Socio-demographic and behavioral factors associated with nutrition-label reading among Saudi adults: insights from a theory of planned behavior approach

Abstract

Background

Nutrition labeling is widely used to help consumers make healthier food choices. In Saudi Arabia, the Saudi Food and Drug Authority introduced mandatory energy labeling in 2019; however, limited research has examined nutrition label use among Saudi adults following the policy’s implementation. This study examined nutrition knowledge, attitudes, and practices related to self-reported nutrition-label reading among Saudi adults.

Methods

A cross-sectional online survey using convenience sampling was conducted among adults in Saudi Arabia between September and November 2020. Ethics approval was obtained from the Institutional Review Board of King Abdullah International Medical Research Center. Selected Arabic-adapted items from the Food Label Use Questionnaire were used. Chi-square tests examined associations between socio-demographic variables, attitudes toward nutrition labels, and label-reading frequency. Binary logistic regression examined factors associated with positive attitudes and frequent nutrition-label reading.

Results

A total of 396 adults were included in the analysis; 85.4% reported positive attitudes toward nutrition labeling, but only 42.6% frequently read nutrition labels. Female gender and married status were associated with more frequent label reading (P < 0.05). Positive attitudes toward nutrition labels were associated with higher odds of frequent nutrition-label reading (OR = 3.70; 95% CI: 1.79–7.14; P < 0.001), while nutrition knowledge was associated with positive attitudes (OR = 1.50; 95% CI: 1.01–2.23; P = 0.045) but not with label-reading frequency.

Conclusions

Positive attitudes toward nutrition labels were associated with more frequent nutrition-label reading among Saudi adults. Improving the perceived relevance and practical use of nutrition labels may support greater engagement with label reading in everyday food choices.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40795-026-01461-7.

Background

Unhealthy dietary patterns characterized by the consumption of energy-dense, nutrient-poor foods and physical inactivity are among the top four major modifiable risk factors contributing to the burden of non-communicable diseases (NCDs) [1]. The high prevalence of poor nutrition, obesity, and lack of awareness of NCD risk status has been documented in the Eastern Mediterranean Region [2]. For example, obesity (body mass index [BMI] ≥ 30 kg/m²) is a major nutrition-related public health concern that affects 24.7% of adults in Saudi Arabia [3], placing a substantial strain on the health system’s capacity [4].

Nutrition labels can be a cost-effective strategy to help consumers make informed dietary choices and reduce the risk of diet-related diseases [5]. In particular, front-of-pack labeling systems such as colour-coded and warning labels have been associated with improved consumer purchasing behaviour and product reformulation [6, 7]. In Saudi Arabia, the Saudi Food and Drug Authority (SFDA) introduced mandatory energy labeling in 2019, requiring restaurants and food service establishments to display energy content on menus. In 2025, SFDA introduced additional mandatory menu-labeling requirements, including high-salt warning labels for menu items exceeding the specified salt threshold, caffeine-content disclosure for beverages, and Physical Activity Calorie Equivalent (PACE) labeling. Together, these measures reflect the continued expansion of nutrition information disclosure in restaurant and food-service settings [8, 9]. However, limited public engagement with nutrition labeling may reduce the effectiveness of these policies. For example, recent studies indicate that although many consumers harbor positive attitudes toward nutrition labeling, this does not necessarily translate into consistent label use or healthier purchasing behavior [10–12]. Previous studies have also identified several factors associated with nutrition-label use, including limited time, label complexity, taste, price, and convenience [13–17].

The Theory of Planned Behavior (TPB) has been commonly used to explain food-choice and health-related behaviors, as it accounts for both motivational and contextual determinants of decision-making [18–20]. TPB suggests that individuals are more likely to perform a behavior when they intend to do so. Behavioral intention is shaped by three main constructs: attitude toward the behavior, subjective norms, and perceived behavioral control [21, 22]. Attitude refers to whether the behavior is viewed positively or negatively, subjective norms refer to perceived social expectations, and perceived behavioral control refers to how easy or difficult the behavior is perceived to be [22].

