highlight to the healthcare stakeholders and nursing management the importance of investing in targeted informatics training and the integration of nursing informatics clinical decision support tools into the clinical nursing practice. Moreover, the findings encourage researchers to explore additional factors influencing clinical decision-making through longitudinal and qualitative research methods to gain a deeper understanding of this complex process.10 0Item Restricted Prevalence of Prediabetes and Type 2 Diabetes Among Undiagnosed Schoolteachers in Riyadh, Saudi Arabia(Saudi Digital Library, 2025) Aldekhayel, Ghassan; Farragher, Tracey; Verma, Arpana; Greenhalgh, Christine; Azmi, ShazliBackground: Diabetes Mellitus (DM) is an important public health issue in the Middle East region because of its high prevalence. In Saudi Arabia, the prevalence of type 2 DM among adults is 23.1%, and is one of the top ten causes of mortality. Patients with type 2 DM may remain undiagnosed for many years, due to its asymptomatic nature especially in the early stages. It is estimated that nearly half of adults with type 2 DM in Saudi Arabia are undiagnosed, which indicates the importance of early detection to understand the true burden of the disease. In addition, early detection and management of type 2 DM prevents complications related to diabetes. Also, identifying prediabetes cases helps prevent or delay the onset of type 2 DM. Methods: This study included both observational cross-sectional and longitudinal study designs. Schoolteachers in Riyadh were randomly selected from the Ministry of Education database and invited to complete the Saudi diabetes risk score questionnaire. Those identified as high risk underwent diabetes diagnostic tests, such as fasting plasma glucose and glycated haemoglobin (HbA1c), at collaborating primary healthcare centres. Participants diagnosed with type 2 DM or prediabetes were followed up after 3 months to assess risk factors associated with changes in HbA1c. Additionally, participants completed health-related quality of life (HRQoL) questionnaires at baseline, 3 months, and 6 months, to assess the quality of life of participants over time and compare HRQoL outcomes between low and high risk participants. Results: Among 945 recruited participants, 387 (41%) were female, the mean age was 42.5 years (SD ± 7.1), and 372 (39.4%) were classified as high risk. Out of 109 high risk participants who attended diabetes diagnostic testing, 7 (6.4%) were diagnosed with type 2 DM, and 19 (17.4%) were diagnosed with prediabetes. Population weighted estimates indicated that 1.8% of teachers in Riyadh had undiagnosed type 2 DM or prediabetes (95% CI: 0%, 6.91%). Among participants diagnosed with type 2 DM or prediabetes greater reductions in HbA1c levels at the 3-month follow-up was associated with higher baseline HbA1c levels (Coefficient: -0.63, 95% CI: [-0.79, -0.47]). Additionally, high risk participants reported lower HRQoL scores across physical, psychological, social relationships, and environment domains compared to low risk participants, with statistically significant differences observed in the physical (Coefficient: -5.57, 95% CI: [-8.65, -2.48]) and psychological (Coefficient: -4.40, 95% CI: [-7.47, -1.33]) domains. Conclusion: The study found a high prevalence of teachers at high risk of type 2 DM in Saudi Arabia. Early identification and intervention for participants with higher baseline HbA1c levels were associated with greater HbA1c reductions after 3 months, which may lead to better health outcomes and reduce the burden of diabetes-related complications. These findings highlight the feasibility and potential benefits of systematic prediabetes and type 2 DM case finding programmes in Saudi Arabia.5 0Item Restricted Factors influencing healthcare workers’ adherence to infection prevention and control in Saudi Arabia(Saudi Digital Library, 2025-07-09) Awal, Zainab Abdullah A; Mcfeely, Clare; Kidd, LisaBackground: Infection Prevention and Control (IPC) practices are crucial in reducing healthcare-associated infections. Despite their importance, adherence among healthcare workers (HCWs) remains suboptimal. In Saudi Arabia, IPC research has increased especially post-COVID-19. However, research on understanding factors influencing adherence, particularly in Intensive Care Units (ICUs) and medical wards, is limited. Objective: This study aimed to explore factors affecting adherence to IPC practices among HCWs in ICUs and medical wards in Saudi Arabia. Methods: A multi-method qualitative approach was employed across three phases in two Saudi hospitals: • Phase 1: Conducted a qualitative systematic review to identify factors influencing IPC adherence among HCWs in Middle Eastern countries. • Phase 2: Held focus groups with infection control team members (n=8) to gather insights on IPC practices and adherence challenges. • Phase 3: Performed semi-structured interviews with HCWs (n=20) from ICUs and medical wards to explore barriers and facilitators of IPC