Adolescents Perceptions and Behaviors Towards Periodic Health Examinations in Riyadh, Saudi Arabia

Adolescents Perceptions and Behaviors Towards Periodic Health Examinations in Riyadh, Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adolescents Perceptions and Behaviors Towards Periodic Health Examinations in Riyadh, Saudi Arabia Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4664136/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Public Health → Version 3 posted 4 You are reading this latest preprint version Show more versions Abstract Objectives: To evaluate and assess the awareness, knowledge, and level of application of recommended Periodic health examinations (PHEs) for adolescents in Riyadh. Methods: Descriptive Cross-sectional study, conducted among adolescents between June 2022 and January 2023. The Sample size was 1199 adolescents of both genders, between the ages of 12-20 years, studying in intermediate and secondary schools in Riyadh. The sample of participants was collected through a stratified multistage random sampling technique. Ethical approval and Ministry of Education acceptance were considered. The data was collected using a structured, self-administered questionnaire containing close-ended questions. The level of knowledge was assessed by using three knowledge items; PHE definition, PHEs performance time, and the list of recommended PHEs known. The level of performance was assessed based on the performance of recommended (Six recommended PHEs by Saudi CDC) and none-recommended (Nine non-recommended PHEs as distractors). Results: Among the (1199) adolescents, the vast majority (70.6%) were aware of the PHEs. There is a positive attitude of adolescents toward PHEs, with (75.8%) acknowledging their importance and (87.1%) willing to undergo PHEs if given the opportunity. Despite this positive attitude, the actual knowledge and performance of PHEs remains relatively low, with (56.1%) being illiterate about it and only (36.8%) having undergone PHEs at least once, and a smaller percentage (26.1%) doing so regularly. There was a clear association (p<0.05) between the level of knowledge and application. Adolescents with adequate knowledge had a higher prevalence of application (56.8% VS 43.2%). There was an association between Adolescents' level of education and their levels of knowledge and performance (p<0.05). The more educated adolescents the higher their knowledge level and performance level. There was also an association between the availability of health insurance and application. The presence of health insurance increases the probability of applying PHEs. The most used sources of information regarding PHEs were digital sources (62.1%). Conclusion: The study concluded that there is a positive attitude of adolescents toward PHEs. The study highlights a disparity in knowledge and performance of PHEs among adolescents, influenced by socio-demographic factors such as gender, nationality, type of school, and parental education. Females and students from private or international schools, as well as those with higher levels of parental education, demonstrated better knowledge and higher performance rates of PHEs. The research underscores the role of digital sources in educating adolescents about PHEs. This study emphasizes the need for targeted educational interventions to improve adolescent knowledge and performance of PHEs, considering the identified barriers and socio-demographic influences. Periodic Health Examinations Knowledge Performance Adolescents Saudi Arabia Introduction Periodic health examinations (PHEs) are defined as a group of medical procedures conducted periodically. [1,2] Its primary objective is to evaluate an individual's overall health status and facilitate the early detection of potential medical conditions. Additionally, it serves as a preventive function by identifying risk factors and implementing appropriate preventive measures. PHEs typically encompass comprehensive data collection, physical assessments, laboratory investigations, and, in certain cases, interventional procedures. The frequency of these examinations is influenced by factors such as age, sex, and medical history, ensuring a tailored approach to health monitoring. [2] The influence of PHEs on community health and the healthcare system—particularly in terms of economic implications, overall health status, and morbidity and mortality rates—remains a subject of debate. Existing literature presents inconsistent findings regarding the extent to which PHEs effectively reduce morbidity, mortality, and disease burden. [3–7] Moreover, a study conducted in Japan on middle-aged workers concluded that regular participation in PHEs can substantially reduce medical expenses. [8] Another study from Japan, conducted on a sample of 48,757 participants aged 40–79, concluded that mortality rates are lower among individuals who undergo PHEs compared to those who do not. [9] Conversely, a meta-analysis published in 2023, which analyzed data from over two million participants, found no evidence supporting the claim that PHEs contribute to increased population lifespan. [10] At the national level, the Public Health Authority (Weqaya), formerly known as the Saudi Center for Disease Prevention and Control, introduced the National Guideline for Periodic Health Examination in 2014. [11] The guideline was subsequently revised in 2019 for its second edition and later updated in 2023 under the new title Saudi Clinical Preventive Guideline. [12] This program was designed to serve as an efficient and user-friendly memory aid, assisting physicians in recalling and implementing evidence-based recommendations during PHEs. By integrating these guidelines into daily practice, physicians can systematically apply preventive measures. The Saudi CDC categorized the population into four age groups: under 6 years, 6–17 years, 18–59 years, and 60 years and above. For individuals aged 6–17 years, the recommended PHEs encompass six key components: assessment of sun exposure and vitamin D levels, depression screening, oral hygiene evaluation, measurement of weight, height, and BMI, screening for sexually transmitted infections, and assessment of smoking status with cessation support. [11] Perceptions and adherence to PHEs vary across different populations. Globally, studies conducted in various countries indicate that, on average, the population demonstrates a moderate to good level of awareness (63.9%, ± 24.8), [13–25] and knowledge (66.9%, ± 19.3) regarding the recommended PHEs. [14,16,18,19,22–24,26–34] Regarding the implementation of PHEs, the majority of studies have reported low participation rates, with particularly lower adherence observed in certain populations. (44.4%, ± 18.2) who have performed PHEs regularly. [13–28,30–43] The healthcare system's focus on the adolescent age group in Saudi Arabia is essential, as they constitute a significant proportion of the overall population. [44] Adolescence is a critical phase for physical, mental, and social development, presenting distinct health challenges such as mental health disorders, substance abuse, sexual health concerns, and non-communicable diseases like obesity, diabetes, and cardiovascular conditions. [45] Investing in adolescent health provides long-term advantages for both individuals and society. There is a limited number of studies that specifically assess adolescents' awareness and adherence to the recommended PHEs for their age group, both nationally and internationally. Some of these studies include adolescents as part of broader age categories. [34,37,38,40,46] Additionally, despite adolescents constituting a significant portion of the population in the Kingdom of Saudi Arabia, [44] There are currently no effective, structured PHE screening systems in the Kingdom. This study was conducted to evaluate and assess the awareness and knowledge levels of adolescents in Riyadh, Saudi Arabia, regarding both recommended and non-recommended PHEs for their age group, as well as their performance status. Methodology Study Design and Setting This descriptive cross-sectional study was conducted among adolescents of both genders studying at public, private, and international schools in Riyadh city, Saudi Arabia. Data was collected from June 2022 to January 2023. Study Population The World Health Organization defines adolescence as the stage between ages 10 and 19 years [57]. However, this definition is debated, as various literature and sources differ in their characterization of this age group. Therefore, we established an operational definition of adolescence specific to Saudi Arabia, encompassing all male and female adolescents aged 12–20 years attending intermediate and secondary schools in Riyadh. First-grade intermediate school students and younger individuals were excluded from the sample, as their ages fall outside the study's operational definition of adolescence and do not align with the targeted age range. Sampling Technique A stratified multistage random sampling technique was employed to minimize selection bias. Riyadh city was divided into five sectors to ensure geographical representation. From each sector, eight schools were randomly selected, consisting of four male and four female schools to maintain gender balance. Within each selected school, two classes were randomly chosen from each grade to capture diversity across academic levels. Finally, twenty students were randomly selected from each chosen class, as this number represents the minimum class size, ensuring adequate representation from classes of varying sizes. Sample Size The sample size was determined using the standard formula for cross-sectional studies, based on an assumed prevalence of 30% (derived from similar studies), a 4% margin of error, and a 95% confidence interval. The sample size was subsequently increased to ensure inclusive representation of the target population and to facilitate bi-variate and multivariate analyses. Data Collection The data for this study was collected using a self-structured questionnaire, administered during face-to-face interactions. The questionnaire was carefully designed to minimize biases, featuring clear, concise close-ended questions supported by examples and prompts to aid memory recall and reduce ambiguity. It was crafted in both Arabic and English, using neutral language to avoid leading participants toward socially desirable answers. Additionally, a definition of periodic health examinations (PHEs) was included later in the questionnaire for reference. Participants self-administered the questionnaire in a private setting, with assurances of anonymity and confidentiality to encourage honest responses. To ensure consistency and accuracy, trained data collectors were present to provide standardized explanations, instructions, and clarifications as needed, maintaining uniformity without influencing participants' responses. The questionnaire was created based on the study objectives and by revising relevant previous studies [14,15,17–19,22,24], and contained four sections. To ensure its reliability and validity, a panel of researchers examined the content validity of the questionnaire. Before distributing the questionnaire, it was piloted among 40 adolescents to assess its feasibility and revise the questions for clarity and interpretability. The questionnaire was refined and finalized based on the feedback. Ethical Approval and Consent The study received ethical approval from the Institutional Review Board at King Saud University (KSU-IRB [E-22-7054]). Additionally, acceptance was obtained from the Ministry of Education and its relevant departments. Informed consent was secured from all participants, and approval was granted by school supervisors. Study Variables The questionnaire incorporated four sections that highlighted the study objective. The first section was the Socio-demographic characteristics, (which included nine items; Gender, age, nationality, type of school, grade, father’s education, mother's education, past medical history, and health-seeking facility.) The second section aimed to measure adolescents' basic knowledge of PHEs (through six items, which included Self-assessment of awareness level, PHEs definition, eligible individuals for PHEs, list of recommended PHEs known, PHEs application time, and the adolescents' sources of information to PHEs). The third section was added to assess the attitude of adolescents towards PHEs for their age group, (which included three items; the importance of PHEs, the tendency to apply PHEs, and the anticipated barriers to PHEs application). The fourth section covered the performance of PHEs, (which included six items; the status of PHEs application, frequency of application, list of PHEs performed, place of application, motivating factors for self-application, and the willingness to encourage other adolescents to perform PHEs). The ‘PHEs definition’ item considered the study literature as follows “A group of medical procedures conducted periodically and aim to check the health and some risk factors”. [1,2] The ‘list of PHEs’ items in the second and fourth sections were based on the ‘National Guideline for Periodic Health Examination’ 2nd edition (2019) by ‘Weqayah’, which recommended six PHEs for adolescents, which included; evaluation of sun exposure and vitamin D consumption, screening for depression, screening for oral hygiene, measurement of length, weight and BMI, screening for sexually transmitted infections, and counseling for smoking cessation. However, another nine commonly performed non-recommended PHEs were added to the lists as distractors. The ‘application time’ item was also based on the National Guideline, which was to be applied “Annually”. [11] Outcome Variables The level of knowledge was assessed by evaluation of adolescents' knowledge of; PHEs definition, the list of PHEs known, and PHEs application time, found in the second section. This process involved reviewing relevant articles that utilized benchmarked evaluation systems to ensure alignment with established practices and methodologies. [14, 18–19, 23–24, 27, 32] Additionally, the authors conducted a series of focus group discussions with research experts, facilitating in-depth meetings and collaborative decision-making sessions. These interactions aimed to critically assess and rank the importance of each item in the manuscript, enabling the development of a weighted scoring system that reflects both empirical evidence and expert consensus, thus ensuring a robust and valid evaluation framework. To calculate the level of knowledge; ⅕ was given to the correct definition, ⅗ - in total - were given to the number of ‘recommended’ PHEs known from the list (⅕ = 1–2, 2⁄5 = 2–4, and ⅗ = 5–6), and ⅕ was given for the correct application time. Those who scored ⅗ and more were considered with adequate knowledge and those who scored less than ⅗ were