Studies using TPB in the context of nutrition labeling show that individuals who hold favorable attitudes toward nutrition labels and perceive fewer obstacles, such as limited time or difficulty interpreting nutrition information, are more likely to engage in nutrition-label reading and use [23, 24]. However, most studies from Saudi Arabia have mainly used descriptive designs to assess consumer awareness and attitudes toward nutrition labeling [25–27]. Although some theory-based studies in Saudi Arabia have examined energy information on restaurant menus and food-choice intentions in restaurant settings [28, 29], these studies focused mainly on energy information at the point of meal purchase. Research examining nutrition knowledge, attitudes, and nutrition-label reading practices among the general Saudi adult population following implementation of the national energy-labeling policy remains limited.

To address these gaps, the current study, guided by TPB, aimed to assess nutrition knowledge, attitudes, and practices related to nutrition-label reading among Saudi adults shortly after implementation of the national energy-labeling mandate. In addition, this study aimed to identify socio-demographic and behavioral factors associated with attitudes toward nutrition labeling and the frequency of nutrition-label reading.

Methods

Study design

This study was a cross-sectional survey conducted among adults in Saudi Arabia from September to November 2020. The study was approved by the Institutional Review Board of King Abdullah International Medical Research Center, Riyadh (IRB No. SP20/215/R; 23 July 2020). At the beginning of the survey, participants received information about the study objectives, data confidentiality, and voluntary participation, after which electronic informed consent was obtained. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Participants

Participants aged 18 years or older were recruited through convenience sampling from academic institutions in Riyadh and social media platforms. This approach was used because no national sampling frame was available for Saudi adults at the time of data collection, and online recruitment was suitable for reaching participants shortly after implementation of the SFDA energy-labeling mandate. The required sample size was estimated at 384 participants using the Raosoft calculator, based on a 95% confidence level and 5% margin of error. A total of 396 responses were received through Google Forms. Because Google Forms only records completed submissions, incomplete questionnaires were not included.

Survey instrument

Selected items from the Food Label Use Questionnaire (FLUQ) were translated into Arabic and used in this study [30]. The original FLUQ was developed among university students; however, items related to nutrition knowledge, attitudes toward nutrition labels, and label-reading practices were selected because they aligned with the objectives of the current study. The questionnaire used in this study was an abbreviated Arabic adaptation of the Food Label Use Questionnaire developed for the present study. Items related to traffic-light labeling and Guideline Daily Amount systems were excluded because these front-of-pack labeling formats were not commonly used in Saudi Arabia at the time of data collection, particularly in restaurant menu settings, where energy information was primarily displayed in kilocalories (kcal). The questionnaire was translated into Arabic independently by two bilingual nutrition researchers, and discrepancies were resolved through discussion. A third bilingual reviewer assessed the final Arabic version for clarity and accuracy. The English version of the adapted questionnaire is provided as Supplementary File 1.

The following three nutrition knowledge questions were adapted from the FLUQ knowledge subscale:

1. “To obtain all essential nutrients, one must eat …” (correct answer: balanced meal).

2. “The nutrient that provides the most energy is …” (correct answer: fats); and.

3. “A balanced diet should contain …” (correct answer: carbohydrates, fats, protein, vitamins, and minerals).

Each item was scored dichotomously (1 = correct, 0 = incorrect), and scores were summed to create a total knowledge score ranging from 0 to 3, with higher scores indicating greater nutrition knowledge. These items were selected to assess basic nutrition knowledge relevant to interpretation of nutrition labels rather than comprehensive nutrition literacy.

Attitudes toward nutrition labels were assessed using a single FLUQ item asking whether participants considered nutrition labels helpful (Do you think nutrition labels are helpful? Yes/No). Responses were coded as positive for “yes” and negative for “no.” One overall attitude item was used to assess participants’ general views on the usefulness of nutrition labels. Participants were also asked how often they read nutrition labels; responses were grouped as frequent reading (always/usually) and infrequent reading (rarely/never).

Additional questions asked about the information participants looked for on nutrition labels, factors influencing food purchases, and reasons for reading or not reading labels, including lack of time, difficulty understanding labels, and health-related reasons.

Pilot testing

The Arabic questionnaire was pilot-tested with 10 adults recruited from colleagues and community contacts who were not involved in the main study. Minor wording changes were made based on participant feedback. The final version of the self-administered questionnaire was created in Google Forms and distributed electronically via institutional networks and social media channels, enabling broad public access. Respondents were not incentivized for participation in this study.