adherence. Findings: The study identified both individual and organizational factors impacting IPC adherence: • Individual Factors: Moral principles, ethical beliefs, cultural habits, knowledge, and awareness of HCWs influenced IPC adherence. • Organisational Factors: Challenges included leadership deficits, training gaps, environmental constraints, organisational culture, and department-specific issues related to patient acuity. Conclusion: Enhancing IPC adherence requires organisational support, effective monitoring strategies, and culturally sensitive IPC policies. Engaging families in IPC practices, fostering a supportive work environment, and addressing staffing and environmental issues are important. Future research should focus on culturally tailored IPC interventions, family involvement in IPC education, and comparative studies across various healthcare settings and disciplines to improve overall IPC adherence.4 0Item Restricted Research on Assessment of Resilience, Mental Toughness, and Confidence Dynamics in Elite Track and Field Athletes in the Kingdom of Saudi Arabia(Saudi Digital Library, 2025-05-01) Moraya, Mohammed; Beattie, StuartAbstract Resilience, mental toughness, and confidence are critical elements for athletes. According to research, resilience entails the ability to withstand or recover quickly from difficulties. Mental toughness, on the other hand, involves the ability to remain persistent and optimistic in the midst of challenges despite the pressure the challenges bring. Lastly, confidence entails a feeling of believing in oneself. This study explores the dynamics of resilience, mental toughness, and confidence among elite athletes in Saudi Arabia, focusing on track and field competitors. A quantitative approach was used to analyze the psychological factors influencing performance and mental well-being. The study involved 99 male athletes from various competition levels across Saudi Arabia. Questionnaires assessed mental toughness, resilience, and confidence, utilizing established psychological scales like MTI, BRS, and SSCI. Data collection was conducted via an online survey, and professional validation ensured the accuracy of the translated questionnaires. Key findings revealed a significant decline in athletes' confidence levels after competition, with resilience (measured by the Connor-Davidson scale) emerging as the strongest predictor of post-performance confidence recovery. While mental toughness predicted pre-match confidence, it had no significant effect on post-match confidence. Only a small percentage of the variance in confidence change was explained by these psychological factors. Cultural factors also played a role, positively correlating self-efficacy with performance outcomes. The research highlights the importance of resilience in helping athletes recover from confidence after poor performance in competitions. This is demonstrated primarily by the Connor-Davidson resilience tool. The same research highlights the role mental toughness plays. As per the findings, it aids in maintaining confidence under pressure. The study advocates incorporating resilience and mental toughness training into athlete development programs to enhance performance and mental health. Future research could explore the long-term impact of these psychological factors and other elements influencing athletic success.4 0Item Embargo Impact of Culinary Destination and Service Performance: Expectation Confirmations, Satisfaction, Trust, and Consumer Revisit Intention(Saudi Digital Library, 2025-07-08) Almasoud, Abdullah Mohammed Abdullah; Joung, David (Chair); Choi, Eun Kyong; Berezina, Katerina; Balkin, RichardPurpose- The dissertation addresses a critical gap in understanding post-dining consumer behavior within a culinary tourism destination at the BLVD RUH CITY destination. It explores how visitors' perceptions of food consumption value, specifically price, taste/quality, interaction, prestige, emotional, and epistemic, influence their perception of the culinary destination's image and their evaluations of restaurant service performance in the culinary destination. The study further examines how these evaluations affect expectation confirmation, influencing key post-dining outcomes, including satisfaction, trust, and revisit intention. Design/Methodology- The study employs an empirical research design supported by a causal-explanatory framework. Data were collected via an online survey and analyzed using a two-step covariance-based structural equation modeling (CB-SEM) approach. The first phase involved confirmatory factor analysis (CFA) to validate the measurement model, followed by CB-SEM to test the hypothesized structural relationships. The research model is grounded in the Theory of Consumption Values (TCV), Expectation Confirmation Theory (ECT), and the trust component of Commitment-Trust Theory (CTT). Demographic variables were included as control variables to obtain more nuanced insights into visitor behavior. Findings- The study revealed that epistemic value