Bridging the gap: assessing public understanding of medical terms in Saudi arabia’s multilingual healthcare context

Abstract

Background

Arabic is the primary language in Saudi Arabia, but healthcare workers often use English medical terms when communicating with patients. This study evaluated the Saudi population’s knowledge of commonly used medical terms.

Methods

A cross-sectional study was conducted using a self-developed questionnaire. It was distributed through a social media platform. Categorical variables were analyzed using frequencies and percentages. The total knowledge score (out of 38) was presented as the mean ± standard deviation. Demographic variables were compared with responses using independent samples t-tests or ANOVA.

Results

A total of 784 respondents participated, with 50% aged 25 years or older. Of the respondents, 53% were female, 90% had a college or university education, and 61% lived in major cities. The majority (57%) were employed, 31% worked in healthcare, and 74% had a family member in the healthcare sector. About 26% reported having a chronic illness, while 29% visited a doctor frequently (4–6 times per year). Respondents aged 18 to 24 had significantly higher knowledge scores than those aged 25 and above (p < 0.001). College/university graduates had higher scores compared to those with only secondary education (p = 0.001). Healthcare workers scored significantly higher than those outside the healthcare sector (p < 0.001).

Conclusion

The study underscores the need for improved communication between healthcare providers and patients in linguistically diverse populations. It suggests educational interventions to enhance understanding of medical terms, particularly for individuals with lower education levels or those outside healthcare.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-07600-1.

Introduction

The field of medicine is advancing rapidly with new research and technological developments introducing new medical terms. The use of such terms by health professionals can be a barrier to effective communication with patients. Interactions laden with medical jargon can cause problems like anxiety, depression, and discouragement among patients [1, 2]. Conversely, using simple language positively impacts patient-doctor relationships and, consequently, ensures better health outcomes [3]. Additionally, cultural globalization and historical diversities have influenced medical terms, exacerbating these problems. However, the internet has provided the public with easy access to medical terms and enhanced their medical vocabulary [1, 2].

In Saudi Arabia, this issue is particularly relevant due to the predominance of English in medical education and practice, while most of the population primarily speaks Arabic. Healthcare professionals, including doctors, nurses, and pharmacists, frequently use English medical terms when communicating with patients and their attendants. However, the extent to which the Saudi population understands these terms remains unclear. Watermeyer, Thwala, and Beukes [4] caution that assuming patients fully grasp medical terminology can be dangerous, especially when language barriers exist. Misinterpretation of medical terms may lead to medical errors, compromise patient safety, and hinder effective treatment [5]. The English language is not commonly spoken in Saudi Arabia. The neglectful use of medical terms can place the Saudi population at a higher risk of misinterpreting Greek or Latin-originated Anglicized medical terms. It is commonly observed that both people with low and high literacy levels may encounter similar difficulties in understanding medical terms [6]. The potential communication gaps between patients and doctors have led to discouragement in using medical terms [7]. However, some patients, particularly from urban areas, prefer their healthcare professionals to use medical terms [8, 9].

Clear communication between patients and healthcare workers is essential for positive health outcomes [10]. Doctors’ interactions with their patients hold special significance in Saudi Arabia because many linguistically diverse healthcare expatriates work in the healthcare sector. Within the healthcare system, Arabic-speaking staff can effectively communicate with local Arabic-speaking patients, while expatriate staff may face challenges in maintaining effective communication with their Arabic-speaking patients [11]. One of the essential determinants of health is proficient communication in the host country’s official language [12]. In Saudi Arabia, the lingua franca is Arabic, and the majority of people do not understand or speak English. This could mainly be that schools in Saudi Arabia primarily teach in the native language [13]. The situation is further complicated by a lack of formal training in doctor-patient communication skills and insufficient research on the Saudi population’s awareness of medical terminology [14]. Saudi Arabia’s healthcare sector is unique due to its large expatriate workforce, which constitutes approximately 60% of doctors, 57% of nurses, and 61% of pharmacists [15]. Given these factors, it is critical to investigate whether language barriers contribute to medical misunderstandings and errors, as nearly 50% of medical errors in Saudi Arabia are attributed to communication failures [16].

