Factors influencing decisions to seek mental healthcare in the Arab Gulf states: a qualitative thematic analysis (2025)

Background

There is a lack of comprehensive research on the mental health needs of individuals in the Gulf Cooperation Council (GCC) countries, so further exploration is needed to understand the barriers to accessing available mental healthcare services. This study examined the factors influencing individuals’ decisions to seek mental healthcare in these countries by analysing the public’s engagement with a mental health campaign on social media.

Methods

We conducted a reflexive thematic analysis of people’s comments in response to a mental health campaign posted by the Gulf Health Council on four social media platforms: TikTok, YouTube, Instagram, and X (previously Twitter).

Results

The analysis included 2,146 comments. Barriers to seeking mental healthcare fell into several themes: personal, family, societal, religious, cultural, and healthcare service barriers. Misconceptions and misinformation were key barriers to seeking mental healthcare, as well as religious and societal perceptions of mental health and the stigma surrounding mental illness. Factors influencing accessibility to professional help included the cost of mental healthcare, lack of competent healthcare professionals, and concerns over privacy and confidentiality.

Conclusion

Our research identified several factors that affect accessing mental healthcare in the GCC, including personal, family, societal, cultural, religious, and healthcare system factors. We expect that the findings will inform the development of policies and interventions designed to facilitate access to mental healthcare services in the GCC.

Mental health illnesses are recognised as a leading cause of disability worldwide [1]. Evidence suggests that disability-adjusted life years (DALYs) associated with mental health have increased from 80.8million people in 1990 to 125million in 2019, with 4.9% of global DALYs attributed to mental disorders [1]. In the Middle East and North Africa (MENA) region, mental disorders contribute to 4.7% of total DALYs [2], which ranks as the ninth leading cause of disease burden in the region [2]. This burden of mental disorders calls for an increase in the quality and access to mental healthcare.

Although there is a growing need for mental health support, reports show that only a small proportion of individuals who require mental health assistance seek or receive it [3]. This may be attributed to various factors, including social and cultural influences [4]. A systematic review of studies exploring beliefs and behaviours towards people with mental illness in the Arab population found that stigma and negative attitudes towards mental health treatment act as barriers to seeking professional help [5] and are exacerbated by limited mental health literacy, even among healthcare professionals [6, 7]. Although mental health services were available, service users are generally dissatisfied and have negative experiences with them [8], therefore further discouraging people from accessing mental health support.

Several countries in the Gulf Cooperation Council (GCC) have taken steps to address the growing mental health needs. These include developing strategies to improve the availability and accessibility of mental health services, promoting overall mental well-being, and reducing the stigma associated with mental disorders [9,10,11]. More recently, in September 2021, the Gulf Health Council (GHC) launched an awareness campaign to promote mental health among people aged 11–25 in the GCC. The GHC is dedicated to improving the health of communities in the GCC through various initiatives and programs [12]. One of its key goals is to promote health awareness, taking account of cultural and religious elements in the region. The GCC is a part of the MENA region and includes Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. The predominant religion in these countries is Islam, and the primary language is Arabic. The campaign aimed to change the negative societal perception of mental health and encouraged parents to recognise and address their children’s mental health issues [13]. It included mental health assessments, educational materials and manuals and was launched on GHC’s social media platforms for three months.

The campaign gained significant attention and reactions from the public, sparking discussions and sharing experiences regarding mental healthcare in the GCC region. Previous evidence emphasised the necessity of thoroughly exploring the connection between mental health needs and the services offered in the GCC countries [7]. It has also been noted that the factors influencing help-seeking behaviours in Arab countries have not been extensively researched [4]. Consequently, examining the public’s response to mental health content and messages is critical for addressing mental healthcare challenges in the region and developing future mental health interventions.

The study examined factors that affect seeking mental healthcare in the GCC by conducting a qualitative thematic analysis of the public’s comments in response to the mental health campaign posted by GHC on four social media platforms: TikTok, YouTube, Instagram, and X (previously Twitter).

The majority of GHC X account followers are males 18 to 44 years of age. In contrast, most Instagram account followers are females 25 to 44 years old, while the majority of YouTube account followers are males 18 to 34 years of age [14]. This suggests a diverse range of characteristics among GHC’s social media followers.