and taste/quality value positively influenced the image of a culinary tourism destination, while emotional, interaction, price, and prestige values did not significantly affect image formation. However, price, taste/quality value, epistemic, and emotional influences had a positive impact on evaluations of service performance. The image of a culinary tourism destination and service performance significantly affected expectation confirmation, which subsequently influenced satisfaction and trust. Ultimately, satisfaction and trust were recognized as crucial predictors of the intention to revisit, confirming the interconnected roles of these concepts in shaping post-dining loyalty in culinary tourism. Practical Implications- The findings offer targeted guidance for restaurant managers, destination marketers, and tourism planners by identifying the food-related values that influence visitor perceptions, service evaluations of restaurants, and behavioral outcomes. Emphasizing taste/quality, as well as epistemic value, can effectively shape a strong destination image, while taste/quality, price, epistemic value, and emotional value can enhance perceptions of restaurant service. Aligning the actual dining experience with visitors’ expectations encourages expectation confirmation, satisfaction, trust, and loyalty. The study’s model provides a framework for improving culinary tourism experiences through better service design, enhanced expectation confirmation, and consistent quality delivery across touchpoints in the destination. Originality/Value- This study is among the first to synthesize three established theories (TCV, ECT, and CTT) into a single, empirically tested model, offering a novel conceptual contribution to marketing, consumer behavior, tourism, and hospitality. It enhances the theoretical literature's understanding of how food-related consumption values, the image of a culinary tourism destination, perceived restaurant service performance, expectation confirmation, satisfaction, and trust interact to shape revisit intention. Furthermore, it enhances empirical research in the underexplored Middle Eastern context by validating this research model in Riyadh, Saudi Arabia, at the BLVD RUH City destination, thereby strengthening the cross-cultural applicability of consumer behavior frameworks.27 0Item Restricted The Impact of Educational Context on the Academic and Social Outcomes of Students with Intellectual Disabilities Who Moved from Inclusive to Segregated Classrooms in Saudi Arabia(Saudi Digital Library, 2025-06-10) Althiab, Mshael D; Ryndak, DianeThis study explores the academic and social outcomes of female students with mild intellectual disabilities (ID) in Saudi Arabia (SA) who transitioned from elementary comprehensive inclusive classrooms (ECICs) to middle self-contained classrooms (MSCCs). Framed within Bronfenbrenner’s Ecological Systems Theory and the Social Model of Disability, the research investigates how educational context, family involvement, and systemic expectations influence the experiences and development of students with ID. Drawing on six emergent themes organized into two overarching categories, the findings highlight that ECICs provided students with meaningful access to age/grade level general education (GE) academic content, opportunities for peer collaboration, opportunities to develop strong social relationships, and high expectations and inclusive teaching practices that led to positive outcomes. In contrast, the shift to MSCCs was associated with curtailed access to age/grade level GE curriculum, lower instructional quality, fewer social interactions with age/grade level peers, diminished expectations, and limited support structures. Family engagement and geographical context further influenced students’ educational experiences, with families in suburban areas experiencing more barriers to advocacy and inclusion. The study underscores the positive impact of inclusive practices in elementary GE classrooms and the importance of sustaining those inclusive practices throughout educational experiences. It also calls for alignment between policy, pedagogy, services, community awareness, and family advocacy. Recommendations are offered for improving inclusive education in SA, with a focus on enhancing teacher training, family-school collaboration, and equitable access to inclusive GE for all students.8 0Item Restricted Social and Cultural Impacts of Saudi Arabia Hosting the Italian Super Cup(Saudi Digital Library, 2025-05-01) Manqarah, Hawra; Pomfret, GillThis dissertation explores the social and cultural impacts of Saudi Arabia hosting the Italian Super Cup, in alignment with the goals of Saudi Vision 2030. The study investigates how this international sports event influenced national pride, community cohesion, cultural exchange, and Saudi Arabia’s global image. A gap in the academic literature was identified concerning mid-sized sporting events in Gulf countries, making this research particularly relevant. Using a quantitative approach, data