Awareness and Perception Toward Obesity and Knee Osteoarthritis and Their Preventive Measures Among the Adult Population in the Northern Borders Region, Saudi Arabia

Background: Osteoarthritis (OA) of the knee poses a significant public health challenge, with its prevalence escalating globally. This study addresses a critical knowledge gap by investigating the awareness and perceptions of knee OA in the Northern Borders Region, Saudi Arabia, focusing on demographic factors that may influence community perspectives. Study aim: The primary aim of this cross-sectional study is to comprehensively examine the awareness and perceptions of knee OA, exploring the influence of demographic variables, including region, gender, age, nationality, and educational levels. Methodology: A total of 501 participants from various cities in the Northern Borders Region, Saudi Arabia, were enrolled in this study. Demographic characteristics, including region, gender, age, nationality, and educational levels, were documented. A structured survey instrument was utilized to collect data on awareness and perceptions of knee OA. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression to explore associations. Results: Demographic insights revealed a predominance of participants from Arar (37.50%) and Rafha (36.50%), with a nearly equal gender distribution (52.90% male, 47.10% female). The majority fell within the 31-45 age group (37.50%), and 97.60% were Saudi nationals. Educational levels varied, with 55.30% holding a bachelor's degree. Awareness levels indicated that 75.40% recognized obesity as a significant factor in knee OA. Significant associations were found between gender and acknowledgment of obesity (p = 0.021), as well as between age and awareness of obesity (p = 0.040). Non-Saudi participants exhibited a higher awareness of knee injury as a reason for arthritis (p = 0.028). Educational levels demonstrated significant associations with awareness of rheumatoid arthritis (p = 0.012), growing old as a reason for knee arthritis (p = 0.002), and various preventive measures and treatment options. Conclusion: This study provides a nuanced understanding of knee OA awareness and perceptions in the Northern Borders Region, Saudi Arabia. The high recognition of obesity as a risk factor, coupled with demographic variations, highlights the need for tailored health education interventions. Addressing gender-specific, age-related, and educational disparities is crucial for promoting effective community-wide initiatives to prevent and manage knee OA.


Introduction
Osteoarthritis (OA) is a prevalent and debilitating joint disorder characterized by the progressive degradation of articular cartilage, changes in subchondral bone, and alterations in joint tissues, leading to pain, stiffness, and functional limitations [1].As a leading cause of musculoskeletal disability worldwide, knee OA poses a substantial public health burden, affecting the quality of life for millions of individuals [2,3].
Like many other regions globally, the Northern Borders Region in Saudi Arabia faces the growing challenge of an aging population and an increased prevalence of chronic diseases [4].Aging is a significant risk factor for knee OA, and as life expectancy rises, the burden of this condition is anticipated to escalate.Furthermore, lifestyle changes, including sedentary behavior, unhealthy dietary patterns, and an increasing prevalence of obesity, contribute to the rising incidence of knee OA [5,6].The intersection of these factors underscores the need for comprehensive research and public health initiatives to address knee OA awareness and perceptions among diverse populations [7].
Understanding the awareness and perceptions of knee OA is crucial for developing effective prevention and management strategies.Patient knowledge and beliefs play a pivotal role in healthcare-seeking behavior, adherence to treatment plans, and overall health outcomes [8].In the context of knee OA, where lifestyle modifications and early interventions can significantly impact disease progression, addressing community awareness becomes a paramount public health priority [9,10].
Despite the recognized importance of knee OA awareness, there is a dearth of research focusing on specific regional populations, such as the Northern Borders Region in Saudi Arabia.Regional variations in demographics, cultural norms, and healthcare accessibility can influence the prevalence of risk factors and the community's understanding of knee OA [11][12][13].Tailoring interventions to address these regional nuances is essential for achieving meaningful impact and reducing the burden of knee OA in the Northern Borders Region [7,8].Moreover, cultural beliefs and societal norms may shape individuals' perceptions about joint disorders, affecting their willingness to seek medical advice, adhere to prescribed treatments, or consider surgical interventions [5].The multifaceted nature of knee OA, involving both biological and sociocultural determinants, necessitates a comprehensive exploration of community attitudes and knowledge to inform targeted educational and preventive efforts [3,6,8].