considered with inadequate knowledge. From the ‘list of PHEs performed’ item in the fourth section, the level of recommended PHEs performance was assessed by the number of ‘recommended’ PHEs performed and was divided into two categories: high performance (3 or more), and low performance (less than 3). On the other hand, the level of non-recommended PHEs performance (malpractice) was assessed by the number of ‘non-recommended’ PHEs performed, and was divided into four categories; None performance (0), low performance (1–3), moderate performance (4–6), and high performance (7 and more). Data Management and Statistical Analysis Data from the paper-based questionnaires were first entered into Google Forms, then exported to Microsoft Excel for initial processing, and subsequently transferred to SPSS 24.0 (Statistical Package for Social Sciences, IBM Inc., Chicago, USA) for data cleaning and management. Descriptive statistics, including frequencies and percentages, were used to summarize the categorical study and outcome variables. To assess associations between categorical variables—such as level of knowledge and status of PHE performance, Pearson’s Chi-square test was applied. Odds ratios (ORs) were used to measure the strength of associations between independent and outcome variables. Additionally, multivariate binary logistic regression was conducted to adjust for potential confounders, providing adjusted odds ratios (AORs). Statistical significance was determined using a p-value of ≤ 0.05, and 95% confidence intervals (CIs) were reported to indicate the precision of the results. Results The total number of adolescents who participated in the study was 1,199, all residing in Riyadh, Saudi Arabia. Table 1 presents the socio-demographic characteristics of the study population. Both genders were represented nearly equally, with a slight predominance of males (55.5%). Participants' ages ranged from 12 to 20 years, with the majority between 15 and 16 years. In terms of nationality, Saudis comprised (75.3%) of the sample, while non-Saudis accounted for (24.7%). The study included students from public (68.3%), private (21.6%), and international schools (10.1%). Regarding parental education, the majority of fathers (69.1%) and mothers (58.2%) held graduate or postgraduate degrees. Furthermore, most participants (87.7%) reported no chronic diseases, compared to (12.3%) who had been diagnosed with chronic illnesses. In terms of healthcare accessibility, participants reported using a variety of providers, including those from the private, public, and governmental sectors. Table 1 Socio-demographic characteristics of participating adolescents in Riyadh Items n % Gender Male 666 55.5 Female 533 44.5 Age 12 24 2.0 13 158 13.2 14 238 19.8 15 248 20.7 16 250 20.9 17 208 17.3 18–20 73 6.1 Nationality Saudi 903 75.3 Non-Saudi 296 24.7 Type of school Public 819 68.3 Private 259 21.6 International 121 10.1 Grade 2nd intermediate schools 283 23.6 3rd intermediate schools 165 13.8 1st secondary schools 270 22.5 2nd secondary schools 244 20.4 3rd secondary schools 237 19.8 Father Education University Degree and above 793 66.1 Secondary school and below 406 33.9 Mother Education University Degree and above 660 55 Secondary school and below 539 45 Health Status Healthy 1052 87.7 Chronically-ill 147 12.3 Accessibility to Healthcare I don’t know 325 27.1 Government sector 242 20.2 Public hospitals 240 20 Standard insurance 172 14.3 Private hospitals 124 10.3 VIP Insurance 96 8 The level of knowledge and awareness regarding PHEs among the participating adolescents is illustrated in Table (2) . The vast majority (70.6%) considered themselves to have a good level of awareness, and approximately half (51%) correctly identified the definition of PHEs. Among the recommended PHEs suggested by the Saudi CDC, the evaluation of sun exposure and vitamin D levels was most frequently recognized (51.3%), while screening for sexually transmitted diseases was selected by fewer participants (17.4%). Conversely, many participants selected non-recommended PHEs, such as complete blood count (46.5%) and blood pressure measurement (45.9%). More than half of the participants identified the correct timing for PHEs (51.3%), and the majority (62.1%) reported obtaining their knowledge about PHEs from digital sources such as the Internet and TV. The attitude of adolescents toward the recommended PHEs was generally positive. A large proportion of participants (75.8%) acknowledged the importance of PHEs, while smaller percentages were neutral (8.4%), uncertain (13.8%), or disagreed (1.9%). In addition, the majority (87.1%) indicated that they would undergo PHEs if given the opportunity. Barriers to undergoing PHEs varied among participants. Some obstacles were related to knowledge and attitude, including inadequate knowledge about the importance of PHEs (44.3%), fear of visiting medical facilities (30.5%), a belief that good health negates the need for PHEs (27.8%), and a lack of desire or enthusiasm (24.7%). Other factors were related to support and logistical issues, such as financial constraints (33.7%), insufficient time (28.9%), unavailability of health insurance (25.9%), lack of family support (22.9%), and transportation difficulties (16.7%). Table 2 The level of knowledge and awareness of adolescents about the PHEs recommended in Riyadh Items n % Self-assessment of awareness Aware 846 70.6 Not aware 353 29.4 PHEs definition Correct 611 51.0 Incorrect 286 23.8 PHEs Eligibility I don’t know 302 25.2 Healthy individuals 97 8.1 Sick individuals 140 11.7 Both of them 734 61.2 I don’t know 228 19.0 Recommended PHEs known Evaluation of Sun exposure and Vitamin D levels* 615 51.3 Complete Blood Count (CBC) 557 46.5 Blood pressure 550 45.9 Weight, length, and BMI* 536 44.7 Blood Glucose levels 505 42.1 Screening for Depression* 383 31.9 Cholesterol and TAGs levels 367 30.6 Evaluation of Smoking status and cessation* 340 28.4 Thyroid gland 338 28.2 Kidney Functions test 337 28.1 Liver functions test 298 24.9 Evaluation of Oral Hygiene* 278 23.2 Stool and urine analysis 262 21.9 Hepatitis screening 228 19.0 Sexually transmitted diseases* 209 17.4 I don’t know 293 24.4 Others 38 3.2 Application time Correct 615 51.3 Incorrect 356 29.7 I don’t know 228 19.0 Sources of information Internet and social media 605 50.5 Family 411 34.3 I don’t have enough knowledge 330 27.5 School's subjects 212 17.7 Medical team 212 17.7 Friends 206 17.2 TV programs 139 11.6 Other 38 3.2 *: Recommended by Saudi Center for Disease Prevention and Control (Weqaya) ‘National Guideline of Periodic Health Examination’ 2nd Edition (2019) The level of adolescents' performance of PHEs is presented in Table (3) . The results showed that (47.4%) of participants have undergone some form of PHEs, with (36.8%) having done so only once in the past, while (26.1%) reported undergoing PHEs on a regular or periodic basis. Regarding the recommended PHEs, evaluation of sun exposure and vitamin D levels was performed by a large number of participants (57.4%), whereas screening for sexually transmitted diseases was the least performed test (3.9%). The most common non-recommended PHEs included complete blood count (CBC) (50.2%), blood pressure measurement (48.1%), and blood glucose level measurement (33.1%). Approximately half of the participants underwent PHEs in public facilities (49.5%), and general health evaluation was the leading reason for seeking medical attention (50.7%). Except for a few outliers, the vast majority of participants (97.9%) who underwent PHEs recommended them to other adolescents. Table 3 The level of adolescents’ performance of PHEs in Riyadh Items n % Status of performance Didn’t Performed 631 52.6 Performed 568 47.4 Total = 1199 100 Frequency of Performance 1199 100 Irregularly 211 37.1 Once 209 36.8 Regularly (Yearly, every 6 months) 148 26.1 Total = 568 100 PHEs done Evaluation of sun exposure and Vitamin D levels* 326 57.40 Weight, length, and BMI* 294 51.80 Complete Blood Count (CBC) 285 50.20 Blood pressure 273 48.10 Blood Glucose levels 188 33.10 Evaluation of Oral hygiene* 162 28.50 Cholesterol and TAGs levels 152 26.80 Thyroid gland 148 26.10 Stool and urine analysis 133 23.40 Kidney functions tests 97 17.10 Liver functions tests 80 14.10 Screening for Depression* 61 10.70 Evaluation of smoking status and cessation * 57 10.00 Hepatitis screening 36 6.30 Sexually transmitted diseases* 22 3.90 Others 49 8.60 Location of performance Public hospital 238 41.9 Private hospital 201 35.4 Public clinic 43 7.6 Private clinic 35 6.2 Private lab 29 5.1 Others 22 3.9 Motivators General health evaluation 288 50.70 Worrying 164 28.90 Early detection of diseases 159 28.0 Family history 84 14.80 Quit harmful habits 33 5.80 Others 65 11.40 Recommendation Yes 556 97.9 No 12 2.1 *: Recommended by Saudi Center for Disease Prevention and Control (Weqaya) ‘National Guideline of Periodic Health Examination’ 2nd Edition (2019) The association between socio-demographic variables and the adolescents' level of knowledge is presented in Table (4) . More than half of the adolescents lacked adequate knowledge regarding PHEs (56.1%). Significant associations were observed between the level of knowledge and various socio-demographic factors, including gender, nationality, type of school, grade, parents' education, and health insurance. In this regard, a higher proportion of females demonstrated adequate knowledge (54.6%) compared to males (35.3%) (p = .001). Similarly, non-Saudis were more knowledgeable (55.1%) than Saudis (40.2%) (p = .001). Furthermore, adolescents in private schools exhibited better knowledge (54.8%) compared to those in international (39.7%) and public schools (41%) (p = .001). It was also observed that knowledge levels increased proportionally with school grade (p = .024). Moreover, adolescents whose parents held university degrees or higher had a higher level of knowledge than those whose parents had secondary school education or below; specifically, for fathers, (48.9% vs 34%, p = .001), and for mothers, (47.3% vs 39.7%, p = .009). The corresponding unadjusted odds ratios, which quantified the association between the level of knowledge and socio-demographic characteristics, also indicated statistically significant associations. In addition, the adjusted odds ratios obtained through multivariate binary logistic regression revealed that the variables Gender (male), Type of school (international and public), Grade (2nd grade intermediate and 1st grade secondary), Father's education (secondary school/below), and Health insurance (no health insurance/don’t know) were independently and statistically significantly associated with inadequate knowledge. Table 4 The association between Socio-demographic variables and the adolescents' level of knowledge using Bi-variate and multivariate logistics regression analysis (n = 1199) Items Level of knowledge p-value (chi-square) Unadjusted Odds ratios (95% CI’s) Adjusted Odds ratios (95% CI’s) Inadequate (< 3) (n = 673) Adequate (≥ 3) (n = 526) n (%) n (%) Gender Male 431 (64.7) 235 (35.3) .001 (44.838) 2.20(1.75,2.78) 2.13(1.61,2.83) Female 242(45.4) 291 (54.6) 1.0(ref.) 1.0(ref.) Nationality Saudi 540 (59.8) 363 (40.2) .001 (20.013) 1.82(1.40,2.38) 1.32(0.95,1.82) Non-Saudi 133 (44.9) 163 (55.1) 1.0(ref.) 1.0(ref.) Type of school International 73 (60.3) 48 (39.7) .001 (16.184) 1.85(1.20,2.86) 2.31(1.41,3.78) Private 117 (45.2) 142 (54.8) 1.0(ref.) 1.0(ref.) Public 483 (59.0) 336 (41.0) 1.74(1.32,2.31) 1.45(1.04,2.01) Grade 2nd intermediate schools 163 (57.6) 120 (42.4) .024 (11.261) 1.52(1.10,2.14) 1.61(1.10,2.38) 3rd intermediate schools 101 (61.2) 64 (38.8) 1.76(1.20,2.64) 1.40(0.91,2.15) 1st secondary schools 162 (60.0) 108 (40.0) 1.67(1.18,2.38) 1.46(1.00,2.15) 2nd secondary schools 135 (55.3) 109 (44.7) 1.38(0.97,1.98) 1.38(0.94,2.03) 3rd secondary schools 112 (47.3) 125 (52.7) 1.0(ref.) 1.0(ref.) Father education Secondary school/below 268 (66.0) 138 (34.0) .001 (24.333) 1.86(1.45,2.38) 1.62(1.23,2.14) University/above 405 (51.1) 388 (48.9) 1.0(ref.) 1.0(ref.) Mother education Secondary school/below 325 (60.3) 214 (39.7) .009 (6.904) 1.36(1.10,1.71) 1.10(0.85,1.43) University/above 348 (52.7) 312 (47.3) 1.0(ref.) 1.0(ref.) Health status Chronic ill 80 (54.4) 67 (45.6) .656 (0.199) 1.0(ref.) 1.0(ref.) Healthy 593 (56.4) 459 (43.6) 1.08(0.76,1.53) 0.85(0.58,1.23) Health insurance Have health insurance 119 (44.4) 149 (55.6) .001 (19.276) 1.0(ref.) 1.0(ref.) No health insurance/Don’t Know 554 (59.5) 377 (40.5) 1.84(1.40,2.42) 1.56(1.16,2.10) Table (5) presents the association between socio-demographic characteristics and the status of PHE performance. Females exhibited a higher performance rate (52.5%) compared to males (43.2%) (p = .001). The type of school was significantly associated with PHE performance, with students from international schools showing the highest rate (62.8%), followed by those in private (47.5%) and public schools (45.1%) (p = .001). Significant differences were also observed across school grades (p < .001), with younger adolescents demonstrating a lower performance rate (38.2%) than older adolescents. An association was also observed between parental education and PHE performance; adolescents whose fathers held a university degree or higher had a higher performance rate (51.5%), and those with mothers holding a university degree or higher showed a similar trend (51.4%) (p < .002). Furthermore, participants with health insurance had a higher rate of PHE performance compared to those without health insurance (60.8% Vs. 43.5%, p = .001). The unadjusted odds ratios derived from bivariate logistic regression indicated statistically significant associations between several socio-demographic variables—including gender (female), type of school (international), grade (3rd grade intermediate, 2nd grade intermediate, and 3rd grade secondary), father’s education (university/above), health status (chronic ill), and health insurance (having health insurance)—and the status of PHE performance. After adjusting for potential confounders in the multivariate logistic regression model, all variables except mother’s education remained independently and statistically significantly associated with the status of PHE performance (performed). Table 5 The association between Socio-demographic variables and the status of PHEs performance using Bi-variate and multivariate logistics regression analysis (n = 1199) Items Status of PHEs performance p-value (chi-square) Unadjusted Odds ratios (95% CI’s) Adjusted Odds ratios (95% CI’s) Performed (n = 568) Did not perform (n = 631) n (%) n (%) Gender Male 288 (43.2) 378 (56.8) .001 (10.248) 1.0(ref.) 1.0(ref.) Female 280 (52.5) 253 (47.5) 1.45(1.15,1.83) 1.44(1.09,1.90) Nationality Saudi 414 (45.8) 489 (54.2) .065 (3.415) 1.0(ref.) 1.0(ref.) Non-Saudi 154 (52.0) 142 (48.0) 1.28(0.98,1.67) 0.97(0.70,1.34) Type of School International 