The knowledge and attitude of adults towards home safety measures of elders in Saudi Arabia

INTRODUCTION

Home safety for elderly individuals is a global concern.¹ According to WHO, there will be 1.4 billion people over the age of 60.² According to a recent statistic from the Department of Statistics, there are roughly 1.3 million elderly people, or 5% of the total population in Saudi Arabia.³ Most elder individuals spend a lot of time at home, where they typically feel safe. However, many accidents could happen to them at home.⁴ The most common accidental injuries occur among the elderly including falls, burning, and poisoning.⁵ Accidental injuries could be avoided by using specified environmental changes and appropriate therapeutic interventions. By conducting a comprehensive assessment, home-care givers can play a significant role in preventing accidental injuries.⁶ In a year the Saudi elderly population in Riyadh had a significant rate of falls (49%), which could be prevented by proper safety measures extrinsic factors, such as environmental dangers, and intrinsic factors, such as aging-related physiological changes (mobility issues), can all contribute to falls. Injury from falls was significantly influenced by environmental factors. Most people do not reside in a risk-free environment.⁷ Most homes have potential risks such as loose carpets, dim lighting, slick flooring, unstable furniture, and blocked walks.⁸ Elderly individuals are also more likely to sustain fire-related injuries.⁹ Several factors put elderly people at risk for fire-related injuries and deaths, including physical changes like poor physical health or injury sensitivity, mental changes, and behavioral changes.¹⁰ Food safety is an important global issue that influences everyone as people age, their sensation tends to deteriorate, that lowers the chance of detection of food poisoning.^11,12 The degree of home hazard can be reduced by increasing associated interventions and boosting awareness.⁸ The Saudi Ministry of Health adopted health education campaigns emphasizing the protection of the elders how to protect them from fall risks and the significance of elderly care, home care is one of the services offered.³ To provide a safe environment for elders, it's essential to understand the adults' knowledge and attitude toward home safety measures of elders since those adults could be current caregivers or future caregivers for the elderly population. Assessment of their knowledge and attitude will detect the future practice of adults in Saudi Arabia, this will lead to reducing the risks of home hazards and help the elder to function well, hence improving the quality of the elderly’s life.⁴

The study aimed to assess the knowledge and attitude of adults regarding home safety measures of elder in KSA.

METHODS

Study design, setting and study duration

A cross-sectional study is conducted among adults in Saudi Arabia. Data was compiled over a period of two months from February to March 2023. The study population included adults ranging from 20 to 59 years old.¹³

Sampling

The participants were recruited through a convenient sampling technique. The research questionnaire was distributed through google forms via social media platforms in the Arabic language.

The sample size was calculated using the Cochran equation: n=Z^2pq/ d^2.¹⁴ Population size >10000, Prevalence of factor understudy: 50%, degree of error: 0.05, confidence level: 95%, design effect: 1 (Cochran, 1977). A sample size of 384 was determined and calculated. However, 399 responses were gathered which fulfilled the requirements of the inclusion criteria.

Research instrument

The research tool was created by the researchers guided by (Check for Safety: A home fall prevention checklist for older adults. CDC, 2016) and (Home safety booklet. Civil Defense, KSA) which consists of 33 questions distributed into four sections as follows^15,16:

Section 1: Consists of 8 questions that covered the characteristics of the participants including age, gender, and nationality, place of residency, marital status, education level, work sector, and income.

Section 2: Consists of 8 questions that measure the knowledge level regarding home safety measures among participants. These questions were presented as multiple choice. Right answers scored 1 point and wrong answers scored zero points and the maximum score was 8 and the minimum was 0. The cutoff score for knowledge was taken according to Bloom’s cutoff.¹⁷ As good if the score was between 80% and 100% (8-7), moderate if the score was between 60% and 79% (6-5), and poor if the score was less than 60% (4-0).

Section 3: Consists of 7 questions that measure the attitude tendencies regarding home safety measures among participants, Answers were presented as a 5-point Likert scale ranging from (strongly agree). Thus, for positive questions, it assigns a value of five to (strongly disagree) which was given a score of one, the maximum score is 35 and minimum score is 7. However, questions (1,2,4,6,7) were reversed. The cutoff point of attitude was taken based on quartile 1 and 3 percentile cutoff as the following (7-16) negative attitude, (17-25) neutral attitude, (>26) positive attitude.

Validity and reliability

The reliability test was conducted using Cronbach’s alpha test, for knowledge it was α=0.62 and for attitude, it was α=0.64. Validity tested all the knowledge and attitude questions which were significantly correlated with the overall score r>0.5.

Data analysis

Data were analyzed by using statistical software (JMP Version 17.0).¹⁸ The descriptive data was presented in frequency tables as numbers, percentages, and graphs to show the frequencies of total knowledge and attitude. As for the inferential statistics, it was conducted by using the Pearson Chi-Square to measure the association between knowledge and attitude, and sociodemographic factors with both variables. The correlation between knowledge and attitude was assessed using the Pearson correlation test, multiple linear regression was performed to assess predictors of attitude regarding home safety measures of elders among the studied sample, and the P value was significant at ≤0.05.

