Saudi Cultural Missions Theses & Dissertations
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Item Restricted Associations Between Living Arrangements, Changes in Lifestyle and Anthropometric Traits During the First Year of University(Saudi Digital Library, 2026) Alharbi, Ferdous; Speakman, John; Hambly, CatherineIntroduction: The transition into university is often accompanied by lifestyle changes that can influence weight and health behaviours, with evidence highlighting increased risk of weight gain during the first academic year. While the “Freshman 15” theory, coined in the United States of America (USA), has been widely discussed, referring to an average weight gain of around 6.8 kg (15 lb) during the first year of university, findings remain inconsistent, and less is known about how different living arrangements may shape these changes. This thesis examines the associations between living arrangements, lifestyle behaviours, and anthropometric changes among first-year university students, and compares these with patterns observed in non-university peers. Methods: Two longitudinal observational studies were conducted. Study 1 followed 78 participants at baseline, three, and eight months after entering University (across one academic year), including those living at home, in private accommodation, in halls of residence (University accommodation), and non-university peers. Study 2 tracked 40 of these participants in halls, private accommodation, and at home as they transitioned to the second year. Anthropometric traits (body weight (BW), body mass index (BMI), body fat percentage (BF%), waist-to-hip ratio (WHR), and weight-for-age percentile (W/A)) were recorded. In addition, lifestyle behaviours (diet, physical activity, sleep, and stress) were assessed using questionnaires, complemented by objective assessments from the ActiGraph GT9X Link accelerometer (physical activity and sleep). Dietary intake was assessed via Intake24’s online 24-hour dietary recall tool and reassessed after excluding misreported records. Results: Most changes in weight, body composition and lifestyle behaviours occurred within groups across the academic year, with students living away from home showing the largest increases in weight, BMI and WHR. Although between-group differences were generally limited, living arrangements influenced the timing and magnitude of changes in diet, physical activity, sleep and stress, and WHR remained consistently higher among students in halls compared with those living at home or in private accommodation. Non-university participants also experienced behavioural and BF% changes, indicating that many challenges were not exclusive to university students. In the follow-up study after one year at university, similar within-group patterns persisted, suggesting that early behavioural and anthropometric changes tended to continue over time. Students who started university in halls and in private accommodation showed further increases in weight and BMI across the 12-month follow-up, while those living at home remained comparatively stable. Conclusions: These findings demonstrate that early lifestyle and body composition changes among young adults are shaped more by within-group patterns than by large differences between accommodation types. By integrating self-reported and objective measures across two longitudinal studies, this thesis provides clearer evidence on how diet, physical activity, sleep and stress evolve from university entry through the first full academic year and after one year at university. The thesis directly addressed its research objectives and answered all research questions by identifying when behavioural and anthropometric changes occur, which groups are most affected, and how living arrangements influence these trajectories over time. The results highlight areas that may benefit from future preventive efforts to support students’ health during the transition into university, such as improving food environments in halls, supporting affordable healthy eating for students living away from home, expanding access to physical activity opportunities, strengthening stress-management and sleep-support resources during this life stage.25 0Item Restricted Does Learning to Perceive English Vowels Help in Perceiving English Lexical Stress? The Case of Arab Learners of English: A Longitudinal Study(Saudi Digital Library, 2025) Allehyani, Manal Abdullah; Smith, RachelThis thesis investigates whether there is a relationship between improvement in the perception of English vowels by Arabic speakers and their improvement in the perception of English lexical stress. Previous research showed that L1 vowel inventory affects the cues exploited to contrast L1 vowels. Arabic and English have different vowel inventories. English was found to rely on spectral, temporal, and intrinsic f0 (IF0) cues whereas Arabic is theoretically assumed to rely on its limited