Development of a Behaviour Change Intervention for Deprescribing for Older People in Secondary Care in Saudi Arabia

Abstract

Introduction Saudi Arabia’s ageing population is increasing, with rising multimorbidity and polypharmacy among older adults. This has contributed to potentially inappropriate medication use, increasing risks of adverse drug events, hospitalisation, and reduced quality of life. Deprescribing can reduce these risks, but evidence on its implementation in Saudi secondary care remains limited. This thesis aimed to provide a theory-based foundation for a behaviour change intervention to support deprescribing for older inpatients in Saudi hospitals, focusing on physicians, pharmacists, patients, and carers. Methods A mixed-methods design was conducted across four studies. Qualitative interviews explored physicians’ and pharmacists’ experiences of deprescribing, using topic guides informed by the Theoretical Domains Framework version 2 (TDF2). Determinants were prioritised and mapped to behaviour change techniques (BCTs). A modified nominal group technique used the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side effects and safety, and Equity) to refine and select BCTs. A cross-sectional survey using the revised Patients’ Attitudes Towards Deprescribing questionnaire assessed older inpatients’ and carers’ views. Finally, a scoping review applied the Behaviour Change Wheel to map hospital interventions to functions and BCTs. Results Key determinants included professional roles, team and hierarchical influences, patient and carer perceptions, concerns about negative outcomes, lack of guidance and documentation, resource constraints, interprofessional support, education, and recognition of benefits. These were linked to six TDF2 domains. Five BCTs were selected: ‘Information about others’ approval’, ‘Social support’, ‘Information about health consequences’, ‘Social comparison’, and ‘Salience of consequences’. Most older inpatients (88.1%) and carers (82.7%) were willing to deprescribe if recommended by a healthcare professional and wanted involvement in decision-making. Conclusion This thesis provides a theory-informed foundation for a feasible hospital-based deprescribing intervention in Saudi Arabia. The selected BCTs offer a practical basis for future intervention development, testing, and integration into routine hospital practice.