BURA Collection:

Characteristics of private health insurance enrollees and the association between health coverage type and outpatient service utilization in Saudi Arabia: Insights from the National Saudi Family Health Survey

Thu, 30 Apr 2026 00:00:00 GMT

Title: Characteristics of private health insurance enrollees and the association between health coverage type and outpatient service utilization in Saudi Arabia: Insights from the National Saudi Family Health Survey Authors: Althabaiti, KS; Hunsberger, M; Khan, J; Ahmed, S Abstract: The Kingdom of Saudi Arabia (KSA) has a mixed health financing system consisting of governmental health coverage (GHC) and private health insurance (PHI). In 2016, KSA launched Vision 2030, which aims to reduce government spending and increase reliance on employer-sponsored PHI. This reform may affect the utilization of health services based on citizenship and the type of health coverage (PHI compared with GHC). The current study aimed to identify the characteristics of private health insurance enrollees and the association between different types of health coverage (GHC and PHI) and outpatient service utilization in the KSA. This study used data from the 2018 Saudi Family Health Survey (SFHS), which included 8,276 respondents aged 18 years and above and collected information on outpatient utilization during the previous 12 months. Statistical analyses were conducted using SPSS version 26. Bivariate analyses (chi-square and t-tests) were used to assess differences by nationality and coverage type. Binary logistic regression was used to examine the characteristics of PHI enrollment, and Poisson regression was used to evaluate the association between coverage type and outpatient utilization. This dataset provides a pre-reform baseline for assessing PHI enrollment and outpatient utilization prior to the implementation of the first phase of the reform in 2019. Most respondents were Saudi nationals (76.8%), and 54.9% were male. About 26.2% of respondents had PHI. Among non-Saudis, 72.8% were enrolled in PHI, compared with only 12.1% of Saudis. The logistic regression analysis revealed that having PHI was associated with factors such as a high monthly income, non-Saudi, male, being married, a high level of education, and a perception of good health. We found that having PHI was negatively associated with the utilization of outpatient services (coefficient −0.107; P < 0.001) compared with GHC. This finding may reflect barriers to access, a lower perceived need, or limitations in awareness of PHI benefits. In addition, this finding suggests that PHI may be associated with disparities in healthcare access, based on the observed lower utilization of outpatient services among its enrollees compared with those covered by GHC. Other factors associated with the utilization of outpatient services were being female, having a high monthly income, being never married, having chronic diseases, and the perception of poor health. The results of this study may inform future health reform efforts to enhance access to healthcare. These findings should be considered when planning the implementation and evaluation of the health system in KSA. Description: Data Availability: The data underlying the findings of this study are from the Saudi Family Health Survey (SFHS) and are owned by the General Authority for Statistics (GASTAT), Saudi Arabia. The dataset cannot be shared publicly, deposited in a public repository, or provided as supplementary material due to legal and ethical restrictions imposed by the data owner and the terms of access approval. Access to the data requires a formal request to GASTAT specifying the study objectives and the required variables. Researchers may request access by contacting GASTAT at cs@stats.gov.sa. The authors do not have the legal right to publicly share or redistribute the dataset.

Support for Older People With Vision Impairment: A Rapid Realist Review

Thu, 11 Jun 2026 00:00:00 GMT

Title: Support for Older People With Vision Impairment: A Rapid Realist Review Authors: Vaidya, A; Davies, M; Wallace, C; Anderson, P; Jones, M; Molik, B; North, R; Ryan, B; Verity, F; Acton, J Abstract: Background: Vision impairment among older adults is a significant public health issue impacting their physical and mental health and overall quality of life. However, access and navigation of support services are inconsistent and lacking. Recognising the need to gain insight to improve access to services in this population, this review aimed to understand how, why, for whom, to what extent and in what context the provisions for care and support for older people with vision impairment worked. Methods: A rapid Realist review was undertaken. Six databases (Cinahl, Cochrane Library, PubMed, Social Services Abstracts, Sociological Abstracts and Sociology Collection) were searched. The review followed the RAMESES Quality Standards for Realist Synthesis and retrieved documents were screened systematically to identify relevant papers. The papers were analysed through iterative and simultaneous use of coding, consolidating and conceptual mapping process to develop a Realist programme theory. Project Advisory Group members contributed to the processes. The Realist review was conducted from July 2023 to July 2024. Results: Ninety-one documents were reviewed and analysed. Novel insights into the provisions of care and support for older people with vision impairment were presented through seven interconnected components: Developing condition literacy, acceptance of the condition and readiness for help, timeliness, access to services, relationships, positive care trajectory and professional knowledge. All contributed to the development of the Programme Theory. Conclusion: The Programme Theory explained why and for whom the services worked, while limited information was found in terms of how and when the services were accessed. The key components identified around the Programme Theory were complex and interconnected in nature, underscoring the importance of a systems approach to effective service provision for older adults with vision impairment. Literature gaps were identified for further exploration in a Realist evaluation. Description: Data Availability: No datasets were generated or analysed during the current study.