Study rationale
In the Northern Borders Region, limited research has been conducted to investigate the awareness and perceptions of knee OA.Existing studies often focus on urban centers, potentially overlooking the unique characteristics and challenges faced by individuals in more rural or less economically developed areas [11,12].A thorough understanding of the region's sociodemographic landscape, prevalence of risk factors, and community attitudes towards knee OA is crucial for developing context-specific interventions.
As healthcare systems strive to implement evidence-based practices and community-centered interventions, a comprehensive understanding of knee OA awareness and perceptions is instrumental [3,5,8].This research contributes insights that can guide healthcare providers, policymakers, and public health professionals in developing strategies to enhance community awareness, promote preventive measures, and improve the overall management of knee OA in the unique context of the Northern Borders Region, Saudi Arabia.

Study objectives
Assess the community's awareness and perceptions of knee OA and obesity, explore variations based on demographic factors, and identify the key determinants influencing knowledge and beliefs.Investigate the factors influencing individuals' decisions regarding treatment modalities for knee OA, with a specific focus on the acceptance and apprehensions associated with knee replacement surgery.

Study design and setting
This study employed a cross-sectional research design to investigate knee OA awareness and perceptions among participants in the Northern Borders Region, Saudi Arabia.The Northern Borders Region was chosen as the study setting due to its diverse demographic composition and relevance to the research objectives.

Study participants
The sample size was calculated by using the formula N=z² p (1-p) / d² where N = sample size, Z = the statistic corresponding to confidence level (1.96), p = the expected prevalence of awareness (50%), and d = precision (0.05).The expected sample size was 383.
The study included a total of 501 participants selected through a stratified random sampling technique.Stratification was based on the distribution of the population across different cities within the Northern Borders Region.The participants were recruited from Arar, Rafha, Turaif, Oweigeila, and other northern cities, ensuring a representative sample reflecting the region's heterogeneity.Data collection participants were approached through various community centers, healthcare facilities, and educational institutions.The research team explained the study's purpose, procedures, and confidentiality measures to potential participants.Informed consent was obtained from each participant before their inclusion in the study.
Structured interviews were conducted using a pre-tested questionnaire developed by the research team.The questionnaire comprised sections on demographic information, awareness of knee OA and related risk factors, perceptions about preventive measures and treatment options, and factors influencing the decision to undergo knee replacement surgery.

Inclusion and exclusion criteria
Men and women, Arabic speaking, and who reside in the Northern Borders Region were included.Those who suffer from OA, non-Arabic speaking, and those who reside outside the Northern Borders Region were excluded from the study.

Results
In Table 1, the characteristics of the included participants (n = 501) are presented.Regarding the distribution by region, the majority of participants were from Arar, constituting 37.50% (n = 188) of the total sample.Rafha closely followed, representing 36.50% (n = 183).Turaif and Oweigeila each accounted for 2.80% (n = 14), while 20.40% (n = 102) were from other northern cities.The gender distribution of the participants is also noteworthy, with 52.90% (n = 265) being male and 47.10% (n = 236) being female.In terms of preventive measures, a substantial proportion of participants recognized the importance of losing weight (75.20%, n = 377) and adhering to correct sitting positions (46.70%, n = 234).The identification of prominent symptoms of knee arthritis revealed that 70.70% (n = 354) recognized knee pain as a significant indicator, while knee swelling, knee joint stiffness, and popping sounds during movement were also acknowledged by substantial percentages of participants.

