Assessment of Level of Knowledge and Beliefs Toward Psoriasis Among Community In Almadina Almonawara City, 2016

Haifa Abdulmohsen Alsrisri, Banan Mohammed Bawazeer, Daniyah Khalid Alfitni, Reham mohammad asad kharabah and Abdulrahman Mohammed Albouk. Kingdom of Saudi Arabia, ministry of education, Taibah University, faculty of medicine. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


…………………………………………………………………………………………………….... Background:-
Psoriasis is a chronic, non-communicable, painful, disfiguring and disabling disease for which there is no cure and with great negative impact on patients quality of life. it can occur at any age, and is most common in the age group 50-69 [1] .The reported prevalence of psoriasis in countries ranges between0.09% [2]and 11.4% [3] , making psoriasis a serious global problem.The etiology of psoriasis remains unclear, although there is evidence for genetic predisposition [4] .The role of the immune system in psoriasis causation is also a major topic of research.Although there is a suggestion that psoriasis could be an autoimmune disease, no auto-antigen that could be responsible has been defined yet.Psoriasis can also be provoked by external and internal triggers, including mild trauma, sunburn, infections, systemic drugs and stress [5] .Psoriasis involves the skin and nails, and is associated with a number of comorbidities.Skin lesions are localized or generalized, mostly symmetrical, sharply demarcated, red papules and plaques, and usually covered with white or silver scales.Lesions cause itching, stinging and pain.Between 1.3% [6] and 34.7% [7] of individuals with psoriasis develop chronic, inflammatory arthritis (psoriatic arthritis) that leads to 2794 joint deformations and disability.Between 4.2% and 69% of all patients suffering from psoriasis develop nail changes (8)(9)(10) .Individuals with psoriasis are reported to be at increased risk of developing other serious clinical conditions such as cardiovascular and other noncommunicable diseases [11,12] .Disfiguration, disability and marked loss of productivity are common challenges for people with psoriasis.There is also a significant cost to mental wellbeing, such as higher rates of depression ,leading to negative impact for individuals and society [13,14] .

Rationale:
There are very few studies on the psoriasis.psoriasis a serious global problem, it can occur at any age.Psoriasis has been associated other serious clinical conditions such as cardiovascular and other non communicable diseases and several other cardiovascular and metabolic disturbances.Psoriasis is not only a disease that causes painful, debilitating, highly visible physical symptoms.It is also associated with a multitude of psychological impairments.For many reasons, psoriasis can be psychologically devastating.Patients' lives become especially difficult when psoriasis is present in highly visible areas of the skin such as the face and hands.

Objectives: General objectives:-
To assessment level of awareness toward Psoriasis Among Community In Almadina Almonawara City and to identify barriers of health beliefs.

Specific objective:-
The goal of this study was to examine community health beliefs regarding Psoriasis and their perceptions related to it, and evaluate the role of demographic factors in shaping beliefs about Psoriasis and assess possible associations between demographic characteristics with the preventive behavior of interest.

Setting and data collection:-
We perform this survey analysis among community in Almadina Almonawara city.A pre-formed selfadministered questionnaire will be distributed to Parents.

Sample:-
Subjects will be chosen according to geographical and sex distribution.Sample size was calculated based on web-site calculator [15] , taking the total size of Almadina Almonawara population (1180770) [16] , confidence level (95%) and margin error (5%) to be 385.Additional 20 % was added to cover the missing data.Number of refusals was 6.The total sample obtained was 461.

Study population:-
Subjects from Almadina Almonawara of both gender and who belonged to the age group of 8 to 71 years were included in the study.

Study tool:
Pre-formed Self-administered questionnaire that requires information about: 1. Socio-demographic data: age, nationality, gender, education level, income, marital status, and employment status.2. Risk Factors Associated with psoriasisclinical manifestation of prognosis -incidence and prognosis of psoriasis.
3. Beliefs about Psoriasis assessment including 8 questions.A score of 1 was given right answer and 0 otherwise.For each subject, a maximum score of 8 was calculated.A scoring system was applied to measure the respondents' beliefs about psoriasis.The awareness level was categorized into 3 levels indicated by weak (0-2), average (3-5) and good (6-8).4. Knowledge about prevention behavior assessment including one question "Do you believe that psychological pressure is one of the psoriasis factors?".A score of 1 was given to yes and 0 otherwise.For each subject, a maximum score of 1 was calculated.The knowledge level score was categorized into 2 levels indicated by poor knowledge (0) and good knowledge (1).

Study limitations:-
The following limitations are expected:  Cooperation of sample  Recall bias Ethical considerations:-All participants will give their informed consent before filling the questionnaire.

