Women Empowerment in Medical Imaging and Radiology: Status and Challenges

Women Empowerment in Medical Imaging and Radiology: Status and Challenges | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Women Empowerment in Medical Imaging and Radiology: Status and Challenges View ORCID Profile Ashwag Rafea S Alruwaili , Alanoud Abdullah Alzahrani , Hajar Abdullah Almater , Lina Abdulaziz Aldibas , Nawal Farah Al anazi , Asma Mohammed Albanyan , Wadha Alyami doi: https://doi.org/10.1101/2024.01.03.24300758 Ashwag Rafea S Alruwaili 1 Radiological Sciences Department, College of Applied Medical Sciences, King Saud University , P.O. Box 145111, Riyadh 4545, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ashwag Rafea S Alruwaili For correspondence: ashalruwaili{at}ksu.edu.sa Alanoud Abdullah Alzahrani 2 Medical imaging department , King Abdulaziz medical city, National guard health affairs, Riyadh 6581, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hajar Abdullah Almater 3 Medical imaging department , King Abdulaziz medical city, National guard health affairs, Riyadh 6581, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lina Abdulaziz Aldibas 1 Radiological Sciences Department, College of Applied Medical Sciences, King Saud University , P.O. Box 145111, Riyadh 4545, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nawal Farah Al anazi 4 College of Science and Human Studies, Department of Biology, Prince Sattam bin Abdulaziz University , P.O. Box 16273, Al-Kharj 7201, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Asma Mohammed Albanyan 5 Department of Social Studies, College of Humanities and Social Sciences, King Saud University , PO Box 8340, Riyadh 12532, Kingdom of Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Wadha Alyami 1 Radiological Sciences Department, College of Applied Medical Sciences, King Saud University , P.O. Box 145111, Riyadh 4545, Saudi Arabia Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Since the pandemic’s beginning, there have been significant setbacks in social and economic inclusion of women. The resistance by public can be quite challenging too due to different reasons, such as religious beliefs or the dominance of custom and traditions creating a consistency in leadership perceptions and prototypes of leaders. The Saudi vision unleashed the exacerbated efforts to increase women involvement in the workforce and empower them in leadership roles. Yet the overall representation of women in leadership positions in health and academe in Saudi Arabia remains low compared to other countries. Exploring women status in medical imaging and the risks of reversals after the pandemic became necessary. An online questionnaire was distributed to female workers in both health and academic institutions in the field of medical imaging from December 31, 2021 to October 10, 2022. A total of 250 responses were received, and only 240 females consented and met the criteria for inclusion in the study. Results show that Saudi women still face the glass ceiling when it comes to administrative roles even though they have high level of self-esteem and efficacy along with the support from the Saudi government by fair wages compared to male counterparts. However, institutions imposed largely more constraints on women, creating difficult environment for gender diversity in work culture such as breastfeeding hour, rest during working hours, leave for accompanying family member in sickness or hospitalization such as children, sick leaves during pregnancy or monthly period. In a remarkably short span of time, the current Saudi government has undertaken commendable initiatives to empower women, achieving their predetermined targets with notable success. Despite that, there are many familial and cultural challenges that hinder them from leading positions. The perceived efficacy of women leaders and the disparities in their leadership philosophies are still up for research. Introduction Global development for women and girls has halted due to the economic and social effects of the pandemic and geopolitical strife, which also run the risk of leaving permanent scars on the universal movements towards empowering women. Empowerment is a combination of power and self-sufficient rather than a single process only, that stimulate individuals to positively contribute to the success of communities. Qualified females remain marginalized in leadership and administrative positions [ 1 ]. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), the global science records showed less than 30% of researchers are female, in which there has been simply 42% in Asia and 30% in Africa, and 32% in North America and western Europe, and 45% in Latin America [ 2 ]. This may explain why female deliver out much less scientific papers than male [ 3 ]. In the United States of America (USA), the presence of female in decanal positions (ie, dean, vice dean, senior associate dean, associate dean, assistant dean) in medical schools make up at most only 15% of the deanship population [ 4 ]. In Saudi Arabia, female researchers represented even less than the numbers by UNESCO where only 23.2 % of total researchers are female [ 5 ]. The gender prejudices and constrictive gender norms that exist in society are reflected and reinforced by the health systems too [ 6 ]. This evidence of bias endangers the well-being of female healthcare professionals as well as the health of entire communities. Culture can be one of the barriers to women empowerment. The belief of the community that health workers should be driven by altruism rather than financial gain is encouraged by health professional themselves and culture norms. This belief can justify the low-paying or unpaid roles, such as volunteering, for females in the health sector. Some collectivist culture, such as middle eastern, public take enormous pleasure in upholding and preserving the Islamic and Arabic traditions and might not be prepared for the change towards women leadership. Particularly, in the Saudi culture, Saudi citizens nurture the Islamic root of their culture which mistakenly misbelieve that women cannot lead [ 7 ]. Although since the announcement of Saudi 2030 vision, women were the highlight of the media focus. Yet empowering women face many obstacles and this quantum leap in new social trend might reshape the Saudi culture in the coming years. Further challenges such as environmental factors, familial responsibilities and duties, male worker dominance at workplace, and gender equality [ 8 ]. The lack of self-motivation and level of education are found to be more personal challenges [ 9 ]. Extreme issues include sexual harassment in workplaces [ 10 ], lack of voice, image of incompetence and male co-workers discomfort with women whom they perceive to be better than them [ 11 ] were previously reported and recognized. There is evidence that entry of women into the field of medicine is about 50% [ 12 ] while the role of women in leadership is way less due to reasons such as delayed leadership opportunities, gender inequality and unequal capabilities. Some female faculty members may have difficulty combining professional and family responsibilities, leading them to leave their leadership work in favor of male due to a lack of cooperation and work-life balance [ 13 ]. Empowering women is derived from the societal concept that this gives women their necessary rights in life, equally to education, making their own decisions, and not being subject to the dominance of masculinity [ 14 , 15 ]. It has been found that even with rising reports of women experiencing violence and discrimination [ 16 , 17 ], empowering women will always provide safety and protection for female to resist the abuse that goes toward them [ 18 ]. Fundamental problems can be addressed through awareness and change in institutional policies towards the role of women, equal opportunities, cooperation to resolve work-and-life imbalance and therefore, improvement in the development of leadership skills. There have been recent efforts to increase women involvement in the workforce and empower them in leadership roles [ 19 , 20 ]. The overall representation of women in leadership positions in Saudi Arabia remains low compared to other countries. Based on the Global Gender Gap Index, Saudi Arabia held the place of number 141 out of 149 in 2018 [ 21 ]. Despite the 130% increase in the number of women working in the private sector by 2022, their leading participation still lags behind their political empowerment and education indices (127 out of 149) [ 21 ]. Further research is needed to fully understand the challenges and obstacles hinder the progress of women empowerment by 2030. There is a scientific agreement on the biological differences between women and men which cannot be neglected. However, the cultural differences are manageable and can be alleviated. Achieving gender equality in Science, Technology, Engineering and Medicine (STEM), can bring us to the ideal health, communal, and economic growth. Gender equality help not only in economic expansion, but lowers the death rate in children, and helps build up nutrition [ 22 ]. Worldwide, repression of women has serious consequences on physical and mental health [ 23 ]. The historical stringent restrictions on Saudi women such as mobility freedom compared to Gulf region was not restricting Saudi women from taking the lead among the gulf women in directing the system’s performance towards health and education with the government’s support to meet women’s rights and needs [ 24 ]. The changing in the policies of Saudi Arabia is in parallel to the community and society increased awareness towards women’s education and rights which are important elements that will improve women’s self-efficacy [ 25 ]. The new vision of Saudi Arabia promotes women empowerment through relaxing the constraints placed against them. It considers women a great asset and has been publicly published that female’s presence should take part in 30% of leading presence in Saudi system since 2016 [ 7 ]. Since the launch of the Kingdom’s Vision 2030, women participation rate increased from 21% in 2017 to reach 31.2% of the workforce in 2020 [ 