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Abstract

Background:

Death is an unavoidable feature of the human experience, and nurses play a critical role in caring for patients at the end of life. Nurses’ attitudes toward death reflect their individual feelings toward death but may affect the quality of care provided at the end of life.

Objectives:

To explore the nurses’ attitudes toward death and the factors that may affect the quality of end-of-life care delivery in Oman among patients cared for in tertiary hospitals.

Design:

A cross-sectional study design.

Methods:

The study explored the nurses’ attitudes toward death in Oman through a nationwide survey of the major governmental hospitals in Oman. The Death Attitude Profile–Revised scale was adopted to collect data from 1469 nurses working in tertiary hospitals using simple random sampling and population proportionate sampling methods.

Results:

The nurses in Oman were Omani (46.8%) or Indian (43.7%) and had a bachelor’s degree in nursing education (54.5%), with a mean age and clinical experience being 35 and 11 years, respectively. The mean scores showed that they had slightly more positive (4.78 ± 0.92) than negative (4.30 ± 0.94) attitudes toward death. Multiple linear regression analysis was performed to explore correlates of negative and positive death attitudes. The negative death attitudes were significantly associated with nationality (β = −1.25, p = 0.007), clinical experience (β = 0.94, p = 0.012), and self-rated spirituality (β = 0.92, p = 0.043). The positive death attitudes were significantly associated with nationality (β = 2.40, p = 0.009), age (β = 3.71, p < 0.001), and clinical experience (β = 2.40, p = 0.004).

Conclusion:

Plain language summary

Nurses’ attitudes towards death in Oman: Prevalence and correlates in a nationwide sample

This research explores how nurses in Oman perceive death and how these perceptions influence the care they provide to patients at the end of life. Understanding nurses’ attitudes toward death is crucial, as it directly impacts the quality of care given to patients and their families during difficult times. We conducted a nationwide survey involving 1,469 nurses working in major hospitals across Oman, utilizing the Death Attitude Profile–Revised to assess their attitudes. The findings revealed that a majority of nurses (approximately 48%) held slightly positive attitudes toward death, while about 43% had negative views. Notably, older nurses and those with more clinical experience tended to have more positive perspectives, whereas negative attitudes were associated with factors such as nationality and personal beliefs about spirituality. These results underscore the importance of providing support and training for nurses to help them navigate their feelings about death, ultimately enhancing the quality of end-of-life care for patients and their families.

Keywords

Oman palliative care attitudes to death hospice and palliative nursing prevalence cross-sectional studies

Introduction

Death is a universal human experience that is perceived differently in different cultures and societies across the world.¹ Nurses play a vital role in end-of-life care; thus, understanding their perspectives and attitudes toward death is important.² Assessing nurses’ attitudes toward death has implications for the quality of care provided to patients diagnosed with terminal illness and during bereavement.^3
–5 The nurses’ attitudes toward death can affect pain management, communication with patients and families, and decisions regarding withdrawal or continuation of treatment during end-of-life care.⁶ In addition, it has been reported that positive attitudes toward death among nurses are significantly associated with better patient outcomes, increased job satisfaction, and improved quality of care in palliative and hospice settings.^7
–9 Therefore, studies exploring nurses’ attitudes toward death in Oman, a country deeply rooted in Arabic culture and Islamic traditions, are needed since the nation is experiencing increasing demand for palliative care and end-of-life care.^10,11 According to Oman’s Ministry of Health, the population of older adults is projected to increase by 4.4%–22% in the period from 2030 to 2065. At the same time, the death rate among the aging population will increase by 0.8 deaths per 1000 inhabitants of the mid-year population due to the prevalence of non-communicable diseases.^12,13

Studies conducted in countries proximal to Oman, such as Saudi Arabia and the United Arab Emirates, highlighted the complex nature of nurses’ attitudes toward death and the factors influencing them, such as personal experiences, cultural background, religious beliefs, and professional training.^14
–16 The above studies provide insights that may help understand the Oman’s context. We did not find any study exploring nurses’ attitudes toward death or end-of-life care in Oman. The current study explored the nurses’ attitudes toward death and the factors that may affect the quality of end-of-life care delivery in Oman among patients cared for in tertiary hospitals.

