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Geographical Disparity of Adverse Childhood Experiences and Chronic Diseases in Saudi Arabia

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Geographical Disparity of Adverse Childhood Experiences and Chronic Diseases in Saudi Arabia University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations Dissertations and Theses July 2020 Geographical Disparity of Adverse Childhood Experiences and Chronic Diseases in Saudi Arabia Fahad Alhowaymel University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_2 Part of the Family Practice Nursing Commons, Maternal, Child Health and Neonatal Nursing Commons, Public Health Commons, and the Public Health and Community Nursing Commons Recommended Citation Alhowaymel, Fahad, "Geographical Disparity of Adverse Childhood Experiences and Chronic Diseases in Saudi Arabia" (2020). Doctoral Dissertations. 1951. https://doi.org/10.7275/fsd1-w597 https://scholarworks.umass.edu/dissertations_2/1951 This Open Access Dissertation is brought to you for free and open access by the Dissertations and Theses at ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. GEOGRAPHICAL DISPARITY OF ADVERSE CHILDHOOD EXPERIENCES AND CHRONIC DISEASES IN SAUDI ARABIA A Dissertation Presented by FAHAD ALHOWAYMEL Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY May 2020 College of Nursing © Copyright by Fahad Alhowaymel 2020 All Rights Reserved GEOGRAPHICAL DISPARITY OF ADVERSE CHILDHOOD EXPERIENCES AND CHRONIC DISEASES IN SAUDI ARABIA A Dissertation Presented by FAHAD ALHOWAYMEL Approved as to style and content by: _____________________________________ Karen A. Kalmakis, Chair _____________________________________ Genevieve E. Chandler, Member ______________________________________ Ryan S. Wells, Member ______________________________________ Cynthia S. Jacelon, Dean College of Nursing DEDICATION To my great father and mother, Musa and Haya. Also, to my beloved brothers and sisters, Sarah; Mishal; Mohammed; Hailah; Asma; Mansour; and Ruba. Their prayers, patience, unwavering support, unconditional love, and wisdoms have sustained me throughout my journey in the USA and in my whole life. To my beloved wife, Sarah, and my lovely little daughter, Layan. Your unconditional love, prayers, encouragement, and patience have helped me during my stressful moments. The joyful moments that we have spent in the USA are unforgettable. You are everything to me. To the soul of my little son, Talal, who passed away during my second year of my PhD study and went to heaven. That moment was the hardest moment for us. You will be always with us. May Almighty Allah grant you the highest place in Jannah, Amen. ACKNOWLEDGMENTS First and foremost, Alhamdullilah. I thank Almighty Allah for his guidance in my life, and in this journey. Without His guidance and blessings, this would not have been possible. I would like to express my sincere gratitude and deepest appreciation to My advisor, Dr. Karen Kalmakis. Thank you for your unwavering support, guidance, and motivation throughout my PhD journey; for your immense knowledge and wisdoms that you have shared with me for my dissertation work and for other projects; for all the opportunities that you have given me to work with you in and outside the College of Nursing. Without your unfailing support, this dissertation would not have been completed at this time. I am also thankful for Dr. Genevieve Chandler and Dr. Ryan Wells for accepting my invitation without hesitation and agreeing to be members on my committee. You have enriched my dissertation work with great ideas and insights. You have been instrumental in getting this dissertation to completion. Thank you for your time and effort. I would like to extend my thanks to the College of Nursing’s faculty members, staff, and colleagues for everything you have provided to me. Special thanks go to Dr. Cynthia Jacelon, Dean and former PhD program director, and to Dr. Rachel Walker, current PhD program director, for their endless support to me during my studies, and to all enrolled students. It is an unforgettable journey at the UMass Amherst, College of Nursing. I would like also to thank Dr. Maha Almuneef, the founder and former director of the National Family Safety Program in Saudi Arabia; and the PI of the Saudi national ACEs project, for providing me with the data and for her immense knowledge that she shared with me. Lastly, I am thankful for the Saudi Government, the Saudi Arabian Cultural Mission, and Shaqra University for giving me the opportunity to complete my graduate studies in the USA. v ABSTRACT GEOGRAPHICAL DISPARITY OF ADVERSE CHILDHOOD EXPERIENCES AND CHRONIC DISEASES IN SAUDI ARABIA MAY 2020 FAHAD ALHOWAYMEL, B.S.N., KING SAUD UNIVERSITY, SAUDI ARABIA M.S.N., UNIVERSITY OF HARTFORD Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Karen A. Kalmakis Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program in Saudi Arabia. A total of 6,356 participants were obtained from the original sample, all of them were Saudi adults aged 18 years or older. The data analyses included: descriptive statistics, t-test, chi-square, and logistic regression. Results: The results of the analyses revealed high rates of ACEs in Saudi Arabia as 87.7% of participants reported at least one ACE, and 49.2% reported 4 or more ACEs. There was a statistically significant geographical difference of ACEs between urban and non-urban settings, with higher mean ACEs score for those who lived in urban settings. The results also showed that 37.6% of the total participants had at least one of the included chronic diseases. There was no vi statistically significant difference in chronic disease prevalence between urban and non-urban settings. However, there was a statistically significant relationship between ACEs and chronic diseases in Saudi Arabia. This relationship was moderated by geographical setting, with greater association among those who reported ACEs and lived in urban settings. Conclusions: This study revealed important results about ACEs prevalence in Saudi Arabia, and relationship between ACEs and chronic diseases, as well as the moderating effect of geography. The results provided insights about ACEs that may help in evaluating, refining, and developing strategies for healthcare in Saudi Arabia. Knowledge of these results can inform healthcare policymakers in the country about the importance of ACEs effect on health. Specific interventions and initiatives are required to track, regularly screen for, and prevent ACEs in Saudi Arabia, with a focus on underserved populations. Keywords: adverse childhood experiences, ACEs, chronic diseases, Saudi Arabia vii TABLE OF CONTENTS Page ACKNOWLEDGMENTS .............................................................................................................. v ABSTRACT ................................................................................................................................... vi LIST OF TABLES ......................................................................................................................... xi LIST OF FIGURES ...................................................................................................................... xii CHAPTER 1. INTRODUCTION .................................................................................................................... 1 Background of the Study .................................................................................................... 1 Statement of the Problem .................................................................................................... 3 Purpose of the Study ........................................................................................................... 4 Significance of the Study .................................................................................................... 5 Theoretical Framework ....................................................................................................... 6 Summary ............................................................................................................................. 9 2. LITERATURE REVIEW ....................................................................................................... 10 Healthcare in Saudi Arabia ............................................................................................... 10 Ministry of Health (MOH) ............................................................................................ 10 Other Sectors ................................................................................................................. 11 Adverse Childhood Experiences (ACEs).......................................................................... 12 Introduction ..................................................................................................................
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