Analysis strategy

Prior to undertaking the analysis of the participants’ responses to the study questions, measures of central tendency such as means, standard deviations, frequencies, percentages and ranges of all the study variables were examined. The independent variables were tested for multi-collinearity (high correlation, r ≥ 0.90) for the purpose of determining the contribution of these variables to the dependent variable (research utilisation score). Further, data distributions were examined for normality. No substitution was made for the missing answers to the open questions in the Barriers Scale. Descriptive and inferential statistics were utilised for analysis of the study data.

4.13.3 Descriptive statistics

For the study, descriptive analysis of the demographic data included frequency tables and cross tabulations. Frequencies and percentages in addition to measures of central tendency such as means, standard deviations and ranges were used to describe demographic variables such as the age, gender, nationality, length of nursing experience

in nursing, nursing qualification, place where the highest level of nursing education obtained, work experience, and years of experience in position in current hospital.

4.13.4. Inferential statistics

Inferential statistical analysis of the demographic data included testing for significant differences amongst each of the categories using a one-way ANOVA for three or more groups, and the two-sample t-test for two groups. For three or more groups where the findings were statistically significant, appropriate multiple comparison t-tests controlling for Type I error were utilised. The above analysis was performed on the global Barriers Scale total score and on its four subscales total scores. Multiple regression analysis was used where appropriate to assess which demographic variables have the largest impact on the Barriers Scale total score and its sub-scale total scores. For comparison of data for clinical nurses and nurse managers, a two-sample t- test was used for rating scale total scores and Chi-square tests for demographic type data. The level of statistical significance was set at p ≤ 0.05.

4.14. Summary

The main aim of this quantitative study was to examine the perceived barriers to and facilitators of research utilisation among nurses in Saudi Arabia. This chapter presents the research methodology of this study. It includes the research design, settings, recruitment and sampling technique, inclusion and exclusion criteria, instruments used to collect data, data analysis, and ethical considerations. A cross- sectional descriptive design was used in this study to investigate the barriers to and the facilitators of nursing research utilisation among nurses in Saudi Arabia. The study was conducted at five hospitals in Saudi Arabia including governmental, non-governmental and educational hospitals. The sample included 1,824 registered nurses who had a minimum of two years nursing experience and worked at the selected hospitals in Saudi

conduct the study was obtained from the Riyadh City Health Affairs Directorate and from the ethical boards at the each of the five selected hospitals. All nurses at the five hospitals who met the inclusion criteria and agreed to participate in the study were provided with adequate information about the study and assurances of confidentiality of their responses. Prior to commencement of the project, a pilot study was conducted to examine the reliability of the survey instruments and included 10% (n=182) of the sample from nurses who met the inclusion criteria.

For data collection two instruments in addition to the demographic survey were used. The instruments included a questionnaire to assess nurses’ perceived barriers to the utilisation of research in Saudi Arabia. This survey tool was the Barriers Scale as developed by Funk et al. (1991a; 1991b). The second instrument was a questionnaire to assess nurses’ perceived facilitators of research utilisation in Saudi Arabia (Hutchinson & Johnston, 2004). Analysis of the study data included multiple descriptive and inferential statistical tests. The next chapter will discuss the analysis of the results from this research.

Chapter 5: Results

5.1. Introduction

Examining the perceived barriers to, and facilitators of, research utilisation among nurses working in hospitals in the Riyadh region of Saudi Arabia was the central aim of the study. Eliciting the nurses’ perspectives on how research was utilised and applied in nursing practice was essential to generate an evidence base of assessing and improving nursing practice in health care institutions in Saudi Arabia. This chapter presents the results according to the specified objectives and within two main themes. This included basic frequency analyses of the demographic characteristics of the respondents and nurses’ perceptions of research utilisation in their clinical practice in Saudi Arabia. Results that are not significant are included in the tables but will not be discussed in the text.

5.2. Demographics

To ensure as close to a representative sample as possible, the study was conducted in Riyadh, the capital of Saudi Arabia across five hospitals representing government, other-governmental and educational health care sectors. The invited hospitals were: King Faisal Specialist Hospital and Research Centre (King Faisal Research Centre), King Salman Bin Abdulaziz Hospital (King Salman), Al-Yamamah Hospital, King Fahad Medical City and Prince Mohammed Bin Abdulaziz Hospital (Prince Mohammed). Hospital managers/directors were informed that the hospital would be identified and what the nature of the research was. Each of the selected hospitals has a bed capacity of more than 500. Table 5.1 details the bed capacity of each of the participating hospitals and the number of eligible nurses.

survey yielding a response rate of 86%. From the responding participants, 670 (36.5%) nurses were from King Fahad Medical City, 615 (33.7%) from King Faisal Research Centre and 202 (11.1%) nurses were from Prince Mohammed Hospital. The remaining participants came from King Salman Hospital (n = 200, 11%) and Al-Yamamah Hospital (n = 137, 7.5%). The nurses from the two largest hospitals (King Faisal Research Centre and King Fahad Medical City, not surprisingly, contributed to the highest number of respondents.

