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am doing an introduction for research on I need more information and her is the prof comment on my work. So, I need your help to complete what he wants. I feel the background or literature review section needs more depth in terms of mentioning the existing studies that have assessed knowledge, attitude, practices regarding obesity, some may have focused on one or two… but we can still mention it.. also we have added body weight perception segment in our questionnaire, so this will be worthwhile writing about to. Finally, gaps in the literature needs to be outlined to highlight the significance of the study. Basically, the studies that you will mention in your section will be covered again in the discussion section, by another colleague, and to be compared with the study findings.I also have some extra references that can help you.Thank youattached my introduction and the research proposal
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1. Background
1
Based on World Health Organization 2016, 13% of adults worldwide were obese (men: 11%; women: 15%).
2
1
3
In 2020, there were 24.7% of Saudi Arabians who were obese. Women were more likely than men to be obese
4
(27.4% vs. 22%). Additionally, compared to the Western and Northern regions of Saudi Arabia, the Eastern
5
and Central regions had a higher frequency of obesity.2
6
Obesity is abnormal or excessive accumulation of fat. It poses a severe risk for several chronic conditions,
7
including type 2 diabetes, cardiovascular disease, disability, and mortality. A combination of factors,
8
including heredity, lifestyle, inactivity, poor diet, and eating habits, contributes to it. Obesity is currently
9
linked to a wide range of illnesses that can impact a person’s quality of life, strain the healthcare system, and
10
harm the nation’s economy.1
11
Dietary habits are the most important risk factor for obesity in Saudi Arabia. Shifting to a Western diet and
12
higher intake of sugary beverages as well as a lack of physical activity. In addition, education and income,
13
Sleep hygiene, psychosocial issues, and physical exercise are all important considerations. Obesity is
14
currently related with a wide range of health issues that can impair an individual’s quality of life, impose
15
stress on the healthcare system, and place a financial burden on the country. 2 ,3
16
The Saudi government is pursuing a wide range of programs under its Vision 2030 plan for a healthier
17
population in response to the enormous health and social repercussions of the obesity crisis.4
18
Furthermore, some current research focused on specific groups, such as physicians or medical students, and
19
had a small sample size, limiting their generalizability to the general
20
1
population.This research helps in the identification of gaps in people’s knowledge, attitudes, and dietary prac
21
tices. It helps in understanding the factors that influence people’s decisions and behaviors.
22
These findings will help researchers in developing community interventions to combat obesity and improve
23
quality of life in Saudi Arabia.
24
25
Reference
26
1. Obesity and overweight. (n.d.). Retrieved from https://www.who.int/news-room/factsheets/detail/obesity-and-overweight
27
28
2. Althumiri, N. A., Basyouni, M. H., AlMousa, N., AlJuwaysim, M. F., Almubark, R. A., BinDhim, N.
29
F., Alkhamaali, Z., & Alqahtani, S. A. (2021). Obesity in Saudi Arabia in 2020: Prevalence,
30
Distribution, and Its Current Association with Various Health Conditions. Healthcare (Basel,
31
Switzerland), 9(3), 311. https://doi.org/10.3390/healthcare9030311
32
3. Salem, V., AlHusseini, N., Abdul Razack, H. I., Naoum, A., Sims, O. T., & Alqahtani, S. A. (2022).
33
Prevalence, risk factors, and interventions for obesity in Saudi Arabia: a systematic review. Obesity
34
Reviews, 23(7), e13448.
35
4. Saudi Arabia Vision 2030 . [Internet]. cited: 2023. July
26. https://www.vision2030.gov.sa/
36
37
2
Assessing Knowledge, Attitudes, and Practices (KAPs) regarding obesity in Saudi
Arabia
Proposal
Literature review:
Obesity is a growing health problem. Since 1980, the global prevalence of overweight and
obesity has doubled making around third of the world’s population overweight or obese (Chooi et
al., 2019). In 2013, a national study in Saudi Arabia revealed that the prevalence of obesity was
33.5% among females and 24.1% among males (Memish et al., 2014). Obesity is primarily
caused by an imbalance between energy intake and expenditure (Daniels et al., 2009). Obesity is
a risk factor of many diseases such as, diabetes, hypertension, and cardiovascular diseases
(Schelbert, 2009).
