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Harnett JE, Desselle SP, Fernandes MB, Yao D, Modun D, Hallit S, Dabbous M, Wahab MSA, Cavaco AM, Magalhães M, Faller EM, Flores JM, Gabriel JRDS, Othman N, Anantachoti P, Sriboonruang T, Sriviriyanupap W, Alnezary F, Alahmadi Y, Fallatah SB, Fadil HA, Ung COL. Defining and supporting a professional role for pharmacists associated with traditional and complementary medicines: a cross-country survey of pharmacists. Front Pharmacol 2023; 14:1215475. [PMID: 37654614 PMCID: PMC10467277 DOI: 10.3389/fphar.2023.1215475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction: An estimated 80% of the world's population use traditional and complementary medicine (T&CM) products as part of their healthcare, with many accessed through pharmacy. This cross-cultural study posed a set of professional practice responsibilities and actions to pharmacists related to T&CM products, with a view toward developing consensus, safeguarding, and promoting the health of the public. Methods: Data were collected from 2,810 pharmacists across nine countries during 2022 via a cross-sectional online survey reported in accordance with the guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Of the 2,810 participants from nine countries, 2,341 completed all sections of the survey. Of these, most agreed (69%) that T&CM product use was common in the community they served, but most did not have adequate training to support consumer needs. Over 75% acknowledged that there were known and unknown safety risks associated with T&CM use. Of 18 professional responsibilities posed, 92% agreed that pharmacists should be able to inform consumers about potential risks, including T&CM side effects and drug-herb interactions. The provision of accurate scientific information on the effectiveness of T&CM products, skills to guide consumers in making informed decisions, and communication with other healthcare professionals to support appropriate and safe T&CM product use were all ranked with high levels of agreement. In order to effectively fulfill these responsibilities, pharmacists agreed that regulatory reforms, development of T&CM education and training, and access to quality products supported by high-quality evidence were needed. Conclusion: General agreement from across nine countries on eighteen professional responsibilities and several stakeholder actions serve as a foundation for the discussion and development of international T&CM guidelines for pharmacists.
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Affiliation(s)
- Joanna E. Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shane P. Desselle
- Touro University California College of Pharmacy, Vallejo, CA, United States
| | - Marcília Baticy Fernandes
- Departamento de Ciências da Saúde, Ambiente e Tecnologias, Universidade de Santiago, Assomada, Cabo Verde
| | - Dongning Yao
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Selangor, Malaysia
- Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart Manufacturing Research Institute, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Selangor, Malaysia
| | - Afonso Miguel Cavaco
- Universidade de Lisboa, Faculdade de Farmácia, Departamento de Farmácia Farmacologia e Tecnologias em Saúde, Lisboa, Portugal
| | - Maria Magalhães
- Universidade de Lisboa, Faculdade de Farmácia, Departamento de Farmácia Farmacologia e Tecnologias em Saúde, Lisboa, Portugal
| | - Erwin Martinez Faller
- Pharmacy Department, School of Allied Health Sciences, San Pedro College, Davao City, Philippines
| | | | | | - Noordin Othman
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
- School of Pharmacy, Management and Science University, University Drive, Off Persiaran Olahraga, Selangor, Malaysia
| | - Puree Anantachoti
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Tatta Sriboonruang
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Faris Alnezary
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Yaser Alahmadi
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Saad Bakur Fallatah
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Haifa Abdulrahman Fadil
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao, China
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Yousef L, AlAngari D, AlShehri R, AlSharif B, Bayameen O, Alnemer Z. Healthcare transformation journey in the Eastern Region of Saudi Arabia: an overview, challenges and lessons learned. J Med Life 2023; 16:583-592. [PMID: 37305832 PMCID: PMC10251372 DOI: 10.25122/jml-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
The Kingdom of Saudi Arabia has embarked on a transformation journey referred to as "Vision 2030", which commenced in June 2016. The healthcare sector is currently going through a radical transformation under this Vision. The new Model of Care shifts the focus of the healthcare sector towards proactive care and wellness, aiming to achieve better health, better care, and better value. This paper aims to provide an overview of the Model of Care and review its achievements and progress in the Eastern Region. The paper will further discuss the challenges faced and lessons learned through the implementation process. Internal documents were reviewed, and a comprehensive literature search was undertaken in relevant search engines and databases. Some of the successes of the Model of Care implementation include improved data management, collection and visualization, and better patient and community engagement. Nevertheless, there is a sense of urgency to face the many challenges identified in the Saudi Arabian health system over the coming decade. Although the Model of Care focuses on addressing these identified challenges and gaps, there are many difficulties facing its implementation in the country and several lessons learned during the first few years since its launch, which this paper mentions. Hence, there is a need to measure the successes of pathways and the overall impact of the Model of Care on both the healthcare provision as well as improved population health.