Non-surgical interventions for pelvic organ prolapse in women: a component network meta-analysis and cost-effectiveness analysis - Protocol (version 1.1)

Thu, 01 May 2025 00:00:00 GMT

Title: Non-surgical interventions for pelvic organ prolapse in women: a component network meta-analysis and cost-effectiveness analysis - Protocol (version 1.1) Authors: Johnson, EE; Vale, L; Kenny, R; Meader, N; Wallace, S; Bugge, C; Thakar, B; Dwyer, L; Spencer, S; Igualada-Martinez, P; Guerrero, K Abstract: Background: Pelvic organ prolapse (POP) is the descent of a woman's womb, bladder or rectum into the vagina. Up to 1 in 10 women have POP, which can be caused by childbirth, obesity, surgical removal of the womb or ageing. Women with POP have emphasised that the condition is life-altering due to symptoms, such as incontinence, that affect daily activities, quality of life, body image and mental health. Surgery for POP is twice as common as incontinence surgery, costing the NHS £45 million per year. The National Institute for Health and Care Excellence (NICE) recommends women try non-surgical treatments for POP (e.g. pelvic floor exercises or pessaries) before surgery. However, in our two patient and public involvement workshops women with POP told us that after clinical guidance they remain unsure what non-surgical treatments are available, and which work best. As the number of people with POP is predicted to increase due to an ageing population, it is important to know which non-surgical treatments work and are value for money. This will allow women to make informed choices about their care and the NHS can make best use of its resources. We are applying for funding to carry out this research. Methods: In a workshop, women with POP from different ethnic and socioeconomic backgrounds discussed what research questions were most relevant to them. They wanted to know what available treatments (from the NHS and elsewhere) were most effective. A statistical method called 'component network meta-analysis' will bring together data from all relevant existing clinical studies to compare treatments and find out how well they work (e.g. do they reduce the severity of prolapse and improve quality of life?). We will use these data to see which non-surgical treatments make best use of NHS resources. This means we will have the best available evidence to inform women, clinicians and policy makers about which non-surgical treatments are best. Patient and public involvement: Patient and public involvement has been central to developing the proposed work. We openly advertised for and recruited two patient co-applicants to help control and influence decision making during the development of this proposed research project. We also involved women with lived experiences of POP, including our patient co-applicants, in a survey and two workshops that have significantly shaped our aims, objectives and helped identify our key outcomes. If funded, we will recruit up to 10 women to an advisory group to provide different perspectives that will help shape the research whilst it is being planned and undertaken. We will provide contributors with training in key methods (e.g. systematic review) designed for lay audiences, so they are better able to shape the work. We will engage the group in all aspects of the work, regularly meeting and sharing progress updates. We will work with the group to discuss their experience of care and how this should determine the health economic analyses. Group members will help us interpret findings and to develop key messages for dissemination that will maximise their public reach. How the findings will be shared: We will share our findings as journal articles and at academic conferences. As identified by workshop discussions, research findings will be shared on appropriate media platforms (e.g. BBC Radio). We will further explore best approaches to share research findings with our planned patient advisory group. Description: Plain English Summary: Research question: What are the most effective and cost-effective non-surgical interventions for treating pelvic organ prolapse in women? Background: Pelvic organ prolapse (POP) is the descent of the female pelvic organs into the vagina. The condition is common, with a UK-based survey finding that 8.4% of women reported a vaginal bulge or lump. The prevalence of POP increases with age and so, given our ageing population, will be an increasing issue for women and the NHS. Current National Institute for Health and Care Excellence (NICE) guidelines for POP recommend non-surgical treatments, e.g. pelvic floor muscle training (PFMT) and pessaries, as first-line treatment. There is currently limited evidence comparing how effective these non-surgical interventions for POP are nor is these enough evidence on their value for money for the NHS. Uncertainty remains surrounding the effectiveness and cost-effectiveness of these interventions, which this work addresses. Aims and objectives: This work will answer 3 research questions: What are the most effective non-surgical interventions for managing POP in women? What are women's preferences for these interventions? Which of these interventions is the most cost-effective from an NHS perspective? Methods: We will conduct a component network meta-analysis (CNMA) of clinical effectiveness according to a pre-defined protocol. A CNMA is the most appropriate and robust method for synthesising data surrounding the potentially heterogenous and complex non-surgical interventions used to treat POP and will provide the best available evidence for decision making. To explore women's preferences for different ways care can be provided and its outcomes we will conduct a discrete choice experiment. The results of this and the CNMA will be incorporated into an economic evaluation model to assess cost-effectiveness. The project will be governed and the conduct further influenced by patient co-applicants and an advisory group of up to 10 women with a lived experience of POP. They will build on the patient involvement embedded into this application to further refine and establish the methods for the CNMA and the health economics. Timeline for delivery: We will deliver this work over 14 months. The CNMA will be conducted between months 1 and 10, with the DCE running between months 4 and 11. The structure of the economic model and additional model requirements will be identified between months 4 and 9, with the integration of the CNMA into the final model occurring in months 11 and 12. The public advisory group will convene in month 1 and formally meet 4 times across the course of the project, as well as meeting to formally discuss and feed into methods across the course of the work. Anticipated impact and dissemination: Our outputs include a detailed final report, at least two peer-reviewed academic journal articles, and conference presentations at relevant societal and methods-focused meetings. We will also feed the results of the project into guidelines produced by NICE, the European Association of Urology and the International Consultation on Incontinence to ensure our work directly impacts on clinical practice. Our work with women with POP has already identified wider platforms to publicly share our work (e.g. radio and podcasts). We will continue to work with our PPIE co-applicants and advisory group to identify public-facing dissemination options and to co-produce dissemination materials.

