The effect of transformation policies on healthcare providers' satisfaction in primary healthcare centers: the case of Eastern Saudi Arabia.

BACKGROUND: The Saudi Arabian Vision 2030 encompasses the Health Sector Transformation Program (HSTP), an initiative aimed at enhancing the accessibility, affordability, and quality of healthcare, with a strong emphasis on patient-centered care. To achieve this vision, the government has been providing training to Primary Healthcare (PHC) centers on patient-centered care, recognizing that spending quality time with patients is crucial for making informed clinical decisions. Therefore, it is essential to evaluate provider satisfaction with the quality of services they provide and assess the impact of organizational factors on care quality. This study represents the first comprehensive assessment of job satisfaction among PHC providers in the Eastern region of Saudi Arabia. It seeks to gauge job satisfaction among PHC providers and explore its associated impact on the quality of care they deliver. METHODS: This study employed a quantitative cross-sectional design. Data were collected using a modified version of the Job Satisfaction Survey (JSS), supplemented by three newly added dimensions. Additionally, questions addressing general characteristics were incorporated into the survey instrument. Data analysis involved calculating frequencies and percentages for univariate analysis, employing t-tests for comparisons between two groups, and utilizing ANOVA for comparisons among multiple groups (bivariate analysis). RESULTS: A total of 143 PHC providers took part in this study. Of these, 48% reported high satisfaction, while the rest were either dissatisfied or neutral. PHC providers were highly satisfied with supervision (17%, N=94). On the other hand, they were dissatisfied with contingent rewards (3%, N=15). There was a significant difference found between the intention to leave the job (yes, no) and job satisfaction scores (mean (SD)= 83.58 (16.174) vs. mean (SD)=101.64 (16.209), p-value < 0.001). There were also significant relationships between general characteristics and the dimensions such as co-workers, promotion, responsibility, nature of work, operating procedure, and communication (p-value< 0.05). CONCLUSION: The main findings of this study suggest that PHC providers working in PHC centers in the Eastern region were satisfied with their work, especially with supervision and patient care. However, the findings also revealed that there are many areas of the job of PHC providers that require planned reform, such as contingent reward and communication. Furthermore, intention to leave the job was significantly related to job satisfaction score and all the dimensions. The study findings will help policymakers and the Ministry of Health to develop an employee engagement and satisfaction program to track the PHC providers' levels of satisfaction.

Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study.

BACKGROUND: Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings. OBJECTIVE: This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA. METHODS: In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic. RESULTS: The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants' age, education level, having children, or having any chronic disease. CONCLUSIONS: Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population.

Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction.

BACKGROUND: Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures. METHODS: A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis. RESULTS: Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05). CONCLUSIONS: Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.

Using mobile health applications to enhance physical activity in Saudi Arabia: a cross-sectional study on users' perceptions.

BACKGROUND: This research aims to assess the users' perceptions of usability and quality of mobile health applications used for promoting physical activity in Saudi Arabia. METHODS: This was a quantitative cross-sectional study. A survey was developed based on the Technology Acceptance Model (TAM) and the Mobile Application Rating Scale (MARS) and distributed among the Saudi population through social media to assess the users' perceptions of using mobile applications to enhance physical activity. The survey questionnaire consisted of 27 questions in six sections, including demographics (nine items), perceived usefulness (three items), perceived ease of use (three items), attitudes (three items), user experience (six items) and subjective quality (three items). All the participants were in Saudi Arabia and >15 y of age. RESULTS: A total of 195 m-Health users participated in the survey. Of the total participants, 25.1% were overweight and 21.0% were obese. The workout frequency of most users was rarely (32.3%) and three to four times a week (29.2%). In addition, 55.9% of the users agreed that the application they use served all fitness levels and >80% either agreed or strongly agreed that it was easy for them to learn how to use the application. More than 70% of users agreed or strongly agreed that the application enhanced their knowledge of workouts and physical activity and >90% would recommend the application to others. There were no differences identified between the male and female participants and younger (<40 y) and older (>40 y) participants with respect to perceived usefulness and ease of use, attitudes, experiences and subjective quality. However, significant differences were observed between participants <40 y and >40 y of age in terms of perceived ease of use of mHealth applications. CONCLUSION: mHealth users across Saudi Arabia believe that the mHealth applications have good usability and quality factors. As a result, they can motivate people and help them achieve their goals in relation to physical activities.