spectral cues due to its small number of vowels, in addition to duration and intensity. Of special importance in the perception of English vowels is their intrinsic f0, which along with F1, help in discriminating the different contrasts. Lexical stress locations in Arabic are phonologically determined by syllable weight and position, which makes Arabic a predictable stress language. Concerning the acoustic cues of Arabic stress, production studies have shown that duration and intensity are the two correlates of stress. On the other hand, lexical stress in English is acoustically signalled primarily by f0 in accented stressed syllables. I categorised three main hypotheses in the literature of L2 segmental, prosodic, and phonetic development. These trends either show that L2 learners improve by either reusing their native acoustic cues or features, reweighting their secondary and primary cues, or learning new cues through accessing Universal Grammar (henceforth, UG). In this study, I tested the learning hypothesis. I hypothesised that Arabic learners of English would initially rely on their L1’s limited spectral, durational, and intensity cues to categorise English vowels. With greater exposure to English, they were expected to expand their vowel space, resulting in learning to attune to IF0 as a perceptual cue to English vowels. This newly-learnt cue (i.e., IF0), I hypothesised, would help Arab learners of English to improve their perception of English stress, which is cued by reliance on f0. To test these hypotheses, three perceptual experiments were administered. One experiment tested the perception of the acoustic cues of duration, intensity, and pitch. The other two experiments tested the participants’ identification of stress locations in disyllabic nonsense words, and their discrimination of English vowels. Participants from Libyan, Jordanian, and Sudanese dialects were recruited for this study. The participants were tested twice with an interval of six months between the two phases to monitor their progress. Signal Detection Theory (henceforth, SDT) was used as an analytical tool to gauge the participants’ sensitivities in the different tasks in the two phases of the study. 1 The thesis addressed three questions, all focusing on change over time as represented by the effect of the participants’ sensitivity to individual acoustic cues (i.e., duration, pitch and intensity) on their perception of vowels and stress locations. First, whether the acoustic cues that affected the participants’ perception of vowels in the first phase would differ after six months of exposure to English. Second, whether the effect of the acoustic cues and vowels on the perception of English stress locations would change from their baseline patterns after six months of exposure to native English. Third, and most importantly, whether a relationship existed between improvement over time in the perception of English vowels and improvement in the perception of English stress. Generally, the results of this thesis did not support the learning hypothesis, but gave support to the reweighting hypothesis, which emphasises enhancement and redeployment of existing cues. The results of the first question showed that the learners of all dialects attended to their native perceptual cues of vowels through showing an effect of intensity and duration on vowel perception in Phase One. After six months of exposure to English, they reweighted their cues, exhibiting an effect of only duration when perceiving the same vowels. For the second question, the results broadly showed that the native cue of intensity in addition to vowels affected the perception of stress locations in Phase One, and the same cues affected their perception of stress locations in Phase Two. The main research question was whether there is a relationship between improving the perception of English vowels and improving the perception of English stress. Again, the results showed that the learners’ improvement in the perception of stress was affected by their improvement in the perception of intensity and vowels. This suggests that the learners improved by enhancing their L1 native cues in addition to vowels instead of learning to attend to a new cue, f0.23 0Item Restricted Effectiveness of mindfulness-based stress reduction (MBSR) in reducing burnout among mental health nurses: A Rapid Review(University of Wollongong, 2024) Almuqayti, Rana; Lapkin, SamExecutive Summary Background: Burnout negatively affects nurses and patients, as well as work quality. Mindfulness-based stress reduction (MBSR) can reduce stress and burnout levels among healthcare professionals, but studies are limited concerning mental health nurses. Aim: To evaluate the effectiveness of MBSR in reducing burnout among mental health nurses. Methods: A comprehensive search was conducted using PubMed, PMC, and JBI. Methodological quality of included studies was assessed using