Health risk behaviours among university students in Saudi Arabia

356 Pages·2017·9.76 MB·English

UNIVERSITY OF SOUTHAMPTON

FACULTY OF SOCIAL, HUMAN AND MATHEMATICAL SCIENCES

Southampton Education School

Health risk behaviours among university students in Saudi Arabia

By

Saad Zafir G. Alshehri
Thesis for the degree of Doctor of Philosophy

3rd November 2016

ABSTRACT

This thesis investigates the features of common health risk behaviours (HRBs), namely,
violent behaviours, sexual behaviours, smoking, drug use and unhealthy dietary
behaviours, and patterns of engagement with these HRBs, among students at a Saudi
university. The study includes a literature review covering the underlying reasons and
consequences of HRBs, and explores existing theoretical models of HRBs in order to
construct an appropriate theoretical model which underpins and guides this
investigation. A mixed methods research methodology was used; quantitative data
was collected using a questionnaire-based survey administered to 722 respondents,
and qualitative data was collected using a series of interviews with 17 students. The
elaborated theoretical model developed from the findings of the study may offer a
more accurate understanding of HRBs amongst students at this Saudi university. In
addition, the theoretical model may help to inform HRB-related research more widely
across universities in Saudi Arabia and beyond. Key findings point to high levels of
smoking, risky driving and violent behaviours, moderate levels of alcohol and illegal
drug consumption, and physical inactivity and unhealthy diet. Students did not report
serious sexual risk behaviours. Furthermore, such HRBs are influenced by traditional
practices, gender, age, influence of other HRBs, the current legal system, globalisation,
and lack of awareness. These practices are well-aligned to three major levels of
influence: the intra-personal, public engagement and socio-cultural. Policy and practice
implications arising from the findings are discussed.
Supervised by: Dr Jenny Byrne and Professor Marcus Grace
Table of Contents
ABSTRACT
Table of Contents
List of Tables
List of Figures
DECLARATION OF AUTHORSHIP
Acknowledgements
Glossary of terms and definitions used in categorising and analysing HRBs

1.1 Background
1.2 Research on HRBs in Saudi universities
1.3 Research Questions
1.4 Research context and personal attachment
1.4.1 Research Context
1.4.2 Personal attachment of researcher
1.5 Purpose and boundaries
1.6 Implications for stakeholders
1.7 Thesis structure

2.1 Introduction
2.2 From Algathal to Riyadh
2.3 Tribal culture and faith-based society
2.4 Experiencing rapid changes
2.5 Understanding the gap in research and planning for an in-depth investigation

3.1 The Structure of the Chapter
3.2 Overview of risky behaviours
3.2.1 Risky behaviours at young age
3.3 Definitions of HRBs
3.3.1 Relationship of HRBs with risks
3.3.1.1 Contributing factors and their roles
3.4 Risks and HRB protective factors
3.5 HRBs in early adulthood
3.5.1 Preventive measures
3.6 Outcomes of HRBs among university students
3.7 Conclusion

4.1 Introduction
4.2 Types of HRBs in Saudi Arabia
4.2.1 Disobedience of Traffic Rules and Car Accidents
4.2.2 Smoking
4.2.3 Substance Abuse
4.2.4 Violent behaviours
4.2.5 Illegal sexual relationship
4.2.6 Unhealthy eating habit and physical inactivity
4.3 Summary

5.1 Introduction
5.2 Models of Risk and Protective Factors, Behaviours and Risk Outcomes
5.3 Social Development Model
5.4 Ecological Systems Model
5.5 The Health Belief Model (HBM)
5.6 The Theory of Planned Behaviour
5.7 Developmental Cognitive Neuroscience framework (DCNF)
5.8 Problem Behaviour Theory
5.9 Behaviour Decision Making Theory
5.10 The Developed Model
5.11 The benefits of developing a University-Based Model
5.12 Conclusion

6.1 Introduction
6.2 Research aims and questions
6.3 Research approaches
6.3.1 Quantitative and qualitative investigation
6.3.2 Mixed method approach
6.4 Decisions on paradigm and methods
6.5 Research design
6.5.1 Research samples
6.5.2 Sampling techniques
6.5.3 Quantitative (questionnaire) sample
6.5.4 Qualitative (interview) sample
6.6 Data collection methods
6.6.1 Questionnaire
6.6.1.1 Types of questionnaires
6.6.1.2 Advantages of questionnaire
6.6.1.3 Disadvantages of questionnaire
6.6.1.4 Types of data
6.6.1.5 Designing a questionnaire for this study
6.6.2 Interview
6.6.2.1 Designing the interview schedule for this study
6.7 Piloting the data collecting instruments
6.7.1 Piloting the questionnaire
6.7.2 Piloting the interview
6.8 Questionnaire distribution procedures
6.9 Interview conduction procedures
6.10 Tools for data analysis
6.10.1 Meta-analysis
6.10.2 Methodological triangulation
6.11 Validity and reliability
6.12 Ethical Considerations
6.13 Conclusion

