|Year : 2021 | Volume
| Issue : 2 | Page : 59-64
Public knowledge and attitude toward vitiligo in Saudi Arabia: A cross-sectional study
Malak A M Algarni1, Waleed A Alqarni1, Logain G Alghanemi2, Maryam M Alnashri3, Rand G Alghanemi3, Nouf T Mleeh2
1 Department of Dermatology, Faculty of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
2 Department of Dermatology, Faculty of Medicine, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
3 Department of Dermatology, Faculty of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
|Date of Submission||27-Nov-2020|
|Date of Acceptance||25-Mar-2021|
|Date of Web Publication||29-Mar-2022|
Dr. Malak A M Algarni
Faculty of Medicine, Ibn Sina National College for Medical Studies, P. O. Box: 31290 , Post Code 21497, Jeddah
Source of Support: None, Conflict of Interest: None
Background: Knowledge and positive attitude toward vitiligo would foster support for affected individuals, improving their sense of well-being and possibly treatment outcome. Purpose: To evaluate the levels of public knowledge and attitude toward vitiligo among Saudis. Methods: A cross-sectional study among 12,181 participants. Data were collected using a self-administered questionnaire enquiring about knowledge, attitude, and perceptions in vitiligo. Results: The response rate was 95.4%. Most respondents had heard about vitiligo (96.9%). The median knowledge score was four out of eight and median attitude score was six out of eight. Social media/Internet was the most commonly reported source of information (34.7%), followed by family/friends/acquaintances (30%). Higher proportions of correct responses were recorded regarding the noninfectious nature of vitiligo (85.0%) and whether vitiligo was dangerous or connected to skin cancer (63.4%). However, unsatisfactory responses were found regarding the immunological basis of the condition: only 24.3% knew that vitiligo was an immune disease and 24.5% knew about the role of heredity in vitiligo. The majority of respondents did not mind employing patients with vitiligo (89.0%). Only 40.6% responded that they would marry someone with vitiligo. Positive attitude was significantly common in respondents aged 31–50 years (P < 0.01), women (P < 0.01), and those who had a university degree or higher (P < 0.05). Conclusion: Although overall attitude toward vitiligo patients was positive, there were gaps in the knowledge, particularly regarding the nature of the disease. More awareness and education are required to improve attitude toward vitiligo patients, with an aim to improve their overall well-being.
Keywords: Attitude, awareness, education, knowledge, Saudi Arabia, vitiligo
|How to cite this article:|
Algarni MA, Alqarni WA, Alghanemi LG, Alnashri MM, Alghanemi RG, Mleeh NT. Public knowledge and attitude toward vitiligo in Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg 2021;25:59-64
|How to cite this URL:|
Algarni MA, Alqarni WA, Alghanemi LG, Alnashri MM, Alghanemi RG, Mleeh NT. Public knowledge and attitude toward vitiligo in Saudi Arabia: A cross-sectional study. J Dermatol Dermatol Surg [serial online] 2021 [cited 2022 May 19];25:59-64. Available from: https://www.jddsjournal.org/text.asp?2021/25/2/59/341197
| Introduction|| |
Vitiligo is common noninfectious, acquired hypopigmentation characterized by a major esthetic disturbance impacting patients' psychological well-being and quality of life.,,,, In social stereotype, vitiligo is associated with several misconceptions varying across cultures and societies.,, These perceptions were demonstrated to predict its acceptance among patients and the society, which impacts patient's well-being, sense of stigmatization, and even treatment outcome.,
To our knowledge, no recent studies addressed public attitude and knowledge toward vitiligo in all five regions of Saudi Arabia. Therefore, we conducted this study to evaluate the knowledge and attitude about vitiligo among Saudis and to explore the local myths.
| Methods|| |
A descriptive and analytic cross-sectional study was conducted among 12,181 Saudi participants. The study included Saudi adults aged 18 years or older, who were dwelling in any of the five regions of the Kingdom of Saudi Arabia (KSA), and who accepted to take part in the study. Non-Saudi and younger adults were excluded. The sample size was calculated using the formula for a cross-sectional study:
n = ([z2 × p × q])/d2
Where: P = prevalence of adequate knowledge (unknown, P = 50%), Z = 95% confidence interval, d = margin of error ≤5%.
The sample size was calculated using the Raosoft website, which yielded a sample of 385 subjects. It was then increased to 482, considering for a 25% non-response rate.
Data were collected using a self-administered questionnaire. The questionnaire items were adopted from a previously prepared self-structured validated questionnaire. The questionnaire included four main parts including sociodemographic characteristics of the participants, knowledge, attitude, and perceptions about vitiligo.