AMSTAR. Main findings: Ten systematic reviews met the inclusion criteria. MBSR reduced stress and burnout levels and improved nurses’ wellbeing. Conclusion: High quality studies that focus on mental health nurses are needed to corroborate the evidence.28 0Item Restricted Mindfulness as a Culturally Sensitive Moderator Between Stress and Anxiety in Saudi Female International Students(University of Cincinnati, 2024) Aldosari, Hend Abdullah; Brubaker, MichaelInternational students studying in the U.S. are becoming increasingly more common as students take advantage of new and existing educational opportunities. One of the larger populations of international students in the U.S. are Saudi students. While students face a number of stressors and anxieties related to schooling, Saudi international students face additional stressors related to adapting and acclimating to the new cultural environment. This is especially exacerbated in Saudi women, as they face discrimination based on the way they dress and have additional burdens such as family and childcare. However, culturally sensitive counseling approaches which address this unique population have yet to be fully investigated or developed. Mindfulness is a technique which involves quieting one’s mind and body and reflecting on one’s situation and circumstances without self-judgment. This approach has been used extensively as a technique to reduce and moderate the relationship between stress and anxiety generally and has been found to be effective in international students as well. Furthermore, mindfulness intersects directly with the principles of Islam through its focus on self-reflection and calming one’s mind, making it a culturally sensitive approach for Muslim clients, such as Saudi women. However, the moderating effects of mindfulness on stress and anxiety in Saudi female international students has yet to be investigated. The goal of this dissertation is to review what is known on the effects of mindfulness on stress and anxiety in international students and to investigate the moderating effects of mindfulness on stress and anxiety in Saudi female students in the U.S.21 0Item Restricted Intensive Care Nurses' Experiences of Burnout During the COVID-19 Pandemic in Saudi Arabia: A Constructivist Grounded Theory Study(King's College London, 2024) Alzailai, Nawal; Xyrichis, Andreas; Barriball, LouiseBackground: Burnout amongst healthcare staff, particularly amongst intensive care unit (ICU) nurses, is a critical issue that intensified during the COVID-19 pandemic. Previous research, especially within the Saudi context, has identified significant levels of burnout in ICU nurses. However, a notable gap exists in the use of qualitative methodologies to deepen our understanding of ICU nurses’ burnout in the Saudi context. Moreover, comprehending the experiences of nurses who suffered from burnout during the pandemic, focusing on the factors that contributed to their stress, has been essential for identifying developmental needs and for shaping interventions aimed at mitigating burnout amongst nurses. Despite this, the existing literature lacks a reliable theory or model that adequately captures the phenomenon of burnout within highly demanding environments like ICUs, particularly under the unpredictable and greatly challenging circumstances of disasters. Aim: To construct a theory grounded in burnout experiences of ICU nurses in Saudi Arabia during the COVID-19 pandemic, intended to act as a foundation for future research that explores burnout in high-stress environments for nurses or other healthcare staff working in similar contexts. Methods: Building from one scoping review and one systematic review, a constructivist grounded theory design was employed for this study, as proposed by Charmaz (2014a). Conducted in four distinct adult ICU departments of a tertiary hospital in Saudi Arabia, the research involved 22 ICU nurses experienced in caring for COVID-19 patients and 10 decision-makers, recruited through initial purposive sampling and subsequent theoretical sampling until theoretical saturation was reached. Data were collected through semi-structured, in-depth interviews. Field notes and a reflexive methodological journal were maintained throughout the research process. Interviews were transcribed verbatim and translated into English where necessary. The analysis followed “Charmazian” principles, which include initial, focused and theoretical coding; constant comparison; theoretical sampling and sensitivity; memo writing; and diagramming. Ethical approval was secured from King’s College London and from the relevant Institutional Review Board in Saudi Arabia. Results: The theory generated by this investigation suggests burnout is a process, resulting from multiple interrelated factors within and beyond an individual’s working environment. This process occurs in three dynamic stages affected by the coping and supportive