Identifying Health Education Competencies for Primary Health Care Nurses in Saudi Arabia

248 Pages·2016·1.83 MB·English

Identifying Health Education Competencies for Primary Health
Care Nurses in Saudi Arabia: A Delphi Consensus Study

Nagla Saleh AlSaleh

Submitted in Partial Fulfilment of the Requirements of
The Degree of Doctor of Philosophy

University of Salford, Manchester
United Kingdom

School of Nursing, Midwifery, Social Work and Social Sciences
May, 2016
Contents
List of Tables .................................................................................................................................... v
List of abbreviations ...................................................................................................................... viii
Acknowledgment ............................................................................................................................ xi
Abstract .......................................................................................................................................... xii
Introduction ...................................................................................................................................... 1
Significance of the research ............................................................................................................. 2
Statement of the problem ................................................................................................................. 2
Research Aim ................................................................................................................................... 3
Objectives:........................................................................................................................................ 3
The structure of the thesis ................................................................................................................ 4
Chapter One: The Research Context: Saudi Arabia ......................................................................... 6
Introduction ...................................................................................................................................... 6
Saudi Arabia and its position in the global context .......................................................................... 6
Population ........................................................................................................................................ 7
Education system in Saudi Arabia ................................................................................................... 8
Socio-economic development .......................................................................................................... 9
Religious and cultural context of Saudi Arabia .............................................................................. 10
Saudi healthcare system ................................................................................................................. 11
Prevalence of diseases and health issues in Saudi Arabia .............................................................. 13
Primary health care in Saudi Arabia .............................................................................................. 15
Nursing in Saudi Arabia and its links with Islam ........................................................................... 17
Nursing in Islam ............................................................................................................... 17
Historical background of nursing education .................................................................... 18
University nursing education ........................................................................................... 19
Conclusion...................................................................................................................................... 21
Chapter Two: Health, Health Promotion, Health Education, & Primary Health Care ‘Policies’ . 22
Introduction .................................................................................................................................... 22
Concepts of health, health promotion and health education .......................................................... 22
Health promotion models ............................................................................................................... 31
Processes of health promotion/ health education ........................................................................... 35
Approaches to health education ..................................................................................................... 36
The emergence of primary health care in health services development ......................................... 37
PHC policies ................................................................................................................................... 40
Primary health care nursing............................................................................................................ 44
Conclusion...................................................................................................................................... 46
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Chapter Three: Literature Review .................................................................................................. 47
Introduction .................................................................................................................................... 47
Comprehensive search strategy ...................................................................................................... 47
Search part one ................................................................................................................... 49
Search strategy for part one ...................................................................................................... 50
Description of the studies retrieved .......................................................................................... 51
Appraisal and quality review of the studies included ............................................................... 56
What the literature tells us in part one ...................................................................................... 64
Search for part two ......................................................................................................................... 67
Search strategy for part two ......................................................................................................... 68
Description of the retrieved articles ............................................................................................. 68
Appraisal of the articles included ................................................................................................. 71
What the literature tells us in part two ......................................................................................... 74
Contribution to the Literature ......................................................................................................... 75
Conclusion...................................................................................................................................... 76
Chapter Four: Discussing Competency: Concepts, Assessment and Frameworks ........................ 77
Introduction .................................................................................................................................... 77
Concepts of competence and competency ..................................................................................... 77
Nursing and competency ................................................................................................................ 83
Assessment of Nurses’ Competency .............................................................................................. 87
Competency framework and examples .......................................................................................... 89
Educational philosophy of competency ......................................................................................... 91
Research framework ....................................................................................................................... 92
Conclusion...................................................................................................................................... 93
Chapter Five: Methodology ........................................................................................................... 94
Introduction .................................................................................................................................... 94
Research paradigms and philosophy .............................................................................................. 94
Relationship between paradigms and methodology ....................................................................... 96
Methods of formal consensus ......................................................................................................... 99
Methods employed within this study: the Delphi technique ........................................................ 100
Philosophical aspects for the Delphi technique ............................................................. 100
Overview of the Delphi technique ............................................................................................... 101
Research design ............................................................................................................................ 104
Aim and objectives of this study .................................................................................................. 106
Data collection process................................................................................................................. 106
Delphi questionnaire ...................................................................................................... 107
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Design of the Delphi questionnaire................................................................................ 108
Translation process of the questionnaire........................................................................ 109
Validity and reliability of the questionnaire .................................................................. 110
Sample of the study and access to PHC centres ............................................................ 111
Consensus ...................................................................................................................... 112
Three rounds of the Delphi questionnaire ...................................................................... 113
First round ...................................................................................................................... 114
Second round ................................................................................................................. 116
Third round .................................................................................................................... 117
What happened between the three rounds of Delphi? ................................................... 118
Ethical considerations .................................................................................................................. 119
Conclusion.................................................................................................................................... 121
Chapter Six: Data Analysis and Results ....................................................................................... 122
Introduction .................................................................................................................................. 122
The demographic characteristics of the PHC nurses .................................................................... 122
Analysis and results for the first round ........................................................................................ 123
Analysis and results for the second round .................................................................................... 129
Analysis and results for the third round ....................................................................................... 132
Conclusion.................................................................................................................................... 137
Chapter Seven: The Workshop .................................................................................................... 138
Introduction .................................................................................................................................. 138
Workshop overview and purpose ................................................................................................. 138
Service users involvement in the workshop ................................................................................. 139
Objectives of the workshop .......................................................................................................... 141
Expected outcomes ....................................................................................................................... 141
Workshop Programme ................................................................................................................. 141
The workshop process .................................................................................................................. 142
Workshop Groups ........................................................................................................................ 143
Main outcomes from the group discussions ................................................................................. 148
Conclusion.................................................................................................................................... 149
Chapter Eight: Discussion of the Results ..................................................................................... 150
Introduction .................................................................................................................................. 150
First round discussion .................................................................................................................. 150
Items reaching consensus ............................................................................................... 151
Items that did not reach consensus ................................................................................ 156
Second round discussion .............................................................................................................. 160
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Items that reached consensus ......................................................................................... 161
Items that did not reach consensus ................................................................................ 162
Third round discussion ................................................................................................................. 164
Items that reached consensus ......................................................................................... 164
Items that did not reach consensus ................................................................................ 165
Summary discussion for the three rounds .................................................................................... 165
Conclusion.................................................................................................................................... 167
Chapter Nine: Conclusion ............................................................................................................ 168
Introduction .................................................................................................................................. 168
The research contribution to existing knowledge ......................................................................... 168
Limitations of the current study ................................................................................................... 170
Implications for clinical nursing practice and policy ................................................................... 172
Recommendations from this research .......................................................................................... 174
Dissemination Plan ....................................................................................................................... 178
Reflection ..................................................................................................................................... 179
Conclusion.................................................................................................................................... 180
References .................................................................................................................................... 182
Appendices ................................................................................................................................... 201

