Saudi Cultural Missions Theses & Dissertations
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Item Restricted EVALUATION OF A WHATSAPP-DELIVERED DIABETIC SELF-MANAGEMENT EDUCATION PROGRAM FOR PEOPLE WITH TYPE 2 DIABETES: A MIXED METHODS STUDY(The University of Newcastle, 2024-06-07) Yaagoob, Esmaeel; Regina, Lee; Chan, Sally; Stubbs, MichelleDiabetes is a severe chronic health and potentially devastating medical condition that has increased in prevalence over the past few decades to constitute a significant public health challenge of the twenty-first century. Inadequate diabetes management can result in severe complications, including cardiovascular diseases and strokes, impacting the quality of life. Effective self-management is crucial, with individuals making daily decisions related to their diabetes care. Diabetes self-management education and support (DSMES) provides people with type 2 diabetes mellitus (T2DM) the necessary knowledge, skills, and confidence to manage their condition. It has been found that increasing individual knowledge regarding disease and its complications has significant benefits in compliance with treatment and decreasing complications associated with diabetes. Traditionally, such programs are conducted via face-to-face group sessions. However, there are challenges in accessing face-to-face programs due to factors such as geographic location and travelling distances. In regions where digital technology and social media are pervasive, there is potential to increase innovative delivery methods such as social media platforms to provide accessible and flexible DSMES, thereby reaching a wider audience and improving health outcomes for individuals with T2DM. Considering the widespread use of WhatsApp in Saudi Arabia, online delivery of the DSMES may serve as a viable platform to decrease the burden and impact of living with T2DM. All research in this thesis was conducted in Saudi Arabia using a mixed-methods experimental design to examine the effectiveness of DSMES delivered via WhatsApp for people with T2DM. There are three phases in this study. In Phase One, a qualitative descriptive study was conducted using semi-structured phone interviews. The objective of this phase was to gain an in-depth understanding of the experiences and perceptions of people with T2DM regarding diabetes self-management. Insights from this phase guided the development of the teaching materials for the online diabetes self-management education program implemented in Phase Two. In Phase Two, a randomised controlled trial (RCT) was conducted. The objective of the RCT study was to evaluate the effectiveness of the WhatsApp-based DSMES in enhancing self-efficacy and diabetic knowledge (primary outcomes), as well as evaluating its impact on glycemic control (HbA1c), health-related quality of life (HRQoL), and levels of anxiety and depression (secondary outcomes). Subsequently, the third phase was a process evaluation to explore the experiences of people with T2DM who participated in the newly developed WhatsApp-based DSMES. In Phase One (qualitative interviews), nineteen (n=19) participants were recruited from the diabetes centres located within Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia. Themes generated from the qualitative analysis included knowledge deficit regarding disease management and its complications, difficulties in coping with the disease, adjusting to lifestyle changes and coping mechanisms influenced by a blend of culture and religion. Participants shared their experiences in accessing diabetic services via social media. Data generated from Phase One were used to develop an intervention that was tailored to the specific needs and experiences of people with T2DM in Saudi Arabia, as identified through the qualitative inquiry. The intervention was developed based on self-efficacy theory and aimed to enhance the self-management skills of people with T2DM through a structured educational delivered via WhatsApp. Common outcomes of WhatsApp-based DSMES for people with DM is to increase motivation to modify behaviours, adopt healthier lifestyles and adhere to prescribed medications. The educational content of the WhatsApp-based DSMES included general diabetes care information, signs and symptoms of diabetes, pathophysiology, aetiology, diet therapy, exercise, and other self-care behaviours. The intervention was delivered over six weeks, with each week focusing on a specific topic related to diabetes management. Participants received text messages, photos, and videos through a WhatsApp group, and were encouraged to interact, share experiences, and ask questions. The educational sessions were designed to take about one hour per week, and participants indicated their engagement by sending a thumbs-up emoji or the word "done" after reviewing the weekly content. In Phase Two (RCT), 80 participants were recruited from the diabetes centres at Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia were randomly assigned into intervention (n=40) and control groups (n=40). The intervention group received a 6-week intervention via WhatsApp, while the control group received usual care. The primary outcomes measured included UK-Diabetes Management Self-Efficacy Scale (DSMES-UK) and the Diabetes Knowledge Test2 (DKT2). The secondary outcomes measured included glycaemic blood test (HBA1C), the Hospital Anxiety and Depression Scale (HADS), and Diabetes Quality-Of-Life scale (DQOL). These outcomes were assessed at three