Abstract
Graceful aging involves the harmonious development of physical, emotional, social, spiritual, and overall well-being, all of which contribute to successful aging. The demographic shift has moved the focus of policymakers, healthcare providers, and researchers from how to extend the lifespan of individuals to the improvement of the quality of life of the person in later years. The study aims to explore the lives of Saudi older adults holistically. The descriptive phenomenological research design was used. A purposive sampling and snowball were utilized. An interview-guide question was applied to examine the lives of 24 Saudi older adults living in the Riyadh Region, Saudi Arabia. The interview was conducted in October 30, 2024 to March 15, 2025. The study generated seven (7) emergent themes: (1) Proper management of physical frailty and recurring sickness; (2) Attentiveness to health and nutritional limitations; (3) Keeping intimate family bond and interpersonal relationship; (4) Acknowledging increased dependence and support from others; (5) Profound and sincere religious and cultural practices; (6) Appreciating and valuing the meaning of life; and (7) Recalling the most memorable moments in life. The research manifests implications primarily in relation to public and private utilities and facilities, healthcare services, and older adults’ health special programs and activities. Additionally, the study bears implications on nursing education, nursing practice, and research in gerontology nursing.
Keywords
What do we already know about this topic?
● The study serves as a guide for the policymakers especially the Saudi government. It highlights the need to enhance the life expectancy of Saudi population in general.
How does your research contribute to the field?
● The study offers a significant contribution to the field of gerontology, particularly in the context of older adult nursing practice in Saudi Arabia.
What are your research’s implications toward theory, practice, or policy?
● The study provides a richer understanding of how Saudi older adults live holistically, often with different traditional and cultural practice. These insights meaningfully expand the current theoretical framework.
Introduction
Graceful aging involves the harmonious development of physical, emotional, social, spiritual, and overall well-being, all of which contribute to successful aging. 1 An older adult is a person who is 60 years of age and above. 2 Every person should be allowed to live a long and healthy life. 3
Saudi or Saudi Arabian refers either to a native or to the nation itself of the Kingdom of Saudi Arabia. 4 According to the World Health Organization, the total population of Saudi Arabia in 2023 is 33.26 million. It is projected that by 2050, the population will increase by 43% or 47.69 million. In the same year report, the older adult population distribution of Saudi is 0.7 million females and 0.8 million males. In 2050, the population projection is 2.9 million females and 2.7 million males. The average life expectancy for both males and females is 76.4 years. This is an improvement of 5.86 years as compared to 70.6 years in 2000. Specifically, the life expectancy for females is 77.4 years while for males is 75.7 years. 5
In 2022, the leading causes of death in Saudi older adults are as follows: ischemic heart disease, hypertensive heart disease, lower respiratory infections, diabetes mellitus, and cerebrovascular disease. 6
The demographic shift has moved the focus of policymakers, healthcare providers, and researchers from how to extend the lifespan of individuals to the improvement of the quality of life of the person in later years. 7 Staying healthy, being active and productive life as a member of society is a remarkable goal for older adults. 8 In addition, they have always played an important role in society as leaders, caregivers, and custodians of traditions that require extensive healthcare. 9
The Saudi government paid great attention to caring for the elderly, as many initiatives have been launched to improve the quality of life and raise the level of services provided to the elderly in society in general and care homes. 10
The researchers believe that there are limited or not so many local studies about them. Older adults make important contributions and influences to society as family members, volunteers, and active participants in the workforce. 11 Moreover, lack of emphasis on the academic program in the Bachelor of Science in Nursing curriculum under the Ministry of Education (MOE) in Saudi Arabia. 12 There is a need to conduct rigorous and robust qualitative studies to explore the Saudi older adult experiences. 13 This research can fill the gap in the body of knowledge applicable to nursing education, and the practice of nursing profession, as well as basis for future research, especially in nursing gerontology.
The study aims to explore the lives of Saudi older adults holistically to ensure safety, enhance a healthy life expectancy, and promote well-being for older adults through concrete and responsive programs. In addition, the findings of the research will provide data useful to policymakers in the creation and formulation of additional programs as well as legislation to improve the lives of Saudi older adults. Increasing safety measures and providing appropriate social support are the primary goals to improve the quality of life among Saudi older adults. The provision of all utilities intended for Saudi older adults such as floor designs, hallways, ramps, stairs, walkways, corridors, doors, washrooms, toilets, should be ensured.
Method
Design
The researchers used a descriptive phenomenological research design to explore the genuine experiences of Saudi older adults. The researchers used the participants’ descriptions or perception to extract meaning and formulate significant themes, which were then related to the existing knowledge about the phenomenon. 14
The method addressed the purpose of understanding the experiences of Saudi older adults across physical, social, emotional, spiritual, and cognitive dimensions. This was done based on demographic categories such as age, sex, socioeconomic status, and educational attainment. Themes were generated from an analysis of the semi-structured interview data.
Participants
The researchers selected 24 Saudi older adults, aged 60 and above, living in the Riyadh Region. Participants had no history of degenerative mental disorder or physical injuries that could hinder their participation. The participants were either married or widowed, with or without children and grandchildren, or unmarried but lived with children and grandchildren and acted as immediate significant others. According to Ahmed, 15 this number of participants was sufficiently represented to identify key themes among diverse populations.
The participants comprised 12 males and 12 females who were Saudi older adults. Both male and female participants were further classified into 3 age groups: 60 and 69 years old (young older adult); 70 and 79 years old (middle older adult), and 80 years old and above (old older adult). Both male and female participants were classified according to the Socioeconomic Status (SES) framework outlined by Alomar et al., 16 which included 4 classes: affluent (class 1), upper middle (class 2), lower middle (class 3), and deprived (class 4). Lastly, both male and female participants were selected on their educational attainment: elementary graduates; high school graduates; and college graduates.
The researchers, assisted by key informants, searched, and selected the participants from the community using a purposive and snowball sampling technique. Participants who met the criteria were included in the final list for the one-on-one interview. For their active participation and cooperation, each participant received snacks valued at 20SAR.
Data Collection
The researchers presented the proposal to the panel of evaluators through a Proportionate Review Ethics Application (PREA) and submitted it to the Scientific Research Services Platform of Shaqra University for final approval.
The semi-structured interview guide questions were submitted to 3 qualitative research experts for their content credibility and validity. The Arabic version was validated by another 3 Saudi or local experts and subjected to a pilot test with 1 prospective participant. Correspondingly, minor comments and suggestions were incorporated, particularly appropriate Arabic terms.