We used the ecological model to explore barriers and facilitators influencing people’s decisions to seek and access mental healthcare. The model suggests that various interconnected factors influence health decisions [15] by providing a comprehensive set of factors beyond focusing on individualistic models, and so challenges the idea that individuals make rational decisions in seeking healthcare based solely on their characteristics [16]. Instead, it proposes that various interconnected factors influence illness and health behaviour [15]. These factors encompass personal, institutional, community-related, and public policy elements [15].

Data collection

The public’s comments on the campaign’s content were collected from the beginning of the campaign on September 1st, 2021, until ten days after the last content was posted on December 10th, 2021. We did not anticipate any additional relevant comments being posted ten days after the campaign, as evidence suggests that posts on top social media platforms typically receive half of their total engagement quickly, ranging from seconds to under nine days [17].

A total of 2,921 comments were extracted into Excel for data cleaning. Figure1 details the comments included from each platform and the data cleaning process. We excluded duplicate comments and comments that were mainly advertisements or unrelated to the research objective.

Data analysis

We conducted a reflexive thematic analysis of the comments using the stages of Braun and Clarke [18], coded using ATLAS.ti software. During the familiarisation stage, two authors (SA & NA) reviewed the comments before coding. The lead author (SA) coded the entire dataset and conducted the initial analysis of the comments. The senior author (NA) independently double-coded a random sample of the comments. All code discrepancies were discussed among the authors, and amendments were made as necessary. Both SA and NA are Saudi female public health researchers who are experienced in qualitative studies.

In the next stage, the codes were grouped and categorised using the study’s theoretical framework. The identified factors were then assessed and grouped using the ecological model of health. Meetings were held to ensure agreement between the authors on categorising each factor and identifying themes. All quotes included in this report were independently translated from Arabic to English by two authors (SA and NA), and then the final translation was jointly agreed upon.

Ethical considerations

We acknowledge the complexity of using data from social media platforms for research purposes [19]. However, these platforms are considered public, and data that has been posted publicly have been previously used to explore mental health-related experiences [20]. To protect the privacy of comment authors, we did not report any comment verbatim, did not include any identifiable information, and excluded comments from private accounts.

The analysis included 2,146 comments. Factors that affect seeking mental healthcare were categorised into several themes (see Fig.2): personal, family, societal factors, religious and cultural barriers, and healthcare service level barriers.

Personal level factors

One of the significant barriers to seeking mental healthcare was a lack of awareness. People did not understand that mental health issues existed, which prevented them from seeking appropriate medical help when needed. For example, commenters expressed concern about their mental health but were unsure if they were suffering from mental disorders. This was confirmed by the comments asking for more information about mental health disorders.

“How can I tell if I have a mental illness?“(TikTok).

”I want to know what the treatment for obsessive-compulsive disorder is?“(TikTok).

Other people mentioned that they were not aware of where to seek help for potential mental health disorders. They lacked knowledge about whether mental health issues are treatable and how to access medical help.

“What is the treatment for social anxiety? And are there any medications for it? Can you suggest a specific clinic or a doctor to treat it?”(Instagram).

Misconceptions and misinformation about mental health treatment were also evident in the comments. Commenters questioned the benefit of seeking professional help and portrayed mistrust in therapists. Others suggested that mental health treatment is fake and damaging, indicating that medications for mental health disorders only numb the condition rather than treat it. Commenters also expressed worries over the long-term effects of medication, such as dependence and addiction.

“So, what is the benefit of a therapist? I don’t see any benefit at all. I tell them about my problems, and they give me the same solutions as other people in my life. Medications are not a radical solution either.”(TikTok).

“Going to a specialist who will provide a treatment for half a million [Riyal] so that they can tell me: “It’s okay, you can do it!”.”(TikTok).

“What treatment are you referring to? If the patient takes the medication, they will become addicted, and if they try to stop, the addiction will destroy their life.”(TikTok).

Other comments emphasised a lack of knowledge of coping skills to manage mental health issues like stress and anxiety while being aware of their importance. People expressed the need to acquire skills such as stress management, identifying anxiety triggers, and effectively dealing with them without letting them disrupt their daily routines.

“Sometimes I feel anxious without any reason. I would love to know what triggers it and how to deal with it, but I don’t know how.”(Instagram).

Family factors

Commenters pointed out the importance of family and community in promoting mental health, particularly for adolescents and young people. The family was often identified as the main barrier to seeking professional help. Families’ denial and dismissal of mental health issues prevented their children from getting the professional help they needed.