Associations Between Obesity, Physical Inactivity, Healthcare Capacity, and the Built Environment: Geographic Information System Analysis.

Background: Obesity is one of the major critical health conditions affecting many people across the world. One of the major causes of obesity is identified to be sedentary lifestyles and physical inactivity, which may be associated with environmental factors. Objective: The study analyzes variations in obesity and physical inactivity in the State of South Carolina, US, and their association with healthcare capacity and the built environment. Methods: Data were obtained from different secondary sources and surveys, 2012, and then linked on the county-level using ArcGIS. Global Moran's I was used to examine the spatial distribution at the state level, and Anselin's local Moran's I was used to detect any significant clusters at the county level. Ordinary least squares regression models were calculated for obesity and physical inactivity separately. Results: More than 70% of SC counties had high levels of obesity and physical inactivity. Spatial analysis showed statistical clusters of high obesity, high physical inactivity, and low access to exercise opportunities in rural areas compared to urban areas. Conversely, clusters of high density of health-care facilities appeared in urban areas. Through the regression models, the density of primary care physicians (p = 0.025) and access to exercise opportunities (p = 0.075) were negatively associated with obesity, while the low perception of own health (p = 0.001) and obesity rate (0.011) were positively associated with physical inactivity. Conclusion: GIS was useful to illustrate and identify significant geographic variations and high clusters of obesity and physical inactivity in rural areas, compared with high clusters of access to exercise opportunities and health-care facilities in urban areas. The international health community is encouraged to utilize spatial information systems to examine variations and recommend evidence-based recommendations to redistribute equitable public health efforts. The development of strategies and initiatives toward reducing variation in health and sustainable development is key to promote the population wellbeing.

Public awareness and use of 997 emergency medical service phone number during the COVID-19 pandemic.

Background: Emergency medical services (EMSs) are an important element of the healthcare system as it provides an opportunity to respond to critical medical conditions and save people's lives. In Saudi Arabia, EMS is offered via the EMS phone number "997" and mobile application "Asefny". Methods: This was an observational cross-sectional survey study exploring public awareness and use of the EMS phone number during the COVID-19 pandemic in Saudi Arabia. A bivariate analysis was performed to investigate factors affecting awareness and use of the EMS phone number and to compare the EMS acceptance to transport and timelines of ambulance arrival between requests made via the "997" EMS phone number and the "Asefny" mobile application during the country's emergency lockdown. Results: A total of 805 participants were included in the analysis, where 66% reported awareness of the EMS phone number and 75% of them accurately identified the nature of the service provided by dialing the number. The men who participated, those with a bachelor's degree, with children, and with chronic conditions were more aware of the EMS phone number compared to the other participants. Of the total sample, 46.7% used EMS phone numbers at least one time (ever users). During the COVID-19 lockdown, the EMS accepted to transport 87% of the calls made by 997 phone number and 56.2% of the mobile application requests (P < 0.00). The ambulance arrived in ≤ 8 min in 53.6% of the 997 phone calls and 35.5% of the Asefny mobile requests (P < 0.00). Conclusions: Findings showed commendable levels of awareness and the use of EMS phone numbers. However, the results suggest room for improvement by developing promotional and educational campaigns inspired by the factors identified as influential on both awareness and use. Mobile applications in EMS are promising to improve prehospital emergency service accessibility, which needs to be further investigated to assess its impact on the public health informatics experience.

Patient Acceptance and Intention to Use e-Consultations During the COVID-19 Pandemic in the Eastern Province of Saudi Arabia.