Considering its association with several health issues, it is important to establish good health
knowledge and attitudes toward overweight and obesity. Furthermore, obesity is seen as a
preventable cause of morbidity and mortality worldwide (Alasmari et al., 2017). Despite its
importance, the awareness levels about the risks associated with obesity are considered to be
insufficient (Alasmari et al., 2017). Researches have revealed limited data concerning population
knowledge of obesity related risks and co-morbidities (Alqahtani et al., 2016, Bin Airul Faizilli
et al., 2020, Gormley & Melby, 2020). Understanding the knowledge, attitudes, and behaviors
related to obesity among the Saudi population can help in designing community interventions
that tackle obesity. Findings from this study will further assist healthcare professionals in
tackling obesity.
Several studies were conducted worldwide to assess knowledge and practices related to obesity.
The majority of these studies targeted specific population i.e. medical students or health care
practitioners rather than the general population. This was also seen in studies taking place in
Saudi Arabia. In Saudi Arabia, seven cross-sectional studies were conducted between the years
2013 and 2020 to examine the knowledge, attitude and practice in relation to obesity knowledge
and management (Alqahtani et al 2016, Alissa et al 2015, Sebiany et al 2013, Alshammari et al
2014, Al-Khaldi et al 2014, Al Noor et al 2020, Alomary et al 2016). The researches took place
1
in the cities of Madinah (Alqahtani et al 2016), Jeddah (Alissa et al 2015), Dammam and AlKhobar (Sebiany et al 2013, Alshammari et al 2014), Riyadh (Al Noor et al 2020) and Aseer (
Al-Khaldi et al 2014). A single study was conducted across the kingdom in centers under the
Ministry of Health (Alomary et al 2016). The studied population ranged from secondary school
level male students (Alqahtani et al 2016), male and female attending medical colleges (Alissa et
al 2015). With the majority of studies done among physicians working in health care centers
(Sebiany et al 2013, Alshammari et al 2014, Al-Khaldi et al 2014, Al Noor et al 2020, Alomary
et al 2016).
A study has assessed the prevalence of overweight and obesity, knowledge, and attitude towards
obesity in 314 male students attending secondary schools in Al-Madinah (Alqahtani et al 2016).
The prevalence of overweight and obesity was 11.8% and 16.2% respectively. Around 76.8%
had insufficient knowledge regarding obesity related issues and about half of students showed
positive attitude towards obese people. Similarly, 64 % of physicians in Aseer region had
inadequate knowledge of obesity (Al-Khaldi et al., 2014).
Alissa et al (2015) have conducted a study in Jeddah on King Abdulaziz University medical
student from both genders to examine their level of knowledge regarding nutrition and physical
activity, in addition to their attitude and practices regarding healthy eating, and barriers to
healthy practices. The study found that regardless of their evident awareness of the importance of
healthy eating habits, daily application of such habits was limited. Around 75% – 94% of
students have shown good knowledge on the following topics: the composition of balanced diet,
healthiest frying method, ideal eating behaviour, vitamins and minerals importance and the
meaning of organic food. Yet, a lower percentage of students (18-39%) have shown knowledge
regarding healthy cooking methods, identification of healthy food and the genetically modified
food definition. The generalizability of study finding is restricted to students with medical
background.
Two studies were conducted in the cities of the Eastern region, and measured physician’s
knowledge regarding obesity diagnosis and treatments, barriers for disease management
(Sebiany et al 2013) and attitude regarding responses and practices for obesity management
(Alshammari et al 2014). The former study found adequate knowledge for obesity prevalence
and diagnosis, yet information regarding risk of obesity in developing cancer was not adequate.
2
This is in parallel with findings from Bocquier et al., (2005) study. It is noteworthy to mention
that the majority of the participating physicians were either overweight or obese and those were
found to be less likely to be involved in patient education regarding weight loss strategies
(Sebiany et al 2013). In this study, only 20 % of physicians reported having adequate training to
treat obesity (Sebiany et al 2013). They identified lack of training and poor administrative
support to be among the main barriers to obesity management in their medical practice.
