|Year : 2021 | Volume
| Issue : 1 | Page : 13-16
A cross-sectional assessment of the knowledge about rheumatoid arthritis among university students in Saudi Arabia
Fahidah Alenzi1, Haifa Al-Sheikh2, Khozama Alaraj1, Taeef Saeed1, Raghad Alfedeah1, Reem Al-Anazi1, Nawal Alfawari1
1 Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
2 Rheumatology Consultant, Department of Medicine and Critical Care, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
|Date of Submission||21-Jun-2021|
|Date of Decision||25-Jul-2021|
|Date of Acceptance||11-Aug-2021|
|Date of Web Publication||13-Nov-2021|
Dr. Fahidah Alenzi
Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Rheumatoid arthritis (RA) is a chronic multisystem autoimmune inflammatory disorder characterized by inflammatory joint and extra-articular organ involvement including lung, eye, and heart that can lead to physical dysfunction and impaired quality of life. Aim: The aim of the study is to estimate the level of knowledge about RA and determine attitudes among university students and staff of Riyadh and to assess the limitations of this knowledge. Materials and Methods: A cross-sectional study was conducted at universities of Riyadh in Saudi Arabia. The study used a close-ended, interviewer-based questionnaire and includes 500 respondents from health and nonhealth college students and administrative staff. Results and Discussion: There were 404 (80.8%) females and 96 (19.2%) males and 65.5% were in the common age group of 18–24 years. The highest number of the participants (234, 48.6%) was from Princess Nourah University, and 53% of the participants were from nonhealth science colleges. 51.4% of the participants had a family member working or studying in a health-related field, and the level of knowledge of these participants about RA was 81 (31.5%). The age group that had poor knowledge of RA was between 31 and 40 years (including 83.3% of the participants). The participants from Princess Nourah Bint Abdulrahman University had good knowledge (31.7%) compared to participants from other universities. Finally, among gender groups, females had a better level of knowledge about RA (30.2%) compared to (69.8%) of males. Conclusion: Our study found that the level of awareness about RA in Riyadh is slightly lower than that observed in previous studies conducted in Saudi Arabia. This could be due to a lack of educational programs and awareness campaigns.
Keywords: Awareness, community, rheumatoid arthritis, Saudi Arabian population
|How to cite this article:|
Alenzi F, Al-Sheikh H, Alaraj K, Saeed T, Alfedeah R, Al-Anazi R, Alfawari N. A cross-sectional assessment of the knowledge about rheumatoid arthritis among university students in Saudi Arabia. Ann Rheumatol Autoimmun 2021;1:13-6
|How to cite this URL:|
Alenzi F, Al-Sheikh H, Alaraj K, Saeed T, Alfedeah R, Al-Anazi R, Alfawari N. A cross-sectional assessment of the knowledge about rheumatoid arthritis among university students in Saudi Arabia. Ann Rheumatol Autoimmun [serial online] 2021 [cited 2022 May 28];1:13-6. Available from: http://www.ara.ssr.com/text.asp?2021/1/1/13/330433
| Introduction|| |
Rheumatoid arthritis (RA) is a multisystem autoimmune inflammatory disorder. It is triggered by multiple factors, such as genetics and environment, resulting in the formation of autoantibodies, immune complexes, and T-cell-mediated antigen-specific responses that damage joints and resulting in synovitis, joint pain, and joint destruction, as well as extracellular manifestations. These lead to disability and an increased rate of mortality.
The worldwide prevalence of RA has been estimated to be 0.24% according to the Global Burden of Disease 2010 Study. The estimated prevalence of RA in the United States of America and Northern European countries is typically high, usually between 0.5% and 1%. A study carried out locally in the Qassim region of Saudi Arabia involving 5891 adults showed the estimated prevalence of RA in Saudi Arabia as approximately 2.2/1000 people. A different study from the same center, including 195 patients observed over 5 years, reported that the effect of RA (seen by rheumatoid factor positivity) and joint involvement in Saudi Arabia was close to that observed in other developed countries.