Frequency (%)
A noteworthy finding is that 92.60% (n = 464) of participants believe there is a cure for knee arthritis.
When considering knee replacement surgery, the majority of participants associated it with pain relief (70.90%, n = 355) and an improvement in walking quality (48.70%, n = 244).Notably, the ability to perform prayer was considered a relevant outcome by 50.10% (n = 251) of participants, highlighting the multifaceted expectations associated with knee replacement surgery.
The participants' perceptions of factors that may prevent them from undergoing knee replacement surgery demonstrated concerns related to postoperative pain (52.90%, n = 265) and general anesthesia complications (33.30%, n = 167).Additionally, 22.40% (n = 112) expressed doubts about the effectiveness of the surgery itself.
Table 3 presents a detailed analysis of the association between sex and the awareness and perception of 501 participants toward knee OA and obesity.In examining the reasons for knee arthritis, a significant association was found between sex and the acknowledgment of obesity as a contributing factor (p-value = 0.021).Specifically, 79.60% of males and 70.80% of females recognized obesity as a likely cause.When assessing preventive measures, the association between sex and the endorsement of exercise as a preventive measure for knee arthritis was statistically significant (p-value = 0.018).Notably, 48.30% of males, compared to 58.90% of females, identified exercise as a preventive measure.
The analysis of methods helping in the treatment of knee OA revealed several noteworthy associations.Females showed a higher recognition of the effectiveness of cold compresses (16.60% vs. 9.30%, p-value = 0.016) and a preference for surgical intervention (35.50% vs. 18.60%, p-value = 0.000) compared to males.
In assessing the purpose of knee replacement surgery, a statistically significant association was observed between sex and the perceived relief of pain (74.70% of males vs. 66.50% of females, p-value = 0.044), increased walking quality (43.40% of males vs. 54.70% of females, p-value = 0.012), and the ability to exercise (40.80% of males vs. 26.30% of females, p-value = 0.001).Notably, the decision-making process for undergoing knee replacement surgery was significantly influenced by the availability of surgeons (34.30% of males vs. 22.90% of females, p-value = 0.005).and perception of 501 participants toward knee OA and obesity.In investigating the reasons for knee arthritis, a significant association was found between age and the acknowledgment of obesity as a contributing factor (p-value = 0.040).Participants aged 46-65 years showed the highest awareness, with 78.70% recognizing obesity as a likely cause, while those aged <18 years exhibited the lowest awareness at 57.10%.* The Chi-square statistic is significant at the 0.05 level.
For repeated pressure on the knee, a statistically significant association was observed with age (p-value = 0.004).Participants under 18 years old demonstrated the lowest awareness (38.10%), while those aged 46-65 years exhibited the highest awareness (20.60%).Regarding genetic reasons for knee arthritis, a significant association with age was identified (p-value = 0.014).Participants under 18 years old showed the lowest awareness (28.60%), while those aged 31-45 years exhibited the highest awareness (92%).
In examining preventive measures, a significant association with age was found for the endorsement of losing weight as a preventive measure (p-value = 0.018).Participants aged 46-65 years demonstrated the highest awareness (79.30%), while those under 18 years exhibited the lowest awareness (52.40%).
The association between age and the recognition of exercise as a method helping in the treatment of knee OA was statistically significant (p-value = 0.001).Participants under 18 years old showed the lowest awareness (71.40%), while those aged 46-65 years exhibited the highest awareness (36.30%).Regarding the purpose of knee replacement surgery, a significant association with age was found for relieving pain (pvalue = 0.037), the ability to exercise (p-value = 0.020), and undergoing surgical intervention (p-value = 0.028).Participants aged 46-65 years consistently exhibited the highest awareness across these categories.
Table 5 presents a detailed analysis of the association between nationality and the awareness and perception of 501 participants toward knee OA and obesity.In assessing the reasons for knee arthritis, no statistically significant association was observed between nationality and the acknowledgment of obesity as a contributing factor (p-value = 0.971).Both Saudi and non-Saudi participants demonstrated similar awareness levels, with 75.50% and 75%, respectively.For knee injury as a reason for arthritis, a statistically significant association was found with nationality (p-value = 0.028).Non-Saudi participants exhibited a higher level of awareness (58.30%) compared to Saudi participants (29%).No significant associations were observed between nationality and awareness of other reasons for knee arthritis, such as repeated pressure on the knee, the patient's sex, lack of movement, genetic reasons, rheumatoid arthritis, growing old, and wrong sitting positions.

