AWARENESS AND ACCEPTANCE OF DIGITAL RECTAL EXAMINATION AMONG THE GENERAL POPULATION IN SAUDI ARABIA: A NATIONWIDE CROSS-SECTIONAL STUDY

Abstract

Background: Digital rectal examination (DRE) is a simple yet essential clinical tool for the evaluation of anorectal and gastrointestinal conditions. Despite its diagnostic value, its utilization remains limited, largely due to low public awareness and multiple psychological and sociocultural barriers. This study aimed to assess awareness and acceptance of DRE among the general population in Saudi Arabia and to identify factors influencing its acceptance.

Methods: A web-based cross-sectional study was conducted among individuals aged 18–75 years across all regions of Saudi Arabia using a snowball sampling technique. Data were collected through a structured, self-administered online questionnaire. The survey assessed sociodemographic characteristics, awareness, acceptance, and perceptions of DRE, as well as knowledge related to hemorrhoids. Statistical analysis was performed using SPSS version 29. Descriptive statistics were used to summarize the data, while inferential analyses, including Chi-square, Mann–Whitney U, and Kruskal–Wallis tests, were applied. Multivariate logistic regression was conducted to identify predictors of awareness. A p-value < 0.05 was considered statistically significant.

Results: A total of 686 participants were included. Overall awareness of DRE was predominantly moderate (53.9%), with 27.1% demonstrating high awareness and 19.0% low awareness. More than half of participants (58.3%) reported that they would refuse DRE if recommended by a physician. Common barriers included shyness (43.1%), fear of the procedure (42.0%), and disgust (30.5%). Awareness was significantly associated with age and employment status (p < 0.001), while acceptance was significantly associated with gender, age, and employment status (p < 0.001). Males, older individuals, and employed participants were more likely to accept DRE.

Conclusion: Awareness of DRE among the general population in Saudi Arabia is moderate; however, acceptance remains limited due to psychological and sociocultural barriers. These findings highlight a critical gap between awareness and actual practice. Targeted, culturally sensitive educational interventions are essential to improve acceptance and promote early clinical evaluation of anorectal and colorectal conditions.