3DPiPPIN: 3D printing of positive airway pressure (PAP) therapy interfaces: a single site feasibility study

Tue, 29 Jul 2025 00:00:00 GMT

Title: 3DPiPPIN: 3D printing of positive airway pressure (PAP) therapy interfaces: a single site feasibility study Authors: Mansell, SK; Olsen, O; Gowing, F; Muwaffak, Z; Kilbride, C; Hilton, S; Main, E; Schievano, S; Mandal, S Abstract: Sleep-disordered breathing (SDB) affects 14% of the population. Positive airway pressure (PAP) therapy is standard, but commercially available interfaces may be ineffective due to poor fit. Three-dimensional (3D) printing can customise PAP therapy interfaces. Is it feasible to manufacture and use 3D-printed customised oronasal PAP interfaces in clinical practice? Do customised interfaces improve patient comfort and reduce side effects compared to off-the-shelf interfaces? A single-site feasibility study involving 10 healthy and 10 patient participants was undertaken. A 3D facial scan was used to 3D print a mould, injected with medical-grade silicone to create a oronasal customised interface. Participants underwent a 10-minute trial with both off-the-shelf and customised interfaces. Comfort (Visual Analogue Scale), skin reactions, and interface leak (L/min) were measured. Patient participants used the customised interface for five nights at home, with data collected on Apnoea Hypopnoea Index (AHI), interface leak, and PAP therapy concordance. The study recruited 20 participants. Customised oronasal interfaces showed a failure rate in manufacturing (23.75% 3D printing, 50%: silicone injection). Adverse reactions were 10% in the patient study. Comfort scores were similar between interfaces. Interface leak was lower with customised interfaces after five nights. AHI was reduced with customised interfaces, but with a trend towards decreased PAP therapy concordance. The study demonstrated 3D-printed customised oronasal PAP interfaces can be manufactured, with potential benefits of reduced interface leak and AHI. Improvements in manufacturing processes are needed to reduce failure rates. Further research via a randomised controlled trial with a longer duration is warranted. Description: Data Availability statement: The data generated and/or analysed during the current study are not publicly available due to data protection and intellectual property protection.