were collected through a digital survey of 61 Saudi citizens who either attended or followed the event. The findings show that participants generally had positive perceptions of the Super Cup, especially in terms of promoting cultural understanding and enhancing national identity. Many respondents supported the idea of hosting similar events in the future, though some limitations were noted, particularly regarding local community involvement in the event’s planning. Overall, the study concludes that mid-sized international sports events like the Italian Super Cup can serve as powerful tools for national branding, cultural diplomacy, and tourism development. Recommendations include improving community participation and conducting long-term evaluations to better align with Vision 2030’s strategic goals.12 0Item Restricted An Exploration of Occupational Therapists’ Understanding of Mental Health in Saudi Arabia: A Qualitative Investigation.(Saudi Digital Library, 2025-03-03) Alrashidi, Raiyad Abbad D Alrashidi; Whitcombe, SteveObjectives: This study explores the understanding of mental health among occupational therapists in Saudi Arabia. The objectives of the research were to examine the professional and cultural factors that influence occupational therapists’ perceptions of mental health, to assess opportunities and challenges faced by occupational therapists working in mental health settings and to explore the perceived value and role of occupational therapy in mental health care in Saudi Arabia. Methodology: This study used an exploratory- descriptive qualitative approach. Data was collected through semi-structured interviews from eight occupational therapists practising in Saudi Arabia. The data was analysed using reflexive thematic analysis, a framework that facilitated identification and development of key themes. Findings: The findings were categorised into four main themes. Firstly, occupational therapists’ perceptions of mental health. The study revealed varying levels of understanding and awareness of mental health which attributed to lack of professional training in this area. Secondly, inadequacies in training and education showed the need for improved professional development opportunities in mental health among occupational therapists in Saudi Arabia. The third theme examined current challenges and cultural influences in that occupational therapists in Saudi Arabia face systematic barriers since there are no policies to support their role in mental health. They are challenges related to stigma surrounding mental health and limited collaboration between OTs and other healthcare professionals. The final theme centred on future perspectives and recommendations, where participants advocated for increased awareness of their role - occupational therapy in mental health situations. There is a need for policy reforms and integration of occupational therapy into mental health services through professional training. Conclusion: This study provides information on whether mental health has been integrated into occupational therapy in Saudi Arabia and examines the opportunities and challenges facing OT professionals working in the mental health field. The study highlights the importance of addressing challenges such as cultural and systematic barriers limiting the integration of metal health in OT and a need to enhance education opportunities promoting the role of occupational therapy in mental health. The findings of this study will inform future policies and research that will support the integration of mental health into occupational therapy.8 0Item Restricted A Focused Ethnographic Study on Kangaroo care of Preterm Infants in a Neonatal Intensive care Unit in Saudi Arabia(University of Dundee, 2025) Almutairi, Amal; McFadden Alison ، Gavine Anna, Malcolm CariBackground: Kangaroo Care (KC), a globally recognised practice involving skin-to-skin contact (SSC) between parents and their preterm infants, is widely endorsed for its physiological, neurobehavioral, developmental, and parental benefits. Despite its significant role in improving survival rates and promoting bonding and breastfeeding, the implementation of KC varies across healthcare settings, often influenced by organisational, practical, and resource-related factors. To initiate this study, a systematic review of the literature was conducted, highlighting a research gap in the Eastern Mediterranean Region (EMR), including Saudi Arabia, where cultural and organisational factors may pose additional barriers to KC adoption. Moreover, KC in Saudi Arabia remains underutilised and insufficiently studied, particularly in NICU setting. Aim: This PhD aimd to explore how KC was perceived, practiced by parents and HCPs in one NICU. It sought to provide insights into the factors that influenced KC implementation, examining the cultural, contextual, and organisational processes, as well as the challenges and opportunities for integrating KC as a standard practice in Saudi neonatal care. Design and methods: A focused ethnographic