This study hypothesizes that a significant portion of the Saudi population has a limited understanding of commonly used English medical terms, leading to potential misinterpretation and communication challenges in providing health care. Additionally, certain demographic groups, such as those with lower education levels or residing in rural areas, may be at a higher risk of misinterpreting medical terms.

This study makes a unique contribution to the existing health communication literature by providing the first empirical evidence of the Saudi population’s knowledge of commonly used medical terms and filling a crucial gap in the understanding of health literacy in the region. Secondly, it highlights the impact of Saudi Arabia’s linguistically diverse healthcare workforce on patient communication and identifying groups at higher risk of misinterpretation. Additionally, this study offers data-driven recommendations to improve doctor-patient communication strategies to reduce miscommunication-related medical errors and enhance patient safety.

By identifying gaps in medical term comprehension and proposing actionable solutions, this study aims to enhance the overall quality of healthcare communication in Saudi Arabia and contribute to broader discussions on language barriers in global health systems.

Methods

Study design

This was a nationwide cross-sectional study to assess people’s level of awareness and exposure to common English medical terms used while communicating with healthcare providers. Following Institutional Review Board (IRB) approval in July 2022, data collection, analysis, and the manuscript were completed in 2024.

Study subjects

This study included all Saudi Arabian citizens, male and female, who were at least eighteen years old and had completed their primary school. Participants were contacted through social media in major cities like Riyadh, Jeddah, Dammam, Al Khobar, Madinah, and Abha to represent the urban population. For the rural population, participants from villages and small cities of different provinces were recruited. Urban areas are characterized by high-density housing and infrastructure, in contrast to rural areas, which are characterized by spacious land with fewer people and homes [17, 18].

This research project, study number NRC21R/543/12, was approved by the Institutional Review Board (IRB), approval number IRB/0050/22, King Abdullah International Medical Research Centre, Riyadh.

Sample size

The current population of Saudi Arabia is 37,436,426 [19]. This study required at least 369 urban and 246 rural participants. These numbers are based on the sample size estimation method suggested by Kotrlik et al. [20] and Cochran [21].

Sampling technique

The target population was approached through social media platforms. An online survey form was distributed, and data were collected.

Development of the questionnaire

People’s knowledge of commonly used medical terms was assessed using a self-developed questionnaire. The questionnaire included participants’ demographics and their familiarity with medical terms. Since the identification of “commonly used medical terms” was subjective, healthcare workers were consulted to minimize bias. They were asked whether the selected medical terms were frequently used in communication with patients and their attendants.

The questionnaire included 54 medical terms with response options: ‘Yes,’ ‘No,’ and ‘Not sure. It was converted into Microsoft Forms, and a QR code and link were generated and shared with healthcare professionals at King Abdulaziz Medical City, National Guard Hospital, Riyadh, via WhatsApp. Healthcare workers were also invited to suggest additional commonly used medical terms not included in the questionnaire.

Medical terms were selected based on responses: those in the upper tertile (top 33%) and middle tertile (middle 33%) were included if at least 70% and 60% of respondents, respectively, agreed that those terms were commonly used in communication. Additionally, two new medical terms suggested by healthcare workers were incorporated into the final selection. The finalized questionnaire included a total of 38 medical terms for public opinion.

The questionnaire was translated into Arabic, and the translation was reviewed by an Arabic language expert. We validated the finalized questionnaire through a multi-step process. First, face validity was assessed by an expert health professional. Then, content validity was evaluated by a subject matter expert.

