Thyroid disorders are globally recognized as a common health concern, yet many go undiagnosed, partially due to the lack of awareness of the risk factors, symptoms, and disease consequences among the general population (Canaris et al., 2013). Given the high prevalence rates of undiagnosed cases of thyroid disorders in Jordan (Ajlouni et al., 2022), and the variations in KAP survey results across different communities worldwide (Rai et al., 2016, Alyahya et al., 2021, Liu et al., 2021, Iqbal et al., 2021, Alhazmi et al., 2022, Alibrahim et al., 2023), it was necessary to assess the knowledge of thyroid disorders among Jordanians. This study also aimed to identify common misconceptions and explore the attitudes and practices related to thyroid disorders.
The findings of the study revealed that participants had a fair level of knowledge, as reflected by a mean knowledge score of 7.22 (± 2.86) out of 14.00. Similar knowledge scores were observed in the literature (Alyahya et al., 2021, Alhazmi et al., 2022, Alibrahim et al., 2023), however, direct comparisons between studies cannot be made due to disparities in the assessment tools used. The study encompassed participants from different regions in Jordan with a higher percentage from the central region (57.7%) compared to the northern (37%) and southern (5.3%) regions. This distribution aligns with the higher population density found in the central governates where the capital city Amman is found. Interestingly, the place of residence did not affect knowledge scores in this survey, indicating that awareness campaigns could be of benefit in any part of Jordan.
The age group did not affect the knowledge score as well, but most of the participants (39.7%) were from the age group (41–55 years of age), probably because of their personal experiences with such disorders making them more motivated to participate, indeed, we found that a staggering 66.1% of participants had a family member who was previously diagnosed with a thyroid disorder. Additionally, a recent study conducted in Jordan showed a high prevalence of thyroid disorders in a population from a similar age group (Abu-Helalah et al., 2019).
Participants showed good knowledge about the function of the thyroid gland and understood that thyroid dysfunction affects metabolism (73.6%) and that thyroid disorders are not contagious (97.2%), but there was a lack of knowledge regarding the impact of thyroid hormone on cholesterol levels (41.8%). In contrast, previous studies conducted in other countries had higher knowledge of this aspect of thyroid function (Almuzaini et al., 2019, Mirghani et al., 2023).
Awareness of thyroid disorders risk factors could help in avoiding such risk factors or may result in an earlier diagnosis. In this study, a family history of thyroid disorders was the most recognized risk factor among participants (68.7%), while recent infection was the least recognized (8.1%). Additionally, the study revealed that only 27.1% of participants correctly recognized the association between smoking and thyroid disorders. Smoking, which is quite prevalent in Jordan (Nakkash et al., 2022), was previously found to be positively associated with hyperthyroidism(Åsvold et al., 2007), this information could possibly be leveraged to alter smoking behavior. A previous study conducted in Saudi Arabia demonstrated a higher level of knowledge of those risk factors compared to our study (Mirghani et al., 2023, Alyahya et al., 2021).
Untreated thyroid disorders, even subclinical hypothyroidism, during pregnancy can have significant implications for both maternal and fetal health (Ramprasad et al., 2012, Casey et al., 2005). Notably, only 19.8% of participants were aware of the association between pregnancy and thyroid disorders, in addition, it was observed that 68.2% of participants either did not know or incorrectly thought women should stop taking thyroid medications during pregnancy, which was similar to a study conducted in India where 63.6% of participants had this understanding (Kumar et al., 2017). Improving public knowledge about thyroid disorder risk factors and treatment, particularly in pregnant women, holds great significance in enhancing awareness and ultimately leading to improved maternal and fetal health outcomes.
Awareness of the symptoms of thyroid disorders and adopting appropriate health-seeking behavior could play a crucial role in reducing the prevalence of undiagnosed cases. In this study, the most commonly mentioned symptom for thyroid disorders was weight change (82.0%), closely followed by fatigue (67.0%). On the other hand, diarrhea/constipation was among the less frequently indicated symptoms (26.1%) among participants. These outcomes are consistent with earlier research that reported similar percentages (Almuzaini et al., 2019, Alyahya et al., 2021, Mirghani et al., 2023).