Patients need to possess accurate knowledge of their disease because a lack of information provided by qualified staff may lead to patients depending on other unreliable sources of information. These sources of information may be incomplete and evoke negative patient behavior and make the treatment process difficult. Low awareness of RA in the general population is associated with poor outcomes and delay in the diagnosis; therefore, raising public awareness about RA is the first step to aid in its early diagnosis and treatment. In this study, we aimed to estimate the level of knowledge about RA and determine the attitude regarding the disorder among university students and staff of Riyadh and to assess the limitations of this knowledge and awareness.
| Materials and Methods|| |
This study was a cross-sectional study conducted from August to September 2018. We measured the level of knowledge about RA and the factors that contributed to poor knowledge among 500 respondent's health and nonhealth science college students and administrative staff in Princess Nourah Bint Abdulrahman University (PNU), King Saud University (KSU), Imam Mohammed bin Saud University (IMMAMU), and Almaarifah University. A validated questionnaire was designed by the author and consisted of two parts. The first part included questions based on demographic data, such as age, sex, social status, education level, university, health versus nonhealth science colleges, family member working in healthcare domain, type of work by the participant in the university, and residency. The second part included multiple questions divided into three parts, measuring the knowledge about causes, symptoms, and signs of RA. Before the distribution of the questionnaire, a pilot study was conducted on 15 participants, including both students and administration staff. They were asked to complete the questionnaire and answer whether it was easy to understand and acceptable. Subsequently, questionnaires were distributed during college hours by the study team members. We consider good knowledge to participant who answers more than 60% of the questionnaire question correctly.
Statistical analysis was performed using SPSS version 16 statistical software package (IBM SPSS). The data were entered into an excel file and transferred into SPSS statistical software package. Results were presented in frequencies and percentage for qualitative data. An independent t-test was used to compare quantitative variables between the two study groups. The Chi-square test was used for comparing qualitative variables between the groups. Fisher's exact test was performed by using 2 × 2 tables. A P ≤ 0.05 was considered statistically significant.
| Results|| |
Out of the 500 respondents, there were 404 (80.8%) females and 96 (19.2%) males and 65.5% were in the common age group of 18–24 years. The highest number of participants (243, 48.6%) was from PNU, followed by 100 participants (20%) from KSU and 99 participants (19.8%) from IMMAMU. There were 264 (53%) participants from nonhealth science colleges such as business administration college, college of computer and information science, college of art and design, college of languages and translation, college of science, and community college. 51.4% of the participants had a family member working or studying in a health-related field, and their level of their knowledge about RA was 81 (31.5%) [Table 1]. Moreover, regarding the course of the disease, 311 (62.2%) participants knew that RA was a chronic inflammatory disease and 411 (82.2%) were aware of its noncontiguous nature. Regarding the symptoms of RA, 177 (35.4%) participants thought that RA caused fever, and only 57 (11.4%) knew that RA did not cause any deformities in the big joints. Regarding the causes of RA, 224 (44.8%) participants answered that RA could be caused due to autoimmune factors and 58 (11.6%) answered that osteoarthritis was not a cause of RA. Regarding extra-articular manifestations, 163 (32.6%) participants had good knowledge of extra-articular symptoms such as lung involvement [Table 2]. The Chi-square test reported that there was a significant association between age and having an RA patient among the participants' family, education level, and university withP = 0.008, 0 .000, 0.039, and 0.000, respectively [Table 1]. The age group that had poor knowledge about the disease was 31–40 years. A total of 15 (83.3%) participants with bachelors had good knowledge of RA. The participants from PNU had better knowledge (77, 31.7%) compared to other universities in Riyadh. Finally, among gender groups, females had a better level of knowledge about RA (122, 30.2%) compared to males.