26 ]. The reforming of the whole system, whether its education or health systems, are in favor for women to play a real role in the advancement of the lifestyle in the Kingdom. These recent moves hold important lessons to put more effort on emerging fields such as medical imaging in both medicine and academe [ 27 ]. Establishing new policies in order to ease women’s career life are very crucial at this stage of transition towards women empowerment. Especially with the aim of lifting restrictions on women to join sectors that previously considered male specialty and to enabled women to access leadership positions. Therefore, the need to investigate women status in the health and academe of Radiology field is demanding. The changes implemented to women empowerment in medical field over the past years remains unprecedented. However, there is still uncertainty about the direction of leadership opportunities and the full empowerment of women in the fields of Radiological sciences and medical imaging. This study aimed; a) Investigate women’s status in leadership and administrative positions in medical imaging field from research the female current status in medical imaging, b) explore other empowering factors related to women’s leadership and administrative roles, c) to address the difficulties facing female empowerment in medical imaging, d) to provide recommendations that can aid the health system towards women empowers in medical imaging. Methods Sample size The recruitment period commenced on December 31, 2021 and concluded on October 10, 2022. During this timeframe, participants were actively sought and enlisted for inclusion in the research, ensuring a comprehensive and representative sample for the investigation. This survey-based study received responses from a total number of 250 and included only 240 female who consented and met the criteria for inclusion; a) Saudi female, b) aged 25 years old or above, c) working in the medical imaging departments or radiological sciences departments either in hospitals or universities in Saudi Arabia. Participants should hold an education degree either a Diploma, Bachelor’s, Master or Ph.D. workers and academics in the field of medical imaging. Results were based on their perspective towards women’s empowerment and the difficulties facing them against their empowerment and what is required to empower them. Questionnaire design The bilingual online surveys were designed by researchers in English and Arabic and divided into four sections: a) demographic data which will cover basic information about the region, age, marital status, number of kids, education level, sector, size of the hospital, years of experience, monthly income if they held a leadership position, and the current position, b) personal empowerment which includes questions about self-esteem, and self-efficacy, c) social/ relational empowerment which includes statements about economic empowerment, and freedom of mobility, d) environmental/ workplace empowerment access to education, resources, support, organizational role, and women rights in work.. A copy of the questionnaire is available in supp 1. The questionnaire was designed to include several domains that are classified under two dimensions, as follows; The first section : include multiple domains with factors related to leadership and administrative roles for women in the field of medical imaging which is divided into several dimensions. The second section : difficulties that face females in the medical imaging field. The next step was formulating the statements of the questionnaire. After reviewing the past theoretical models, research and previous literature related to woman leadership in medical imaging, with the tools used in previous studies, we constructed current tool statements. A 5-scale Likert scale has been set for responses where one is strongly disagreed and 5 represent totally agree. Statistical analysis Exploratory data analysis and cross tabulation was carried out such as calculated frequencies of participants for each question, weighted average, and standard deviation. Both percentage and frequencies were applied to identify the demographics of the study sample and to determine the results of the main dimensions in the study tool. Weighted Mean was used to investigate the level of agreement on the statements and arrange the statements based on the highest weighted mean. Validity of the study tool and internal consistency are available on Supp 2 Ethics Ethical approval was issued by the Institutional Review Board (IRB) at King Saud University Medical City (KSU-MC) number E-21-6532. Participants provided informed consent by answering an explicit question before proceeding with the survey, affirming their voluntary participation and understanding of the study’s objectives and their rights. Results Study population The sample represents the female community of all specializations in the field of radiology in both health and academic sectors. The questionnaire was distributed online to the study population, and a total number of 240 participants were valid for statistical