Background: Over the last decade, the use of digital technology has increased immeasurably and transformed both our personal and professional lives. The medical profession quickly embraced this development, especially after the spread of the COVID-19 pandemic. Medical consultations were transitioned to online settings as a substitute for face-to-face consultations. This exponential acceleration of the use of remote online consultations (e-consultations) was deemed necessary to respond to the impact of the global pandemic. This study identifies the factors that influence actual patient use and the intention to use e-consultations in Saudi Arabia. Methods: A cross-sectional survey was distributed online via social media platforms targeting the population living in Saudi Arabia from August to December 2020. The questionnaire measured patient perceptions of and attitudes toward utilizing e-consultations using a validated questionnaire informed by the technology acceptance model (TAM). Analyses were performed in SPSS to identify the external factors that influence patients' actual use of e-consultations and to assess the TAM factors (usefulness, social influence, and ease of use) that influence the intention to use e-consultations across both actual users and never-users. Results: A total of 150 participants completed the questionnaire; the average age was 38 years old, 85% of the participants were females, and 67% reported never using e-consultations. Additionally, motivation, trust, attitude, and social influence were significantly related to participants' intention to use e-consultations. Conclusion: Participants' trust in and perception of the usefulness of e-consultations were significant factors in their intention to use e-consultation services. Policymakers' attention to those factors could play a role in increasing public acceptance and the use of e-consultations to improve distance medical care.

Factors affecting compliance with national accreditation essential safety standards in the Kingdom of Saudi Arabia.

Accreditation is a widespread culture internationally and nationally. The effectiveness of compliance with accreditation standards was positively correlated with health care settings' performance in multiple aspects: leadership, professional performance, patient safety and organizational culture. There is limited knowledge of the national compliance rate with accreditation standards. Therefore, it is important to assess the hospital compliance with accreditation rate in the Kingdom Saudi Arabia (KSA) and its related factors. This paper presents a quantitative cross-sectional study. Data were extracted from the annual Essential Safety Requirement (ESR) survey database from the Central Board for Accreditation of Health care Institutions (CBAHI) research center during the period 2016 to 2018. Hospitals that started their operation after the first ESR survey round in 2016 or shut down during the study period were excluded. The hospital scoring was on a scale of 0 to 100 and classified as follows: score 2 if the hospital satisfactory compliance (Fully Met) was ≥ 80% and score 1 if particular compliance (Partially Met) was ≥ 50% to < 80%. Then, a score of 0 indicated insufficient compliance (Not Met) when < 50% and a score of not applicable (NA) if the standard does not apply to the hospital. A total of 437 hospitals were surveyed in 20 regions in the KSA and had an overall compliance rate on average that was higher among private hospitals than among public hospitals (77% vs. 66%). Overall, private hospitals had a significantly better compliance rate than public hospitals (mean rate = 84% vs. 68%, respectively, P = 0.019). Large hospitals had more compliance with some standards than smaller hospitals. After adjusting for the year of the survey report, the private hospital type was more compliant than the public hospital. This study supports mandatory accreditation programs for both public and private health sectors, with increased monitoring by the concerned parties (i.e., CBAHI and the Ministry of Health). The authors encourage the application of accreditation for specialized and independent health services.

Awareness and Use of Virtual Clinics following the COVID-19 Pandemic in Saudi Arabia.

Studies have shown that virtual clinics enjoyed high use and high patient satisfaction during the COVID-19 pandemic. Thus, virtual clinics are expected to be the new normal mode of receiving care after the COVID-19 pandemic. This study aimed to assess public awareness and use of virtual clinics following the pandemic and identify factors associated with virtual clinic use. Methods: A cross-sectional design was employed in which data were collected via a structured online questionnaire based on the Technology Acceptance Model (TAM) domains: perceived usefulness, perceived ease of use, and social influence. Participants were selected based on the non-probability sampling of convenience. Univariate, bivariate, and binary logistic regression models were used for analysis. Results: A total of 405 responses were received; of those, 286 (70.6%) were aware of the existence of virtual clinics and 99 (34.6%) were post-pandemic users. Among users, 50% used virtual clinics more than two times, 72% used virtual clinics to seek care for themselves, with the vast majority using it via voice calls (83.8%), and for visits to the family medicine clinic (55%). Young adults, females, single adults, those with a higher level of education, the employed, and those with lower income were more likely to use virtual clinics (p < 0.05). The logistic regression model showed that 20% of the variation in virtual clinic use was explained by perceived usefulness and perceived use (p < 0.001). Conclusion: This study showed high awareness of virtual clinics among the population following the COVID-19 pandemic, with one-third being active users. Age, gender, marital status, education, income, employment status, perceived usefulness, and ease of use are associated with virtual clinics' awareness and use. Considering those factors is important when planning for sustained use of e-health and virtual care.