Studies conducted in other Middle Eastern countries such as Saudi Arabia and the United Arab Emirates highlighted the complex nature of nurses’ attitudes toward death and the factors influencing the care provided to patients diagnosed with terminal illnesses, such as personal experiences, cultural background, religious beliefs, and professional training.^14
–16 In contrast to existing studies conducted in neighboring Middle Eastern countries, which have predominantly Muslim populations, Oman presents a unique sociocultural landscape characterized by its distinct group within Islam. This religious diversity within the region necessitates a tailored understanding of nurses’ attitudes toward death and end-of-life care within Oman. By exploring these attitudes and their influencing factors specifically within Oman’s context, this study offers insights that contribute to the refined cultural and religious dimensions prevalent in the Omani healthcare system. Such insights are crucial for developing culturally sensitive policies and interventions aimed at enhancing the quality of end-of-life care delivery, not only in Oman but also across the broader Middle Eastern region. Therefore, the current study aimed to explore the nurses’ attitudes toward death and the factors that may affect the quality of end-of-life care delivery in Oman among patients cared for in tertiary hospitals.

Methods

Research design

A cross-sectional design was used to explore nurses’ attitudes regarding death and end-of-life care for patients in tertiary hospitals across Oman.

Setting

The study participants were nurses recruited from most major governmental hospitals in Oman, where a significant number of Omanis seek healthcare at the end-of-life stage. These nurses did not work in operating theaters and psychiatric wards.

Sample

A sample of 1469 nurses was selected using simple random sampling and population proportionate sampling methods to ensure representation from each hospital. The inclusion criteria were nurses who were registered nurses working in a government tertiary hospital, with a minimum of 1 year of clinical experience, and able to speak and write in English. The nurses working in operating theaters and psychiatric units, and previous work experience from Western countries such as the United States, United Kingdom, Australia, and Canada were excluded from the study.

Study instrument

The Death Attitude Profile–Revised (DAP-R) consists of 32 items, and each item is rated on a 7-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = moderately disagree, 4 = undecided, 5 = moderately agree, 6 = agree, and 7 = strongly agree), and the total scores are calculated by dividing the subscale scores by the number of items. More death attitude tendencies are indicated by higher subscale mean scores (1–7). There are five subscales: fear of death (7 items), death avoidance (5 items), neutral acceptance (5 items), approach acceptance (10 items), and escape acceptance (5 items), The DAP-R has been shown to be highly reliable and the subscales of fear of death and death avoidance result in negative death attitudes, while neutral, escape, and approach acceptance result in positive ones.^2,17
–19 In this investigation, the DAP-R has a Cronbach’s α of 0.860. Participants’ demographics, self-rated religion and spirituality, and experience caring for terminally ill and dying patients were also collected using the questionnaire.

Data collection procedure

Upon study approval, researchers engaged nursing directors at each hospital to explain the study objectives and the data collection procedures. The research assistants (RAs), themselves nurses (excluded from the study), were selected and authorized to approach colleagues within the respective hospitals to administer the questionnaire for data collection during various shifts. The participants were randomly selected from lists provided by the nursing directorate. Verbal reminders were used to follow-up with participants and ensure questionnaire completion. Participants had 4 h to complete the questionnaire due to patient care responsibilities, and questionnaires were retrieved on the same day. The data were collected from January to December 2023.

Data analysis

Statistics analysis was performed using SPSS 26.0 (IBM Corporation, Armonk, NY, USA). The categorical variables were summarized as percentages, while the continuous variables were summarized using means and standard deviations (SD). The independent two-sample t test was used to compare the means between two groups, while an analysis of variance (ANOVA) was used to compare the means of more than two groups. Multiple linear regression analysis was used to explore the correlates of death attitudes. A p < 0.05 was considered significant in all analyses.

Ethical considerations

Ethical approval was obtained from the Research and Ethical Review and Approval Committee of the Ministry of Health, Oman (SQU-EC/283/2022; MoH/CSR/22/26113) dated 25 September 2022 and 13 December 2022. Permission to collect data was obtained from the nursing directorates of each hospital. Before data collection, participants were briefed on the study objectives, procedures, potential benefits, risks, and rights. Participants completed a written consent form. Confidentiality was maintained by avoiding the collection of personal identifiers and using study serial numbers for questionnaire tracking. Data were securely stored in password-protected computer files. The reporting of this study conforms to the STROBE guidelines for cross-sectional studies²⁰ (Supplemental File).

