Wound care perception and attitude. A school-related experience in Saudi Arabia

Introduction

A wound is defined as a disruption of continuity of the skin, which disrupts cellular and anatomic structures, thus, physiological functions are disrupted 1. Normal wound healing is a complex and dynamic process that includes bleeding, coagulation, and the initiation of an acute inflammatory response in response to the initial injury 2.

Wound injury is a common occurrence, with up to 50 million people reported worldwide in 2015 alone 3, 4. In the United States, over 6 million lacerations are treated in emergency departments (ED) each year 3, 5. Road traffic accidents, systemic diseases such as Diabetes mellitus, and other factors are the most common causes of wound injury 3, 6. Individuals' health can be jeopardized if wound injuries are not properly managed 3, 6. Wound injuries have been linked to approximately 10% of deaths and 12% of morbidity worldwide 3, 6.

Wound care has been identified as a major challenge in the health-care system. One of the most serious problems in medical treatment is wound infection 3. There is little information available about patients' knowledge and attitudes toward traumatic wound care 3.

Poor general health, smoking, and corticosteroid use are all etiological variables that contribute to wound infection 3. Swelling, discomfort, fever, and purulent discharge are some of the signs and symptoms of wound infection 3, 7. Patients with insufficient wound care expertise may face implications such as increased healthcare costs, financial hardship, and a lower quality of life. Patients' awareness of the effects of numerous factors on wound healing is growing because to social media. There are very few studies in the literature that examine the knowledge and attitude of patients who are caring for wound injuries 3, 8,9,10.

In order to avoid complications, health care facilities must provide proper wound care and treatment 11. A recent systematic review shows a limitation of high-quality evidence to support practical training techniques and achieve an ultimate first-aid learning experience among schoolchildren 12. In the light of the current literate, limited studies investigating the perception, attitude, and level of experience of wound care among students and teachers in Saudi Arabian schools. Therefore, the current study aimed to investigate school students and teachers level of knowledge and perceptions of wound care in western Saudi Arabia.

Subjects and methods

Study design, inclusion, and exclusion criteria

This is a descriptive cross-sectional survey conducted during between January and February 2022. The study includes male and female high school students and teachers in the Makkah region, Saudi Arabia. We excluded the participants who've willingly disagreed to participate in this study, high school students and teachers from other Saudi' regions.

Sample size and techniques

The intended sample size in this study was determined by Epi Info™ 7.1.5 (Center for Disease Control and Prevention; Atlanta, Georgia, USA). Thus, the least possible sample size to achieve an accuracy of ± 5% with a 95% confidence interval (CI) is 384. However, the final sample size was 674 was targeted during data collection. Furthermore, a convenient sampling technique was used for sample selection.

Ethical consideration

The research ethics committee of Umm Al-Qura State provided their approval with the IRB number (HAPO-02-K-012-2022-02-963). The biomedical ethics committee of Umm Al-Qura University's ethical criteria and the 1964 Helsinki statement and its subsequent amendments will be followed in all operations involving human subjects in this study.

Questionnaire tool

A structured self-administered questionnaire, which its idea was driven from a validated questionnaire conducted by Jan M, 2021 3. We gathered participants' demography first included participants' age, gender, educational level (students or teacher), and nationality. Then, the second part of the questionnaire evaluated the participants' perception and attitude towards wound care. The second part of the questionnaire contains questions about the participants' experience level of various wound care classifications sites and indicates symptoms for a hospital requires, sterilization, and covering methods for wound care. Lastly, we evaluated participants' attitudes in the third part of the survey.

Statistical analysis

We used Microsoft Excel spreadsheets to input the information. Data were entered into a Statistical Package for the Social Sciences (SPSS) v.23 spreadsheet after verifying the correctness and minimal typographic inaccuracies (IBM, Armonk, NY). Descriptive statistics were described as percentages for categorical data and mean standard deviation for continuous data, with a p-value of less than 5% considered statistically significant. The independent Chi-square test was used to compare categorical data.

Results

Overall, 674 were respondents in this survey study. Participants' mean were 22.12 (SD=13.23); most of participants' age group was (10-20) years old, followed by (40-50) years old (n=461, 68.4%), (n=77, 11.4%), respectively. (Table 1). Female respondents show predominant responses representing (n=424, 62.9%) (Table 1). About three-quarters of participants were students representing (n=509, 75.5%), whereas Saudi respondents were predominant representing (n=563, 83.5%) (Table 1).

