Barriers to and facilitators of research utilisation among nurses in Saudi Arabia A thesis submitted

240 Pages·2017·2.18 MB·English

Barriers to and facilitators of research utilisation
among nurses in Saudi Arabia

A thesis submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy

Mohammed Saleh Almalki
RN, BSN, MSN

School of Health and Biomedical Sciences
College of Science, Engineering and Health
RMIT University

September 2017
Declaration
I certify that except where due acknowledgement has been made, the work is that of the
author alone; the work has not been submitted previously, in whole or in part, to qualify
for any other academic award; the content of the thesis is the result of work which has
been carried out since the official commencement date of the approved research
program; any editorial work carried out by a third party is acknowledged; and, ethics
procedures and guidelines have been followed.

Mohammed Saleh Almalki

Signed: _________________________ Date: 28/09/2017
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Acknowledgements
I firstly thank Allah, the Lord of the world for giving me the strength and the
determination to complete this research study. This thesis would not have been possible
without His support.
I would like to express my gratitude to my supervisors Dr. Linda Jones, Dr.

Amanda Kimpton and Associate Professor Cliff Da Costa for their continuous support
and encouragement, for not giving up on me and for ensuring that I stayed focused.
Their guidance, immense knowledge, and kindness helped me through the research and
writing of this thesis. My sincere thanks also go to RMIT University staff.
Also, I would like to sincerely thank the participants from the five hospitals for
their contributions in openly sharing their experiences. This would not have been
possible without the support from the Saudi Ministry of Health and King Faisal
Specialist and Research Centre who supported me in the collection of the research data
at the hospitals in the Riyadh region.
This task would not have been accomplished without the assistance of the Saudi
Ministry of Education, in particular Taif University, which gave me the opportunity to
complete my studies in Australia. I would also like to thank the Saudi Arabian Embassy
and the Saudi Cultural Mission in Australia for their encouragement and generous
academic support.
My deepest thanks go to my beloved wife Badour and children, Durar, Kanzi
and Sahab who have encouraged me at all times and for their heartfelt constant love and
support during my PhD journey. To my mother’s family and friends in Saudi Arabia for
support, encouragement and, for accepting all these years of study overseas which took
me away from home; you provided me with the inspiration to successfully complete my
study.
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Finally, I would like to thank everyone who assisted in the successful realisation
of this thesis, as well as expressing my apologies that I could not mention each of you
personally.
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Contents
Declaration ................................................................................................................................ i
Acknowledgements .................................................................................................................. ii
Contents .................................................................................................................................. iv
List of Figures ....................................................................................................................... viii
List of Tables .......................................................................................................................... ix
List of Abbreviations ............................................................................................................. xi
Abstract .................................................................................................................................. xii
Chapter 1: Introduction .......................................................................................................... 1
1.1. Introduction ..................................................................................................................... 1
1.2. Background of the study ................................................................................................. 1
1.3. Aim of the study .............................................................................................................. 5
1.4. Objectives of the study .................................................................................................... 5
1.5. Significance of the study ................................................................................................. 6
1.6. Problem statement ........................................................................................................... 8
1.7. Overview of the thesis ..................................................................................................... 9
1.8. Summary ....................................................................................................................... 11
Chapter 2: Contextual Background ..................................................................................... 12
2.1. Introduction ................................................................................................................... 12
2.2. The Kingdom of Saudi Arabia ...................................................................................... 12
2.3. Healthcare services in Saudi Arabia ............................................................................. 14
2.3.1. Hospitals in Saudi Arabia....................................................................................... 16
2.4. Nursing in Saudi Arabia ................................................................................................ 17
2.4.1. Nursing education in Saudi Arabia ........................................................................ 19
2.4.2. Nursing regulation .................................................................................................. 20
2.4.3. Nursing research activities ..................................................................................... 21
2.4.4. Nursing challenges ................................................................................................. 22
2.4.5. Saudisation ............................................................................................................. 23
2.5. Summary of the chapter ................................................................................................ 24
Chapter 3: Literature Review ............................................................................................... 26
3.1. Introduction ................................................................................................................... 26
3.2. Search strategy .............................................................................................................. 26
3.3. Key findings and concepts ............................................................................................ 28
3.3.1. The concept of research utilisation ........................................................................ 29
3.3.2. Benefits of evidence-based practice ....................................................................... 30
3.3.3. Research utilisation ................................................................................................ 32
3.3.4. Barriers to research utilisation ............................................................................... 37
3.3.5. Barriers to research utilisation in North America .................................................. 38
3.3.6. Barriers to research utilisation in Europe ............................................................... 39
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3.3.7. Barriers to research utilisation in Asia ................................................................... 45
3.4. Facilitators of research utilisation ................................................................................. 53
3.4.1. Facilitators of research utilisation in USA ............................................................. 54
3.4.2. Facilitators of research utilisation in Europe ......................................................... 55
3.4.3. Facilitators of research utilisation in Asia .............................................................. 57
3.5. Factor analysis of the Barrier Scale .............................................................................. 60
3.6. The theoretical framework ............................................................................................ 61
3.7. Limitations of the chapter ............................................................................................. 65
3.8. Summary of the chapter ................................................................................................ 65
Chapter 4: Methodology ........................................................................................................ 67
4.1. Introduction ................................................................................................................... 67
4.2. Aim of the study ............................................................................................................ 68
4.3. Research questions ........................................................................................................ 68
4.4. Research design ............................................................................................................. 69
4.5. Characteristics of quantitative research ........................................................................ 69
4.6. The study settings .......................................................................................................... 71
4.7. Sample and sampling technique .................................................................................... 73
4.7.1. Inclusion and exclusion criteria ............................................................................. 74
4.7.2. Sample size............................................................................................................. 74
