Knowledge and Awareness of Osteoarthritis Among Adult Saudi Population in Al-Baha Region, Saudi Arabia

Introduction:

osteoarthritis (OA) is a chronic degenerative disease that primarily affects the articular cartilage of the joint. It is characterized by the progressive breakdown of cartilage due to mechanical stress and low-grade inflammatory processes, leading to joint destruction and resulting in pain, loss of mobility, stiffness, and swelling1. Commonly affected joints include the hands, knees, hips, and spine, It could affect a single joint (localized OA) or multiple joints (generalized OA)1. Furthermore, as the most prevalent form of arthritis in both industrialized and developing nations2. However, there is a poor association between radiographic alterations and joint pain severity3. As age advances, the incidence of OA tends to rise significantly.

Statistics reveal a progressive increase in OA prevalence with age. Notably, among individuals aged 46-55 years, the prevalence of OA stands at 30.8%. Furthermore, within the age bracket of 66-75 years, the prevalence skyrockets to a staggering 60.6%. These figures serve as a testament to the escalating impact of age on the development and manifestation of OA 4.

Looking at the literature review Several studies conducted in different regions of Saudi Arabia have revealed significant variations in public awareness and knowledge of OA. In Sudair, a 2021 study involving 387 participants found that only 14% of respondents had adequate knowledge of OA, while 34.6% demonstrated inadequate awareness 5. Similarly, a 2020 study in Jeddah with 1,238 participants revealed that just 37% correctly identified the mechanism behind OA, indicating low levels of understanding, particularly among younger age groups.⁶

In contrast, a 2022 study in Tabuk involving 420 participants reported average knowledge levels, with a mean knowledge score of 8.03 (SD = 2.1), and highlighted the need for improved public education.th average knowledge, indicating a need for increased public education 7. Also, a study in Aseer with 1,052 participants found significantly higher awareness levels, with 89% of the sampled population had good knowledge of the precautions to take against knee OA, and 82.6% reporting a high overall awareness of the disease.⁸

Previous studies have reported the prevalence of OA in the Kingdom of Saudi Arabia, with varying levels of knowledge regarding OA among the population. However, no studies have been conducted to specifically assess the knowledge level regarding OA among the Saudi population in Al-Baha, Saudi Arabia. Our study aims to assess knowledge and awareness of OA and its related risk factors among the Saudi population in Al-Baha region, Saudi Arabia.

Materials and Methods:

Study design

This cross-sectional study utilized a structured validated questionnaire developed and validated by Ali H. Alyami et al. to assess the knowledge and awareness of the general population in Jeddah Saudi Arabia6. Permission was obtained for its use. The questionnaire has been previously utilized in a study by Alahmed et al. to assess knowledge about OA and its related risks factors in Hail3.

Study setting and population :

The study was conducted in Al-Baha, Saudi Arabia, among Saudi adults aged 18 and above. Both males and females were invited to participate. Participants were recruited in October 2023 via an online questionnaire using a Google Form link form, distributed through social media platforms (WhatsApp, Instagram, X, Snapchat) utilizing convenience sampling method.

Inclusion and Exclusion Criteria:

Inclusion criteria: male and female Saudi population above 18 years of age living in Al-Baha region.

Exclusion criteria: participants below the age of 18, non-Saudi population, and people who lived outside Al-Baha region.

Sample size and sampling procedure:

616 individuals in the study completed the survey using convenience sampling. The standard sample size method was used to estimate the minimum sample size at a 95% confidence range. A minimum sample size of 384 was found to be sufficient for the study.

Data Collection Methods:

Three components of a self-administered questionnaire in Arabic were used. Demographic information, including age, gender, and educational attainment, was given in the first section. Group 1: 18–29, Group 2: 30-39, Group 3: 40–49, Group 4: 50–59, and Group 5: 60 and older participants were divided into 5 age groups. No education, less than secondary, secondary, bachelor's, or higher education were the other categories for education level. Participants were questioned about the concept of OA and their understanding of it in the second portion. Using a 20-item quiz, participants' knowledge was evaluated in the third portion, which concentrated on basic information, symptoms, risk factors, diagnosis, and OA treatment choices.

