Saudi Cultural Missions Theses & Dissertations
Permanent URI for this communityhttps://drepo.sdl.edu.sa/handle/20.500.14154/10
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Item Restricted Healthcare in Crisis: Assessing Medication Adherence, Health Care Access, Telehealth Utilization, and Variations of Depression Treatment in the Era of COVID-19 for US Hypertensive Patients(Howard University, 2025) alharbi, Rehab; La’Marcus, WingateBackground: Coronaviruses (CoVs) are highly contagious viruses that cause respiratory and gastrointestinal illnesses. It disrupted global healthcare systems and affected access to care for chronic conditions like hypertension. It is a major risk factor for cardiovascular disease and a leading cause of death in the U.S. However, the pandemic shifted healthcare focus to COVID-19. Telehealth emerged as a critical tool for maintaining continuity of care. The pandemic also intensified mental health issues, such as depression. This study explores medication adherence, healthcare access, telehealth utilization, and depression treatment patterns among U.S. hypertensive patients during COVID 19. Methods: This cross-sectional analysis used secondary data from the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS).Outcomes included medication adherence among hypertensive patients, telehealth use, healthcare delay during the pandemic, and depression treatment variations in adults with both hypertension and depression. Descriptive statistics were utilized to describe patients’ characteristics, while logistic regression identified predictors of outcomes. Results: Medication adherence varied across antihypertensive classes, with ARBs having the lowest (53.4%) and beta-blockers having the highest (60.6%) levels of adherence. Older adults had lower adherence (adjusted odds ratio (AOR) = 0.87, p < 0.05) compared to younger adults (18-34). Whites were more likely to utilize telehealth than Blacks (AOR = 1.13, P = 0.05). Older individuals faced higher odds of delayed care, with those aged 50–64 having an (AOR = 1.19 ,p = 0.02), and v those aged 65 and above having an (AOR=1.29,p < 0.001). Additionally, Older adults aged 50–64 were more likely to receive depression treatment (AOR: 2.81, p < 0.001), and whites had 2 times higher odds of receiving depression treatment compared to blacks, with a p-value of 0.05. Those with poor physical health had the highest odds of receiving treatment (AOR = 5.99, p < 0.001), compared to those with excellent physical health status. Conclusions: The study highlights disparities in medication adherence, healthcare access, telehealth use, and depression treatment among hypertensive patients during COVID-19. Influenced by age, race, physical health, and gender. These findings highlight the need for policy interventions to improve access to chronic disease care.5 0Item Restricted Bridging the gaps in mortality data and healthcare access: A novel verbal autopsy application using subnational T2DM register in Saudi Arabia.(University of Gothenburg, 2025) Alyazidi, Faleh; Hussain-Alkhateeb, Laith; Petzold, Max; Shakely, DelérAbstract Background: Diabetes mellitus is an increasingly critical health concern in Saudi Arabia, often with other comorbidities and mortality causes, such as cardiovascular disease (CVD). National sociodemographic changes entail the urgent need for reliable insights on the scale and causes of mortality in order to develop appropriate healthcare policy. Where death certification is inadequate, verbal autopsy (VA) can serve as a useful tool to fill crucial gaps in vital data. This thesis aims to explore various contextual dimensions using the validated VA method. Specifically, this thesis aims to explore the community perception of causes of death, measure the circumstantial barriers (social and health system) to accessing healthcare, assess and validate the adequacy of medical certification of cause of death at population level, and investigate the clinical and demographic factors influencing out of hospital deaths among deceased individuals with specific health conditions T2DM and CVD. Methods: Studies I-IV utilized mortality data from the T2DM register at a major hospital in Makkah City, while Study V used data from the CVD registers at two major hospitals. For the first three studies, 302 VA assessments were conducted with the deceased’s next of kin. The VA data were analyzed using the computerized InterVA-5 software, which provided probable causes of death and circumstances of mortality categories (COMCATs). Study I employed Lin’s concordance correlation coefficient (CCC) to assess the concordance between verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death. Also, the study employed multiple logistic regression to identify factors influencing community perception of causes of death. Study II applied epidemiological estimations of absolute measures and Causes Specific Mortality Fractions (CSMFs), while also using numerical and graphical assessment to describe trends and patterns in the VA data. The COMCATs were ranked across the causes of death based on their derived probabilities. Study III employed Lin’s CCC to assess the concordance between physician reviewed causes of death (PRCoD) and VACoD at the population level. Study IV employed multiple logistic regression to identify factors influencing out of hospital deaths among deceased with T2DM, while Study V focused on CVD. Findings: Study I demonstrated broad community perceptions of causes of death, with notable misconceptions related to type of death and marital status. Study II found most deaths were seen as inevitable, with the COMCATs ‘recognition’ and ‘traditions’ being identified as avoidable barriers. Study III showed moderate concordance between PRCoD and VACoD, though discrepancies were apparent in the CSMFs, particularly for the most prevalent causes. Studies IV and V uncovered that cause and year of death in addition to nationality significantly influenced out of hospital deaths, with both studies illustrating decreasing trend of out of hospital mortality. Conclusion: This thesis uncovers challenges for Saudi public health policy concerning T2DM-related mortality, identifying issues in access to healthcare, community perceptions, and medical certification. Misconceptions about mortality causes of death hamper prevention strategies, while health system and sociocultural barriers heighten latent problems. The findings underscore the requirement to enhance the medical certification, as discrepancies between PRCoD and VA data suggest challenges in current practices on population level.6 0