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Adel F Almutairi,1 Mahmoud Salam,1 Abdallah A Adlan,2 Abdullah S Alturki3 1Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard health affairs, Riyadh, Saudi Arabia; 2Bioethics Section, King Abdullah International Medical Research center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 3Research operations, King Abdullah International Medical Research center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Moral distress is a serious problem in healthcare environments that requires urgent attention and management. It occurs when healthcare providers are unable to provide the care that they feel is right or take, what they believe to be, ethically appropriate actions for their patients. Thus, this study aims to examine moral distress among nurses and physicians working in tertiary teaching hospitals in Saudi Arabia, as well as to evaluate the level of association between moral distress and turnover. Methods: This cross-sectional study, which employed an anonymous 21-item Moral Distress Scale, was undertaken at a large medical institution located in different regions of Saudi Arabia. The data were analyzed using bi-variate analyses, and logistic regression. Results: Of the 342 participants, 239 (69.9%) were nurses/staff physicians and 103 (30.1%) were fellows/consultants. Approximately 24.3% of respondents experienced severe moral distress, whereas 75.7% reported mild moral distress. There was no statistically significant difference between men and women in terms of moral distress. Age was found to be a notable factor: moral distress was significantly higher in those younger than 37 years compared to those 37 years and older (P=0.015). Less than half of the participants (137, 42.8%) indicated their willingness to leave their jobs. A significant association was observed between severe moral distress and leaving the career (OR=3.16; P

Mostafa A Abolfotouh,1 Adel F Almutairi,2 Zainab Almutairi,3 Mahmoud Salam,2 Anwar Alhashem,1 Abdallah A Adlan,4 Omar Modayfer5 1Research Training and Development Section, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Science and Technology Unit, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Stem Cells Donor Registry, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4Bioethics Section, King Abdullah International Medical Research Center/ King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Division of Mental Health, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia Background: It has been reported that the majority of individuals with mental illnesses (MIs) do not seek help. Few studies have focused on correlates of a positive attitude toward professional help-seeking for MI. This study aimed to determine levels of knowledge, perception, and attitudes toward MI, determine attitudes toward mental health help-seeking, and identify sociodemographic predictors of correct knowledge and favorable attitudes among the Saudi public. Methods: A cross-sectional survey was conducted on 650 Saudi adults aged >18 years who attended the Saudi Jenadriyah annual cultural and heritage festival during February 2016. The previously validated Attitudes to Mental Illness Questionnaire was used. Attitude to professional help-seeking was also assessed, using a tool retrieved from the World Mental Health Composite International Diagnostic Interview part II. Multiple regression analyses were applied, and statistical significance considered at P0.05). Conclusion: The Saudi public reported lack of knowledge of MI and stigmatizing attitudes toward people with MI in relation to treatment, work, marriage, and recovery and toward professional help-seeking. Sociodemographic characteristics predicted correct knowledge and favorable attitudes, while Saudi culture was the likely factor behind negative judgments about mentally ill persons. Efforts to challenge this negative publicity and stigma through antistigma campaigns and public education through schools and media are recommended. Keywords: psychiatric illness, discrimination, people with mental illness, PWMI, stigma, antistigma, negative publicity, judgment of mental issues, professional help-seeking, social distance

Adel F Almutairi, Mahmoud Salam, Oraynab Abou Abbas, Maliha Nasim, Abdallah A Adlan King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Human beings may face many circumstances, such as surgery, trauma, and ­anemia, in which they could require an urgent blood transfusion. However, only a few ­studies have examined people’s risk perception of blood transfusion. Therefore, this study aims to evaluate the public’s risk perception of blood transfusion in Saudi Arabia, and to identify factors associated with their risk perception.Methods: Self-reported questionnaires on blood transfusion risk perception were distributed to the public during a Saudi national festival in Riyadh. Data were analyzed using mean, SD, Student’s t-test, and linear regression.Results: The overall percentage mean score±SD of risk perception was 59.8±16.1. Male participants were significantly more likely to perceive blood transfusion negatively, both in terms of the dread/severity domain (β=−0.23, p=0.003) and their overall risk perception score (β=−0.17, p=0.028). Older participants were considerably more likely to have a more negative perception (β=0.12, p=0.041) of the benefits of blood transfusion compared with younger participants. Study participants who received blood in the past had a significantly better perception (β=−0.13, p=0.029) of the benefits of transfusion. Additionally, participants who had previously donated blood had a considerably more positive perception in the dread/severity domain (β=−0.18, p=0.017) and their overall score (β=−0.15, p=0.045).Conclusion: Saudi males are more likely to perceive blood transfusion as a high-risk procedure. Similarly, older Saudis will probably have a more negative perception of the benefits of blood transfusion. Previous recipients and donors will likely have a better perception of the benefits of blood transfusion and a more positive overall risk perception. Keywords: blood transfusion, perception, risk, knowledge, benefit, Saudi

Mostafa A Abolfotouh, Abdallah A AdlanKing Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaBackground: Informed consent is considered the most important step in clinical interventions. The aims of this study were (1) to assess the quality of informed consent for invasive procedures with regard to consent process and information given about risks and alternative treatments, and (2) to determine patients' attitude toward informed consent at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: A cross-sectional study was conducted of 162 adult patients in different wards after undergoing surgery or invasive procedures within 1–2 days of signing the informed consent, using a previously validated interview questionnaire. Data on patients' characteristics, type of invasive procedure, and some informed consent-related issues were collected. Multiple linear regression analysis was used to identify the predictors of the percentage mean score of quality of informed consent, and significance was considered at P ≤ 0.05.Results: The quality of informed consent was generally poor (% mean score = 50.98 ± 17.49). About two-thirds of patients were told during the informed consent process that they have to sign merely as routine, 48% thought that if they refused the treatment plan they would lose the interest of the treating physician to help them, 42% thought that by saying no they would lose the good relationship with their physician, and 42.6% were not interested in having a copy of the informed consent document. Significantly higher quality was predicted when the physicians were the ones who explained the informed consent (t = 4.15, P < 0.001) and when informed consent was explained to younger patients (t = 2.754, P = 0.007). The overall attitude of the patients toward the process of informed consent was satisfactory (% mean score = 76.31 ± 7.63).Conclusion: The results suggest either that patients are not aware of their rights or that physician paternalism is practiced in Saudi Arabia. Cultural barriers should not be an argument to diminish the role of informed consent. Further studies should focus on how the value of autonomy can be appreciated in the Saudi culture.Keywords: informed consent, quality, invasive procedure, Saudi Arabia