Statistical analysis

Descriptive statistics (frequencies and percentages) were calculated for all variables. The chi-square test of independence was used to examine associations between socio-demographic characteristics and nutrition-label reading or attitudes; Fisher’s exact test was used when the expected cell frequency was < 5.

Two binary logistic regression models were constructed to examine factors associated with label-reading behavior, with odds ratios (ORs) and 95% confidence intervals (CIs). Model A examined factors associated with the frequency of nutrition-label reading, including socio-demographic variables, knowledge score, attitudes toward nutrition labels, and reasons for not reading labels (perceived barriers). Model B examined factors associated with attitudes toward nutrition labeling and included socio-demographic variables, knowledge score, and perceived barriers related to label reading. This design enabled exploration of TPB-informed relationships in which nutrition knowledge was examined as a potential antecedent factor associated with attitudes and perceived behavioral control. Model fit was evaluated using Nagelkerke R² and the Hosmer–Lemeshow goodness-of-fit test.

All data analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 29.0 (IBM Corp., Armonk, NY, USA). A two-sided p-value < 0.05 was considered statistically significant.

Results

Socio-demographic characteristics

A total of 396 valid responses were included in the final analysis. Most respondents were female (75.0%) and young adults aged 18–29 years (56.8%). Slightly more than half were married (53.3%), and the majority held a bachelor’s degree (61.6%). Household income varied across the sample, with 23.7% reporting a monthly income of Saudi Riyal 3,000–6,000 and 21.0% reporting ≥ Saudi Riyal 23,000. Based on self-reported height and weight, 26.5% of participants were classified as overweight and 23.7% as obese according to World Health Organization (WHO) BMI categories. Additional socio-demographic characteristics are presented in Table 1.

Table 1.

Socio-demographic characteristics (n = 396)

Variables	Frequency	Percentage
Gender
Male	99	25.0
Female	297	75.0
Age (years)*
18–29	225	56.8
30–39	77	19.4
40–49	48	12.1
≥ 50	46	11.6
Marital status
Single/Other	185	46.7
Married	211	53.3
Education level
High school	93	23.5
Diploma	44	11.1
Bachelor	244	61.6
Postgraduate	7	1.8
Other	8	2.0
Family income (Saudi Riyal/month)
3,000–6,000	94	23.7
7,000–10,000	77	19.4
11,000–14,000	53	13.4
15,000–18,000	56	14.1
19,000–22,000	33	8.3
≥ 23,000	83	21.0
BMI category†
Underweight (< 18.5)	24	6.1
Normal (18.5–24.9)	173	43.7
Overweight (25–29.9)	105	26.5
Obese (≥ 30)	94	23.7

*Age was collected as a continuous variable and categorized for analysis

†BMI calculated from self-reported weight and height; categorized using WHO cut-offs

Nutrition knowledge, attitudes, and practices

Participants’ responses related to nutrition knowledge, attitudes, and nutrition-label reading practices are shown in Table 2. Most respondents (83.6%) reported that essential nutrients are obtained from a balanced meal, and 74.0% correctly identified the major food groups included in a healthy diet. The majority of respondents (85.4%) reported positive attitudes toward nutrition labeling. However, only 42.6% reported frequently reading nutrition labels.

Table 2.

Nutrition knowledge, attitudes, and practices toward nutrition labels among Saudi adults (n = 396)

Domain	Item	Response	n	%
Nutrition knowledge	To get all essential nutrients, we must eat…	Correct (balanced meal)	331	83.6
		Incorrect	65	16.4
	The nutrient that provides the most energy is…	Correct (fats)	45	11.4
		Incorrect	351	88.6
	A balanced diet should contain…	Correct (carbs, fat, protein, vitamins, minerals)	293	74.0
		Incorrect	103	26.0
Attitude	Attitudes toward nutrition labels	Positive	338	85.4
		Negative	58	14.6
Practices	Frequency of reading nutrition labels	Always	31	7.8
		Usually	138	34.8
		Rarely	63	15.9
		Never	164	41.4

Factors associated with label reading and food choices

The most commonly reported factor checked when reading nutrition labels was energy (kcal) (37.1%), followed by fat (30.1%) and ingredients (14.4%) (Table 3). Taste (33.3%) and nutritional value (26.8%) were the most commonly reported factors considered in purchasing decisions, whereas expiration date (17.9%), ingredients (14.6%), price (4.3%), and packaging (3.0%) were reported less frequently.