time points: baseline, immediate post intervention at 6th week and two months after the intervention at 12th week. Findings at 6- and 12-week time points showed significant improvement in DSMES-UK and DKT2 in the intervention group compared to the control group. No significant difference in secondary outcomes was observed in HbA1c, total HADS, total DQoL, T0 to T1. In Phase Three (process evaluation), twenty-three (n=23) participants from the intervention group were recruited. Those who had previously consented during Phase Two and had indicated their willingness to share their experiences of the intervention were invited to participate in semi-structured phone interviews. Qualitative analysis found the participants expressed positive feedback surrounding the acceptability, flexibility, and relevance of the intervention content along with elements of cultural inclusion of the WhatsApp-based program. The participants also supported that the 6-week WhatsApp-based DSMES intervention enhanced a healthy change in lifestyle choices. They offered recommendations for enhancing the WhatsApp-based DSMES including more interactive and real-time features, the inclusion of allied health professionals for specialized support, the involvement of family members, and the integration of the program into standard diabetes care practices. These suggestions could increase the WhatsApp-based DSMES effectiveness, engagement, and overall impact on diabetes management. Findings of this study highlighted the positive effects of a WhatsApp-based DSMES on self-efficacy and diabetic knowledge of people with T2DM. Findings also provided feasibility data for the delivery of an evidence-based social media intervention to achieve optimal diabetes control, health outcomes, and quality of life for people with T2DM within communities. Findings further demonstrated DSMES was easily accessible, flexible, and assisted participants in modifying their behaviours to adopt a healthier lifestyle. By incorporating social media and culturally specific needs into DSMES, we can enhance health outcomes for people with T2DM and alleviate disease burden. Healthcare providers and policymakers may improve health outcomes for people living with T2DM by implementing the delivery of DSMES via social media platforms such as WhatsApp. Future research should focus on multicentre clinical trials with longer follow-up periods to investigate the long-term and cost-effectiveness of WhatsApp-based DSMES. Future studies should also explore the perspectives of diabetes educators and nurses and the readiness of healthcare centres to implement such online educational interventions. Expanding the scope to include a family-centred approach may lead to more sustainable interventions to promote self-management skills for people living with T2DM within communities.34 0Item Restricted The Association of Patient Activation with Type 2 Diabetes Mellitus Self-Management and Clinical Outcomes in Saudi Arabian Primary Care Settings(University of Wollongong, 2023-08-15) Almutairi, Nasser; Hosseinzadeh, HassanBackground: Type 2 diabetes mellitus (T2DM) is a major public health challenge. The primary tool to manage T2DM is self-management (i.e., diet, physical activity, blood glucose self-monitoring, foot care and adherence to medication). Patient activation, ‘an individual’s knowledge, skill and confidence for managing their health and health care,’ is associated with better self-management and clinical outcomes. Despite the increasing number of studies exploring the association between patient activation and T2DM self-management behavioural and clinical outcomes, no study has been conducted in Saudi Arabian primary care settings. This study attempted to fill this gap by conducting a two-phase study. Phase I aimed to map any association between patient activation and T2DM self-management and clinical outcomes. Phase II aimed to assess the impact of a patient activation-focused self-management intervention on T2DM self-management among people diagnosed with T2DM in Saudi Arabian primary care settings. Methods: Phase I was a cross-sectional study, while phase II was a pre- and post-intervention study. Patients attending the primary care centres who were aged ≥18 years old and diagnosed with T2DM were recruited to participate in the survey and interventional studies. A survey consisting of questions about demographics, clinical outcomes and patient activation measure (PAM) was administered. The survey also contained the summary of diabetes self-care activities (SDSCA) test, the diabetes knowledge test (DKT), the problem area in diabetes test and the diabetes quality of life test. Patients who agreed to participate in the phase II study received tailored patient activation intervention consisting of monthly face-to-face 15–30 minute sessions for 3 months, followed by a telephone call per month for the next 3 months. The intervention was designed and tailored based on the participants’ patient activation level, which was collected at baseline. The main objectives of the intervention were to improve diabetes knowledge, problem-solving and goal-setting skills, self-management and stress management skills among the participants. The participants were actively involved in the program through shared decision-making. Results: A total of 398 patients (male, 54.9%) with a mean age of 53.2 years old (SD = 10.7 years) participated in the survey study (phase I). The mean haemoglobin A1C (HbA1c) was 8.4% (SD = 