Saudi Cultural Missions Theses & Dissertations
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Item Restricted A Study of Perspectives of Patients and Stakeholders regarding the Privacy, Security, and Confidentiality of Data collected via mHealth apps in Saudi Arabia: A Mixed Method Analysis(University of Warwick, 2024) Alhammad, Nasser; Epiphaniou, Gregory, Alajlani Mohannad and Arvanitis TheodorosMobile health (mHealth) apps have the potential to enhance healthcare service delivery but the adoption could be shaped by users’ awareness and concerns regarding patients’ data privacy, and security. This thesis aims to achieve the following research objectives; (1) to systematically assess patients’ perspectives and awareness level of data privacy, confidentiality, and security of mHealth apps, (2) to explore patients, healthcare workers and stakeholders’ perspectives regarding these issues, (3) to develop a model for predicting the influencing factors by combining the Technology Acceptance Model (TAM) and the PSC concept, and (4) propose initiatives to enhance the adoption of mHealth apps among patients. The research objectives were executed by systematically analysing 33 relevant articles on the research problems using a mixed-method study design comprising quantitative and qualitative phases. A cross-sectional survey instrument was piloted, validated and administered online to patients and end users (n = 600) of mHealth apps from various provinces in Saudi Arabia. Data were analysed using descriptive statistics and linear regression models. With a response rate of 90% (n = 567/600), most patients were aware about mHealth apps but moderate to high level of concerns were raised regarding data privacy and security. These concerns were significantly higher among female patients, those with higher educational qualifications, and younger age groups. Qualitative exploration among 25 stakeholders of mHealth apps revealed that patients needed to be more informed regarding data privacy and security than healthcare workers. Facilitators of mHealth apps include patient education, advanced security features, user-friendly features, online consultation for emergencies, remote monitoring features, and considering patients’ needs. In conclusion, patients’ socio-demographic factors and data security and privacy concerns influence their behavioural intention to use mHealth apps. Educating users on these issues, as well as targeting the younger population, may also be considered. The present findings will contribute to policymaking by informing the development of data security standards in mHealth apps, addressing user concerns, and enhancing adoption. It offers insights into socio-demographic factors influencing behavioural intention, guiding targeted awareness campaigns and educational initiatives. Additionally, the findings support the creation of user-centric features and advanced security measures, aligning with the goals of Vision 2030. This ensures that policymakers can implement evidence-based strategies to improve patient trust and the effective integration of mHealth technologies into Saudi Arabia’s healthcare system.42 0Item Restricted Investigating the potential of using mHealth apps to support DASH diet self-management among individuals with high blood pressure in Saudi Arabia(University of Sheffield, 2024-09) Alnooh, Ghadah; Williams, Elizabeth; Hawley, MarkBackground: Hypertension is a significant risk factor for cardiovascular disease and stroke, affecting 1.28 billion adults worldwide. Saudi Arabia has a high prevalence of hypertension, with 48.2% of adults aged 40 to 64 living with high blood pressure (BP) in 2018. Lifestyle management is crucial in addressing this issue. Strategies for preventing and controlling hypertension include maintaining a healthy body weight, increasing physical activity levels, and adopting the Dietary Approaches to Stop Hypertension (DASH) diet as the front-line strategy. Effective dietary self-management can enhance adherence to the DASH diet and help control BP. In this context, mobile health (mHealth) apps are increasingly considered valuable resources for managing individuals’ diets. Smartphone apps may provide new opportunities to improve nutrition interventions and change behaviour. Nevertheless, despite these advantages, patients and health-care professionals can face difficulties in identifying and selecting the most suitable apps. Further research is needed to determine whether mHealth apps can support DASH diet self-management and improve adherence among individuals with high BP in Saudi Arabia. Aims: The overall aim of this thesis is to investigate the potential of using mHealth apps to support DASH diet self-management among individuals with high BP in Saudi Arabia. Methods: Four studies were conducted in two phases. Phase one aimed to identify the most suitable DASH diet self-management apps. An exploratory approach was used to gather information on relevant apps, including their effectiveness, theoretical basis, quality, safety, security, characteristics, and functions. This phase consisted of two studies: 1) a systematic review of existing literature and 2) an app store review. Phase two aimed to select the most suitable DASH diet app for the Saudi Arabian context and to evaluate its feasibility and acceptability within this context. This exploratory phase involved two studies: a qualitative