Data Analysis

Data was gathered, cleaned, examined, and then examined again. The Statistical Package for Social Sciences, version 28, was used for all statistical studies, guaranteeing dependable and sturdy outcomes. Descriptive statistics were used in the study to summarize the data, which included participant biographical information, medical history linked to OA , and knowledge of other individuals with OA . Counts, proportions (%), and mean values with standard deviations were presented as applicable. The amount of knowledge that participants knew about chronic OA was tallied, while the general degree of awareness and the information source were graphed and shown in figures. The Mann-Whitney U test and the Kruskal-Wallis test was used in statistical studies to examine the link between participants' bio-demographic factors and their level of awareness and knowledge. Statistical significance was defined as p < 0.05, or a significance level less than 0.05.

Additionally, the Shapiro-Wilk and Kolmogorov-Smirnov tests were used to evaluate statistical collinearity. A score of one point was awarded for each right response. The discrete scores for each item on the questionnaire were tallied to measure the participants' level of knowledge regarding open access. A total score of sixty percent was interpreted as indicating a good degree of awareness, and any score below sixty percent was seen as unsatisfactory. For every research variable, frequency distributions and percentages were prescribed in order to do descriptive analysis.

Ethical Considerations

The study was approved by the (BLINDED) approval number (REC/SUR/BU-FM/2023/94). The questionnaire included an opening question in order to protect the privacy of collected data and guarantee each participant's informed consent. In addition, strict labeling and handling guidelines were put in place to protect the confidentiality of the data, and no individually identifiable participant data was gathered.

Result

Bio-demographic data of study participants, Al-Baha Region, Saudi Arabia

The bio-demographic data of study participants from Al-Baha Region, Saudi Arabia shows that most participants were in the 18-29 age group (42.4%) and were predominantly female (57.8%). Most participants had university degrees (57.5%) and identified the wear and tear of cartilage as the main cause of OA (47.9%). A significant number of participants knew someone with OA (66.7%). Table1

Figure 1
Bio-demographic data of study participants, Al-Baha Region, Saudi Arabia	Count	%
Age Grouping	18 - 29 Years old	261	42.4%
30 - 39 Years old	84	13.6%
40 - 49 Years old	165	26.8%
50 - 59 Years old	90	14.6%
60 years old and more	16	2.6%
Gender	Male	260	42.2%
Female	356	57.8%
Education	Uneducated	3	0.5%
Less than a high school degree	32	5.2%
High school degree	197	32.0%
University	354	57.5%
Postgraduate degrees	30	4.9%
Do you know how osteoarthritis develops?	The amount of blood that reaches the joint decreases with age	71	11.5%
The nerve that passes near the joint is pressed	67	10.9%
Accumulation of acids inside the joint	51	8.3%
The cartilage at the ends of the bones wears away over time	295	47.9%
I do not know	132	21.4%
Do you know anyone who has osteoarthritis ?	No	122	19.8%
Yes	411	66.7%
I am not sure	83	13.5%

Figure 1. Source of information about chronic OA in Al-Bahah Region, represented by percentage of participants. The most cited source was "relatives and friends" (48.20%), while healthcare staff were not commonly cited (2.80%) among our participants.