1.7%), and 74.5% of patients had uncontrolled blood glucose. The mean patient activation measure (PAM) score was 55.9 (SD = 13.); 24.4% of patients were at level 1, 26.7% were at level 2, 37.4% were at level 3 and 11.5% were at level 4. Most patients had low self-management behaviours, moderate to low diabetes-related knowledge, moderate diabetes-related distress and average quality of life. A high PAM level was significantly associated with better glycaemic control, a higher SDSCA overall score and higher scores on the subscales (including diet, physical activity, blood glucose self-testing, foot care and smoking) (p < .05) but not with adherence to medication. We also found that a high activation level was significantly associated with better diabetes-related knowledge and quality of life (p < .05). In the interventional study (phase II), 100 participants from phase I were recruited, out of which 82 completed the intervention. The majority of the participants were female (61%), with a mean age of 51.3 years old (SD = 9.9 years). After 6 months of intervention, there was a significant increase in PAM score from 54.74 to 61.58 (p < .001), a significant decrease in HbA1c from 8.38 to 7.55 (p < .001) and in body mass index from 30.90 to 29.16 (p < .001), a significant increase in SDSCA scores (diet from 3.12 to 3.67, exercise from 2.54 to 3.49, blood glucose self-testing from 2.37 to 3.24; p < .001) and in DKT from 6.29 to 7.22 (p = .01). The results suggest that the intervention effectively enhanced the participants' ability to self-manage their diabetes, leading to positive clinical outcomes such as improved HbA1c and BMI. Conclusions: The findings from this study concluded that a high activation level was significantly associated with better T2DM self-management and better glycaemic control. These findings indicated that tailoring intervention based on the patient’s activation level can improve T2DM clinical outcomes and self-management behaviours. These findings provide valuable information for clinical practice to deliver interventions that meet patient needs based on each patient’s activation level.11 0Item Restricted Exploring the barriers and facilitators experienced by physiotherapists and patients with musculoskeletal conditions when using digital health interventions as a self-management approach in Saudi Arabia: a sequential explanatory mixed method study.(Cardiff University, 2024-02-08) Sroge, Roaa; Carrier, Judith; Sparks, ValerieBackground: Musculoskeletal (MSK) conditions constitute a significant public health challenge due to their increasing incidence and potential severe negative impact on patients' quality of life. One recommended treatment is self-management, endorsed in MSK management guidelines, including the National Institute for Health and Care Excellence guideline (2021). Self-management for MSKs can be delivered via digital health interventions (DHIs), which is the term referred to as the delivery of healthcare and the translation of information, knowledge, and communication via digital technologies to help the individual manage their health and well-being. Purpose: The present thesis aims to determine and identify barriers and facilitators to recommending and using DHIs by MSK patients and physiotherapists in Saudi Arabia. Methods: This study used sequential explanatory mixed methods. A cross-sectional design utilised an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and cultural factors for two populations (MSK patients and physiotherapists). Eighteen users (11 physiotherapists and seven patients with different MSKs) were interviewed within seven physiotherapy departments. This study was conducted during the time period when the use of DHIs was made mandatory by the Ministry of Health (MOH). An audio recording, verbatim transcription, and English translation of the interviews were conducted. Descriptive analysis was used to interpret the quantitative data, and reflexive thematic analysis was used to analyse the qualitative data. Findings: The questionnaire was completed by 143 respondents (76 physiotherapists and 67 MSK patients). Regarding the patient's characteristics, the most common condition for patients was low back pain (LBP) 46.3% and arthritis 25.4 %, with the majority being chronic conditions (71.6 %). The experience level of utilising DHIs up to two months was common for physiotherapists and less than two months for patients. Almost 90% of patients received no training before using DHIs. Regarding the UTAUT framework, there were mixed views on the compatibility of DHIs with patients’ needs. However, both physiotherapists and patients agreed that DHIs improved their therapeutic relationships. Notably, both the physiotherapists and patients also had a substantial level of agreement about their intentions to use and expectations of using DHIs in the future. However, their rate of agreement was lower for using DHI regularly. Four themes were identified under thematic analysis, revealing the areas that support the utilisation of DHIs. Concepts reported within all four themes included aspects, such as perceived effectiveness, patients' willingness to use DHIs, cultural impact, and social influences. The study indicated that physiotherapists who used DHIs before the health delivery organisation deemed this type of delivery mandatory were likely to recommend DHIs to patients with MSKs. Conclusion: The study reveals that despite initials challenges, such as lack of training and mixed views on