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Exploring public attitudes towards the health system of the Kingdom of Saudi Arabia (KSA)

Aljaffary, A. (2018). Exploring public attitudes towards the health system of the Kingdom of Saudi Arabia (KSA). (Unpublished Doctoral thesis, City, University of London)


This study explores public attitudes towards healthcare in the Eastern Province of KSA. It employs a sequential mixed-method design. Semi-structured focus group discussions (FGDs) were conducted with fifty-four participants in the Eastern Province. The qualitative arm of the study used a framework thematic analysis. A questionnaire was constructed from evidence-based items from four sources: an international performance assessment framework, literature review, systematic review, and the FGDs. The questionnaire was administered to 813 participants using on-site and online recruitment modes. Two qualitative validity assessments and quantitative construct validity and reliability tests were then carried out for the questionnaire.

The FGDs indicate a public sense of pride in the Saudi health system. However, some concerns emerged from the FDGs—most notably, access barriers to the government health sector including the referral system from primary to secondary care and the necessity of personal connections, or ‘wasta’, to access timely care. Access barriers also emerged in the private health sector, namely the affordability of care and health insurance companies’ delays in responding to medical claims. Participants also considered their inability to discuss treatment plans and to be involved in decision-making processes with their doctors as issues in both the public and private sectors. Participants were also concerned about the Ministry of Health (MOH) monitoring and regulating both sectors. This affected participant attitudes towards health service provisions.

The questionnaire demonstrated qualitative validity and good psychometric properties in construct validity and internal reliability. Participants perceived doctor-patient communication as the most positive aspect of the Saudi health system while they perceived MOH monitoring of the private sector and affordability of care as the most negative aspects. Socio-demographic characteristics were considered as strong predictors of participants’ attitudes towards the health system, and nationality and insurance status were identified as the most frequent predictors of satisfaction.

Recommendations include implementing policies that monitor pricing in the private sector, fairer access to government healthcare, and patient involvement in decision-making processes. Future research should investigate the relationship between public attitudes towards the Saudi health system and health-related decisions to ensure better use of healthcare services in KSA.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Healthcare Services Research & Management
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