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Affiliation(s)
- Lamees Yousef
- Model of Care Hub Department, Health Holding Company, Khobar, Saudi Arabia
| | - Dannah AlAngari
- Model of Care Hub Department, Health Holding Company, Khobar, Saudi Arabia
| | - Rahaf AlShehri
- Model of Care Hub Department, Health Holding Company, Khobar, Saudi Arabia
| | - Bader AlSharif
- Model of Care Hub Department, Health Holding Company, Khobar, Saudi Arabia
| | - Omar Bayameen
- Model of Care Hub Department, Health Holding Company, Khobar, Saudi Arabia
| | - Zeinab Alnemer
- College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alothman SA, Alshehri MM, Almasud AA, Aljubairi MS, Alrashed I, Abu Shaphe M, Alghannam AF. Virtual Behavioral Intervention to Promote Healthy Lifestyle Behaviors: A Feasibility RCT during COVID-19 Pandemic. Healthcare (Basel) 2022; 11:healthcare11010091. [PMID: 36611550 PMCID: PMC9818895 DOI: 10.3390/healthcare11010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND the COVID-19 pandemic has had a substantial impact on human health, affecting many lifestyle behaviors such as physical activity, sedentary behavior, dietary habits and sleep. PURPOSE to assess the feasibility of six sessions of a virtual behavioral intervention to promote healthy lifestyle practices during a stay-at-home advisory phase of the COVID-19 pandemic. METHODS A participant-blinded randomized controlled trial was performed through a virtual platform setting. Participants were randomly assigned into two groups. They were assigned to a motivational interviewing (MI) intervention or attention group, with pre- and postintervention assessments. The MI treatment consisted of six sessions (twice each week). The same number of virtual structured sessions were provided for the attention group, and they provided brief advice to promote healthy lifestyles. The study was conducted from April to June 2020. RESULTS The feasibility outcomes indicated that 39 of the 50 participants (78%) completed the trial. The dropout rate was 21.7% for the attention group and 22.2% for the intervention group. Participating in MI had a significant positive interventional effect on physical activity level, distress and fear of COVID-19. CONCLUSIONS It is feasible to deliver behavioral change interventions virtually. Further, MI can be used as a useful strategy for the favorable promotion of a healthy lifestyle. TRIAL REGISTRATION NCT05392218 (26/05/2022).
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Affiliation(s)
- Shaima A. Alothman
- Lifestyle and Health Research, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11321, Saudi Arabia
- Correspondence:
| | - Mohammed M. Alshehri
- Physical Therapy Department, Jazan University, Jazan 45142, Saudi Arabia
- Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Alaa A. Almasud
- Lifestyle and Health Research, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11321, Saudi Arabia
| | - Mohanad S. Aljubairi
- Lifestyle and Health Research, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11321, Saudi Arabia
| | - Ibrahim Alrashed
- Lifestyle and Health Research, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11321, Saudi Arabia
- School of Psychology, University of Queensland, St Lucia 4072, Australia
| | | | - Abdullah F. Alghannam
- Lifestyle and Health Research, Health Science Research Center, Princess Nourah bint Abdulrahman University, Riyadh 11321, Saudi Arabia
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Alazmi AS, Alhamad J. Attitudes and practices of complementary and alternative medicine among patients attending primary care center in Saudi Arabia: A prospective cross-sectional study. J Family Med Prim Care 2021; 9:5177-5182. [PMID: 33409184 PMCID: PMC7773103 DOI: 10.4103/jfmpc.jfmpc_871_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/14/2020] [Accepted: 08/31/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction and objectives Estimated complementary and alternative medicine (CAM) usage in Saudi Arabia is 70%. The Saudi Food and Drug Authority, National Center for Complementary and Alternative Medicine (NCCAM) regulates the license-based practices of various CAM modalities including procedures, herbs, and devices. As an aid to help primary care physicians for understanding CAM practices among general population, this study aimed to explore the prevalence of CAM along with its most common modality, and to understand attitude and practices among patients attending primary care center in Riyadh (Saudi Arabia). Methods A prospective cross-sectional study was conducted among 403 literate patients aged more than 18 years, coming to the primary care center for regular check-up from 1st April 2019 to 1st April 2020 Saudi Arabia. Data was collected using self-administered questionnaire. Results Around 44.5% participants had practiced one method of alternative medicine in their life. Majority of participants who attended primary care centers belonged to the age group of 18-39 years (71.1%). The most common used method of alternative medicine was honey healing. More than half of the study participants had heard about the CAM from their family and friends. Nearly 45.7% had stated that the CAM cannot be used without consulting a medical professional. Nearly 3/4th population used it for treating up to 3 ailments. Conclusion Use of alternative medicine was found to be prevalent in Riyadh. Family and friends were recognized as gatekeepers for propagating information about CAM usage in the society. Primary healthcare physicians need to be trained on prevalent practices of CAM to understand the societal needs.