“We understand and acknowledge the importance of mental health. However, who can convince and educate parents and families when they dismiss their children and believe they know better.”(TikTok).

Young people mentioned that they had to wait to be of legal age to seek professional help for mental illness, as parental consent is required for mental health services.

“I am just waiting until I become 18 years old [to get treatment].”(TikTok).

Lack of family support can cause individuals living with mental health issues to conceal their condition from their families. The fear of sharing a diagnosis with family members can lead people to experience and cope with mental health problems alone. Some commenters explained that instead of being a source of support, certain families may mock or stigmatise their children if they express their mental health struggles.

“Please take those who suffer from mental disorders seriously. Do not ignore their feelings and their suffering, do not abuse them, and stand by them. They desperately need their family’s support. They are suffering in silence.“(TikTok).

“If I talked, my family would laugh at me. They would never acknowledge what I have and contribute to my mental suffering.”(TikTok).

Stigma and lack of access to professional treatment and support can lead to severe and irreversible consequences, including suicide attempts and acts of self-harm. In some cases, families might choose to confine their children or family members when they observe signs of mental health issues.

“My family doesn’t want me to go to a doctor. I tried to commit suicide. I tried to cut myself, and I tried to jump [off a building], but they say you’re fine, you are just spoiled.”(TikTok).

“They [people with mental illness] require support and care. I know someone who is given therapy and expert treatment, but she is locked up at home, and they do not let her go out anywhere.”(TikTok).

Since the campaign targeted younger populations and their parents, commenters emphasised the importance of families in monitoring and evaluating their children’s mental health. It was stated that families should actively provide the space and understanding needed to promote their children’s mental health. Many comments called for maintaining a loving and supportive relationship between children and their parents. However, other commenters disagreed and believed in authoritarian parenting, advocating for discipline rather than befriending their children.

“The most important point is noticing the symptoms. A large proportion of people who suffer from mental disorders would be much better if those around them were more aware, especially during childhood.”(Instagram).

“Befriend your son??! Your son does not want a friend; he wants a parent. Friends are for playing with and having fun. When you befriend your son, you will have to engage with him in his activities, such as playing video games or sending him videos on Snapchat; they should be intimidated by you [the parent].”(X).

It was also suggested that the way society views mental illness is the main reason why families may not fully support their children in addressing their mental health. This denial was seen as a cultural norm.

“I feel pressured in my life and education, and my family doesn’t care about my mental health due to our customs and traditions.”(TikTok).

Societal factors

Fear of stigma and social exclusion often prevents people from seeking medical care and disclosing their mental health status. Disclosure of mental illness was linked to fears of social isolation and deprivation of fundamental rights. Several commenters expressed fear of losing their jobs or being unable to find employment if they revealed their mental health status.

“I have a problem that was diagnosed two years ago. Now I am scared that if I meet someone and they know about my mental illness, they will leave me, and no one will stay by my side.”(TikTok).

“I would like to seek help, and I know it is good for me. But once I am diagnosed with a mental health problem, it will be included in my medical records. This will influence my chances of employment, making it difficult and near impossible for me to be employed even if I had highly desirable qualifications.”(TikTok).

Commenters emphasised the importance of addressing stigma and creating a supportive social environment to enhance mental health. The impact of society on mental health is complex, influencing personal, familial, and social factors. Consequently, ensuring a supportive environment for individuals with mental disorders extends beyond the immediate family.

“Mental health requires a supportive, humanitarian, respectful, and inclusive social environment as well as educated and skilled professionals.”(TikTok).

“God knows how much I’m suffering, facing abuse and contempt because of my condition. I wish I could die and stop suffering. Our environment does not help us get better.”(X).

Religious and cultural factors

Commenters discussed the interplay between mental health and religion. Many expressed the belief that a lack of connection with God and weak faith can lead to mental illness. This perception led some to doubt the need to seek medical help for mental health issues as they believed that religious failings cause mental illness. Some were adamant that the only solution for mental illness was religion and being close to God.

“Mental health requires constantly praying and reading the Qur’an [the Muslim holy book]. Stop that nonsense.”(Instagram).

”Read the Qur’an; it will cure any mental health issue, anxiety, depression, and distress. God says: Pray to Me, and I will respond to you… improve your relationship with God, and everything will be better.”(X).

