Countries and cities around the world are searching for ways to plan urban development to accommodate the growing demand for public infrastructure and amenities due to high rates of urbanization. Urban policies deemed to be successful are often adopted by other cities and hence applied across contexts. Urban Policy Mobility (UPM) theories study the ways in which political relationships, power dynamics, and other potential drivers influence the circulation of urban policies. UPM provides a guiding framework to analyze the policymaking associated with mobilized urban policies to understand the socio-spatial processes that motivate the adoption of urban policies from elsewhere. This dissertation engages with the UPM literature by investigating the assemblage and implementation processes of a mobilized urban policy to explore how the fixed socio-spatial processes embedded within a particular planning culture interact with and absorb a flowing urban policy. The term flowing in this study refers to the process of transposing policies from one place to another. Little attention has been paid to how the planning culture in a developing country can shape the adoption (or non-adoption) of certain policy elements, and what challenges arise during the implementation of a flowing urban policy. Given this context, this study answers two research questions: (a) How does urban policy mobility unpack in practice in response to local socio-spatial processes? and (b) What challenges emerge when policies are transposed into new urban policy environments that are dissimilar from those in which they originated? A case study methodology was used to study the changes that occurred when a Transit-Oriented Development (TOD) urban policy was introduced in Riyadh, Saudi Arabia. A qualitative content analysis of archival resources, documents, and semi-structured interviews revealed how local urban planning conditions and challenges influenced Riyadh's TOD assemblage and implementation. Public officials and consultants from Riyadh, national officials, and experts were interviewed to develop a clear understanding of the TOD policy assemblage and implementation processes. The two main findings from this research are that: 1) there was an incomplete translation of TOD into the local planning culture, primarily due to Riyadh's stronger emphasis on the density, diversity, and design features of TOD and less concern with the sustainability dimensions; and 2) several governance and prioritization challenges emerged during the policy implementation process, which stem from institutional constraints and institutional and resource gaps. This research expands the UPM field by tracing the trajectory of policy mutation due to local socio-spatial processes. Additionally, this study provides a conceptual framework that synthesizes three heterogeneous elements: planning culture, planning policy, and policy carriers. It offers a methodological contribution that advances UPM analysis to better explain policy mutation. This study can be used as a cautionary tale for officials engaged in adopting urban policies that originate in other jurisdictions. / Doctor of Philosophy / City officials around the world are looking beyond their borders for urban policies that can promote sustainability and improve quality of life. However, those officials rarely consider how differences between urban areas can alter the nature of policies being adopted. To address this challenge, the field of Urban Policy Mobility (UPM) emerged to shed light on how the unique local factors that shape each city environment affect what elements of an urban policy are and are not adopted. This study examines the changes that occurred when a Transit-Oriented Development (TOD) urban policy was introduced in Riyadh, Saudi Arabia. In order to learn about the changes and challenges associated with Riyadh's TOD policy, interviews were conducted with employees responsible for the policy. Additionally, TOD policy documents and other publications that contained information about Riyadh's TOD were reviewed to build a deeper understanding of why certain policy elements were implemented and others were not. This study found that: 1) the TOD policy was not completely translated into Riyadh, with greater emphasis placed on increasing building density, diversifying land uses, and enhancing design aesthetics, and less on other important policy elements that enhance economic and social sustainability; and 2) the implementation of the TOD policy led to governance challenges due to the differences in how urban planning is undertaken in Riyadh compared to western countries. This in-depth study of Riyadh's experience can inform other cities that are looking to implement urban policies borrowed from other countries.

Riyadh city suffers from high housing and construction costs, which have increased by more than 200% over the last 7 years. This problem led to a significant interest from the government and the citizens of the city in understanding the causes of housing and construction cost escalation and the best strategies to address this problem in the short and long-terms, in order to find solutions for affordable housing. In response to the absence of research regarding this problem, the researcher has decided to conduct a scientific survey about the factors that might have led to this problem in Riyadh. While conducting the literature review, the researcher identified 16 possible factors that were mentioned as possible causes for this problem. Thus, the main objective of this study is to identify the main factors that affect housing cost escalation. All of the survey samples were collected from construction industry professionals and experts working in Riyadh. The sample size required was calculated using the statistical equation mentioned in Chapter 4, and based on an estimated level of confidence of 90%, standard error of 10%, and a standard deviation calculated from 30 random samples collected initially. The required sample size was estimated to be at least 215 surveys, and the researcher was able to collect a total of 237 surveys. After collecting the data, the researcher analyzed the data through Microsoft Excel software by applying descriptive statistics, means, modes, and standard deviations. Tables and figures have been used to show the results of the survey. After analyzing the data, the researcher identified the main factors based on the mode and mean averages. The researcher has identified four major impacting factors that affected housing and construction costs. The most impacting factors on housing and construction cost are the corruption in selling land, speculative purchases of land, high demand for housing, and the high population growth rate in Riyadh. The main recommendations that should help the government to solve this problem are: to apply an annual tax on large plots, prevent speculative purchases in housing areas, monitor the prices of consruction materials, and revive small cities around Riyadh to reduce congestion and crowding.