Sustaining blended and online learning during the normal and new normal conditions in a Saudi higher education institution: health science students' perspectives.

Background: Higher education institutions (HEIs) shifted from in-person attendance to blended and online learning due to the COVID-19 lockdowns. Objective: This study investigated the students' perception of satisfaction, convenience, engagement, and learning towards blended and online courses conducted before, during, and after the COVID-19 lockdowns. Methods: A longitudinal study design was adopted to examine the students' perception of online and blended learning courses before, during, and after the COVID-19 lockdowns. The subjects consist of Health science students (N = 130) belonging to two different colleges of a public university and the study period includes three academic years (i.e., six semesters) (2018-2021). A survey tool was developed to collect data from students studying the computer fundamentals course through blended and online learning modes from 2018 to 2021. Results: Over 95% of students have been satisfied with the course offered through various blended learning formats since 2018. The blended 0.50-course format is the most preferred one for the students; however, the Blended 0.75-course format is highly rated by the students regarding their satisfaction and engagement than other learning formats during the COVID-19 lockdowns. Following adaption after COVID-19, the students reported a high perception of learning towards the course when delivered through 100% online learning mode. Conclusion: Students' achievement is significantly associated with the learning modes, exam modes, and various student batches. The blended 0.75-course format group shows a higher achievement than the other three-course format groups. Likewise, those students who appeared in their exams online showed higher achievement than those who appeared physically. Further, the students felt equally convenient with Blended 0.75 and 100% online learning course formats. These findings would also help HEIs choose appropriate learning and examination modes while designing courses.

Sociodemographic and Occupational Factors Associated With Burnout: A Study Among Frontline Healthcare Workers During the COVID-19 Pandemic.

Purpose: To describe the prevalence of burnout among frontline healthcare workers (HCWs) during the COVID-19 pandemic and the associated sociodemographic and occupational factors. Methods: A cross sectional survey study was carried out to study HCWs burnout using the 19-item Full Copenhagen Burnout Inventory (CBI) that includes personal, work, and patient-related burnout subscales. Bivariate analysis was used to test for associations and p < 0.05 was considered statistically significant. Results: A total of 207 responses received; where the mean score of personal burnout was 67.23, the mean of work-related burnout was 61.38, and the mean of patient-related burnout was 54.55. Significant associations were found; where female HCWs, those working in rotating day-and-night shifts, working more than 55-h per week, and who had their shift time and hours changed during the pandemic, had higher levels of personal and work-related burnout (P < 0.05). Patient-related burnout was higher among those who were single (divorced or separated), nurses, non-Citizens, those with fewer years of experience, and who were infected by COVID-19 and have been quarantined (P < 0.05). Age was not a significant factor of burnout in any of the CBI subscales. Conclusions: There is a prevalent level of burnout among frontline HCWs during the COVID-19 pandemic. Findings highlight key sociodemographic and occupational factors affecting burnout; which can help planning for psychological support strategies. Furthermore, effective administrative control is important to institute policies and mechanisms to identify, and freely report burnout symptoms among HCWs to promote their wellbeing.

Shared Decision-Making: A Cross-Sectional Study Assessing Patients Awareness and Preferences in Saudi Arabia.