analysis. Sample demographics Geographical Distribution-Most of the respondents are from Riyadh represented by 55.4% of the total study sample, and they are the largest category of the study sample. The next dominant percent was represented by the Eastern region of 13.8 % while the lowest percentage of participants was from both Albaha (0.8%) and the Northern borders (0.4%). The regions of Asir and Makkah had almost similar numbers of respondents (7-7.5%). Figure 1 shows the geographical distribution of the study sample and the years of experience. Most of the respondents had 5 years of experience or less (n=145, 60.4%), and they are the largest category of the study sample. Next, is 6 - 10 years of experience (n=52, 21.7%), then the 11 - 15 years of experience (n= 23, 9.6%). Only 20 participants had over than 15 years of years of experience, representing 8.3 % of the total study sample. Download figure Open in new tab Figure1 Age groups-the study sample’s age group of less than of 25 years old (n= 118) represent 49.2% of the total study sample’s age group and they are the largest category of the study sample. The respondents who are between 25-30 years old (n= 44) represent 18.3% of the total study sample. The group age of more than 30 to 35 years (n= 43) represents 17.9% of the whole respondents. Above the age 35(n= 35) represents 14.6%. Table 1 shows the details of each age group. View this table: View inline View popup Table 1: Age distribution of the total participants. The majority of the study sample’s (n=125) are single females who represent 52.1% of the total respondents and have never been married. While (n=108) of them are married and represent 45% of the female sample. The divorced females (n=7) are the lowest number of the study sample representing 2.9% of the total number of the study sample. Among the last two samples of married (n=108) and divorced (n=7), A total of 70.4% of (n=81) have 1-2 children, 28.7 % (n=33) had 3-6 children, and only one participant had more than 7 children. The annual income of most respondents (n=176, 73.3%) is equal or more than $32,000 and they are the largest category of the study sample, while only (n=38,15.8%) of them represent the sample who had their annual income of $16,000 to $32,000. While the least are the female respondents (n= 26, 10.8%) who receive an annual income of $16,000 or less, ( Figure 2-A ). The sample education level distribution was a follow; respondents with undergraduate degree (n=181, 75.4%), master’s degree (n=26, 10.8%), diploma (n=23, 9.6%), and Ph.D. (n=6, 2.5%). Only (n=4, 1.7%) were in fellowship ( Figure 2-B ) shows the education level distribution for the sample included in this study. More than half of the respondent (n=160, 66.7%) are representative of the government health sector of the study sample and (n=39, 16.3%) in the private health sector. Among these groups, (n=44,22.1%) worked in a hospital sized 100 beds, (n=29, 14.6%) in hospitals sized 110-150 beds, and majority of the health sector respondent (n=126, 63.3%) worked in bigger size hospital of more than 150 beds compared to the others ( Figure 2-C ). Figure 2-D shows the employment field and the size of hospitals for the respondents from health fields. This study found that only (n=44, 18.3%) of females have been in leading roles or administrative positions while the majority (n=196, 81.7%) have never worked in a leadership or administrative position. From the 18.3% female leaders, majority (n=32, 72.7%) held the leadership/administrative role within the medical imaging field and only (n=8, 18.2%) of them, held these positions outside the medical imaging field. Only few (n=4, 9.1%) of them were in leading roles inside and outside the field of medical imaging. We further investigated the location of these positions and found that the largest sample (n=36, 81.8%) were assigned leadership and administrative roles within their institution, while (n=7, 15.9%) of them had been leading outside their institution. Only one respondent held a leading position inside and outside her institution ( Figure 2-E ). Download figure Open in new tab Figure2 The Empowerment Factors related to Self-worth In general, the respondents strongly agreed on self-esteem factors related to leadership roles and administrative positions with an average of 4.29 out of 5.00 and SD=0.622, which indicates the “strongly agree” scale on the study tool. They strongly agree on two factors of self-esteem related roles leadership and administrative which are a) “On the whole, l am satisfied with myself” (85.9%, mean 4.26±0.934), and b) “I feel that I’m a person of worth, at least on an equal plane with others” (95.8%, mean±SD 4.64±0.639). While the rest of the statements had lower strength of agreement compared to the previous two ( Table 2 ). The second axis in the domain of self-efficacy which showed a moderate agreement with an average of 4.04 out of 5.00 that refers to the “I agree” option on the study tool. Breaking down the results we noticed the homogeneity in the agreement on the factors related to this axis, where the average