Knowledge and Awareness of Practices Regarding Correct Posture During Studying among Medical Students in KSA

Bad posture is a significant risk factor for musculoskeletal pain among medical professionals. Prolonged shoulder flexion and improper spinal alignment can lead to discomfort and potential injuries. Poor workstation setup and prolonged standing or sitting can further contribute to the development of musculoskeletal pain. Healthcare practitioners should prioritize good posture and ergonomics to mitigate these risks and maintain their well-being throughout their careers [1]. As confirmed by multiple reports, sedentary lifestyles and poor sitting posture are on the rise, leading to musculoskeletal pain and significant health implications [2]. The global impact of the COVID-19 pandemic has been profound, particularly on teaching and learning practices. This mode of education is expected to continue until early 2021, potentially posing health and physiological challenges for university students [3]. Having a physiotherapist in the school setting promotes the development of healthy postural habits. Following the program, all adolescents reported reduced back pain [4].

The relationship between knowledge and attitude toward ergonomic sitting position, sitting duration, and posture among medical students was examined. The results showed that 23.3% of participants had good knowledge, 40% had adequate knowledge, and 56.7% had a positive attitude towards ergonomic sitting positions. Furthermore, 60% of participants spent more than 8 hours a day sitting, and 43.3% maintained a straight sitting posture [5]. Tavakkol et al. conducted a study to assess the prevalence of low back pain among operating room personnel and its association with their awareness of risk factors. The findings revealed that the prevalence of low back pain was 74% among the personnel. However, no significant relationship was found between the prevalence of low back pain and the personnel’s awareness of risk factors. This highlights the significance of addressing low back pain in the operating room setting [6]. Furthermore, it is advisable to implement early diagnostic survey programs as a preventive measure against long-lasting pain in adulthood. It is recommended that future research focus on evaluating the impact of school ergonomics and furniture designed to provide comprehensive support for the body, aiming to prevent musculoskeletal pain. To assist adolescents in managing musculoskeletal pain and promoting a healthy lifestyle, school nurses should develop and execute structured health education programs. These programs should address various aspects, such as proper coping strategies for musculoskeletal pain and the adoption of healthy habits [7].

Relevant studies show that medical students experience stress and perceive knowledge gaps during their academic journey [8,9]. These studies suggest a potential lack of emphasis on correct posture during medical education. Further research is needed in Saudi Arabia to identify strategies to assess awareness of proper posture among medical students.

Objectives

Primary Objective: To assess the knowledge and awareness of the correct posture while studying among students in KSA.

Secondary Objective

• To identify the relationship between knowledge of practices regarding correct posture during studying among medical students and sociodemographic characteristics
• To establish awareness of practices regarding correct posture during studying among medical students in association with sociodemographic characteristics

Materials and Methods

This cross-sectional study was conducted in the Kingdom of Saudi Arabia. The target population for this study is medical students. The research was shared and advertised through online posters, online study groups, social media, and any common areas frequented by medical students. Interested students can then voluntarily participate in the study. The research team use a combination of convenience sampling to ensure a representative sample.

Inclusion and Exclusion Criteria

Participants must be currently enrolled in medical colleges as medical students, encompassing all years of medical school, including both pre-clinical and clinical years. The study aims to include both male and female participants, allowing for a diverse representation of genders. It is imperative that participants willingly provide informed consent to participate in the study, ensuring their autonomy and understanding of the research objectives. The study specifically targets full-time medical students who are not employed, as this criterion helps to focus on individuals whose primary commitment is their medical education. Finally, the study is limited to Saudi Arabian nationals, aiming to gather data from this specific demographic group.

Individuals who are unwilling or unable to provide informed consent, graduated medical professionals, such as doctors, residents, or fellows, participants with physical impairments or medical conditions that may affect their posture or ability to adhere to proper posture guidelines, Non-Saudi Arabian nationals, part-time or distance-learning medical students and individuals who are not enrolled in medical programs, including students from other healthcare disciplines was excluded from the study. These exclusion criteria are put in place to ensure the homogeneity and relevance of the participant population for the specific objectives of the study.

