Osteoporosis represents a growing public health concern in the Middle East and North Africa (MENA) region, where ageing populations and limited healthcare access contribute to high fracture rates and poor treatment adherence. Despite the existence of clinical practice guidelines, these often lack integration of stakeholder perspectives such as those of patients, healthcare providers, insurers and systems. Understanding knowledge, attitudes and practices (KAP) related to osteoporosis is essential to inform inclusive, culturally relevant strategies for prevention and management. This systematic review aims to evaluate the knowledge, attitudes (preferences) and practices (behaviours) of key stakeholders, including adults aged 50 years and older and healthcare providers, regarding the prevention, diagnosis and treatment of osteoporosis in the MENA region.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines, we conducted comprehensive searches of MEDLINE and Embase for studies published from January 1994 to January 2025. Two reviewers independently screened titles, abstracts and full texts in duplicate. Title/abstract and full-text screening were completed by September 2025. Data extraction will begin in October 2025 and will be performed in duplicate using piloted standardised forms. Risk of bias assessment and data synthesis will follow, using validated design-specific tools and a narrative approach guided by the Synthesis Without Meta-analysis framework. The review was initiated in June 2025, and completion of analysis and manuscript preparation is anticipated in June 2026.

This review synthesises data from publicly available literature and does not involve primary data collection with human participants; therefore, ethics approval is not required. Findings will be disseminated through peer-reviewed publications, conference presentations and deposition of study materials on the Open Science Framework.

This protocol is registered on the Open Science Framework.

Interest in workplace bullying (WPB) has been steadily growing with a focus on understanding its consequences as well as prevalence rates in different occupations and across different countries with varying cultural contexts. Research in the Middle East remains limited, especially in Lebanon. The scarcity of data from the Lebanese healthcare sector underscores the need to better understand WPB in this unique sociocultural and organisational environment.

The primary aim of this study is to investigate the prevalence of WPB among healthcare providers and hospital staff in Greater Beirut. The secondary aim is to investigate the relationship between WPB, psychological well-being, burnout and sick leaves in the Lebanese cultural context.

A cross-sectional study design was conducted.

Seven hospitals in Greater Beirut took part in the study, including six private hospitals and one public hospital.

A total of 958 participants aged 18–64 were recruited using stratified proportionate non-random sampling. Stratification by hospital size and department aimed to ensure broad representation of nursing and support staff across institutions. The participants included nursing and supporting staff, of which 26.3% were males and 73.7% were females. Those employed for less than 6 months were excluded.

The Arabic versions of each of the Negative Acts Questionnaire-Revised (NAQ-R), the General Health Questionnaire (GHQ-12) and the Copenhagen Burnout Inventory (CBI) were administered. These instruments were selected for their established reliability and widespread use in cross-cultural occupational health research. Surveys were administered via paper-and-pencil (six hospitals) and online (one hospital). Prevalence of bullying using the NAQ-R cut-off scores was first calculated and then their respective thresholds identified using receiver operating characteristic analysis. Pearson’s correlation coefficient was used to evaluate the relationship between the NAQ-R and the GHQ-12, CBI and number of sick leaves.

Using the lower threshold as a cut-off on the NAQ-R, 35.1% of participants were classified as bullied. When applying the higher threshold as a cut-off, the percentage was slightly lower but remained comparable at 32.4%. Results showed that across the two outcomes, those who were bullied both when using a lower threshold and upper threshold were significantly more distressed and burnt out (pt(df) = –8.43, p±1.96; Upper threshold: ² (4, N=902)=9.963, p=0.019, Standardised residual for 6–10 days=2.2>±1.96).

Findings yielded lower prevalence rates of WPB among nurses and the entire sample as compared with research carried out in the Arab region. Our study further supports the impact of culture on the perpetuation of WPB and the uniqueness of Lebanon’s culture on influencing this prevalence. Results indicated that participants who were bullied were significantly more distressed, more burnt out and reported taking up more sick leaves. These findings highlight the need to consider local workplace culture when addressing bullying and reinforce the significant psychological and occupational toll bullying takes on affected individuals. Healthcare institutions are encouraged to implement and reinforce clear antibullying policies, WPB prevention strategies and confidential reporting mechanisms. Future research should explore longitudinal patterns of bullying, obtain a more nationally representative sample and examine the effectiveness of targeted interventions to create safer, more supportive work environments.