Results

Participant characteristics

The sample consisted of 1469 registered nurses, and the majority were female (84.3%). The results presented in Table 1 show that most participants were Omani (46.8%), Indian (43.7%), and Filipino (9.5%), married (81.1%), and had a bachelor’s degree level of professional education (54.5%). The participant’s mean age and clinical experience were 35 years (SD = 6.70) and 11 years (SD = 6.50), respectively. The participants’ self-rated religiosity and spirituality revealed that 40.8% considered themselves very religious and 41.2% were very spiritual. A significant portion of the participants had experience caring for a person with cancer in their family (33.4%) and had been involved in caring for a dying close family member (45.7%). Only 25.1% had attended a palliative care program while in nursing school, and 18.9% had attended a similar training only after graduation. The majority of nurses (73.7%) had experience in caring for terminally ill patients.

Table 1.

Characteristics of participants in the study (N = 1469).

Characteristics	Total sample, N (%)
Gender
Male	230 (15.7)
Female	1239 (84.3)
Nationality
Philippines	139 (9.5)
Oman	688 (46.8)
India	642 (43.7)
Marital status
Single	262 (17.8)
Married	1191 (81.1)
Divorced	16 (1.1)
Education level (nursing)
Associate degree	627 (42.7)
Bachelors	801 (54.5)
Masters	41 (2.8)
Clinical experience in years (M = 11.01, SD = 6.50)
⩽5	298 (20.3)
6–10	400 (27.2)
⩾11	771 (52.5)
Age in years (M = 35.19, SD = 6.70)
21–30	399 (27.2)
31–40	799 (54.4)
41–50	236 (16.1)
⩾51	35 (2.4)
Self-rated religiosity
Very religious	599 (40.8)
Moderately religious	777 (52.9)
Slightly religious	73 (5)
Not religious	20 (1.4)
Self-rated spirituality
Very spiritual	605 (41.2)
Moderately spiritual	746 (50.8)
Slightly spiritual	103 (7)
Not spiritual	15 (1)
Has been involved in providing care for a person with cancer in their family
Yes	490 (33.4)
No	979 (66.6)
Has been involved in caring for a dying close family member
Yes	671 (45.7)
No	798 (54.3)
Attended a training program on palliative care while studying in nursing school
Yes	368 (25.1)
No	1101 (74.9)
Attended a training program on palliative care after graduation
Yes	278 (18.9)
No	1191 (81.1)
Has experience in taking care of terminally ill patients
Yes	1083 (73.7)
No	386 (26.3)

Death attitudes of nurses in Oman

The mean scores of the death attitudes total score, negative death attitudes, and positive death attitudes were 4.60 ± 0.72, 4.30 ± 0.94, and 4.78 ± 0.92, respectively (Table 2). The average scores for the five dimensions of the DAP-R show that the top three highest ranked (agreeable) were neutral acceptance (5.27 ± 1.29), approach acceptance (4.83 ± 1.14), and death avoidance (4.38 ± 1.25). Overall, the nurses had slightly more positive death attitudes (4.78 ± 0.92) than negative death attitudes (4.30 ± 0.94).

Table 2.

Description of death attitudes of nurses in Oman.

Variable	Min	Max	Median (total)	Mean ± SD (total)	Mean ± SD (item)
Fear of death	7	49	29	29.70 ± 7.37	4.24 ± 1.05
Death avoidance	5	35	21	21.90 ± 6.23	4.38 ± 1.25
Neutral acceptance	5	35	27	26.35 ± 6.43	5.27 ± 1.29
Approach acceptance	10	70	46	48.28 ± 11.38	4.83 ± 1.14
Escape acceptance	5	35	20	20.87 ± 7.0	4.18 ± 1.40
Negative death attitudes	12	84	50	51.59 ± 11.26	4.30 ± 0.94
Positive death attitudes	20	140	94	95.50 ± 18.33	4.78 ± 0.92
Total score of death attitudes	32	224	146	147.68 ± 22.97	4.60 ± 0.72

Correlates of positive and negative death attitudes with demographic characteristics

Table 3 shows the results of the univariate analysis of factors related to positive and negative death attitudes. The negative death attitudes showed statistically significant differences among the factors of gender (p < 0.001), age (p < 0.001), nationality (p < 0.001), clinical experience (p = 0.005), and self-rated spirituality (p = 0.036). The positive death attitudes showed statistically significant differences by the factors of age (p < 0.001), nationality (p < 0.001), marital status (p = 0.049), and having experience caring for a family member with cancer (p = 0.013).

