A Cross-Sectional Assessment of Quality of Life Among Healthcare Professionals in North-Central Saudi Arabia: Implications for Workforce Well-Being and Policy Development

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for inviting me to review this paper. This study examined the QoL among HCPs in North-Central Saudi Arabia and its associated factors. While the study topic is not new, the methodology and presentation of results are sound and clear. This paper may have some implications for local healthcare workers and public health practitioners. The manuscript was well-written, and only minor revisions may be required. Well-done!

 

Title: Good

Abstract: The abstract is well written. Please clarify whether the sample included employees from a single hospital or multiple hospitals and specify when the survey was conducted.

 

Materials and Methods

The methods section is logically structured and clearly described.

Sampling description: Please describe how the researchers promoted the study and recruited participants (e.g. via online or SNS).

Data collection: Please provide a brief description of each QOL domain for

readers who may not be familiar with the WHOQOL-BREF.

 

Results

Lines 175–176: p < 0.001 for all correlation tests? Please clarify.

 

Discussion

The limitations of convenience sampling and lack of generalizability should be mentioned in the limitation section.

Author Response

Authors’ reply/modifications according to the reviewer 1 comments/suggestions

General:

The authors would like to thank the reviewer for the precious time spent reviewing the paper and his excellent suggestions for improving it. Efforts have been made to modify the paper as per the reviewer’s suggestions and recommendations. The authors will be happy to hear a positive reply. All the points included according to the reviewer’s comments can be seen in track changes.

Specific response to the reviewer’s suggestions:

Kindly find the attached response to each question one by one:

Point 1: Title: Good.

Response 1: Thanks for the comment. The authors are pleased to hear the positive comments of the reviewer on the significance of the topic and the title.

Point 2: Abstract: The abstract is well written. Please clarify whether the sample included employees from a single hospital or multiple hospitals and specify when the survey was conducted.

Response 2: Thanks for the comment. The authors are pleased to hear the positive comments of the reviewer on the abstract. According to the reviewer’s comments, we revised the abstract as follows:

“In this cross-sectional study, data were collected from 388 HCPs from multiple healthcare facilities using the WHOQOL-BREF questionnaire. The survey was conducted from August 2025 to October 2025.”

Point 3: Materials and Methods. The methods section is logically structured and clearly described.

Response 3: Thanks for the comment. The authors are pleased to hear the positive comments of the reviewer on the methods.

Point 4: Sampling description: Please describe how the researchers promoted the study and recruited participants (e.g. via online or SNS).

Response 4: Thanks for the comment. According to the reviewer’s comments, a clarifying sentence has been added to the data collection section to specify that participants were personally approached at their workplace and that data were recorded on-site using data collectors’ personal electronic devices.

Point 5: Data collection: Please provide a brief description of each QOL domain for readers who may not be familiar with the WHOQOL-BREF.

Response 5: Thanks for the comment. According to the reviewer’s comments, we included a brief description of each domain in the revised manuscript as follows.

 

“This instrument includes 26 items that assess four major domains of QoL: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items). Specifically, the physical health domain assesses energy, mobility, pain, sleep, and daily activities; the psychological domain evaluates positive and negative feelings, self-esteem, and cognitive functions. The social relationships domain examines personal relationships and social support, while the environmental domain covers financial resources, safety, healthcare access, and physical living conditions. Two additional items assess overall QoL and general health perception.”

Point 6: Lines 175–176: p < 0.001 for all correlation tests? Please clarify.

Response 6: Thanks for the comment. Yes, all correlations were statistically significant. According to the reviewer’s comments and for better clarifications, we detailed the statement in the revised manuscript.   

 

Point 7: Discussion: The limitations of convenience sampling and lack of generalizability should be mentioned in the limitation section.

 

Response 7: Thanks for the comment. According to the reviewer’s comments, we included the limitations in the revised manuscript as follows.

“Finally, the use of convenience sampling may limit the generalizability of the findings beyond the study population, and the results should therefore be interpreted with caution when extrapolating to HCPs in other regions.”

