Saad Alyahya

During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals. This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn’t take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups. Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p = 0.001; 19.1%, p = 0.011; 19.0%, p = 0.013; 18.4%, p = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group (p < 0.001). The percentages of booked appointments made by Young adults (18–35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p = 0.016) and ego groups (21.0%, p = 0.010). At the same time, sex didn’t affect the percentages of booked appointments in any group. Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations.

Objective: Tolerance is considered one of the most important values in any society. The present study aimed to validate the Tolerance Index on the Saudi society. Method: A 2019 Tolerance Index (56 items) by the King Abdulaziz Center for National Dialogue was used. A total of 1071 participants completed the survey. The sample was randomly selected using geographical sampling. The Exploratory Factor Analysis (EFA) was used to validate the Tolerance Index. Result: The principal components analysis, along with the orthogonal rotation matrix (Varimax rotation) revealed that 35 items of the Tolerance Index were loaded on six main factors: twelve items were loaded onto two social and cultural factors; eight items were loaded onto two economic factors; four items were loaded onto one political factor; and 11 items were loaded onto one religious factor. Conclusion: The Tolerance Index is valid and is a reliable index that can be used in the Saudi society.

(1) Background: Women have become more influential and powerful; however, implicit bias continues to plague organizations when it comes to women in leadership positions. This study examines the implicit and explicit biases that favor men as leaders among Saudi Arabian primary healthcare professionals. (2) Methods: A secure, web-based survey was administered to primary healthcare professionals. The survey included questions about leadership as well as an Implicit Association Test (IAT) for implicit gender bias. (3) Results: Out of 690 eligible, 448 respondents completed the survey, representing a response rate of 65%. Male residents had a mean IAT score of 0.27 (SD 0.31) and females 0.12 (SD 0.29), both favoring males in leadership roles, and the difference was statistically significant. There was a significant association between gender and gender IAT. In the explicit bias, gender, education, gender of the current manager, and being manager were associated with the gender explicit bias. Explicit bias favoring males in leadership roles was associated with increased implicit bias favoring males in leadership roles. (4) Conclusions: This study found that explicit and implicit gender bias is present among primary healthcare professionals favoring men in leadership positions held by both men and women.

This study aimed to assess the association between role conflict and ambiguity among nurses in primary healthcare centers (PHCs) in Saudi Arabia and their stress levels during the coronavirus disease 2019 (COVID-19) pandemic. In this online cross-sectional study, sociodemographic and occupational characteristics, role conflict, and ambiguity of 432 nurses were assessed using the Bowling Scale for Role Conflict and Ambiguity and stress was assessed using the 10-item Perceived Stress Scale from September 27 to October 17, 2020. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for above-median stress levels of nurses with average and high (2nd and 3rd tertiles) role conflict and ambiguity compared with nurses with low role conflict and ambiguity (1st tertile). The mean (standard deviation) age of the nurses was 36.5 ± 6.6 years, and 25.9% of them were males. After adjusting for PHC type and working hours, nurses with average and high role conflict had significantly higher stress rates than those with low role conflict, with ORs (95% CIs) of 2.69 (1.62–4.46) and 6.31 (3.78–10.53), respectively. Similarly, nurses with average- and high-role ambiguity had significantly higher stress than those with low role ambiguity, with ORs (95% CIs) of 2.15 (1.30–3.55) and 7.68 (4.54–13.01), respectively. Increasing stress rates were detected across increasing categories of role conflict and ambiguity (P values for trend <.001). We found that role conflict and ambiguity were associated with stress among nurses in PHCs in Saudi Arabia during the COVID-19 pandemic.

Vaccine refusal or hesitancy is one of the significant issues that can have an adverse impact on people’s health and their countries’ economy. Additionally, vaccine acceptance or refusal could have a decisive role in controlling the COVID-19 pandemic. This study aims to investigate the factors affecting COVID-19 vaccine refusal and hesitancy among the general population in Saudi Arabia. The method is a cross-sectional survey using an online questionnaire, and data were collected from 1935 participants between 18 February 2021 and 1 April 2021. Out of 1935 participants aged ≥18 years and residing in Saudi Arabia, 46.9% reported their intention to receive the COVID-19 vaccine, 22.4% had received the vaccine, 9.5% did not intend to receive the vaccine, and 21.2% had not made their decision. In the multinomial logistic regression models, vaccine refusal was associated with age (OR: 0.961), nationality (OR: 0.182), monthly income of more than SAR 18,000 (OR: 2.325), chronic diseases (OR: 0.521), knowledge about the vaccine (OR: 0.937), and concerns about the vaccine (OR: 1.5). The hesitancy was associated with age (OR: 0.977), nationality (OR: 0.231), monthly income between SAR 6000 to 12,000 (OR: 0.607), chronic diseases (OR: 0.640), knowledge about the vaccine (OR: 0.907), and concerns about the vaccine (OR: 1.3). The main concerns about the vaccine were “COVID-19 vaccines are not tested enough on people”, “drug companies are interested in COVID-19 vaccine sales only”, and “COVID-19 vaccines have serious adverse effects”. Awareness programs and vaccination campaigns should consider people’s concerns and correct their misinformation.

Work-related stress can affect the quality of healthcare during the COVID-19 pandemic. This study aimed to assess the relationship between selected work-related stressors and stress levels among healthcare professionals providing preventive and curative services to people with COVID-19 symptoms in the Fever Clinics in Saudi Arabia. A systematic random sampling using an online questionnaire approach was used to select healthcare professionals in the Fever Clinics in Saudi Arabia during September 2020. Participants were asked to fill out a questionnaire including data on their sociodemographic and occupational characteristics, role conflict and ambiguity, social support, and stress. The results showed that role conflict and ambiguity were significant risk factors for stress, and social support was negatively associated with stress levels. Additionally, younger and non-Saudi healthcare professionals exhibited higher stress levels than their older and Saudi counterparts. In conclusion, role conflict, ambiguity, and social support can predict the risk of stress among healthcare professionals in the Fever Clinics in Saudi Arabia.