Method For Data Collection and Instrument (Data Collection Technique and Tools)

A structured questionnaire was utilized as the study tool. This tool has been developed based on relevant studies conducted in Saudi Arabia. The final version of the questionnaire consists of 12 questions, categorized into two main sections. The first section includes questions about participants' knowledge and background characteristics. The second section focuses on the importance of correct posture in ergonomics and the need to include related courses in the medical curriculum. The survey instrument was a self-administered, anonymous questionnaire in English. It was comprised of questions aimed at assessing participants' knowledge and awareness of the correct sitting position, duration of sitting, health disorders associated with prolonged sitting, and the importance of posture for medical students. This instrument has been previously used among health students in Saudi Arabia. Data collection was conducted through participants' responses to the questionnaire. The questionnaire gathered information on demographic factors such as age, gender, and specialty. Participants were asked about their average daily sitting duration, preferred sitting location, and usual sitting position.

Scoring System

Knowledge Score: Promoted responses of general knowledge about good posture were considered for calculating the knowledge score. Each respondent was asked 6 questions that could be answered with a yes or no, and a score of 1 was given for a 'yes' answer. There was no negative marking for 'no. The maximum possible score for the knowledge part was 6x1 = 6.

Awareness Score

Each respondent was asked a 6-item questionnaire related to their awareness of the right posture. Responses were recorded as strongly agree, disagree, somewhat agree, somewhat disagree, don't know, or can't say. Depending on the level of awareness, scores ranging from 0 to 5 were allotted. A score of '0' was given for don't know or can't say responses. Similarly, the maximum possible score for the awareness section was 6x5 = 30.

The participants were classified based on their scores in the knowledge section, resulting in the formation of three distinct groups. Those who achieved a score of 6 were categorized as possessing a commendable level of knowledge, while those who scored 4–5were classified as having a moderate level of knowledge. Lastly, individuals who scored 3 or lower were designated as having a comparatively limited level of knowledge. The participants were categorized into three distinct groups during the awareness phase, as determined by their scores. Those who achieved a score between 26 and 30 were recognized as having excellent awareness. Participants scoring between 21 and 25 were acknowledged as having moderate knowledge, while individuals scoring 20 or below were identified as having limited awareness.

Analysis and Entry Method

The data was initially entered into a computer using Microsoft Office Excel Software, specifically the 2016 version for Windows. Subsequently, the data was transferred to the Statistical Package for the Social Sciences (SPSS) software. The specific version used for analysis was IBM SPSS Statistics for Windows, Version 20.0, developed by IBM Corp. This software was utilized to conduct the statistical analysis of the data. In this study, both descriptive statistics and the chi-square test were used.

Table 1 displays various demographic parameters of the participants with a total number of 288. The participant sample consists of participants with a mean age of 22.7 years, and 46.2% of the participants are under the age of 22. A statistical analysis reveals that women (65.6%) make up most of the research participants because of an apparent gender disparity that could impact the study results. The Southern Region dominates participant enrollment, but both the Northern and Eastern Regions exhibit insufficient participation, because of which the findings may lack wider geographical applicability. Most participants reside in families that earn more than 15000 SR per month because 68.8% of respondents fall within this category, demonstrating an upper-class family background. This group demonstrates excellent academic performance because 43.4% of students maintain a Very Good GPA rating.

Figure 1 shows important findings regarding the study time habits of the entire 288 participant group. Among the entire 288-person sample, only 14 individuals studied for less than an hour daily, constituting 4.9% of the group. The research data indicates that 152 participants, composing 52.8% of the study body, spend longer than five hours daily in academic studying activities. The study duration of four to five hours per day was indicated by 81 participants, which represented a total of 28.1% of the respondents. Fifty-two percent of the participants engaged in their studies for more than five hours a day, whereas 14.2% distributed their study time across one to three hours daily.

Table 2 in the research article presents detailed findings regarding medical students' understanding and behavior patterns for proper studying posture, together with critical patterns and challenges. The study duration of more than five hours per day was reported by a significant number of respondents (52.8%), thus prompting concerns about long-term effects on musculoskeletal health. The study demonstrates a key problem in this demographic since 74.3% of students suffered pain after their academic work. This research shows that back pain stands out as the most prevalent condition since it affects 84.7% of respondents, with neck and shoulder pain ranking second, indicating potential poor alignment of existing study postures to ergonomic standards. Almost all (96.9%) participants from the study observed musculoskeletal disorders, yet 92.7% understood that proper posture serves as a protective measure against such health problems.