The purpose of this study was to explore and describe the surgical nurses’ perceptions about the management of post-operative pain and strategies employed in management of pain in patients who have undergone total hip or knee replacement surgery in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative, exploratory-descriptive research design was applied. Purposive nonprobability sampling was used and data collected by means of audio-recorded semistructured individual interviews. Data saturation was reached after interviewing twenty surgical nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. One of the key findings was that patients reportedly experience moderate to severe pain during the first three days after surgery, before it is controlled on mild to moderate levels or before the patient is pain free. Conclusions were drawn, and one of the major ones was that multimodal strategies are employed by the surgical to manage post-operative pain. Recommendations were also made from findings of this study, and one key recommendation was that expatriate nurses to have access to Arabic speakers to overcome language barriers. / Health Studies

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M. A. (Heath Studies)

The purpose of this study was to explore and describe the surgical nurses’ perceptions about the management of post-operative pain and strategies employed in management of pain in patients who have undergone total hip or knee replacement surgery in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative, exploratory-descriptive research design was applied. Purposive nonprobability sampling was used and data collected by means of audio-recorded semistructured individual interviews. Data saturation was reached after interviewing twenty surgical nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. One of the key findings was that patients reportedly experience moderate to severe pain during the first three days after surgery, before it is controlled on mild to moderate levels or before the patient is pain free. Conclusions were drawn, and one of the major ones was that multimodal strategies are employed by the surgical to manage post-operative pain. Recommendations were also made from findings of this study, and one key recommendation was that expatriate nurses to have access to Arabic speakers to overcome language barriers. / Health Studies / M.A. (Health Studies)

Road safety is a serious societal concern in Riyadh city, Kingdom of Saudi Arabia. Because of the negative impact of traffic crashes which cause losses in the form of deaths, injuries and property damage, in addition to the pain and social tragedy affecting families of the victims, it is important for transport policy makers to reduce their impact and increase safety standards by reducing the severity and frequency of crashes in the city of Riyadh. It is therefore important to fully understand the relationship between traffic crash severity and frequency and their contributing factors so to establish effective safety policies which can be implemented to enhance road safety in Riyadh city. Data used in previous research have only consisted of basic information as there was unavailability of suitable and accurate data in Riyadh and there are very few studies that have undertaken as small area-wide crash analysis in Riyadh using appropriate statistical models. Therefore safety policies are not based on rigorous analyses to identify factors affecting both the severity and the frequency of traffic crashes. This research aims to explore the relationship between traffic crash severity and frequency and their contributing factors by using statistical models and a GIS approach. The analysis is based on the data obtained over a period of five years, namely AH 1425, 1426, 1427, 1428, and 1429 (roughly equivalent to 2004, 2005, 2006, 2007, and 2008). Injury crash severity data were classified into three categories: fatal, serious injury and slight injury. A series of statistical models were employed to investigate the factors that affect both crash severity (i.e. ordered logit and mixed logit models) and area-wide crash frequency (i.e. classical Poisson and negative binomial models). Because of a severe underreporting problem on the slight injury crashes, binary and mixed binary logistic regression models were also estimated for two categories of severity: fatal and serious crashes. The mixed binary logit model and the negative binomial model are found to be the best models for crash severity and crash frequency analyses respectively. The model estimation results suggest that the statistically significant factors in crash severity are the age and nationality of the driver who is at fault, the time period from 16.00 to 19.59, excessive speed, road surface and lighting conditions, number of vehicles involved and number of casualties. Older drivers are associated with a higher probability of having a fatal crash, and, as expected, excessive speeds were consistently associated with fatal crashes in all models. In the area-level crash frequency models, population, percentage of illiterate people, income per capita and income per adult were found to be positively associated with the frequency of both fatal and serious injury crashes whereas all types of land use such as percentages of residential use, transport utilities, and educational use in all models were found to be negatively associated with the frequency of occurrence of crashes. Results suggest that safety strategies aimed at reducing the severity and frequency of traffic crashes in Riyadh city should take into account the structure of the resident population and greater emphasis should be put on native residents and older age groups. Tougher enforcement should be introduced to tackle the issue of excessive speed. This thesis contributes to knowledge in terms of examining and identifying a range of factors affecting traffic crash severity and frequency in Riyadh city.