7.1 Introduction
7.2 Profile of the respondents
7.3 Students’ health risk behaviours
7.3.1 Behaviours that contribute to vehicle injuries
7.3.2 Behaviours that contribute to violence
7.3.3 Sad feelings
7.3.4 Tobacco use
7.3.5 Alcohol and other drug use
7.3.6 Body weight
7.3.7 Unhealthy dietary behaviours
7.3.8 Physical inactivity
7.3.9 Sexual behaviours that contribute to sexually transmitted diseases
7.3.10 Students' risk attitude and risk taking activities
7.4 Summary of the results

8.1 Introduction
8.2 Data coding and reporting procedures
8.3 Findings
8.3.1 State of HRBs in University X
8.3.2 Risk Factors of HRBs
8.3.3 Reasons for HRBs involvement
8.4 HRBs related reasons: two superordinate themes
8.4.1 Gender-based differences in HRB engagement
8.4.2 Levels of HRBs engagement
8.5 Conclusion

9.1 Introduction
9.1.1 Chapter structure
9.2 Answers of the research questions
9.2.1 The state of HRBs among students of University X
9.2.2 Reasons of HRBs
9.2.2.1 Reasons for students’ involvement
9.2.2.2 Reasons for the existence of some HRBs
9.2.3 Reasons for the existence of particular HRBs in University X
9.3 HRB patterns in Saudi higher education institutions
9.4 Levels of influence on students at University X to HRBs
9.5 Conclusion

10.1 Introduction
10.2 Key findings
10.3 Contributions of the study
10.3.1 Methodological contributions
10.3.2 Theoretical contributions
10.3.3 Empirical contributions
10.4 Limitations and transferability
10.5 Recommendations
10.6 Future research direction
List of References
Appendices
Appendix 1 (initial framework)
Appendix 2 (initial mind map of my study 1)
Appendix 3 (initial mind map of my study 2)
Appendix 4 (Related theories and models of my study )
Appendix 5 (the questionnaire)
Appendix 6 (Pilot study version sent to experts, Arabic)
Appendix 7 (the interview)
Appendix 8 (Quantitative Analysis, tables)
Appendix 9 (Consent form English)
Appendix 10 (Cover Letter for the questionnaire)
Appendix 11 (ethical approval from the University of Southampton)
Appendix 12 (Interview transcript Arabic for one participant )
Appendix 13 (Interview transcript for one participant English version)
List of Tables

Table 4.1: Violence Rate in Saudi Arabia
Table 6.1: Questionnaire items used in the study
Table 6.2: Education specialists involved in the pilot questionnaire
Table 6.3: Survey schedule
Table 7.1: Profile of the questionnaire respondents
Table 7.2: Mean and standard deviation of age, current year of study and grade for students
Table 7.3: Number of students wearing seat belt (by gender)
Table 7.4: Risks taken during driving (male respondents only)
Table 7.5: Frequency and percentage of violence aspects for all respondents
Table 7.6: Mean score of violence for all respondents
Table 7.7: Frequency and percentage on sad feelings aspects
Table 7.8: Frequency and percentage of drug use and alcohol
Table 7.9: Frequency and precentage of body weight aspect
Table 7.10: Frequency and percentage of body weight for male respondents
Table 7.11 frequency and percentage of body weight for female respondents
Table 7.12: Mean scores on diet for all respondents
Table 7.13: Mean scores on diet aspects for male respondents
Table 7.14: Mean scores on diet aspects for female respondents
Table 7.15: Aspects of diet
Table 7.16: Mean scores on physical activities aspects
Table 7.17: Mean scores of physical activities aspects for male respondents
Table 7.18: Mean scores on physical activity aspects for female respondents
Table 7.19: Percentage of some aspects of sedentary activities
Table 7.20: Frequency and percentage of risk taking activities for male respondents
Table 7.21: Mean of a self-assessment of all respondents risk attitude
Table 7.22: Mean of a self-assessment of male respondents risk attitude
Table 7.23: Mean of a self-assessment of female respondents risk attitude
Table 8.1: HRBs enaggment based on male and female stduents
Table 8.2: HRBs factors, reasons and levels