Fahad Nasser Alhazmi

Background/Objectives: The Chippaux–Smirak Index (CSI) measures relative midfoot plantar contact, whereas the six-item Foot Posture Index (FPI-6), navicular drop test (NDT), and resting calcaneal stance position (RCSP) assess static foot posture, change in navicular height, and calcaneal alignment, respectively. This study examined associations among these measures, agreement between CSI and FPI-6 classifications, and measurement reliability in young adults. Methods: This cross-sectional study included 350 young adults, with both feet assessed (700 feet). Two orthotists independently measured CSI, FPI-6, NDT, and RCSP. Generalised estimating equation models accounted for correlations between feet and were adjusted for age, sex, body mass index, and foot side. Agreement was assessed using exact percentage agreement and linear weighted Cohen’s kappa, and reliability using intraclass correlation coefficients (ICCs). Results: After adjustment, each increase of 10 percentage points in CSI was associated with a 2.141-point-higher FPI-6 total score, a 2.660 mm greater navicular drop, and an RCSP that was 3.240° more valgus (all p < 0.001). CSI and grouped FPI-6 classifications agreed for 82.9% of feet (linear weighted κ = 0.664, 95% CI 0.595–0.727). Single-measure interrater ICCs ranged from 0.644 for NDT to 0.884 for CSI. Digital remeasurement of CSI demonstrated excellent intrarater reliability (ICC(A,1) = 0.989). Conclusions: Higher CSI values were associated with a more pronated static foot posture, greater navicular drop, and a more valgus RCSP. Incomplete agreement between CSI and FPI-6 classifications indicates that these methods provide related but distinct information and should be interpreted according to the specific foot characteristic assessed.

Background: Patient-centered care (PCC) is central to diabetes management; unfortunately, evidence concerning its relationship with patient-reported outcome measures (PROM) in primary healthcare facilities in Jeddah is limited. This study examined the association between validated PCC scores and patient-reported outcomes and explored how PCC domains could be interpreted through four ethical principles. Methods: A cross-sectional survey was conducted on 594 adults with diabetes recruited from 47 primary care facilities between July and August 2023. The primary exposure was the validated 36-item, eight-domain PCC total score, while the primary outcome was a study-specific core PROM composite. Satisfaction and patient-reported experience measure (PREM) scores were measured as secondary measures. Statistical analysis was completed through multivariable ordinary least-squares regression with HC3 heteroscedasticity-robust standard errors adjusted for sociodemographic and health characteristics, while the four author-defined ethical groupings were examined exploratorily. Results: Among 594 adults with diabetes who completed the study, the mean PCC was 76.91 (SD 17.01), core PROM was 63.51 (SD 16.85), satisfaction was 81.41 (SD 19.30), and PREM was 77.27 (SD 20.45). PCC correlated with core PROM (r = 0.437), satisfaction (r = 0.251), and PREM (r = 0.239). In the primary adjusted model (n = 591), PCC remained positively associated with core PROM (B = 0.433, 95% CI [0.359, 0.507], p < 0.001). Female sex and severe self-rated health were associated with lower PROM scores, whereas older age and type 2 diabetes were associated with higher scores. The model explained 27.0% of PROM variance. Conclusions: Higher PCC was independently associated with better PREM. The ethical mapping provides a potentially useful interpretive framework but requires independent psychometric validation.

Background: Healthcare quality is increasingly dependent on the patients’ perspective to ensure care aligns with patients’ needs and experiences, especially for those living with chronic conditions such as diabetes. The Swedish National Diabetes Register instrument (NDR) combines patient-reported experiences and outcomes to evaluate patient-centered diabetes care, but it has not yet been accessible in Arabic. This study aimed to assess the validity and reliability of the Arabic version of the Swedish National Diabetes Register questionnaire among patients with diabetes. Methods: A cross-sectional study was carried out from July to August 2023 at 47 primary healthcare centers in Saudi Arabia, involving 594 adult patients with diabetes. Reliability was measured with Cronbach’s alpha and composite reliability. Construct validity was tested using confirmatory factor analysis, and discriminant validity was assessed through the Heterotrait–Monotrait Ratio. Data analysis was performed using SPSS (version 28) and the lavaan package in R (version 4.3.2). Results: The Arabic version showed high internal consistency, with Cronbach’s α ranging from 0.716 to 0.886 and CR between 0.663 and 0.855. It also exhibited good model fit indices, including χ²/df of 2.72, RMSEA of 0.054, SRMR of 0.073, and a CFI above 0.90. All item loadings were statistically significant (p < 0.01). The HTMT values were below 0.85, confirming adequate discriminant validity. Conclusions: The Arabic version of the NDR instrument is a valid and reliable tool for measuring patient-reported experiences and outcomes among Arabic-speaking patients with diabetes, which supports its application in diabetic care across the Arab region. Health policymakers in the region are recommended to incorporate this validated Arabic tool into their national diabetes initiatives.