The researchers finalized the qualitative research tool, which consisted of 2 phases: first, gathering the profile of participants for screening and selection; and second, using the interview guide questions to gather data. the questions were formulated to include the various aspects of the participants’ lives, such as their physical, social, emotional, spiritual, and cognitive well-being.
The researchers submitted the manuscript, after which it was approved via the online portal of the Scientific Research Programs Committee of Shaqra University with reference number: ERC_SU_F_202400041. A letter of invitation was sent to the prospective participants. Initially, key informants asked participants a set of questions to gather demographic information, including age, socioeconomic status, and educational attainment. The prospective participants’ profiles served as the basis for identifying the final participants, after which the researchers proceeded to the face-to-face interview, which was conducted at each participant’s home.
The researchers conducted a comprehensive discussion and orientation, which included the aims and objectives of the research, selection of the participants, interview procedure and duration, expected outcomes and risks, remuneration for active participation, confidentiality of the results and right to refuse, before the participants signed the informed consent. Data gathering was conducted through narrative inquiry and in-depth one-on-one interviews. The interviews also helped establish confirmability. The interview proceedings were audio-taped after special consent had been secured from the participants. To provide emotional support, a licensed psychologist was available for participants, especially when sensitive issues were discussed. The one-on-one interview took an average time of 50 min per participant. All participants completed their interviews and none withdrew. The interview of the selected participants was conducted from October 30, 2024 to March 15, 2025.
The researchers transcribed the audio-taped proceedings. Data were analyzed for theme generation using Colaizzi’s method for qualitative data analysis. Participants were coded to maintain confidentiality. The participants were informed of the results before the final report was written.
Trustworthiness
The researchers used the 4-dimensional criteria of credibility, transferability, dependability, and confirmability, as outlined by Lincoln and Guba’s Rigor of Research, to assess the trustworthiness of the study. 17
Credibility
The researchers employed a robust research design and methodology to ensure study’s internal validity. Furthermore, multiple data references were provided to demonstrate that the linked literature is extensive and well-developed.
Transferability
The study identified emergent themes and contextualized patterns among the participants to enhance the transferability of its findings. The research was then disseminated to relevant individuals, groups, and communities for their use.
Dependability
The researchers ensured the dependability and confirmability of the study’s findings through rigorous methodology. Implications were drawn from careful conceptualizations, which were then reviewed by experts in the same field of competence and used to inform new literature.
Confirmability
The researchers thoroughly reviewed the data gathered from the subjective interviews of the participants to formulate accurate conclusions. A panel of validators evaluated the research narrative to ensure the conclusions were supported by the actual data.
Ethical Consideration
The researchers adhered to ethical standards and general principles to minimize potential risks. 18 The Scientific Research Programs Committee of Shaqra University approved the study on October 8, 2024. The key ethical considerations included:
Informed Consent
Participants were fully informed about the study’s purpose and given time to decide whether to participate, without any coercion. They received information sheets and consent forms, which allowed them to ask questions and express concerns before giving written consent. Participants were informed of their right to withdraw from the study at any time, even after consent, without penalty or loss of entitled benefits.
Privacy and Confidentiality
Participants’ identities were protected by using codes instead of names, and their personal information remained confidential throughout the study. Participants could access their records upon request. To do so, they could contact the researchers directly, and arrangements were made to provide them with copies of their data, ensuring that this process aligned with confidentiality and ethical standards. The generated data were kept in a secure, locked cabinet, and will be personally destroyed through shredding after 5 years.
Minimization of Risk
The study avoided causing physical or psychological harms to participants. Thus, a licensed psychologist was invited to manage the participant’s thoughts, feelings, and behaviors during the actual interview. Sensitive topics were carefully handled to focus on the participants’ experiences, ensuring the well-being of all involved.
Validity and Reliability
The researchers ensured accurate and reliable data collection through content validation, pilot testing, and ethical review by both panelists and the Research Ethics Committee (REC) of Shaqra University. In addition, the researchers utilized the Consolidated criteria for Reporting Qualitative research (COREQ) checklist by the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network to ensure explicit and comprehensive reporting of qualitative studies in in-depth interviews. 19 The 3 qualitative research experts validated and rated the semi-structured interview guide for its content and credibility, judging it according to clarity, objectivity, and conciseness. Additionally, another 3 experts in Arabic validated the local language version of the interview guide questions.
Data Sharing and Publication
The researchers presented the findings at relevant academic conferences and submitted the final manuscript for publication in peer-reviewed journals. All data were presented in aggregate form to ensure that no individual participant could be identified. Participants were informed of the plans for data presentation and publication and were given the option to receive a summary of the findings. Any data shared in publications complied with ethical guidelines and ensure the confidentiality of participants.
Data Analysis
The researchers used the Colaizzi’s 7-step method to analyze data gathered from the interview. This structured approach for phenomenological research ensured depth, rigor, and fidelity to participants’ lived experiences. 13 After the one-on-one in-person interviews with the selected 24 participants, the data were carefully transcribed. The researchers used a hands-on coding technique, manually analyzing transcripts to identify emerging themes. The transcripts were then reviewed and read before being finalized. Based on a line-by-line interpretation of the transcripts, the researchers generated significant statements, cluster themes, and derived themes.
The researchers labeled and highlighted significant statements from each participant. Several codes were grouped together to create categories and formulate meanings. The clustered categories described the connections between each other and created emergent themes. These emergent themes were then summarized, described, and carefully discussed by the research team. The findings were returned to the participants for validation to ensure accuracy and credibility. Finally, the results were interpreted in light of literature from journals, reliable websites, books, and other research databases.
Results
A total of 463 significant statements were identified and extracted from the verbatim transcripts. The significant statements generated 22 clustered themes, which were then consolidated into 7 emergent themes: (1) Proper management of physical frailty and recurring sickness; (2) Attentiveness to health and nutritional limitations; (3) Keeping an intimate family bond and interpersonal relationship; (4) Acknowledging increased dependence and support from others; (5) Profound and sincere religious and cultural practices; (6) Appreciating and valuing the meaning of life; and (7) Recalling the most memorable moments in life.
Based on the identified themes, the physical dimension comprises themes 1 and 2; the psychosocial dimension is theme 3; the socio-emotional dimension is theme 4; the spiritual dimension comprises themes 5 and 6; and the cognitive dimension is theme 7. To provide support and ensure transparency, the researchers highlighted each formulated and clustered them with significant quotes from participants.
