Knowledge and Awareness among Parents in Al Baha, KSA, about Short Stature in School-Aged Children

Introduction

Short stature is a common reason for referral to pediatric endocrinologists1. It can significantly affect physical, social, and emotional well-being. In children with short stature, while it can be a normal familial variation, it can also be a symptom of an underlying disease, so it is important to make early identification and treatment according to their causes2. Short status is defined as height more than two standard deviations (SD) below the mean for age, or less than the 3rd percentile3. A child’s short stature can be hereditary, idiopathic4, a variable of gender and race, and also involves nutritional causes, chronic diseases, and a variety of endocrine disorders5.

An observational study that was conducted in Al Qassim region in KSA, in 2022, investigated parental knowledge about children's short stature. It involved 384 participants and revealed that only around 47% of them had good knowledge6. Another survey of 469 participants in 2022 showed that most respondents (68.4%) had poor knowledge, while 31.6% demonstrated good knowledge, and higher knowledge scores were linked to being married, having children, and having a family history of short stature7.

This study aims to determine the parental knowledge and awareness that is essential for recognizing developmental issues like short stature, as well as for assisting in its early detection and proper treatment. The pattern and clinical outcomes of non-diabetic pediatric endocrine disorders have been described in a retrospective analysis from Al-Baha, Saudi Arabia, involving 744 patients between 2018-2022, highlighting that thyroid disorders, short stature, obesity, and calcium-phosphate metabolism disorders were the most common conditions8 ; however, no study has specifically focused on the awareness of families regarding short stature in school-aged children.

Methods:

This study employed a cross-sectional design to assess the knowledge and awareness of parents regarding short stature among school-aged children. The study was conducted in Al Baha, Saudi Arabia. The study was approved by the Institutional Review Board at the Faculty of Medicine at Al Baha University, Al Baha, KSA. The target population for this study includes parents, residing in Al Baha, of school-aged children. Demographic data were collected, including the age, gender, education level, and location of residence. Inclusion criteria for the study are parents or guardians of children, residing in Al Baha region. Exclusion criteria included parents who are healthcare professionals, and parents who refused consent for participation in the study. The sample size was calculated using the Raosoft online sample size calculator (Raosoft Inc., 2004)9, which is a widely used tool for determining adequate study samples. The sample size that was determined was 384, with an indicator percentage of 0.50, a margin of error of 5 percent, and a confidence level of 95%. The sample was a representative random cluster sample of 384 participants. The sampling technique was simple random sampling. Data was collected from January 2025 to February 2025, through an electronic, self-administered questionnaire, which was delivered to respondents using WhatsApp. Consent was obtained from all participants, we received 780 responses, 111 responses were excluded for not meeting the inclusion criteria, and 384 responses were selected randomly for the study.

The questionnaire was developed to assess the knowledge and awareness about the early diagnosis and intervention of short stature among children and was curated by an endocrinology expert. It was adopted from an already pretested questionnaire7. The pretested questionnaire was chosen because it had already been validated and used in similar studies, ensuring reliability and clarity of the questions. Also using a pretested tool may minimize measurement errors and enhance comparability with previous research. It involves multiple-choice questions in two sections: Section one included sociodemographic characteristics of participants and consisted of 10 questions, the second section included 5 qualitative questions regarding knowledge, four of these questions were developed to measure the knowledge level. Each of these questions was given a score of one, where a score of 0-1 is considered low knowledge level, a score of 2 is considered moderate knowledge level, and a score of 3-4 is considered high knowledge level. The definition, causes, best time to consult, relevant medical professionals, and type of intervention were among the main questions.

Statistical Analysis:

A comprehensive statistical analysis was conducted using the IBM SPSS (29.0.0), which included both descriptive and inferential statistics. The descriptive statistics were used to summarize the participant demographics, including the frequencies and the percentages for the variables such as age, gender, education level, employment status, marital status, and nationality. To examine the associations between the categorical variables, Pearson’s Chi-Square Test was primarily employed. Where expected cell counts were <5, the Fisher’s Exact Test was applied to ensure the statistical validity. The threshold for statistical significance was set at p < 0.05. Subsequently, the binary logistic regression analysis was performed to identify the adjusted predictors of high parental knowledge regarding the short stature in the school-age children. The variables entered into the regression model included the age, gender, education level, job status, marital status, nationality, whether the respondent had children, age of children, and the family history of short stature. The outcome variable (knowledge level) was dichotomized into "High" vs. "Low to Moderate" based on the pre-established scoring criteria from the questionnaire. The results were reported using the adjusted odds ratios (AOR) with 95% confidence intervals (CI), and the corresponding p-values.