Background and Aim: Shared decision-making (SDM) has become broadly accepted during the consultation, especially when there are many options of treatment. This study aims to assess patients' levels of awareness and preferences of SDM in Saudi Arabia. Methods: This is a cross-sectional study targeting patients in Saudi Arabia. Two validated questionnaires were used, the first validated questionnaire focuses on measuring knowledge, attitude and experiences of shared-decision making. The second questionnaire is the the Autonomy-Preference-Index focusing on patients' preferences for being involved in SDM. Relevant items to the study aim were chosen and translated into Arabic. Psychometric testing was conducted for Arabic and English versions and tested for content and face validity. The questionnaire administered online via social media channels, between February 2021 and May 2021. A total of 411 respondents completed the questionnaire. Results: The findings showed a positive association between awareness and preferences of SDM among patients in Saudi Arabia. In the awareness of the SDM domain, females reported higher scores than male participants (t = -4.504, P < 0.001). Saudis reported higher scores in their awareness of SDM than non-Saudis (t = 2.569, P = 0.011). Participants without health insurance reported higher scores in their awareness of SDM than those insured (t = -2.130, P = 0.034). Participants with degree have higher knowledge levels than participants with no degree (f = 10.034, P < 0.001). Females reported higher scores in their preferences of SDM than the male (t = -2.099, P = 0.036). Participants who visited private health-care settings in their last clinical encounter reported higher preferences of SDM than participants who received care in other settings (f = 2.653, P = 0.048). Conclusion: The study concludes that the more aware a patient is, the more likely they prefer SDM practice. This finding can support health-care policymakers in developing SDM policies that enhance patient-centered care.

Factors Affecting Utilization of the E-Health "Seha" Interactive Application for Online Medical Consultation in Saudi Arabia.

Purpose: Telehealth, Internet interventions, or digital apps provide healthcare to isolated regions and can span borders. The purpose of this research was to assess the use of the Seha application, public perceptions toward the application, and factors that affect its utilization. Methods: The cross-sectional method was used to analyze the quantitative data. Grounded Theory was used to analyze the qualitative data. This study was conducted from December 1, 2018, to January 31, 2019. A total of 419 participants were surveyed online, and semi-structured interviews were conducted for 20 participants. The participants were chosen based on convenience sampling techniques. The survey contained two sections. The first section consisted of demographic data and the second section included eight questions, each covering one main aspect. For the qualitative approach, participants were chosen using a theoretical sampling technique. Researchers acted as the primary data collection instrument. Results: Out of the total, 88.5% of the participants did not use "Seha" application. Among users, the main perceived benefit from the application was the ability to contact a general practitioner anytime. Among non-users, the greatest barrier to use was the lack of awareness about it, while the ability to contact a general practitioner any time (25%) and reducing visits to the doctor (23%) were the top motivations. A conceptual framework was developed to define the different aspects affecting the use of the online medical consultation application. These aspects included awareness and education, technical issues, access, and consultation information. Conclusion: Public awareness and education about the application, as well as the integration of its functions with other healthcare systems were the main recommendations suggested. Implementing these recommendations is encouraged to deliver value to e-health initiatives in Saudi Arabia.

Use of social media for the improvement of radiation safety knowledge among Saudi Arabian radiographers.

BACKGROUND: Radiographers have used social media networks for education, research, professional development and other purposes. However, in Saudi Arabia, there are no studies on the use of social media by radiographers. Therefore, the objective of this research was to evaluate the use of social media for the improvement of radiation safety knowledge among Saudi Arabian radiographers. METHODS: A questionnaire was designed to collect the data from Saudi Arabian radiographers. The questionnaire was created using Google Forms and was sent to 530 radiographers using WhatsApp. In total, 159 participants completed and returned the questionnaire through WhatsApp. The response rate was 30%. Basic descriptive statistics were employed to analyse the data. RESULTS: Most of the participants (79.9%) thought that social media could be used as a tool for the improvement of radiation safety knowledge. Also, almost half of participants (49.7%) employed social media when they needed to obtain information about radiation protection. Similarly, a majority of respondents (69.2%) used social media when they required information related to radiation safety. In addition, 81.7% of participants observed on video the existing information on radiation safety. Also, 71.7% of them were disposed to expand the use of social media to obtain information for radiation protection in their professional activities. CONCLUSION: The results indicate that social media can help to improve radiation safety knowledge among Saudi Arabian radiographers. Consequently, participants were willing to increase the use of these tools in their professional work.