As shown in Figure 2, The demographic figure illustrates how 288 study participants detected the connection between bad posture and musculoskeletal issues. 144 individuals who make up 50% of the sample showed strong agreement toward the statement positioning them as particularly aware of this matter. A substantial 41.7% of participants joined 120 others to accept the link between posture and musculoskeletal health based on their responses. A minority portion of survey participants displayed ambiguity regarding this statement since 21 individuals (7.3%) were undecided, but 3 respondents (1.0%) disagreed with it.

Table 3 in the research article reveals powerful information about medical students' recognition and opinion levels regarding posture and ergonomics in their studies. Study participants demonstrated strong agreement about their familiarity with risky musculoskeletal injuries from improper posture because 50.0% strongly agreed while 58.3% stated correct posture was essential. The results demonstrate that medical students possess a well-developed understanding of posture impacts on health since their academic workload represents a high level of challenge. The medical curriculum should include ergonomics courses according to 49.3% of students who participated in the study.

Table 1: Sociodemographic Characteristics of Participants (N=288)

Figure 1: Time of Daily Studying Among Participants

Table 4 shows medical students’ understanding about proper study postures. Survey results show that students who hold an acceptable level of knowledge about ergonomics take up 60.8% of the sample which represents a substantial portion of the total participants. A large number of students (78.5% and 7.3%) show moderate to low levels of awareness about correct posture, according to the results released by the research article.

Table 5 shows that medical students display mainly positive understanding about correct posture practices during their studies, according to the presented data. A substantial number of 61.5% respondents had expert knowledge about proper posture advantages thus showing their understanding of how correct posture prevents musculoskeletal problems during study hours. Additionally, a large proportion of 32.3% of participants showed moderate understanding of postural health although they still had room to develop their knowledge base. Educational strategies should focus on the 6.3% population segment, which demonstrates minimal understanding because it represents an essential educational need.

Table 6 shows that knowledge of practices regarding correct posture during studying has statistically significant relation to gender (p value = 0.010), age (p value = 0.0001), monthly family income (p value = 0.0001), academic year (P value=0.0001), time spent studying daily (p value = 0.003), and usual posture during studying (p value = 0.001). It also shows statistically insignificant relation to region of residence, and current GPA. Participants of female gender, aged 23 years old, with a monthly income of more than 15000 SAR, in the fifth academic year, and studying more than 5 hours daily were found to have higher knowledge level than others.

Table 7 shows that awareness of practices regarding correct posture during studying has a statistically significant relation to academic year (p value = 0.027), current GPA (p value = 0.001), and time of daily studying (p value = 0.026). It also shows a statistically insignificant relation to gender, age, region of residence, monthly family income, and usual posture during studying. Participants who are in the fifth academic year, have excellent GPAs, and spend more than 5 hours studying daily had better awareness levels than others.

Table 2: Parameters Related to Knowledge of Practices Regarding Correct Posture During Studying Among Medical Students (N = 288).

*Results may overlap

The problems related to medical students' knowledge and understanding of posture have progressively gained importance over the last few years. A cross-sectional study investigated medical students' knowledge and perception of proper studying postures in educational institutions throughout the Kingdom of Saudi Arabia. This research showed that the relationship between study time length and self-reported ergonomics familiarity leads to an increased incidence of academic-related musculoskeletal discomfort in students. Previous research supports this study by demonstrating a high incidence of musculoskeletal disorders, which affects students who spend numerous hours studying from multiple postures.

The research shows that medical students demonstrate good comprehension of ergonomic postural practices since 60.8% of them exhibit this capability. Although awareness about posture stands high at 60.8%, 74.3% of respondents admit to experiencing discomfort and lower back pains activate as the leading discomfort reported among 84.7% of respondents. The reported statistics that show pain prevalence match previously published research such as Hasan et al. [11], who documented 88.5% of undergraduate students experiencing musculoskeletal pain problems across different educational settings. Similar to Alnaimat et al. [12], the obtained comparative data showed that medical students commonly experience persistent bodily pain, so early intervention and ergonomics-focused healthcare curricula need to be developed.