Theme 1: Proper Management of Physical Frailty and Recurring Sickness
Saudi older adults in the study experienced common physical frailty and recurring sickness. According to them, their daily physical activities declined with age, specifically after reaching 60 years. The majority shared that they feel tired easily, lack energy and feel weak. They are sedentary, perform only simple tasks, and require frequent rest and sleep. They seldom walk and have little interest in household chores. They tend to move slowly to prevent injury, such as a fall or slips.
These perceptions of physical frailty were supported by the following statements: The participant verbalized, “Now, I feel the difference between young and older adults. I am weak and feel tired easily when I do simple tasks.” The participant shared, “There were instances that I preferred to stay at home rather than to go anywhere, unlike during my childhood years and teenage period. I was very active before.” The participant said, “I love to take rest and sleep all the time, especially during noon time and afternoon.” The participant mentioned, “I am now very careful with my daily activities because I really feel weak as well as moving slowly and carefully.” The participant shared, “I limit my activities and focus on simple household chores or sit rather than doing extra effort to get those things or achieve it.”
Based on the Saudi older adults’ age, the data revealed that physical changes became more pronounced during the middle older adult period. As age progresses, body pains and the need for assistance with walking or standing became more evident. The data also showed that older adults in class 4, deprived, experiences physical changes more frequently than those in class 1, 2, and 3.
These experiences of physical changes were supported by the following statements: The participant verbalized, “I experience body pain and slowly move every time I do something extraneous activities. The participant mentioned, “Most often, I requested my son, daughter, or grandchild to assist me in doing household chores.” The participant shared, “I really experience difficulties and limitations as well as dependence on others.”
The majority of Saudi older adults raised the occurrence of physical illness and diseases as a significant issue. They commonly reported suffering from the following conditions: diabetes mellitus, heart disease, hypertension, seasonal influenza, arthritis, joint pain, back pain, blurring of vision, hearing problems, and asthma. Data showed that these occurrences are exhibited during the middle older adult period. However, young older adults begin to experience common illnesses like joint pain, arthritis, and back pain. With increasing age, hearing problems and blurred vision also become more prevalent. Moreover, some male older adults reported encountering these illnesses more often than female older adults. In terms of economic status, older adults in class 3 and class 4 frequently experience more illnesses than those in class 1 and class 2.
These experiences of disease or illness occurrence were supported by the following statements: The participant verbalized, “I have illnesses such as diabetes mellitus, hypertension. I was diagnosed by the physician. The participant mentioned, “I have heart problems as well as I experience blurring of vision and hearing problems.” The participant shared, “I have arthritis and sometimes joint pains attack. It hurts me a little bit, especially everytime I move. So, I move it slowly.” The participant said, “I experienced an asthma attack and seasonal influenza. Maybe these are due to our weather conditions here in Saudi Arabia.” The participant shared, “I start to feel back and muscle pains. It worsens when I do extraneous activities.”
Theme 2: Attentiveness to Health and Nutritional Limitations
To maintain a healthy lifestyle, the majority of the Saudi older adults kept themselves physically active and productive. Some are creative enough to preoccupy themselves with simple physical exercises such as walking and jogging or hunting and hiking around the desert farm. Data revealed that young older adults engage in physical activities to become more physically fit. Moreover, a few middle older adults mentioned that they love to cook as a form of exercise.
As age increased, participants performed fewer activities such as hiking, walking and jogging to stay fit. The result also indicated that they performed simple exercises to promote healthy lifestyles. However, female older adult enjoying cooking and preparing food as a form of activity. In addition, most of the participants in class 3 and class 4 engaged in activities to maintain good health, while participants in class 1 and class 2 were mostly engaged in household activities. Likewise, the results showed that older adult college graduate were more engaged in physical activities than high school graduates, with elementary graduates being the least frequently engaged.
These verbalizations of keeping themselves physically active and productive were highlighted and supported by the following statements: The participant shared, “I love hiking and hunting animals in the desert. This is to keep myself physically active and do something as an exercise. The participant mentioned, “I love to walk and move around, especially during nighttime or late afternoon.” The participant said, “Most often, I volunteer and help to cook special dishes for my family. I help our khadama or servant to do simple household chores to keep moving.” The participant shared, “Sometimes I go to the farm and do simple exercises such as walking, jogging, or stretching while watching the camels and goats eat grass.” The participant said, “Yes, I am very conscious and fully aware that exercise is really good to keep myself active.”
The majority of Saudi older adults maintained a healthy lifestyle through careful dietary management and proper nutrition. They reported being conscious of their food and drink preferences, with many making it a point to include camel meat in their daily diet. Participants also mentioned specific dishes like khabsa, jareesh, marqouq, matazeez, and al-ruqsh, and noted their regular consumption of tea and Saudi coffee (qahwa). The data showed that older adult across all age groups were mindful of their diet.
These perceptions of maintaining a healthy lifestyle and being careful of one’s diet and nutrition were supported by the following statements: The participant verbalized, “I drink Saudi coffee or “qahwa” daily. I believe this traditional coffee is healthy and good for our body. I drink 2 to 3 times a day. At the same time, I drink “shay” or Saudi tea regularly. You can get it at the store or cafeteria, and anytime. This is part of our tradition that drinking coffee is really a way of life, and as a form of socialization. This is a very special activity for Saudi people.” The participant mentioned, “I love to eat khabsa, jareesh, marquoq, matazeez, or al-qursh. These dishes are special Saudi meals that you can see in all gatherings or occasions here in Saudi Arabia. At present, I eat cautiously and have limitations since I consider myself old and due to health problems, which I encountered recently.”
The importance of taking maintenance medication was emphasized by some Saudi older adults. In terms of medication compliance, data showed that younger and middle older adults were more compliant and took their medications as compared to the old older adults.
These verbalizations of regular taking of medicines as maintenance were supported by the following statements: The participant shared, “My doctor prescribed me some medicines such as atorvastatin, metformin, and glusimide. I take it religiously. I do online consultation with the help of my son or daughter.” Participant mentioned, “I take panadol, mounjaru and ozempic.” The participant said, “I request my grandson and granddaughter to make an online appointment on my behalf via Sehhaty -an online application provided by the Ministry of Health (MOE).”
Theme 3: Keeping an Intimate Family Bond and Interpersonal Relationship
Saudi older adults find time and varied ways to keep family relationships and significant others together. Ensuring a happy and good relationship with one another is very significant among Saudi older adults. They stressed that family gatherings, especially every Friday after noon time prayer with traditional meals, are important and special. Everybody makes and finds time to celebrate special family occasions and significant events.