Knowledge and attitude of Saudi Arabian citizens towards telemedicine during the COVID-19 pandemic.

BACKGROUND: The objective of this study was to investigate the knowledge and attitudes of Saudi Arabian citizens towards telemedicine during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A cross-sectional survey was designed to carry out this study. The electronic survey, prepared using Google Forms, was distributed to 1500 randomly selected citizens of Saudi Arabia. A total of 330 participants completed and returned the questionnaire. Basic statistics were used to describe the data. RESULTS: The majority of the respondents (73.9%) were female. More than half of them (54.8%) were >35 y of age and had graduate or postgraduate degrees (65.5%). A total of 96.7% of the respondents were Saudis. Most of the participants (70.0%) were familiar with the term 'telemedicine' and thought that telemedicine (92.1%) could reduce transportation costs. Of the respondents, 58.8% had not seen a telemedicine system before and 67.0% indicated that they had not previously used telemedicine services. A total of 87.3% of the participants agreed or strongly agreed that telemedicine was a useful tool during the COVID-19 pandemic. Also, more than half of the participants agreed or strongly agreed that telemedicine facilitates the diagnosis of people (58.8%), increases communication (58.2%), reduces clinic visits (85.9%) and performs tasks quickly (70.3%). Also, 51.5% of the respondents disagreed or strongly disagreed that telemedicine affects patient privacy. CONCLUSIONS: The outcomes indicated that most of the participants had a positive attitude towards the use of telemedicine as a response to the COVID-19 pandemic in Saudi Arabia. They believed that telemedicine saves time, labour and costs and is an effective tool to treat coronavirus patients at a safe distance. However, the government should develop programs to raise awareness in the population about the use of telemedicine for the treatment of various diseases that afflict the Saudi Arabian people. Likewise, a legal framework must be implemented to protect the privacy of patients and healthcare providers.

Virtual Reality: Is It Helping Children Cope with Fear and Pain During Vaccination?

BACKGROUND: Virtual reality (VR) is an innovative distraction technology in health care, but little is known about this topic in Saudi Arabia. The aim of this study was to assess the effectiveness of using VR to reduce pain and fear among children during vaccination. METHODS: It is a cross-sectional study design. A total of 104 children (ages 4-6 years) receiving routine vaccinations in a single primary health care in Eastern Region, Saudi Arabia, participated in the study and grouped to a VR technology intervention group or vaccination as usual without VR distraction. The primary outcome is the difference in the child's self-rated fear and pain scores between those who have been vaccinated with or without VR distraction, measured by the two validated international facial expressions scales Wong-Baker FACES Pain Scale and Children's Fear Scale. RESULTS: In the two-month study period, 53 children were vaccinated using the VR technology and 50 children were vaccinated without VR. Bivariate analysis showed a significantly lower pain score among the VR group (=1.36, SD 2.06) compared with the group without VR (=6.90, SD 3.47) (P-value < 0.001). Similarly, fear score was lower in the VR group (=0.64, SD 0.92) compared with the group without VR (=2.88, SD1.55) (P < 0.001). In multivariable regression models adjusted for age and gender, children vaccinated using the VR technology had significantly lower pain and fear scores compared with those who were vaccinated as usual without VR distraction. CONCLUSION: VR technology showed a positive impact on reducing pain and fear among children aged 4-6 years during vaccination. Policymakers are encouraged to expand the use of this distraction tool in primary health centers to improve the vaccination experience among children.

Usage and Acceptability of the Wateen Application Among the Population of Saudi Arabia.