ranged between 3.96 to 4.11. Two factors of self-efficacy are; a) “My coping capability help me calm in a hard situations” ranked first in terms of the agreement of among 80.8% of the respondents with an average of 4.11 out of 5 and SD=0.892, and the second statement b) “ It is easy for me to focus on my objectives and accomplish my goals” ranked second with 73.3% of the total agreement and an average of 3.96 out of 5 SD=0.965. View this table: View inline View popup Download powerpoint Table 2: Results of Self-Empowerment Dimension The Empowerment Factors related to Socio-economical dimension Most of the study sample agree on most of the economic related factors with an average of 3.78 out of 5.00, which indicates the “I agree” option on the Likert-scale. The highest level of agreement on two statements, a) “I can have/ask for lends and loans” with 79.6% (4.04±0.93), and b) “There is equality in allowance provided from work between men and women (Health and medical field)” with 71.3% (3.87±1). The least agreed statement were; a) “I find equality between men and women in accessing economic opportunities” with 60.5% (3.68±1), and b) “I can benefit various services in the community (such as commercial, investment, and Residential) without restrictions” with 56.2% (3.64±1). Table 3 . View this table: View inline View popup Download powerpoint Table 3: Results of Socioeconomical Dimension The Empowerment Factors related to Mobility Freedom In freedom of mobility that can contribute to taking roles in leadership and administrative positions, the general level of agreement was an average of 3.46 out of 5.00, which indicates the “I agree” option. There discrepancy in the agreement on freedom of mobility. Agree on two factors represented in the two phrases; a) “ I can travel inside the Kingdom to participate in conferences and events depending on clear and easy-to-apply submissions” few disagreed while the rest 70.7% agreed on this statement with (3.86±1.065), b) “I can travel outside the Kingdom to participate in conferences and events without restrictions”, had total agreement of only 52.5% (3.47±1.203). However, more than half of the respondent 58.3%(3.06±1.273) did not agree on their freedom of mobility of transfer between jobs in the field of medical imaging which was stated as “I have the freedom of mobility between work fields in radiology with clear policies”, Table 4 . View this table: View inline View popup Download powerpoint Table 4: Results of Mobility Freedom Dimension The Empowerment Factors related to Environmental Factors The results here are surprising as the female responded to the environmental factors related to empowering women, in general, with neutral response on the Likert-scale with an average of (2.95 out of 5.00). Although many agreed on one factor which is related to the ability to travel freely within the country with 70.5% of total responses (3.49+1.2), they hardly agreed on their freedom to travelling abroad with 52.5% (3.37+1.2). Compared to that, less percentage of female in medical imaging around 44.2% (3.18+1.2) agreed that there is equity in nomination for funding the training courses at work while 29.2% were neutral and 26.7% disagreed with the statement “I find equality between men and women in nominations for courses at work”. It is unfortunate that 50.5-51.5% of these females do not find the support from their work field in keeping gifted, hardworking, and intelligent (2.52+1.2) nor providing a library or resources for updates in the field (2.66+1.3). Table 5 shows the average of responses for the rest of the statements which was the weakest on the population agreement. View this table: View inline View popup Table 5: Results of Environmental Dimension The Empowerment Factors related to Institutional factors The respondents in this section were hesitant to agree or disagree with an average of (3.32 out of 5.00), which is the category that indicates a “neutral” option in the Likert-scale. Responses towards election and nomination for leading positions had higher disagreement 41.3% compared to agreement of 33.3% and neutral 25.4% which pushes the total mean to 3.83+1.3. The next statement that had better level of agreement 66.7% compared to the latter statement is “I feel I do belong to my work field” with an average 3.63+1.2. The rest of the statements’ level of agreement is in Table 6 . View this table: View inline View popup Download powerpoint Table 6: Results of Institutional Dimension The Empowerment Factors related to job factors An average of (2.92 out of 5.00) meet the neutral category of the Likert-scale response of females in medical imaging on statements related to job empowering factors that can support women in medical imaging careers. There is significant discrepancy in the agreement among many of the statements. Most of the statements in this dimension is below neutral and towards disagreeing. The agreement level to the rights for breastfeeding hour (47.9%, 3.4+1), rest during working hours (52%, 3.26+1.3), leave for accompanying family member in sickness such as a parent or children (37.5%, 3.06+1.3), sick leaves during pregnancy (36.3%, 3.09+1.2) or monthly period (17%, 2.22+1.2), and the availability for rest area at work had (51.7%, 3.1+1.358). Moreover, childcare services or centres in the institution had more disagreement than the rest of the statements with (63.8%, 2.35+1.3), Table 7 . View this table: View inline View popup Download powerpoint Table 7: Results of Job Empowering Dimension The challenges facing women empowerment The final dimension was challenges facing women empowerment in medical imaging. Although these challenges were phrased in statements, open question was present in the questionnaire to allow further challenges to be recognised. However, the statements in this dimension had more neutral responses compared to the rest of the scale. Women agree upon the difficulties they face to balance work and life (54.6%, 3.47+1.2) especially the family responsibilities. This may contribute to the long working hours as per more than half of the respondents (52.5%, 3.57+1.2), the societal restriction (42.1%,3.12+1.2), difficulty to care for own children during working hours (41.3%, 3.47+0.95). Less agreement on the statement “Men’s attitude towards women and leadership is negative in the department I work in” (33.4%, 3.1+1.2), Table 8 . View this table: View inline View popup Download powerpoint Table 8: Results of Challenges Towards Women Empowerment Discussion The study was conducted to investigate women’s status in leadership and administrative positions in the field of medical imaging from both health sector and the academe. Exploring other empowering factors related to these roles and addressing the difficulties facing female empowerment in medical imaging was included. An important observation emerged from this study is that 67.5% of the sample size were under 30 years of age, which indicate that the number of female graduates has increased recently and that could be attributed to women’s opportunities provided since the announcement of the Saudi 2030 vision [ 28 ]. Although previous studies suggest that micro factors such as personal, and familial, factors can influence women’s empowerment, the macro factors such as society, culture, organizations, and governments are more essential to rapidly facilitate empowerment. Self-esteem and self-efficacy are internal factors that can be predictor of women empowerment level [ 29 ] which found to be high in our sample (M = 4.29, SD = 0.622) and (M = 4.04, SD = 0.79), respectively. Both factors can be used when designing empowering programs to support women leadership. We consider these results promising for the future empowerment because low self-esteem is a significant obstacle in the work environment as it leads to avoidance of leadership positions and satisfaction by mere participation without the ability to make decisions [ 25 , 30 , 31 ]. Many evidence showed that women faced fewer tenured faculty positions with slower career advancement despite increasing research activity over time, which lead to slower promotion than males [ 32 ]. These disparities have persisted for decades, despite increasing in women entering the field of radiology over 40 years, women presence in radiology editorial boards are still lagging and never held a position as editor-in-chief [ 33 ]. The economic empowerment is defined as “the transformative process that helps women move from limited power at home to having the skills, resources, and opportunities needed to compete equitably in job markets in order to control and benefit from economic gains” [ 34 ]. Our study investigated this domain because women’s access to economic resources and opportunities, such as employment, financial services, real estate, and other productive assets, increases with economic empowerment. We found that the participants were satisfied and agreed on equity between men and women in salaries, allowances, promotions, rewards, and access to investment opportunities, because equal wages are stipulated in the National labor system [ 35 ]. Our finding is outstanding and incomparable to the global problem of gender wage inequality where gender pay gaps were reported across all medicine specialties without clear explanation by seniority, career breaks, and/or part-time work [ 36 ]. Women inability to negotiate salary results in wage gap in academe [ 3 ] which reinforced, along with other studies, that pay gap is one of the international challenges in women empowering [ 37 – 40 ]. Inequality in wages has led many women dropping out of their jobs, which negatively affects women’s empowerment and leadership opportunities. As working in the radiology sector is stressful, some women may find that their financial return when obtaining leadership positions is not worth the efforts [ 37 , 38 ]. However, our findings in wage equity were not an issue and supports women empowerment in Saudi Arabia. Besides the economic factors, the mobility freedom for Saudi women in medical imaging was investigated. We found that the participants were satisfied and agreed on the factors of this domain although the women history of