Saudi Cultural Missions Theses & Dissertations
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Item Restricted THE INTRICATE RELATIONSHIP BETWEEN TOURISM AND HEALTH: A SYSTEMATIC REVIEW(University of Surrey, 2024-02-26) Alqahtani, Saad; Chen, JasonBackground: There exists a direct relationship between tourism, travel and health. According to the United Nations World Tourism Organization (2015), tourism can directly promote health and wellness through the provision of strategically reinvented health-related services. It is from this perspective that the rise of medical tourism became apparent. Medical tourism is the practice of travelling abroad for medical services. Under normal circumstances, wellness tourism is aimed at advancing the motivation of relaxation, mental therapies, and an improved quality of life for the tourists. There is a direct link between travel/tourism and health as the former directly impact an individual’s state of health in association with social, physical and mental wellbeing (Alipour et al., 2020: Lee et al., 2020). Moreover, according to Hartwell et al. (2018), tourism presents a direct influence on psychological, emotional, spiritual and cognitive dimensions of a normal person’s wellbeing. The above arguments by Alipour et al. (2020) and Lee et al. (2020) support a previous finding indicating that there is a causal relationship between tourism and health based on the observation that older tourists tend to be healthier and active as compared to non-tourists (Ferrer et al., 2016). Research aim: To identify, evaluate, and synthesise evidence from the published research on the relationship between tourism and health to set precedence for the future research on the identified gaps. Research objectives: 1) To summarise and synthesise the existing evidence on the relationship between tourism and health 2) To identify knowledge gaps in the extant literature in relation to the nexus between tourism and health 3) Establish precedence and set a background for the future research on the relationship between tourism and health 4) To make relevant recommendations that will inform decision-making practices by companies operating within the tourism sector on the provision of health-oriented services 5) To make recommendations that will influence the perceptions and decisions made by tourists in visiting destinations solely for meeting their health and wellness needs Methods: Philosophy: The interpretivist-constructivist was preferred because it tends to focus on plausibility, authenticity, justifiability, coherence, criticality, comprehensibility, compulsion, and assessability of a certain topic of interest. The interpretivism-constructivism approach is justified because the researcher is aiming to derive meaning from the existing secondary sources on the relationship between tourism and health. Design: The systematic review design was used to determine the extent and nature of evidence published on the aspects of tourism and health. Search process: The online databases from which the evidence was retrieved include MEDLINE (PubMed) and Google Scholar. The combined keywords were [Tourism OR travel OR vacation] AND [health OR well-being OR medical OR mental health OR physical health OR wellness] AND [impact OR effect OR association] AND [population OR community OR individual]. The PRISMA 2020 flow diagram was used as a guide to the evidence search process. Quality appraisal: The mixed methods appraisal tool (MMAT) was adopted in the appraisal of methodological quality of the included studies. Results: The initial search retrieved 534 reports that were evaluated based on the inclusion/exclusion and eligibility criteria leading to the final list of 15 articles (2 qualitative and 13 quantitative). Evidence was then retrieved from the 15 articles. The intricate relationship between tourism and health was revealed in four perspectives. First, medical tourism positively impacts tourists’ physical and psychological health, wellness in the form of positive emotions and life satisfaction due to the tourist’s autonomy, experience, and intrinsic motivation. Second, higher perceptions of community well-being arose from greater economic performance of medical tourism. Given the perceived positive impacts of tourism, the community’s attitudes toward medical tourism influenced the overall satisfaction with the practice and eventually, the community’s willingness to pay higher taxes and participate in the promotion of medical tourism. Third, the negative health impacts of tourism include increased crime rates, overcrowding and congestion that heighten the residents’ stress levels leading to ill health. Finally, medical tourists’ require to be motivated, and the factors that influence their intentions to visit a destination include follow-up care, advanced and affordable medical technology, tourism activities for companions, strong government support, extra support for patients, price, variety of treatments, accessibility and service, and infrastructure at the destination, perceived risks, and medical facilities associated with the destinations. The factors that influence revisit intentions are health evaluation, international certified doctors, doctors’ expertise, quality of medical treatment, advanced medical treatment, high healthcare quality, hospital contact information, waiting time until treatment, and availability of medication. Limitations: The scope of the review was limited as only 15 articles were included. There was inadequate theoretical development in the studies due to failure to incorporate key elements pertaining to this relationship such as public awareness and tourism campaigns in cementing medical tourism, responding