resources that the nurse has used/received. The core category that emerged, ‘we fought and now we need to be healed’, encapsulates the essence of the nurses’ experiences with perceived burnout and their vital need for recovery and support. This finding led to the development of the BuRN-ICU19 model, a comprehensive framework representing the ICU nurses’ experiences with burnout during the COVID-19 pandemic and informed by results from two fundamental reviews: a scoping review and a systematic review. Conclusion: This thesis offers novel insights into the experiences of burnout among ICU nurses in Saudi Arabia during a disaster situation. It highlights the critical need for targeted interventions and policy reforms to alleviate burnout in, improve the well-being of and effectively support ICU nurses in demanding situations. The BuRN-ICU19 model presents a valuable framework for future research and practical application in ICU nursing, with potential implications extending beyond the Saudi context.54 0Item Restricted Exploring the Impact of Animal Assisted Activities on overall Well-being, Stress, and Mindful Awareness(Saudi Digital Library, 2023-12-01) Alraddadi, Majed; Roberts, JudithHuman-animal interactions have emerged as a promising intervention for improving mental health. Although several studies examined the impact of human-dog interactions on mental health, limited studies examined the psychological outcomes of human-donkey interactions. Hence, this study aims to examine the impact of human-donkey interactions on stress, mental health, mindful awareness, and other potential psychological outcomes. A total of six participants were recruited to take part in the quantitative phase, while only two of them were involved in the qualitative phase. They participated in an intervention involving interactions with donkeys in Snowdonia. Perceived stress, mindful awareness, and mental wellbeing were measured using the Perceived Stress Scale (PSS), the Mindful Attention Awareness Scale (MAAS), and the Warwick-Edinburgh Mental Wellbeing Scales (WEMWBS). The paired sample t-test demonstrated insignificant differences in the MAAS and PSS scores pre- and post-intervention. However, there were significant differences in the scores of WEMWBS. The results show improvement in mental health following the intervention. Five themes emerged: connection, mental refreshment, mild anxiety at the beginning, improved wellbeing in general and satisfaction of social needs and connectedness. Therapists are recommended to incorporate human-donkey interactions into their clinical practice. Longitudinal studies are needed to examine psychological outcomes in the long term.33 0Item Restricted The Impact of Electronic Health Records on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study(Saudi Digital Library, 2023-11-27) Alobayli, Fatimah Yahya; Holloway, Aisha; Cresswell, KathrinBackground: There is growing evidence suggesting that electronic health records (EHRs) can be associated with clinicians’ burnout, which may hamper the effective use of EHRs and introduce risks to patient safety and quality of care. Nursing research in this area is minimal in comparison with studies conducted on burnout among physicians. In addition, although the majority of research on the impact of EHR use on nursing burnout was conducted in Western contexts, this study fills the gap by exploring this prevalent issue within the context of Saudi Arabia. Aim: The research aim was to examine the association between nursing burnout and EHR use and to explore the contributing factors to nursing burnout related to EHR use in a hospital setting in Saudi Arabia. Methods: The study used a mixed-methods approach with an explanatory sequential design: a quantitative study followed by a qualitative study. The study was conducted in a hospital that was adopting an advanced EHR system, in Riyadh, Saudi Arabia. Using a purposive sampling method, registered nurses working in inpatient units using an EHR system on a daily basis were included in the study. Two validated instruments were used in the online survey, the Mini-Z and EHR perceptions, to examine the association between nursing burnout and EHR-related factors. Qualitative interviews, undertaken both online and in- person, were used to gain an in-depth understanding of factors associated with nursing burnout and hospital EHR use. Survey data were analysed using regression analysis. Thematic analysis was utilised for the interview data. The study was informed by a iii sociotechnical approach to understanding the relationship between the social system (nurses) and the technical system (EHR use) in a given context (a hospital in Saudi Arabia). Results: A total of 282 completed survey responses were included in the study, and a total of 21 nurses participated in the interviews. Participants were predominantly female and worked in acute and critical care units. Most survey