study was conducted in a large neonatal unit in Saudi Arabia. Data generation, employing purposive sampling with maximum variation, was carried out in three iterative steps: observations and fieldnotes, interviews and a focus group, and document collection. One hundred and fifty hours of observations, 13 interviews with parents (n=13), and 15 interviews and one focus group with HCPs (n=19), and documentary analysis were conducted. Reflexive thematic analysis adapted from Braun and Clarke, (2021) was applied informed by a social-ecological model and family integrated care model. Findings: The systematic review showed generally positive attitudes toward KC among HCPs but identified barriers, including unclear guidelines, staff shortages, and inadequate training. Parents were often uninformed about KC and relied on HCPs for guidance. Practical challenges, such as discomfort with prolonged KC, medical equipment, and lack of private spaces, hindered implementation. The ethnographic study found parents were often unaware of KC before their NICU experience, relying heavily on HCPs for guidance. Initial apprehension, driven by their infants’ fragility and the medicalised NICU environment, highlighted the lack of formal KC training among both parents and HCPs. A hierarchical NICU structure prioritised physician-led decision-making, limiting nurses’ autonomy and excluding parents, particularly in unstable infant cases. Cultural norms, including modesty expectations and traditional gender roles, restricted paternal involvement, while religious practices and open NICU layouts added barriers. Restrictive visitation policies, rigid routines, and an overemphasis on hygiene protocols led to KC being viewed as supplementary rather than integral, deviating from WHO guidelines promoting prolonged SSC. Organisational barriers like inconsistent policies and inadequate staffing further impeded KC implementation. Facilitators included supportive HCP attitudes, particularly among those with international experience, and private NICU spaces that encouraged greater parental participation. Conclusions and implications: The findings of this study emphasise the need for culturally informed, systemic changes to integrate KC as a routine practise of neonatal care in this NICU. There is need for integrating KC into healthcare education, policies, and practices through mandatory training for HCPs, parental education, and infrastructural improvements to ensure privacy. Aligning NICU protocols with WHO guidelines and FiCare can address organisational and cultural barriers, enhancing KC adoption and neonatal outcomes. Future research should focus on scaling up KC implementation, standardising practices, and exploring strategies to promote consistent adherence to evidence-based guidelines.45 0Item Restricted Responsibility for Online Harms: A Critical Analysis of Cyber Governance in Saudi Arabia(Saudi Digital Library, 2025-03) Alsaiedi, Yara M; Basu, Subhajit; Walker, CliveThis thesis investigates the topic of internet governance within the context of Saudi Arabia. It focuses on the component of ‘Responsibility’ for internet governance when applied to the policy area of combating online harms. As such, the research work investigates and evaluates the present framework of responsibility devised to address online harms, considering the assemblage which regulates online content and cybersecurity in the Kingdom of Saudi Arabia. This approach aims to facilitate the prevention and mitigation of the harmful effects of online activities and content, thereby aligning with the objectives outlined in the Saudi state’s long-term project known as Vision 2030. The thesis adopts the hypothesis that effectively addressing online harms requires a primary objective of establishing a robust responsibility structure. This method can best be achieved by facilitating the active participation of all stakeholders in the strategic deployment of responsive – including preventive – measures. Consequently, the thesis advocates a multistakeholderism approach with reference to governance for the prevention and mitigation of online harms in Saudi Arabia. It evaluates the effectiveness and fairness of the responsibility structure in fostering cybersecurity and mitigating the harmful effects of online content in the Saudi context. The formal study employs semi-structured interviews with elite figures and authorities from governmental and private organisations, internet content and service providers, as well as corporate users, which are the small and medium enterprises (SME) as internet users. Additionally, it integrates the policy transfer methodology to draw insights from the experiences of the United Kingdom in the realm of internet governance. In sum, the thesis proposes areas of improvement to develop a comprehensive online harms governance framework in Saudi Arabia. Such amendments are expected to contribute to the recognition and realisation of the declared Vision 2030 goals related to internet governance in the Saudi realm.6 0