Results

A total of 384 participants were included to assess Parental Awareness, Knowledge, and Attitudes Toward Short Stature in School-Aged Children. Notably, most participants were female (68.4%). The largest age groups were aged 40-49 years (n=134, 34.7%). In terms of education, the majority had a university degree (76.0%), while only (3.4%) had less than secondary education. More than half were employed (58.7%). Nearly all participants were Saudi nationals (98.7%). The marital status indicated that the overwhelming majority were married (87.7%).

Table 1 presents the assessment of parental awareness, knowledge, and attitudes toward short stature in school-aged children (n=384). The majority of participants were parents (90.1%). Most participants cared for children under 12 years old (52.2%). A family history of short stature was reported by 57 participants (14.9%), whereas 327 (85.1%) reported no such history. Most parents believed that a child should see a doctor for growth concerns before puberty (80.4%). Regarding defining short stature (73.1%) relied on a specialist’s diagnosis. When consulting a specialist (80.4%) preferred early intervention before puberty. The most recognized specialists for managing short stature were pediatricians (49.6%) and endocrinologists (37.3%). Most parents favored a combination of therapeutic and non-therapeutic interventions (73.1%).

Figure 1 presents the assessment of parental knowledge regarding different causes of short stature in school-aged children. The majority of parents identified genetic causes (87.7%) as a primary reason for short stature, followed by deficiency or excess of some hormones (65.3%) and malnutrition (55.6%). Less than 10% of parents linked short stature to conditions such as heart disease, kidney disease, or liver disease. Additionally, 16.4% mentioned "other" causes, while (20.1%) believed short stature could occur without an apparent reason.

Figure 2 shows the overall knowledge level of parents regarding short stature in school-age children. The majority of parents demonstrated high knowledge (55.1%), while 27.4% had a moderate level of knowledge, and 17.5% exhibited low knowledge. These results indicate that more than half of the parents have a strong understanding of short stature, including its causes and management.

Table 2 shows the association between parents' attitudes toward seeking medical advice or possible interventions for short stature with different sociodemographic and familial factors. Notably, age did not significantly influence attitudes (p=0.194). The gender difference was significant (p=0.016), with more males (n=106, 87.6%) favoring early consultation compared to females (n=202, 77.1%). Education level, job status, and nationality did not show significant associations with parental attitudes. Parents with children under 12 years were slightly more likely to seek early consultation than those with older children, but the difference was not significant (p=0.764). A family history of short stature did not significantly impact attitudes, although those with a diagnosed family member (84.2%) were slightly more likely to favor early intervention.

Table 3 presents the association between parents' knowledge level about short stature and various sociodemographic and familial parameters. Age was not significantly associated with knowledge level (p=0.665), though knowledge tended to increase with age, with 70.0% of those above 60 years demonstrating high knowledge. Gender differences were almost insignificant (p=0.065), as males (62.0%) had higher knowledge levels compared to females (51.9%). Education level did not significantly impact knowledge, though those with higher education (51.4%) had slightly greater knowledge levels. Employment status was not significantly associated (p=0.434), though employed individuals had slightly higher knowledge levels (57.3%) than unemployed individuals (50.0%). Notably, parents with a family history of short stature were more likely to have low to moderate knowledge (56.1%), compared to those without such a history (42.9%), though this trend did not reach statistical significance (p=0.065).

Table 4 presents the adjusted predictors of high knowledge level about short stature using logistic regression analysis. While no predictors achieved statistical significance, there were indications that males had 38.1% higher odds of having high knowledge compared to females, although this association was not significant (B=0.323, p=0.178). Age was not a significant predictor (B=0.099, p=0.272), but the odds of having high knowledge increased slightly with age (Exp(B)=1.104). Higher education did not significantly associate with knowledge and employment status also showed no significant effect. Interestingly, individuals with a family history of short stature had lower odds of high knowledge (B=-0.513, p=0.080), though this association was not statistically significant.

Discussion

This study aimed to assess the knowledge, awareness, and attitudes of parents in Al Baha, Saudi Arabia, regarding short stature in school-aged children. The findings revealed that 55.1% of the participants demonstrated a high level of knowledge, while 27.4% had moderate knowledge and 17.5% showed low knowledge. This indicates a generally good awareness among the community.