Table 3.

Factors influencing label reading and food choices among Saudi adults (n = 396)

Domain	Item	n	%
Factors considered when reading nutrition labels	Energy (kcal)	147	37.1
	Fats*	119	30.1
	Ingredients	57	14.4
	Protein	18	4.5
	Sugar†	17	4.3
	Sodium	6	1.5
	Other‡	32	8.1
Factors influencing purchasing decisions	Taste	132	33.3
	Nutritional value	106	26.8
	Expiration date	71	17.9
	Ingredients	58	14.6
	Price	17	4.3
	Packaging	12	3.0
Reasons for using nutrition labels	Health/weight management	226	57.0
	Understanding information	127	32.1
	Food allergy	24	6.1
	Health problems	19	4.8
Reasons for not using nutrition labels	No health problems	81	20.5
	No time	97	24.5
	Do not know how to read	95	24.0
	Other	123	31.1

*Includes trans-fat, saturated fat, cholesterol, and total fat

†Includes all types of sugar

‡Includes fiber, serving size, carbohydrates, and general nutrition facts

Health and weight management (57.0%) and understanding nutrition information (32.1%) were the most commonly reported motivations for reading nutrition labels (Table 3). The most commonly reported reasons for not reading nutrition labels included lack of time (24.5%), difficulty understanding information (24.0%), and lack of perceived health need (20.5%), while 31.1% cited other reasons.

Associations of nutrition-label reading and attitudes

The bivariate associations between socio-demographic characteristics, nutrition-label reading, and attitudes are presented in Table 4. No significant associations were observed for age, education, or income (all P > 0.05). However, gender and marital status were significantly associated with label-reading frequency and attitudes toward nutrition labeling. A higher proportion of females reported frequent label reading (P = 0.018) and positive attitudes toward nutrition labeling (P = 0.021) than males. Similarly, married participants were more likely than single or other respondents to report frequent label reading (P = 0.012) and positive attitudes (P = 0.016).

Table 4.

Bivariate associations of socio-demographic characteristics with nutrition-label reading and attitudes

Characteristic	Frequent Label reading n (%)	Infrequent Label reading n (%)	P	Positive Attitude n (%)	Negative Attitude n (%)	P
Gender
Male	29 (29.3)	70 (70.7)	0.018	75 (75.8)	24 (24.2)	0.021
Female	140 (47.1)	157 (52.9)		263 (88.6)	34 (11.4)
Age group
18–29	91 (40.4)	134 (59.6)	0.334	196 (87.1)	29 (12.9)	0.417
30–39	37 (48.1)	40 (51.9)		66 (85.7)	11 (14.3)
40–49	20 (41.7)	28 (58.3)		38 (79.2)	10 (20.8)
≥ 50	21 (45.7)	25 (54.3)		38 (82.6)	8 (17.4)
Marital status
Married	104 (49.3)	107 (50.7)	0.012	188 (89.1)	23 (10.9)	0.016
Not married	65 (35.1)	120 (64.9)		150 (81.1)	35 (18.9)
Education
Low (≤ Diploma)	55 (40.4)	81 (59.6)	0.287	113 (83.1)	23 (16.9)	0.304
High (≥ Bachelor)	114 (43.8)	146 (56.2)		225 (86.5)	35 (13.5)
Income
Low (≤ 14k)	83 (42.1)	114 (57.9)	0.551	166 (84.3)	31 (15.7)	0.447
High (≥ 15k)	86 (43.2)	113 (56.8)		172 (86.4)	27 (13.6)

Chi-square or Fisher’s exact test applied where appropriate. Label reading is defined as frequent (always/usually) vs. infrequent (rarely/never)

Multivariate logistic regression analysis showed that male (OR: 0.54 vs. female, 95% CI 0.33–0.90, P = 0.019) and single (OR: 0.52 vs. married, 95% CI 0.28–0.96, P = 0.038) participants had lower odds of nutrition-label reading after adjustment for confounders (Model A, Table 5). In contrast, positive attitudes toward nutrition labels were associated with higher odds of label reading (OR: 3.70, 95% CI 1.79–7.14, P < 0.001). No significant associations were observed for age, education, income, knowledge score, or reported barriers in Model A.

Table 5.