Knowledge And Awareness of Osteoarthritis Among Saudi Population in Al-Baha Region

The results showed that the majority of participants recognized OA as a chronic problem (64.9%) and acknowledged that different joints can be affected (39.9%). However, there were misconceptions, as a minority believed that OA is rare (9.3%) and caused by cold, damp weather (25%). Some of the participants were aware of common symptoms such as pain (as a symptom of OA ) (52.8%) and stiffness (56.0%), but fewer recognized swelling (41.9%) as a sign. Knowledge regarding diagnostic methods varied, with a majority aware of physical examination and X-ray (61.0%) but fewer aware of the unusefulness of blood tests (42%). Treatment options such as NSAIDs (33.6%), exercise like swimming (61.0%), and physiotherapy (75.2%) were known, but there were misperceptions about the effectiveness of acid-free diets (35.4%) and intra-articular injections (23.2%). Joint replacement surgery was considered a viable option by 45.1% of participants. Table 2

Table 2. Knowledge And Awareness of OA Among Saudi Population in Al-Baha Region
Knowledge And Awareness of osteoarthritis Among Saudi Population in Al-Baha Region	No	Yes	I am not sure
Count	%	Count	%	Count	%
Osteoarthritis is a chronic problem.	128	20.8%	400*	64.9%	88	14.3%
Osteoarthritis is rare.	495*	80.4%	57	9.3%	64	10.4%
Different joints can be affected by osteoarthritis.	219	35.6%	246*	39.9%	151	24.5%
Osteoarthritis is caused by cold, damp weather.	309*	50.2%	154	25.0%	153	24.8%
Osteoarthritis is developed by a microorganism.	251*	40.7%	173	28.1%	192	31.2%
Pain is the only symptom of osteoarthritis .	325*	52.8%	204	33.1%	87	14.1%
Stiffness is a symptom of osteoarthritis.	96	15.6%	345*	56.0%	175	28.4%
Swelling is a sign of osteoarthritis.	180	29.2%	258*	41.9%	178	28.9%
Osteoarthritis can lead to loss of joint movement.	102	16.6%	388*	63.0%	126	20.5%
There are genetic factors that can predispose people to osteoarthritis.	243	39.4%	190*	30.8%	183	29.7%
Aging is a risk factor for osteoarthritis.	60	9.7%	495*	80.4%	61	9.9%
Men and women are equally affected by osteoarthritis.	305*	49.5%	174	28.2%	137	22.2%
Physical examination and x-ray are used to diagnose osteoarthritis.	72	11.7%	376*	61.0%	168	27.3%
Blood tests are used to diagnose osteoarthritis.	259*	42.0%	164	26.6%	193	31.3%
NSAIDs can improve osteoarthritis symptoms.	280	45.5%	207*	33.6%	129	20.9%
Some forms of exercise like swimming are suitable for people with osteoarthritis .	89	14.4%	376*	61.0%	151	24.5%
Acid-free diets are a proven treatment for osteoarthritis	109*	17.7%	218	35.4%	289	46.9%
Physiotherapy can cause a great improvement in the symptoms of osteoarthritis.	55	8.9%	463*	75.2%	98	15.9%
Intra-articular injection by stem cells or hyaluronic acid is an effective modality for curing osteoarthritis.	234*	38.0%	143	23.2%	239	38.8%
Joint replacement surgery will be the ultimate option to relieve the symptoms of osteoarthritis.	152	24.7%	278*	45.1%	186	30.2%
* Right Answer

Level of Knowledge Regarding OA Among Saudi Population in Al-Baha Region

The results indicate that a majority of participants (60.9%) had inadequate knowledge about OA, while a smaller proportion (39.1%) had adequate knowledge. The Mean score of 0 to 20 was 10.2, with a median score of 11. The standard deviation was 3.53. Figure 2

241

375

Figure 2. Level of Knowledge Regarding OA Among Saudi Population in Al-Baha Region. 39.10% (241 individuals) demonstrated inadequate knowledge, while 60.90% (375 individuals) had adequate knowledge (Total N = 616).

The association between bio-demographic factors and the levels of knowledge and awareness of OA Among Saudi Population in Al-Baha Region.