Although few local studies have used validated instruments in their studies (Alqahtani et al 2016,
Alissa et al 2015, Alshammari et al 2014, Al Noor et al 2020, Alomary et al 2016), the low
sample size, the targeted group, and the different study objectives makes it rather difficult to
apply it to the general population. Therefore, it is necessary to develop a new questionnaire to
assess the Knowledge, Attitude, and Practices (KAPs) related to obesity among in Saudi Arabia.
Research significance:
Considering the alarming rates of obesity in Saudi Arabia and in alignment with Vision 2030,
there is a need to understand the underlying reasons and factors that may influence individual’s
choices and lifestyle. Doing so will help in designing interventions that aims at improving the
community health and quality of life. One way of achieving this is through assessing the current
knowledge, attitude, and practices (KAPs) of Saudi population regarding obesity. Limited KAPs
studies have been conducted in Saudi Arabia. In addition, the existing studies were concerned
with specific groups such as physicians or medical students and based on small sample size
limiting its generalizability across the general population. To the researcher’s knowledge, this is
the first study to assess KAPs related to obesity among Saudi population. This study will help
identify the gaps in people’s knowledge, attitudes, and dietary practices. It will also help
understand the factors that influence people’s choices and behaviors. These findings will help
inform researchers on community interventions aimed at tackling obesity and improving quality
of life in Saudi Arabia.
Objectives:
•
To assess the current knowledge, attitudes, and dietary practices of obesity among Saudi
population.
3
•
Assess the relationship between knowledge and attitude of obesity among Saudi
population.
•
Assess the relationship between knowledge and dietary practices of obesity among Saudi
population.
•
Assess the social factors that may influence knowledge, attitude, and practices of obesity
among Saudi population.
Methods:
KAPs questionnaire:
This is a cross sectional study design, a self-administered questionnaire will be distributed
through emails and social media accounts such as Twitter and LinkedIn. Participants will be
asked to give their consent prior to inclusion of the study. Also, participants’ confidentiality will
be ensured through data handling “anonymously”. Ethical approval will be obtained prior to data
collection.
The study population will include adults residing in Saudi Arabia. Sample size was estimated
using Raosoft with a confidence level of 95%, 385 subjects will be included. Researchers will
consider several elements prior to developing a questionnaire: content, response format, validity
and reliability. Following this, the questionnaire will be tested in a pilot study.
A. Validity: Content validity, face validity, and construct validity of the developed questionnaire
will be assessed through experts’ evaluation (n = 10) in the fields of obesity and nutrition.
Construct validity will be assessed through Spearman’s or Pearson’s correlations. Items with
correlation coefficient >0.7 will be omitted. Content validity will be ensured by making sure
each item is verified using different health policy and report documents such WHO, The Food
Standard Agency, and American Dietetic Association, and the British Dietetic Association.
B. Reliability: Internal consistency and reliability of each scale will be tested using Cronbach
alpha reliability test. The homogeneity of the question items in each domain will be evaluated
using Cronbach’s α coefficient (Tavakol and Dennick, 2011). A coefficient of 0.7 or higher is
preferred for a questionnaire to be internally consistent (Deniz and Alsaffar, 2013).
4
C. Components of the questionnaire: The components of the questionnaire were divided into
five main sections: sociodemographic data, anthropometric data, knowledge questions
(Definition of obesity, risk factors, and consequences), attitude questions, and practice questions.
D. Response format and scoring: Closed ended questions will be used in this study as it is
easier to conduct and allow quicker compared to open-ended questions. Furthermore, more
number of statements can be answered within a specific time period. A combination of response
formats will be used: True, False, and uncertain, and Likert scale. Considering the widespread of
study sample with different education level, 5-point Likert scale will be used in the response
format.
