Professional practice environment and advanced nursing interventions associated with nurse-perceived quality of healthcare delivery in selected rural facilities in Saudi Arabia: a multisite cross-sectional correlational study
- 1Department of Community and Psychiatric Mental Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University
- 2Department of Medical-Surgical Nursing, College of Nursing, King Saud University
- 3School of Archaeology and Anthropology, College of Arts and Social Sciences, The Australian National University
Abstract
Background: Rural Saudi health services face workforce shortages and geographical isolation, and nurses are often the principal providers of clinical care, patient education, and health promotion. This study examined whether the professional practice environment (RPPE) and engagement in advanced nursing interventions were associated with nurses' perceived quality of healthcare delivery (PQHD) in selected rural Saudi facilities.
Methods: This cross-sectional correlational study is reported according to STROBE. A total of 187 nurses from three rural healthcare facilities in three Saudi regions (South, North, East; one purposively selected facility per region) were recruited using proportional stratified random sampling within region × role strata. An online survey included the validated Revised Professional Practice Environment (RPPE) scale and two study-specific scales (advanced nursing interventions; PQHD) assessed for content validity and internal consistency. Analyses used Pearson correlations, t -tests, one-way ANOVA, and multivariable linear regression (IBM SPSS v26).
Results: PQHD was positively and significantly correlated with the RPPE total score ( r = 0.56, p < 0.001) and with advanced nursing interventions ( r = 0.47, p < 0.001); the two predictors were moderately intercorrelated ( r = 0.55, p < 0.001). In the multivariable model, the RPPE total score (β = 0.45, p < 0.001) and advanced nursing interventions (β = 0.25, p < 0.001) remained independently associated with PQHD after adjustment for nursing role, years of experience, and site (region); the model explained 43% of the variance ( R ² = 0.43, adjusted R ² = 0.40, F (7, 179) = 19.07, p < 0.001). In bivariate analyses, nurse practitioners reported higher PQHD than registered nurses, male nurses reported slightly higher PQHD than female nurses, and PQHD did not differ by age group, education, years of experience, or region; neither difference survived Holm adjustment.
Conclusion: A more favorable professional practice environment and more frequent engagement in advanced nursing interventions were independently associated with higher nurse-perceived quality of healthcare delivery in these rural Saudi facilities. Because the design is cross-sectional and the outcome is nurse-reported, causal and patient-level inferences cannot be drawn. These associations may inform efforts to strengthen rural practice environments and advanced practice roles, pending longitudinal, multi-source confirmation.
Related
- Educational Interventions for Professional Identity Formation in Undergraduate Medical Education: A Scoping Review
- Patient expectations and healthcare professional education in obesity care: A comparative qualitative study
- Barriers to professional mental health help-seeking and considerations for school-based interventions among Secondary School adolescents: an exploratory qualitative study
- Patient and healthcare professional preferences among predefined features of a peritoneal dialysis monitoring application in South Korea: an exploratory choice-based conjoint study
- Self-directed learning readiness and its associated factors among undergraduate nursing students in Maldives: A cross-sectional correlational study.
BibTeX
@article{almutairi2026professional,
title = {{Professional practice environment and advanced nursing interventions associated with nurse-perceived quality of healthcare delivery in selected rural facilities in Saudi Arabia: a multisite cross-sectional correlational study}},
author = {Asrar S. Almutairi and Rayhanah R. Almutairi and Mohammed Almutairi and Hend N. Almutairi and Abdulaziz M. Alodhailah},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1950161},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1950161/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Professional practice environment and advanced nursing interventions associated with nurse-perceived quality of healthcare delivery in selected rural facilities in Saudi Arabia: a multisite cross-sectional correlational study
AU - Asrar S. Almutairi
AU - Rayhanah R. Almutairi
AU - Mohammed Almutairi
AU - Hend N. Almutairi
AU - Abdulaziz M. Alodhailah
PY - 2026
DA - 2026/10/29
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1950161
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1950161/full
AB - Background: Rural Saudi health services face workforce shortages and geographical isolation, and nurses are often the principal providers of clinical care, patient education, and health promotion. This study examined whether the professional practice environment (RPPE) and engagement in advanced nursing interventions were associated with nurses' perceived quality of healthcare delivery (PQHD) in selected rural Saudi facilities. Methods: This cross-sectional correlational study is reported according to STROBE. A total of 187 nurses from three rural healthcare facilities in three Saudi regions (South, North, East; one purposively selected facility per region) were recruited using proportional stratified random sampling within region × role strata. An online survey included the validated Revised Professional Practice Environment (RPPE) scale and two study-specific scales (advanced nursing interventions; PQHD) assessed for content validity and internal consistency. Analyses used Pearson correlations, t -tests, one-way ANOVA, and multivariable linear regression (IBM SPSS v26). Results: PQHD was positively and significantly correlated with the RPPE total score ( r = 0.56, p < 0.001) and with advanced nursing interventions ( r = 0.47, p < 0.001); the two predictors were moderately intercorrelated ( r = 0.55, p < 0.001). In the multivariable model, the RPPE total score (β = 0.45, p < 0.001) and advanced nursing interventions (β = 0.25, p < 0.001) remained independently associated with PQHD after adjustment for nursing role, years of experience, and site (region); the model explained 43% of the variance ( R ² = 0.43, adjusted R ² = 0.40, F (7, 179) = 19.07, p < 0.001). In bivariate analyses, nurse practitioners reported higher PQHD than registered nurses, male nurses reported slightly higher PQHD than female nurses, and PQHD did not differ by age group, education, years of experience, or region; neither difference survived Holm adjustment. Conclusion: A more favorable professional practice environment and more frequent engagement in advanced nursing interventions were independently associated with higher nurse-perceived quality of healthcare delivery in these rural Saudi facilities. Because the design is cross-sectional and the outcome is nurse-reported, causal and patient-level inferences cannot be drawn. These associations may inform efforts to strengthen rural practice environments and advanced practice roles, pending longitudinal, multi-source confirmation.
SN - 2296-2565
ER -