Public awareness of central nervous system tumors in the Kingdom of Saudi Arabia

Shahad H. Aljuhani; Saja A. Bamaroof; Thoraya H. Alghamdi; Alhanoof A. Almogbel; Alhanof S. Alkhammash; Batool S. Alkhammash; Amjad A. Bahusayn; Mohamad H. Bangash; Saleh S. Baeesa; Adeel G. Chaudhary; Adel M. Abuzenadah; Ahmed A. Mirza; Mohamad Y. Saka; Deema M. Hussein

doi:10.17712/nsj.2018.3.20180055

Article Figures & Data

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Table 1

Sociodemographic characteristics of all participants.

Characteristics	All participants	Personally delivered	Provided online	χ²

	n (%)
*Age group*
<18	277 (9.2)	69 (4.6)	208 (13.9)	80.84^*
18-39	2318 (77.3)	1142 (76.1)	1176 (78.4)
40+	291 (9.0)	178 (11.9)	113 (7.5)
Not declared	114 (3.8)	111 (7.4)	3 (0.2)
*Gender*
Male	781 (26.0)	552 (36.8)	229 (15.3)	170.306^*
Female	2134 (71.1)	926 (61.7)	1208 (80.5)
Not declared	85 (2.8)	22 (1.5)	63 (4.2)
*Region*
Riyadh	476 (15.9)	0 0	476 (31.7)	1189.797^*
Jeddah	2145 (21.5)	1500 (100)	645 (43)
South	72 (2.4)	0 0	72 (4.8)
North	72 (2.4)	0 0	72 (4.8)
East	189 (6.3)	0 0	189 (12.6)
Outside KSA	40 (1.4)	0 0	40 (2.7)
Not declared	6 (0.2)	0 0	6 (0.4)
*Ethnic group*
Arab	2251 (75.0)	1094 (72.9)	1157 (77.1)	0.682
Other	126 (4.2)	66 (4.4)	60 (4.0)
Not declared	623 (20.8)	340 (22.7)	283 (18.9)
*Language*
Arabic	2907 (96.9)	1423 (94.9)	1484 (98.9)	24.187
English	47 (1.6)	40 (2.7)	7 (0.5)
Not declared	46 (1.5)	37 (2.5)	9 (0.6)
*Marital status*
Single	1745 (58.2)	851 (56.7)	894 (59.6)	8.638^*
Married	1131 (37.7)	615 (41.0)	516 (34.4)
Not declared	124 (4.1)	34 (2.3)	90 (6.0)
*Highest level of education*
None	21 (0.7)	14 (0.9)	7 (0.5)	25.608^*
<University	1010 (33.7)	497 (33.1)	513 (34.2)
≥University	1894 (63.1)	943 (62.9)	951 (63.4)
Other	23 (0.8)	23 (1.5)	0 (0.0)
Not declared	52 (1.7)	23 (1.5)	29 (1.9)
*Work status*
Employed	1107 (36.9)	733 (48.9)	374 (24.9)	180.668^*
Unemployed	1818 (60.6)	738 (49.2)	1080 (72.0)
Not declared	75 (2.5)	29 (1.9)	46 (3.1)
*CNST contact*
Yes	893 (29.8)	471 (31.4)	422 (28.1)	6.908^*
No	2006 (66.9)	952 (63.5)	1054 (70.3)
Not declared	101 (3.40)	77 (5.1)	24 (1.6)

CNST - Central nervous system tumor, KSA - Kingdom of Saudi Arabia. Pearson Chi-Square test for independence comparing characteristics for participants recruited via the personally delivered verses the online provided method.
↵* represents significance p<0.05

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Table 2

Frequencies of participants’ agreements with statements associated with the signs and symptoms or risk factors for central nervous system tumors.