The connection between mental health and religiosity implies that those experiencing mental illness should accept and endure it, as part of being religious involves accepting God’s will and His destiny for them. To support this idea, some commenters referenced Qur’anic verses that encourage seeking refuge in God.

“Mental health can be achieved by trusting in God’s destiny and accepting both the good and the bad. Worshiping God as He should be worshipped and consistent with prayers and remembrances is important. Spending time reading the Qur’an at night can be beneficial and will eliminate the need for psychiatric help.”(Instagram).

“This is nonsense. The only psychological treatment in the world is the Qur’an. There are multiple reasons for this. God Almighty said, “Call upon Me, I will respond to you.” Psychological treatment is nonsense.”(X).

Some commenters shared their experiences of using religion and faith to treat their mental health issues, reaffirming the strong connection between mental health issues and religious practices.

“Now that God has guided me to prayer, my mental health is better than it was before when I was not praying, even though I still have many misfortunes in my life, but my mental health is good thanks to God.”(TikTok).

Linking mental health with religiosity can lead to feelings of shame for those suffering from mental health issues. This connection significantly contributes to the stigma and taboos around mental illness. Mental illness is often attributed to witchcraft, demon (Jinn) possession, or moral and religious failings. This belief acts as a barrier to seeking professional help, leading people to often seek religious healers instead of medical assistance.

“Most families do not know what a psychiatrist is. Once they see their child depressed or isolated from other people, they would take them to the religious healer and say they are possessed by a demon (Jinn) and require exorcism.”(Instagram).

Some comments acknowledge the importance of religion for mental health but still believe in the importance of seeking professional medical treatment. It was often mentioned that religion encourages seeking help for any problems, including mental health. Commenters emphasised that seeking medical treatment does not undermine religiosity.

“Staying connected to God and prayers are all obligatory things and can also comfort the heart, but the medical aspect must also be considered. If I become seriously ill, God forbid, I must pray to God to heal, but at the same time, I will definitely go to a doctor to treat me and figure out the reasons… The same applies to mental health.”(Instagram).

“Those who say prayer is the solution, this is partly true, but we must also seek medical treatment. Pray, read the Qur’an, and also get treated.”(TikTok).

“Do not engage in a conversation with whoever says the cure is the Qur’an. Certainly, the Qur’an is a cure for the soul, but this is a disease that needs medical help and treatment.”(TikTok).

Individuals living with mental health issues also expressed that seeking medical care would assist them in their religious practices. Mental health struggles were thought to have a detrimental impact on their ability to engage in and enjoy various activities, including spiritual practices. This was frequently cited as a reason to prioritise mental health, as it was believed to enhance the inclination and drive to become more devout in faith.

“I am tired of having an obsessive-compulsive disorder with my prayers. When it’s time to pray, you cannot imagine how many times I must repeat my ablution and how many times I repeat my prayers. So please stop acting holier than thou and making us think our mental illness is because we don’t pray.”(TikTok).

“Whoever says prayer is the solution, in fact, for those who suffer from depression, you will not be able to enjoy prayer, and everything will be dark in your view. I do not underestimate spiritual acts of worship, but you must consult a specialist.”(TikTok).

Many comments emphasised the importance of distinguishing between mental health issues and spirituality. Some stressed that there is no connection between mental health and religion. While becoming more religious may enhance spirituality, mental health issues need to be addressed with medical help.

“We need to separate these two. Mental illness has nothing to do with religion.”(TikTok).

“To those [in the comments] who say prayer and faith are the cure: when will you understand this is a psychological thing that has nothing to do with faith.”(TikTok).

Due to the intricate relationship between religion and mental health, some individuals highlighted the significance of providing “culturally appropriate” content. They believed that promoting mental health through non-religious means may not be culturally or religiously fitting. Mental health promotion was perceived as a Western idea that is irrelevant to Muslim communities.

“Do you honestly believe the solution is to practice yoga or breathing exercises? No mention of religious education. Doing anything other than religious practices is blasphemy.”(X).

“The West has worsened the illness, and the numbers are continuing to increase there. Going back to religion and doing what God has asked of us is the cure.”(TikTok).

Healthcare services factors

People found the costs of professional consultations and mental health treatment to be a significant barrier to seeking help. Commenters who want to seek medical care without their parent’s approval highlighted that the main barrier to accessing mental health treatment is the lack of financial resources.

“Specialists are expensive, and I want to seek treatment without my family’s approval. Are there any centres with reasonable prices?”(TikTok).

