Knowledge, Attitudes, and Preventive Practices Related to Hepatitis B Infection Among Adults in Saudi Arabia: A Nationwide Cross-Sectional Study.

Background

Hepatitis B virus (HBV) infection poses a persistent global public health challenge, with substantial associated morbidity, mortality, and healthcare utilization. Although Saudi Arabia has maintained a national HBV vaccination program for decades, population-level data on hepatitis B infection knowledge, attitudes, and practices (KAP) remain scarce and regionally limited. This study aimed to comprehensively assess KAP toward hepatitis B infection prevention among the general adult population across all regions of Saudi Arabia and to identify independent sociodemographic predictors of each domain to inform targeted healthcare interventions.

Methods

This nationwide cross-sectional study used a convenience sampling approach and a validated, self-administered questionnaire disseminated via online social media platforms across all regions of Saudi Arabia between August 2024 and February 2025. KAP was assessed using an instrument adapted from Haq et al. (Cronbach's α = 0.70). Good knowledge was defined as a score ≥11/20 (≥55%), positive attitude as ≥5/7 (≥71.4%), and good practice as ≥6/8 (≥75%). Multivariable linear regression was used to identify independent predictors, adjusting for sociodemographic covariates.

Results

A total of 1278 participants were included (mean age 30.3 ± 12.4 years; 60.9% female). Overall, 54.2% demonstrated good knowledge, 68.5% demonstrated positive attitudes, and only 16.2% exhibited good preventive practices. Screening (14.6%) and vaccination uptake (26.5%) were markedly low. Educational program participation was the strongest modifiable predictor across all three domains: knowledge (β = +1.89, 95% CI: 1.20-2.58, p < 0.001), attitude (β = +0.47, 95% CI: 0.25-0.69, p < 0.001), and practice (β = +1.43, 95% CI: 1.09-1.77, p < 0.001). Healthcare sector employment was independently associated with higher KAP scores across all domains. Income demonstrated a positive dose-response relationship with knowledge and practice outcomes. Polygyny was associated with lower scores across all three domains.

Conclusions

Despite moderate knowledge and generally favorable attitudes, preventive practices remain critically deficient, revealing a persistent knowledge-practice gap. Integrated, behavior-oriented interventions targeting modifiable determinants, particularly health education, income disparities, and stigma, are urgently needed to support progress toward national and global HBV elimination targets.