study and a feasibility study. The qualitative study sought to gain insights into the experiences and perspectives of individuals with high BP and healthcare professionals who have used the DASH diet self-management apps identified in phase one as high-quality, secure, and potentially effective (Noom and DASH To Ten). This information was crucial in selecting the most appropriate app for the Saudi context. The feasibility study evaluated the feasibility and acceptability of using the Noom app to support DASH diet self-management among individuals with high BP in Saudi Arabia. Results: The first phase identified two high-quality, secure, and potentially effective DASH diet apps: DASH To TEN and Noom. In the second phase, the participants in the qualitative study selected the Noom app as the most suitable for the Saudi context. While during the feasibility study, the participants found the Noom app to be feasible and acceptable, they also suggested improvements for greater accessibility to the Saudi population, including translating it into Arabic and simplifying the food logging process. Conclusion: The contributions of this thesis are significant in addressing a crucial gap in current research: the need for more studies exploring the use of smartphone apps to enhance adherence to the DASH diet to control BP. The research employed a systematic staged approach to identify and select commercial dietary smartphone applications, enabling researchers to make well-informed decisions when selecting dietary apps. This approach provided a solid basis for developing a high-quality RCT of a widely available DASH diet app since this research carefully identified and selected a commercial DASH diet app and evaluated its feasibility, usability, and acceptability among individuals with high BP in Saudi Arabia. However, conducting an RCT in Saudi Arabia may face challenges if the app is not adapted to address participants' recommendations, particularly concerning the need to enhance its educational content to better align with the needs of Saudi users. In addition, dietitians can leverage these findings to recommend two high-quality, potentially effective, and secure apps to their patients, aiding in DASH diet self-management. This research also offers critical insights into the interactive features of these dietary apps, informed by feedback from both patients and health professionals. These insights are instrumental for researchers and developers aiming to design more effective and user-friendly dietary applications. This research’s exploration of the feasibility and acceptability of commercial dietary apps among Saudis can inform further studies in the mHealth field.16 0Item Restricted Home Monitoring in Interstitial Lung Disease(University College London, 2024) Althobiani, Malik Abdulmalik; Hurst, John R; Porter, Joanna; Russell, Anne-Marie; Folarin, AmosIntroduction: Interstitial lung disease (ILD) comprises a variety of conditions affecting the parenchyma of the lung, with a diverse incidence. Some patients are prone to rapid progression, while others are susceptible to exacerbations. Forced vital capacity (FVC) is used as an endpoint in clinical trials for novel idiopathic pulmonary fibrosis (IPF) therapies. However, it is often measured every three months, resulting in lengthy monitoring periods to identify meaningful treatment responses or disease trajectories. Home spirometry may enable more regular monitoring, potentially allowing for faster detection of ineffective treatment and reductions in clinical trial size, duration, and cost. Individuals with ILD often experience cough, shortness of breath, anxiety, exercise limitation, and fatigue, impacting their quality-of-life (QoL). Conventional indicators of disease progression, such as pulmonary function tests (PFT), may not completely capture the severity of symptoms experienced by patients. Continuous remote patient monitoring involving more than FVC may provide a more complete and real-time assessment of physiological parameters and symptoms. However, the views of clinicians and patients are poorly understood, as is the feasibility and utility of delivering such an approach. Aim: To systematically gather, summarise and evaluate the evidence from clinical trials for feasibility, reliability, and detection of exacerbations and/or disease progression in patients with ILD. To understand the views of clinicians and patients about home monitoring in patients with ILD. To investigate the feasibility and utility of a 4 contemporary approach to patient care using commercially available technology to detect disease progression in patients with ILD through continuous monitoring of physiological parameters and symptoms. Methods: A systematic review was conducted assessing studies on home monitoring of physiological parameters and symptoms to detect ILD exacerbations and progression. This was followed by an international survey of clinicians to explore their perspectives on using telehealth for remote ILD health care support. A patient survey was then conducted to quantify patients’ use of and experiences with digital devices. These preliminary studies informed the development of the research question and main PhD hypotheses. To test these hypothesis, two subsequent studies were conducted. Firstly, a feasibility study that assessed the feasibility, acceptability, and value of remote monitoring using commercially