Logistic regression models examining factors associated with frequent nutrition-label reading and positive attitudes

Variable	Odds Ratios	95% CI	P
Model A. Factors associated with frequent nutrition-label reading
Age (per group increase)	0.80	0.59–1.08	0.143
Gender (Male vs. Female)	0.54	0.33–0.90	0.019
Marital status (Single/Other vs. Married)	0.52	0.28–0.96	0.038
Education (Low vs. High)	0.90	0.56–1.43	0.652
Income (Low vs. High)	1.05	0.68–1.63	0.832
Knowledge score (0–3)	1.02	0.75–1.38	0.895
Attitudes toward nutrition labels (Positive vs. Negative)	3.70	1.79–7.14	< 0.001
Reasons for not using labels	1.04	0.86–1.26	0.701
Model B. Factors associated with positive attitudes toward nutrition labels
Age (per group increase)	0.81	0.53–1.25	0.344
Gender (Male vs. Female)	0.97	0.49–1.91	0.928
Marital status (Single/Other vs. Married)	0.33	0.13–0.82	0.017
Education (Low vs. High)	1.61	0.82–3.16	0.168
Income (Low vs. High)	1.10	0.61–1.98	0.750
Knowledge score (0–3)	1.50	1.01–2.23	0.045
Reasons for not reading labels	0.99	0.77–1.28	0.947

Logistic regression models adjusted for all variables shown. Label reading = frequent (always/usually) vs. infrequent (rarely/never). Attitude = positive vs. negative

Single participants were also less likely to report positive attitudes toward nutrition labeling than married participants (OR: 0.33, 95% CI 0.13–0.82, P = 0.017) (Model B, Table 5). In addition, higher knowledge scores were associated with higher odds of positive attitudes toward nutrition labeling (OR: 1.50, 95% CI 1.01–2.23, P = 0.045). No significant associations were observed for age, gender, education, income, or reported barriers in Model B.

Both models demonstrated acceptable fit (Nagelkerke R² = 0.10 and 0.07 for Models A and B) and good calibration (Hosmer–Lemeshow χ²(8) = 9.90, P = 0.27 and 2.85, P = 0.94 for Models A and B).

Discussion

Positive attitudes toward nutrition labels were associated with more frequent self-reported nutrition-label reading than nutrition knowledge or perceived barriers, although regular label reading remained modest among Saudi adults in this sample. These findings are consistent with the commonly reported gap between positive attitudes and actual health-related behaviors [31, 32]. Lack of time and difficulty understanding labels were also common barriers, similar to earlier Saudi studies [26, 33]. However, these barriers were not significantly associated with label reading after adjustment. This suggests that attitudes toward nutrition labels may be more closely related to label reading than reported barriers in this sample. Self-reported label reading was used as an indicator of nutrition-label use, although reading a label does not necessarily mean that the information was used in purchasing decisions.

Although most participants demonstrated general nutrition awareness, recognizing balanced meals and dietary diversity as beneficial, few correctly identified fat as the most energy-dense nutrient, consistent with regional findings of limited applied nutrition knowledge among Saudi adults [34, 35]. Similar relationships between nutrition knowledge, attitudes, and self-reported label reading have been reported in previous TPB-informed research, where knowledge appears to shape attitudes more strongly than behavior itself [36].

Participants in the current study prioritized taste and overall nutritional value when making food purchase decisions, regardless of label-reading behavior. Evidence from global and regional studies indicates that taste remains one of the strongest drivers of food choice in real-world contexts, often outweighing health considerations [37, 38].

Among socio-demographic variables, female gender and marital status were associated with nutrition-label reading and attitudes. These findings are consistent with previous studies reporting greater engagement with nutrition labels and awareness of energy labels among females [39, 40]. Previous Saudi research suggests that women commonly play a major role in grocery shopping and family food choices [41], consistent with broader international patterns of gendered household food responsibilities [42]. However, the present study did not directly assess household food-purchasing responsibility, which limits interpretation of the gender and marital status findings. Meanwhile, education, income, and age were not significantly associated with nutrition-label reading in the current study, unlike findings reported in some Western populations [43].