OA and obesity (n=501).
* The Chi-square statistic is significant at the 0.05 level.
Regarding preventive measures for knee arthritis, no statistically significant association was found between nationality and awareness of losing weight (p-value = 0.169), adhering to correct sitting positions (p-value = 0.817), avoiding constant pressure on the knee (p-value = 0.214), and promoting exercise and motor activity (p-value = 0.417).In exploring methods for treating knee OA, no significant associations were observed between nationality and awareness of exercise, hot compresses, cold compresses, topical cortisone injections, drugs, physical therapy, and surgical intervention.
For the purpose of knee replacement surgery, no statistically significant associations were found between nationality and awareness of relieving pain, increasing walking quality, the ability to exercise, and the ability to perform prayer.In examining factors influencing the decision to undergo knee replacement surgery, no significant associations were observed between nationality and awareness of postoperative pain, general anesthesia and its complications, surgery not being helpful, and the availability of surgeons.
Table 6 provides a comprehensive analysis of the association between educational levels and the awareness and perception of 501 participants toward knee OA and obesity.In assessing the reasons for knee arthritis, no statistically significant association was observed between educational levels and the acknowledgment of obesity as a contributing factor (p-value = 0.576).The participants with different educational backgrounds demonstrated relatively similar awareness levels, ranging from 69.10% to 78%, suggesting a consistent understanding of the impact of obesity on knee arthritis across various educational levels.* The Chi-square statistic is significant at the 0.05 level.
For knee injury as a reason for arthritis, no significant association was found between educational levels (pvalue = 0.444).The absence of a substantial difference in awareness levels indicates a uniform understanding of the relationship between knee injury and arthritis among participants with different educational backgrounds.Regarding rheumatoid arthritis and the influence of growing old as reasons for knee arthritis, statistically significant associations were found (p-values = 0.012 and 0.002, respectively).Higher percentages of participants with postgraduate and bachelor degrees demonstrated awareness of these factors compared to those with lower educational levels.In exploring preventive measures for knee arthritis, participants with higher educational levels showed a statistically significant association with the awareness of losing weight (p-value = 0.014), exercise and motor activity (p-value = 0.038), topical cortisone injections (p-value = 0.035), drugs (p-value = 0.005), physical therapy (p-value = 0.012), and surgical intervention (p-value = 0.030).
For the purpose of knee replacement surgery, no statistically significant associations were found between educational levels and the awareness of relieving pain, increasing walking quality, the ability to exercise, and the ability to perform prayer.In examining factors influencing the decision to undergo knee replacement surgery, no significant associations were observed between educational levels and awareness of postoperative pain, general anesthesia and its complications, surgery not being helpful, and the availability of surgeons.

Discussion
Osteoarthritis is a prevalent musculoskeletal disorder globally, contributing significantly to the burden of chronic conditions [2].The knee joint is particularly susceptible to OA, and understanding community awareness and perceptions is crucial for developing targeted interventions [3].This study explores the nuanced landscape of knee OA awareness and perceptions in the Northern Borders Region of Saudi Arabia, shedding light on demographic factors influencing these perspectives.
According to our results, gender-based differences in awareness were identified, particularly in recognizing obesity as a significant factor in knee OA.While 79.60% of males acknowledged obesity, 70.80% of females shared this awareness, indicating a slight but statistically significant difference (p = 0.021).This discrepancy may stem from varying sociocultural factors influencing health beliefs and behaviors, emphasizing the importance of tailored interventions for each gender [8,11].
Age-wise categorization highlighted a concentrated distribution within the 18-45 age groups, indicating the need for early interventions and preventive measures [13].The recognition of obesity as a contributing factor showed significant age-related variations, with participants aged 46-65 exhibiting the highest awareness (78.70%, p = 0.040).Conversely, those under 18 demonstrated the lowest awareness (57.10%).This age-specific divergence underscores the necessity of age-tailored educational efforts to bridge knowledge gaps and instill preventive practices early in life [14,15].
Nationality-based analyses revealed a consistent understanding of obesity's role in knee OA across Saudi and non-Saudi participants.However, a significant association was found concerning knee injury as a reason for arthritis, with non-Saudi participants exhibiting higher awareness (58.30% vs. 29%, p = 0.028).This highlights the importance of considering cultural and contextual factors influencing awareness and perceptions of specific risk factors within diverse populations [12,16].
Educational levels played a pivotal role in shaping awareness and perceptions [16].Participants with higher educational backgrounds demonstrated a more comprehensive understanding of various aspects, including rheumatoid arthritis and the influence of growing older as reasons for knee arthritis.Moreover, educational attainment significantly influenced awareness of preventive measures and treatment options.These findings emphasize the role of education in empowering individuals to comprehend the multifaceted nature of knee OA and make informed health-related decisions [12,14,15].
Comparing these findings with existing literature, the study corroborates the global trend that associates obesity with an increased risk of knee OA [11][12][13][14][15][16].The high awareness levels regarding obesity as a risk factor align with studies conducted in different regions, emphasizing the universality of this perception [14].However, gender-specific and age-related variations identified in this study contribute nuanced insights that may guide the tailoring of health education programs [17].
The gender-based differences in acknowledging obesity as a risk factor resonate with studies emphasizing gender-specific health beliefs and behaviors [11,[13][14][15].Sociocultural factors, role expectations, and access to health information may contribute to these disparities.Tailoring interventions to address these nuances is imperative for promoting equitable awareness and preventive practices [15].
Age-related variations in awareness align with studies indicating that older individuals may exhibit heightened awareness due to an increased likelihood of exposure to arthritis-related information over time [12,15].However, the lower awareness among younger participants underscores the importance of early and targeted health education interventions to instill preventive measures and shape lifelong health behaviors [13].
The consistency in awareness across nationalities suggests that certain aspects of knee OA awareness may transcend cultural differences [18].However, the higher awareness of knee injuries among non-Saudi participants underscores the importance of cultural sensitivity in health education initiatives, recognizing unique cultural perspectives that may shape awareness and perceptions [19].
Educational attainment as a determinant of awareness aligns with studies highlighting the positive correlation between education and health literacy [16].The more nuanced understanding of preventive measures and treatment options among participants with higher educational backgrounds reinforces the need for accessible and tailored health information across diverse educational levels [16,19].