The questionnaire underwent a comprehensive validation process to ensure its effectiveness and relevance. Face validity was established through a review by an experienced health professional specializing in patient communication, who confirmed that the terms used were appropriate and understandable for the target population. Content validity was assessed by a subject matter expert with expertise in medical terminology and health literacy, ensuring that the questionnaire accurately represented the domain of commonly used medical terms and adequately covered the intended content. Additionally, a pilot study involving 10% of the target sample was conducted. This provided empirical data on the questionnaire’s performance and allowed for necessary revisions based on participant feedback.

The questionnaire was modified based on the feedback received during the pilot testing phase. The questionnaire was created on MS Forms, and a QR code was generated. Before performing the descriptive and inferential statistical analysis of the data generated by survey, its Cronbach’s alpha value was calculated. This value determines the internal consistency reliability, which reflects if the multiple items used in the survey are measuring the same construct consistently or not. The Cronbach’s alpha value of the survey used in this study was 0.974. This value indicated exceptionally high internal consistency and reliability of the survey items used. It provided evidence of quality and veracity of the survey items and scales used for data collection. It assures other researchers and readers that the survey items used captured the intended concept and the results derived from it are dependable and reproduceable.

Data collection

The local population of Riyadh, Saudi Arabia, participated in the data collection process. Initially, the university’s Saudi faculty and staff were contacted to share the questionnaire’s QR code with their family members, relatives, and friends residing in different parts of the country. The inclusion criteria were explained, and they were asked to share the QR code only with individuals who met the study criteria. For rural areas, students who were originally residents of villages and small cities in the Riyadh province were involved in the data collection process. Later, participants from other major cities, such as Jeddah, Madinah, and Abha, and villages were involved. All information was stored securely in MS Forms, with no personal data collected except for a few demographic variables.

Data management and analysis

The data were downloaded into an MS Excel file from the MS Forms online questionnaire. Data coding and cleaning were done in MS Excel before importing the data into SPSS v24 for analysis. The data are presented as frequencies and percentages for all categorical variables; the total knowledge score (out of 38) is presented as mean ± standard deviation (SD). The mean knowledge scores were compared between demographic variables using the independent samples t-test or ANOVA, as appropriate. Multivariable regression analysis was performed to identify the main variables associated with higher mean knowledge scores. All variables with a p-value less than 0.20 in the bivariate analysis (independent samples t-test/ANOVA) were included in the multivariable analysis. The significance level was set at 0.05 for all statistical tests.

Results

A total of 784 respondents filled out the survey. Their demographic characteristics are shown in Table 1. Half of the respondents, i.e., 393 (51%), were 25 or older, and 384 (49%) aged between 18 and 24 years. There were slightly more female respondents, i.e., 408 (53%), a large number (90%) of the respondents had college or university level education, and 475 (61%) were residents of main cities. More than half were employed in the public or private sector (57%) while 224 (30%) were retired or unemployed. A total of 238 (31%) of the respondents were healthcare workers, and 574 (74%) had a family member working in healthcare. There were 126 (26%) who reported suffering from a chronic illness. The frequency of visits to a doctor or clinic was reported as 4–6 times a year by 223 (29%), while another 220 (28%) reported visiting once or twice a year. The knowledge of medical terms was higher for young participants, having college or higher educational level, lived in villages, and employed in healthcare-related sector or have some members in the family working in the sector. The participants who visited the doctors more frequently did not have a higher score.

Table 1.

Demographic characteristics of the respondents (N = 784)

		n*	%
Age (N = 777)	18–24 years	384	49%
	25 years & above	393	51%
Gender (N = 771)	Male	363	47%
	Female	408	53%
Educational Status (N = 769)	Up to Secondary School	75	10%
	College/University	694	90%
Residential Area (N = 776)	Main City	475	61%
	Village/ Small cities	301	39%
Employment Status (N = 746)	Public or Private Sector Employee	425	57%
	Self Employed	39	5%
	Housewife	58	8%
	Retired or Unemployed	224	30%
Occupation related to health care (N = 770)	Yes	238	31%
	No	532	69%
Any family members’ occupation related to healthcare (N = 774)	Yes	574	74%
	No	200	26%
Suffer from any chronic illness (N = 770)	Yes	126	16%
	No	644	84%
How often visit a doctor or clinic (N = 773)	Rarely	280	36%
	Once or twice a year	220	28%
	4–6 times a year	223	29%
	Every month	50	6%

