People’s Knowledge and Attitudes About Factors That Can Impact Wound Healing in the Eastern Province, Saudi Arabia

Background Wounds, ranging from acute to chronic, demand timely intervention to prevent complications. Infections can impede healing, leading to sepsis. Chronic wounds impact society, causing limitations in mobility and social exclusion. Early identification of infections is crucial for effective treatment, reducing unnecessary antibiotic use, and improving patient outcomes. Methodology This cross-sectional study was conducted from June to October 2023 in Saudi Arabia using a self-administered online questionnaire to assess wound healing knowledge and attitudes. Convenient random sampling via social media was employed to collect data. Data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results Our study predominantly featured female (67.1%), Saudi (94.8%), aged 18-25 years (42.0%), and married (51.1%) participants. Chronic illnesses were prevalent in 24.2%, with heart disease (5.7%) and hypertension (4.5%) being notable. Burn injuries (27.4%) and upper extremity wounds (40.9%) were common, prompting immediate medical care (54.1%). Internet sources (22.6%) and relatives/friends (18.4%) were key for wound care information. Participants displayed solid awareness of wound-related factors, with notable misconceptions regarding Zamzam water (44.4%) and coffee beans (39.3%). Participants prioritized stopping bleeding (41.1%) and using wound patches (42.1%) for home injuries. Age group, education, marital status, and occupation impacted knowledge about wound healing. Conclusions Our study highlights key demographics, prevalent chronic illnesses, common wound types, and crucial sources of wound care information. Participants’ awareness, coupled with notable misconceptions, emphasizes the importance of tailored education. Factors such as age, education, marital status, and occupation impact knowledge about wound healing.


Introduction
A wound may be defined as any disruption of the integrity of skin, mucous membrane, or organ tissue.Thus, skin functionality is affected as a result of the disruption of cellular and anatomical structures [1].Skin breaks can be caused by several factors, including illnesses, injuries, or burns [2].There are various types of wounds, ranging from minor to severe, and the type of treatment required depends on the severity of the wound.An acute wound is caused by surgery or burns, whereas a chronic wound has other causes, including leg ulcers, diabetic foot ulcers, and pressure ulcers [2].Acute wounds need specialized care, whereas chronic wounds may require a longer-term approach to heal.Additionally, it could be defined as a non-healing wound for more than six weeks.To manage wounds successfully, early intervention is imperative [3].Globally, 50 million people have been injured by wounds since 2015 [4].Approximately 6 million lacerations are treated every year in American emergency departments (EDs) [5].Studies indicate that over 5 million people suffer from chronic wounds that require medication and management due to car accidents and systemic diseases, particularly diabetes [6].Due to wound infection, wound healing may be slowed, and, in the worst-case scenario, an individual may develop sepsis, which can be fatal [7].Moreover, chronic wounds are associated with hidden tensions in the community as a result of limitations in mobility, limited functional abilities, social isolation, loss of labor market participation, and social exclusion [8].The introduction of care in conjunction with evidence-based guidelines has resulted in reported improvements in healing and recurrence rates [8].An individual's health can be adversely affected by improper wound treatment [3].A wound that is not adequately treated can lead to infection (3%-15%) [9,10].Fever, swelling, pain, and purulent exudate are common symptoms of wound infection [11].It is important to note that certain factors, such as corticosteroid use, smoking, and poor general health conditions, impair wound healing [12].A poor wound care regimen and neglect of the consequences of inadequate wound care cause a tremendous financial burden and a significant reduction in the quality of life for patients [13].It is vital to identify wound infections early and accurately initiate appropriate treatment in a timely manner and to prevent further complications.As a result of accurate diagnosis of infection, unnecessary antibiotic use can be avoided [7].In this study, we aim to assess the knowledge and attitude toward wound healing and the factors that can affect it.

Study methodology
This cross-sectional study targeted the general population of Eastern Province, Saudi Arabia to determine the knowledge and attitudes about the factors that impact wound healing.The study was conducted between June 2023 and October 2023.An online survey was created using Google Forms for data collection.The online survey was disseminated to the general population in Eastern Province, Saudi Arabia, and people were encouraged and invited to participate.To enroll as many participants as possible, two or more data collectors were recruited from every city.Data were collected through an online self-administered questionnaire where participants first consented to participate in the study before filling out the questionnaire.The questionnaire included three sections, of which the first section asked about sociodemographic data, including gender, nationality, education level, habit of smoking and any comorbidities, occupation, and marital status.The second part asked about general characteristics such as the type, site, source, signs, and symptoms of wound care.The third section asked about various factors affecting wound care by asking questions with three options of "agree," "disagree," and "don't know."The questionnaire we utilized was partly taken from a different study and modified to fit our practices and culture in addition to other studies [1,3].The study was presented to specialists in general surgery for improvement and approval.It was first developed in English and then translated into Arabic to be comprehensible for the targeted population.The Arabic version was examined by three language experts, and the translation was approved after grammatical and linguistic modifications.After that, a pilot study was performed on a small group of people (15 persons) to confirm a uniform understanding of the questions.Ethical approval was obtained from the ethics committee of King Faisal University (approval number: ETHICS1227).