4.7.3. Recruitment and data collection ............................................................................. 75
4.8. Data collection instruments ........................................................................................... 77
4.8.1. Demographics survey ............................................................................................. 77
4.8.2. The Barriers Scale .................................................................................................. 77
4.8.3. The Facilitators Scale ............................................................................................. 78
4.8.4. Validity and reliability of the instruments ............................................................. 79
4.9. Content validity ............................................................................................................. 79
4.10. Pilot study ................................................................................................................... 80
4.11. Data management ........................................................................................................ 81
4.12. Ethical considerations ................................................................................................. 81
4.13. Data analysis process .................................................................................................. 82
4.13.1. Data coding, entry and cleaning ........................................................................... 82
4.13.2. Analysis strategy .................................................................................................. 83
4.13.3 Descriptive statistics.............................................................................................. 83
4.13.4. Inferential statistics .............................................................................................. 84
4.14. Summary ..................................................................................................................... 84
Chapter 5: Results .................................................................................................................. 86
5.1. Introduction ................................................................................................................... 86
5.2. Demographics ............................................................................................................... 86
5.2.1. Comparison of demographics across the hospitals ................................................ 90
5.2.2. Participation in research related activities.............................................................. 93
5.3. Barriers to research ....................................................................................................... 99
5.3.1. Total Barrier Score ............................................................................................... 105
5.3.2. Association of demographics with Barrier Score ................................................ 107
5.4. Facilitators of research utilisation ............................................................................... 112
5.4.1. Total Facilitator Score .......................................................................................... 115
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5.4.2. Association of demographics with Facilitator Score ........................................... 120
5.5. Comparison of Barrier and Facilitator Scores across gender ...................................... 127
5.6. Exploration of potential influential factors of the Barrier Score................................. 128
5.6.1. Multiple Linear Regression .................................................................................. 128
5.6.2. Al-Yamamah Hospital ......................................................................................... 128
5.6.3. Prince Mohammed Hospital ................................................................................. 129
5.6.4. King Fahad Medical City ..................................................................................... 130
5.6.5. King Salman Hospital .......................................................................................... 132
5.6.6. King Faisal Research Centre ................................................................................ 133
5.7. Findings from survey open-ended questions............................................................... 135
5.8. Summary of the chapter .............................................................................................. 135
Chapter 6: Exploratory factor analysis of the Barriers Scale.......................................... 136
6.1. Introduction ................................................................................................................. 136
6.2. Background information on factor analysis of the Barriers Scale .............................. 136
6.3. Method for exploratory factor analysis of the Barriers Scale ..................................... 138
6.4. Results for exploratory factor analysis of the Barriers Scale ...................................... 139
6.4.1. Factor One (Lack of incentives in applying Research) ........................................ 141
6.4.2. Factor Two (Drawbacks in applying Research) ................................................... 142
6.4.3. Factor Three (Drawbacks in consuming Research) ............................................. 142
6.4.4. Factor Four (Inadequacies of current Research) .................................................. 142
6.4.5. Factor Five (Implementing Research) .................................................................. 143
6.5. Summary of the chapter .............................................................................................. 143
Chapter 7: Discussion .......................................................................................................... 144
7.1. Introduction ................................................................................................................. 144
7.2. Research aim ............................................................................................................... 144
7.3. Response rate .............................................................................................................. 145
7.4. Demographics ............................................................................................................. 146
7.5. Barriers to research utilisation .................................................................................... 150
7.6. Effect of demographics on Barrier Score .................................................................... 154
7.7. Exploratory factor analysis of the Barrier Scale ......................................................... 155
7.8. Facilitators of research utilisation ............................................................................... 157
7.9. Influence of demographics on Facilitation Score........................................................ 159
7.10. Relationship between demographics and barriers and facilitators of research ......... 160
7.11. Organisational climate: research related activities .................................................... 164
7.12. Overview of results ................................................................................................... 167
7.13. Research and EBP practice ....................................................................................... 169
7.14. Organisational ........................................................................................................... 171
7.15. Individual factors ...................................................................................................... 174
7.16. Education and preparation ........................................................................................ 174
7.17. Supportive administration ......................................................................................... 176
7.18. Critique of the Theoretical Framework ..................................................................... 177
7.19. Summary of the chapter ............................................................................................ 181
Chapter 8: Conclusion and Recommendations ................................................................. 183
8.1. Introduction ................................................................................................................. 183
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8.2. Strengths of the study .................................................................................................. 183
8.5. Limitations .................................................................................................................. 184
8.6. Implications for practice ............................................................................................. 186
8.7. Implication for nursing education ............................................................................... 187
8.8. Implications for future research .................................................................................. 188
8.9. Conclusion .................................................................................................................. 188
References ............................................................................................................................. 192
Appendix A. The Socio-demographic Survey .................................................................... 211
Appendix B. Permission to Use the Barriers Scale ........................................................... 214
Appendix C. Barriers and Facilitators to Using Research in Practice............................ 216
Appendix D. Facilitators to Research Utilisation .............................................................. 218
Appendix E. Research approval from CHEAN ................................................................ 219
Appendix F. Permission from Institutional Review Board (IRB) ................................... 220
Appendix G. Permission from office of Research Affairs at King Faisal Research
Centre .................................................................................................................................... 221
Appendix H. Project Information Statement .................................................................... 222