Regarding knowledge items, a score of one was given for each correct response and a score of zero was given for incorrect responses or missing values. The total score of knowledge was computed by the summation of responses for each participant. Adequate knowledge was defined as total score equal to or greater than the median value, while lower scores indicated inadequate knowledge.
Regarding attitude items, a score of two was given to each positive attitude, one for unsure responses, and zero for negative attitude. A total score for attitude was computed as the summation of responses for each participant. A positive attitude was defined as a total score that is equal to or greater than the median value, whereas lower scores indicated a negative attitude. Data were collected using an electronic questionnaire administered through the Google Forms platform (https://www.google.com/forms/about/). The questionnaire's online link was sent to the study population through social media with the assistance of data collectors all-over the five regions of KSA: Northern, Southern, Central, Eastern, and Western.
Written consent was included in the electronic questionnaire as a mandatory field to be agreed prior to participation. Data were collected considering privacy, safety, and confidentiality of the participants. Ethical approval was obtained from the Institutional Review Board of the authors' affiliation, a tertiary care center in Western Saudi Arabia.
Statistical analysis plan
Data were extracted from the electronic questionnaire, Google Forms, as an Excel file (Microsoft Corporation). Then, the data were transferred to the Statistical Package for the Social Sciences (SPSS) (version 21.0 for Windows (SPSS Inc., Chicago, IL, USA) for analysis. Frequency and percentage were used to describe the categorical variables, whereas mean and standard deviation were used for the continuous variables. A Chi-square test was conducted to investigate the association of knowledge and attitude with the demographic factors. Differences with P < 0.05 were considered statistically significant.
| Results|| |
Characteristics of the study population
Of the 12,181 participants included in the study, 555 (4.6%) were excluded as they were non-Saudi giving a response rate of 95.4%. Women represented 72.1% of the sample (n = 8380). Participants aged 18–30 years represented more than half of the sample (n = 6853, 58.9%). The study included participants from all around Saudi Arabia, with the majority being residents of the Eastern region (n = 2983, 25.7%) and Southern region (n = 2775, 23.9%). The characteristics of the study population are shown in [Table 1].
Knowledge about vitiligo
Most of the respondents stated that they heard about vitiligo (n = 11,265, 96.9%). The median knowledge score of the total sample was four out of eight, indicating average knowledge. As shown in [Table 2], higher proportion of participants were aware that vitiligo was noninfectious (n = 10,351, 85.0%), and it was not dangerous or connected to skin cancer (n = 7,357, 63.4%). A total of 5177 (62.8%) answered correctly regarding the effects of vitiligo on the social status of patients. However, the rates of correctness were unsatisfactory regarding the immunological basis of the condition; only 2822 (24.3%) knew that vitiligo was an immune disease, as well as regarding the role of heredity in vitiligo (n = 2846, 24.5%). Approximately half (n = 5509, 47.4%) of the respondents agreed with the availability of treatment for vitiligo [Table 2].
Attitude toward vitiligo
Our respondents had a median attitude score of six out of eight, indicating overall positive attitudes toward vitiligo. As shown in [Table 3], most respondents had positive attitude toward communication with vitiligo patients including handshaking (n = 10,301, 88.6%), eating food prepared by patients (n = 9106, 78.3%), and sharing food with patients (n = 9318, 80.1%); and the majority of respondents did not mind employing patients with vitiligo (N = 10,346, 89.0%). However, only 4730 (40.7%) thought that they would marry someone with vitiligo. The self-reported prevalence of vitiligo was reported by 262 (2.3%) ever-married individuals.
Factors associated with knowledge about vitiligo
Adequate knowledge about vitiligo was significantly more frequent in respondents who previously heard about vitiligo (P < 0.01), those aged 50 years or older than (P < 0.01), women (P < 0.01), residents of the Northern region of Saudi Arabia (P < 0.01), those who had a university degree or higher (P < 0.01), and those who were employed (P < 0.01) [Table 4].
Factors associated with attitude towards vitiligo
Positive attitude toward vitiligo was significantly more common in respondents aged 31–50 years (P < 0.01), women (P < 0.01), residents of the Southern region of Saudi Arabia (P < 0.01), those who had a university degree or higher (P < 0.05), and those who were unemployed (P < 0.01) compared with their counterparts [Table 5].