These verbalizations of keeping intimate family bonds as well as interpersonal relationships were supported by the following statements: The participant shared, “I always attend family gatherings every Friday at 1pm – 2pm after noon time prayer. Family centeredness is really practiced by all Saudi people.” The participant mentioned, “We set it every weekend, especially Friday and Saturday, as well as during special occasions. Sometimes we do family gatherings in a special place called istiraha or chalets.” The participant said, “We, Saudi people, have a strong family relationship and traditionally celebrate it with festivity.”
Maintaining family ties was highlighted by most Saudi older adults as part of strong relationship. Data revealed that family showed togetherness through special family and religious occasions such as Ramadan and Eid al-Adha. Additionally, Saudi National Day and Saudi Founding Day were celebrated to meet and gather together. The majority celebrated family gatherings to strengthen their family ties through the most and important religious activities.
These perceptions of a strong relationship through maintaining family ties of Saudi people were supported by the following statements: The participant verbalized, “Most of the time, we celebrate family bonding and eat special dishes together in one place, especially at home. This is really meaningful to us, Saudi. We talk, share, and laugh together. All my children always came to celebrate with us, especially during Ramadan and Eid al-Adha.” The participant said, “Annually, Ramadan and Eid al-Adha are celebrated meaningfully. All family members are gathered together. These religious activities are the most important events. We will prepare something special together.” The participant mentioned, “Traditionally, Saudi people celebrate only two special religious celebrations, but now Saudi National Day and Saudi Founding Day have been celebrated annually in recent years.”
The presence of children and grandchildren during special occasions or family gatherings is significant for Saudi older adults because it is a source of happiness. They mentioned the feeling of being complete when their children and grandchildren were around, it is served as bonding moments. The data revealed that happiness was a more frequent source of fulfillment for middle and old older adults compared to young older adults.
These verbalizations about the presence of children and grandchildren as an ultimate source of happiness were supported by the following statements: The participant shared, “Indeed, there is always an excitement everytime I see my sons and daughters as well as my grandchildren, especially during special occasions because their presence makes me fulfilled and complete. I always request my children to visit us here in our house.” The participant said, “To always see my children who are now adults and have good jobs as well as their children makes me really happy.” The participant mentioned, “Happiness and joy of my children as well as grandchildren are also my happiness and joy. It makes my life very meaningful.” The participant said, “I am always looking forward to seeing and meeting all my family members in person.”
Theme 4: Acknowledging Increased Dependence and Support from Others
Seeking care from children and grandchildren is important for Saudi older adults. Some participants also asked their children to hire a khadama or helper to assist with daily activities. The data showed that older adults in the oldest age group most frequently requested help from their children, compared to the middle-aged adults and young older adults.
These perceptions of seeking care from immediate family members and others were supported by the following statements: The participant verbalized, “I feel that to be an independent person is inevitable. I am so blessed because of my children, who are here taking care of me.” The participant mentioned, “I request my children to hire khadama to assist me here at home.” The participant shared, “I go with them. . . to my children. I call them when I need something to do, such as transferring furniture, appliances, and other heavy materials.” The participant shared, “Sometimes I feel sad and lonely if people are not around here in our house for work.” The participant said, “I hire a helper or servant to do household chores and assist me in my daily living.”
Some Saudi older adults reflected on the importance of having financial support from family members. Male older adults mentioned needing more financial support from others than female older adults. Likewise, class 4 or economically deprived older adults stated that they needed financial assistance from others, whereas class 1, class 2, and class 3 older adults reported needing less financial support.
These verbalizations of becoming self-dependent towards others were supported by the following statements: The participant said, “Sometimes, I need support from my immediate family members, especially for daily expenses and other financial matters.” The participant mentioned, “There was a time that I asked or sought financial support from the government, particularly medicines.” The participant shared, “I always pray that my son will never stop providing me financially.”
Striving to be more productive was also very significant among Saudi older adults. The majority kept themselves more productive, active, and independent in their daily living. Data showed that some of the young and middle older adults found time to keep themselves busy, productive, and self-reliant more often than the oldest older adults. Moreover, some male older adults shared that they continued to do their work and earn more money than female older adults.
These verbalizations of striving to be more productive in life were highlighted and supported by the following statements: The participant said, “Even though I am an older adult, I work and do something such as hunting birds in the desert farm. I just make sure that I keep myself busy and productive.” The participant shared, “I work regularly as a form of routine activity as well as an exercise.” The participant mentioned, “I need to work and find alternative ways to make myself busy.” The participant said, “I personally monitor my own business here in our town, which keeps me busy throughout the day. I love this kind of activity anyway.”
Theme 5: Profound and Sincere Religious and Cultural Practices
The majority of Saudi older adults emphasized feeling closer to Allah through regular prayer at the Mosque and reading Qur’an. This was particularly true for male participants. A strong faith in Allah was evident among older adults. Most mentioned that their religion provides inner peace and promises paradise. All participants said that they frequently communicated with Allah through prayers.
These perceptions of profound faith and religious practices were highlighted and supported by the following statements: The participant mentioned, “Alhamdullilah! I attend prayer at the Mosque near here at home five times a day. I feel really incomplete if praying is not complete.” The participant said, “Indeed, I have a very strong Islamic faith. Allah gives me hope and wisdom.” The participant shared, “I continue reading the Qur’an regularly as a way to communicate with Him. Allah is my savior.” The participant said, “I have inner peace because of Him. He is the source of all.” The participant shared, “Praying is a form of communication so I talk personally with Him.”
Saudi older adults also highlighted dealing with their problems through prayers. All participants reported trusting Allah and prayed 5 times daily, hoping that Allah would help them resolve their problems.
These verbalizations of deep and sincere praying to Allah were highlighted and supported by the following statements: The participant shared, “Through prayer, there is peace and love. I love my family.” The participant said, “I offer myself to Allah. If I encountered problems in life. I will just pray.” The participant mentioned, “I pray that whatever I ask right now, Allah will grant it for sure.” The participant said, “Keep praying to solve my problems.” The participant mentioned, “Just simply pray with Him because I know He will listen.” The participant said, “I thank Him for the gift of life and do it by praying daily.”
The majority of Saudi older adults also expressed a belief in Allah’s constant presence. They believed that Allah is the king of all kings, controller, the provider, the giver of hope, and the healer. All participants reflected on the constant presence of Allah in their lives.
These perceptions of believing that Allah is present all the time were supported by the following statements: The participant verbalized, “Yes, Allah is with us from the beginning.” The participant mentioned, “Allah is the king. I offer my life with Him. My faith will remain very strong.” The participant shared, “He is a great provider and healer.” The participant said, “My savior and hope.”