This study also found that only 38.1% of participants were aware that thyroid disorders can lead to menstrual abnormalities, although 62.9% of participants were female, while another study conducted in Saudi Arabia reported better knowledge of this symptom with 48.4% of participants identifying it correctly (Mirghani et al., 2023). It should be noted that menstrual abnormalities were reported by around 30% of hypothyroid patients in a recent study (Koyyada, 2020), this suggests that this symptom is quite prevalent among hypothyroid patients. Considering that hypothyroid disorders are estimated to impact around 4–10% of women, there should be awareness of thyroid disorders symptoms within the realm of women’s health (Redmond, 2002). This point was also emphasized in a study among Indian women that concluded that knowledge among women on thyroid disorders was inadequate (Rai et al., 2016)
This study investigated participants’ knowledge of dietary recommendations for individuals with thyroid disorders. Specifically, it focused on the consumption of cruciferous vegetables and soya products, which contain naturally occurring goitrogens that have the potential to interfere with thyroid function (Messina and Redmond, 2006). The findings revealed that a significant majority, specifically 69.4% of the participants, did not believe that such foods should be avoided, which exceeded the results of a previous study conducted in India (Rai et al., 2016), but was comparable to those of a separate study conducted in Saudi Arabia (Alyahya et al., 2021). Literature on this topic indicates that such foods, consumed at normal levels, do not affect thyroid function in healthy individuals and are unlikely to have an effect in individuals susceptible to thyroid disorders (Messina and Redmond, 2006).
In our study, a mere 6% of participants believed that thyroid disorders could be treated with herbal medicine, which significantly contrasts with studies conducted in India where a higher percentage perceived herbal medicine as viable treatment options for thyroid disorder (Rai et al., 2016, Singh et al., 2014). On the other hand, a separate study conducted in Jordan revealed a high prevalence of herbal product utilization, with chronic disease being the most common reason for their use (Abdel-Qader et al., 2020). While herbal medicine is commonly utilized for general chronic conditions in Jordan, its specific effectiveness in treating thyroid disorders is not widely recognized or supported, probably due to the high success rate and availability of thyroid treatments (Sundaresh et al., 2017).
It was interesting to note that participants who displayed good knowledge were the ones who considered thyroid disorders as common and dangerous, which could be attributed to a previous personal encounter with the disease as alluded to earlier. Another reason could be the education received regarding thyroid disorders from physicians, which is supported by the fact that around 35.9% chose to learn about thyroid disorders from a physician, and more than half of the participants (57.5%) reported having undergone a physical examination of their thyroid. The belief that thyroid disorders are preventable was held by most participants (59.8%) and was also more prevalent among participants with good knowledge. Preventive measures that could be taken to reduce the risk of thyroid disorders include sufficient iodine intake, exercise, and avoiding smoking (Azizi et al., 2017).
Participants displayed good health-seeking behavior since they primarily relied on healthcare professionals or their family and friends as their main sources of information about thyroid disorders. This emphasizes the importance of incorporating patient perspectives and social support networks in delivering comprehensive care for thyroid disorders by physicians. Yet a majority indicated a preference for consulting endocrinologists as their first choice, and only 19.3% of participants chose to visit a primary health care center. This could indicate an underutilization of the primary healthcare system in Jordan. Collaborative efforts between primary healthcare providers and specialized practitioners, such as endocrinologists, could lead to more efficient and effective management of thyroid disorders, optimizing resource allocation within the healthcare system (Todd, 2009).
A higher knowledge score was associated with factors such as being female, having higher education, and a personal history of thyroid disease, some of those factors were reported to be associated with better knowledge in several studies in Saudi Arabia (Alyahya et al., 2021, Syed et al., 2022) and Pakistan (Iqbal et al., 2021). While another study, also in Saudi Arabia, found that those factors did not affect knowledge or perceptions of the disease(Alhazmi et al., 2022). In KAP studies among the public in Jordan, being female was often associated with a better knowledge score (Alaridah et al., 2023a, Alaridah et al., 2023b), on the other hand, gender was not a significant factor when KAP studies were performed among university students (Abu-Humaidan et al., 2022, Abu-Humaidan et al., 2021). Our study identified an additional factor that was significantly associated with knowledge levels, specifically, being divorced or widowed was a significant indicator of having lower knowledge levels regarding thyroid disorders. One possible explanation for this is that spouses often function as in-home caretakers, providing support and assistance in managing health-related matters.
The data generated in this study should be interpreted considering some limitations. Firstly, the use of convenience sampling introduced a potential bias regarding participation, which would restrict the generalizability of findings, for example, most participants were females (62.9%), however, thyroid disorders are known to be more predominant in females. Thus, this limitation might be inherent to the topic being studied. Secondly, participants' ability to accurately remember and report past experiences, such as previous physical examinations for thyroid disorders or family history of thyroid conditions, may be subject to memory distortions or forgetfulness. Lastly, there was the possibility of self-selection bias, those who chose to participate in the study might have had a preexisting interest or knowledge about thyroid disorders, which could lead to an overrepresentation of individuals who were well-informed.