Predictors of positive attitude toward vitiligo
Adequate knowledge was independently associated with positive attitude toward individuals having vitiligo, with odds ratio (OR) = 1.85 (P < 0.001) compared with inadequate knowledge. Other independent factors associated with positive attitude toward individuals having vitiligo included older participant's age (31–50 years: OR = 1.31, P = 0.000; >50 years: OR = 1.36, P = 0.002), female gender (OR = 1.14, P = 0.003), higher educational level (middle school: OR = 2.63, P = 0.031; high school: OR = 2.69, P = 0.024; and university+: OR = 2.71, P = 0.023), and Central (OR = 1.20, P = 0.001) and Northern (OR = 0.63, P < 0.001) regions [Table 6].
|Table 6: Independent factors associated with positive attitudes toward vitiligo|
Click here to view
Sources of information on vitiligo
The most frequently cited source of vitiligo-related information among the respondents was Social media/Internet (n = 4040, 34.7%), followed by Family/Friends/Acquaintances (n = 3570. 30.7%) and healthcare provider/doctor (n = 1936. 16.7%). A small fraction mentioned books/magazines/newspapers (n = 921, 7.9%), television (N = 561, 4.8%), and other sources of information (n = 341, 2.9%). Eighty-three participants (0.7%) reported that they suffered/are suffering from vitiligo, and 10,626 (91.4%) thought that there was a lack of public awareness regarding vitiligo and its treatment [Table 7].
| Discussion|| |
Public attitude plays an important role in the psychological dimension of vitiligo as it constitutes one of the possible causes of depression, isolation, and distress among patients. Beyond the disfiguring effect, vitiligo is associated with several misconceptions that vary across cultures and societies. Among the common misconceptions is the belief that it is an infectious disease or caused by specific type of food and drinks. Vitiligo has also been misperceived as a form of leprosy, linked to skin cancer, or thought that it is a hereditary and nontreatable condition. In the Arab culture, one of the beliefs is that vitiligo is related to the evil eye and Jinn (evil spirits). The main focus of this population-based study was the knowledge, attitude, and perceptions about vitiligo among the Saudi population. The findings showed relatively low levels of knowledge about various aspects of vitiligo, notably misconceptions about the disease and unawareness about its pathophysiological mechanisms and treatment. These low levels of knowledge contrasted with generally positive attitude including tolerance regarding individuals with vitiligo, especially during common societal interactions; however, a good percentage of participants expressed reluctance to have a person with vitiligo as a partner. Both overall knowledge and attitudes levels were significantly more adequate among participants with older age, female gender, higher educational level, and some regional variances existed as well.
A Saudi study conducted by AlGhamdi et al. reported that various misconceptions and negative attitude about vitiligo among the public were prevalent, affecting vitiligo patients' quality of life. Another study by Thompson et al. analyzed British vitiligo patients and discovered that they suffer from avoidance and concealment. A similar study by Kent and Al'Abadie revealed that vitiligo affects lives in a variety of ways, mainly due to activities such as avoidance and negative reactions by others. A previous study revealed that 33.63% of patients with vitiligo in a teaching hospital in India suffered from psychiatric morbidity. In comparison with earlier studies, our study differ by analyzing the knowledge, attitude, and perceptions in five Saudi regions (Eastern, Western, Central, Southern, and Northern).
In contrary to previous studies, interesting finding in this study was significantly positive attitude toward patients with vitiligo.,,, However, the percentage of positive attitude varied according to the type of interaction with the vitiligo patients. Only 40% of the respondents reported that they would accept to marry a vitiligo patient, while 26% refused and 33.3% have not answered. In contrast, 56.1% and 42.8% reported unwilling to marry a patient with vitiligo in the studies by AlGhamdi et al. and Fatani et al., respectively. Further, Fatani et al. reported that 24% would avoid shaking hands with a vitiligo patient to prevent infection which is significantly different from the findings in our study (8%). Regarding sharing food with a vitiligo patient, 80% of our respondents reported willingness to eat with them. However, only 10% refused, which is lower than previous findings reported by Fatani et al. (24.8%). Comparison of our findings with previous local data suggests impressive changes in the population's attitude toward patients with vitiligo. This is probably due to the remarkable development in Saudi Arabia during the last decade in terms of education and health sectors. The positive attitude of respondents was seen among those with university degree or higher educational levels in the Saudi population.
While majority of the participants were aware that vitiligo is not an infectious disease, <45% were knowledgeable about the effect of autoimmunity and stress in the pathogenesis of the disease, whereas 46.1% believed that it is a hereditary disease. In addition, more than 30% admitted having no knowledge about majority of the knowledge questions. Although etiology of vitiligo is not fully understood, it appears to include an interaction of genetic, neurological, and immunological factors., In addition, patients commonly attribute the onset of their disease to specific events, including physical injury, pregnancy, sunburn, or emotional stress. To date, there is no evidence supporting a causal relationship of these factors with vitiligo. On the other hand, high frequency of comorbid autoimmune diseases, such as halo nevus and malignant melanoma, in patients with vitiligo, suggests an autoimmune etiology of the disease.