This thesis examines public participation in regional development in Saudi Arabia at the local government level. The main objective of the study examines the current policies and practices of Riyadh Regional Council with regard to regional development, paying particular attention to the issue of public participation. Key decision-makers and decision locations are identified as focal points of policy development and implementation. The work begins from the premise that public participation is one of the key elements of effective regional policy that has so far been under-researched and consequently under-utilised in the Saudi Arabian context. The research opens by examining the national and cultural context of regional development in Saudi Arabia. It identifies and examines the relationship between policy development and the traditions and constitutional arrangements. These considerations are followed by an interrogation of the literature that reveals a range of concepts and perspectives on regional development and public participation. Of particular relevance to this study is the importance of the ‘institutional turn’ in regional development and the role of public participation in enhancing the functioning of those institutions associated with regional development. Saudi Arabia has an economy that is largely dependent on revenues generated from the export of crude and refined petrochemicals. This places Saudi Arabia in a category of nations that are liable to suffer from the ‘resource curse’. The literature suggests that avoiding this particular phenomenon is in part dependent on having robust institutions. This firmly connects the research problem to previous research and provides a sound rationale for the conduct of the study. / Interpretivism is advanced as a suitable philosophical framework for the conduct of the research. It offers a methodological rationale for a case study investigation that draws on a range of qualitative data sources. Such an approach is especially useful for examining situations that are bound in time and space and can provide theoretical and practical insights that are useful in other contexts. This research presents new insights into how local government in Saudi Arabia can develop strategies for enhancing public participation in the creation of regional development policies and practices. There has been recent rapid economic development in Saudi Arabia that has influenced overall planning directions and development achievements and made it possible for the government to achieve systematic progress in long-term economic diversification into industrialisation, education, health, transport, and communication and social services. Even so, the Saudi Arabian government is concerned about increasing public participation in all areas. The formation of the regional councils in 1992 can be considered as a step towards public participation in the socio-economic development of their regions. However, the findings of this research demonstrate that there is a need for creating new policies and techniques to help regional councils in improving their performance to meet the needs of their citizens, and public participation is a key to achieving this end. To do this it is recommended that the councils should be granted executive and legislative authority to enable them to take adequate decisions and work together with citizens in ways that will increase their participation leading to enhanced transparency and accountability and effective regional development policy. / Following the findings, a set of recommendations are provided to improve the role of Riyadh Regional Council in enhancing public participation in regional development. This thesis closes with suggestions and directions for future research with regard to the potential contribution to the public sector management literature. The findings of this research provide benefits for policy makers to correct, maintain, and eliminate any obstacles facing administrative policies and consequently provide a long-term strategy that could incrementally be implemented in stages throughout time. The research methods, ideas and insights developed here could also be adapted and applied to other nations facing similar issues.

The purpose of this study was to determine the views of nephrology nurses regarding pre-operative education prior to kidney transplant. The study was conducted in Nephrology Ward in King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Qualitative descriptive design was used. Purposive non-probability sampling was used until data saturation occurred. Target population were registered nurses working in the Nephrology Unit. Both male and female nurses aged between 25 and 59 years working for a period of at least one year in the Nephrology Unit were included in the study. Data saturation was reached after interviewing 15 nephrology nurses. Themes and categories emerged from adopting Creswell’s (2013) “data analysis spiral”. Some of the key findings were that pre-operative patient education is a multidisciplinary team approach and that psychosocial aspects of the patients should be taken into consideration before educating the patients. Conclusions were drawn and recommendations were also made from findings of this study. Ultimately, key recommendations were that there is a need to train and empower nurses in importance of delivering pre-operative education and that expatriate nurses have access to Arabic speakers to overcome language barriers while educating the patients / Health Studies / M.A. (Health Studies)