Table 3.

Factors associated with positive and negative death attitudes using independent-sample t tests and ANOVA.

Factors	Negative death attitudes		Positive death attitudes
Factors	M ± SD	t/F Value, p Value	M ± SD	t/F Value, p Value
Gender*
Male	4.24 ± 0.79	t = 12.03, p ⩽ 0.001	4.75 ± 0.84	t = 5.12, p = 0.024
Female	4.31 ± 0.96	t = 12.03, p ⩽ 0.001	4.78 ± 0.93	t = 5.12, p = 0.024
Age in years**
21–30	4.15 ± 0.79	F = 6.00, p ⩽ 0.001	4.62 ± 0.90	F = 9.55, p < 0.001
31–40	4.38 ± 0.96		4.79 ± 0.92
41–50	4.26 ± 1.07		4.93 ± 0.89
⩾51	4.41 ± 0.94		5.24 ± 0.77
Level of education
Associate	4.34 ± 0.99	F = 1.08, p = 0.339	4.76 ± 0.91	F = 0.74, p = 0.476
Bachelors	4.27 ± 0.89		4.78 ± 0.92
Masters	4.26 ± 1.05		4.96 ± 0.94
Nationality
Philippines	4.35 ± 0.97	F = 10.78, p ⩽ 0.001	4.75 ± 0.94	F = 24.43, p < 0.001
Oman	4.17 ± 0.85		4.69 ± 0.86
India	4.41 ± 0.99
Marital status
Single	4.16 ± 0.91	F = 1.74, p = 0.158	4.76 ± 0.91	F = 2.63, p = 0.049
Married	4.32 ± 0.95		4.94 ± 1.01
Divorced	4.31 ± 0.67		4.53 ± 0.66
Clinical experience in years
⩽5	4.15 ± 0.80	F = 5.09, p = 0.005	4.59 ± 0.89	F = 18.45, p < 0.001
6–10	4.32 ± 0.91		4.65 ± 0.90
⩾11	4.35 ± 0.99		4.91 ± 0.92
Self-rated religiosity
Very religious	4.28 ± 1.0	F = 0.90, p = 0.439	4.80 ± 0.92	F = 1.75, p = 0.154
Moderately religious	4.32 ± 0.89		4.78 ± 0.92
Slightly religious	4.29 ± 0.77		4.56 ± 0.84
Not religious	4.0 ± 1.33		4.60 ± 1.06
Self-rated spirituality
Very spiritual	4.25 ± 0.98	F = 1.078, p = 0.036	4.78 ± 0.94	F = 1.05, p = 0.368
Moderately spiritual	4.33 ± 0.92		4.79 ± 0.90
Slightly spiritual	4.33 ± 0.80		4.67 ± 0.85
Not spiritual	4.50 ± 1.32		4.48 ± 1.28
Has been involved in caring for a family member with cancer
Yes	4.32 ± 0.96	t = 1.037, p = 0.309	4.82 ± 0.88	t = 6.18, p = 0.013
No	4.29 ± 0.93	t = 1.037, p = 0.309	4.75 ± 0.93	t = 6.18, p = 0.013
Has been involved in caring for a dying family member
Yes	4.32 ± 0.94	t = 0.162, p = 0.670	4.78 ± 0.92	t = 0.01, p = 0.929
No	4.28 ± 0.94	t = 0.162, p = 0.670	4.77 ± 0.92	t = 0.01, p = 0.929
Attended training focusing on palliative care during nursing school
Yes	4.31 ± 0.97	t = 3.514, p = 0.061	4.78 ± 0.97	t = 0.233, p = 0.629
No	4.30 ± 0.93	t = 3.514, p = 0.061	4.77 ± 0.90	t = 0.233, p = 0.629
Attended continuing education focusing on palliative care after graduation
Yes	4.24 ± 0.98	t = 0.643, p = 0.423	4.68 ± 0.97	t = 2.03, p = 0.155
No	4.31 ± 0.93	t = 0.643, p = 0.423	4.80 ± 0.90	t = 2.03, p = 0.155
Has experience in taking care of terminally ill patients
Yes	4.30 ± 0.95	t = 1.26, p = 0.262	4.78 ± 0.93	t = 1.15, p = 0.284
No	4.31 ± 0.92	t = 1.26, p = 0.262	4.76 ± 0.88	t = 1.15, p = 0.284

ANOVA: analysis of variance.