* Some missing data for different demographic variables

The survey (appendix 1) included 38 medical terms to assess the respondents’ knowledge, with one point given for each correct answer. The mean score for all respondents was 22.6 ± 12.4. Knowledge scores were compared across various demographic variables as shown in Table 2. Respondents aged 18–24 years had a higher mean score (26.7 ± 11.1) compared to those aged 25 years and older (20.2 ± 11.3) (p < 0.001). Respondents with college or university-level education had a higher mean score of 23.6 ± 12.2 than those with education up to high school (17.2 ± 11.2) (p < 0.001).

Table 2.

Respondents’ knowledge scores for the medical terms

		Total Knowledge score (Max = 38)
		N	Mean	sd	p-value
Age	18–24 years	384	26.8	11.1	< 0.001 a
	25 years & above	393	18.9	12.2
Gender	Male	363	22.5	12.7	0.55 a
	Female	408	23.1	12.0
Educational Status	Up to Secondary school	75	17.2	11.2	< 0.001 a
	College/University	694	23.6	12.2
Residential Area	Main City	475	21.7	12.5	0.002 a
	Village/ Small cities	301	24.5	12.0
Employment Status	Public or Private Sector Employee	425	22.1	12.4	< 0.001 b
	Self Employed	39	23.6	12.1
	Housewife	58	15.7	9.8
	Retired or Unemployed	224	25.0	12.1
Occupation related to health care?	Yes	238	33.5	6.8	< 0.001 a
	No	532	18.1	11.1
Any family members’ occupation related to healthcare?	Yes	574	23.0	12.2	0.58 a
	No	200	22.6	12.6
Suffer from any chronic illness?	Yes	126	21.2	12.3	0.09 a
	No	644	23.2	12.2
How often visit a doctor or clinic?	Rarely	280	24.1	12.3	0.002 b
	Once or twice a year	220	24.2	12.0
	4–6 times a year	223	20.6	12.3
	Every month	50	20.8	12.0

a: Independent samples t-test b: ANOVA

Respondents from villages/small cities scored higher (24.5 ± 12.0) than those from larger cities (21.7 ± 10.9) (p = 0.002). Housewives had a lower overall mean score (21.7 ± 10.9) compared to those who were employed, self-employed, or retired/unemployed (p < 0.001). Respondents in healthcare-related occupations had a significantly higher mean knowledge score (33.5 ± 6.8) compared to those not in healthcare-related occupations (18.1 ± 11.1) (p < 0.001). Finally, respondents who visited a doctor or clinic more frequently (every month or 4–6 times a year) had lower scores compared to those who visited rarely or only once or twice a year (p < 0.01).

A multivariable regression analysis was conducted to identify key demographic variables associated with the total knowledge score (Table 3). The variables significantly associated with the knowledge score were age group, education level, and healthcare-related occupation. Respondents aged 18 to 24 were more likely to have a higher knowledge score compared to those aged 25 and above (p < 0.001). Those with a college/university education had higher knowledge score compared to those with only education secondary school (p = 0.001). Healthcare workers had significantly higher knowledge score than those who were not employed in the healthcare sector (p < 0.001).

Table 3.