available technologies over 6 months period. Secondly, a prospective observational cohort study that evaluated a real-time multimodal program using commercially available technology to detect disease progression in patients with ILD through continuous monitoring of physiological parameters and symptoms. Results: The systematic review provided supportive evidence for the feasibility and acceptability of home monitoring in patients with ILD and identified priorities for future research. The findings of the follow-up studies indicated that although health care professionals recognised the potential benefits of home monitoring, their adoption rate was low due to barriers like lack of organisational support, technical issues, and 5 workload constraints. Although the findings of the mixed-methods study have demonstrated that digital devices are widely used among patients with ILD, the views and perspectives regarding the use of these devices is varied. The prospective multi- centre observational cohort study provided evidence supporting the feasibility and acceptability of remote monitoring to capture both subjective and objective data from varied sources in patients with respiratory diseases. The high engagement level observed from the passively collected data suggests the potential value of wearables for long-term, user-friendly remote monitoring in chronic respiratory disease management. The main study is one of the first to employ a comprehensive multimodal remote monitoring system to investigate the potential of home-monitoring to detect progression in patients with ILD. The results demonstrate the potential of multimodal home-monitoring to assess associations between physiological parameters and symptoms with disease progression, and to detect disease progression in patients with ILD. Moreover, the results suggest a strong correlation between hospital and home measurements of forced vital capacity in patients with ILD. Conclusion: Taken collectively, the findings presented in this thesis supports the use of a multimodal home-monitoring system, and the potential role for physiological parameters and symptoms to detect ILD progression. It provides a contemporary, personalised approach to patient management. These results provide a critical initial step towards further evaluating the value of home-monitoring for ILD management. However, larger, longitudinal validation studies are required. Future research could explore the potential of machine learning algorithms on this data for real-time detection of ILD disease progression. Machine learning models could provide early detection of changes in lung function and alert patients and healthcare providers to acute and chronic changes and empower patients to better self-manage their disease. This could allow for timely interventions and more personalised management of ILD.23 0Item Restricted FemTech Ethics – An Empirical and Normative Analysis of FemTech and Women’s mHealth Apps(University of Zurich, 2023-09-28) Alfawzan, Najd; Christen, Markus; Biller-Andorno, Nikola; Hamper, JosieFemTech (female technology) is a growing market with a large user base globally. The investments in FemTech are huge. Collecting women’s health data is important for closing the gender health gap. However, as women have been subject to historical sociocultural oppression and surveillance, legal consequences might follow women who provide their data to FemTech companies. The primary thesis of this work is that an ethical perspective and grounding are critical for the analysis of FemTech, because technology is inextricably linked to morality, norms, and the sociocultural context in which it acts. FemTech is distinct from other types of technology and markets in that it emerged from these circumstances and has a significant impact on users within their social contexts. In my thesis, I focused on the ethical concerns in data privacy, sharing, and security by studying the privacy policies and consent practices of FemTech companies, particularly in the context of women’s mHealth apps. Data privacy and protection have been introduced as fundamental human rights. Notably, the women’s health data collected by FemTech is considered to be intimate, sensitive, and private data. Moreover, some women’s mHealth apps collect not only women’s sensitive data, but also data of their children and infants. This layer of complexity introduced by including children's data let me investigate in depth the practices of apps that collect children’s data and the related ethical and legal concerns. In short, the collection of women’s personal and health data could have negative consequences on women in certain legal and social systems of the world. The worldwide nature of the services provided by FemTech companies presents challenges in complying with the many regulations and laws that exist in different nations. Data protection and privacy legislation, for example, can differ widely from country to country. Furthermore, the sensitivity of women's health issues can differ depending on local cultural or religious considerations, with possible repercussions for national laws, particularly when it comes to sexual orientation and reproduction. In some cases, the data collected could even become evidence in criminal proceedings. Therefore, the handling of women’s intimate data must be approached with sensitivity to protect women's privacy rights.48 0