Statistical analysis:
The collected data will be recorded, coded, and verified. All data analyses will be conducted
using Statistical Package for Social Sciences (SPSS version 24). Inferential and descriptive
analyses will be performed. Frequency statistics presents the distribution of the scores while
inferential statistics determine if the findings from the sampled population can be generalizable
(Spector et al., 2014). Descriptive statistics (means, standard deviations, frequencies, and
percentages) will be calculated. The Kolmogorov-Smirnov test will be used to assess data
normality.
Non- normally distributed continuous data and categorical data will be analysed using a nonparametric statistical testing (Chi-square tests, Mann-Whitney U Tests) Kruskal-Wallis Tests
will be used to determine differences in scores between age, gender and BMI groups (subanalysis for more than 3 groups). Differences were considered significant at P < 0.05. Spearman
Rho correlation coefficients will be computed to test possible relationships between variable of
interest (health behaviours, their attitudes, and their knowledge regarding obesity risk), in
addition to their correlation with sociodemographic, anthropometrical and nutritional data
collected.
5
References:
Alasmari, H. D., Al-Shehri, A. D., Aljuaid, T. A., Alzaidi, B. A., & Alswat, K. A. (2017). Relationship
between body mass index and obesity awareness in school students. Journal of clinical medicine
research, 9(6), 520.
Al-Khaldi, Y. M., Melha, W. S. A., Al-Shahrani, A. M., Al-Saleem, S. A., & Hamam, M. A. (2014).
Knowledge, attitude and practice of primary health care physicians in Aseer region regarding obesity.
Saudi Journal of Obesity, 2(2), 54.
Alomary, S., Saeedi, M., Alotaibi, T., al Shehri, F., Bashir, A., Ali, A., & El-Metwally, A. (2016).
Knowledge and training needs of primary healthcare physicians regarding obesity management in Saudi
Arabia. Saudi Journal of Obesity, 4(1), 20. https://doi.org/10.4103/2347-2618.184952
Al-Qahtani, A. M., & Sundogji, H. (2016). Attitudes and knowledge of obesity risks among Male high
school students in Al-Madinah, Saudi Arabia. Journal of Applied Pharmaceutical Science 6(10):154-158.
doi: 10.7324/JAPS.2016.601021.
Alshammari Al-Shammari Yf, Y. F. F. (2014). Attitudes and practices of primary care physicians in the
management of overweight and obesity in eastern saudi arabia. International Journal of Health Sciences,
8(2), 151–158. http://www.ncbi.nlm.nih.gov/pubmed/25246882
B Al Noor, M. A., Fayez Horaib, Y., Abdulaziz Almusallam, N., Yousef Alyousef, A., Suliman
Alkahmous, F., Yousef Alyousef, A., & Ali Al laili, D. (n.d.). International Journal of Medicine in
Developing Countries Physicians’ knowledge, feelings, attitudes, and practices toward obesity at family
medicine setting in Riyadh, Saudi Arabia. https://doi.org/10.24911/IJMDC.51-1573494087
bin Airul Faizili, A., Hidayahtun Najihah Binti Yahaya, N., Binti Jasman, N., Yee Jie, O., & Prasha
Selvakumaran, T. (2020). A Cross Sectional Study of Attitude Towards Obesity Among Medical
Undergraduates. In International Journal of Biomedical and Clinical Science, 5 (4).
Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P, Paraponaris A. Overweight and
obesity: knowledge, attitudes, and practices of general practitioners in france. Obes Res. 2005;13(4):787–
795. doi: 10.1038/oby.2005.89
Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism, 92, 6-10.
Daniels, S. R. (2009). Complications of obesity in children and adolescents. International journal of
obesity, 33(1), S60-S65.
Deniz MS, Alsaffar AA. Assessing the validity and reliability of a questionnaire on dietary fibre related
knowledge in a Turkish student population. J Health Popul Nutr. 2013;31:497–503.
Gozal, D., & Kheirandish-Gozal, L. (2012). Childhood obesity and sleep: relatives, partners, or both?—a
critical perspective on the evidence. Annals of the New York Academy of Sciences, 1264(1), 135.
Memish ZA, El Bcheraoui C, Tuffaha M, Robinson M, Daoud F, Jaber S, et al. Obesity and Associated
Factors — Kingdom of Saudi Arabia, 2013. Prev Chronic Dis 2014;11:140-236.