respondents were from the Philippines (53%), Malaysia (21%), and Saudi Arabia (11.7%), with South African and European nurses accounting for about 5% each. Interviewees were primarily from the Philippines and Saudi Arabia (33% each), and 24% from Malaysia. The findings indicated that despite the overall acceptance of the EHR among the nurse participants being relatively high, negative perceptions of the EHR and stress related to EHR use were found. There was a slight inconsistency between the quantitative and qualitative results regarding the perceived burnout outcome. The survey statistics showed that the minority of nurses who reported negative perceptions about the EHR were likely to be burnt out while the interviews showed that all participants who reported stress related to the EHR did not think that EHR-related stress would lead to burnout. This inconsistency suggests there is a weak link between EHR use and burnout may exist, possibly indicating the mitigating role of resilience identified in the qualitative study. In this qualitative study, I identified specific perceived organisational stressors associated with EHR use, such as high EHR documentation workload creating a conflict between organisational requirements and direct patient care. Technological stressors were also identified, including usability issues causing disruption to nurses’ workflow, and concerns about data privacy through unauthorised access by healthcare workers at the hospital. Despite these stressors, resilience was demonstrated at both individual and organisational levels, which emerged as a protective factor from EHR-related burnout. Factors like computer literacy, perceived usefulness of the EHR, and nurses’ adaptability to iv change were key contributors to individual resilience that aided nurses in navigating EHR stressors and adjusting to the EHR system. At the organisational level, health information infrastructure facilitated smoother interaction with the EHR system, reducing potential stressors while supportive organisational culture fostered teamwork, work–life balance, continuous learning, and iterative improvement, thereby bolstering resilience among nurses. Conclusion: EHR did not significantly contribute to nursing burnout in a specific Saudi Arabian hospital context. The resilience mechanisms in place at both individual and organisational levels mitigated the potential impact of EHR-related stress on nurses’ burnout. The unique contribution of this research is the introduction of a novel conceptual model elucidating the impact of EHR on nursing burnout. This renewed perspective emphasises the role of resilience at both individual and organisational levels and their collective influence on mitigating EHR-related burnout among nurses. This model has the potential for further development and application both locally and globally. This study signals a need for healthcare organisations to foster resilience-building strategies in their EHR implementation processes and usability that should be tailored to the specific needs and circumstances of each organisation, to effectively manage EHR-related stress and prevent potential burnout. These include encouraging self-care practices among nurses, promoting work–life balance, fostering supportive workplace culture, improving health information infrastructure, providing training and continuous learning, and improving EHR usability through regular feedback sessions from EHR users. Additional research is needed to corroborate this finding with different types of clinicians in the same hospital, and in other hospital settings within Saudi Arabia.48 0Item Restricted Occupational Stress and Burnout in Nurses Working Extended Shifts: A Systematic Review(Saudi Digital Library, 2023-11-09) Almajed, Hamedh; Kerr, ClaireBackground: Extended nursing work hours have become common internationally, due to inadequate staffing levels and increasing population demands. Extended work hours can have adverse effects on the psychological well-being of nurses, including the manifestation of occupational stress and burnout.Aim: This review aims to explore if and how nurses working extended duty hours experience occupational stress and/or burnout.Methodology: A systematic search was conducted on four electronic databases: CINAHL Plus, MEDLINE, PubMed, and PsycINFO. A methodical search strategy was developed in collaboration with an expert librarian. Medical subject headings, keywords, and synonyms were utilised. Reference lists of papers eligible for inclusion in the review were also hand searched. The quality of each study was evaluated using the Joanna Briggs Institute's quality appraisal tool for cross-sectional studies. Meta-analyses were not possible; thus, findings were synthesised narratively.Results: Five studies were included, all focusing on the impact of extended shifts. One study focused on the nurses’ experience of occupational stress mainly; one