The majority of Saudi older adults mentioned that Allah is the center of their life. They believe that Allah is the source of all life and that everything depends on His limitless power and will. They profess that Allah is the Creator and controller of everything. All participants expressed belief in His divine power.
These perceptions of believing that Allah is the center of life were highlighted and supported by the following statements: The participant verbalized, “Yes, Allah is the controller, source of life, and creator of all things.” The participant said, “He is so powerful, and because of him I am here now.” The participant mentioned, “I always look up to Him because of his kindness and great mercy to all people.” The participant said, “He is everything.” The participant shared, “Allah is the center of my life.” Participant shared, “I owe my life to Him.”
Theme 6: Appreciating and Valuing the Meaning of Life
Saudi older adults expressed that they found meaning in both life and death by reflecting on their past. A significant was valuing life through Allah, and some participants viewed life as full of opportunities, an integral part of the human journey, full of wisdom and experience, a test, and temporary.
These perceptions of valuing life were supported by the following statements: The participant verbalized, “I value my life in the sense that I always take care of myself and others.” The participant said, “I should do the right thing for the good of my family members and others. This is what matters most to value life regardless of who they are and their status in life.” The participant mentioned, “Life is so good and full of opportunities. Enjoy it.” The participant said, “It is my journey to experience life which Allah has given me.” The participant mentioned, “Always do the best in life because this is just temporary. Only Allah knows! I must prepare for whatever journey I have right now. I believe that I have a place in heaven.”
Saudi older adults also emphasized that life is a gift from Allah. The data revealed that middle and oldest older adults more often believed this than young older adults. Moreover, female older adults more frequently recognized life as having meaning than male older adults.
These verbalizations of life as the greatest gift were highlighted and supported by the following statements: The participant shared, “My life is the best gift I ever received from Allah.” The participant said, “I am here in this world because I believe that Allah has a purpose for me to carry on.” The participant mentioned, “I have a mission to accomplish and fulfill the purpose here on earth.”
Most Saudi older adults recognize the inevitability of death. They mentioned fearing death because it can happen at any time and no one is exempted. However, they also view death as a gift from Allah and believe in the promise of peace in paradise, which is fulfilled at the final judgment. The majority of them welcome the possibility of death as a transition to the next life.
These perceptions of life’s inevitability were supported by the following statements: The participant said, “Death is part of my life. Nobody knows about the final judgment. Let us offer life to the one who created us.” The participant shared, “I know that no one is excused from death. Facing this stage gracefully is my ultimate wish.” The participant mentioned, “The same gift. . . I believe that death is a gift from above.” The participant said, “Death is part of the cycle of life.” The participant mentioned, “I am ready to accept it because no one is above him.”
A significant finding among Saudi older adults was their wish for a longer life. The participants mentioned that they pray fervently for more years and thanked Allah for the gift of life. Some believed that Allah would allow them to live longer. This wish was a common sentiment among the older adult participants.
These verbalizations of extending life and wishing for more years were also highlighted and supported by the following statements: The participant shared, “You know, part of my prayer is really to extend my life. I ask Allah to continue and give me a good life.” The participant said, “I wish to have a very meaningful life here on earth.” The participant mentioned, “Keeping healthy is my ultimate prayer.” The participant said, “I know that death will come anytime as a final judgment day. I am praying and hopeful to extend more years.” The participant shared, “Yes, sometimes I have a fear of death. I always think about life positively.”
Theme 7. Recalling the Most Memorable Moments in Life
Saudi older adults reminisced about their happiest moments in life. They cherished becoming grandparents, playing with grandchildren, visiting Mecca seeing their children graduation, building their own homes, attending children’ marriages, and opening businesses. These moments were marked as very significant in their lives. Saudi older adults also enjoyed the annual celebrations of Saudi National Day and Saudi Founding Day.
These verbalizations of recalling and reminiscing memorable moments in life by Saudi older adults were supported by the following statements: The participant shared, “I am very thankful everytime I see my family, especially my spouse, children, and grandchildren in good health.” The participant said, “I am happy for what they have achieved in life. Their achievements during school days are also my achievements indeed. Especially, all my children graduated from college and have stable jobs.” The participant mentioned, “I am happy to see my children taking good care of my grandchildren.” The participant said, “Attending and witnessing children’s special events as well as establishing business are also reminisced.” Participant shared, “Everytime I visit Mecca and continue reading the Quran is so special for me.”
The death of children and other immediate family members was the saddest event in their lives. The majority of Saudi older adults said that the death of a family member or close friend was the saddest event that happened in their lives. Most participants remembered and marked the death of loved ones. In addition, participants also considered a child’s failure to graduate and conflicts within the family as sad moments.
These verbalizations of remembering the saddest life’s events were highlighted and supported by the following statements: The participant said, “I felt sad everytime I remember a family member’s death. I always remember their presence everytime we have a family bonding or special gatherings.” The participant mentioned, “Sometimes, I regret seeing my kids or grandchildren who did not finish their school and get a good job.” The participant mentioned, “I felt sad to know if there is conflict between family members.” The participant shared, “I was very sad when I learned that my son died due to an accident. Until right now, I cannot move on because of the accident. I believe that there is eternal life for him.”
On the other hand, Saudi older adults shared that they often forget things and events as the age. Data revealed that middle and old adults most often experienced forgetfulness.
These experiences of forgetfulness were supported by the following statements: The participant verbalized, “Now, I feel that forgetfulness is real and happening. I observe that my children are always saying. . . you forget it again!” The participant shared, “Most often, I forget to remember special events such as wedding dates, family’s memorable occasions, and others.” The participant said, “Sometimes, I forget to remember my cellphone’s passwords.” The participant mentioned, “There was a time that I forgot to bring the car key or house keys. I tend to blame others or deny it instead of finding or searching for it.”
Handling common forgetfulness was a significant concern among Saudi older adults. The majority said that browsing news or reading social media platforms like WhatsApp, Snapchat, Twitter, or X helped them improve their memory. Data showed that younger and middle older adults tended to find alternative ways to overcome forgetfulness more often than the oldest adults. Male older adults more often mentioned finding reasons for their forgetfulness than female older adults. They sought alternative ways to overcome memory loss.
