UNDER-REPORTING OF COMMUNICABLE DISEASES IN A REGIONAL CITY, SAUDI ARABIA: THE PERCEPTIONS OF PRIMARY HEALTHCARE PHYSICIANS AND OTHER STAKEHOLDERS

Abstract

Purpose Infectious diseases in the era of globalisation and today’s highly mobile world are demonstrably able to spread much faster in a geographical sense than at any other time in human history. Communicable diseases reporting by physicians is a key step in the public health surveillance system that aims to ensure disease prevention and control. However, ensuring that physicians report to public health authorities remains a challenge. Under-reporting by physicians has repeatedly been demonstrated in a range of studies worldwide. This study aims to explore and understand the perspectives of primary healthcare physicians (PHCPs) and other key stakeholders on the drivers of the under-reporting of notifiable diseases in a regional city in Saudi Arabia in order to develop a clearer and more comprehensive understanding of reporting practice and its determinants. Design An inductive exploratory qualitative approach was utilised, based on a two-phase data-gathering, sequential design using in-depth, face-to-face semi-structured interviews with PHCPs (22 participants) and other stakeholders (8 participants). Data were analysed using thematic analysis, as described by Braun and Clarke (2006). Relevant measures were assessed for robustness in ethics and rigour. Findings and Conclusions Several factors emerged from the thematic analysis that could be categorised into two main overarching themes which yielded relevant themes and sub-themes. The first overarching theme, ‘Knowledge and attitudes of PHCPs to reporting, centred on PHCPs’ personal factors including their diagnosis of communicable diseases, awareness and understanding of associated roles and procedures, and anxiety about assuming responsibility. The second overarching theme, ‘Cultures and contexts as behavioural drivers in reporting’ focused on contextual/environmental factors. These included the work-culture at Primary Healthcare Centres (PHCCs), workplace and cultural barriers, the patient-PHCP encounters within the PHC setting, and socio-cultural pressures and power dynamics. This study identified factors that influence the reporting of notifiable diseases in Saudi Arabia. It has unveiled a complex interplay of individual, organisational, and sociocultural factors that shape the behaviours and practices of PHCPs in this regard, alongside noticeable gaps in leadership and implementation culture. These findings inform a set of recommendations for policy, practice, and future research. Contribution This work is among the few studies to consider the Middle East region, and the first study in Saudi Arabia to explore, using a qualitative approach, the issue of under-reporting from the perceptions of PHCPs and other direct stakeholders. It adds to the general understanding of this issue by identifying a range of novel findings regarding contributory factors that have not previously been identified in the literature. It also contributes to an understanding of these factors that could be applied in other, similar contexts.