The results showed that there was no significant association between age groups (p = 0.492) or gender (p = 0.378) and the level of knowledge about OA. However, there was a significant association between education level and the level of knowledge (p = 0.011), with higher education levels being associated with a higher level of knowledge. Additionally, knowing someone with OA was significantly associated with a higher level of knowledge (p = 0.033). Table 3

Table 3
The association between bio-demographic factors and the levels of knowledge and awareness of osteoarthritis Among Saudi Population in Al-Baha Region.	Level of Knowledge	P-Value
Inadequate	Adequate
Count	%	Count	%
Age Grouping	18 - 29 Years old	153	58.6%	108	41.4%	.492
30 - 39 Years old	58	69.0%	26	31.0%
40 - 49 Years old	96	58.2%	69	41.8%
50 - 59 Years old	57	63.3%	33	36.7%
60 years old and more	11	68.8%	5	31.3%
Gender	Male	153	58.8%	107	41.2%	.378
Female	222	62.4%	134	37.6%
Education	Uneducated	3	100.0%	0	0.0%	.011
Less than a high school degree	26	81.3%	6	18.8%
High school degree	127	64.5%	70	35.5%
University	200	56.5%	154	43.5%
Postgraduate degrees	19	63.3%	11	36.7%
Do you know anyone with OA?	No	77	63.1%	45	36.9%	.033
Yes	229	55.7%	182	44.3%
I am not sure	69	83.1%	14	16.9%

Discussion

The most prevalent illness and cause of impairment among the elderly is osteoarthritis (OA) 9. Therefore, it is crucial to raise awareness of OA in the Kingdom of Saudi Arabia to help people adopt healthy habits and accept newly suggested prevention measures 1. This study aimed to assess the knowledge of OA among the general population in the Al-Baha region. The findings revealed that out of the 616 participants, more than half exhibited insufficient knowledge about OA , which aligns with the results of similar studies conducted in other regions of Saudi Arabia, such as Makkah, Tabuk, and Jeddah. 6,7,10 . It is interesting to note that two studies from Qunfudah, Sudair and Aseer, revealed a higher degree of knowledge 1,2,5.

The bio-demographic data of the participants in our study aligns with several other studies conducted in different regions of Saudi Arabia. Like our study, the studies in Tabuk, Jeddah, and Makkah all found that the majority of participants were in the younger 18-29 age group and were predominantly female 6,7,10. This suggests that the population seeking health information or participating in these types of studies on OA tends to skew towards younger adult women in Saudi Arabia. The difference in results between older and younger populations may suggest that younger individuals use technology more frequently than the elderly. However, this also raises concerns about potential sampling bias, as the findings may not be generalizable to the entire population, particularly older adults and men. However, the study in the Aseer region had contrasting findings, with the sample being predominantly middle-aged (30-49 years old) and having more male participants than female. This disparity highlights the potential regional differences 2. An interesting commonality across the studies is the association between higher education levels and greater knowledge about OA. Our study, as well as the ones in Tabuk and Jeddah, found a significant positive relationship between educational attainment and OA awareness. This suggests that targeted educational interventions, particularly for those with lower levels of formal education, could be an effective strategy to improve overall understanding of this condition within the Saudi population 6,7. A significant number of participants knew someone with OA (66.7%), This was expected given that earlier research indicated that 15.3% of Saudi Arabians had OA overall 12. Additionally, our study finding that knowing someone with OA was linked to higher levels of knowledge aligns with the Makkah study 10, which also reported this association (p = 0.001). This implies that personal experiences or exposure to disease can play an important role in shaping individuals' awareness and understanding of OA.

In our study, the majority of participants (48.2%) reported relying on relatives and friends as their main source of information about OA . This was followed by the internet and social media (25.3%) as another common source. These results suggest that in the Al-Bahah region, informal and personal connections are the predominant channels through which people seek and obtain information about this chronic condition. In comparison, the Makkah study found markedly different results 10. Their findings indicated that participants who sourced their OA information from more formal and educational sources, such as their own studies (49% had good awareness) and medical specialists (41% had good awareness), tended to have higher levels of awareness about OA. Conversely, those who relied on other, potentially less reliable sources only had a 21.6% rate of good awareness. This discrepancy raises questions about the credibility and accuracy of information disseminated through informal channels and social media. It is possible that misinformation or lack of access to reliable medical information contributes to the knowledge deficit observed in our study.