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List of Figures
Figure ‎2.1. Map of Saudi Arabia (Google Maps) .................................................................... 13
Figure ‎3.1. Outline of search of literature using nominated databases .................................... 28
Figure 3.2. Havelock’s Framework for dissemination and utilisation of knowledge .............. 63
Figure ‎3.3. Adaptation of Linkage Model for research utilisation ........................................... 64
Figure ‎4.1. The percentage distribution of the sample across hospitals................................... 75
Figure ‎5.1. Comparison of mean total Barrier and Facilitators Scores as a percentage of
total scores across hospitals ........................................................................................... 119
Figure ‎7.1. Adaptation of Linkage Model for research utilisation. ........................................ 178

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List of Tables
Table ‎2.1. Demographic characteristics of the Saudi population............................................. 14
Table ‎2.2. Age distribution of Saudi Arabia population in 2015 ............................................. 14
Table ‎2.3. Number of hospitals and beds provided by health care sectors in Saudi
Arabia ............................................................................................................................... 17
Table ‎2.4. The nursing workforce in Saudi Arabia in 2015 ..................................................... 17
Table ‎5.1. Bed capacity of hospitals ........................................................................................ 87
Table ‎5.2. Demographics of the respondents ........................................................................... 88
Table ‎5.3. Roles and qualifications of nurses included in the current study ............................ 90
Table ‎5.4. Nurses’ role by hospital .......................................................................................... 92
Table ‎5.5. Region where nurses’ received their qualifications across hospitals ...................... 92
Table ‎5.6. Association between research activities and hospital type (n=1824) Part 1 ........... 94
Table ‎5.7. Association between research activities and hospital types (n=1824) Part 2 ......... 97
Table ‎5.8. Ranking of barriers to research utilisation (moderate to great extent) .................. 101
Table ‎5.9. Top four ranked barriers to research utilisation (moderate to great extent) .......... 103
Table ‎5.10. Top four ranked barriers to research utilisation (little to no extent) ................... 104
Table ‎5.11. Mean total Barrier Score for hospitals ................................................................ 105
Table ‎5.12. Comparison of mean total Barrier Score across hospitals .................................. 106
Table ‎5.13. Mean total Barrier Score for various qualifications of nurses ............................ 108
Table ‎5.14. Comparison of mean total Barrier Score across nurse qualifications ................. 108
Table ‎5.15. Mean total Barrier Score for nurses’ experience levels ...................................... 109
Table ‎5.16. Mean total Barrier Score for region of qualification........................................... 110
Table ‎5.17. Mean total Barriers Score for clinical roles of nurses ......................................... 110
Table ‎5.18. Comparison of mean total Barrier Score across clinical roles of nurses ............ 111
Table ‎5.19. Mean total Barrier Score by age group of nurses................................................ 112
Table ‎5.20. Ranking of facilitators of research utilisation (moderate to great extent) ........... 113
Table ‎5.21. Top four ranked facilitators of research utilisation (moderate to great extent) .. 114
Table ‎5.22. Top four ranked facilitators of research utilisation (little to no extent) .............. 115
Table ‎5.23. Mean total Facilitator Score for hospitals ........................................................... 116
Table ‎5.24. Comparison of mean total Facilitator Score across hospitals ............................. 117
Table ‎5.25. Mean total Facilitator Score for various qualifications of nurses ....................... 120
Table ‎5.26. Comparison of mean total Facilitator Score across nurse qualifications ............ 121
Table ‎5.27. Mean total Facilitator Score for nurses’ experience levels ................................. 121
Table ‎5.28. Comparison of mean total Facilitator Score across nurses’ experience levels ... 123
Table ‎5.29. Mean total Facilitator Score for region of nurses’ qualification ......................... 123
Table ‎5.30. Comparison of mean total Facilitator Score across region of nurses’
qualification.................................................................................................................... 124
Table ‎5.31. Mean total Facilitator Score for clinical roles of nurses ..................................... 125
Table ‎5.32. Comparison of mean total Facilitator Score across clinical roles of nurses ....... 126
Table ‎5.33. Mean total Facilitator Score for nurses’ age categories ...................................... 126
Table ‎5.34. Comparison of mean total Facilitator Score across age of nurses’ age
categories........................................................................................................................ 127
Table ‎5.35. Comparison of Barrier and Facilitator Scores for males and females ................ 127
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