Background: The Kingdom of Saudi Arabia (KSA) has made tremendous efforts to promote the adoption of advanced technologies such as artificial intelligence (AI). While the successful adoption of AI is dependent on physician perception, there is a scarcity of data concerning KSA physicians’ perception of the technology. Objective: The purpose of this study was to conduct a cross-sectional survey that would provide updated statistics on physicians’ attitudes toward AI with a focus on ethical and practical perspectives among physicians licensed in the KSA. Methods: A pilot study was conducted with 10 physicians to enhance the clarity of the survey questions. The pilot was followed by a cross-sectional survey, which was conducted through 25 online, self-administered questionnaires hosted on Qualtrics. A total of 218 physicians filled out the survey. The dataset was then exported into Microsoft Excel and analyzed using descriptive statistics rather than inferential analyses given the exploratory nature of this study and its primary aim to generate updated descriptive insights rather than test specific hypotheses. Results: A total of 201 fully filled surveys, representing 127 (63.2%) female and 74 (36.8%) male physicians with experience ranging from 3 to ≥30 years, were analyzed. Most physicians (n=165, 82.1%) trusted AI-based clinical decision-making, and 76.6% (n=154) believed that the technology improved efficiency in health care delivery. Unfortunately, only 25.9% (n=52) of physicians had used AI in the previous year. Common barriers to AI adoption included lack of training, high implementation costs, and resistance to change, as well as concerns related to privacy, data security, bias in AI-based recommendations, patient autonomy, and liability. Participants recommended training through workshops (n=50, 25%), online courses (n=47, 23.4%), hands-on experience (n=44, 21.9%), and a combination of online courses and hands-on experience (n=17, 8.5%). Conclusions: Physicians who responded to this survey supported AI’s use in health care but reported facing financial, ethical, and training barriers, which could be addressed through informed consent and staff training.

Personal health records (PHR) systems are designed to ensure that individuals have access and control over their health information and to support them in being active participants rather than passive ones in their healthcare process. Yet, PHR systems have not yet been widely adopted or used by consumers despite their benefits. For these advantages to be realized, adoption of the system is necessary. In this study, we examined how self-determination of health management influences individuals’ intention to implement a PHR system, i.e., their ability to actively manage their health. Using an extended technology acceptance model (TAM), the researchers developed and empirically tested a model explaining public adoption of PHRs. In total, 389 Saudi Arabian respondents were surveyed in a quantitative cross-sectional design. The hypotheses were analysed using structural equation modelling–partial least squares (SEM-PLS4). Results indicate that PHR system usage was influenced by three major factors: perceived ease of use (PEOU), perceived usefulness (PU), and security towards intention to use. PHR PEOU and PHR intention to use were also found to be moderated by privacy, whereas usability positively moderated PHR PEOU and PHR intention to use and negatively moderated PHR PU and PHR intention to use. For the first time, this study examined the use of personal health records in Saudi Arabia, including the extension of the TAM model as well as development of a context-driven model that examines the relationship between privacy, security, usability, and the use of PHRs. Furthermore, this study fills a gap in the literature regarding the moderating effects of privacy influence on PEOU and intention to use. Further, the moderating effects of usability on the relationship between PEOU, PU, and intention to use. Study findings are expected to assist government agencies, health policymakers, and health organizations around the world, including Saudi Arabia, in understanding the adoption of personal health records.

Purpose: This study focuses on the concept of medical tourism, its significance, and its implications for the Jordanian health sector. Patients travel to Jordan to seek elective, less expensive medical procedures while having a vacation. Other factors that promote medical tourism include better quality of care, shorter queues, exotic locations, and culture. The Medical Liability Law passed not long ago, further encouraged more patients to seek treatment in Jordan. Medical tourism's contribution to Jordanian GDP is noteworthy; providing economic growth and employment opportunities. Though medical tourism received great recognition, little is said about specific concerns like the brain drain of health workers and incurring high costs on Jordanian citizens. This issue needs further attention. Design/methodology/approach: This research employed qualitative analysis by conducting semi-structured, in-person interviews with ten Jordanian professionals who have an interest in the field of medical tourism. The interviewees included a health marketer, private hospital directors, a health policymaker, a health accreditation expert, a quality assurance manager, and health care professionals. The key participants responded to the same open-ended interview questions. The selected participants represent a diversity of facilitators involved in the medical tourism industry. Interviews were transcribed and correlated with the literature. Findings: The competitive edge of Jordan in medical tourism arises from cost-effective health services, its renowned reputation in healthcare, and the diversity of touristic attractions. Most foreign patients that come to Jordan are from Arab countries. Jordan offers no language barrier and similar culture. The importance of medical tourism to Jordan is reflected in its contribution to the GDP by 3.5 percent or $1 billion. Little attention is drawn to some issues such as brain drain, high-incurring costs, promotional campaigns, medical inequality, and other pitfalls. Practical implications: Health policymakers and health services providers around the globe with similar health systems have expressed interest in facilitating the growth of the medical tourism industry. They should encourage what reduces operational and medical risks that may accompany the medical tourism industry. This paper could provide a better understanding of medical tourism in Jordan as a hot spot in the world for medical tourism. Social implications: Medical tourism can drive a robust social multiplier effect on a nation in terms of enhancing employment generation as well as fostering a culture of innovation and advancement in the field of healthcare and medicine. Originality/value: The interviews and other secondary data sources help shed some insight into the current status and ramifications of medical tourism in Jordan.