iv
List of Tables
Table Inclusion and exclusion criteria for articles for part one……49
3.1.
Table 3.2 Search strategy for part one…………………………………51
Table 3.3 Summary of the studies included for part one……………....53
Table 3.4 Inclusion and exclusion criteria for the articles for part two...67
Table Search Strategy for part two…………………………………68
3.5.
Table Summary of included articles for part two…………………..69
3.6.
Table Types of Delphi…………………………………………….103
5.1.
Table 5.2 Reliability test using Cronbach’s alpha…………………….111
Table 6.1 Demographic characteristics of PHC nurses……………….123
Table 6.2 Items of PHC experts’ knowledge needed for competent health
education in S.A. that reached consensus in the first round…124
Table 6.3 Items of PHC experts’ skills needed for competent health
education in S.A. that reached consensus in the first round...125
Table 6.4 Items of PHC experts’ attitudes needed for competent health
education in S.A. that reached consensus in the first round…126
Table 6.5 Items of PHC experts’ knowledge needed for competent health
education in S.A. that did not reach consensus in the first
round......................................................................................127
Table 6.6 Items of PHC experts’ skills & attitudes needed for competent
health education in S.A. that did not reach consensus in the first
round………………………………………………………128
Table 6.7 Items of PHC experts’ knowledge needed for competent health
education in S.A. that reached consensus in the second round..130
Table 6.8 Items of PHC experts’ skills and attitudes needed for competent
health education in S.A. that reached consensus in the second
round…………………………………………………………130
Table 6.9 Items of PHC experts’ knowledge, skills and attitudes needed for
competent health education in S.A. that did not reach consensus in
the second round………………………………………………131
v
Table Items of PHC experts' skills and attitudes needed for competent
6.10 health education in S.A. that reached consensus in the third
round…………………………………………………………..132
Table Items of PHC experts’ knowledge needed for competent health
6.11 education in S.A. that did not reach consensus in the third
round…………………………………………………………...133
Table Summary of the results of the three rounds…………………….134
6.12
Table Competencies which reached consensus after all the rounds….134
6.13

vi
List of Appendix
Appendix 1. The letter for the nurse managers of PHC Centres………………202
Appendix 2. Information sheet………………………………………………...203
Appendix 3. Research Participant Consent Form (PHC Nurses)……………..206
Appendix 4. First Round Questionnaire………………………………………208
Appendix 5. Second Round Questionnaire……………………………………215
Appendix 6. Third Round Questionnaire……………………………………...218
Appendices 7 and 8. Ethical forms……………………………………………220
Appendix 9. Package of PHC nurses and nurses’ managers (Workshop)…….222
Appendix 10. Package of service user (workshop)……………………………226
Appendix 11. Outcomes from the workshop…………………………………. 230

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List of abbreviations
ANA American Nurses Association
APHA American Public Health Association
APNA Australian Primary Health Care Nurses Association
BSN Bachelor of Science in Nursing
CDSI Central Department of Statistics and Information
CNA Canadian Nurses Association
CVD Cardiovascular disease
DM Diabetes Mellitus
DN District Nurse
DOH Department of Health
DTP Dementia Training Programme
G6PD Glucose-6-phosphate Dehydrogenase Deficiency
GP General Practitioner
HBM Health-belief model
HCPRDU Health Care Practice Research and Development Unit
heiQ The Health Education Impact Questionnaire
HF Heart Failure
HPM Health Promotion Model
HPP health-promotion practice
HV Health Visitor
ICN International Council of Nurses
ICU Intensive Care Unit
IDF International Diabetes Federation
IT Information Technology
JCAHO Joint Commission on Accreditation of Healthcare Organisations
KSA knowledge, skills and attitudes
M Mean
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MCH Maternal and Child Health
MOH Ministry of Health
MSK Musculoskeletal
NGT Nominal group technique
NHS National Health Service
NICE National Institute for Health and Care Excellence
NMC Nursing and Midwifery Council
OED Oxford English Dictionary
PHC Primary Health Care
PHCCs Primary Health Care Centres
PHN public-health nursing
PN Practice Nurse
QSEN Quality and Safety Education for Nurses
RAND Research and Development
S.A. Saudi Arabia
SPSS Statistical Package for the Social Sciences
UK United Kingdom
US United States
WHO World Health Organisation

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