Association of prior interstitial lung disease awareness with knowledge, attitudes, and practices in Saudi Arabia: a...

Interstitial lung diseases (ILDs) are a heterogeneous group of diffuse parenchymal lung disorders, including idiopathic interstitial pneumonias, connective-tissue-disease-associated ILD and sarcoidosis. Patients often experience prolonged diagnostic delays and non-specific symptom profiles that overlap with more prevalent conditions. While these delays are well documented, the contribution of low public awareness to these delays is not well described in the Middle East. We aimed to determine the prevalence of ILD awareness in Saudi Arabia and evaluate its independent association with knowledge, attitudes, and care-seeking practices.

We conducted a cross-sectional study of adults (≥18 years) across Saudi Arabia between May and October 2025. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guideline (STROBE). Data were collected using a validated knowledge, attitudes, and practices questionnaire, developed with reference to World Health Organisation guidance and the Theory of Planned Behaviour. Factors associated with prior ILD awareness were assessed using multivariable logistic regression. KAP domain scores, Knowledge (0-8), Attitude (1-5), and Practice (1-5) were compared between awareness groups using Mann-Whitney U tests and analysed using multivariable linear regression with standard errors, adjusting for demographics and healthcare background. p Values were adjusted for multiple comparisons using the Benjamini Hochberg false discovery rate procedure. Ethical approval was obtained from King Abdulaziz University.

Of 830 individuals who initiated the survey, 628 (75.7%) provided complete responses and were included in the analysis. Of 628 participants, 116 (18.5%) reported prior ILD awareness. Healthcare providers had 6.45-fold higher odds of awareness (95% CI 3.12-13.32; p < 0.001), and other demographic factors showed no independent association. After adjustment, prior awareness was associated with higher knowledge (β = 3.27, 95% CI 2.77-3.77; p < 0.001) and higher practice scores (p < 0.001). Attitude differences were small and were not statistically significant after full adjustment (p = 0.051). Lack of awareness was reported as a care-seeking barrier by 81% (413/512) of unaware and even by 78% (90/116) of aware participants. Unaware participants prioritised symptom information (65% vs. 53%), whereas aware participants prioritised specialist centre access (53% vs. 43%).

ILD awareness in Saudi Arabia is low (18.5%), concentrated among healthcare providers, with knowledge gaps across both the public and healthcare professionals. The persistence of perceived knowledge deficits, even among those aware demonstrates unmet educational needs. Findings support targeted public campaigns emphasising symptom recognition and primary care education to support earlier recognition, diagnosis, and timely specialist referral.