Cuts wounds show a high level of responses among respondents representing (n=392, 58.2%), while the most experienced wound care managements were in thighs and legs (n=342, 50.7%) (Table 2). Most participants believe that deep wounds need hospital admission (n=460, 68.2%) (Table 2). Medical plasters, dry, and wet gauze demonstrated a substantial response between participants towards wound converge (n=410, 60.8%), (n=177, 26.3%), and (n=42, 6.2%) respectively, while most participants prefer to use prep pads for wound sterilization (n=495, 73.4%) (Table 2). Moreover, most participants believe that wound cleaning is the first action to take in wound care 34.27%, while wound coverage represents the least responded action among participants 9.94% (Figure 1).

More than 50% of the majority of respondents show a positive attitude towards the importance of healthy nutrition and wound coverage for promoting wound healing, hand washing before wound sterilization, and the consequences of bacteria in increased wound complications. However, other related promoting and delaying wound healing factors, including smoking, perfumes, honey, salt-water, air exposure, Vaseline application, tetanus vaccine, and coffee beans, show an unfavorable attitude among participants (Table 3).

The majority of participants show a reasonable level of experience towards wound care 67.06% (Figure 2). In addition, the student population reveals an adequate level of experience concerning wound care (n=359, 53.26%), compared with the teacher population (n=150, 22.26%) (Figure 3).

Medical researches, ambulance calls, and healthcare providers (30.42%, 23.89%, and 18.55%, respectively) were the most utilized knowledge sources that participants frequently used for wound care-related knowledge and practice (Figure 4).

The vast majority of the students correspond significantly towered burn and cuts wound, while most teachers correspond towards surgical and diabetic wounds (P-value, 0.013). Additionally, most students show an exceptionally high level of experience towards thigh/legs and back wound care. At the same time, teachers reveal a good experience level with chest and face wounds (P-value, 0.003) (Table 4).

Surprisingly, most students prefer to use tissues and perfumes for wound sterilizations, while teachers would mostly prefer mercurochrome and traditional herbs in managing wound injuries (P-value, 0.028).

On the other hand, the presence of foreign bodies at the site of wounds and utilizing gauze in wound coverage were remarkably demonstrated a high level of experience among students rather than teachers, who prefer to use tissues to sterilize wounds. However, no significant statistical associations were found between (indicated symptoms for going to hospital and wound coverage methods) and participants' occupation (P-value, 0.611, 0.096, respectively) (Table 4).

Discussion

The current study evaluated students' and teachers' levels of experience and attitudes toward basic wound care knowledge. Unfortunately, we found very few research studies that assessed the school population's attitude and knowledge regarding this topic.

This study has 674 high school students and teachers in the Makkah region surveyed and analyzed. The majority of participants' age group was (10-20) years old 68.4%. Moreover, 62.9% of participants were female. Results showed that more than half of the participants positively towards wound care practice. In addition, it revealed that female gender and students have a satisfactory level of knowledge towards wound care, wound healing accelerated factors, and delaying factors.

In our study, the most common type of wound was cuts wound, and the wound site was thigh/leg. In compression with another study by Jan M 3, the most common wound site was the abdomen, while in Kuan 9, the knee was the most common wound site, followed by arms. In this study, deep wounds were the most symptoms that indicated seeking medical advice, while Jan M 3 was excessive bleeding 58.5%.

It was observed that study medical plasters were the most common use of wound dressing followed by dry gauze; in Jan M study 3, the majority used Dry gauze 65.5% to cover the wound followed by plaster. Alcohol swab was most commonly used to sterilize the wound, followed by betadine. In line with Malaekah 11, Alcohol swab was followed by tap water.

To the best of the authors' knowledge, the following study is the first study conducted in Makkah city, Saudi Arabia, to assess the level of knowledge and attitude toward basic knowledge of wound care among students and teachers. Furthermore, our study highlighted the cultural factors and misconceptions used in treating wounds. However, this study has some limitations. The majority of responders were students. Therefore, our results may not apply to the teachers' population. Moreover, as self-report was adopted to understand the wound care knowledge, attitudes, and practices, participants may adhere to perceived social norms.

This study showed that medical research was the most source of information while social media was the least, so we recommend concerned institutions to join efforts to raise public awareness of the use of social media, as it is more accessible to the general population. We also recommend conducting an essential annual awareness campaign about wound care in schools. Furthermore, a recent studies reveals that wound care simulation and demonstration methods have a good impact on students' level of knowledge and practice concerning wound care injuries 13-14. Finally, more studies with a larger sample size, including more teachers, are needed to confirm our results.

Conclusion

In conclusion, most of the participants recorded excellent levels of knowledge and attitude towards wound care practice. However, the awareness of some wound delaying factors and the correct ways to deal with wound injuries, especially for serious cases such as diabetic wounds, is still a challenge for public health awareness.

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