Also, the study's results showed that 64.9% of participants correctly identified OA as a chronic problem, while 80.4% correctly identified it as not being a rare condition. These results are far better to those of earlier Malaysian research13, where only 51.9% of participants were aware that OA is a common disease. Additionally, other studies have reported that about 82.4% of respondents have correctly identified the basic mechanism for OA, and 49.6% have said it is a chronic condition10. In the current study, 52.8% of participants correctly answered that pain is not the only symptom of OA, 56.0% correctly identified that stiffness is a symptom, 41.9% correctly identified that swelling is a sign, and 63.0% correctly identified that OA can lead to loss of joint movement. These results are in line with earlier studies. According to research by Hunter DJ et al., stiffness and discomfort are the main symptoms of OA14–17. Additionally, a study by Saeed F et al. reported that 62% of OA patients experience joint swelling, and 71% suffer from restricted mobilization18. Similar findings were reported in a prior study conducted in Jeddah by Ali H. Alyami et al., where almost half of the participants correctly identified pain and stiffness as the primary symptoms of OA6.

Furthermore, our study found that only a small proportion of respondents (39.9%) believe that OA can affect different joints. While Yucesoy B et al reported medical understanding that OA can impact various joints, including the knees, hips, hands, and spine19. Regarding genetic factors, our study only found that 30.8 % of participants recognized that genetic predisposition could increase the risk of OA. This aligns with the evidence from the systematic review by Tschon et al20. which noted the high heritability of OA, ranging from 40-70% depending on the joint. However, our study also found that a sizeable proportion (29.7%) were unsure about the genetic link, indicating that more education may be needed in this area. On the risk factor of aging, our study revealed a moderate level of awareness, with 80.4% of respondents correctly identifying it as a key risk factor. This finding is supported by the study from Areej Amanat et al.21, which also reported a good understanding of age as a risk factor for OA among the general public. The gender-related aspects of OA showed more mixed results in our study. While 49.5% of respondents believed that men and women are not equally affected, the previous systematic review by Tschon et al. has consistently revealed that women had a higher risk of developing OA and having symptoms that are more severe 20. This discrepancy suggests that there may be room for improved public awareness and understanding of the gender-specific patterns of OA. Hormonal, genetic, and social factors may contribute to this disparity. Targeted educational programs , such as awareness campaigns, should focus on educating menopausal women, along with other groups who are at risk of osteoarthritis. This could decrease morbidity, improve outcomes and quality of life for the affected, and decrease incidence of osteoarthritis. A significant correlation was observed between education level and knowledge level (p = 0.011), suggesting that individuals with higher education tend to possess greater knowledge. This trend may be attributed to increased access to technology, reading materials, and research resources, which facilitate information acquisition and comprehension.

A substantial portion of participants (48.20%) reported obtaining their knowledge from relatives and friends, while only 2.80% relied solely on healthcare staff. This may be linked to the longer duration of familiarity with friends and family. physicians may not build a trustworthy relationship and rapport with their patients, which is a necessity for patients to trust and follow management plans, thus potentially causing further complications to patients and increasing load on healthcare providers and medical facilities.

OA can be diagnosed using a straightforward film X-ray, history, and physical examination, according to the study by Ariani A et al. It is uncommon to diagnose OA utilizing biochemical markers in the blood 22. Comparatively, our study revealed that just 42.0% of respondents properly identified that blood tests are not usually used to diagnose OA, whereas 61.0% of respondents correctly identified that physical examination and x-ray are used to do so. According to the study by Safa H. Alkalash, just 45% of the respondents knew that an X-ray and physical examination may be used to diagnose OA . This is less than 61.0% of participants in our research who were able to identify these diagnostic techniques accurately 1. Guidelines from research such as Ariani A et al., Bannuru RR et al., and Kolasinski SL et al. with regard to the treatment of OA. suggest NSAIDs (non-steroidal anti-inflammatory medicines) as a first line of treatment 22–24. According to our survey, 33.6% of participants knew that NSAIDs help lessen the symptoms of OA. This is less than the 46% discovered in the study by Ali H. Alyami 6. but higher than the 28% revealed in the study by Safa H. Alkalash1. It is advised to launch awareness efforts to provide the public with clear, fact-based information on this debilitating illness. The low awareness of treatment options, particularly NSAIDs, may be due to a lack of targeted education on osteoarthritis management. This could have significant implications for patient outcomes, as those unaware of effective treatments may delay seeking medical help or rely on less effective remedies.