Implications and recommendations
The implications of this study are far-reaching, providing a foundation for targeted health education initiatives to enhance knee OA awareness and promote preventive practices in the Northern Borders Region, Saudi Arabia.Recognizing the demographic variations in awareness allows for the development of tailored interventions, acknowledging gender-specific, age-related, and educational nuances.
In light of gender-based differences, health campaigns could employ diverse communication channels and content strategies to ensure equitable access and impact.Incorporating sociocultural considerations may enhance the effectiveness of interventions in promoting a holistic understanding of knee OA [17,18].
Age-specific interventions, particularly targeting the younger population, are crucial for establishing preventive practices early in life [13,16].Leveraging educational institutions, social media, and community engagement platforms can effectively disseminate information and shape positive health behaviors.
Cultural sensitivity should be central to health education initiatives, recognizing and respecting diverse perspectives on health and illness [12].Incorporating cultural influencers, community leaders, and local healthcare providers in awareness campaigns can bridge cultural gaps and foster a more inclusive approach [18].
Educational programs need to be accessible and tailored to varying educational levels, employing clear and straightforward communication strategies.Leveraging digital platforms and community-based workshops can facilitate the widespread dissemination of information, ensuring that individuals across educational spectrums receive adequate and comprehensible health messages [14,15].

Study limitations and future directions
While this study contributes significantly to the understanding of knee OA awareness in the Northern Borders Region, certain limitations should be acknowledged.The cross-sectional design limits the establishment of causal relationships, warranting future longitudinal studies.Additionally, the study's reliance on self-reported data introduces the possibility of recall bias.
Future research endeavors could explore the effectiveness of targeted interventions developed based on the identified demographic variations.Longitudinal studies tracking changes in awareness and behaviors over time would provide insights into the sustained impact of health education initiatives.

Conclusions
In conclusion, this study offers a comprehensive examination of knee osteoarthritis (OA) awareness and perceptions in the Northern Borders Region, Saudi Arabia.The findings highlight the influence of demographic factors, including region, gender, age, nationality, and educational levels, on community perspectives.By aligning these findings with existing literature, the study contributes insights for developing context-specific and tailored health education interventions.Recognizing and addressing the demographic nuances identified in this study will be instrumental in shaping effective strategies to enhance knee OA awareness and foster preventive practices in the community.

TABLE 3 : Sex in association with awareness and perception of participants toward knee OA and obesity (n = 501).
* The Chi-square statistic is significant at the 0.05 level.OA: Osteoarthritis.