76 (62.8) 45 (37.2) .001 (13.332) 2.10(1.39,3.05) 2.39(1.46,3.92) Private 123 (47.5) 136 (52.5) 1.10(0.83,1.46) 1.28(0.92,1.77) Public 369 (45.1) 450 (54.9) 1.0(ref.) 1.0(ref.) Grade 2nd intermediate schools 108 (38.2) 175 (61.8) .001 (19.939) 1.0(ref.) 1.0(ref.) 3rd intermediate schools 87 (52.7) 78 (47.3) 1.81(1.23,2.66) 2.08(1.37,3.17) 1st secondary schools 117 (43.3) 153 (56.7) 1.24(0.88,1.74) 1.23(0.83,1.82) 2nd secondary schools 131 (53.7) 113 (46.3) 1.88(1.33,2.66) 2.31(1.54,3.45) 3rd secondary schools 125 (52.7) 112 (47.3) 1.81(1.27,2.57) 2.14(1.45,3.15) Father education Secondary school/below 160 (39.4) 246 (60.6) .001 (15.617) 1.0(ref.) 1.0(ref.) University/above 408 (51.5) 385 (48.5) 1.63(1.28,2.08) 1.21(0.94,1.57) Mother education Secondary school/below 229 (42.5) 310 (57.5) .002 (9.379) 1.0(ref.) 1.0(ref.) University/above 339 (51.4) 321 (48.6) 1.43(1.14,1.80) 1.32(1.0,1.73) Health status Chronically ill 93 (63.3) 54 (36.7) .001 (16.973) 2.10(1.46,2.98) 2.06(1.41,3.01) Healthy 475 (45.2) 577 (54.8) 1.0(ref.) 1.0(ref.) Health insurance Have 163 (60.8) 105 (39.2) .001 (25.037) 2.02(1.53,2.66) 1.80(1.34,2.42) Don’t have 405 (43.5) 526 (56.5) 1.0(ref.) 1.0(ref.) The association between the level of knowledge and the level of performance of PHEs is presented in Table (6). Participants with an adequate level of knowledge demonstrated a higher overall performance of PHEs compared to those with inadequate knowledge (56.8% vs. 40%, p = .001). In addition, those with adequate knowledge exhibited a higher level of recommended PHE performance than participants with inadequate knowledge (8.4% vs. 3.3%, p = .001). Conversely, a significant negative association was observed between the performance of non-recommended PHEs and the adequacy of knowledge; participants who performed more non-recommended PHEs had lower levels of knowledge than those who performed fewer non-recommended PHEs (p = .001). Table 6 The association between the level of knowledge and the level of PHEs performance Items Level of Knowledge P-value (chi-square) Adequate Inadequate n (%) n (%) Status of PHE performance Performed PHEs 299 (56.8) 269 (40) .001 (33.719) Didn’t perform PHEs 227 (43.2) 404 (60) Total (1199) 526 673 The levels of Recommended PHEs performance* Low (0–3) 274 (91.6) 260 (96.7) .012 (6.330) High (4–6) 25 (8.4) 9 (3.3) Total (568) 299 269 The levels of Non-Recommended PHEs performance** None (0) 17 (5.7) 45 (16.7) .001 (35.177) Low (1–3) 180 (60.2) 177 (65.8) Moderate (4–6) 79 (26.4) 43 (16.0) High (7–9) 23 (7.7) 4 (1.5) Total (568) 299 269 * : Six Recommended PHEs for adolescents : 1/Low: performed (0–3) of the recommended PHEs, 2/High: performed (4–6) of the recommended PHEs. ** : Nine Non-Recommended PHEs for adolescents : 1/ None: performed (0) of the non-recommended PHEs, 2/ Low: performed (1–3) of the non-recommended PHEs, 3/ Moderate: performed (4–6) of the non-recommended PHEs, 4/ High: performed (7–9) of the non-recommended PHEs. Discussion Saudi Arabia has made significant advancements in providing accessible, high-quality healthcare. The Ministry of Health (MOH), through the Saudi Center for Disease Control and Prevention (CDC) ‘Weqayah’, has developed national guidelines [11] for PHEs across multiple age groups, including adolescents, recognizing the essential role these examinations play in preventive healthcare. Although the MOH and CDC have made concerted efforts to promote PHEs, local studies have revealed considerable variability in the awareness and utilization of these examinations across different demographics and regions [16,22–24,28,29,36,37,40]. This study aimed to assess the awareness, knowledge, and performance of PHEs among adolescents in Riyadh. According to the findings of this study, the vast majority (70.6%) of adolescents were aware of the existence of PHEs for their age group. This high level of awareness aligns with many previous studies [13–15,17–21,25] and can be attributed to the efforts of the MOH, Saudi CDC, and private healthcare providers through various health education campaigns and programs, such as the “Know Your Numbers” campaign, the School-based Obesity Control (Rashaqa) campaign, and the national guideline for PHEs [11,47]. Digital sources, such as the Internet and television, were the most common channels through which adolescents obtained information, which is consistent with findings from multiple previous studies [16,19,22]. This contrasts with a study in China, where medical staff, along with digital media, were identified as the most useful sources [26]. Adolescents exhibited relatively low levels of knowledge regarding the details of PHEs, with only (43.9%) demonstrating adequate knowledge. A similar study conducted in Jazan, Saudi Arabia, reported comparable findings, with only (40%) of participants possessing sufficient knowledge about PHEs [24]. Likewise, a study in Northwest Nigeria found that only (43%) of participants had adequate knowledge of PHEs [19]. On the other hand, several studies have reported higher levels of knowledge related to PHEs [14,16,22,27–34]. For example, a local study conducted in the Makkah region found that (76.4%) of participants had an adequate level of knowledge [23]. Despite increased awareness and multiple efforts to improve public perceptions, knowledge levels remain insufficient. This gap could be attributed to limitations in the adequacy and comprehensibility of health information, as highlighted in health literacy assessments conducted by local studies [48]. To address this issue, a well-structured health education program tailored specifically for adolescents should be developed, incorporating age-appropriate information to enhance their understanding. There were clear associations between socio-demographic characteristics—such as gender, nationality, and educational level—and both knowledge and performance of PHEs. Regarding gender and knowledge, females demonstrated better knowledge than males. This finding aligns with a study conducted in the Makkah region, where females were significantly more knowledgeable than males [23], as well as studies in Pakistan, where two separate investigations reported similar results [20,33], along with other studies that support this trend [29,31,36]. However, studies conducted in Jazan, Riyadh, and Al-Jouf reported that males were more knowledgeable than females [16,22,24]. Meanwhile, some studies found no association between gender and knowledge levels; for example, a study in Uganda concluded that gender did not significantly influence participants' knowledge adequacy [15]. The association between gender and PHE performance varies across literature. While some studies confirmed a significant relationship [21,22,28,31,32,36,40,42,49], others did not find any association [13–15,18,20,24,26,27,33,39,43]. Despite these variations, most of the literature suggests that females generally exhibit greater knowledge and higher engagement in PHEs. This trend may be attributed to the fact that females tend to be more invested in their health-seeking behaviors, as they are often more attentive to symptoms and their potential implications. Conversely, males may be less likely to engage in PHEs due to societal expectations that associate masculinity with strength and resilience, leading them to downplay health concerns [50,51]. Individuals with higher education often exhibit better health-seeking behavior. This may stem from the idea that increased health literacy enables individuals to better understand symptoms, treatment options, and preventive measures, thereby protecting them from misinformation, missed diagnoses, delayed care, and potentially worsening health outcomes [52]. In this study, a direct association was observed between the educational level of adolescents and their parents with both knowledge and performance of PHEs. This finding aligns with most of the existing literature [13–19,21–24,29,31,33,36,38,40], although some studies have reported no significant association [20,26,27,39,43]. These findings reinforce the critical role of literacy in enhancing individuals’ knowledge of their health and well-being. As expected, a positive association was observed between the presence of health insurance and the level of knowledge. Additionally, health insurance was found to motivate adolescents to undergo PHEs, a finding consistent with previous studies [21,34,36,37,40,53]. However, some studies reported no significant association [17,26]. The positive impact of health insurance on PHE performance is often attributed to its convenience, time efficiency, access to a broader range of healthcare services, and incentive plans such as discounts on gym memberships and healthy lifestyle products. However, in Saudi Arabia, individuals without health insurance are still eligible to receive free healthcare services at public facilities, as the government provides comprehensive healthcare coverage to all citizens. Despite these extensive healthcare opportunities, accessibility remains a challenge. Studies suggest that direct factors—such as limited staffing, increased workloads, overcrowded healthcare centers, shortages in required infrastructure, and lower expertise levels—continue to obstruct access to public healthcare services [17,22,24,49]. The identification of the meaning of PHEs among adolescents in this study falls within the midrange of international findings. While some studies suggest that adolescents have a good understanding of PHEs [17], others report the opposite [19]. Regarding specific PHE components, sexually transmitted disease (STD) screening, one of the recommended assessments for adolescents, was the least recognized by participants in this study. This finding contrasts with a study conducted in Africa, where both adolescents and adults considered STD screening an essential part of PHEs for adolescents [54], highlighting cultural differences in perceptions of preventive healthcare. The overall attitude of adolescents toward PHEs was generally positive, as reflected in their willingness to undergo PHEs and their tendency to recommend them to others. This positive perception was also evident in their engagement with both recommended and non-recommended PHEs. As anticipated, nearly half of the adolescents in this study engaged in PHEs, with (26%) doing so regularly. The majority of the existing literature supports similar findings, indicating that populations generally exhibit low levels of PHE practice [13,15–19,21–24,27,28,31,34,36–38,40–43]. However, some studies have reported surprisingly higher engagement levels [14,20,25,26,30,32,33,35,39]. Adolescents in this study attributed their limited participation in PHEs to several factors, including inadequate knowledge, financial constraints, lack of health insurance, fear or anxiety, perceived good health, lack of motivation, insufficient family support, and transportation difficulties. These barriers have also been observed in other studies [14–17,19–22,26,27,29,30,32–34,36,38–41,49,54]. Despite widespread awareness and knowledge about PHEs, studies have revealed a notable disconnect between knowledge and practice. While many communities exhibit high levels of PHE awareness and knowledge, actual participation often remains low [13–19,21,23,27,36]. However, the findings of this study, along with those of other studies [14,20,25,30,32,33], suggest the opposite. This has been attributed to the assumption that societies with higher levels of knowledge tend to have greater exposure to and experience with PHEs [27]. This contradiction highlights the complex relationship between knowledge and practice, which is influenced by various factors beyond the mere dissemination of information. Studies exploring this relationship have identified multiple determinants, including financial status, availability of resources, accessibility, psychological factors, and other barriers [14–17,19–22,26,27,32–34,36,38–41,49,54]. These findings align with the obstacles reported by adolescents in this study, further reinforcing the multifaceted nature of PHE participation. Limitations The limitations of our study include the challenge of generalizing findings across diverse populations due to inherent variability in characteristics. Additionally, reliance on adolescents' perceptions, rather than medical records, may have led to less accurate outcomes. The limited body of research on periodic health examinations, particularly regarding adolescents, also restricted our ability to explore specific adolescent traits and compare our data with existing literature. However, older adolescents (18–20 years) were included in most studies, often within broader age groups. Lastly, the lack of a defined recall period in the questionnaire may have introduced variability in the data, as participants reported behaviors based on their most memorable or impactful experiences rather than a standardized timeframe. This variability could affect response consistency and should be addressed in future studies by implementing a specific recall period. Policy Recommendations To improve adolescents' knowledge and performance, healthcare systems should collaborate with the Ministry of Education and schools to establish structured educational programs tailored to this age group. These programs should focus on recommended PHEs, leveraging digital platforms and campaigns to engage adolescents effectively. At the policy level, the Ministry of Health should integrate adolescent-targeted PHEs into national health guidelines and allocate resources for regular screenings in schools. Furthermore, school curricula should incorporate age-appropriate health literacy topics to foster preventive care among students. Conclusion The study provides valuable insights into adolescents' awareness, attitudes, and practices regarding PHEs. While adolescents displayed a notably positive attitude towards PHEs, their actual knowledge and performance remained relatively low. The study identifies a gap in both knowledge and implementation, influenced by socio-demographic factors such as gender, nationality, type of school, and parental education. It also emphasizes the role of digital sources in enhancing adolescent education about PHEs. Declarations Consent to Participate: According to the Ethics of Scientific Research rules of King Saud University [55], and the General Education School Regulations of Ministry of Education [56] in Saudi Arabia regarding individuals younger than 18-year-old. Upon approval from the Institutional Review Board (IRB) and the Ministry of Education (MOE) and its departments for a research survey, the school, through its supervisors, has the authority to accept or reject the proposal without the need to obtain consent from parents or legal guardians, provided that no interventions are made, and no personal data are collected. After selecting eligible participants, they were informed about the study's