Table 3: Participants’ Awareness of Practices Regarding Correct Posture During Studying Among Medical Students (N = 288).

Table 4: Shows Knowledge of Practices Regarding Correct Posture During Studying Among Medical Students, Score Results.

Table 5: Shows Awareness of Practices Regarding Correct Posture During Studying Among Medical Students Score Results.

Students who dedicated more than five hours to daily studying experienced higher rates of back and neck pain, as confirmed by results from Abumohssin et al. [13] and other studies. The prolonged study duration intensified their discomfort due to improper sitting positions. Research shows that musculoskeletal complaints affect a large number of students who study intensively [14] while confirming the widespread occurrence of these complaints during this period. The collected data shows that students who have better posture understanding tend to report more discomfort even though their enhanced knowledge does not fully lead to positive changes in their workspace behavior.

Females exhibited better scores in ergonomic knowledge than males among university students, according to the statistical data (p≤0.05). According to Wijnhoven et al. [15], studies demonstrate that females suffer from musculoskeletal disorders at a higher rate than males. The review conducted by Alshagga et al. [16] demonstrated higher incidence rates of pain in medical students, with special attention to academic pressure along with study-related behaviors as contributing risk factors. Medical education needs to explicitly address the way women report pain differently because it remains important for current and future curricula and ergonomic consultations directed at students.

The study data shows Southern Region respondents make up most of the participants at a time when economic disparities show through family income levels, thus affecting access to ergonomic resources. The literature supports that socioeconomic status shapes health outcomes, especially regarding school bag-induced musculoskeletal pain, according to Kanjilal et al. [17]. The educational and ergonomic resources for students in Saudi Arabia appear more accessible to those students who have a monthly family income exceeding 15,000 SAR. The importance of ergonomics education stands clear, according to Khan and Chew [18], while this essential medical field remains poorly established.

Table 6: Relation Between Knowledge of Practices Regarding Correct Posture During Studying Among Medical Students and Sociodemographic Characteristics

*P value was considered significant if ≤ 0.05.

Table 7: Awareness of Practices Regarding Correct Posture During Studying Among Medical Students in Association with Sociodemographic Characteristics

*P value was considered significant if ≤ 0.05.

Our study data demonstrates a considerable interest among medical students to incorporate ergonomics into curriculum education because 49.3% of respondents supported such integration. The requirement to improve medical education about musculoskeletal health matches previous recommendations from Gomes et al. [19] regarding student ergonomic learning requirements during remote education. The findings presented in Malmborg et al. [20] confirm that curriculum changes should focus on creating musculoskeletal pain prevention strategies because they affect academic performance and students' overall health status. Student awareness about the usefulness of this knowledge stands strong, yet academic establishments show minimal incorporation of such knowledge into their frameworks.

Limitations

The current study has notable restrictions that require special attention. This study uses 288 medical students as participants who create a strong analytical base, yet their geographic grouping reduces the potential for a universal conclusion. Self-reported data collection methods could introduce subjective interpretation errors that affect participants' ratings of discomfort and their sense of being aware of their posture. Future investigations should augment the research by combining long-term examination with standardized measurements for posture analysis as well as injury measurement methods. The obtained research data serves as base of knowledge, yet researchers must handle results with caution because further investigation about this matter should build upon this initial information.

The findings demonstrate that Saudi medical students show a promising understanding of postural correctness and exhibit high rates of musculoskeletal pain because of their extended study activities. These results show that educational reforms alongside personalized ergonomic solutions must be implemented as soon as possible because they would reduce health risks. Future research must bridge the gap between academic student knowledge about ergonomics and their actual implementation by studying appropriate medical education interventions and ergonomic integration effects on student health.

Acknowledgement

We acknowledge all of the volunteers who provided samples for this research.

Ethical approval

After fully explaining the study and emphasizing that participation was optional, each participant gave informed consent. The information gathered was safely stored and utilized exclusively for the study.

This study was not supported by any outside sources.

Conflict of interests

The authors declare no conflict of interest.

Informed consent

Written informed consent was acquired from each study participant.

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