Results:-I-Examine community health beliefs regarding Psoriasis and their perceptions related to it:-1-Demographics of the studied subjects:-
The socio-demographic characteristics are shown in table ( 1)    273 (60%) of the patients were aware that psoriasis was a genetically determined disease and 217 (47,7%) thought that psychological pressure is one of psoriasis factors. Only 65 (14,3%) subjects knew that psoriasis increases the risk of heart disease. Most of the subjects 250 (55,1%) knew that psoriasis may begin at any age. The majority of respondents 181 (40,9%) did not know if they will be ashamed or not, if they have psoriasis. The majority of respondents 327 (72%) think that psoriasis can be cured and only 10,4% of the subjects knew the fact that the disease is not curable. The results of the study suggested that 227 (49,9%) subjects were aware of the fact that psoriasis is not contagious.There is a statistical significant association between gender, educational level and the level of awareness about Psoriasis, respectively (p=0,01 < 0,05) and (p=0,027 < 0,05).

Assessment of possible associations between demographic characteristics with the preventive behavior of interest:
-Psychological pressure is one of the psoriasis factors, which is reported in the fifth question; that is why it is important to avoid stress as prevention of the disease.There is a statistical significant association between age, gender, nationality, marital status and the level of knowledge about stress as factor of Psoriasis, respectively (p=0,17 < 0,05), (p=0,42 <0,05), (p=0,19 < 0,05) and (p=0,41 <0,05).

Discussion:-
Tham SN, Tay YK (17) and other studies (18) have reported in their work that many patients have a gap of knowledge about their disease and treatment aspects (17).
This study identified that:  The majority of respondents have an average level of awareness toward Psoriasis. The majority of the studied subjects have a good knowledge about the fact that psychological stress is one of the factors of the pathology of Psoriasis.
Leovigildo et al. indicated that was an exacerbating factor of Psoriasis (19).
Our study showed that about half of respondents were not sure or were affirmative that psoriasis is contagious, respectively 30,8% and 19,3%.
Dika et al. have reported that physicians and dermatologists should be aware that their patients may have an inadequate understanding of their pathology (20).

Recommendations:-
 Therapeutic management is not limited to its molecular aspect by using drugs. Improving the health of a patient goes through many other aspects as essential as drugs: education, prevention, hygiene, listening, social solidarity...This change in vision has made it possible:  To become aware of all the consequences of illness on the quality of life of the patient  To identify the handicap and the resulting social exclusion  To consider that psychological suffering is as important to take In charge as physical suffering, Indeed, the purpose of treatments is not only to eliminate the symptoms but, more generally, to improve the quality of life and, in the context of skin diseases, to return to the patient all his freedom in his relations with himself and with others (21). According to Jankowiak et al (22):  Patients with psoriasis need to improve their knowledge of the disease and self-care methods to avoid exacerbation of disease. The disease requires systematic treatment and appropriate care. Health education is a main part of the management of psoriasis.

Conclusion:-
Our study showed that most of studied subjects had an inadequate level of knowledge about psoriasis.Efforts should be instaured to improve the knowledge of people about psoriasis in order to ensure better well being and a better care of patients.

Figure 2 :
Figure 2:-Responses to questions With "Yes"II-Evaluation of the role of demographic factors in shaping beliefs about Psoriasis Level of awarenessTable 4:-Respondents' awareness evaluation for Psoriasis Level of awareness Frequency Percent (%) 0-2 : Weak 153 34,8 3-5 : Average 260 59,1 6-8 : Good 27 6,1 Total 440 100,0 Data were entered into the Statistical Package for Social Sciences (SPSS, version 20) and descriptive analysis conducted.Association of respondents' characteristics with beliefs about Psoriasis and knowledge about prevention behavior of interest was evaluated using: 1. Frequencies and percentages.2. Chi-squared test.3. Independent Samples Test (T-test).4. ANOVA oneway test.Statistical significance was accepted at p < 0.05.

Table 1 :
-socio-demographic characteristics.We see that (278) of the respondents have a university degree with a percentage of 62,1%.We see that (219) of the respondents are married with percentage of 48,5%.We see that (183) of the respondents have an income (<3000 RS) with percentage of 42,5%.We see that (277) of the respondents are unemployed with percentage of 61,7%.Out of 454 subjects, 360 (79,3%) subjects reported not being affected with Psoriasis, 13% did not knew if they are affected or not and 35 (7,7%) respondents reported that they suffer from Psoriasis, as it is shown in the figure below: By looking at table(1), related to the distribution of respondents according to demographic factors:  The mean age of population was: 28,82 years.Withrespect to gender, a majority of the subjects (298)( 65,8%) were Female.2796395(87,6%)subjects had Saudi nationality.Knowledgeregardingthe diagnosis of Psoriasis:-Table 2:-Do you suffer from psoriasis?Do you suffer from psoriasis?

Table 3 :
-Responses to questions on beliefs regarding Psoriasis (Green: correct answer) No Yes Don'

Table 4 :
-Respondents' awareness evaluation for Psoriasis 7%) have expected count less than 5.The minimum expected count is 3,45.0%) have expected count less than 5.The minimum expected count is 12,82.
YesFigure 3:-Level of awareness Association of the subjects' knowledge with socio-demographic variables 1-Age

Table 5 :
-Do you think that psychological pressure is one of the psoriasis factors?3%) of the respondents have a poor knowledge about psychological pressure as a factor of psoriasis while 47,7% of the subjects have a good knowledge. ,463