Alghamdi, Alaa M.; (2024) Primary Healthcare in Saudi Arabia – Improving Appropriate Engagement. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: In Saudi Arabia (SA), many patients use emergency departments (EDs) for conditions that would have been treatable in primary healthcare (PHC). Up to 65% of cases seen in emergency departments have been classified as non-urgent and could have been managed in PHC. Primary care seems underutilised, and residents may not know the location of their nearest PHC centre, and many are not very keen to visit PHC. Previous research has focused on patient satisfaction with PHC services. However, engagement with PHC is a more complex process beyond satisfaction. Specifically, engagement with PHC is a process and behaviour that results in continuous patient utilisation of PHC while being influenced by the environment in which PHC is delivered. Little is known about what influences patient engagement with PHC in SA and how this might be improved. / Aim: This research aimed to explore the factors that influence patient engagement with PHC, in order to offer recommendations for improving patient engagement with PHC services in SA. / Methods: This project was conducted in three stages: • Study 1: A realist review to understand the causal explanations for patient engagement with Saudi PHC services. This included a range of different peer-reviewed studies, relevant grey literature, related media items and stakeholder involvement. • Study 2: A qualitative study using semi-structured interviews with 24 patients to explore the barriers and facilitators of patient engagement with PHC. • Study 3: A qualitative study using semi-structured interviews with 17 stakeholders, including healthcare providers and policymakers, to explore challenges and views on how to encourage patients to engage appropriately with PHC. / Findings: Patients in SA lacked knowledge about how to seek medical help. Negative societal perceptions of PHC contributed to patients’ poor health-seeking behaviour. There was also a lack of trust in PHC that impacted patient engagement with PHC. Participants believed that general practitioners’ (GPs) qualifications significantly impact patient trust in PHCs. Additionally, patients expressed a need for GPs to show commitment and motivation to provide quality care. This was believed to improve patient trust in GPs and in PHC. There was also a notion of a lack of professionalism in PHC that hampered patient engagement with PHC. The perceived lack of professionalism in PHC was believed to be influenced by insufficient interpersonal skills among staff members, poorly equipped built environments and a lack of a uniform standard of care and regulations across PHC centres. Convenient access initiatives, such as appointment applications and the flexible registration policy, have made it easier for patients to access PHC. However, patients felt the quality of service provided was insufficient and remains a barrier to their engagement. Healthcare practitioners perceived operationalisation gaps in service delivery, characterised by contradictory regulations and a lack of continuity of care, which continue to restrict patient engagement with primary care. / Conclusions: Patient engagement with PHC is multifactorial and influenced by personal, social, local and environmental factors, as well as organisational processes and available resources. There is a substantial unmet need for policy and regulation reforms to promote patient engagement with PHC in SA. My findings provide evidence-based recommendations to improve the structure and system of PHC service, quality and delivery in SA to promote patient engagement with PHC. Overall, my research findings indicate that the system must address and remove barriers to engagement with PHC rather than solely prioritising efforts to enhance patient access and utilisation of PHC.

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