compatibility with patient needs, DHIs were viewed positively by both physiotherapists and patients for managing MSK disorders. Although there is a high agreement among physiotherapists and patients about their intentions and expectations to use DHIs in the future, efforts should be made to enhance their regular use in Saudi Arabia. Implications and recommendations: The study contributes both theoretical and practical implications. Concerning its theoretical contribution, it enriches the literature on DHIs by using the associated constructs of the UTAUT model. Its practical contribution offers valuable information to guide and support the implementation of DHI and training of public hospital physiotherapists and enhance MSK patients' awareness of the benefits of using DHIs. Having physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a potentially effective strategy to increase the use of this treatment method Further research is needed to provide insight into the barriers and facilitators that non-users of DHIs may encounter because the current study only included users of DHIs.35 0Item Restricted Self-Management Interventions To Improve Mobility In The Community Post-Stroke(Saudi Digital Library, 2023-05-18) Sahely, Ahmad; Rosewilliam, SheebaIndividuals’ lives after stroke are affected by multiple levels of disability. Appropriate rehabilitation services can help them to regain their functions and improve their quality of life. In the UK and other developed countries, there has been a tendency toward the early supported discharge from hospital after a stroke with the aim of providing care at home after discharge. However, stroke survivors’ needs after discharge from the hospital have been unmet as the health care services lack sufficient resources. Self-management strategies have been developed to help stroke survivors improve their self-efficacy and independence and play an active role in their rehabilitation process. The efficacy and appropriateness of self-management as an additional component to the current practice have been examined in several contexts, but there has been limited research around self-management strategies to improve mobility after stroke. The overarching aim of this thesis was to develop, implement, and test the feasibility of a self- management (SM) intervention to improve functional mobility for stroke survivors in the community. Chapter 1 (the introduction) provides a background of the research problem and the knowledge to practice gap. It demonstrates the prevalence, impact, and management of stroke with focus on mobility rehabilitation as a main physical impairment. It also discusses the gap in current practice regarding the delivery of optimum amount of therapy and the role of SM in bridging the gap and facilitating the recovery of stroke survivors. Chapter 2 demonstrates the philosophical stance taken by the researcher to select the appropriate methodology for each stage of this research work. It shows the advantages of applying different methods to address the specific objectives of the thesis. Chapter 3 includes a systematic review of the evidence about specific SM interventions that can be applied for the rehabilitation of mobility post-stroke. A new intervention was then developed in consultation ii with senior clinicians and stroke patients to adapt the use of evidence to a local context of stroke rehabilitation within the West Midlands. In study 2 (chapter 4). A qualitative exploratory study was carried out during the Covid-19 pandemic exploring needs and experiences of stroke patients and NHS therapists who worked with stroke patients with a special focus on the utility of self-management strategies post discharge. This study found four main themes that described the modifications in the care system because of the pandemic, impact on the stroke survivors at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. The findings from the study contributed to the modification of the intervention developed to integrate technology and promote remote strategies for self-management. Study 3 (chapter 5), aimed to evaluate feasibility of implementation, to explore participants’ perspectives about the acceptability, practicality, and fidelity of the new intervention and to scope out methodological feasibility of a future randomised control trial of the new self-management intervention for mobility following stroke (SIMS). A mixed-methods study design was carried out including a feasibility randomised control design and focus groups to collect data. The study recruited 24 participants (14 males: 10 females; age range (36-87 years)) into both the intervention and control groups. The study findings showed that it was feasible to recruit participants from hospital and community, but the rate was low due to effects of the COVID-19 pandemic. Randomisation and blinding were successful. Retention rate was 83% at 3 months and 79.2% at 6 months assessments. Adherence to the intervention varied mainly due to post stroke fatigue, COVID-19 and the impact of mood changes. It was feasible to deliver the intervention online with no serious events related to the study. Focus groups discussed participants’ motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in walking outcomes, facilitators and challenges for self-management, and suggestions for improvement. Lastly, chapter 6 provides a summary of findings and discussion points about the key findings from all three studies included in this thesis work.23 0