Table 5.1. Bed capacity of hospitals

Hospital name Bed capacity

Estimated number of nurses with more than two years of experience

Number of participants King Faisal Research Centre 920 1200 615 King Salman Hospital 500 250 200 AL Yamamah Hospital 500 200 137 King Fahad Medical City 1095 750 670 Prince Mohammed Hospital 500 250 202

The demographics of the respondents appear in Table 5.2. The majority of responding nurses were females (n=1509, 82.7%). Results show that the largest proportion of participating nurses working in these particular hospitals was aged between 20 to 40 years (70.4%).

Table 5.2. Demographics of the respondents (n= 1824)

Characteristics Number Percentage (%) Age 20-30 Years 616 33.8 31-40 Years 669 36.7 41-50 Years 413 22.6 51-64 Years 126 6.7 Sex Male 315 17.3 Female 1509 82.7 Country of birth KSA 242 13.3 Philippines 857 47.0 India 501 27.5 South Africa 50 2.7 Jordan 62 3.4 Pakistan 35 1.9 Egypt 4 0.2 Australia 7 0.4 USA 13 0.7 Canada 8 0.4 Malaysia 40 2.2 Lebanon 2 0.1 UK 3 0.2 Experience (Years) 2-5 369 20.2 6-10 544 29.8 11-15 418 22.9 16-20 175 9.6 >20 318 17.4

Most of the nurses were not from Saudi Arabia (86.7%). The largest group of expatriate nurses came from the Philippines (47%), followed by India (27.5%) while only 242 (13.3%) were from Saudi Arabia and smaller proportions of nurses came from European and Middle Eastern States (Table 5.2). This large proportion of expatriate nurses may be explained by the increasing need for health care and hence number of hospital beds in Saudi Arabia and thus the need for more nurses. It is quicker to recruit expatriate nurses compared to educating nurses from Saudi Arabia. This has been identified as the number one challenge facing the Saudi Ministry of Health (MOH).

Currently, the MOH is trying to address this through its strategic plan of increasing the training and education of Saudi Arabian nurses (Tumulty, 2001; Almalki et al., 2011a).

Nurses’ experiences also varied (Table 5.2), ranging from two to twenty or more years. Their experience could be categorised as follows: 29% with 6 to 10 years, followed by 22.9% with 11 to 15 years of the total sample (1824 nurses) while nurses who had 16 to 20 years’ experience comprised the smallest group in this sample (n=493, 18%).

The participating nurses varied in their roles from clinical bedside nursing to educational and managerial responsibilities. Clinical nurses represented the majority of respondents (82.4%), followed by nurse managers (12.7%) and nurse educators (4.9%) (see Table 5.3). This difference in numbers reflects the nursing workforce as the majority of nurses are clinical nurses who provide nursing care directly to the patients. The proportion of nurse educators was less than the proportion of nurse managers as the expectation is for nurse educators to cover several wards, while nurse managers take charge of single wards.

Nurses varied in their education qualifications. The majority of nurses had a Bachelor degree qualification (82.7%) while nurses with a hospital certificate and a Master’s degree constituted the smallest proportion (0.8% and 1.8%, respectively). This is presented in Table 5.3.

The countries where the nurses obtained their qualifications were collapsed into three groups: Philippines and Malaysia (Asian), India and Pakistan, and Western qualified. This grouping was done to facilitate Chi-square testing. When collapsed by region, half of these nurses received their qualification in an Asian region (50.1%), followed by India and Pakistan as a region (29.3%) and the Middle Eastern region (16%). The remaining nurses received their qualifications in a Western region (4.5%), which includes North America, South Africa, United Kingdom and Australia.

Table 5.3. Roles and initial qualifications of nurses included in the current study n % Current role Clinical 1503 82.4 Manager 231 12.7 Educator 89 4.9 Qualification Hospital Certificate 14 0.8 Diploma 269 14.7 Bachelor 1508 82.7 Master 33 1.8 Qualification by country KSA 224 12.3 Philippines 874 47.9 India 503 27.6 Jordan 62 3.4 South Africa 46 2.5 Malaysia 39 2.1 Pakistan 32 1.8 Australia 13 0.7 USA 13 0.7 Canada 8 0.4 Egypt 4 0.2 UK 4 0.2 Lebanon 2 0.1 Hospital Al-Yamamah 137 7.5 Prince Mohammed 202 11.1

King Fahad Medical City 670 36.7

King Salman 200 11.0

King Faisal Research

Centre 615 33.7

Qualification by region

Middle East 292 16.0

Asia: Philippines & Malaysia 913 50.1

India/Pakistan 535 29.3

Western: America, Europe,

South Africa and Australia 84 4.6