Cultural adaptation of self-management models for Type 2 Diabetes in Saudi Arabia

According to the global prevalence of diabetes, Saudi Arabia is ranked 7th. Currently the Ministry of Health in Saudi Arabia spends around US $6 billion, or more than 16% of its budget on treating diabetes and its complications. The focus of this thesis is type 2 diabetes. Some countries have developed their own type 2 diabetes self-management education programmes. These programmes aim to educate individuals with type 2 diabetes to become independent and capable of taking initiative in dealing with their type 2 diabetes in order to have better health and quality of life. Saudi Arabia does not have such a programme. The main aim of this thesis was to carry out an initial need assessment for type 2 diabetes self-management education programmes to examine if the solutions provided through self-management education programmes can help individuals with type 2 diabetes in Saudi Arabia. This aim was pursued through three complementary studies, each of them aimed to cover a specific point of this need assessment. Study one aimed to evaluate needs based on the degree of success of self-management strategies used in any existing programmes or attempts. Evidence on such success was driven from published type 2 diabetes self-management studies in Saudi Arabia and sister Gulf Cooperation Council (GCC) countries. Study two examined demographic and clinical associations with type 2 diabetes in Saudi Arabia. Study three aimed to provide an insight into how health professionals dealing with type 2 diabetes and those under their care in Saudi Arabia perceive the current type 2 diabetes management options and if the solutions offered through self-management programmes are needed or could be of a benefit. The above approach was based on a model devised by Kumpfer and colleagues for need assessment and cultural adaptation. This model describes nine steps to assess the need of a self-management programme. Part of the need assessment is to assess the need for cultural adaptation to make the programme suitable for a new setting or population. Step one in this model recommends reviewing published literature, which was done through a systematic review. It also suggests examining factors associated with the healthcare condition targeted by the programme and understanding the views of those affected by this condition. This thesis systematically reviewed publications on type 2 diabetes self-management studies in Saudi Arabia and GCC. Although none of the reviewed studies (n=8) tested a full type 2 diabetes self-management programme, it was clear that teaching participants how to monitor their blood glucose, become more active or eat healthier, was associated with an improvement in the control of their diabetes. However, the systematic review also showed that the studies did not consider the concept of cultural adaptation. Without cultural adaptation to make the programme more suitable to the local context, one can expect the success of some aspects of such a programme to be compromised. In order to build on these recommendations suggested in the first step of Kumpfer’s model, this thesis used the Saudi Health Interview Survey, published in 2013, to investigate sociodemographic, health and lifestyle factors associated with type 2 diabetes and its control. The survey included the responses of a representative sample (n=10,827). Of Saudi adults 7.5% (n=808) had type 2 diabetes. Factors associated with type 2 diabetes were being a male, above 55 years and overweight. The analysis also showed comorbidity between hypertension and type 2 diabetes. However, some unexpected findings were encountered in this secondary data analysis. Factors such as physical activity and smoking were not statistically significant in association with type 2 diabetes. On the other hand, people who ate more fast food were less likely to have type 2 diabetes and those who ate more fruits and vegetable were more likely to have poorly controlled type 2 diabetes. Finally, to conclude the first step in the Kumpfer model, a qualitative study was designed to understand the views of participants who have type 2 diabetes (in-depth interviews with 12 participants with type 2 diabetes) and the health professionals (n=9 divided into two focus groups) responsible for their care at a specialised endocrinology centre. The study revealed some challenges to successful management of type 2 diabetes, which can be overcome with type 2 diabetes self-management programmes. All individuals with type 2 diabetes from the city, in which the specialised endocrinology centre is located, and the surrounding rural areas attended this one centre. This led to overcrowding in clinics. For many, particularly women, it was not easy to practice outdoor sports; indoor sport facilities were available, but not affordable for some. Many were dependent on cars, while some found it difficult to quit smoking. It was also useful to know that many, who started to eat healthier food such as vegetables, or had given up on eating fast food, had only started doing so after they were diagnosed with type 2 diabetes, which may explain some of the unexpected findings in the quantitative study. In summary, this thesis used three different research methods, systematic review, quantitative data analysis and qualitative study, in order to advise on the need for initiating a national type 2 diabetes self-management programme in Saudi Arabia. It is clear that a culturally adapted programme to be specific to Saudi Arabia is needed to help to tackle issues associated with clinic overcrowding, restrictions on achieving better physical activity levels and weight control for both sexes and all age groups, particularly older individuals who may require help to self-manage other chronic illnesses

Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study)

Background: Saudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia. Methods: A qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols. Results: Focus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions. Conclusion: The findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes

Hand Hygiene Knowledge and Perception among the Healthcare Workers during the COVID-19 Pandemic in Qassim, Saudi Arabia: A Cross-Sectional Survey