 The authors thank the reviewer once again for the positive and constructive comments.

 

Reviewer 2 Report

Comments and Suggestions for Authors

Regarding the abstract, it is recommended that the study design be clearly specified within the methods section. Explicitly identifying the research as a cross-sectional study represents good academic practice and improves transparency for readers. For instance, the abstract could state: “In this cross-sectional study, data were collected from 388 healthcare professionals using the WHOQOL-BREF questionnaire.” In addition, the abstract would benefit from a reduction in statistical detail. While odds ratios and confidence intervals are valuable, their extensive inclusion makes the abstract overly dense for a general readership. It is advisable to retain only the key associated factors and reserve detailed statistical reporting for the results section. Furthermore, the conclusion of the abstract should be made more actionable and less generic by directly linking the main findings to practical recommendations and avoiding vague phrasing such as “it is suggested”. A clearer formulation would be: “The findings highlight the need for targeted workplace and health support interventions, particularly for non-Saudi healthcare professionals and those with chronic conditions.”

In the introduction, the scientific gap addressed by the study should be articulated more explicitly. Although the gap is present, it is currently embedded within the narrative and would benefit from a clear and direct statement, ideally in the penultimate paragraph. Moreover, the distinctiveness of the Hail region should be more strongly emphasised. While the region is mentioned, the introduction could better highlight why Hail constitutes a unique context by addressing specific structural challenges, such as geographic dispersion, human resource constraints, limited access to professional training, and difficulties in staff retention. Finally, the concluding paragraph of the introduction would benefit from reformulation to better align with scientific objectives. At present, it is somewhat lengthy and descriptive; a more concise, research-oriented paragraph ending with a clearly stated study aim would strengthen the overall structure.

With respect to the methodology, a stronger justification for the use of convenience sampling is recommended. While this approach is acceptable, the rationale should be more robustly defended, and the steps taken to mitigate selection bias—such as recruiting participants from diverse professional categories and healthcare settings—should be explicitly described. The pilot study also requires clarification: it should be clearly identified as a pilot study, its methodological purpose (e.g. assessing clarity and cultural validity of the instrument) should be stated, and it should be clarified whether pilot participants were excluded from the final sample. Additionally, the dichotomisation of quality-of-life scores using median splits may be questioned by reviewers; therefore, a brief methodological justification supported by an appropriate reference would strengthen this aspect of the analysis.

In the results section, greater terminological consistency is advised. The manuscript alternates between “overall QoL”, “Overall QoL”, and “overall quality of life”. Selecting a single standard term and applying it consistently throughout the text would improve clarity and professionalism.

The discussion would benefit from a more thorough exploration of counterintuitive findings. In particular, the associations between older age and poorer quality of life, the positive association between chronic disease and environmental quality of life, and the lack of significant gender differences across several domains warrant more explicit explanatory commentary. Dedicating specific interpretative sentences to these findings would demonstrate critical engagement with the data and help pre-empt potential reviewer concerns. In addition, the limitations section, although generally appropriate, could be strengthened by linking limitations more directly to the study’s findings. Explicit mention of selection bias arising from convenience sampling, the limitations of median-based dichotomisation, and the absence of organisational variables such as salary, workload, and shift patterns would enhance methodological transparency.

Regarding the conclusion, the section is coherent and policy-relevant; however, it could be improved by becoming more concise. Some repetition of points already addressed in the discussion is evident. It is recommended that the conclusion be streamlined into one main summary paragraph followed by a short paragraph outlining practical implications. The recommendations themselves should also be made more specific. Statements such as “implement extensive surveillance and prevention measures” are rather vague and could be replaced with concrete examples, including occupational health programmes, institutional psychological support services, and differentiated policies for expatriate healthcare workers. For example: “Targeted occupational health programmes, mental health support services, and tailored policies for expatriate healthcare workers should be prioritised.” Additionally, while the suggestion of qualitative research is appropriate, it should be clearly framed as a direction for future research rather than introduced as a new argument within the conclusion.