Several studies examined the knowledge about vitiligo and showed that misconceptions and poor awareness about vitiligo are prevalent among the public and even among patients, which is consistent with our findings., Locally, a recent Saudi study reported that 33% of the participants did not know that vitiligo was not infectious and 45% did not know that the condition was not related to food. Another local study showed that 8% believed that vitiligo was an infectious disease, and 25.1% were not sure, while a study from India showed 17% misconception about the infectious origin of the disease. AlGhamdi et al. found that 31.3% of the participants believed that hereditary is also one of the causes of vitiligo and 33.1% thought it is infectious. Another local study that assessed awareness of vitiligo in 486 Saudi school students, of whom 24.1% had vitiligo, concluded that myths about causes of vitiligo are widespread and delayed seeking medical management. The author attributed the prevailing myths among Saudi school students to inadequate knowledge about the disease, low level of education, social misconception, and cultural beliefs.
All these misconceptions may explain some of the findings related to attitude found in our study. Most of our respondents believed that there was a lack of awareness regarding vitiligo and most reported the social media and internet as their source of knowledge. This suggests a starting point for spreading awareness, knowledge, and help with the public attitudes.
| Conclusion|| |
Despite the fact that overall attitude toward vitiligo patients was positive, there remained some gaps in the knowledge, particularly, regarding the nature and pathophysiology of the disease. More awareness and education are required to improve public attitude toward patients. These steps would improve patient well-being.
We would like to appreciate all participants who accepted to join this study. We are also thankful to the data collectors who enthusiastically aided the implementation of this work. We extend special thanks to Dr. Ameera A. Algarni for her valuable comments that were needed to complete our paper.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yaghoobi R, Omidian M, Bagherani N. Vitiligo: A review of the published work. J Dermatol 2011;38:419-31.
Mohammed GF, Gomaa AH, Al-Dhubaibi MS. Highlights in pathogenesis of vitiligo. World J Clin Cases 2015;3:221-30.
Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet 2015;386:74-84.
Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res 2003;16:208-14.
Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan C C E, et al
. Revised classification/nomenclature of vitiligo and related issues: The Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012;25:E1-3.
Al Robaee AA. Assessment of quality of life in Saudi patients with vitiligo in a medical school in Qassim province, Saudi Arabia. Saudi Med J 2007;28:1414-7.
Bin Saif GA, Al-Balbeesi AO, Binshabaib R, Alsaad D, Kwatra SG, Alzolibani AA, et al
. Quality of life in family members of vitiligo patients: A questionnaire study in Saudi Arabia. Am J Clin Dermatol. 2013;14:489-95.
Tarlé RG, Nascimento LM, Mira MT, Castro CC. Vitiligo – Part 1. An Bras Dermatol 2014;89:461-70.
Kent G, Al'Abadie M. Psychologic effects of vitiligo: A critical incident analysis. J Am Acad Dermatol 1996;35:895-8.
Porter J, Beuf AH, Lerner A, Nordlund J. Response to cosmetic disfigurement: Patients with vitiligo. Cutis 1987;39:493-4.
Fatani MI, Aldhahri RM, Al Otaibi HO, Kalo BB, Khalifa MA. Acknowledging popular misconceptions about vitiligo in western Saudi Arabia. J Dermatol Surg 2016;20:27-31.
Sharaf FK. Prevailing misconceptions of Vitiligo among Saudi school children. Int J Health Sci (Qassim) 2014;8:33-8.
AlGhamdi KM. Beliefs and perceptions of Arab vitiligo patients regarding their condition. Int J Dermatol 2010;49:1141-5.
Alghamdi KM, Moussa NA, Mandil A, Alkofidi M, Madani A, Aldaham N, et al
. Public perceptions and attitudes toward vitiligo. J Cutan Med Surg 2012;16:334-40.
Thompson AR, Clarke SA, Newell RJ, Gawkrodger DJ; Appearance Research Collaboration (ARC). Vitiligo linked to stigmatization in British South Asian women: A qualitative study of the experiences of living with vitiligo. Br J Dermatol 2010;163:481-6.
Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in vitiligo and psoriasis: A comparative study from India. J Dermatol 2001;28:424-32.
Alzolibani A. Genetic epidemiology and heritability of vitiligo in the Qassim region of Saudi Arabia. Acta Dermatovenerol Alp Pannonica Adriat 2009;18:119-25.
Asati DP, Gupta CM, Tiwari S, Kumar S, Jamra V. A hospital-based study on knowledge and attitude related to vitiligo among adults visiting a tertiary health facility of central India. J Nat Sci Biol Med 2016;7:27-32.
Alshahrani AS, Alamar RS. Awareness, knowledge and beliefs about vitiligo among female university students in Abha city, Saudi Arabia. Eur J Pharm Med Res 2016;3:24-30.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]