Multivariable linear regression analysis for demographic variables associated with the knowledge score

				95% Confidence Interval for B
		N	B	Lower	Upper	p-value
Age group	18–24 years	346	3.95	2.12	5.78	< 0.001
	25 years & above (ref)	383
Education	Up to Secondary school	72
	College\University	657	3.87	1.49	6.25	0.001
Residence	Main City	449	-1.41	-3.01	0.19	0.08
	Village/ Small cities (ref)	280
Employment status	Public or Private Sector Employee	412	2.07	-0.64	4.78	0.13
	Self Employed	38	2.61	-1.46	6.68	0.21
	Housewife	57	2.76	-0.26	5.77	0.07
	Retired or Unemployed (ref)	222
Occupation related to health care	Yes	223	14.16	12.55	15.77	< 0.001
	No (ref)	506
Suffer from any chronic illness	Yes	121	0.64	-1.31	2.59	0.52
	No (ref)	608
How often visit a doctor or clinic	Rarely	264	0.74	-2.24	3.73	0.63
	Once or twice a year	206	1.02	-2.00	4.05	0.51
	4–6 times a year	211	-0.98	-3.99	2.03	0.52
	Every month (ref)	48

Discussion

Most of the studies on communication barriers between the Saudi population and healthcare workers focus on the perspectives of healthcare professionals and hospital-related settings [22–24]. This study is unique as it directly captures the general public’s understanding of commonly used medical terms, providing a patient-centered perspective often overlooked in other local studies. By assessing public comprehension rather than just healthcare workers’ perceptions, this study offers a more comprehensive insight into the real-world implications of medical jargon in Saudi Arabia’s multilingual healthcare system. Hence, it adds a critical dimension to the discourse on health communication and literacy in the region.

In this study, responses to the 38 medical terms in the questionnaire varied among participants, with some not responding to certain questions. The researchers were expecting a higher number of participants. The response to a questionnaire-based studies and their items can be influenced by demographic factors such as age, sex, education, and profession [25]. Cultural sensitivity also plays a role in the participation rate in social science research. Furthermore, participation in studies can vary depending on the type of study, the topic being investigated, and how and by whom the study is conducted [26]. Lallukka, Pietiläinen [27] found that older age, higher occupational class, and higher income are more likely to volunteer in survey-based studies. Similarly, in this study, half of the respondents were 25 years or older. Female participation was comparatively higher, reflecting the growing trend of women’s involvement in education and research. This may be due to various initiatives by the Saudi Arabian government to encourage and empower women in all aspects of life [28, 29].

90% of the respondents had a college or university education, indicating that the surveyed population was representative of the more educated group of the population. The majority (81%) of the Saudi Arabia’s population lives in urban areas [30], and this study also had a higher representation from cities (61%) compared to rural areas (39%). Respondents with family members working in healthcare actively participated in the study. 16% of respondents reported suffering from a chronic disease.

The knowledge scores of the respondents aged 18–24 were significantly higher than of those aged 25 years and above. Young adults are often more familiar with technology and online platforms, which are commonly used to distribute questionnaires, making it easier for researchers to reach them [31]. The education level of this age group matches with their higher college/university education level, resulting in significantly higher scores compared to those with education up to high school level. Interestingly, respondents from rural areas had a significantly higher knowledge score than those from urban areas. The lower knowledge scores among the urban population could be attributed to the busy lifestyles in big cities, which might reduce their interest in participating in such studies. Conversely, people living in rural areas have the luxury of time and respond diligently to the questionnaire items. Additionally, the classification of residential areas in Saudi Arabia can be confusing, as many individuals who claim to be rural residents work in cities, and their knowledge levels align with those living in urban areas. Evidence suggests that rurality alone does not account for rural-urban health literacy differences; sociodemographic factors also play a significant role [32]. Furthermore, it needs to be investigated the underlying causes more rigorously in future research, including the role of sociodemographic and contextual variables that may influence health knowledge across rural and urban populations.

Employed or retired individuals had significantly higher knowledge scores compared to housewives, who are often occupied with household responsibilities and childcare. Healthcare workers also had significantly higher knowledge scores than those not employed in healthcare-related occupations, indicating that healthcare workers recognized the importance of the study and responded to a greater number of questionnaire items.

Although not statistically significant, individuals who visited a doctor or clinic less frequently had higher knowledge scores than those who visited four or more times a year. These individuals might include healthcare workers who do not visit doctors as often and may treat themselves. Moreover, people who rarely visit hospitals might be more eager to learn about certain symptoms they encounter, unlike patients who tend to visit the hospital upon developing any symptoms and prefer to inquire about things they do not understand.