Since the early 1960s the government of the Kingdom of Saudi Arabia (KSA) has had several urban development strategies that have been designed to spearhead development through the deployment of internationally recognised architects and urban planners. The adoption of this strategy has opened debate on the paradigm shift away from restrictive planning regulations at both national and regional levels. The process has enabled foreign policies and ideas based on internationalisation to drive the new urban centre developments in Saudi cities including Riyadh and Dammam. In 2008, this key shift saw the traditional restrictive urban development strategies, which prescribed – among other things – the number of storeys a building could have, being replaced by a strategy permitting an unlimited number of storeys. This dissertation examines the role played by international firms of architects and developers in shaping how architecture is practised in the Kingdom. The process has led to the adoption of modern architectural styles and has advanced a modernised planning approach, whereby traditional architectural structures and the use of local materials have gradually been replaced by modern styles, high-tech buildings and the use of new foreign materials, causing the loss of historic buildings throughout the country. This is seen by many to constitute an injury to national culture and could lead to cultural conflicts that may be exacerbated by the possible importation of planning principles and regulations. A chronological review of internationalisation and how international architectural practices have been mobilised to work in the KSA reveals the impact of this process on the Kingdom’s urban development. While this may be desired by the authorities, it has been argued that the process does not seem to provide any clear strategy for the implementation of the desired sustainable urban centre development in the KSA. Hence, in the absence of clear directives, international architectural firms operate their own set of sustainability criteria to deliver the desired urban centres in the Kingdom. There has been little or no research into the mobilisation of international firms and foreign policies, nor into the impact of internationalisation on the development of planning codes, the modernisation of urban centres and the sustainability approach espoused by the KSA’s planning development strategy. This study investigates the impact of the participation of international firms in Saudi Arabia’s urban development. Government planning regulations and master plans are reviewed and a case study is conducted to identify the factors behind the engagement of international firms in the delivery of two capital projects: the King Abdullah Financial District in Riyadh and the Central Business District in Dammam. The study also explores the concept of sustainability and the engagement of foreign firms from the perspectives of various stakeholders through face-to-face interviews and a structured questionnaire. It establishes how the role of internationalisation as a driver of policy mobility has impacted on the new sustainable urban centres and in addition, how internationalisation has been operationalised through the notion of sustainability. Although planning codes and regulations may have been developed with good intent by the international firms concerned, their implementation has not yielded the desired result of delivering sustainable urban centres in the KSA. Thus, there is a conflict between a rapid urban development which seeks to integrate historical and traditional contexts on one hand, and the continual import and impact of globalised morphologies on the other. This leads to clear demarcations in urban evolution, making this conflict one of the key characteristics of emerging urban centres in the KSA.

The Kingdom of Saudi Arabia (KSA) faces an increasing chronic disease burden. Despite the increase in numbers of primary health care centres (PHCCs) current evidence from the KSA, which is limited overall, suggests that access and utilisation of PHCCs, which are key to providing early intervention services, remain unequal with its rural populations having the poorest access and utilisation of PHCCs and health outcomes. There is a dearth (lack) of information from the KSA on the barriers and facilitators affecting access and utilisation of primary health care services (PHCS) and therefore this study aimed to examine the factors influencing the access and utilisation of primary health care centre (PHCC) in urban and rural areas of Riyadh province of the KSA. The behavioural model of health services use (Andersen’s model) provided the contextual and individual characteristics and predisposing, enabling and need factors which assist with an understanding of the barriers and facilitators to access and utilisation of PHCCs in Riyadh province. A mixed methods approach was used to answer the research questions and meet the objectives of the study. The converged qualitative and quantitative findings show that there are a number of predisposing (socio-demographic characteristics; language and communication and cultural competency) enabling barriers such as; distance from PHCCs to the rural residence, lack of services, new services, staff shortages, lack of training, PHC infrastructure, and poor equipment. Facilitators: service provider behaviour/communication, free PHCS, service provision and improvements, primary health care (PHC) infrastructure, manpower, opening hours, waiting time, and segregated spaces and need (increasing prevalence of chronic diseases, PHC developments in the KSA) factors influencing access and utilisation of PHCS. This study highlights important new knowledge on the barriers and facilitators to access and utilisation of PHCS in Riyadh province in the KSA. The findings have some important policy and planning implications for the MOH in the KSA. Specifically, the findings suggest: the need for clear documentation/guidance on minimum standards against which the PHCS can be measured; an audit of service availability at the PHCCs, regular patient satisfaction evaluations of PHCS, that the MOH take a parallel approach and continue to resource and improve buildings and equipment in existing PHCCs, the recruiting of more GPs, nurses, pharmacists, nutritionists and physiotherapists to meet patient demand and more Saudi health care staff, more targeted health education and interventions for the prevention of chronic diseases in the KSA and the need for an appointment system for attending the PHCCs. There is a need for further research into the barriers and enablers to accessing and utilising health care in Riyadh and the KSA overall. This research would be made easier with a clearer definition of rural and urban in the KSA context which would allow a greater comparability between urban and rural PHCS for future research, audit and evaluation as well as comparison with PHCS in other parts of the world. The Andersen model provided a useful conceptual model to frame this research and provided a structure for contrasting and comparing the findings with other studies that have used the Andersen model to understand the barriers and enablers to accessing and utilising health care services.