objectives and assured of the confidentiality of their data. Consent was obtained from all participants, and legal consent was granted by the school supervisors of each institution after reviewing the survey content to ensure it aligned with school values and avoided sensitive topics. Consent for Publication : Not applicable. Author details 1 Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia 2 College of Medicine, King Saud University, Riyadh, Saudi Arabia Funding: Not applicable. Ethics Approval : The study protocol was approved by the Institutional Review Board at King Saud University (KSU-IRB [E-22-7054]) and the Ministry of Education (MOE) along with its departments. In addition, consent was obtained from all participants and school supervisors. All procedures conducted in studies involving human participants adhered to the ethical standards of the institutional and/or national research committee, in accordance with the 1964 Helsinki Declaration and its subsequent amendments, or comparable ethical standards. Competing Interest : Not applicable. Acknowledgment : The authors would like to thank the College of Medicine Research Center, Deanship of Scientific Research King Saud University, Saudi Arabia for the support of this research. We also extend our heartfelt appreciation to the diligent associates; Atheer Aljubeiri, Faris AlQarni, Mohammed AlZahrani, Mohammed Naasani, and Sarah AlQuwaiz, whose careful efforts were invaluable to this research endeavor Availability of Data and Materials : All materials described in this manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes. The questionnaire used for data collection in this study is available for download as a supplementary file. The questionnaire was developed by the authors specifically for this research project and includes a combination of original questions and questions adapted from previous studies [14,15,17–19,22,24]. We acknowledge the original authors of the adapted questions by citing their studies. A table detailing the assessment criteria and methodology used in the assessment of the level of knowledge and the table discussing the attitude of adolescents towards PHEs are included in the supplementary materials accompanying this manuscript. The ‘National Guideline of Periodic Health Examination 2nd Edition (2019)’ supporting the findings of this study is available within the supplementary files of this article, as ‘Weqaya’ has updated it to the newer version ‘Saudi Clinical Preventive Guideline 3rd Edition (2023)’ and may no longer be available in its original form. The previous version of the document, which was utilized in this study, is included in the supplementary files for reference and transparency. Author Contribution Conceptualization: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiMethodology: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiSoftware: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiValidation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiFormal Analysis: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa, Salman Alotaibi and Shaffi Ahmad ShaikInvestigation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiResources: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiData Curation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiWriting – Original Draft: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiWriting – Review & Editing: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa, Salman Alotaibi and Shaffi Ahmad ShaikVisualization: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiSupervision: Mohammed AlrukbanProject Administration: Mohammed AlrukbanFunding Acquisition: Not aplicable Acknowledgement The authors would like to thank the College of Medicine Research Center, Deanship of Scientific Research King Saud University, Saudi Arabia for the support of this research. 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Supplementary Files Tables.docx PerceptionTable.pdf EvaluationTable.pdf Questionnaire.pdf NationalGuidelineforPeriodicHealthExamination2ndEdition2019.pdf Cite Share Download PDF Status: Published Journal Publication published 14 Apr, 2025 Read the published version in BMC Public Health → Version 3 posted Editorial decision: Revision requested 28 Mar, 2025 Editor assigned by journal 28 Mar, 2025 Submission checks completed at journal 21 Mar, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4664136","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436561830,"identity":"2fa8e008-0e88-11f0-91e4-06cc9d20a69f","order_by":0,"name":"Mohammed Alrukban","email":"","orcid":"","institution":"Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Alrukban","suffix":""},{"id":436561831,"identity":"37bc0ece-0e88-11f0-91e4-06cc9d20a69f","order_by":1,"name":"Ahmad Alsultan","email":"","orcid":"","institution":"College of Medicine, King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Alsultan","suffix":""},{"id":436561832,"identity":"41788d9d-0e88-11f0-91e4-06cc9d20a69f","order_by":2,"name":"Alwaleed Alnasser","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYDACdijNxt//8cEHEIMdn3IQYIbSfBIHjA1ngLQw41OOrEWOIcFMmgdZBBfgb+Y9+PHHH5t8NoYDadI2v7bJ8zEzMH74mINbi8RhvmRp3rY0yzbmhsPWuX23DduYGZglZ27DY81hHgNpxobDBmwMBxtv5/bcZgRqYWPmxaNF/jCP8c8ff/4DtSQzSFv23LYnqMXgMI+ZBA/bAaCWNCZphh+3EwlqMQRqseZtSzZgkzjDbNjbcDu5jZmxGa9f5I73GN/88cfOQL6/h/HBjz+3bee3Nx/88BGf91EAYxuYbCBWPQj8IUXxKBgFo2AUjBQAAP+ZSjZHPuziAAAAAElFTkSuQmCC","orcid":"","institution":"College of Medicine, King Saud 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University","correspondingAuthor":false,"prefix":"","firstName":"Salman","middleName":"","lastName":"Alotaibi","suffix":""},{"id":439611220,"identity":"23ca3604-a3fa-4b3c-a738-99b9c9bfd988","order_by":6,"name":"Shaffi Ahamed Shaik","email":"","orcid":"","institution":"Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia","correspondingAuthor":false,"prefix":"","firstName":"Shaffi","middleName":"Ahamed","lastName":"Shaik","suffix":""}],"badges":[],"createdAt":"2024-06-30 19:52:17","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-4664136/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-4664136/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-22554-1","type":"published","date":"2025-04-14T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81051014,"identity":"701545bd-f7a4-418a-bcbb-c5790081a41d","added_by":"auto","created_at":"2025-04-21 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23:51:03","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":477447,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4664136/v3/57bc76777fa0b30a9117c3ba.pdf"},{"id":79622901,"identity":"b355ffab-99db-4d64-86be-b6df438d499b","added_by":"auto","created_at":"2025-03-31 23:51:03","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":477593,"visible":true,"origin":"","legend":"","description":"","filename":"NationalGuidelineforPeriodicHealthExamination2ndEdition2019.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4664136/v3/b679e3cc43c87ab98ab5f1ac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adolescents Perceptions and Behaviors Towards Periodic Health Examinations in Riyadh, Saudi Arabia","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeriodic health examinations (PHEs) are defined as a group of medical procedures conducted periodically. [1,2] Its primary objective is to evaluate an individual's overall health status and facilitate the early detection of potential medical conditions. Additionally, it serves as a preventive function by identifying risk factors and implementing appropriate preventive measures. PHEs typically encompass comprehensive data collection, physical assessments, laboratory investigations, and, in certain cases, interventional procedures. The frequency of these examinations is influenced by factors such as age, sex, and medical history, ensuring a tailored approach to health monitoring. [2]\u003c/p\u003e \u003cp\u003eThe influence of PHEs on community health and the healthcare system\u0026mdash;particularly in terms of economic implications, overall health status, and morbidity and mortality rates\u0026mdash;remains a subject of debate. Existing literature presents inconsistent findings regarding the extent to which PHEs effectively reduce morbidity, mortality, and disease burden. [3\u0026ndash;7] Moreover, a study conducted in Japan on middle-aged workers concluded that regular participation in PHEs can substantially reduce medical expenses. [8] Another study from Japan, conducted on a sample of 48,757 participants aged 40\u0026ndash;79, concluded that mortality rates are lower among individuals who undergo PHEs compared to those who do not. [9] Conversely, a meta-analysis published in 2023, which analyzed data from over two million participants, found no evidence supporting the claim that PHEs contribute to increased population lifespan. [10]\u003c/p\u003e \u003cp\u003e At the national level, the Public Health Authority (Weqaya), formerly known as the Saudi Center for Disease Prevention and Control, introduced the National Guideline for Periodic Health Examination in 2014. [11] The guideline was subsequently revised in 2019 for its second edition and later updated in 2023 under the new title Saudi Clinical Preventive Guideline. [12] This program was designed to serve as an efficient and user-friendly memory aid, assisting physicians in recalling and implementing evidence-based recommendations during PHEs. By integrating these guidelines into daily practice, physicians can systematically apply preventive measures. The Saudi CDC categorized the population into four age groups: under 6 years, 6\u0026ndash;17 years, 18\u0026ndash;59 years, and 60 years and above. For individuals aged 6\u0026ndash;17 years, the recommended PHEs encompass six key components: assessment of sun exposure and vitamin D levels, depression screening, oral hygiene evaluation, measurement of weight, height, and BMI, screening for sexually transmitted infections, and assessment of smoking status with cessation support. [11]\u003c/p\u003e \u003cp\u003ePerceptions and adherence to PHEs vary across different populations. Globally, studies conducted in various countries indicate that, on average, the population demonstrates a moderate to good level of awareness (63.9%, \u0026plusmn;\u0026thinsp;24.8), [13\u0026ndash;25] and knowledge (66.9%, \u0026plusmn;\u0026thinsp;19.3) regarding the recommended PHEs. [14,16,18,19,22\u0026ndash;24,26\u0026ndash;34] Regarding the implementation of PHEs, the majority of studies have reported low participation rates, with particularly lower adherence observed in certain populations. (44.4%, \u0026plusmn;\u0026thinsp;18.2) who have performed PHEs regularly. [13\u0026ndash;28,30\u0026ndash;43]\u003c/p\u003e \u003cp\u003eThe healthcare system's focus on the adolescent age group in Saudi Arabia is essential, as they constitute a significant proportion of the overall population. [44] Adolescence is a critical phase for physical, mental, and social development, presenting distinct health challenges such as mental health disorders, substance abuse, sexual health concerns, and non-communicable diseases like obesity, diabetes, and cardiovascular conditions. [45] Investing in adolescent health provides long-term advantages for both individuals and society.\u003c/p\u003e \u003cp\u003eThere is a limited number of studies that specifically assess adolescents' awareness and adherence to the recommended PHEs for their age group, both nationally and internationally. Some of these studies include adolescents as part of broader age categories. [34,37,38,40,46] Additionally, despite adolescents constituting a significant portion of the population in the Kingdom of Saudi Arabia, [44] There are currently no effective, structured PHE screening systems in the Kingdom. This study was conducted to evaluate and assess the awareness and knowledge levels of adolescents in Riyadh, Saudi Arabia, regarding both recommended and non-recommended PHEs for their age group, as well as their performance status.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis descriptive cross-sectional study was conducted among adolescents of both genders studying at public, private, and international schools in Riyadh city, Saudi Arabia. Data was collected from June 2022 to January 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe World Health Organization defines adolescence as the stage between ages 10 and 19 years [57]. However, this definition is debated, as various literature and sources differ in their characterization of this age group. Therefore, we established an operational definition of adolescence specific to Saudi Arabia, encompassing all male and female adolescents aged 12\u0026ndash;20 years attending intermediate and secondary schools in Riyadh. First-grade intermediate school students and younger individuals were excluded from the sample, as their ages fall outside the study's operational definition of adolescence and do not align with the targeted age range.\u003c/p\u003e\n\u003ch3\u003eSampling Technique\u003c/h3\u003e\n\u003cp\u003eA stratified multistage random sampling technique was employed to minimize selection bias. Riyadh city was divided into five sectors to ensure geographical representation. From each sector, eight schools were randomly selected, consisting of four male and four female schools to maintain gender balance. Within each selected school, two classes were randomly chosen from each grade to capture diversity across academic levels. Finally, twenty students were randomly selected from each chosen class, as this number represents the minimum class size, ensuring adequate representation from classes of varying sizes.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined using the standard formula for cross-sectional studies, based on an assumed prevalence of 30% (derived from similar studies), a 4% margin of error, and a 95% confidence interval. The sample size was subsequently increased to ensure inclusive representation of the target population and to facilitate bi-variate and multivariate analyses.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe data for this study was collected using a self-structured questionnaire, administered during face-to-face interactions. The questionnaire was carefully designed to minimize biases, featuring clear, concise close-ended questions supported by examples and prompts to aid memory recall and reduce ambiguity. It was crafted in both Arabic and English, using neutral language to avoid leading participants toward socially desirable answers. Additionally, a definition of periodic health examinations (PHEs) was included later in the questionnaire for reference. Participants self-administered the questionnaire in a private setting, with assurances of anonymity and confidentiality to encourage honest responses. To ensure consistency and accuracy, trained data collectors were present to provide standardized explanations, instructions, and clarifications as needed, maintaining uniformity without influencing participants' responses.