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Affiliation(s)
- Amal S Alazmi
- Family Medicine Center, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Jamal Alhamad
- Family Medicine Center, Security Forces Hospital, Riyadh, Saudi Arabia
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Aboushanab T, Baslom S. A new official national regulations for complementary medicine practices in Saudi Arabia. Integr Med Res 2020; 10:100472. [PMID: 33117651 PMCID: PMC7581918 DOI: 10.1016/j.imr.2020.100472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Tamer Aboushanab
- National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Baslom
- National Center for Complementary and Alternative Medicine (NCCAM), Ministry of Health, Riyadh, Saudi Arabia
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Almalki MT, BinBaz SS, Alamri SS, Alghamdi HH, El-Kabbani AO, Al Mulhem AA, Alzubaidi SA, Altowairqi AT, Alrbeeai HA, Alharthi WM, Alswat KA. Prevalence of chronic pain and high-impact chronic pain in Saudi Arabia. Saudi Med J 2020; 40:1256-1266. [PMID: 31828278 PMCID: PMC6969620 DOI: 10.15537/smj.2019.12.24690] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: To estimate the prevalence of chronic pain (CP) and high-impact chronic pain (HICP) in a sample of the general adult population in Saudi Arabia. Methods: This is a cross-sectional online survey (N=24,265). Forty data collectors from 5 regions of Saudi Arabia approached people to complete the questionnaires through different social media applications, using a validated survey in Arabic language. Results: Chronic pain and HICP prevalences in the Saudi adult population were found to be 46.4% (CP) and 4% (HICP), with a higher prevalence among women and elderly. Chronic back pain was the most reported pain location. Half of the respondents reported dissatisfaction with pain services. Greater prevalence of HICP was found among women, elderly, unemployed, and those with low-income status. Patients with HICP were more likely to have more healthcare utilization and have more negative impacts on their physical and psychological wellbeing. Conclusion: Chronic pain and HICP are common in Saudi Arabia, especially among females and elderly, suggesting a public health problem. This calls for collaborative efforts at various levels of the social hierarchy to ensure the provision of effective management of CP in Saudi Arabia.
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Affiliation(s)
- Mohammed T Almalki
- Department of Anesthesia, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia. E-mail.
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Al-Hanawi MK, Chirwa GC, Kamninga TM. Decomposition of Gender Differences in Body Mass Index in Saudi Arabia using Unconditional Quantile Regression: Analysis of National-Level Survey Data. Int J Environ Res Public Health 2020; 17:E2330. [PMID: 32235630 PMCID: PMC7178090 DOI: 10.3390/ijerph17072330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022]
Abstract
Understanding gender differences in body mass index (BMI) between males and females has been much debated and received considerable attention. This study aims to decompose gender differentials in the BMI of people of the Kingdom of Saudi Arabia. The study decomposed the BMI gender gap into its associated factors across the entire BMI distribution by using counterfactual regression methods. The main method of analysis was newly developed unconditional quantile regression-based decomposition, which applied Blinder-Oaxaca decomposition using data from the Saudi Health Interview Survey. Gender differentials were found in the BMI, with females showing a higher BMI than males. The aggregate decomposition showed that both the covariate effect and the structural effect were significant at the 25th and 50th quantiles. Detailed decomposition indicated that income level and employment status as well as soda consumption and the consumption of red meat were significantly correlated in explaining gender differentials in BMI across various quantiles, but the magnitude varied by quantile. Our study suggests the government should consider introducing programs that specifically target women to help them reduce BMI. These programs could include organizing sporting events at the workplace and at the national level. Furthermore, the effect of soda consumption could be reduced by levying a tax on beverages, which might reduce the demand for soda due to the increased price.