An independent-sample t test.

ANOVA.

Predictors of positive and negative death attitudes

Multiple linear regression analysis was performed to explore correlates of negative and positive death attitudes (Table 4). The negative death attitudes were significantly associated with nationality (β = −1.25, p = 0.007), clinical experience (β = 0.94, p = 0.012), and self-rated spirituality (β = 0.92, p =0.043). The positive death attitudes were significantly associated with nationality (β = 2.40, p = 0.009), age (β = 3.71, p < 0.001), and clinical experience (β = 2.40, p = 0.004).

Table 4.

Multivariate analysis of factors influencing death attitudes.

Variable	β	SE	Beta	p Value	Exp (β) 95% CI
Negative death attitudes
Constant	49.88	1.44		<0.001	47.06 to 52.70
Nationality	−1.25	0.46	−0.07	0.007	−2.14 to −0.34
Clinical experience	0.94	0.38	0.07	0.012	0.21 to 1.68
Self-rated spirituality	0.92	0.46	0.05	0.043	0.03 to 1.82
F = 6.27, p < 0.001, R² = 0.013
Positive death attitudes
Constant	79.23	2.13		<0.001	75.04 to 83.40
Nationality	2.40	0.92	0.10	0.009	0.59 to 4.21
Age in years	3.71	0.74	0.13	<0.001	2.26 to 5.17
Clinical experience	2.40	0.83	0.10	0.004	0.77 to 4.03
F = 20.67, p < 0.001, R² = 0.041

Discussion

This study contributes to the existing body of knowledge on nurses’ attitudes toward death by highlighting the prevalence of negative and positive attitudes and the associated factors. Our findings show that nurses in Oman had slightly more positive than negative attitudes toward death. Previous studies about the nurses’ attitudes toward death from other Middle Eastern countries, such as Palestine, Turkey, Jordan, and North Africa, also found attitude levels ranging from moderate to slight.^21
–25 Another study conducted in Turkey found that nurses generally demonstrated moderately positive attitudes toward death.²⁶ In addition, our results align with those of previous studies conducted in the Southern United States, European countries, and China among nurses and nursing students, showing significant positive attitudes toward caring for the dying.^2,5,7,27,28 The tendency toward positive attitudes may stem from professional training and, hence, similar results from various study settings.

However, in this study, the majority of nurses reported not having attended a training program on palliative care either during their nursing education or after graduation, and negative attitudes toward death (mean score: 4.30 ± 0.94) were also prevalent among the participating nurses. These findings underscore the need for continuing professional education and training in palliative and end-of-life care to equip nurses with appropriate attitudes that sustain quality patient care. In this study, the negative death attitudes were significantly associated with nationality, clinical experience, and self-rated spirituality. Studies on attitudes toward death suggested that continuing professional education and training can be tailored to address specific aspects related to culture, clinical experience, religion, spirituality, and aspects that might influence diverse attitudes toward death to help the nurses perceive the end of life with a more positive attitude, which will enhance the quality of care at the end of life.^{3,21,22,25,29}

In line with our study findings, research conducted in the United States, China, the United Kingdom, Greece, and Poland revealed significant associations between negative death attitudes and factors such as age, gender, and clinical experience of nurses.^25,30
–33 Similarly, studies conducted in Jordan and Ethiopia found significant relationships between negative death attitudes and demographic factors such as nationality and self-rated spirituality.^34
–36 However, some of these studies suggest that, in spite of professional training for nurses, their cultural and spiritual background always influences their attitude and, subsequently, the care provided at the end of life.³⁴

In addition, in Turkey and the United Kingdom, nurses and nursing students were found to have, positive death attitudes, which were significantly associated with age, nationality, marital status, and personal experiences with caring for a family member with cancer.^22,30,34 Furthermore, several systematic reviews have reported nationality, clinical experience, and level of spirituality as predictors of negative death attitudes among nurses and highlighted the importance of interventions that address the cultural and other demographic characteristics of nurses in their attitudes toward death.^7,37,38

