Developing a culturally adapted competency framework for community paramedicine practice in Saudi Arabia

Community paramedicine (CP) has emerged globally as a model for extending healthcare access, but little evidence exists on how it can be adapted to the sociocultural and systemic context of Saudi Arabia. This study aimed to develop a culturally tailored competency framework for CP to inform education, practice, and policy. A qualitative design using semi-structured interviews with 15 experts from diverse regions and professional roles in Saudi Arabia was adopted. Thematic analysis was conducted to identify the core competencies. To complement the qualitative synthesis and explore structural patterns among the identified domains, exploratory factor analysis (EFA) was applied to expert ratings of competency importance, enabling validation of interrelationships between themes. Twelve interrelated competency domains were identified, including: chronic disease management, communication and cultural competence, leadership and decision-making, community engagement, system integration, telemedicine and digital health, mental health and palliative care, public health and prevention, simulation-based and rural training, policy and governance, ethical and legal awareness, and research and evidence-based practice. The EFA revealed three principal axes: (1) interpersonal and cultural competencies, (2) operational and clinical preparedness, and (3) policy and research orientation. Together, these dimensions highlight the balance between culturally embedded care, clinical readiness, and strategic policy integration. This study presents the first comprehensive and culturally adapted competency framework for CP in Saudi Arabia. The framework demonstrates how context-sensitive training can address rural-urban healthcare disparities by equipping paramedics with both clinical and culturally grounded skills. It also underscores how education and accreditation pathways can overcome sociocultural barriers to care. By linking clinical competencies with policy and governance structures, this framework provides strategic guidance for training, accreditation, and system integration, supporting Saudi Arabia's national health transformation goals.