Musculoskeletal pain and disorders (MSDs) constitute a well-recognised occupational hazard to the dental community. Fortunately, they are preventable. Dental office ergonomics plays a key role in addressing these musculoskeletal challenges. An ergonomic improvement project based on Kotter’s eight-step change model management theory was implemented within a dental practice. The project provided valuable evidence-based ergonomic interventions to prevent or reduce MSDs. The task force motivated staff to engage in strategies and interventions to enact an ergonomic vision. This case study represents an action plan to guide this ergonomic change. The key results of this project were an evidence-based ergonomics health promotional brochure, reduced sick leave attributable to MSDs, and workplace ergonomic checkpoints. The ergonomic change model represents an ongoing process where innovative trends and evaluative methods can be supported. Research limitations and practical implications were acknowledged.

This study examines nurses’ Continuance Intention (CI) to use electronic health records (EHRs) through a combination of three conceptual frameworks: the Unified Theory of Acceptance and Use of Technology (UTAUT), the theory of expectation-confirmation (ECT), and the Five-Factor Model (FFM). A model is developed to examine and predict the determinants of nurses’ CI to use EHRs, including top management support (TMS) and the FFM’s five personality domains. Data were collected from a survey of 497 nurses, which were analyzed using partial least squares. No significant relationship was found between TMS and CI. The study revealed that performance expectancy significantly mediated the influences of two different hypotheses of two predictors: agreeableness and openness to testing CI. A significant moderating impact of conscientiousness was found on the relationship between performance expectancy and CI and the relationship between social influence and CI. The findings of this study indicated that rigorous attention to the personality of individual nurses and substantial TMS could improve nurses’ CI to use EHRs. A literature gap was filled concerning the mediating effects of performance expectancy on the FFM-CI relationship, and the moderation effects of Conscientiousness on UTAUT constructs and CI are another addition to the literature. The results are expected to assist government agencies, health policymakers, and health institutions all over the globe in their attempts to understand the post-adoption use of EHRs.

The pandemic’s context is rife with numerous dangerous threats and high fear levels, influencing human decision-making. Such characteristics are identified by investigating the acceptance of exposure detection apps from the technology acceptance model (TAM) perspective. This study purposed a model to investigate protection technology acceptance, specifically exposure detection apps in the context of COVID-19. Quantitative study approach and a cross-section design targeted 586 participants from Saudi Arabia. As the study model is complex, the study hypotheses were analysed using the structural equation modelling–partial least squares (SEM-PLS3) approach. The findings support the entire model hypothesis except the link between social media awareness and exposure detection apps’ intention. Mediation of COVID-19 anxiety and influence was confirmed as well. The current paper contributes to the technologies acceptance domain by developing a context-driven model comprising the major pandemic characteristics that lead to various patterns of technology acceptance. This study also fills the literature gap regarding mediating effects of social influence and COVID-19 anxiety in the relationship between trust in government and exposure detection apps implementation, and between COVID-19 anxiety and exposure detection apps implementation, respectively. The results may assist government agencies, health policymakers, and health organisations in the wide world and specifically Saudi Arabia, in their attempts to contain the COVID-19 pandemic spread.

To investigate the associated factors underlying vaccination intentions for Coronavirus Disease 2019 (COVID-19), an online cross-sectional survey was conducted among adults 18 years or over in the Kingdom of Saudi Arabia. Data were collected between 8 and 14 December 2020. A logistic regression analysis was employed to examine and identify the variables associated with vaccination intentions for COVID-19, with the odds ratio (OR) and 95% confidence interval (CI) also calculated. A total of 2137 respondents completed the questionnaire. Overall, about 48% of Saudi adults were willing to receive the COVID-19 vaccine. Participants had stronger intentions to receive a vaccination if they resided in the southern region (OR: 1.95; 95% CI: 1.21–3.14), received the seasonal influenza vaccination in the past (OR: 1.52; 95% CI: 1.17–1.97), believed in mandatory COVID-19 vaccination (OR: 45.07; 95% CI: 31.91–63.65), or reported high levels of concern about contracting COVID-19 (OR: 1.91; 95% CI: 1.29–2.81). Participants were less likely to have an intention to be vaccinated if they had a history of vaccine refusal (OR: 0.28; 95% CI: 0.19–0.40). The low acceptance rate among the Saudi population should be targeted with multifaceted interventions aimed at raising awareness and emphasizing the safety and efficacy of the COVID-19 vaccine.