These verbalizations of proper handling of forgetfulness were highlighted and supported by the following statements: The participant said, “Browsing Twitter or X and reading online news are my ways to keep myself healthy and as a form of mental exercise as well.” The participant shared, “Now, I love to browse social media applications such as Snapchat, WhatsApp, and others. These are my ways to keep myself updated.” The participant mentioned, “I play games with my grandchildren involving counting and reading.” The participant shared, “Sometimes, I make checklists or write a note in my mobile phone to remember easily.”
Discussion
Aging in the modern world provides a rich source of topic for research. It offers diverse cultural perspectives and personal narratives. 20 It serves as an invaluable source for understanding and addressing the challenges associated with the aging population. 21 Moreover, aging is a dominant theme in the 21st century. Population aging is probably one of the major achievements nor problems of modern societies. It demands societies related institutions even governments to create plans and programs to improve nutrition, sanitation, medicine, healthcare, education, knowledge, and economic well-being in general. 22
In Saudi Arabia, the population of people aged 60 or more is predicted to be 25% of the total population of 40 million by the end of 2050. Moreover, the number of people aged 80 or more is expected to reach 1.6 million, or 4% of the total population in the same period. An unprecedented factor is that the Saudi elderly have become healthier in recent decades. 23
Proper Management of Physical Frailty and Recurring Sickness
Dealing with increasing frailty and recurring illnesses belongs to the physical dimension. 24 A recent report from the United Nations states that the percentage of elderly individuals in the Kingdom of Saudi Arabia (KSA) will witness a sharp increase in the next 3 decades. This situation will lead to an increased prevalence of comorbidities and hence, will require close monitoring and constant care of such individuals who are prone to suffer from complications such as arthritis, cardiovascular disorders, diabetes, neurological disorders, and the like. Frailty is one such age-related phenomenon that enhances the risk of falling, functional restrictions, and greater vulnerability to adverse consequences, which tend to lead to institutionalization. 25 In a recent study published, their findings provide strong evidence that physical frailty is a significant risk factor for recurrent falls in older adults. 26 In Riyadh, the overall prevalence of pre-frailty and frailty were 47.3% and 21.4%, respectively, considered high. The following factors were associated with being frail: age; living alone; having more chronic conditions; and cognitive impairment. 27
Saudi older adults experienced common physical frailty and recurring sickness. The study observed that physical functionalities declined after reaching age 60 years old, resulting in an increased need for rest and sleep and a decrease in mobility. The increasing frailty and recurring illnesses become a major issue among Saudi older adults. To be considered frail, an older adult must have these 3 or more characteristics such as low physical activity, muscle weakness, slow performance, fatigue or poor endurance, and unintentional weight loss associated with morbidity and mortality. 28 Most healthy and active people do not need the expertise of a geriatrician until they are 70, 75, or even 80 years old. However, some people need to see a geriatrician at a younger chronological age because of their medical conditions. 29
However, the recurrence of illnesses requires further study. According to a published article, sarcopenia is evident in the older adult period. 30 This is due to a decline in skeletal muscle mass and function based on anatomy and physiology. Beginning as early as the 4th decade of life, evidence suggests that skeletal muscle mass and skeletal muscle strength decline linearly, with up to 50% of mass being lost by the 8th decade of life. 31 In an article published, the elderly people are more vulnerable to chronic diseases and their complications, deterioration in functional ability, disability, and discrimination as well as its negative consequences for them. 9
Attentiveness to Health and Nutritional Limitations
Maintaining a healthy lifestyle is central component of the physical dimension. 32 The majority of Saudi older adults demonstrated an awareness of and took steps to manage the physical changes brought about by aging. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Handling such changes is considered the key of staying in good health. 33
Saudi older adults kept themselves physically active and energetic to maintain a healthy lifestyle. Some verbalized that they made themselves more creative and productive. It is important to note that not all older adults are at the same health level. Those who are still active must be given the freedom to engage in the activities they can do and use their energy for their benefit. 34 In a systematic review conducted in 2018 on inactivity prevalence in Saudi Arabia, it found out that a national policy encouraging active living and discouraging inactivity be established as its major recommendation. 35
In the Kingdom of Saudi Arabia (KSA), demographics are changing as life expectancy increases and the number of older Saudi Arabians rises. Saudi Arabia has a higher rate of physically inactive people, and most of them are between the ages of 55 to 64. Walking is one of the most prevalent forms of physical activity in Saudi Arabia and the study showed that most people prefer walking for recreational and health benefits. 36
Maintaining a healthy lifestyle means they are careful with their diet and nutrition. 37 Balanced diets, exercise, and self-management reflect a positive trend toward embracing healthy aging. 38
The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age, being widowed, and having dental problems. On the other hand, risk factors associated with malnutrition in women were lower body mass index and being disabled. In conclusion, the findings provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population. 39
Taking maintenance medications was also emphasized by the Saudi older adults. Several factors contribute to adherence, including adequate healthcare integration, old age, and high income. 40 However, there was a study conducted and published regarding prevalence of nonadherence to medications. The common factors encountered were forgetfulness, feeling well, and taking multiple medications. Therefore, the study highly recommended that medication adherence is essential to optimize clinical outcomes particularly for older adults in Saudi Arabia. 41
Keeping an Intimate Family Bond and Interpersonal Relationship
This emergent theme belongs to the social dimension. 42 During Ramadan, families, mostly during weekends, host iftar at their homes for friends and families. Eid Al-Fitr and Eid Al-Adha are the 2 most important religious holidays in the Islamic calendar. These are the joyous occasions for extended families to gather to celebrate, exchange gifts, and enjoy traditional food and drinks. 43
As cited in the International Journal on Ageing in Developing Countries, based on Saudi Arabia’s cultural values and Islamic traditions, maintaining strong family bonds, and interpersonal relationships among older adults is a deeply embedded and common practice. 44 Upholding family traditions and maintaining kinship ties are an integral part of Saudi society and culture that is passed down from one generation to the next from sports to desert picnics. Family is a central pillar for Saudi society. It forms the basis of most Saudi’s social circle. Some families have a designated room called a majilis, in their house where important family matters are discussed and guests are welcomed for socializing. 45
In Saudi Arabia, it is common to rent an istiraha, or chalet, a place for a temporary stay that often has a pool, a large living room for families to gather, and a garden with a play area for children. In cooler months, most families also enjoy outdoor activities such as picnics in the desert. Other popular family activities include camping, desert safari tours, camels, sandboarding, quad biking, and stargazing. 46
Acknowledging Increased Dependence on Others
The realization of being dependent on others is part of the socio-emotional dimension. 47 The major adjustments of all Saudi older adults are the transition from independence to dependence or loss of work role to other views of life such as grandparenting, loss of loved ones, and even the perception of changes in health and functioning or poor lifestyle behaviors. 48