Given that attitude, rather than knowledge, was the stronger correlate of label reading, improving nutrition knowledge alone may not be sufficient. This is consistent with Saudi studies showing that positive attitudes toward nutrition labeling are associated with label-influenced food choices [25, 26]. For example, approximately half of participants in one study reported that energy labeling influenced their order, while another study found that a smaller proportion regularly paid attention to energy labels when choosing food [25, 26]. Public health efforts may therefore need to move beyond awareness and focus on the practical use of nutrition labels in everyday food choices [44]. Strengthening consumers’ confidence in finding and interpreting nutrition information may help improve engagement with nutrition labels, particularly as menu-labeling requirements continue to expand in Saudi Arabia. Lower engagement among male and single adults may also indicate the need for more targeted outreach in these groups.

Energy information, typically displayed in kilocalories (kcal), is often more visually prominent on labels [45], which may partly explain the greater consumer attention to energy content compared with sugar or sodium. The impact of nutrition labeling can vary by label format and population [46, 47], and simplified front-of-pack labeling systems, such as traffic-light and Nutri-Score formats, have been associated with greater consumer attention and comprehension than traditional back-of-pack labels [48, 49]. Similar findings have been reported among Saudi consumers, where Nutri-Score most improved understanding of nutritional quality across food categories [50]. Recent SFDA menu-labeling initiatives, including PACE labeling, sodium warnings, and caffeine disclosures, reflect broader international efforts to improve nutrition communication and consumer awareness [51].

Several limitations should be considered when interpreting these findings. First, the cross-sectional design does not allow causal interpretation. Second, the questionnaire used selected adapted FLUQ items, which may have limited assessment of some constructs, particularly knowledge and attitudes. In addition, two adapted items related to food purchasing decisions and reasons for using nutrition labels did not include an “Other” response option, which may have limited the range of motivations captured. The low proportion of participants correctly identifying fat as the most energy-dense nutrient (11.4%) may also partly reflect ambiguity in interpretation of the original multiple-choice item. Third, convenience sampling and online recruitment resulted in a higher proportion of younger, female, and more educated participants, which may limit generalizability to the broader Saudi adult population. Fourth, all measures were self-reported and may therefore be affected by recall, reporting, and social desirability bias, potentially resulting in over-reporting of positive attitudes and nutrition-label use. Finally, because the survey was administered through Google Forms, response rates could not be calculated.

Despite these limitations, this study contributes to the limited evidence on nutrition-label use among Saudi adults following the implementation of mandatory energy labeling on menus in Saudi Arabia. The study was informed by TPB, which helped frame the examination of attitudes, knowledge, perceived barriers, and nutrition-label reading behavior, although not all TPB constructs were directly measured. The use of multivariable logistic regression allowed examination of factors independently associated with nutrition-label reading after adjustment for socio-demographic variables and other covariates. Future studies should include direct measures of behavioral intention and purchasing behavior to determine whether positive attitudes toward nutrition labels translate into food-choice decisions over time. Including measures of household food-purchasing responsibility may also help clarify the associations observed for gender and marital status.

Conclusion

Positive attitudes toward nutrition labels were more strongly associated with frequent self-reported nutrition-label reading than nutrition knowledge among Saudi adults in this sample. Although time pressure and difficulty understanding labels were commonly reported barriers, they were not independently associated with label-reading behavior after adjustment. Overall, the findings suggest that positive attitudes toward nutrition labels may be more closely associated with label engagement than nutrition knowledge. Lower self-reported label reading among male and single adults may indicate the need for more targeted public health communication strategies in these groups. Future longitudinal and intervention studies are needed to determine whether improving attitudes toward nutrition labels leads to sustained changes in nutrition-label use and healthier food choices.

Abbreviations

BMI

Body Mass Index

CI

Confidence Interval

FLUQ

Food Label Use Questionnaire

NCDs

Non-communicable diseases

OR

Odds Ratio

PACE

Physical Activity Calorie Equivalent

SFDA

Saudi Food and Drug Authority

TPB

Theory of Planned Behavior

WHO

World Health Organization

Authors’ contributions

The author was solely responsible for the conceptualization, study design, data analysis, interpretation of findings, manuscript drafting, and final approval of the version to be published.

Funding

This research received no external funding.

Data availability

The data are available on reasonable request from the corresponding author.

Declarations

Ethics approval and consent to participate

The study was approved by the Institutional Review Board of King Abdullah International Medical Research Center, Riyadh (IRB No. SP20/215/R; 23 July 2020). Information about the study objectives, data confidentiality, and voluntary participation was provided to participants at the beginning of the survey, after which electronic informed consent was obtained. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.