to health crises such as pandemics, the dynamics of medical tourists’ behaviours during pandemics, the role of policy, regulation, technology, ethics and sustainability as fundamental pillars of medical tourism. Moreover, methodological limitations were evident in the sampling strategies and data collection methods used. Most of the studies adopted purposive and convenience sampling strategies, which are non-probabilistic. This introduced sampling bias that affected the credibility and generalisability of the results. Additionally, interviews are subjective while cross-sectional designs do not depict causal relationships. Implications for practice and future research: This review positively contributes to the tourism industry. Since the number of health-conscious visitors is on the rise, businesses with stake in tourism, hospitality, and travel sectors should position themselves to offer services that appeal to such tourists. They can segment their clients according to their needs and invest in the required services and products to generate more revenues. Furthermore, since the review outlines the factors that motivate medical tourists to either visit or revisit an attraction destination, it is beneficial to the destinations that offer health and wellness services. These destinations will adopt the factors that motivate medical tourists to visit, and as a result, improve their competitiveness in that sphere of service provision. This will open up innovation in the sector in relation to enhancing medical tourism. The future research should pursue additional variables including the role of the tourism sector in responding to health crises such as pandemic, the dynamics of medical tourists’ behaviours during pandemics, the role of policy, regulation, technology, ethics and sustainability as fundamental pillars of medical tourism. The future research should consider investigating this relationship from the lenses of multiple motivational theories including Maslow’s Hierarchy of Needs, Theory of Planned Behaviour (TPB), Self-Determination Theory (SDT), and Expectation Confirmation Theory (ECT). Mixed methods, experimental, and quasi-experimental designs are recommended for future research to establish causal relationships among variables developed from the relationship between tourism and health. Conclusions: The review posits that tourism is not only for leisure purposes but serves even more interesting purposes such as promotion of health and wellness. It is evident that medical tourism is on the rise and its social, wellness, cultural, and economic value is acknowledgeable. Therefore, more efforts should be invested in medical tourism for the benefit of businesses, visitors, healthcare systems, and communities and their economies. Nevertheless, research is underdeveloped in this area, and thus, justifies the need for continued research to fill the existing knowledge gaps.26 0Item Restricted Exercise and quality of life in patients with alpha-1 antitrypsin deficiency(Saudi Digital Library, 2023-12-04) Alshahrani, Mohammed; Pye, Anita; Turner, AliceIntroduction Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that affects the production of a protein called alpha-1 antitrypsin. This protein helps to protect the lungs from damage. People with AATD are at increased risk of developing lung and liver diseases. This dissertation explores the effectiveness of exercise on the quality of life in AATD patients. Physical activity is known to have many health benefits, including improving lung function, and reducing the risk of chronic diseases. However, it is not clear whether physical activity is beneficial for people with AATD. The main aim of this study is to examine the relationship between exercise and quality of life in AATD patients who lead physically active or sedentary lifestyles. Methods This cross-sectional study examined the associations between physical activity, quality of life, and well-being in 64 participants with AATD. Utilising a customised questionnaire, activity levels and perspectives were evaluated. More clinical information was extracted from the AATD registry. Results There were 64 participants whose ages and lung function varied considerably. Perspectives on physical activity varied; some were physically active while others were sedentary. The impact of AATD on activity capacity varied among participants. The majority of respondents reported that physical activity improves Quality of life (QOL) and emotional health, but some described barriers. Diverse forms of exercise were preferable. Patients who engaged in more physical activity reported improved quality of life, including less shortness of breath, fatigue, and anxiety, according to the results. In addition, they reported having higher levels of energy and generally feeling better. Positive correlations were observed between physical activity, QOL, and emotional well-being. Conclusion These findings suggest that physical activity would be a beneficial intervention for AATD patients. in addition, this dissertation highlights the importance of incorporating exercise as an integral component of holistic health management for individuals with AATD, showcasing its potential to improve various dimensions of quality of life, both physically and emotionally. However, more research is needed to confirm these findings and to determine the optimal amount and type of physical activity for AATD patients with larger sample size.14 0Item Restricted A Socio-Technical System to Understand and Mitigate The Negative Impacts of Planned Disruptions on People’s Well-being(ProQuest, 2023) Hammad, Omar; Mishra, ShivakantPlanned disruption events such as highway construction