This quantitative observational cross-sectional study was conducted among all psychiatrists at the Ministry of Health Institute between August and September 2020. Participants were invited to complete an online survey that included questions about their knowledge and attitudes regarding rTMS and a demographic survey. We distributed questionnaires to psychiatrists in specialized psychiatric hospitals (tertiary care hospitals) and polyclinic (secondary care) psychiatry departments using the Google Documents platform. Eligible participants included male and female psychiatrists working at the Ministry of Health Hospital during the study period. Participants on leave, those with missing data, or those who refused to sign informed consent were excluded. Participants were assured that their participation would be anonymous and voluntary and that they could withdraw from the study at any time. A printable consent form was provided, and participants were required to read and sign it electronically before participating. The convenience sampling method was used in this study, and all psychiatrists who agreed to participate in the self-administered online survey were included. The sample size was determined based on the rTMS knowledge scores of a previous study in Saudi Arabia, which found a mean knowledge score of 14.3±4.8. Using Power Analysis, this study required a minimum of 48 participants, assuming a ±14% variation and a moderate effect size (=0.417), with 5% and 80% type I and II errors of 5% and 80%, respectively.
Study Instrument and Sociodemographic Variable
Socio-demographic factors
Demographic information was collected, including age in years, sex (male, female), and level of education, and grouped into four categories (resident (junior or senior), specialist and consultant). We also gathered data on citizenship (Omani or non-Omani). Participants were asked about the number of conferences they attend annually, their primary place of work (tertiary or secondary care hospital), if they had received training abroad for more than six months (yes, no), their primary source of knowledge updating (articles/textbooks or conferences/peer discussion), the presence of an rTMS device at work (yes or no), and their previous experience with rTMS devices (yes or no).
Study Instrument
A self-administered questionnaire assessing knowledge and attitudes towards TMS was used in this study. The questionnaire was adapted from a previous study conducted among psychiatrists in Saudi Arabia [12]. The survey included two sections: knowledge and attitudes. The knowledge section consisted of 21 items that evaluated various aspects of knowledge of rTMS. Participants responded with "yes," "no," or "I don't know." Correct responses were awarded 1 point, while incorrect and "I don't know" responses were awarded 0 points as they indicated a lack of knowledge. The attitudes section included 13 items with both positive and negative statements. Participants rated their agreement on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree." Responses were scored from 0 to 4 based on the positivity or negativity of the statement. The modified questionnaire achieved high levels of validity and reliability, with scores of 0.88 and 0.61, respectively.
Data Analysis
Descriptive statistics, including frequency, percentage, mean, standard deviation (SD), median, and range, were used to explore the profile of psychiatrists according to their demographics, knowledge of, and attitudes towards rTMS. The knowledge score was dependent, and the demographic and attitude scores were independent variables. The univariate comparison of each independent variable in the knowledge score was evaluated with the independent t-test, correlation, and ANOVA with post hoc (Scheffé method) tests. Multiple linear regression was performed after the univariate analysis. The variables shown significantly in the univariate analysis were used in the linear regression to identify the risk factors associated with knowledge levels. All analyzes were performed using IBM SPSS 23.0 [13]and set at a 5% significance level.
Ethical approval
The Ministry of Health Research and Ethics Committee (MH/DGHS/DPT/637/2020) approved the ethics. The study was carried out according to the Declaration of Helsinki and the American Psychological Association. [14]It concerns ethical human research, including confidentiality, privacy, and data management.