mobility freedom had sensational events [ 41 ]. In the book “Gender, Class, Nationality, and Women’s Access to Public Places in Riyadh ” Saudi women faced obstacles in many aspects of their lives that hindered their empowerment and independence [ 42 ]. Examples of reasons behind the almost complete absence of women in public places mentioned by the author included; a) women driving was prohibited in the past b) the lack of public transportation, c) the financial cost in the case of hiring a driver, d) lack of anti-harassment laws, which is restricting the mobility freedom [ 42 ]. Limited access to transportation can increase women’s “hidden” barriers to the participation in the labor market and negatively affect their access to other services such as education or health, and ultimately reduce women’s empowerment [ 43 , 44 ]. Since the announcement of the 2030 vision, women empowerment is one of the targets and was set to achieve 30% increase women presence in labor market by 2020. Many of these obstacles were resolved and solution is still being facilitated by the government. In 2018, the women were given numerous rights such as allowing them to drive and issue driving licenses besides setting and immediate execution of harassment laws. In 2019, the travel requirement for women with a male guardian was abolished. The Saudi Human Resources Development Fund initiated “Wusool” which aims at increase women’s involvement in the job market and support the newbies in overcoming transportation barriers if working for private sector and, thus, ensure job stability. The program provides financial assistance for transportation costs for eligible workers, covering up to 80% of the cost and lasts for 24 months [ 45 ]. These changes explain our findings, where participants agreed on the freedom of mobility factors. We found that although the participants showed a high level of loyalty and passion towards their careers and institutions, no tangible efforts have been made by the workplace in terms of caring and motivating talented and hardworking female employees, therefore the participants showed their dissatisfaction with such element. Studies have confirmed that having talented women in leadership positions benefit the final work outcomes, as well as offer the advantage of different perspectives [ 46 , 47 ]. Nevertheless, the Women in the Workplace 2017 report revealed that although women make up 52% of the US population, they make up only 20% of leadership roles [ 48 , 49 ]. This reflects how difficult it can be for women to get to the top. During recruitments, institutions can; a) assign diverse committee with prominent females to interview applicants [ 50 ], b) showcase the success of female employee/faculty, c) set flexible tone in welcoming environment. In the context of the institutional empowerment, participants agreed that workplace lack of nurseries and childcare, prohibit leave during menstrual cycle. One practical factor that assists women in fully participating in the workplace is the implementation of institutional policies that promote exclusion of the gendered experience. Inclusive policies which help foster an enabling environment are those that provide support for working female parents and continually evaluate workplace flexibility. Qurrah Subsidy Program is another Saudi initiative that was launched through the Child Welfare Authority intended to provide support to working mothers by ensuring that their children are well-cared for while they pursue employment opportunities in private sector [ 51 ]. This explains the increase in the number of fresh women in the field of medical imaging by our findings. As for the difficulties in the field of medical imaging, long working hours, lack of development, and the inability to attend conferences and workshops are among the most common barriers that were repeated by the participants. Professional conferences are an important source of training, networking, and learning opportunities in every field [ 52 ]. To limit the negative impact of these barriers, we propose part-time job opportunities and motivate stand-out workers at a rate of one workshop per month for the most accomplished employee. We call for the establishment of programs that promote the development of women’s skills in management and leadership, as their effectiveness has been evident [ 53 ]. Having an administrative role in the field of medical imaging reflects empowering status and indicates effective women leadership and influence in the field. This enables role modelling function for future generations. Unexpectedly, our study revealed that majority of our sample (81.7%) have never held a leadership or administrative position. Which is supported by underrepresented US academic women in the field of radiology despite having comparable levels of experience to men [ 54 , 55 ]. Workplace is expected to provide training and development programs for employees/faculty on topics such as unconscious prejudice, negotiation skills, and equity. The low presence of women in leading positions in our study may be attributed to two reasons; 