Factor	All Participant

	Recall	Recognition	χ²a
	n (%)
*Signs and symptoms*
Headaches	1355 (45.2)	2555 (85.2)	1059.96*
Drowsiness or prolonged sleepiness	663 (22.1)	1700 (56.7)	756.51*
Difficulty in awareness and learning	560 (18.7)	1702 (56.7)	927.35*
Arm paralysis, muscle weakness	520 (17.4)	1550 (51.7)	783.91*
Visual impairment	466 (15.5)	1924 (64.1)	1486.99*
Abnormal involuntary movements	407 (13.6)	2538 (84.6)	3035.04*
Back pain, back stiffness, odd posture	384 (12.8)	1066 (35.5)	423.37*
Vomiting without diarrhea	307 (10.2)	1086 (36.2)	567.74*
Clumsiness/loss of balance	305 (10.2)	2386 (79.5)	2921.82*
Loss of weight	169 (5.6)	1644 (54.8)	1718.13*
Not eating or having a poor appetite	162 (5.4)	1674 (55.8)	1801.30*
Deafness	109 (3.6)	1507 (50.2)	1654.32*
Excessive emotional problems	102 (3.4)	701 (23.4)	515.36*
Enlarged head development	97 (3.2)	1435 (47.8)	1572.42*
Behavior problems, personality change	94 (3.1)	710 (23.7)	545.48*
Unusual head tilt or stiff neck	29 (0.97)	1441 (48.0)	1796.03*
Congenital anomaly of brain	19 (0.6)	1126 (37.5)	1324.35*
Physical delay	9 (0.3)	1133 (37.8)	1365.98*
Loss of bladder/bowel control	8 (0.3)	435 (14.5)	443.91*
Average score (SD) out of 19	1.92 (± 1.8)	9.44 (± 3.53)	p=0.000
*Risk factors*
Radioactive location/occupation	713 (23.8)	2524 (84.1)	2206.50*
Close relative with CNST	469 (15.6)	1454 (48.5)	778.31*
Low physical activity	186 (6.2)	737 (24.6)	413.52*
Repetitive long periods of exposure to mobile phones	158 (5.3)	1976 (65.9)	2424.47*
Low fruit and vegetable intake	288 (4.8)	760 (12.7)	256.48*
Frequent exposure to bisphenol A	109 (3.6)	1956 (65.2)	2530.19*
Red/processed meat	216 (3.6)	650 (10.8)	257.28*
Frequent exposure to dental X-rays	79 (2.6)	1294 (43.1)	1409.94*
Exposure to computed tomography (CT) scans	45 (1.5)	1390 (46.3)	1671.51*
Infection	43 (1.4)	580 (19.3)	569.11*
Overweight (body mass index [BMI] over 25)	40 (1.3)	938 (31.3)	998.31*
Exposure to pesticides	36 (1.2)	2117 (70.6)	3149.27*
Over 70 years of age	25 (0.8)	1069 (35.6)	1239.57*
Average score (STD) out of 13	0.80 (± 1.04)	5.82 (± 3.04)	p=0.000

*Chi-Square test for independence with yates continuity correction. *represents significance p<0.05, *P-values for ANOVA Welch and Brown-Forsythe

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Table 3

Influence of sociodemographic factors on total knowledge scores for prompted signs and symptoms and risk factor items.

Sociodemographic Characteristic	All participants

	Mean total score out of 32	P-value	Multiple regression analysis

			Beta	P-value	95% confidence interval
			Beta	P-value	Lower	Upper
*Age*
<18	14.37	0.004^*	0.030	0.211	-0.203	0.922
18-39	15.37
40+	15.65
*Gender*
Male	15.60	0.058	–0.019	0.444	-0.788	0.346
Female	15.16
*Ethnicity*
Arab	15.34	0.017^*	0.032	0.173	-0.327	1.81
Other	16.46
*Language*
Arabic	15.25	0.102	0.026	0.261	-0.825	3.04
English	16.89
*Marital status*
Single	14.99	0.000^*	0.020	0.389	-0.277	0.712
Married	15.71
*Education*
No qualifications	15.00	0.184	0.004	0.856	-0.407	0.490
<University	15.07
≥University	15.41
Other	13.13
*Employment status*
Employed	15.86	0.000^*	–0.088	0.001^*	-1.50	-0.409
Unemployed	14.92
*Cancer contact*
Yes	15.97	0.000^*	–0.082	0.000^*	-1.39	-0.475
No	14.94

P-values for ANOVA Welch and Brown-Forsythe.
↵* represents significance p<0.05

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Table 4

Participants’ agreement with statements associated with barriers to seeking help.