Hand hygiene is among the most important factors of infection control in healthcare settings. Healthcare workers are the primary source of hospital-acquired infection. We assessed the current state of hand hygiene knowledge, perception, and practice among the healthcare workers in Qassim, Saudi Arabia. In this cross-sectional study, we used the hand hygiene knowledge and perception questionnaire developed by the World Health Organization. Knowledge and perceptions were classified into good (80–100%), moderate (60–79%), and poor (<60% score). The majority of the healthcare workers had moderate knowledge (57.8%) and perception (73.4%) of hand hygiene. Males were less likely to have moderate/good knowledge compared to females (OR: 0.52, p < 0.05). Private healthcare workers were less likely (OR: 0.33, p < 0.01) to have moderate/good perceptions compared to the government healthcare workers. Healthcare workers who received training on hand hygiene were more likely to have good/moderate perception (OR: 3.2, p < 0.05) and to routinely use alcohol-based hand rubs (OR: 3.8, p < 0.05) than the ones without such training. Physicians are more likely (OR: 4.9, p < 0.05) to routinely use alcohol-based hand rubs than technicians. Our research highlighted gaps in hand hygiene knowledge, perception and practice among healthcare workers in Qassim, Saudi Arabia and the importance of training in this regard

Needle-Stick and Sharp Injuries among Hospital Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey

Needle-stick or sharp injuries (NSIs) are critical occupational hazards for healthcare workers. Exposure to blood and body fluids through NSIs increases the risk of transmission of blood-borne pathogens among them. The objectives of this study were to estimate the annual incidence of NSIs and investigate the associated factors of NSIs among the healthcare workers in Saudi Arabia. A cross-sectional online survey was conducted between October and November 2021. A total of 361 healthcare workers participated in the survey from all over Saudi Arabia. The one-year incidence of at least one event of NSIs among the healthcare workers is estimated at 22.2% (95% CI: 18.0, 26.8). More than half of the injury events (53.8%) were not reported to the authority by the healthcare workers. Incidence of NSIs was highest among the physicians (36%) and was followed by nurses (34.8%), dentists (29.2%), and medical technologists (21.1%). The odds of NSIs was higher among the healthcare workers aged 26–30 years compared to the 20–25 years age group (OR: 2.51; 95% CI: 1.04, 6.03), as well as among the workers who directly dealt with needles or other sharp objects while working compared to those who did not (OR: 5.9; 95% CI: 2.69, 12.97). The high incidence and low rate of reporting of NSIs highlights the need of education and awareness raising programs targeting healthcare providers with higher risk of injury

The National Strategies for and Challenges in Infection Prevention and Control of the Healthcare System in the Kingdom of Saudi Arabia (Review Study)

Healthcare-associated infections (HAIs) lead to considerable morbidity. Prolonged hospital HAIs, also known as hospital infections or nosocomial infections, refer to infectious diseases that occur within 48 h of hospital admission, within three days of discharge or 30 days after having received healthcare. A total of 39 government-owned hospitals with a total of 10,822 beds providing the majority (59.9%) of Saudi Arabian healthcare were analyzed. Medicare and Medicaid use hospital data to track hospital performance on matters pertaining to IPC. In addition, many hospitals have limited capacity with which to develop the core components required to build an effective IPC programme. Hajj has been associated with the increased prevalence and spread of infectious diseases. These factors include changes in human demographics and behaviour, the effect of new technologies and industries, an increase in international travel and commerce, and breakdown resulting from public health measures. Overall public health service expenditure originates from the administration and services that are provided free of charge to all Saudi citizens

The relationship between work readiness and perceived clinical competence among graduates transitioning into professional practice

Background: Nursing Residency Programs (NRPs) reportedly help close the disparities in job-related knowledge, expertise, and attitudes that affect new nurses, healthcare organizations, and care quality by offering instructions and resources for new graduate nurses. Aim: This study aims to explore the relationship between work readiness and perceived clinical competence among graduates attending the NRP as compared to nurse interns at one university hospital. Methods: This study employed a quantitative cross-sectional research design, recruiting 203 graduate nurses through a purposive sampling technique via electronic invitations. Results: The results of this study showed that graduates attending the NRP had higher scores at all levels of work readiness and clinical competence, with work readiness being found as a predictor of clinical competence. Conclusions: Healthcare organizations are responsible for exploring the transition to practice programs and their effectiveness in enhancing work readiness to increase the quality of care offered to patients and to prepare skillful new graduates for professional and safe practice

The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia

The Escherichia coli that produces extended-spectrum lactamases (ESBL-E. coli) can develop resistance to many antibiotics. The control of ESBL-E. coli disorders is challenging due to their restricted therapeutic approaches, so this study aims to determine the prevalence and pattern of the antibiotic resistance of ESBL-E. coli among male and female patients with urinary tract infections in Riyadh, Saudi Arabia. During the period of 2019 to 2020 at King Fahd Medical City, Riyadh, 2250 urine samples from patients with urinary tract infections (UTIs) were collected, and microbial species were cultured and identified using standard biochemical techniques. A double-disc synergy test was used to identify ESBL-producing strains of E. coli, and an in vitro method and the clinical laboratory standard institute (CLSI) criteria were employed to determine the resistance of these strains to antimicrobial drugs. ESBL-E. coli was detected in 510 (33.49%) of the 1523 E. coli isolates, 67.27% of which were recovered from women and 33.7% of which were recovered from men. A total of 284 (55.69%) ESBL-E. coli isolates were found in patients under 50 years of age, and 226 (44.31%) were found in patients over 50 years of age. Nearly all the isolates of ESBL-E. coli were resistant to cephalosporins (ceftriaxone, cefotaxime, cefepime, cefuroxime, and cephalothin) and penicillin (ampicillin), whereas the majority of the isolates were sensitive to several carbapenems (imipenem, meropenem, and ertapenem), aminoglycosides (amikacin), and nitrofurantoins. The development of antibiotic resistance by ESBL-E. coli, the most frequent pathogen linked to urinary tract infections, plays a crucial role in determining which antibiotic therapy is appropriate