Multivariable regression analysis showed that age group, education status, and healthcare-related occupation were significantly associated with the knowledge score. Respondents aged 18 to 24 years were more likely to have a higher knowledge score compared to those aged 25 years and above. This younger age group tends to have more flexible cognitive abilities, such as memory retention and processing speed, which are generally at their peak during early adulthood. These cognitive factors can contribute to better performance in knowledge-based assessments [33]. Moreover, their recent formal education may also be an important factor.

This study depicts that those with a college or university education had higher knowledge scores compared to those with only secondary school education. Higher literacy is generally associated with a better understanding of health issues, enabling individuals to comprehend medical instructions, navigate the healthcare system, and engage in preventive health behaviors [34]. However, it is important to acknowledge that comprehension of medical terms can also be influenced by factors such as personal interest, prior health experiences, occupation, and access to health-related information, regardless of formal education level. These findings support the idea that, overall, individuals with higher education levels tend to have a better understanding of medical terminology, although variations do exist.

Healthcare workers had higher knowledge scores than those not employed in the healthcare sector. It is well known that healthcare workers undergo rigorous education and training specific to their field, equipping them with a comprehensive understanding of medical concepts, terminology, and procedures. This specialized training contributes significantly to their higher knowledge scores [35].

Conclusions

The findings of this study highlight the variable responses to medical terms within a diverse demographic framework. The age, sex, education, and profession show significant impacts. The higher participation of females and educated individuals from urban areas aligns with broader social trends and governmental initiatives in Saudi Arabia to promote urbanization, education, and women’s empowerment.

The lower scores of urban populations and higher scores of rural populations suggest that sociodemographic factors and rurality play a crucial role in health literacy. The young adults showed higher knowledge, likely due to their familiarity with digital platforms and higher education levels. Significant correlations between occupation and knowledge scores highlight the impact of professional background on medical understanding. Additionally, the association of higher education with a better understanding of medical terms emphasizes the critical role of education in health literacy. These findings underscore the need for targeted healthcare policies and educational interventions to enhance medical literacy and patient engagement. Healthcare policymakers can integrate health literacy programs into educational curricula to improve public understanding of commonly used medical terms from an early stage. By developing bilingual or simplified medical communication materials, the health care institutions can bridge language gaps, particularly for patients with limited English language proficiency. Additionally, cultural and linguistic training for expatriate healthcare professionals may enhance doctor-patient interactions in a predominantly Arabic-speaking population. By addressing gaps in medical communication, these measures can improve patient comprehension, reduce misinterpretations, and ultimately enhance healthcare outcomes in Saudi Arabia.

Limitations of the study

The main limitation of this study is the under representation of the rural population. Although 39% of respondents stated that they belonged to rural areas, their current residency status and duration of residency were not known. In this region, people often identify villages and rural areas as their original place of residence, but many may have lived in urban areas for a significant period of time. Another limitation is the participants’ affiliation with the health profession or having family members related to the health profession. Among the participants, 31% were health professionals, and 74% had some family members related to the profession. This could have introduced some biased data.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

“Ismail Memon. Nabeel Qamar. and Zeeshan Feroz”. Designed the study, wrote the proposal, collected data, wrote and reviewed the manuscript.“Abdulaziz Alarifi. Ahmed Aljohani. Abdulmalek Mengash. Saad Al Qarni. and Abdulmohsin Alkushi”. Collected data, wrote and reviewed the manuscript.Aamir Omair and Shahid Akhund”. Methodology supervision, conducted data analysis, wrote and reviewed the manuscript.

Funding

No funding received.

Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The ethical clearance was obtained from the institutional ethical committee, King Abdullah International Medical Research Centre, Riyadh. Informed consent to participate was obtained from all of the participants in the study. The study methodology and execution adhered to the Helsinki declaration ethical standards.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.