“The reason for my anxiety is because I am broke and unemployed, and you want me to seek treatment! Where can I get the money?”(X).

“Mental health requires a specialist with five years of experience, and each session will cost you 400 riyals [over US$100]. Unfortunately, mental healthcare became a business.”(TikTok).

“Are you serious? Do you know how much seeing a professional will cost me, let alone the cost of the medications? I won’t be able to afford food and drink.”(TikTok).

While some noted that free mental healthcare is available, those with access to it emphasised the insufficient quality of the services. Public hospitals lack healthcare professionals who are skilled in treating mental illness and the necessary resources to provide comprehensive mental healthcare.

“Mental health requires a lot of money to go to a doctor who will treat you. You might be able to go to a public hospital and get free treatment, but you will be there for five years and see zero improvement. Unfortunately, one doctor even told me that I do not have the capabilities and resources to treat you.”(TikTok).

Commenters suggested that mental healthcare services are driven by profit, which causes a lack of trust in their value and benefits. To tackle this issue, some proposed introducing regulations on the prescription of medications and the costs of mental health services to enhance accessibility and make them more affordable.

“There needs to be close monitoring and regulation over the prices of mental health treatment and the astronomical prices of psychiatrists. I had depression for a very long time but could not afford a psychiatrist.”(Instagram).

In addition to the high cost, some commenters pointed out the shortage of qualified psychiatrists and psychologists.

“We do not have competent doctors, most of whom exacerbate the condition rather than treat it.”(TikTok).

Several people highlighted the importance of mental health services ensuring patient confidentiality and privacy. Some expressed concerns about the potential negative impact on their lives and careers if their mental health diagnosis was made public. As a result, they advocated for providing confidential and easily accessible mental healthcare.

“I am afraid to go to specialists as they will expose my diagnosis to my family. I don’t trust them.”(TikTok).

”Why doesn’t the GCC have a hotline so that anyone can call it at any time and provide quick and confidential care and preserve people’s privacy without even asking for the caller’s name?“(X).

In this study, we explored factors affecting the use and access to mental healthcare in the GCC. The public identified several factors on multiple and interrelated levels that affect these factors: personal, family, societal, cultural, religious, and healthcare-related. A key barrier to seeking mental healthcare, as reported by writers in social media, was a lack of awareness of mental health illnesses symptoms and treatment and where to seek help. The way families and society view mental health and mental illness influences people’s attitudes towards mental health conditions and seeking treatment, as well as religious beliefs. Barriers related to mental healthcare accessibility also included the high cost of mental healthcare, limited access to qualified healthcare professionals, and concerns about privacy and confidentiality.

In our study, we observed negative attitudes towards seeking professional help and treatment for mental health issues. Commenters questioned the value of mental healthcare, and we found that individual views were often influenced by family and societal stigma surrounding mental illness. Research on Arab populations, whether living in Arab countries or elsewhere, has indicated that cultural and societal stigma remains a significant barrier to seeking mental healthcare and treatment [4]. It is important to note that the stigma towards mental illness is universal, but its impact differs in different societies [21]. Family plays a critical role either in the promotion or demotion of mental health. Due to societal and cultural stigma of mental health, families may act as a barrier to seeking mental healthcare, especially among young populations [22]. In developing programs and policies for mental healthcare, it is therefore crucial to actively involve families as a valuable resource. By targeting families, we can encourage and motivate individuals to seek mental health services when needed, which can positively impact the overall well-being of the individual and the family as a whole.

A significant barrier to mental healthcare, as reported in the current study, is the negative impact of a mental illness diagnosis on social interactions. People living with mental illness fear being labelled negatively and avoid social situations due to their mental health diagnosis [4]. Consistent with our findings, prior research has indicated that stigmatising treatment and social isolation of individuals living with mental disorders impact employment and marriage prospects [5]. This might explain why people seek psychological support from informal sources, such as family and friends, rather than professional help [4]. It is crucial to improve social integration and promote greater acceptance of individuals living with mental illness in the community. Normalising discussions about mental health disorders is essential to reduce social stigma and ensure better access to mental healthcare. In addition, it is urgent to provide comprehensive social support to individuals dealing with mental disorders, including support in the workplace and educational institutions and encouragement to participate in social activities [3].