|Table 1: The correlation between the level of knowledge toward rheumatoid arthritis regarding the demographic variable of our participants|
Click here to view
|Table 2: The participants' knowledge regarding cases, symptoms, treatment of rheumatoid arthritis (n=500)|
Click here to view
| Discussion|| |
RA is a chronic, incurable disease requiring a high cost of treatment if the diagnosis is delayed. This study revealed that the majority of the participants had poor knowledge about RA and only 28.4% had good knowledge. The knowledge score ranged between 0 and 30, with a mean of 15 ± 5.85. The knowledge score was highest among participants from PNU, followed by Almaarefa University, KSU, and IMMAMU with a significant difference. In contrast to our results, a prior study was conducted in January 2017 in Taif City of Saudi Arabia where most (86.9%) of the participants had good knowledge about the symptoms and prevention methods of RA. However, this difference in results may be due to the difference in sample size where our study had 500 participants and the study in Taif City had 252 participants with 94% more males than females. According to our study, 81% of the participants were females with no significant difference in knowledge between the genders. These results vary from the results of the study conducted by Pytel and Wrzosek, 2012, who reported a significantly high women's knowledge of RA. In addition, the level of knowledge in administrative staff (12, 31%) was slightly higher than that in students (130, 28%) with no significant difference. This may be attributed to a lack of participation as the administrative staff were 32 out of 500 participants only. Moreover, participants in the age group of ≥41 years had the best knowledge score with a significant difference. There is evidence that improving the level of education of the patients with RA may improve their understanding of the disease progression, knowledge of its management, and the disease-specific facts. Our results reported a significant correlation between the education level and knowledge regarding RA, wherein the participants who had a bachelor's degree had good knowledge compared to those who did not. Many participants have inadequate knowledge about RA globally. Lorig has provided various explanations for this. She states that the foremost reason may be that educational services are not typically delivered within the scope of medical practice; moreover, rheumatologists have inadequate time to create and implement well-structured educational programs. This study found that 88%, 76%, and 72% of the participants thought that RA causes deformity in big joints, hair loss, and vomiting and diarrhea, respectively, which are incorrect assumptions. All these results indicate a lack of awareness about RA in our community.
| Conclusion|| |
This study shows that the level of awareness of RA in Riyadh is slightly lower than that found in previously conducted studies in Saudi Arabia, and this could be related to a lack of educational programs and awareness campaigns. We believe that further epidemiological studies and introduction of community awareness campaigns will make a significant contribution to the evaluation of more factors that could be related to a lack of awareness about RA.
Ethical approval for this study was obtained from the Institutional Review Board (18-0323) of PNU. The confidentiality of the anonymously collected data was maintained at all times. Informed consent was obtained from all participants with the help of a questionnaire.
We would like to thank all the participants for their time and supporting this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bae SC. Epidemiology and etiology of rheumatoid arthritis. J Korean Med Assoc 2010;53:843-52.
Cross M, Smith E, Hoy D, Carmona L, Wolfe F, Vos T, et al
. The global burden of rheumatoid arthritis: Estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73:1316-22.
Hunter TM, Boytsov NN, Zhang X, Schroeder K, Michaud K, Araujo AB. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatol Int 2017;37:1551-7.
Al-Dalaan A, Al Ballaa S, Bahabri S, Biyari T, Al Sukait M, Mousa M. The prevalence of rheumatoid arthritis in the Qassim region of Saudi Arabia. Ann Saudi Med 1998;18:396-7.
Alballa SR. The expression of rheumatoid arthritis in Saudi Arabia. Clin Rheumatol 1995;14:641-5.
Nagwan Elhussein, Rania Mohammed Ahmed, Rawan Alosaimi, Haifa Alshehri, Shahad Altwerqi, Bashaer Alotaibi, Afaf Mohamed. awareness of rheumatoid arthritis among population in Taif, Saudi Arabia. Indian journal of applied research 2018;8:9-12.
Pytel A, Wrzosek Z. Estimation of patient knowledge on rheumatoid arthritis in the range of their own disease--Preliminary study. Adv Clin Exp Med 2012;21:343-51.
Bozbaş GT, Gürer G. The level of knowledge about the rheumatoid arthritis in Turkish patients. Anatol Clin J Med Sci 2018;23:12-9. [doi: 10.21673/anadoluklin. 325831].
Helliwell PS, O'Hara M, Holdsworth J, Hesselden A, King T, Evans P. A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. Rheumatology (Oxford) 1999;38:303-8.
Lorig K. Patient education: Treatment or nice extra. Rheumatology 1995;34:703-4.
[Table 1], [Table 2]