study focused on the nurses’ experience of burnout; and two studies focused on the contributing factors of stress and burnout. The methodological quality of these studies was deemed satisfactory. The prevalence of 12-hour shifts was high, and evident across various countries. Long working hours and other variables such as inadequate rests, break-times, and fatigue contributed to the nurses’ experience of occupational stress and burnout. Conclusions: Extended shifts in nursing are a widely observed practise internationally. This systematic review sheds light on the effects of extended shift patterns and the prevalence of occupational stress and burnout among nurses. A better understanding of these concepts may help in building organisational initiatives and strategies to support nurses who work long shifts.27 0Item Restricted Eating disorder psychopathology predicts heart-rate variability under social evaluative stress in female adolescents(Saudi Digital Library, 2023-08-24) Allehyany, Bshaier; Burmester, VictoriaThis study investigated whether eating disorder psychopathology predicts increased vulnerability to social evaluative stress in female adolescents (mean age = 14.64 years) and whether social anxiety disorder symptoms amplified this relationship. Twenty-two females answered eating disorder and social anxiety psychopathology questionnaires and underwent a modified sing-a-song test to provoke social evaluative stress, while their heart-rate variability was recorded. We extracted mean heart-rate variability intervals for the sing-a-song stress test, and evaluated whether eating disorder psychopathology predicts heart-rate variability using a linear regression model with moderation analysis. Results indicated that higher eating disorder psychopathology predicted lower heart-rate variability (β = -4.082; p =.003) and that only high symptoms of social anxiety intensified this relationship (β =.2973, p =.0001). We demonstrate that subthreshold eating disorder psychopathology may explain increased reactivity to social evaluation in female adolescents, and that social anxiety symptoms may facilitate this relationship. Future work should account for subthreshold eating disorder symptoms when investigating the stress response in female adolescents. As well, possible mechanisms underlying the associations between subthreshold eating disorder symptoms and social stress need to be investigated, such as body image anxiety and fear of weight gain.20 0Item Restricted Burnout of Transformational Nurse Leaders(2023-08-05) Alenezi, Latifah; Gillespie, Gordon Lee; Smith, Carolyn; Davis, KermitBackground and Purpose Nurse leaders need to pay attention to their own wellbeing by understanding what leads to burnout. The aims of this dissertation are to: (a) review the evidence and determine how transformational leadership (TFL) characteristics are associated with burnout among nurse leaders; (b) identify the differences in burnout between male and female nurse leaders while considering work-life balance and COVID-19 impact; and (c) investigate the relationship between TFL and burnout by examining the mediating effect of stress, role overload, peer support, and work-life balance. Methods Using PRISMA guidelines, an integrative review and critique of 11 articles was conducted. Personal burnout, work-related burnout, client burnout, work-life balance, and COVID-19 impact were assessed through a gender lens in a sample of 210 nurse leaders using ANCOVA testing. The relationship between TFL and burnout was investigated while examining the mediating effect of stress, role overload, peer support, and work-life balance in a sample of 210 nurse leaders using multiple regression analysis. Results Findings from the integrative review aid in developing a better understanding of the general construct of TFL and burnout among nurse leaders; however, studies exhibited several limitations warranting further research in this area. Females had significantly higher personal burnout than males (Mean 56.2 vs. 49.3, F= 5.853, p = 0.019). Males had significantly higher client related burnout than females (Mean 45.3 vs. 34.8, F= 7.014, p = 0.008). Quantitative data derived from the multiple regression analysis revealed that among transformational nurse leaders, inspirational motivation skills (p <.000, 95% CI [6.8, 2.6]), work-life balance (p = 0.022, 95% CI [5.7, 0.4]), stress (p <.000, 95% CI [4.1, 11.0]), role overload (p <.000, 95% CI [2.2, 5.7]), and peer support (p = 0.001, 95% CI [4.6, 1.2]) were all retained as significant predictors of the burnout score. Conclusions Examining factors that might be linked to burnout is important to increase awareness of the prevalence and impact of burnout in nurse leaders. Future researchers need to engage in meaningful conversations on the role of gender among nurse leaders and investigate TFL skills and their relationships with burnout among nurse leaders.25 0