Usually, parents financially support their children into adulthood, depending on them for financial support. In return, elderly family members are cared for by their children and grandchildren into their old age. 49 Extended family members often play a huge role in raising children, especially if both parents work. Some Saudi families have been known to specifically hire domestic workers or commonly called khadama or servant with English skills so that their children grow up speaking English and absorbing some cultural cues. 50
Caring for grandchildren was also important for Saudi older adults. Some reported taking care of their grandchildren, providing for their needs, and offering care when the parents were away. However, many of the older adults became more dependent on others due to the land emotional imitations this responsibility imposed. 51 Socioeconomic status can encompass quality of life attributes as well as the opportunities and privileges afforded to older adults within the society. 52
Some of the Saudi older adults receive government support. 53 The Ministry provides the elderly with comprehensive care in health, social and psychological. The social care homes are spread throughout the regions of Saudi Arabia to provide financial and in-kind assistance to the needy elderly and their families through the Social Security Agency, and prosthetic devices such as wheelchairs, medical beds, and a program home care for the elderly within the family framework through a program of follow-up visits to them. 33
Reaching a certain age will prevent a person from practicing the activities they usually do, and they are anxious to become weak and a burden on the family. 54
Profound and Sincere Religious and Cultural Practices
Profound and deeper religious and cultural practices are part of the spiritual dimension. 55 Saudi older adults expressed deep faith in Allah. With Allah they are empowered to rise above their physical, intellectual, emotional, and social challenges and discover the peace and harmony that facilitates their healing and well-being. Saying “Alhamdulillah” is a recognition of Allah’s blessings and use those blessings to do good. It is gratitude transformation from a feeling into a lifestyle. 56
A notable characteristic of Saudi older adults is their closer relationship with Allah in their later years. As reported in a published article, religion is a core aspect of everyday life in the Saudi Arabia, playing a dominant role in the country’s governance and legal system, and daily life. The official religion is Islam, with the majority of Saudi citizens being Sunni Muslims, roughly 90%. It is estimated further 10% of Saudi citizens are Shi’a Muslims. There is also a large expatriate community of various faiths, both Muslims and non-Muslims. 57
For centuries, the people of the Arabian Peninsula have possessed a strong identity based upon the tenets of Islam. Saudi Arabia is a modern nation that adheres to Islam, honors its Arab heritage and tradition, and presses vigorously forward in the service of Islam while securing the welfare of its people. 58
Many of the Saudi older adults hope that opportunities for new adventure and pleasure of life will unfold with each tomorrow. 59 In an article published, some studies have found that older adults who are very religious and use religious coping mechanisms are less likely to develop depression and anxiety and have a greater sense of psychological well-being. 60
Appreciating and Valuing the Meaning of Life
Understanding and valuing the meaning of life through Allah belongs to the spiritual dimension. 61 Many Saudi older adults are still in search for the meaning of their lives. They have a strong sense of moral values and reflect the mysteries and wonders of life. 62
In a qualitative study published on the meaning and role of spirituality for older adults, the results indicate that spirituality may play a crucial role in guiding older adults’ lives and can help them clarify the meaning of their lives. 63 The level of religious participation is greater among older adults than any other age group. A sense of meaning and purpose in life is one of the mental health benefits. 60
Older adults find meaning in life through different processes. Human relationship is the major source of meaning. 62 Recognizing the inevitability of death was also verbalized by the majority of the Saudi older adults. They stated that death comes anytime, destiny, a final judgment, no one is exempted. They consider death as gift from Allah. Majority of them believed the death is part of life. 64
Recalling the Most Memorable Moments in Life
Remembering significant moments in life, whether positive or negative, as well as experiencing forgetfulness, are all part of the cognitive dimension. 65 Erikson’s theory emphasizes that older adults must change and adapt their behavior to maintain control over their lives. If the older adult can achieve their tasks according to the stage in personality development, she or he will be able to accept satisfactorily and accomplish the task gracefully. This will resolve and attain a sense of integrity in older adult’s life. 66
The death of an immediate family member or close friend is the saddest event that may happen in the lives of most Saudi older adults. The sudden death of family members or relatives is considered the saddest moment they experienced. Some of them could not forget the loss of their loved ones. According to an article published by Heid, losing someone in the family or close friend can be a traumatic event in someone’s life. Many experts say that if a loved one dies, there is a process that people go through. Holding on to fond memories of a spouse, child, parent, or friend who died is very likely stay for so long. 67 Moreover, experts say that human life and relationships are a gift that should be cherished. 68
Due to the many losses and challenges in late life, the older adult may be heavily stressed by their emotional, physical and social burdens which could lead to mental problems and illness. 1 A published article states that memory loss is not an inevitable part of the aging process, a person can train his brain and learn new things at any age. 34
On the other hand, one of the common experiences that Saudi older adults encountered was forgetfulness. This common forgetfulness indicates that the majority of Saudi older adults face challenges brought about by aging. This decline includes increased difficulty learning new things such as languages, decreased attention span, and increased forgetfulness. 29
Forgetfulness is another aspect of the aging process that Saudi older adults are confronted with. There are negative labels that younger generations have associated with it such as loss of memory or slips of their memory and use the term “senior moment” which gives more negativity for older people. 69
As people get older, they might experience more frequent instances of memory loss. Some people may notice that it takes longer to learn new things; they tend to forget information or lose things like their glasses. 70 It would be helpful if they have small notebooks or sticky notes on their refrigerators as a reminder. 71 Common strategies to address forgetfulness are the following: always read newspapers or books to update oneself regularly, take a list when shopping or buying something else, keep a list of important contact numbers, use post-it notes, make more permanent signs that are visible and use an alarm clock or an alarm watch. 72
According to one study, almost 40% of people over the age of 65 experience some form of memory loss. This memory loss in old age is a normal process of aging. 73 Aging is the common underlying pathophysiology of sarcopenia and frailty. 74
One of the challenges that older adults may undergo is Alzheimer’s disease. As the person gets older, memory lapses become occasional. Studies have shown that preserved thinking skills later in life and a reduced risk of Alzheimer’s disease are associated with participating in social events, reading, dancing, playing board games, creating art, playing an instrument, and other activities that require mental and social engagement. 75
Promoting active and healthy lifestyles is the key improved mental health of older adults. Specific health promotion for older adults involves creating living conditions and environments that support well-being and. Allow older adults to lead healthy lives. Promoting mental health depends largely on strategies. 76
Implication
Graceful aging is the combination of physical, emotional, social, spiritual, and mental aspects that have been successfully developed, leading to what is known as successful aging. 1
The findings of this study offer a significant contribution to the field of gerontology, particularly in the context of older adult nursing practice. By exploring the lived experiences of Saudi older adults, the study uncovers how these individuals engage in their routine activities. In doing so, it provides a perspective that contributes to the literature on how to enhance and achieve successful aging.