Barriers to seeking help	All participants
Barriers to seeking help	n	(%)
Worried about what the doctor might find	2220	(74.0)
Too scared	2029	(67.6)
Difficult to make an appointment with the doctor	1737	(57.9)
Too busy to make time to go to the doctor	1521	(50.7)
Have too many other things to worry about	1503	(50.1)
Difficult to arrange transport to the doctor’s clinic	1389	(46.3)
Difficult to talk to the doctor	1113	(37.1)
Too embarrassed	671	(22.4)
Do not feel confident talking about my symptoms with the doctor	618	(20.6)
Worried about wasting the doctor’s time	402	(13.4)

Participants’ responses to prompted question for signs and symptoms of CNS tumors.

Signs and Symptoms	Method of Administration
	Personal						Online
	Y		N		DK		Y		N		DK

	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)
Not eating or having a poor appetite	908	60.5	329	21.9	252	16.8	766	51.1	428	28.5	306	20.4
Experiencing abnormal involuntary movements	1223	81.5	158	10.5	114	7.60	1315	87.7	84	5.60	101	6.73
Difficulty in awareness and learning	839	55.9	427	28.5	229	15.3	863	57.5	437	29.1	200	13.3
Congenital anomaly of brain	670	44.7	460	30.7	362	24.1	456	30.4	715	47.7	329	21.9
Drowsiness or prolonged sleepiness	857	57.1	357	23.8	275	18.3	843	56.2	393	26.2	264	17.6
Think back pain, back stiffness, odd posture	577	38.5	591	39.4	327	21.8	489	32.6	676	45.1	335	22.3
Excessive emotional problems	390	26.0	784	52.3	321	21.4	311	20.7	889	59.3	300	20.0
Arm paralyzed, monoplegia, muscle weakness	782	52.1	370	24.7	343	22.9	768	51.2	439	29.3	293	19.5
Physical delay	612	40.8	513	34.2	371	24.7	521	34.7	636	42.4	343	22.9
Unusual head tilt or stiff neck	686	45.7	438	29.2	372	24.8	755	50.3	435	29.0	310	20.7
Clumsiness loss of balance	1125	75.0	192	12.8	179	11.9	1261	84.1	127	8.47	112	7.47
Deafness	684	45.6	469	31.3	345	23.0	823	54.9	422	28.1	255	17.0
Headaches	1220	81.3	150	10.0	127	8.47	1335	89.0	79	5.27	86	5.73
Visual impairment	870	58.0	343	22.9	276	18.4	1054	70.3	281	18.7	165	11.0
Enlarged head development	727	48.5	349	23.3	416	27.7	708	47.2	459	30.6	333	22.2
Loss of bladder/bowel control	269	17.9	660	44.0	561	37.4	166	11.1	861	57.4	473	31.5
Behaviour problems, personality change, constant confusion	374	24.9	631	42.1	486	32.4	336	22.4	776	51.7	388	25.9
Vomiting without diarrhoea	512	34.1	487	32.5	496	33.1	574	38.3	572	38.1	354	23.6
Loss of weight	787	52.5	351	23.4	361	24.1	857	57.1	369	24.6	274	18.3

Y - yes, N - no, DK - do not know

Participants’ responses to prompted possible risk factors for CNS tumors.