Study population
The study subjects were the entire general population of Eastern Province, Saudi Arabia who consented to participate in this study between June and October 2023 and met the inclusion criteria.The inclusion criteria consisted of being an adult aged 18 years and older; living in Eastern Province, Saudi Arabia; and consenting to participate in the study.The exclusion criteria consisted of being younger than 18 years old; living outside of Eastern Province, Saudi Arabia; and not consenting to participate in the study.The sampling technique utilized was convenient random sampling where the questionnaire was disseminated via social media platforms, and the general population of Saudi Arabia was invited to participate through an online link.The sample size was calculated using the formula n = z2pq/d2, with a confidence level of 95%, an estimated proportion of 50%, and a 5% level of precision.The minimum sample size was calculated to be 385.However, more participants and candidates were included to ensure sufficiency.

Study procedure
According to the inclusion and exclusion criteria, certain participants who fulfilled the criteria and agreed to the given consent were enrolled.Each participant anonymously filled out the questionnaire.The results of the questionnaires were analyzed statistically.The results of the study were interpreted accordingly.Interpretation of the collected data was done accordingly, and proposals for potential solutions, when applicable, were delivered.

Data management
The data were stored in a trusted place, and only approved personnel had access to the data.Privacy and confidentiality were a priority, there was no part of this study threatening participants' confidentiality, and the identities of the participants were unknown.The data were analyzed and interpreted later by the investigator.

Statistical analysis
Data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA).Frequency and percentages were used to present categorical variables.Minimum, maximum, mean, and standard deviation were used to present numerical variables.The chi-square test was used for comparison between variables.
The level of significance was set at 0.05.

Results
Our study included 1,522 participants from the Eastern Province of Saudi Arabia.Table 1 shows that the majority were females (1,021, 67.1%), Saudis (1,443, 94.8%), and aged 18-25 years (639, 42.0%).Participants were mostly married (777, 51.1%) and had a bachelor's education (545, 35.8%).Most participants were students by occupation (519, 34.1%) and earned less than 5,000 SAR monthly (775, 50.9%).Most participants were non-smokers (1,340, 88.0%).Health's hotline 937 Ministry of Health (234, 15.4%) also served as significant sources.Social media (162, 10.7%)and health awareness campaigns (150, 9.9%) were also utilized, albeit to a lesser extent.Table 3 shows people's knowledge and attitudes concerning factors that can impact wound healing.The majority of participants recognized the significance of good nutrition for wound healing (1,465, 96.3%) and the necessity of handwashing before changing wound dressing (1,497, 98.4%).Moreover, most participants were aware that unpleasant smells in wounds are caused by a bacterial infection (1,435, 94.3%).Additionally, a considerable proportion acknowledged that diabetes does not delay wound healing (333, 21.9%), the negative impact of smoking on wound healing (1,267, 83.2%), and the necessity of antibiotics for wound healing (945, 62.1%).There was a recognition that wound care is typically performed by someone other than the injured person (1,163, 76.4%).There was a perception that topical honey use is effective in wound healing (629, 41.3%) and that bathing may delay wound healing (724, 47.6%).Moreover, a significant majority believed that exposing wounds to fresh air promotes wound healing (1,052, 69.1%), while others acknowledged that obesity can delay wound healing (856, 56.2%).Additionally, participants recognized the potential effects of cortisone on healing time (1,086, 71.4%) and the role of age in wound healing (1,336, 87.8%).However, there were misconceptions, such as the belief in the beneficial effects of using Zamzam water to improve healing time (676, 44.4%) and the anti-inflammatory effect of saltwater (1,029, 67.6%).Moreover, participants acknowledged the anti-inflammatory effect of topical aloe vera application (880, 57.8%) and the potential utility of vaseline in reducing wound scars (769, 50.5%).Additionally, the majority recognized the importance of vitamins C, A, K, zinc, and magnesium in the wound healing process (1,389, 91.3%).However, there seemed to be a misconception about the usefulness of coffee beans in controlling bleeding (598, 39.3%).Furthermore, whereas most participants understood that the location, size, or shape of the wound can impact healing time (1,142, 75.0%), a substantial proportion held the opposite belief (380, 25.0%).