Finally, concerning the references, the manuscript demonstrates several strengths. The reference list is up to date, with many sources from 2023 to 2025, includes a balanced combination of international and regional studies, and consistently provides DOIs, all of which reflect good scholarly practice.

Author Response

Authors’ reply/modifications according to the reviewer 2 comments/suggestions

General:

The authors would like to thank the reviewer for the precious time spent reviewing the paper and his excellent suggestions for improving it. Efforts have been made to modify the paper as per the reviewer’s suggestions and recommendations. The authors will be happy to hear a positive reply. All the points included according to the reviewer’s comments can be seen in track changes.

Specific response to the reviewer’s suggestions:

Kindly find the attached response to each question one by one:

Point 1: Regarding the abstract, it is recommended that the study design be clearly specified within the methods section. Explicitly identifying the research as a cross-sectional study represents good academic practice and improves transparency for readers. For instance, the abstract could state: “In this cross-sectional study, data were collected from 388 healthcare professionals using the WHOQOL-BREF questionnaire.”.

Response 1: Thanks for the comment. According to the reviewer’s comments, we revised the abstract to mention the study design.

Point 2: In addition, the abstract would benefit from a reduction in statistical detail. While odds ratios and confidence intervals are valuable, their extensive inclusion makes the abstract overly dense for a general readership. It is advisable to retain only the key associated factors and reserve detailed statistical reporting for the results section.

Response 2: Thanks for the comment. According to the reviewer’s comments, we have removed odds ratios and confidence intervals details from the revised manuscript’s abstract.

Point 3: Furthermore, the conclusion of the abstract should be made more actionable and less generic by directly linking the main findings to practical recommendations and avoiding vague phrasing such as “it is suggested”. A clearer formulation would be: “The findings highlight the need for targeted workplace and health support interventions, particularly for non-Saudi healthcare professionals and those with chronic conditions.”

Response 3: Thanks for the comment. According to the reviewer’s comments, we modified the conclusion section of the revised manuscript as follows:

“The findings highlight the need for targeted workplace and health support interventions to manage the mental and physical health of HCPs, particularly for non-Saudi HCPs and those with chronic conditions, through tailored training, education, and lifestyle-based support programs.”

Point 4: In the introduction, the scientific gap addressed by the study should be articulated more explicitly. Although the gap is present, it is currently embedded within the narrative and would benefit from a clear and direct statement, ideally in the penultimate paragraph. Moreover, the distinctiveness of the Hail region should be more strongly emphasised. While the region is mentioned, the introduction could better highlight why Hail constitutes a unique context by addressing specific structural challenges, such as geographic dispersion, human resource constraints, limited access to professional training, and difficulties in staff retention.

Response 4: Thanks for the comment. According to the reviewer’s comments, we have expanded the scientific knowledge gap pertaining to hail region in the revised manuscript.

Point 5: Introduction: Finally, the concluding paragraph of the introduction would benefit from reformulation to better align with scientific objectives. At present, it is somewhat lengthy and descriptive; a more concise, research-oriented paragraph ending with a clearly stated study aim would strengthen the overall structure.

Response 5: Thanks for the comment. According to the reviewer’s suggestions, we modified the paragraph into short and research-oriented paragraph as follows.

“To develop regional strategies to improve the workplace situation, reliable, context-related QoL data are required. Given the constant changes in healthcare delivery in Saudi Arabia, it is necessary to continuously monitor epidemiological data on workforce well-being to inform evidence-based planning. Therefore, the present study aimed to assess QoL and its determinants among HCPs in the Hail region, Saudi Arabia.”

Point 6: With respect to the methodology, a stronger justification for the use of convenience sampling is recommended. While this approach is acceptable, the rationale should be more robustly defended, and the steps taken to mitigate selection bias—such as recruiting participants from diverse professional categories and healthcare settings—should be explicitly described.

Response 6: Thanks for the comment. According to the reviewer’s comments, we have enhanced the justifications for using convenience sampling and relevant limitations also added. Furthermore, to reduce selection bias, participants were recruited from diverse professional categories and multiple healthcare settings within the region. The reviewer may find the results sections that the present study included different HCPs from various healthcare settings.