When asked about the causes of short stature, the majority of participants identified genetic factors as the primary cause (87.7%). This was followed by a large number who believed that hormonal imbalances (65.3%) and malnutrition (55.6%) were significant contributors. Fewer participants mentioned bone diseases (36.8%), while only a small portion recognized causes like rheumatoid arthritis, digestive issues, and psychological conditions, indicating some gaps in deeper understanding.

Regarding medical consultation, the majority of parents believed that children should visit a doctor for growth concerns before reaching puberty (80.4%), showing strong awareness of the value of early intervention. Pediatricians and endocrinologists, (49.6%) and (37.3%), were the most frequently chosen specialists to manage such cases. In terms of treatment, most parents preferred a combined approach using both therapeutic and non-therapeutic interventions (73.1%), reflecting a well-rounded and thoughtful attitude toward managing the condition.

These findings reflect a promising level of parental health literacy in Al Baha region, which can support timely diagnosis and appropriate management of short stature in children.

In this study, the most significant finding was that 55.1% of parents demonstrated a high level of knowledge regarding short stature in school-aged children. In contrast, a study in Al Qassim region, KSA, reported only 31.6% of parents with high knowledge levels7. This difference could be attributed to regional disparities in awareness campaigns and health education initiatives. Moreover, the widespread use of social media and digital health platforms may also contribute to improved parental understanding.

Another notable result in this study is that 87.7% of parents identified genetic factors as the main cause of short stature. This percentage aligns with previous studies as genetic causes were the most identified cause in Alharbi et al., 2022, 7 and, Alhumaidi et al., 2023 1. However, awareness of less common causes, such as, digestive system diseases (9.7%), psychological disorders (8.1%), and cortisone use (7.6%) was relatively low, which is similar to the findings of Alharbi et al., 2022 7 who also reported low recognition rates for these less frequently acknowledged causes. This suggests a shared knowledge gap across different populations regarding rare or complex causes of short stature, highlighting the need for more inclusive, and detailed educational efforts.

In terms of attitudes, this study revealed that 80.4% of parents preferred seeking medical advice before puberty in concerns of short stature. This is similar to the 79.5% reported in the study by Alharbi et al. 2022 7, but higher than the 65.6% reported in Alhumaidi et al., 2023 1. This may indicate a shift toward early intervention awareness. The difference may reflect a growing public understanding of the importance of early diagnosis and treatment.

Despite these positive results, some of them were unexpected. Notably, the study revealed that there is no significant association between parental education level and their knowledge about short stature. This is opposite to the expectations, as some people believe that higher educational levels will lead to a greater awareness of health conditions. One potential explanation is that the broad availability of medical information on social media and other online platforms could be one reason since it could bridge the knowledge gap between parents with formal education and those with less formal education.

Additionally, families with a history of short stature were not linked to having high knowledge, though this association was not statistically significant. This finding aligns with a study done by Alharbi 2024 6, which suggested that knowledge about short stature was seemingly independent from reporting a family history of short stature. This could be due to that these families believe that short stature is a normal variation within a population.

From a gender-based perspective, there was a statistically almost insignificant difference in attitudes by gender, with men more likely to support early medical consultation than women (87.6% vs. 77.1%). These are aspects less emphasized in prior studies. Nonetheless, limitations include the use of an online questionnaire, which may have restricted participation from certain groups. This difference could also reflect cultural differences in the region or a greater reliance on male decision-making in healthcare matters in some households.

When it comes to study strength, a good sample size (n = 384), systematic data collection, and the use of both descriptive and inferential statistical analyses through SPSS software. Moreover, the inclusion of a diverse demographic profile enhances the relevance of the findings for regional public health planning.

The study does, however, have limitations. The results might not be entirely applicable to other parts of Saudi Arabia because they are limited to Al Baha region. Recall or bias are risks associated with using self-reported data, also the cross-sectional design prevents any causal inferences from being made about the factors influencing knowledge or attitudes.

Conclusion

In conclusion, this study underscores the generally high level of knowledge and awareness among parents in Al Baha regarding short stature in school-aged children, with 55.1% demonstrating a strong understanding of the condition. Parents showed substantial awareness of genetic causes and the importance of early medical consultation, though gaps remained in recognizing rarer causes like digestive or psychological conditions. Interestingly, no significant correlation was found between parental education levels and knowledge, suggesting that widespread online information may bridge traditional educational divides. These findings underscore the need for targeted health campaigns to address existing knowledge gaps, while prompting further reflection on digital health literacy's role and cultural influences in medical decision-making.

Conflict of interest

The authors confirm no conflict of interest exists.

Financial support

No financial grant accepted from any source for this publication

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