49.4% of the participants were recent graduates, and 60.4 % of our sample have less than 5 years of work experience. This supported by previous literature where higher number of women fill low rank positions compared to advanced ranks [ 56 , 57 ]. Women are 18% less likely to get promoted than their male peers [ 46 ]. Without supportive policies, talented employees will fall behind or not being able to fully reach maximum potential in their careers [ 37 , 46 ]. Another attribute to underrepresentation in leading positions and advanced ranks, is the lack of retention of women particularly in academia [ 58 ]. Lack of role models and poor mentoring can hinder female to accept leading/administrative positions [ 59 ]. Active support in the workplace through mentoring talented women to achieve their full potential is recommended to avoid the “leaky pipeline” which is pronounced in medical fields [ 60 ]. Further evident reason is that women miss such opportunities due to familial obligations and societal expectations following parenting and domestic responsibilities [ 61 ]. We recommend implementing family-friendly policies and promoting a work– life integration culture at institutional, departmental, and individual levels tailored to acknowledge gender-specific difficulties [ 62 ]. These can be achieved through f1exible working hours and support for returners after maternity breaks or leaves ( Table 9 ). Workforce policies should include provisions for breastfeeding or lactation breaks for new mothers. The Saudi working woman has the right for a conditional paid maternity leave up to three years after birth. If returning to work before that, she is entitled to a period, or rest periods, for the purpose of breastfeeding her newborn, with pay, not exceeding a total of an hour per day for 24 months postpartum [ 63 ]. View this table: View inline View popup Download powerpoint Table 9: Summary of recommendations to empower women and promote equity A limitation of our study is that many participants have recently graduated and lack work experience, and this is attributed to the tremendous changes that Saudi Arabia is going through to achieve Vision 2030 through offering academic programs for female that was previously inclusive to male and enforcing more job opportunities for women. These are not surprising compared to global evidence of increases drop-off of academic females at the associate and full professor levels [ 59 ]. On top of all, the pandemic has affected women more than men, and it impede the promotion of female academic radiologists as it has adversely affected academics’ productivity and disproportionately increased women’s household and childcare duties [ 64 ]. Further studies are required to measure the extent, efficacy, and quality of women empowerment in leadership and administrative positions. The largest increase in the representation of women in leadership positions in tight cultures should come through egalitarian behaviors. There should be a strong dedication by decision makers to significantly improve women status in empowering positions and avoid the implicit biases in women leadership prototypes. Future research is mandated in the effectiveness of women leadership in this field and specifically in the Middle East and North Africa (MENA) and developing countries. In addition, researchers ought to explore the gender diversity in fields where women are underrepresented to come up with a more proactive strategy for laying the foundation for gender parity in the burgeoning industries of the future. We need to establish promoting women for leadership positions in the field of medical imaging academe and industry to facilitate the placement of highly qualified women into leadership positions. Conclusion The current status of women in the field of medical imaging and the challenges that could lead to the glass ceiling for women empowerment in both sectors is presented here. Our study found that women do not lack self-esteem or efficacy and government supports their presence and empower them. The culture places some constraints on women emancipation, however, the real hurdle lays upon the recruiting institutions to facilitate the emergence of women as leaders. The glass ceiling effect is an existing issue bolstering female leadership in fields dominated by men through accelerating gender egalitarianism must be a core part of the public and private agenda. The Saudi Arabian government has demonstrated exemplary leadership of proactive initiatives that effectively empowered women in the workforce. Data Availability All relevant data are within the manuscript and its Supporting Information files. Acknowledgments We extend our deepest gratitude to the remarkable women who generously participated in this research study. Your voices have added depth to our findings, and we hope that the insights gained from this study will contribute to the betterment of women empowerment all around the world. References 1. ↵ Alghofaily L . Women leadership in higher education in Saudi Arabia . 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