The current study enhances our understanding of nurses’ attitudes toward death in Oman. The results suggest a need for healthcare organizations in Oman to prioritize continuing education and professional training, interventions should focus on increasing understanding of the death and dying process, communication skills, and supportive work environments that facilitate open discussions about death-related issues, providing tailored support and resources to nurses based on their demographic characteristics can help alleviate barriers and promote positive perspectives toward end-of-life care, and collaboration between stakeholders, healthcare institutions, educational institutions, and professional associations to create sustainable, evidence-based programs that address the factors influencing nurses’ attitudes toward death and the quality of end-of-life care provided to patients and families.^{7,33,39
–41}

Limitations of the study

The study used a self-reporting method of data collection. Nurses may have either underestimated or overestimated their positive response to socially acceptable answers intentionally. The study used a cross-sectional research design, which allowed the researchers to meet the participants at a single point in time. However, attitudes toward death may tend to change over a period of time. The generalizability to other countries and cultures is limited since the study focused only on nurses from tertiary care centers in Oman.

Future recommendations

Based on the current study and other studies conducted globally, the results recommend that Oman’s healthcare organizations should focus on continued education and professional training to maintain favorable attitudes toward death, palliative care, and end-of-life care. Interventions should improve death and dying knowledge, communication skills, and supportive work settings that allow open discussions about death. Providing nurses with demographically specific assistance and tools can reduce obstacles and improve end-of-life care attitudes. Strategic interventions to change nurses’ death attitudes can be implemented by hospitals, educational, and professional bodies. Sustainable, evidence-based programs that address nurses’ attitudes around death and end-of-life care for patients and families are created through stakeholder collaboration.

Conclusion

The current study shows that nurses in Oman have slightly more positive than negative attitudes toward death. The positive death attitudes were significantly associated with increasing age and clinical experience. The negative attitudes were significantly associated with increasing age and self-rated spirituality. Nationality is also a significant predictor of both negative and positive death attitudes. To support nurses in providing compassionate end-of-life care, healthcare institutions should prioritize training, ongoing support, and worker environments where nurses can express diverse perspectives about death and are equipped to navigate the emotional challenges of palliative care and end-of-life care.

Supplemental Material

sj-docx-1-pcr-10.1177_26323524251348498 – Supplemental material for Nurses’ attitudes toward death in Oman: Prevalence and correlates in a nationwide sample

Supplemental material, sj-docx-1-pcr-10.1177_26323524251348498 for Nurses’ attitudes toward death in Oman: Prevalence and correlates in a nationwide sample by Eilean Rathinasamy Lazarus, Joshua K. Muliira, Omar Al Zaabi, Murtadha K. Al-Khabori, Mudhar Mohammed Al Adawi and Qasim Al Mamari in Palliative Care and Social Practice

Footnotes

Acknowledgements

The study acknowledges all the study participants and the authors who were permitted to use the standardized instruments.

Author’s note

We declare that the manuscript has been read and approved by all the authors that the requirements for authorship as stated for publication in the Palliative Care and Social Practice have been met, and that each author believes that the manuscript represents honest work.

ORCID iDs

Omar Al Zaabi

Murtadha K. Al-Khabori

Ethical considerations

Ethical approval was obtained from the Research and Ethical Review and Approval Committee of the Ministry of Health, Oman (SQU-EC/283/2022; MoH/CSR/22/26113). The study conforms to the recognized standards of the Declaration of Helsinki.

Author contributions

Eilean Rathinasamy Lazarus: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing.

Joshua K. Muliira: Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Validation; Visualization; Writing – original draft; Writing – review & editing.

Omar Al Zaabi: Writing, Methodology; – original draft; Writing – review & editing; extensively editing the methods and results sections, and overseeing the review and revisions process, including addressing reviewer’s comments.

Murtadha K. Al-Khabori: Writing – original draft; Writing – review & editing.

Mudhar Mohammed Al Adawi: Investigation; Writing – original draft; Writing – review & editing.

Qasim Al Mamari: Investigation; Writing – original draft; Writing – review & editing.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Sultan Qaboos University Internal Grants (IG-CON-AHCC-23-02).

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The dataset generated and/or analyzed during the current study is not publicly available due to participant privacy. Data can be available from the corresponding author upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

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