Stress and academic engagement among Saudi undergraduate nursing students: The mediating role of emotion regulation and emotional intelligence

Abstract Aim To assess the mediating role of emotion regulation and emotional intelligence in the relationship between stress and academic engagement among Saudi undergraduate nursing students. Design This study employed a quantitative cross‐sectional research design. Methods The study recruited 367 Saudi undergraduate nursing students at a major Saudi university. Structural equation modelling was used to explore the mediational model. Results The results of the ANOVA and Welch F‐test demonstrated that the emotional intelligence, emotional regulation and academic engagement scores were statistically significantly different according to stress levels (p‐values <0.01). Perceived stress has a statistically significant moderate negative correlation with academic engagement and emotional intelligence and a strong negative correlation with emotional regulation. The results also showed that academic engagement had a statistically significant moderate positive association with emotional intelligence and emotional regulation. Results indicate that stress and academic engagement are negatively correlated among Saudi undergraduate nursing students. It focuses on the balancing functions of emotional regulation and emotional intelligence, highlighting their ability to lower stress levels and improve academic engagement. No Patient or Public Contribution

The mediating role of learning motivation in the relationship among perceived stress and emotional regulation among Saudi nursing students in clinical practice

Abstract Background Nursing students often face high levels of stress due to demanding responsibilities during clinical placement. Emotional regulation, the ability to manage and regulate one’s emotions effectively, is crucial for nursing students in dealing with stress and maintaining their overall well-being. Additionally, learning motivation plays a vital role in students’ engagement and academic success. The current investigation aimed at studying the link that exists among stress, learning motivation, and emotional regulation among Saudi undergraduate nursing students. The study also aimed at investigating the sequential mediating effects that motivation might perform in this association. Methods A quantitative cross-sectional methodology was used in the present research, which recruited 367 Saudi undergraduate nursing students. Results The results of the ANOVA showed that the level of perceived stress was linearly and negatively correlated with emotional regulation and motivation. Upon conducting structural equation modeling, significant direct and indirect effect pathways were identified between perceived stress, emotional regulation, and motivation, while only indirect pathways were identified between perceived stress and emotional regulation. Conclusions This study provides evidence of the mediating role of learning motivation in the relationship between perceived stress and emotional regulation among Saudi nursing students. The results highlight the negative impact of stress on emotional regulation and learning motivation and emphasize the importance of addressing motivational factors in interventions aimed at enhancing emotional regulation among nursing students

Vaccination Intention against COVID-19 among the Unvaccinated in Jordan during the Early Phase of the Vaccination Drive: A Cross-Sectional Survey

Objective: This study assessed the intention and predictors of accepting the corona virus disease 2019 (COVID-19) vaccine in Jordan. Method: A national-level online survey was conducted among adults (≥18 years) in Jordan between June and September 2021. Descriptive analyses were performed to report vaccination intent. In addition, bivariate and multivariate logistic regression analyses were done to evaluate the association between vaccination intent and its predictors. Results: A total of 2307 adults participated. Most of them (83.7%) expressed an intention to receive a COVID-19 vaccine. Their vaccination intention was significantly (p &lt; 0.001) associated with male gender (aOR: 2.6), residence in the Amman region (aOR: 51.8), and no history of COVID-19 infection (aOR: 6.0). In contrast, individuals aged 50-64 years (aOR: 0.2, p &lt; 0.001), Jordanians (aOR: 0.7, p = 0.038), and those with an occupation designated as “other” (unemployed, general workers, housewives) (aOR: 0.2, p &lt; 0.001) were less likely to have a positive vaccination intent. Among the health belief model constructs, perceived future (aOR: 2.8) and present (aOR: 5.0) susceptibility to COVID-19 infection; severity of complications (aOR: 9.9); and benefits (aOR: 100.8) were significantly (p &lt; 0.001) associated with a higher likelihood of having a vaccination intent. On the other hand, individuals who are concerned about the efficacy (aOR: 0.2) and side effects (aOR: 0.2) of the vaccine were less likely to have a positive vaccination intent (p &lt; 0.001). Conclusion: Despite having high rates of intention to receive a COVID-19 vaccine, Jordanians, older adults and housewives, general workers and unemployed individuals were less likely to be vaccinated. These findings highlight that need-based public health campaigns are necessary to ensure maximum COVID-19 vaccination uptake in Jordan