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Affiliation(s)
- Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 80200, Saudi Arabia
| | - Gowokani Chijere Chirwa
- Centre for Health economics, University of York, Heslington, York YO10 5DD, UK or
- Economics Department, Chancellor College, University of Malawi, Zomba, P.O. Box 280, Malawi
| | - Tony Mwenda Kamninga
- Department of Social and Health Sciences, Millennium University, Blantyre P.O. Box 2797, Malawi;
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Khattab E, Sabbagh A, Aljerian N, Binsalleeh H, Almulhim M, Alqahtani A, Alsalamah M. Emergency medicine in Saudi Arabia: a century of progress and a bright vision for the future. Int J Emerg Med 2019; 12:16. [PMID: 31286863 PMCID: PMC6615245 DOI: 10.1186/s12245-019-0232-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Although emergency medical services (EMS) and pre-hospital care have existed in the Kingdom of Saudi Arabia (KSA) since 1934, emergency medicine (EM) is a relatively new medical field in the country that was not formally recognized as a medical specialty until 2001. In 2005, the Saudi Board of Emergency Medicine formed to develop, implement, and evaluate a standardized curriculum for EM residents. Since then, EM and the pre-hospital system in the KSA has evolved and grown. This article provides an overview of emergency medicine in Saudi Arabia and the progress it has made in the pre-hospital system, healthcare delivery system, and emergency medicine training. Finally, we will discuss the challenges and opportunities faced as this specialty continues to develop.
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Affiliation(s)
- Eyad Khattab
- Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC2, Boston, MA, 02215, USA. .,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulrahman Sabbagh
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawfal Aljerian
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of Health, Riyadh, Saudi Arabia
| | - Hashim Binsalleeh
- Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mobarak Almulhim
- Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC2, Boston, MA, 02215, USA.,Royal Clinics of the Custodian of the Two Holy Mosques, Riyadh, Saudi Arabia
| | | | - Majid Alsalamah
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of Health, Riyadh, Saudi Arabia
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Aboushanab T, Khalil M, Al Ahmari Y. The present state of complementary medicine regulation in Saudi Arabia. Journal of Integrative Medicine 2019; 17:147-149. [DOI: 10.1016/j.joim.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 01/07/2023]
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Khalil MKM, El-Olemy AT, Aboushanab TS, AlMudaiheem A, Hussein AA, AlSanad S. Posttraining Knowledge Retention among Licensed Cupping Providers in Saudi Arabia. Complement Med Res 2019; 26:329-335. [PMID: 30943523 DOI: 10.1159/000497357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 01/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND One of the licensing requirements for cupping providers in Saudi Arabia is to attend a compulsory training course that lasts 5 days for non-physicians and 4 days for physicians, irrespective of any previous experience in cupping therapy. The course is conducted by the National Center of Complementary and Alternative Medicine (NCCAM/MOH). As a part of course auditing, the current study aimed to evaluate knowledge retention among licensed cupping providers 1-3 years after passing the official cupping course. METHODS Licensed cupping providers were invited to attend a continuing medical education activity. Sixty-two attended the continuing medical education activity. Before the event, participants were asked to answer 35 multiple-choice questions taken from the same data bank as the pretest and posttest of the course. The test scores were linked and compared with the pre- and posttest of the training course. RESULTS A paired t test showed significant differences between the pre- and posttest knowledge scores (mean difference: 224.6 ± 86, p = 0.0001) and between the posttest and follow-up knowledge scores (mean difference: -115.26 ± 103.9, p = 0.0001). The follow-up score was still significantly higher than the pretest score, with a mean difference of 112 (95% CI: 83.66-140.34, p = 0.0001). There was no significant effect of category (physician vs. non-physician) on knowledge retention after controlling for the postcourse score. Gender, the total duration of experience, and total years of experience in cupping did not affect knowledge score retention between the physicians and the non-physicians. CONCLUSION The official cupping training course of the NCCAM/MOH achieved reasonable knowledge retention. To achieve long-term knowledge retention, refresher training/courses and continuous professional development will be required.
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Affiliation(s)
- Mohamed K M Khalil
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmed T El-Olemy
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia, .,Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt,
| | - Tamer Shaban Aboushanab
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah AlMudaiheem
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Asim Abdelmoneim Hussein
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Saud AlSanad
- National Center of Complementary and Alternative Medicine, Ministry of Health, Riyadh, Saudi Arabia.,College of Pharmacy, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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