PURPOSE: The main objective of this research was to investigate the opinion of the population of Saudi Arabia on the use and acceptability of the Wateen application. METHODS: This research was a quantitative cross-sectional study in which an online questionnaire was distributed among the target population who were healthy people over 18 years of age that had used or known about the Wateen application. A total of 352 participants responded to the questionnaire. The data collection was carried out between November and December 2020. A basic descriptive statistical analysis was used to analyze the data. RESULTS: The participants had used the Wateen app to follow the donation record, as a reminder of donation dates, to find lists and blood bank locations, to request blood donation, and to find donation requests on social media. After receiving the blood donation request from the Wateen app, majority of the respondents felt encouraged, motivated, and educated to donate blood, and about blood donation, respectively. Participants also indicated that the application helped them to find donors. Besides, majority of the respondents stated that the Wateen app had reduced the gap between blood donors and the need for blood. However, few participants expressed that they had not received or observed a post about the Wateen application on social media networks. CONCLUSION: The results of this research indicated that there is a general acceptance of the use of the Wateen app among the participants of this study. However, the importance of the Wateen app needs to be further advertised so that it can be used in the blood donation process in all regions of Saudi Arabia. In this way, the people of Saudi Arabia will be more aware of the importance of the Wateen app in the blood donation process, and the goal of the Ministry of Health of bridging the gap between donation centers and blood donors could be achieved.

The Impact of WhatsApp on the Blood Donation Process in Saudi Arabia.

BACKGROUND: WhatsApp was the most popular messenger app used in Saudi Arabia with 71% of the total population using it in 2020. WhatsApp is increasingly being used as a tool for mobile health (m-health) interventions; however, concerning blood donation, there is a lack of research studies on the topic. OBJECTIVE: This study aims to measure the general awareness levels of the blood donation process and assess blood donation history, the motivators and inhibitors to donating blood, and to assess the impact of WhatsApp on the blood donation process in Saudi Arabia. METHODS: In this research study, a descriptive quantitative cross-sectional analysis was adopted. A questionnaire survey was designed using Google Forms and distributed online through social media applications to collect data. All citizens aged above 18 years of age were eligible to participate in the survey. There were a total of 150 participants in the study. RESULTS: More than 90% of participants were aware of their blood group, blood donation requirements, and causes to be deferred from the donation. Furthermore, 27% of participants donated blood because their relatives or friends needed blood, 26% donated due to human solidarity, 18% did not donate blood because of their health condition and 14% did not because of the fear of needles. About 33% of participants relied on WhatsApp to search for blood donors, and all the requests were fulfilled with blood donors. In addition, 94% of participants strongly believed that the WhatsApp application had a significant role in bridging the gap for blood banks' need for blood donors. CONCLUSION: Social media applications such as WhatsApp can bridge the gap between blood banks, blood donors and the patients in need of blood in Saudi Arabia, where there is a shortage of blood donors.

An Investigation of Healthcare Worker Perception of Their Workplace Safety and Incidence of Injury.

Background: Managing the safety climate in health care is a promising tool for improving employee and patient safety in the health care work environment. Gaps in the theoretical and conceptual underpinnings of safety climate, as well as the evidence base for its practical application in health care remain. The purpose of this study was to evaluate the number of work injuries occurring in health care work units and associated safety climate beliefs. Methods: A retrospective analysis was conducted utilizing organizational staff survey data collected by a large medical hospital in the Midwest in 2015. Employees (n = 32,327) were invited to identify safety climate perceptions via survey. Injuries, days restricted, and days absent were identified through the Hospital's Occupational Safety and Health Administration (OSHA) log. Zero inflated negative binomial regressions used injuries as dependent variables and safety climate perceptions as independent variables. Findings: In all, 23,599 employees completed the survey (73% response rate) across 1,805 employee work units which were defined as groupings of employees reporting to a single supervisor. We found that there was an association between fewer injuries and health care workers indicating that they share responsibility for compliance with safety rules and procedures (relative risk [RR] = 0.98, 95% confidence interval [CI] = [0.98, 0.99]). Conclusion/Application to Practice: This study supports the use of a safety climate measure to assess working units' perceptions of employee safety. A continued focus on the health and safety of employees who interact directly with patients is warranted, as well as employees who do not provide direct patient care.

Cost of Acute and Follow-Up Care in Patients With Pre-Existing Psychiatric Diagnoses Undergoing Radiation Therapy.

PURPOSE: The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS: Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS: Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS: Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.