 

Point 7: The pilot study also requires clarification: it should be clearly identified as a pilot study, its methodological purpose (e.g. assessing clarity and cultural validity of the instrument) should be stated, and it should be clarified whether pilot participants were excluded from the final sample.

 

Response 7: Thanks for the comment. According to the reviewer’s suggestions, we have clarified the details in the revised manuscript.

Point 8: Additionally, the dichotomisation of quality-of-life scores using median splits may be questioned by reviewers; therefore, a brief methodological justification supported by an appropriate reference would strengthen this aspect of the analysis.

 

Response 8: Thanks for the comment. According to the reviewer’s comments, we have included the proper justifications with appropriate references in the revised manuscript as follows.

“QoL domain scores were dichotomized using median values to facilitate comparative analysis, given the ordinal nature of the WHOQOL-BREF and the non-normal distribution of domain scores. Categorization of QoL scores based on measures of central tendency, including mean or median cut-offs, has been widely applied in QoL and public health research when distributional assumptions required for parametric analyses are not met [21-24].”

Point 9: In the results section, greater terminological consistency is advised. The manuscript alternates between “overall QoL”, “Overall QoL”, and “overall quality of life”. Selecting a single standard term and applying it consistently throughout the text would improve clarity and professionalism.

 

Response 9: Thanks for the comment. According to the reviewer’s comments, the Results section has been carefully reviewed to ensure terminological consistency. The term “overall QoL” is used consistently throughout the Results, with appropriate capitalization based on sentence position and table formatting.

Point 10: The discussion would benefit from a more thorough exploration of counterintuitive findings. In particular, the associations between older age and poorer quality of life, the positive association between chronic disease and environmental quality of life, and the lack of significant gender differences across several domains warrant more explicit explanatory commentary. Dedicating specific interpretative sentences to these findings would demonstrate critical engagement with the data and help pre-empt potential reviewer concerns.

 

Response 10: Thanks for the comment. According to the reviewer’s comments, we have included several discussion points in the revised manuscript related to the variables suggested by the reviewer.

Point 11: In addition, the limitations section, although generally appropriate, could be strengthened by linking limitations more directly to the study’s findings. Explicit mention of selection bias arising from convenience sampling, the limitations of median-based dichotomisation, and the absence of organisational variables such as salary, workload, and shift patterns would enhance methodological transparency.

 

Response 11: Thanks for the comment. According to the reviewer’s comments, we have enhanced the limitations sections in the revised manuscript.

Point 12: Regarding the conclusion, the section is coherent and policy-relevant; however, it could be improved by becoming more concise. Some repetition of points already addressed in the discussion is evident. It is recommended that the conclusion be streamlined into one main summary paragraph followed by a short paragraph outlining practical implications. The recommendations themselves should also be made more specific. Statements such as “implement extensive surveillance and prevention measures” are rather vague and could be replaced with concrete examples, including occupational health programmes, institutional psychological support services, and differentiated policies for expatriate healthcare workers. For example: “Targeted occupational health programmes, mental health support services, and tailored policies for expatriate healthcare workers should be prioritised.”

 

Response 12: Thanks for the comment. According to the reviewer’s suggestions, we have modified the conclusion in the revised manuscript.

Point 13: Additionally, while the suggestion of qualitative research is appropriate, it should be clearly framed as a direction for future research rather than introduced as a new argument within the conclusion.

 

Response 13: Thanks for the comment. According to the reviewer’s suggestions, we have modified the qualitative research recommendations in the revised manuscript.

Point 14: Finally, concerning the references, the manuscript demonstrates several strengths. The reference list is up to date, with many sources from 2023 to 2025, includes a balanced combination of international and regional studies, and consistently provides DOIs, all of which reflect good scholarly practice.

 

Response 14: Thanks for the comment. The authors are pleased to hear the positive comments regarding the references that reflect good scholarly practice.

 The authors thank the reviewer once again for the positive and constructive comments.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I consider that the changes made by the authors make the article suitable for publication.