\u003c/p\u003e \u003cp\u003eThe questionnaire was created based on the study objectives and by revising relevant previous studies [14,15,17\u0026ndash;19,22,24], and contained four sections. To ensure its reliability and validity, a panel of researchers examined the content validity of the questionnaire. Before distributing the questionnaire, it was piloted among 40 adolescents to assess its feasibility and revise the questions for clarity and interpretability. The questionnaire was refined and finalized based on the feedback.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval and Consent\u003c/strong\u003e \u003cp\u003e The study received ethical approval from the Institutional Review Board at King Saud University (KSU-IRB [E-22-7054]). Additionally, acceptance was obtained from the Ministry of Education and its relevant departments. Informed consent was secured from all participants, and approval was granted by school supervisors.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cp\u003eThe questionnaire incorporated four sections that highlighted the study objective. The first section was the Socio-demographic characteristics, (which included nine items; Gender, age, nationality, type of school, grade, father\u0026rsquo;s education, mother's education, past medical history, and health-seeking facility.) The second section aimed to measure adolescents' basic knowledge of PHEs (through six items, which included Self-assessment of awareness level, PHEs definition, eligible individuals for PHEs, list of recommended PHEs known, PHEs application time, and the adolescents' sources of information to PHEs). The third section was added to assess the attitude of adolescents towards PHEs for their age group, (which included three items; the importance of PHEs, the tendency to apply PHEs, and the anticipated barriers to PHEs application). The fourth section covered the performance of PHEs, (which included six items; the status of PHEs application, frequency of application, list of PHEs performed, place of application, motivating factors for self-application, and the willingness to encourage other adolescents to perform PHEs).\u003c/p\u003e \u003cp\u003eThe \u0026lsquo;PHEs definition\u0026rsquo; item considered the study literature as follows \u0026ldquo;A group of medical procedures conducted periodically and aim to check the health and some risk factors\u0026rdquo;. [1,2] The \u0026lsquo;list of PHEs\u0026rsquo; items in the second and fourth sections were based on the \u0026lsquo;National Guideline for Periodic Health Examination\u0026rsquo; 2nd edition (2019) by \u0026lsquo;Weqayah\u0026rsquo;, which recommended six PHEs for adolescents, which included; evaluation of sun exposure and vitamin D consumption, screening for depression, screening for oral hygiene, measurement of length, weight and BMI, screening for sexually transmitted infections, and counseling for smoking cessation. However, another nine commonly performed non-recommended PHEs were added to the lists as distractors. The \u0026lsquo;application time\u0026rsquo; item was also based on the National Guideline, which was to be applied \u0026ldquo;Annually\u0026rdquo;. [11]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome Variables\u003c/h3\u003e\n\u003cp\u003eThe level of knowledge was assessed by evaluation of adolescents' knowledge of; PHEs definition, the list of PHEs known, and PHEs application time, found in the second section. This process involved reviewing relevant articles that utilized benchmarked evaluation systems to ensure alignment with established practices and methodologies. [14, 18\u0026ndash;19, 23\u0026ndash;24, 27, 32] Additionally, the authors conducted a series of focus group discussions with research experts, facilitating in-depth meetings and collaborative decision-making sessions. These interactions aimed to critically assess and rank the importance of each item in the manuscript, enabling the development of a weighted scoring system that reflects both empirical evidence and expert consensus, thus ensuring a robust and valid evaluation framework. To calculate the level of knowledge; ⅕ was given to the correct definition, ⅗ - in total - were given to the number of \u0026lsquo;recommended\u0026rsquo; PHEs known from the list (⅕ = 1\u0026ndash;2, 2\u0026frasl;5\u0026thinsp;=\u0026thinsp;2\u0026ndash;4, and ⅗ = 5\u0026ndash;6), and ⅕ was given for the correct application time. Those who scored ⅗ and more were considered with adequate knowledge and those who scored less than ⅗ were considered with inadequate knowledge.\u003c/p\u003e \u003cp\u003eFrom the \u0026lsquo;list of PHEs performed\u0026rsquo; item in the fourth section, the level of recommended PHEs performance was assessed by the number of \u0026lsquo;recommended\u0026rsquo; PHEs performed and was divided into two categories: high performance (3 or more), and low performance (less than 3). On the other hand, the level of non-recommended PHEs performance (malpractice) was assessed by the number of \u0026lsquo;non-recommended\u0026rsquo; PHEs performed, and was divided into four categories; None performance (0), low performance (1\u0026ndash;3), moderate performance (4\u0026ndash;6), and high performance (7 and more).\u003c/p\u003e\n\u003ch3\u003eData Management and Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eData from the paper-based questionnaires were first entered into Google Forms, then exported to Microsoft Excel for initial processing, and subsequently transferred to SPSS 24.0 (Statistical Package for Social Sciences, IBM Inc., Chicago, USA) for data cleaning and management. Descriptive statistics, including frequencies and percentages, were used to summarize the categorical study and outcome variables. To assess associations between categorical variables\u0026mdash;such as level of knowledge and status of PHE performance, Pearson\u0026rsquo;s Chi-square test was applied. Odds ratios (ORs) were used to measure the strength of associations between independent and outcome variables. Additionally, multivariate binary logistic regression was conducted to adjust for potential confounders, providing adjusted odds ratios (AORs). Statistical significance was determined using a p-value of \u0026le;\u0026thinsp;0.05, and 95% confidence intervals (CIs) were reported to indicate the precision of the results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe total number of adolescents who participated in the study was 1,199, all residing in Riyadh, Saudi Arabia. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socio-demographic characteristics of the study population. Both genders were represented nearly equally, with a slight predominance of males (55.5%). Participants' ages ranged from 12 to 20 years, with the majority between 15 and 16 years. In terms of nationality, Saudis comprised (75.3%) of the sample, while non-Saudis accounted for (24.7%). The study included students from public (68.3%), private (21.6%), and international schools (10.1%). Regarding parental education, the majority of fathers (69.1%) and mothers (58.2%) held graduate or postgraduate degrees. Furthermore, most participants (87.7%) reported no chronic diseases, compared to (12.3%) who had been diagnosed with chronic illnesses. In terms of healthcare accessibility, participants reported using a variety of providers, including those from the private, public, and governmental sectors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of participating adolescents in Riyadh\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of school\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity Degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity Degree and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronically-ill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAccessibility to Healthcare\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGovernment sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIP Insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe level of knowledge and awareness regarding PHEs among the participating adolescents is illustrated in \u003cb\u003eTable\u0026nbsp;(2)\u003c/b\u003e. The vast majority (70.6%) considered themselves to have a good level of awareness, and approximately half (51%) correctly identified the definition of PHEs. Among the recommended PHEs suggested by the Saudi CDC, the evaluation of sun exposure and vitamin D levels was most frequently recognized (51.3%), while screening for sexually transmitted diseases was selected by fewer participants (17.4%). Conversely, many participants selected non-recommended PHEs, such as complete blood count (46.5%) and blood pressure measurement (45.9%). More than half of the participants identified the correct timing for PHEs (51.3%), and the majority (62.1%) reported obtaining their knowledge about PHEs from digital sources such as the Internet and TV.\u003c/p\u003e \u003cp\u003eThe \u003cb\u003eattitude\u003c/b\u003e of adolescents toward the recommended PHEs was generally positive. A large proportion of participants (75.8%) acknowledged the importance of PHEs, while smaller percentages were neutral (8.4%), uncertain (13.8%), or disagreed (1.9%). In addition, the majority (87.1%) indicated that they would undergo PHEs if given the opportunity. Barriers to undergoing PHEs varied among participants. Some obstacles were related to knowledge and attitude, including inadequate knowledge about the importance of PHEs (44.3%), fear of visiting medical facilities (30.5%), a belief that good health negates the need for PHEs (27.8%), and a lack of desire or enthusiasm (24.7%). Other factors were related to support and logistical issues, such as financial constraints (33.7%), insufficient time (28.9%), unavailability of health insurance (25.9%), lack of family support (22.9%), and transportation difficulties (16.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe level of knowledge and awareness of adolescents about the PHEs recommended in Riyadh\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-assessment of awareness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot aware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHEs definition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHEs Eligibility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy individuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSick individuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth of them\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecommended PHEs known\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of Sun exposure and Vitamin D levels*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete Blood Count (CBC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight, length, and BMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Glucose levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreening for Depression*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol and TAGs levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of Smoking status and cessation*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid gland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney Functions test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver functions test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of Oral Hygiene*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStool and urine analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexually transmitted diseases*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eApplication time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSources of information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet and social media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don\u0026rsquo;t have enough knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool's subjects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTV programs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e*: Recommended by Saudi Center for Disease Prevention and Control (Weqaya) \u0026lsquo;National Guideline of Periodic Health Examination\u0026rsquo; 2nd Edition (2019)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe level of adolescents' performance of PHEs is presented in \u003cb\u003eTable\u0026nbsp;(3)\u003c/b\u003e. The results showed that (47.4%) of participants have undergone some form of PHEs, with (36.8%) having done so only once in the past, while (26.1%) reported undergoing PHEs on a regular or periodic basis. Regarding the recommended PHEs, evaluation of sun exposure and vitamin D levels was performed by a large number of participants (57.4%), whereas screening for sexually transmitted diseases was the least performed test (3.9%). The most common non-recommended PHEs included complete blood count (CBC) (50.2%), blood pressure measurement (48.1%), and blood glucose level measurement (33.1%). Approximately half of the participants underwent PHEs in public facilities (49.5%), and general health evaluation was the leading reason for seeking medical attention (50.7%). Except for a few outliers, the vast majority of participants (97.9%) who underwent PHEs recommended them to other adolescents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe level of adolescents\u0026rsquo; performance of PHEs in Riyadh\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatus of performance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDidn\u0026rsquo;t Performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTotal =\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of Performance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrregularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegularly (Yearly, every 6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTotal =\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHEs done\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of sun exposure and Vitamin D levels*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight, length, and BMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete Blood Count (CBC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Glucose levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of Oral hygiene*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol and TAGs levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid gland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStool and urine analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney functions tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver functions tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreening for Depression*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of smoking status and cessation *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis screening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexually transmitted diseases*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation of performance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate lab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotivators\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral health evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorrying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly detection of diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuit harmful habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e*: Recommended by Saudi Center for Disease Prevention and Control (Weqaya) \u0026lsquo;National Guideline of Periodic Health Examination\u0026rsquo; 2nd Edition (2019)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe association between socio-demographic variables and the adolescents' level of knowledge is presented in \u003cb\u003eTable\u0026nbsp;(4)\u003c/b\u003e. More than half of the adolescents lacked adequate knowledge regarding PHEs (56.1%). Significant associations were observed between the level of knowledge and various socio-demographic factors, including gender, nationality, type of school, grade, parents' education, and health insurance. In this regard, a higher proportion of females demonstrated adequate knowledge (54.6%) compared to males (35.3%) (p\u0026thinsp;=\u0026thinsp;.001). Similarly, non-Saudis were more knowledgeable (55.1%) than Saudis (40.2%) (p\u0026thinsp;=\u0026thinsp;.001). Furthermore, adolescents in private schools exhibited better knowledge (54.8%) compared to those in international (39.7%) and public schools (41%) (p\u0026thinsp;=\u0026thinsp;.001). It was also observed that knowledge levels increased proportionally with school grade (p\u0026thinsp;=\u0026thinsp;.024). Moreover, adolescents whose parents held university degrees or higher had a higher level of knowledge than those whose parents had secondary school education or below; specifically, for fathers, (48.9% vs 34%, p\u0026thinsp;=\u0026thinsp;.001), and for mothers, (47.3% vs 39.7%, p\u0026thinsp;=\u0026thinsp;.009). The corresponding unadjusted odds ratios, which quantified the association between the level of knowledge and socio-demographic characteristics, also indicated statistically significant associations. In addition, the adjusted odds ratios obtained through multivariate binary logistic regression revealed that the variables Gender (male), Type of school (international and public), Grade (2nd grade intermediate and 1st grade secondary), Father's education (secondary school/below), and Health insurance (no health insurance/don\u0026rsquo;t know) were independently and statistically significantly associated with inadequate knowledge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between Socio-demographic variables and the adolescents' level of knowledge using Bi-variate and multivariate logistics regression analysis (n\u0026thinsp;=\u0026thinsp;1199)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLevel of knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003cp\u003e(chi-square)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eUnadjusted Odds ratios (95% CI\u0026rsquo;s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAdjusted Odds ratios\u003c/p\u003e \u003cp\u003e(95% CI\u0026rsquo;s)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate (\u0026lt;\u0026thinsp;3)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;673)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdequate (\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;526)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e431 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(44.838)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.20(1.75,2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.13(1.61,2.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e242(45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e291 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e540 (59.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e363 (40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(20.013)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.82(1.40,2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.32(0.95,1.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of school\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(16.184)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.85(1.20,2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.31(1.41,3.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e483 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74(1.32,2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.45(1.04,2.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e.024\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(11.261)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52(1.10,2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.61(1.10,2.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.76(1.20,2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.40(0.91,2.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.67(1.18,2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.46(1.00,2.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.38(0.97,1.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.38(0.94,2.03)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school/below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e268 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(24.333)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.86(1.45,2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.62(1.23,2.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e405 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e388 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school/below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e325 (60.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.009\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(6.904)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36(1.10,1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.10(0.85,1.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e348 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic ill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.656\u003c/p\u003e \u003cp\u003e(0.199)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e593 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08(0.76,1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85(0.58,1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave health insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(19.276)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo health insurance/Don\u0026rsquo;t Know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e554 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e377 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84(1.40,2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.56(1.16,2.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(5)\u003c/b\u003e presents the association between socio-demographic characteristics and the status of PHE performance. Females exhibited a higher performance rate (52.5%) compared to males (43.2%) (p\u0026thinsp;=\u0026thinsp;.001). The type of school was significantly associated with PHE performance, with students from international schools showing the highest rate (62.8%), followed by those in private (47.5%) and public schools (45.1%) (p\u0026thinsp;=\u0026thinsp;.001). Significant differences were also observed across school grades (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with younger adolescents demonstrating a lower performance rate (38.2%) than older adolescents. An association was also observed between parental education and PHE performance; adolescents whose fathers held a university degree or higher had a higher performance rate (51.5%), and those with mothers holding a university degree or higher showed a similar trend (51.4%) (p\u0026thinsp;\u0026lt;\u0026thinsp;.002). Furthermore, participants with health insurance had a higher rate of PHE performance compared to those without health insurance (60.8% Vs. 43.5%, p\u0026thinsp;=\u0026thinsp;.001). The unadjusted odds ratios derived from bivariate logistic regression indicated statistically significant associations between several socio-demographic variables\u0026mdash;including gender (female), type of school (international), grade (3rd grade intermediate, 2nd grade intermediate, and 3rd grade secondary), father\u0026rsquo;s education (university/above), health status (chronic ill), and health insurance (having health insurance)\u0026mdash;and the status of PHE performance. After adjusting for potential confounders in the multivariate logistic regression model, all variables except mother\u0026rsquo;s education remained independently and statistically significantly associated with the status of PHE performance (performed).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between Socio-demographic variables and the status of PHEs performance using Bi-variate and multivariate logistics regression analysis (n\u0026thinsp;=\u0026thinsp;1199)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStatus of PHEs performance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003cp\u003e(chi-square)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eUnadjusted Odds ratios (95% CI\u0026rsquo;s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAdjusted Odds ratios\u003c/p\u003e \u003cp\u003e(95% CI\u0026rsquo;s)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePerformed\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;568)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDid not perform\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;631)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e288 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e378 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(10.248)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e280 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45(1.15,1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.44(1.09,1.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e414 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e489 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.065\u003c/p\u003e \u003cp\u003e(3.415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (52.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.28(0.98,1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97(0.70,1.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of School\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(13.332)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.10(1.39,3.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.39(1.46,3.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123 (47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10(0.83,1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.28(0.92,1.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e369 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e450 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(19.939)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd intermediate schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.81(1.23,2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.08(1.37,3.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.24(0.88,1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.23(0.83,1.82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.88(1.33,2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.31(1.54,3.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd secondary schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.81(1.27,2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.14(1.45,3.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school/below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(15.617)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e408 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e385 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.63(1.28,2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.21(0.94,1.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school/below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e229 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e310 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(9.379)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity/above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e339 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e321 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.43(1.14,1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.32(1.0,1.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronically ill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (63.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(16.973)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.10(1.46,2.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.06(1.41,3.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e475 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e577 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(25.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02(1.53,2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.80(1.34,2.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t have\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e405 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e526 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(ref.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe association between the level of knowledge and the level of performance of PHEs is presented in \u003cb\u003eTable\u0026nbsp;(6).\u003c/b\u003e Participants with an adequate level of knowledge demonstrated a higher overall performance of PHEs compared to those with inadequate knowledge (56.8% vs. 40%, p\u0026thinsp;=\u0026thinsp;.001). In addition, those with adequate knowledge exhibited a higher level of recommended PHE performance than participants with inadequate knowledge (8.4% vs. 3.3%, p\u0026thinsp;=\u0026thinsp;.001). Conversely, a significant negative association was observed between the performance of non-recommended PHEs and the adequacy of knowledge; participants who performed more non-recommended PHEs had lower levels of knowledge than those who performed fewer non-recommended PHEs (p\u0026thinsp;=\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between the level of knowledge and the level of PHEs performance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLevel of Knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003cp\u003e(chi-square)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStatus of PHE performance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformed PHEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(33.719)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDidn\u0026rsquo;t perform PHEs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e227 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e404 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTotal (1199)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe levels of Recommended PHEs performance*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e274 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260 (96.