typically span a relatively longer period of time and hence have negative impact on the health and wellbeing of people living in the surrounding communities. Further, these communities tend to have low socio-economic status with high unemployment rate and limited resources (Environmental Justice Communities). The goal of this dissertation is to understand and mitigate the negative impacts of planned disruption projects via a socio-technical system linking data from smartphone apps integrated with existing air quality and transportation APIs. Our focus in this project is on a highway expansion construction project in North Denver, USA (the C70 Project) and its surrounding communities. We started by designing an developing a smartphone app called PureMotion in a three-round usability study with community members from the affected area. After that we deployed PureMotion over two cohorts spanning for four months in total (two month each) and reported results from the analysis done on the data collected. Finally we designed, developed and deployed two intervention apps, PureNav and PureConnect, that contributed in helping community members mitigate the top issues that we have learned from the first two studies, transportation and lack of information11 0Item Restricted Surgeon Burnout, Patient Safety and Quality of Care: Contributors, Consequences and Possible Solutions(Tmam Al-Ghunaim, 2023-05-21) Al-Ghuanim, Tmam; Johnson, Judith; O'Conner , Daryl; Biyani, ShekharAbstract Research has linked increased staff burnout to poorer patient safety in healthcare settings. Surgeons, in particular, are more inclined to suffer from burnout whereas surgeons often suffer silently when they are experiencing stress and burnout and do not ask for help which make the issue not clear. There needs to be more research on surgeon burnout, how it affects them and how to enhance their well-being. This thesis aimed to improve understanding of surgeon burnout and identify potential solutions. This thesis reports five studies. The first was a systematic review and meta-analysis which aimed to investigate the association between surgeon burnout and 1) patient safety and 2) surgical professionalism. The results of a systematic review provided important insights into the existing evidence base on surgeon’s burnout and identified gaps in knowledge, one of which is that there is not enough qualitative study to give a deep understanding of how surgeons experience and deal with burnout. Hence, the next two studies used semi-structured interviews to explore the main factors that lead to surgeon burnout and to examine how surgeons cope with burnout at work (Study 2) and to understand how burnout affects surgeons and the care they provide (Study 3). The systematic review also revealed that there is no evidence regarding the link between surgeon burnout and patient safety in the UK, to address this, the fourth study used questionnaire survey methods to investigate the association between surgeon burnout and patient safety outcomes. This study also tested whether surgeons' burnout levels varied over the first six months of the COVID-19 pandemic. The fifth study, ../ qualitative methods, investigated the effects of the COVID-19 pandemic on surgeons' mental health. Key findings This thesis found a significant link between surgeon burnout and patient care. The systematic review and meta-analysis (Study 1) results showed that burnout was associated with a 2.5-fold increased risk of medical error. Study 3 identified four themes about how burnout affects patient care: first, burnout weakens surgeon–patient relationships; second, burnout affects patient safety; third, burnout hurts staff relationships; and fourth, burnout makes surgeons less motivated to improve. Burnout was also associated with patient safety in the survey study (Study 4), and the longitudinal findings indicated a bi-directional connection between burnout and patient safety perceptions (Study 4). Regarding the main factors that can lead to burnout in surgeons, the thematic analysis identified several factors captured in the following themes: rising to the challenge of surgical work; interpersonal conflict at work; greater demands than resources; the challenge of work-life balance; and the devastating impact of errors and poor patient outcomes (Study 2). The analyses also revealed various strategies surgeons employed to cope with burnout: cognitive restructuring; seeking social support; stepping aside or down from the job; and prioritising personal health. Additionally, some surgeons also reported using maladaptive coping (Study 2). A second qualitative analysis also found three themes in surgeons' experiences of burnout: first, burnout is common but frequently not recognised nor understood; second, burnout is a personal crisis; and third, burnout creates vulnerability at work (Study 3). The impact of the COVID-19 pandemic on surgeons was also investigated in this thesis (Studies 4 and 5). Qualitative thematic analysis identified four major themes: a changing and challenging work environment due to the COVID-19 pandemic; professional development and life challenges; personal change and loss, and emotional and psychological repercussions (Study 5). Quantitative analyses found that burnout increased during the pandemic's first (June 2020) to second waves (January 2021) (Study 4). In conclusion, surgeons suffer from a high level of burnout, especially after the COVID-19 pandemic (Study 4). Without a defined retention plan, the problem affects not only surgeons through bad habits such as substance abuse, but also organisations through workforce loss due to surgeons leaving. It may also increase risks to patient safety.12 0