This research has an IRB number (23-7900), participation was voluntary, and participants were assured that their information is kept confidential, the information collected was anonymous, and the objectives of the study and purpose of data collection were explained to the participants.

RESULTS

The sociodemographic characteristics are shown in table 1. The percentage of females is 82.2%. 76.7% of the participants were in the age group 20-29. The majority of participants were Saudi. 80% of participants lived in Riyadh. Regarding education level and working status, 59.5% of participants were students and 75.9% had bachelor’s degree. 76.2% were unmarried and 69.2% had a middle income.

Table 2 describes the knowledge regarding home safety measures among the studied sample. 70.2% of participants knew the characteristics of a safer bedroom for elders and 87.2% knew what a suitable bed for elders is. While 39.1% answered the question about elders’ safety during bathing incorrectly and 34.3% of participants answered incorrectly regarding elders’ food safety question.

Figure 1 describes the overall knowledge score among the studied sample. 42% of the participants had fair knowledge, 38% had poor knowledge, and 20% had good knowledge.

Table 3 demonstrates the attitude regarding home safety measures among the studied sample. 61.9% of participants feel that fire alarms are important for elders’ safety, and 50.6% of participants feel that it’s better to replace multiple extension cords with one long extension cord. While 6.80% of participants feel that having a step ladder in the kitchen is important, and 35.2% feel that monitoring the elder by using camera surveillance is enough.

Figure 2 describes the overall attitude score of the individuals, 57% of participants had a neutral attitude, 34% had a positive attitude, and 9% had a negative attitude.

Table 4 shows the association between sociodemographic and knowledge. There is a significant association between knowledge and gender, where 91.4% of females had “good” knowledge at a p value (0.02).

Table 5 shows the association between sociodemographic and attitude. There is a significant association between attitude and gender, where 89% of the participants who had a positive attitude were females at a p-value (0.03).

Table 6 shows the association between knowledge and attitude. There was a significant association between knowledge and attitude at a p-value of 0.001.

DISCUSSION

Knowledge

Most of the participants had poor to fair knowledge regarding home safety measures for elders while nearly a quarter of participants showed good knowledge. This could be attributed to the participants being student as they may have little knowledge as well as they may have no motives to learn about elders' safety. Yet, most participants have high knowledge regarding falling which is the most common accident in elders. Similarly, a study conducted in the USA showed that all employees of senior-serving organizations cited falls as a critical health concern for people 65 and older, with 62% saying it is a "critical" or "very urgent" concern.¹⁹ The current study showed a significant association between knowledge and gender as well as females have higher knowledge than males, this could be attributed to females` nature of being knowledgeable with most of the information regarding health topics This was in line with a Saudi Arabian study that revealed a considerable gender gap, with women scoring higher on both knowledge and practice of home safety.²⁰

Attitude

More than half of the participants had a neutral to positive attitude regarding elders’ home safety, while a minority had a negative attitude. There was a significant association between attitude and gender as females showed a positive attitude more than males, this could be related to their nature of being caring for family members, and having a sense of emotions towards elders which was similar to a study conducted in Saudi Arabia to assess the attitude of females towards elders as they believe that it’s not acceptable for the elder to be sent to the nursing home.²¹ The participants showed negative attitude regarding use of fire extinguisher for fire safety measures of elders. This could be attributed to the age of participants as most of them are young adults (20-29) which may indicate that their ability to use a fire extinguisher is limited. This was contrary to a study conducted in Amsterdam assessing the knowledge and behavior of elders regarding fire safety. The elders stated from their point of view that they can use fire extinguishers as they believe that they're able to extinguish the fire.⁹

Association between knowledge and attitude

The findings showed that there was a significant positive association between knowledge and attitude toward home safety measures for elders. Participants who had better knowledge regarding home safety were more likely to have a positive attitude towards implementing these measures in their homes. This was similar to a study conducted in China assessing attitudes as mediators between knowledge and behavior in unintentional injuries at home. As it stated that knowledge and attitude play a crucial role in providing a safer environment at home.²² This was confirmed by the results of the current study, as when applying the correlation test, there was a significant correlation between knowledge and attitude.

CONCLUSION

In conclusion, knowledge, and attitude regarding elders` home safety measures are significantly correlated and most of the participants demonstrate poor to fair knowledge. However, approximately half of the participants showed neutral attitude regarding home safety measures towards elders. Therefore, it is recommended that the government and non-governmental organizations should conduct awareness campaigns to educate adults about home safety measures for the elders. These campaigns should be conducted in different languages to reach a wider audience. The community should be involved in promoting home safety measures for elders. Also, it is recommended to conduct future research to assess the home safety measures practice toward elders.

ACKNOWLEDGEMENTS

We would like to thank Dr. Huny M. Bakry for her helpful advice and assistance during the research process. Her knowledge and advice helped us overcome obstacles. We also like to express our gratitude to people who participate in the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Princess Nourah Bint Abdulrahman University IRB: No. of approval 23-7900

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