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e.012\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(6.330)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (3.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTotal (568)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe levels of Non-Recommended PHEs performance**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(35.177)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (60.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177 (65.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (7\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal (568)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e*\u003c/b\u003e: \u003cb\u003eSix Recommended PHEs for adolescents\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e1/Low: performed (0\u0026ndash;3) of the recommended PHEs,\u003c/p\u003e \u003cp\u003e2/High: performed (4\u0026ndash;6) of the recommended PHEs.\u003c/p\u003e \u003cp\u003e\u003cb\u003e**\u003c/b\u003e: \u003cb\u003eNine Non-Recommended PHEs for adolescents\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e1/ None: performed (0) of the non-recommended PHEs,\u003c/p\u003e \u003cp\u003e2/ Low: performed (1\u0026ndash;3) of the non-recommended PHEs,\u003c/p\u003e \u003cp\u003e3/ Moderate: performed (4\u0026ndash;6) of the non-recommended PHEs,\u003c/p\u003e \u003cp\u003e4/ High: performed (7\u0026ndash;9) of the non-recommended PHEs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSaudi Arabia has made significant advancements in providing accessible, high-quality healthcare. The Ministry of Health (MOH), through the Saudi Center for Disease Control and Prevention (CDC) \u0026lsquo;Weqayah\u0026rsquo;, has developed national guidelines [11] for PHEs across multiple age groups, including adolescents, recognizing the essential role these examinations play in preventive healthcare. Although the MOH and CDC have made concerted efforts to promote PHEs, local studies have revealed considerable variability in the awareness and utilization of these examinations across different demographics and regions [16,22\u0026ndash;24,28,29,36,37,40]. This study aimed to assess the awareness, knowledge, and performance of PHEs among adolescents in Riyadh.\u003c/p\u003e \u003cp\u003eAccording to the findings of this study, the vast majority (70.6%) of adolescents were aware of the existence of PHEs for their age group. This high level of awareness aligns with many previous studies [13\u0026ndash;15,17\u0026ndash;21,25] and can be attributed to the efforts of the MOH, Saudi CDC, and private healthcare providers through various health education campaigns and programs, such as the \u0026ldquo;Know Your Numbers\u0026rdquo; campaign, the School-based Obesity Control (Rashaqa) campaign, and the national guideline for PHEs [11,47]. Digital sources, such as the Internet and television, were the most common channels through which adolescents obtained information, which is consistent with findings from multiple previous studies [16,19,22]. This contrasts with a study in China, where medical staff, along with digital media, were identified as the most useful sources [26].\u003c/p\u003e \u003cp\u003eAdolescents exhibited relatively low levels of knowledge regarding the details of PHEs, with only (43.9%) demonstrating adequate knowledge. A similar study conducted in Jazan, Saudi Arabia, reported comparable findings, with only (40%) of participants possessing sufficient knowledge about PHEs [24]. Likewise, a study in Northwest Nigeria found that only (43%) of participants had adequate knowledge of PHEs [19]. On the other hand, several studies have reported higher levels of knowledge related to PHEs [14,16,22,27\u0026ndash;34]. For example, a local study conducted in the Makkah region found that (76.4%) of participants had an adequate level of knowledge [23]. Despite increased awareness and multiple efforts to improve public perceptions, knowledge levels remain insufficient. This gap could be attributed to limitations in the adequacy and comprehensibility of health information, as highlighted in health literacy assessments conducted by local studies [48]. To address this issue, a well-structured health education program tailored specifically for adolescents should be developed, incorporating age-appropriate information to enhance their understanding.\u003c/p\u003e \u003cp\u003eThere were clear associations between socio-demographic characteristics\u0026mdash;such as gender, nationality, and educational level\u0026mdash;and both knowledge and performance of PHEs. Regarding gender and knowledge, females demonstrated better knowledge than males. This finding aligns with a study conducted in the Makkah region, where females were significantly more knowledgeable than males [23], as well as studies in Pakistan, where two separate investigations reported similar results [20,33], along with other studies that support this trend [29,31,36]. However, studies conducted in Jazan, Riyadh, and Al-Jouf reported that males were more knowledgeable than females [16,22,24]. Meanwhile, some studies found no association between gender and knowledge levels; for example, a study in Uganda concluded that gender did not significantly influence participants' knowledge adequacy [15]. The association between gender and PHE performance varies across literature. While some studies confirmed a significant relationship [21,22,28,31,32,36,40,42,49], others did not find any association [13\u0026ndash;15,18,20,24,26,27,33,39,43]. Despite these variations, most of the literature suggests that females generally exhibit greater knowledge and higher engagement in PHEs. This trend may be attributed to the fact that females tend to be more invested in their health-seeking behaviors, as they are often more attentive to symptoms and their potential implications. Conversely, males may be less likely to engage in PHEs due to societal expectations that associate masculinity with strength and resilience, leading them to downplay health concerns [50,51].\u003c/p\u003e \u003cp\u003eIndividuals with higher education often exhibit better health-seeking behavior. This may stem from the idea that increased health literacy enables individuals to better understand symptoms, treatment options, and preventive measures, thereby protecting them from misinformation, missed diagnoses, delayed care, and potentially worsening health outcomes [52]. In this study, a direct association was observed between the educational level of adolescents and their parents with both knowledge and performance of PHEs. This finding aligns with most of the existing literature [13\u0026ndash;19,21\u0026ndash;24,29,31,33,36,38,40], although some studies have reported no significant association [20,26,27,39,43]. These findings reinforce the critical role of literacy in enhancing individuals\u0026rsquo; knowledge of their health and well-being.\u003c/p\u003e \u003cp\u003eAs expected, a positive association was observed between the presence of health insurance and the level of knowledge. Additionally, health insurance was found to motivate adolescents to undergo PHEs, a finding consistent with previous studies [21,34,36,37,40,53]. However, some studies reported no significant association [17,26]. The positive impact of health insurance on PHE performance is often attributed to its convenience, time efficiency, access to a broader range of healthcare services, and incentive plans such as discounts on gym memberships and healthy lifestyle products. However, in Saudi Arabia, individuals without health insurance are still eligible to receive free healthcare services at public facilities, as the government provides comprehensive healthcare coverage to all citizens. Despite these extensive healthcare opportunities, accessibility remains a challenge. Studies suggest that direct factors\u0026mdash;such as limited staffing, increased workloads, overcrowded healthcare centers, shortages in required infrastructure, and lower expertise levels\u0026mdash;continue to obstruct access to public healthcare services [17,22,24,49].\u003c/p\u003e \u003cp\u003eThe identification of the meaning of PHEs among adolescents in this study falls within the midrange of international findings. While some studies suggest that adolescents have a good understanding of PHEs [17], others report the opposite [19]. Regarding specific PHE components, sexually transmitted disease (STD) screening, one of the recommended assessments for adolescents, was the least recognized by participants in this study. This finding contrasts with a study conducted in Africa, where both adolescents and adults considered STD screening an essential part of PHEs for adolescents [54], highlighting cultural differences in perceptions of preventive healthcare.\u003c/p\u003e \u003cp\u003eThe overall attitude of adolescents toward PHEs was generally positive, as reflected in their willingness to undergo PHEs and their tendency to recommend them to others. This positive perception was also evident in their engagement with both recommended and non-recommended PHEs.\u003c/p\u003e \u003cp\u003eAs anticipated, nearly half of the adolescents in this study engaged in PHEs, with (26%) doing so regularly. The majority of the existing literature supports similar findings, indicating that populations generally exhibit low levels of PHE practice [13,15\u0026ndash;19,21\u0026ndash;24,27,28,31,34,36\u0026ndash;38,40\u0026ndash;43]. However, some studies have reported surprisingly higher engagement levels [14,20,25,26,30,32,33,35,39]. Adolescents in this study attributed their limited participation in PHEs to several factors, including inadequate knowledge, financial constraints, lack of health insurance, fear or anxiety, perceived good health, lack of motivation, insufficient family support, and transportation difficulties. These barriers have also been observed in other studies [14\u0026ndash;17,19\u0026ndash;22,26,27,29,30,32\u0026ndash;34,36,38\u0026ndash;41,49,54].\u003c/p\u003e \u003cp\u003eDespite widespread awareness and knowledge about PHEs, studies have revealed a notable disconnect between knowledge and practice. While many communities exhibit high levels of PHE awareness and knowledge, actual participation often remains low [13\u0026ndash;19,21,23,27,36]. However, the findings of this study, along with those of other studies [14,20,25,30,32,33], suggest the opposite. This has been attributed to the assumption that societies with higher levels of knowledge tend to have greater exposure to and experience with PHEs [27]. This contradiction highlights the complex relationship between knowledge and practice, which is influenced by various factors beyond the mere dissemination of information. Studies exploring this relationship have identified multiple determinants, including financial status, availability of resources, accessibility, psychological factors, and other barriers [14\u0026ndash;17,19\u0026ndash;22,26,27,32\u0026ndash;34,36,38\u0026ndash;41,49,54]. These findings align with the obstacles reported by adolescents in this study, further reinforcing the multifaceted nature of PHE participation.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe limitations of our study include the challenge of generalizing findings across diverse populations due to inherent variability in characteristics. Additionally, reliance on adolescents' perceptions, rather than medical records, may have led to less accurate outcomes. The limited body of research on periodic health examinations, particularly regarding adolescents, also restricted our ability to explore specific adolescent traits and compare our data with existing literature. However, older adolescents (18\u0026ndash;20 years) were included in most studies, often within broader age groups. Lastly, the lack of a defined recall period in the questionnaire may have introduced variability in the data, as participants reported behaviors based on their most memorable or impactful experiences rather than a standardized timeframe. This variability could affect response consistency and should be addressed in future studies by implementing a specific recall period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePolicy Recommendations\u003c/h2\u003e \u003cp\u003eTo improve adolescents' knowledge and performance, healthcare systems should collaborate with the Ministry of Education and schools to establish structured educational programs tailored to this age group. These programs should focus on recommended PHEs, leveraging digital platforms and campaigns to engage adolescents effectively. At the policy level, the Ministry of Health should integrate adolescent-targeted PHEs into national health guidelines and allocate resources for regular screenings in schools. Furthermore, school curricula should incorporate age-appropriate health literacy topics to foster preventive care among students.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study provides valuable insights into adolescents' awareness, attitudes, and practices regarding PHEs. While adolescents displayed a notably positive attitude towards PHEs, their actual knowledge and performance remained relatively low. The study identifies a gap in both knowledge and implementation, influenced by socio-demographic factors such as gender, nationality, type of school, and parental education. It also emphasizes the role of digital sources in enhancing adolescent education about PHEs.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eConsent to Participate:\u003c/strong\u003e \u003cp\u003e According to the Ethics of Scientific Research rules of King Saud University [55], and the General Education School Regulations of Ministry of Education [56] in Saudi Arabia regarding individuals younger than 18-year-old. Upon approval from the Institutional Review Board (IRB) and the Ministry of Education (MOE) and its departments for a research survey, the school, through its supervisors, has the authority to accept or reject the proposal without the need to obtain consent from parents or legal guardians, provided that no interventions are made, and no personal data are collected. After selecting eligible participants, they were informed about the study's objectives and assured of the confidentiality of their data. Consent was obtained from all participants, and legal consent was granted by the school supervisors of each institution after reviewing the survey content to ensure it aligned with school values and avoided sensitive topics.