Limitations and strengths

There are various restrictions on this study. First off, the self-administered online questionnaire might only be useful for people who can read, are accustomed to using computer tools, have access to the internet, and are prone to memory bias. Second, there appears to have been a biased selection since 42.4% of the participants were between the ages of 18 and 29. Even with the size of the study sample, it only included one Saudi Arabian city, which might have an impact on how generalizable the results are to other parts of the kingdom. Nonetheless, these drawbacks, the study represents a significant effort to raise awareness of this widespread illness in the general public. The questionnaire tool was designed in a manner that neither defined misconceptions about osteoarthritis (OA) for the participants nor provided them with an opportunity to express their own misconceptions.

Recommendations

Future research should investigate the quality of information accessible through informal channels and examine its influence on public awareness more thoroughly. This deeper understanding could help shape targeted awareness campaigns aimed at educating the public about available treatments and their benefits. In addition future studies should aim for a more balanced sample in terms of age and gender to ensure broader applicability of the results.

Conclusion

The study results indicate that the majority of participants (60.90%) had inadequate knowledge about OA, unfortunately that may be due to about 48.2% of participants relying on relatives/friends and 25.3% on social media for know about OA. While only 39.10% had adequate knowledge. Notably, higher education levels were correlated with greater knowledge (p=0.011), and familiarity with someone who has OA was significantly associated with increased knowledge (p=0.033). The minimal role of medical professionals (2.8%) in disseminating OA information indicates a missed opportunity for accurate patient education during clinical visits. While 64.9% of participants correctly identified OA as a chronic problem and 80.4% recognized it as a common condition, only 39.9% knew that different joints can be affected. Awareness of OA symptoms varied: 52.8% identified that pain is not the only symptom, while 56.0% and 41.9% recognized stiffness and swelling as symptoms, respectively. Only 30.8% were aware of genetic predispositions, though 80.4% correctly linked aging as a risk factor; only 49.5% knew that men and women are not equally affected. While 61.0% were aware that physical examination and X-ray are used for diagnosis, only 42.0% knew that blood tests are not used. Understanding of treatment options was limited, with 33.6% knowing that NSAIDs can improve symptoms, 75.2% recognizing the benefits of physiotherapy, and 61.0% aware that exercises like swimming are suitable. Furthermore, 45.1% correctly identified joint replacement surgery as an ultimate option for relieving symptoms . Only 33.6% knew NSAIDs alleviate symptoms, due to fear of side effects (e.g., gastrointestinal risks). Overestimation of Surgery while few understood its role as a last resort, highlighting the need for clearer guidelines on conservative management (e.g., physiotherapy, weight loss).Therefore, it is highly advised to launch awareness campaigns to inform the public about this crippling illness through the use of condensed, based on evidence information, partnering with Ministry Of Health and local media, utilizing short-form videos and infographics on social platforms, and integrating OA awareness into primary healthcare visits. As Limitations of sample which was the overrepresentation of younger women the sample skewed toward females (57.8%) and adults aged 18–29 (42.4%), groups less likely to experience OA. This restricts generalizability to older adults, which are the riskiest group, and men who had lower awareness of gender disparities.

Funding

No author has any financial interest or has received any financial benefit or funding from this research.

Availability of data and materials

The datasets analyzed during the current study are available with the corresponding author upon request.

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