6
Mokbel Alissa, E. (2015). Knowledge, Attitude and Practice of Dietary and Lifestyle Habits Among
Medical Students in King Abdulaziz University, Saudi Arabia. International Journal of Nutrition and
Food Sciences, 4(6), 650. https://doi.org/10.11648/j.ijnfs.20150406.18
Schelbert, K. B. (2009). Comorbidities of obesity. Primary Care: Clinics in Office Practice, 36(2), 271285.
Sebiany, A. (2013). Primary care physicians′ knowledge and perceived barriers in the management of
overweight and obesity. Journal of Family and Community Medicine, 20(3), 147.
https://doi.org/10.4103/2230-8229.121972
Spector, M., Merrill, D., Elen, J., Bishop, M.J., 2014. The Handbook of Research for Educational
Communications and Technology, 4th ed. Springer, New York.
Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53–5.
World Health Organization. Obesity: Preventing and Managing the Global Epidemic. World Health
Organization: Geneva, 2000.Accessed Aug 2016
7
1. Background
1
Based on World Health Organization 2016, 13% of adults worldwide were obese (men: 11%; women: 15%).
2
1
3
In 2020, there were 24.7% of Saudi Arabians who were obese. Women were more likely than men to be obese
4
(27.4% vs. 22%). Additionally, compared to the Western and Northern regions of Saudi Arabia, the Eastern
5
and Central regions had a higher frequency of obesity.2
6
Obesity is abnormal or excessive accumulation of fat. It poses a severe risk for several chronic conditions,
7
including type 2 diabetes, cardiovascular disease, disability, and mortality. A combination of factors,
8
including heredity, lifestyle, inactivity, poor diet, and eating habits, contributes to it. Obesity is currently
9
linked to a wide range of illnesses that can impact a person's quality of life, strain the healthcare system, and
10
harm the nation's economy.1
11
Dietary habits are the most important risk factor for obesity in Saudi Arabia. Shifting to a Western diet and
12
higher intake of sugary beverages as well as a lack of physical activity. In addition, education and income,
13
Sleep hygiene, psychosocial issues, and physical exercise are all important considerations. Obesity is
14
currently related with a wide range of health issues that can impair an individual's quality of life, impose
15
stress on the healthcare system, and place a financial burden on the country. 2 ,3
16
The Saudi government is pursuing a wide range of programs under its Vision 2030 plan for a healthier
17
population in response to the enormous health and social repercussions of the obesity crisis.4
18
Furthermore, some current research focused on specific groups, such as physicians or medical students, and
19
had a small sample size, limiting their generalizability to the general
20
1
population.This research helps in the identification of gaps in people's knowledge, attitudes, and dietary prac
21
tices. It helps in understanding the factors that influence people's decisions and behaviors.
22
These findings will help researchers in developing community interventions to combat obesity and improve
23
quality of life in Saudi Arabia.
24
25
Reference
26
1. Obesity and overweight. (n.d.). Retrieved from https://www.who.int/news-room/factsheets/detail/obesity-and-overweight
27
28
2. Althumiri, N. A., Basyouni, M. H., AlMousa, N., AlJuwaysim, M. F., Almubark, R. A., BinDhim, N.
29
F., Alkhamaali, Z., & Alqahtani, S. A. (2021). Obesity in Saudi Arabia in 2020: Prevalence,
30
Distribution, and Its Current Association with Various Health Conditions. Healthcare (Basel,
31
Switzerland), 9(3), 311. https://doi.org/10.3390/healthcare9030311
32
3. Salem, V., AlHusseini, N., Abdul Razack, H. I., Naoum, A., Sims, O. T., & Alqahtani, S. A. (2022).
33
Prevalence, risk factors, and interventions for obesity in Saudi Arabia: a systematic review. Obesity
34
Reviews, 23(7), e13448.
35
4. Saudi Arabia Vision 2030 . [Internet]. cited: 2023. July
26. https://www.vision2030.gov.sa/
36
37
2
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