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e \u003cb\u003eConsent for Publication\u003c/b\u003e:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthor details\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia\u003c/p\u003e \u003cp\u003e \u003csup\u003e2\u003c/sup\u003e College of Medicine, King Saud University, Riyadh, Saudi Arabia\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003e\u003cb\u003eEthics Approval\u003c/b\u003e: The study protocol was approved by the Institutional Review Board at King Saud University (KSU-IRB [E-22-7054]) and the Ministry of Education (MOE) along with its departments. In addition, consent was obtained from all participants and school supervisors. All procedures conducted in studies involving human participants adhered to the ethical standards of the institutional and/or national research committee, in accordance with the 1964 Helsinki Declaration and its subsequent amendments, or comparable ethical standards.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCompeting Interest\u003c/b\u003e: Not applicable.\u003c/p\u003e \u003cp\u003e\u003cb\u003eAcknowledgment\u003c/b\u003e: The authors would like to thank the College of Medicine Research Center, Deanship of Scientific Research King Saud University, Saudi Arabia for the support of this research. We also extend our heartfelt appreciation to the diligent associates; Atheer Aljubeiri, Faris AlQarni, Mohammed AlZahrani, Mohammed Naasani, and Sarah AlQuwaiz, whose careful efforts were invaluable to this research endeavor\u003c/p\u003e \u003cp\u003e\u003cb\u003eAvailability of Data and Materials\u003c/b\u003e: All materials described in this manuscript, including all relevant raw data, will be freely available to any scientist wishing to use them for non-commercial purposes. The questionnaire used for data collection in this study is available for download as a supplementary file. The questionnaire was developed by the authors specifically for this research project and includes a combination of original questions and questions adapted from previous studies [14,15,17\u0026ndash;19,22,24]. We acknowledge the original authors of the adapted questions by citing their studies. A table detailing the assessment criteria and methodology used in the assessment of the level of knowledge and the table discussing the attitude of adolescents towards PHEs are included in the supplementary materials accompanying this manuscript. The \u0026lsquo;National Guideline of Periodic Health Examination 2nd Edition (2019)\u0026rsquo; supporting the findings of this study is available within the supplementary files of this article, as \u0026lsquo;Weqaya\u0026rsquo; has updated it to the newer version \u0026lsquo;Saudi Clinical Preventive Guideline 3rd Edition (2023)\u0026rsquo; and may no longer be available in its original form. The previous version of the document, which was utilized in this study, is included in the supplementary files for reference and transparency.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiMethodology: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiSoftware: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiValidation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiFormal Analysis: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa, Salman Alotaibi and Shaffi Ahmad ShaikInvestigation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiResources: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiData Curation: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiWriting \u0026ndash; Original Draft: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiWriting \u0026ndash; Review \u0026amp; Editing: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa, Salman Alotaibi and Shaffi Ahmad ShaikVisualization: Mohammed Alrukban, Ahmad Alsultan, Alwaleed Alnasser, Ahmed Alayban, Mohammed Almousa and Salman AlotaibiSupervision: Mohammed AlrukbanProject Administration: Mohammed AlrukbanFunding Acquisition: Not aplicable\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the College of Medicine Research Center, Deanship of Scientific Research King Saud University, Saudi Arabia for the support of this research. We also extend our heartfelt appreciation to the diligent associates; Atheer Aljubeiri, Faris AlQarni, Mohammed AlZahrani, Mohammed Naasani, and Sarah AlQuwaiz, whose careful efforts were invaluable to this research endeavor\u003c/p\u003e"},{"header":"References","content":"\u003cli\u003e\u003cspan\u003e1. Connelly JE. Periodic Health Examination. In: Prevention in Clinical Practice. Boston, MA: Springer US; 1988. p. 419\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2. Johns Hopkins Medicine Maryland based in B. Routine Screenings Overview [Internet]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/routine-screenings\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e3. Krogsb\u0026oslash;ll LT, J\u0026oslash;rgensen KJ, Gr\u0026oslash;nh\u0026oslash;j Larsen C, G\u0026oslash;tzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews. 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e4. Ponka D. The periodic health examination in adults. Can Med Assoc J. 2014 Feb;186(16):1245.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e5. Sun X, Chen Y, Tong X, Feng Z, Wei L, Zhou D, et al. The use of annual physical examinations among the elderly in rural China: a cross-sectional study. BMC Health Serv Res. 2014;14(1):16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e6. Elsom KA. PERIODIC HEALTH EXAMINATION. J Am Med Assoc. 1960;172(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e7. Sinsongsook T. Why are Annual Health Checkup Results So Important? [Internet]. Samitivej Hospital in Bangkok, Thailand. Available from: https://www.samitivejhospitals.com/article/detail/annual-checkup-guide-importance-early-detection\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e8. Suka M, Yoshida K, Matsuda S. 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Shin J, Choi Y. Awareness and Behavior on the Periodic Health Examination in Korean Elderly Subjects. Innov Aging. 2017;1(suppl_1):391.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e26. Sun X, Chen Y, Tong X, Feng Z, Wei L, Zhou D, et al. The use of annual physical examinations among the elderly in rural China: a cross-sectional study. BMC Health Serv Res. 2014;14(1):16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e27. Ojong IN, Nsemo AD, Aji P. Routine Medical Checkup Knowledge, Attitude and Practice among Health Care Workers in a Tertiary Health Facility in Calabar, Cross River State, Nigeria. Glob J Health Sci. 2020;12(8):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e28. Alzahrani AM, Felix HC, Al-Etesh NS. Determinants of periodic health examination uptake among adults in Al-Jouf Region, Saudi Arabia. J Family Community Med. 2023;30(3):197\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e29. Alzahrani AM, Felix HC, Al-Etesh NS. Characteristics Associated with Knowledge about Periodic Health Examinations among Adults in Al-Jouf Region, KSA. J Taibah Univ Med Sci. 2023 Jun;18(3):652\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e30. S\u0026ouml;zen F, Aydemir S, Kut A. The awareness of patients regarding periodical health examinations within a sample from a university hospital. T\u0026uuml;rkiye Aile Hekimliği Dergisi. 2015;19(3):112\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e31. APPIAH H. Assessment of Knowledge and Practice of Periodic Medical Check- Up Among Workers at Kaneshie Market in Accra, Ghana. Afribary [Internet]. 2021; Available from: https://afribary.com/works/assessment-of-knowledge-and-practice-of-periodic-medical-check-up-among-workers-at-kaneshie-market-in-accra-ghana#overview\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e32. Surazu B, Muktar AM, Salifu A. Periodic Medical Checkup among Health Workers at a Teaching Hospital in Ghana. Journal of Health Care Communications. 2023;8(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e33. Fazal F, Shahani HA, Gondal MF, Tanveer U, Haider M, Us Sabah N, et al. Attitudes and Factors Determining the Practice of Routine Medical Checkups in the People of Rawalpindi, Pakistan: A Cross-Sectional Study. Cureus. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e34. Protection HKC for H, Health HKD of. Knowledge, Attitude and Practice of Medical Checkup. 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e35. Chandak A, Yeravdekar R, Shukla S. Trends in Students\u0026rsquo; Outlook for Annual Health Checkup at an Indian University. Indian J Public Health Res Dev. 2017;8(4):662.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e36. AlBaloushi. NN, AlOmair. SA, Ali SI. 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Practice of Periodic Medical Examination among Hospital Workers in a Nigeria Teaching Hospital. Nig Q J Hosp Med. 2008;14(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e44. Statistics SGA for. Saudi Census 2022. Saudi Census 2022: Population by Age Group. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e45. Alessy SA, Alattas M, Mahmoud MA, Alqarni A, Alghnam S. Population health data in KSA: Status, challenges, and opportunities. J Taibah Univ Med Sci. 2022;17(6):1060\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e46. Erten J, Zaman I. Importance of routine health checkups in young adults. Journal of Adolescent Health. 2004;34(1):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e47. Ministry of Health (MOH). School-Based Obesity Control (Rashaqa) [Internet]. MOH Initiatives \u0026amp; Projects. 2021. 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Br J Health Psychol. 2007;12(3):403\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e52. ADLER NE, OSTROVE JM. Socioeconomic Status and Health: What We Know and What We Don\u0026rsquo;t. Ann N Y Acad Sci. 1999;896(1):3\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e53. Culica D, Rohrer J, Ward M, Hilsenrath P, Pomrehn P. Medical Checkups: Who Does Not Get Them? Am J Public Health. 2002 Jan;92(1):88\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e54. Chingono RMS, Mackworth-Young CRS, Ross DA, Tshuma M, Chiweshe T, Nyamayaro C, et al. Designing Routine Health Checkups for Adolescents in Zimbabwe. Journal of Adolescent Health. 2021;69(6):940\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e55. Deanship of Scientific Research King Saud University. Rules Governing the Ethics of Scientific Research [Internet]. Rules Governing the Ethics of Scientific Research as Approved by the Sixth Meeting of the University Council on 11/06/1436 H. 2015. Available from: https://dsrs.ksu.edu.sa/sites/dsrs.ksu.edu.sa/files/imce_images/aklaqyat-sfar-1437.pdf\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e56. Ministry Of Education. Rules, regulations and policies [Internet]. General Education School Regulations. 2021. Available from: https://www.moe.gov.sa/en/aboutus/nationaltransformation/Pages/rpr.aspx\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e57. World Health Organization: WHO. Adolescent health [Internet]. 2019. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1\u003c/span\u003e\u003c/li\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Periodic Health Examinations, Knowledge, Performance, Adolescents, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-4664136/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4664136/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Objectives: To evaluate and assess the awareness, knowledge, and level of application of recommended Periodic health examinations (PHEs) for adolescents in Riyadh. Methods: Descriptive Cross-sectional study, conducted among adolescents between June 2022 and January 2023. The Sample size was 1199 adolescents of both genders, between the ages of 12-20 years, studying in intermediate and secondary schools in Riyadh. The sample of participants was collected through a stratified multistage random sampling technique. Ethical approval and Ministry of Education acceptance were considered. The data was collected using a structured, self-administered questionnaire containing close-ended questions. The level of knowledge was assessed by using three knowledge items; PHE definition, PHEs performance time, and the list of recommended PHEs known. The level of performance was assessed based on the performance of recommended (Six recommended PHEs by Saudi CDC) and none-recommended (Nine non-recommended PHEs as distractors). Results: Among the (1199) adolescents, the vast majority (70.6%) were aware of the PHEs. There is a positive attitude of adolescents toward PHEs, with (75.8%) acknowledging their importance and (87.1%) willing to undergo PHEs if given the opportunity. Despite this positive attitude, the actual knowledge and performance of PHEs remains relatively low, with (56.1%) being illiterate about it and only (36.8%) having undergone PHEs at least once, and a smaller percentage (26.1%) doing so regularly. There was a clear association (p\u003c0.05) between the level of knowledge and application. Adolescents with adequate knowledge had a higher prevalence of application (56.8% VS 43.2%). There was an association between Adolescents' level of education and their levels of knowledge and performance (p\u003c0.05). The more educated adolescents the higher their knowledge level and performance level. There was also an association between the availability of health insurance and application. The presence of health insurance increases the probability of applying PHEs. The most used sources of information regarding PHEs were digital sources (62.1%). Conclusion: The study concluded that there is a positive attitude of adolescents toward PHEs. The study highlights a disparity in knowledge and performance of PHEs among adolescents, influenced by socio-demographic factors such as gender, nationality, type of school, and parental education. Females and students from private or international schools, as well as those with higher levels of parental education, demonstrated better knowledge and higher performance rates of PHEs. The research underscores the role of digital sources in educating adolescents about PHEs. This study emphasizes the need for targeted educational interventions to improve adolescent knowledge and performance of PHEs, considering the identified barriers and socio-demographic influences.","manuscriptTitle":"Adolescents Perceptions and Behaviors Towards Periodic Health Examinations in Riyadh, Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2025-03-31 23:50:58","doi":"10.21203/rs.3.rs-4664136/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-28T08:24:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-28T08:22:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-21T07:56:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public 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