Discussion
Wounds, if untreated, pose serious risks, necessitating tailored management for acute and chronic cases.Infections and subsequent complications, such as sepsis, underscore the importance of timely intervention and adherence to evidence-based protocols.Patient education about proper wound care is critical due to the potential for severe complications.Recognizing factors that impede healing is crucial for effective treatment and improved patient outcomes.Our study provides a comprehensive understanding of wound healing in the Eastern Province of Saudi Arabia, encompassing participant demographics, chronic illness prevalence, wound characteristics, sources of wound care information, knowledge and attitudes about wound healing, practices for home injuries, and the associations between wound healing knowledge and sociodemographic factors.
The study's demographic findings indicate a prevalence of females, young adults, and married individuals, mirroring the local population profile in Saudi Arabia.Similarly, the dominance of participants with bachelor's degrees and lower income aligns with the region's typical educational and economic patterns.
The prevalence of chronic diseases, particularly heart disease and hypertension, among the participants underscores the importance of addressing the specific challenges these individuals may face in wound healing.These findings are consistent with the previous studies which showed that heart diseases impaired the healing process in obese patients and hypertensive patients had a higher risk of prolonged wound discharge after total hip arthroplasty than their normotensive counterparts [12,13].Understanding the impact of these comorbidities on wound healing can guide healthcare professionals in implementing targeted interventions to improve healing outcomes.
Regarding the characteristics of wounds and medical care-seeking behavior, there is a high prevalence of burns and injuries, especially on the upper extremities, which emphasizes the significance of providing specialized wound care tailored to the nature and location of these wounds.The prompt seeking of medical attention, primarily driven by specific wound characteristics, indicates the community's awareness of the importance of immediate and appropriate medical care for effective wound management [14].
The reliance on the Internet and healthcare professionals as primary sources of wound care information indicates the growing influence of technology and medical expertise in disseminating knowledge about wound care.Welsh et al. (2018) showed that the hospital's wound care specialist nurses are the primary source of information for participants to manage acute wounds [15].This highlights the potential for utilizing these platforms to implement targeted health education programs and ensure the accurate dissemination of wound care information among the community.
Regarding the knowledge and attitudes about wound healing, there is a high level of awareness regarding the importance of good nutrition, handwashing (prevents infections and promotes healing), and the detrimental effects of smoking on wound healing, which reflects a commendable understanding of basic wound care principles among the participants [16][17][18].However, the prevalence of certain misconceptions, such as the belief in the anti-inflammatory effect of saltwater and the utility of coffee beans in controlling bleeding, suggests the need for targeted educational initiatives to address these misunderstandings and promote evidence-based wound care practices.
Regarding the practices in case of home injuries, the prioritization of stopping bleeding and the preference for using sterilizing wipes for wound cleaning among participants indicate a strong commitment to immediate and effective wound management at home.Atiyeh et al. (2009) showed that sterile wound dressing prevents infection and may be used in the irrigation process [19].These practices align with the recommended first aid measures and underscore the community's preparedness to address common injuries promptly.
Finally, we observed the associations between wound healing knowledge and sociodemographic factors, including age, education, occupation, and marital status, emphasizing the potential influence of these factors on individuals' understanding of wound care [20].These findings underscore the importance of tailoring educational interventions to bridge knowledge gaps and promote uniform awareness of wound care practices across different demographic groups.
Comparatively, our findings corroborate with previous research, indicating a general understanding of basic wound care principles among the population.However, certain unique trends, such as the prevalent use of the internet for wound care information and the persistence of specific misconceptions, underscore the need for targeted educational interventions to address the specific challenges identified in the Eastern Province context.Additionally, our study contributes valuable insights into the community's practices and perceptions related to wound care, further enriching the existing literature on wound healing practices in the region.

Limitations
Several limitations of the study include potential recall bias due to self-reported data, which could affect the accuracy of participant responses.Additionally, the cross-sectional design may limit the establishment of causal relationships, warranting further longitudinal investigations for comprehensive understanding.

Conclusions
Our study provides comprehensive insights into the knowledge, attitudes, and practices concerning wound healing among the population of the Eastern Province of Saudi Arabia.The findings underscore the need for targeted educational interventions, the promotion of evidence-based wound care practices, and the dissemination of accurate wound care information to foster optimal wound healing outcomes in the community.Further research is essential to explore specific strategies for addressing the identified knowledge gaps and improving wound care practices in the region.

FIGURE 2 :
FIGURE 2: Different information sources for home care of wounds.

Table 4
Frequency (n = 1,522) Percentage What you will do in case of an injury at home