Risk Factors	Method of administration
	Personal										Online N (%)
	SA		A		NS		D		SD		SA		A		NS		D		SD

	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)
Radioactive location/occupation	716	47.7	487	32.5	231	15.4	53	3.53	12	0.8	1003	66.9	318	21.2	157	10.5	8	0.53	10	0.67
Frequent Exposure to Dental X-Rays	220	14.7	441	29.4	634	42.3	169	11.3	29	1.93	275	18.3	358	23.9	632	42.1	85	5.67	127	8.47
Exposure to CT Scans	240	16.0	463	30.9	579	38.6	182	12.1	28	1.87	291	19.4	396	26.4	612	40.8	66	4.40	118	7.78
Frequent Exposure BPA (Bisphenol A)	379	25.3	569	37.9	417	27.8	114	7.60	20	1.33	531	35.4	477	31.8	395	26.3	30	2.00	56	3.73
Exposure to Pesticides	392	26.1	633	42.2	342	22.8	110	7.33	21	1.40	618	41.2	474	31.6	327	21.8	28	1.87	44	2.93
Repetitive long period exposure to mobile phones	351	23.4	592	39.5	404	26.9	121	8.07	30	2.00	584	38.9	449	29.9	352	23.5	37	2.47	60	4.00
Low fruit and vegetable intake	84	5.60	212	14.1	467	31.1	531	35.4	202	13.5	91	6.07	373	24.9	587	39.1	116	7.73	251	16.7
Red/processed meat	60	4.00	168	11.2	530	35.3	577	38.5	163	10.9	84	5.60	338	22.5	633	42.2	136	9.07	251	16.7
Overweight (BMI over 25)	102	6.80	227	15.1	535	35.7	516	34.4	112	7.47	199	13.3	410	27.3	545	36.3	113	7.53	201	13.4
Over 70 years of age	120	8.00	289	19.3	472	31.5	480	32.0	132	8.80	244	16.3	416	27.7	523	34.9	106	7.07	169	11.3
Close relative with CNST	214	14.3	363	24.2	326	21.7	411	27.4	182	12.1	389	25.9	488	32.5	314	20.9	87	5.80	159	10.6
Infection	67	4.47	113	7.53	283	18.9	556	37.1	474	31.6	91	6.07	309	20.6	413	27.5	134	8.93	321	21.4
Low physical activity	87	5.80	130	8.67	414	27.6	569	37.9	300	20.0	154	10.3	366	24.4	517	34.5	112	7.47	241	16.1

A - strongly agree, A - agree, NS - not sure, D - disagree, SD - strongly disagree, BMI - body mass index, CNST - central nervous system tumor

Participants’ responses to statements associated with barriers to seeking help.

Barriers to seeking help	Method of administration
	Personal						Online N (%)
	Y		N		DK		Y		N		DK

	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)	n	(%)
Too embarrassed	430	28.7	1034	68.9	33	2.20	241	16.1	1184	78.9	70	4.70
Too scared	960	64.0	510	34.0	28	1.90	1069	71.3	400	26.7	26	1.70
Worried about wasting the doctor’s time	233	15.5	1215	81.0	48	3.20	169	11.3	1277	85.1	45	3.00
Difficult to talk to the doctor	552	36.8	870	58.0	68	4.50	561	37.4	848	56.5	86	5.70
Difficult to make an appointment with the doctor	803	53.5	619	41.3	69	4.60	934	62.3	499	33.3	61	4.10
Too busy to make time to go to the doctor	775	51.7	650	43.3	68	4.50	746	49.7	678	45.2	67	4.50
Have too many other things to worry about	765	51.0	656	43.7	71	4.70	738	49.2	691	46.1	62	4.10
Difficult to arrange transport to the doctor’s clinic	651	43.4	765	51.0	79	5.30	738	49.2	692	46.1	68	4.50
Worried about what the doctor might find	1036	69.1	402	26.8	58	3.90	1184	78.9	269	17.9	42	2.80
Do not feel confident talking about my symptom with the doctor	532	35.5	878	58.5	87	5.80	86	5.70	122	8.10	1292	86.1