This inquiry provides a richer understanding of how Saudi older adults live holistically, often with different traditional and cultural practice. These insights meaningfully expand the current theoretical framework. For instance, in an article published by Stowe and Cooney regarding Rowe and Kahn’s concept of successful aging, the holistic experiences of Saudi older adults are emphasized as a lifelong process that is contextually influences by development, including culture and place, historical time, social-relational factors. Thus, the findings reflect a life course perspective. 77
This study serves as a guide for the Saudi government, especially policymakers. It highlights the need to enhance the life expectancy of Saudi population in general. Despite the challenges faced by most of Saudi older adults, their experiences point to the need for the development and enhancement of current practice to meet their needs in both public and private agencies.
In essence, this research enriches the knowledge of gerontology, informs nursing theory, and offers a practical foundation for policies. These insights are relevant for shaping nursing education, practice, and research worldwide.
Conclusion
The research on the diverse faces of Saudi older adults has several implications primarily for public and private utilities and facilities, healthcare services, and special programs and activities. In addition, there are some implications secondarily for nursing education, nursing practice, and gerontology nursing research.
Government authorities and private agencies may intensify efforts to ensure all public services and facilities are age-friendly for Saudi adults and comply with their specific needs. Given that older Saudi adults who experience frailty, they need to be supervised and monitored closely. The use of appropriate facilities and safety measures that could help them feel more comfortable, such as providing clutter-free pathways, wide-open ramps, bare flooring, sufficient lighting, hand or grab bars, accessible stairways, mechanical elevators or lifters, and other accessible devices, is highly recommended.
Saudi older adults require consistent access to maintenance medications. Professional healthcare providers should continuously monitor and assess these medications. The health agency may develop a create, simple, and easy guideline to promote proper nutrition among Saudi older adults. This guideline may serve as a basis for them to follow, as well as a reminder to take their medicines regularly. Increased access to telehealth and other online services might be intensified.
There is a need for the Ministry of Health (MOH) to strengthen and initiate more special programs and activities that will promote health among Saudi older adults in every community. The Ministry may also increase and develop more visible, meaningful, achievable, environment-friendly, and long-term programs that will support and promote wellness among Saudi older adults.
In addition, the Ministry may strengthen its annual program that will focus on and encourage all Saudi families to celebrate a national day for the family. This will help them to build a strong family bonds and relationship, which are necessary for the development of emotional and psychological stability among family members.
Since Saudi older adults experience personal and emotional challenges, the agency may need to provide adequate professional psychologists in each health center or dispensary who are present, visible, and readily available for consultation.
The Ministry may need to intensify efforts to ensure all Saudi people, especially the economically disadvantaged, are provided with education. This support will help the older Saudi adults send their children to school and earn a degree, which many consider a great achievement and a source of happiness.
For nursing practice, the limited avenue for gerontology nursing in the Kingdom of Saudi Arabia poses a great challenge to Saudi nurse practitioners to enhance their knowledge and skills. Thus, nursing education should prepare future nurses for exposure to gerontology nursing. Saudi nurses need training, workshops, and a higher level of education for gerontology nursing.
Increasing the number of older adults’ facilities that cater to them must be highly prioritized in all areas of Saudi Arabia. However, the low number of trained gerontology nurses in Saudi Arabia also places a big strain on elderly facilities. In addition, there are only a few Saudi nurses who practice gerontology nursing. Most of them likely acquired their clinical skills through experience in older adult facilities and relied upon other foreign nurses. Additionally, there is a need to enhance the knowledge of all Saudi people about aging, support and service, healthy lifestyle, telehealth, and other topics about older adults.
For the Ministry of Education (MOE), specifically in the academe or educational institutions, the exposure and experience of student nurses to elderly facilities are also very limited. At present, student nurses spend less time on their clinical experience in gerontology nursing. Likewise, the theory or concept of gerontology nursing has not been integrated fully into the course specification. Therefore, a national standard for gerontology in the nursing curriculum must be established in all colleges and universities in Saudi Arabia.
Lastly, the literature review revealed that there are few, or even a lack of, studies on gerontology nursing in Saudi Arabia. There is very few published research focusing on Saudi older adults and gerontology nursing. Thus, more engagement in publication and research should be conducted on gerontology nursing pertaining to Saudi older adults.
Footnotes
Acknowledgements
The authors would like to thank the Deanship of Scientific Research at Shaqra University for supporting this work.
Author Note
I, Jose Colin C. Yee, Ph.D., the corresponding author, declare that this manuscript is original, has not been published previously, and is not under consideration for publication elsewhere. I confirm that all named authors have read and approved the final output or version of the manuscript and consent to its submission to INQUIRY. I accept responsibility for communicating with the Executive Editor on behalf of all authors regarding the editorial process, revisions, and final proofs.
ORCID iDs
Ethical Considerations
Scientific Research Programs Committee, Shaqra University.
Author Contributions
Jose Colin C. Yee, Ph.D.: Principal Investigator, conceptualization (lead); writing – original draft (lead); writing – review and editing (lead); writing – final manuscript (lead); methodology (lead); data saturation and thematic analysis (lead). Nahed Alquwez, Ph.D.: Project Coordinator, conceptualization (equal); writing – original draft (equal); writing – review and editing (equal); writing – final manuscript (equal); methodology (equal); data saturation and thematic analysis (equal). Khalaf Alotaibi, Ph.D.: Research Associate, conceptualization (equal); writing – original draft (equal); writing – review and editing (equal); methodology (equal); data saturation and thematic analysis (equal). Hanaa Diab Khalfallha, Ph.D.: Research Associate, writing – review and editing (equal); methodology (equal); data saturation and thematic analysis (equal). Abdulellah Alsolais, Ph.D.: Research Associate, writing – review and editing (equal); data saturation and thematic analysis (equal). Ahmed Mohammed Almoghairi, Ph.D.: Research Associate, writing – review and editing (equal); data saturation and thematic analysis (equal). All authors discussed and validated the final results and contributed to the final manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data underlying this study are not publicly available due to data privacy.
Grant Number
Approved study with research reference number ERC_SU_F_202400041.