Religion appears to have a very significant impact on whether individuals seek mental healthcare. Its role in help-seeking could be bidirectional. On one hand, it may discourage seeking healthcare by associating mental illness with religious devotion, thereby increasing the stigma around mental health issues. On the other hand, religion can also encourage seeking professional help, as it is considered part of taking care of one’s health, especially in the context of Islam. A systematic review of mental health help-seeking behaviour in the Middle East indicated that people highlighted the alignment between Islamic beliefs and seeking help when necessary [23]. Research has shown that in Muslim communities, higher levels of religiosity are associated with more positive attitudes towards seeking mental health assistance [24]. However, people with mental disorders may seek help from religious healers before turning to mental healthcare [24]. It is, therefore, essential to ensure that mental health services and programs are culturally sensitive and inclusive, considering the diverse religious practices of the community. Incorporating and respecting these beliefs can encourage people to seek professional help while maintaining their faith in the benefits of treatment and medical care.

In addition to social and cultural barriers to seeking professional help, the study also identified logistical barriers. Timely diagnosis and treatment are essential for improving overall mental health, and delaying access to appropriate services could exacerbate mental health issues [25]. Previous evidence suggested that barriers to accessing mental healthcare services included long wait times, lack of availability of mental health services, and a shortage of suitable healthcare professionals [4, 23]. It has also been reported that costs and transportation play a significant role in accessing mental health services [4, 23]. Additionally, due to the close-knit nature of Arab communities, individuals expressed concerns about breached confidentiality and privacy. They feared that their mental health diagnosis could be exposed, potentially damaging their reputation [4].

Adolescents and younger adults may face more significant challenges in accessing mental healthcare. Regardless of their religion or culture, young people experience significant barriers to obtaining the mental healthcare they need [26]. Key obstacles include low trust in healthcare professionals, financial costs, and limited access to professional help [26]. It is crucial to provide young populations with various tools to access necessary mental healthcare services. This can include high-quality digital healthcare, free or low-cost consultations, and integration of mental health services into primary care centres. These tools could encourage individuals, especially young people, to seek help and have greater control over healthcare decisions, including treatment.

Social media campaigns have the potential to influence public attitudes toward people with mental illness positively [27, 28]. They provide a crucial platform for sharing information about mental health, raising awareness, and encouraging open discussions about mental health issues [27]. It has been suggested that mental health awareness campaigns on social media provide peer support that helps guide individuals to useful resources and highlights the insular nature of stigmatisation [28, 29]. This can help create a more informed and supportive environment for those affected by these challenges. By leveraging these platforms, individuals can engage in meaningful discussions, share personal experiences, and foster a community of support, thereby contributing to a broader understanding of mental health challenges and the importance of mental well-being. There is a pressing need for mental health campaigns in the region to increase awareness, reduce stigma, foster open discussion, and gain insight into people’s experiences with mental healthcare.

Strengths and limitations

Our study provides a unique methodology to explore barriers and facilitators to mental health services. To our knowledge, this is the first study to examine the public’s views of mental health services in the GCC. It has been suggested that social media platforms offer a safe space for the public to discuss mental health issues openly, thus reducing social desirability bias [30]. In the current analysis, all comments posted in response to the mental health campaign have been included, up to 10 days after it ended, which increases the chances of capturing views of different populations from the GCC and beyond.

When using social media data for research, it’s important to be aware of potential biases. Social media platforms allow for anonymity, which may lead to exaggerated negative comments that do not necessarily reflect the perspectives of all GCC communities [14, 31]. Another limitation of using social media data is the inability to identify the demographic characteristics of commenters, such as their location, gender, and age. Most comments on social media are also brief and difficult to interpret, which may lead to misinterpretation [32]. To minimise uncertainties and improve the validity of our analysis, we conducted continuous discussions and included several quotes from the data [33].

Authors and Affiliations

1. Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Kingdom of Saudi Arabia

   Samah Alageel,Norah M. Alsadhan,Ghadah Alkhaldi&Noura Alomair

2. Insurance Operations Policies Department, Insurance Authority, Riyadh, 13519, Saudi Arabia

   Rawan AlKasabi

Contributions

SA, NMA, GA, RA and NA contributed to the conceptualization and design of this project. Data analysis was conducted by SA and NA. Emerging results were discussed with all the authors. SA wrote the first draft of the paper; all authors contributed to reviewing and editing subsequent drafts and reviewed the final manuscript.

Corresponding author

Correspondence to Samah Alageel.

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions