Influence of Educational Campaigns on Community Knowledge About Chronic Kidney Disease: Results from a Community-Based Campaign

Highlights

Public health relevance—How does this work relate to a public health issue?

• Chronic kidney disease remains underrecognized despite its growing prevalence and association with diabetes and hypertension.
• Community-based educational campaigns may improve public awareness and promote earlier recognition of CKD risk factors.

Public health significance—Why is this work of significance to public health?

• Participants demonstrated higher immediate post-campaign knowledge of CKD symptoms, assessment, risk factors, and treatment than at baseline.
• Misconceptions regarding herbal treatments for CKD decreased after the educational intervention.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?

• Community awareness campaigns can serve as practical tools to improve CKD health literacy in high-risk populations.
• Future initiatives should link awareness efforts with early detection and encourage collaboration between healthcare providers, universities, public health authorities, and community organizations.

Abstract

Chronic kidney disease (CKD) is an emerging public health problem, and low public awareness may result in late diagnosis and poor outcomes. We evaluated baseline knowledge of CKD among participants in a community awareness campaign and immediate knowledge change following a focused educational intervention. The study was designed as a biphasic pre- and post-intervention study that took place over the course of a 3-day public campaign that coincided with World Kidney Day on 13 March 2025. The campaign consisted of six educational stations on important topics of CKD, blood-pressure and blood-glucose measurements, with access to nephrologist consultation. Participants completed a validated questionnaire prior to and after attending the campaign. The changes in knowledge about kidney function, risk factors, symptoms, diagnostic methods, and treatment were evaluated. A total of 134 responses were received; 102 participants were eligible and completed both assessments. Knowledge scores and several item-level response proportions were higher immediately after campaign participation than before participation. The knowledge of diabetes mellitus as a risk factor for CKD increased from 34.3 to 80.4%, the knowledge of blood tests for renal assessment increased from 52.0 to 80.4%, and the knowledge of pharmacological treatments that slow down the progression of CKD increased from 52.9 to 78.4%. The percentage of people who think that herbal medicines are effective to treat CKD decreased from 19.6% to 8.8%. No demographic or clinical predictors of change in overall knowledge were statistically significant, although differences were seen in specific knowledge domains. These findings show higher CKD knowledge immediately after participation in a structured community campaign. Controlled studies with longer follow-up are needed to determine causality, durability, behavior change, and clinical impact.

1. Introduction

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for at least 3 months, with implications for health; diagnostic criteria include reduced GFR (<60 mL/min/1.73 m²) or markers of kidney damage. CKD slowly damages kidney function over time, so many patients undergo renal replacement therapy, including dialysis or a transplant. This decline is connected to an increased risk of heart disease, stroke, and anemia [1]. Because CKD progresses slowly and early signs are subtle, many individuals remain undiagnosed until the disease is advanced [2].

Globally, CKD represents a major health concern, accounting for substantial morbidity and mortality, as it is estimated that approximately 800 million individuals are affected by CKD [3]. The burden is higher in low- and middle-income countries due to increasing rates of diabetes, hypertension, and obesity [4].

In Saudi Arabia, CKD represents a substantial health burden; a recent population-based study estimated a prevalence of 4.76% [5]. Additionally, 28,256 patients were reported to have end-stage renal disease (ESRD) by the Center for Organ Transplantation (SCOT) [5].

Diabetes mellitus and hypertension are currently the primary global contributors to chronic kidney disease [6]. Both conditions are common in the local population, impacting nearly one-third of adults [7,8].

Although diabetes and hypertension are major causes of advanced kidney disease in Saudi Arabia, the etiologic profile is heterogeneous. In the Saudi Center for Organ Transplantation 2019 hemodialysis report, diabetic nephropathy and hypertensive nephropathy accounted for 43% and 34% of renal failure, respectively, while other reported causes included unknown etiology (9%), glomerulonephritis (4%), obstructive uropathy (2%), congenital malformations (2%), heredofamilial disease (2%), vasculitis (1%), and pregnancy-related causes (1%) [5]. More recent data from the Kidney Disease in the National Guard (KIND) registry likewise identified diabetic nephropathy (35.2%), glomerulonephritis (17.2%), and hypertensive renal disease (12.7%) as major CKD etiologies, with approximately one quarter of cases classified as unknown etiology [9]. These findings underscore the need for public education to address both cardiometabolic risk factors and non-diabetic/non-hypertensive kidney diseases.

Lifestyle factors such as smoking, physical inactivity, and high dietary sodium intake have also been linked to an increased risk and faster progression of kidney disease [10].

Beyond its medical impact, CKD affects quality of life, mental health, and financial stability, imposing a significant socioeconomic burden and contributing to global and local mortality [11,12].

Another issue in community CKD education is the cultural use of herbal and complementary medicine. Herbal preparations are widely used in Saudi Arabia and may be selected because they are perceived to be natural, traditional, convenient or safer than conventional pharmacological therapies. However, “natural” does not necessarily mean kidney safety. Depending on their composition and use, herbal products may cause direct nephrotoxicity, contamination, interactions with conventional drugs or delayed use of evidence-based treatment. Thus, culturally sensitive CKD education should include addressing misconceptions about herbal remedies for established kidney disease, as well as the possible dangers of their unsupervised use.

Therefore, raising public awareness on the prevention and early detection of CKD is important. Improved health literacy can help in identifying risk factors, promoting appropriate health-seeking behavior and adherence to preventive measures and evidence-based treatment. Community campaigns provide a chance to reach different populations with these messages outside of traditional healthcare settings.

Thus, enhancing public awareness is important to facilitate early detection, modification of lifestyles, and efficient management of significant risk factors such as DM and hypertension, which are highly prevalent in the region. The current study aimed to gauge the efficacy of a community educational program regarding CKD in a local setting and to examine how demographic factors, such as age, educational level, and previous exposure to health information, may affect responsiveness to educational interventions.

2. Materials and Methods

2.1. Ethical Considerations

Ethical approval was obtained from the Deanship of Scientific Research at King Faisal University prior to the commencement of the study (Reference No. KFU-2025-ETHICS3062, dated 3 March 2025), and all procedures followed the principles of the Declaration of Helsinki. Participation was voluntary, and all respondents were informed about the study’s objectives, the anonymous nature of the questionnaire, and their right to withdraw at any time without consequence.

Electronic informed consent was obtained from all participants prior to accessing the survey.

2.2. Study Setting

The campaign was conducted for three days at a major shopping mall in Al-Ahsa, Saudi Arabia. The campaign period included World Kidney Day, 13 March 2025. The mall-based setting was chosen to allow direct contact with members of the general community in a non-clinical setting.

The educational intervention consisted of 6 interactive stations addressing complementary aspects of CKD education: (1) kidney structure and physiological functions; (2) symptoms and warning signs of kidney disease; (3) complications of advanced CKD; (4) available treatment options, including dialysis; (5) CKD prevention strategies; and (6) lifestyle-related and modifiable CKD risk factors. Blood pressure (Microlife AG, Widnau, Switzerland) and blood glucose (LifeScan Europe GmbH, Zug, Switzerland) were also measured during the campaign, and visitors had the opportunity to consult a nephrologist. These components were designed to work synergistically to integrate health education, risk-factor awareness, basic health assessment, and opportunities for professional discussion.

The station-based format allowed participants to cycle through different CKD topics sequentially rather than having all educational information presented in one presentation. Future studies should consider publishing standardized station materials, educational scripts, duration of exposure, and training procedures as Supplementary Materials to further enhance reproducibility across settings.

2.3. Study Design and Data Collection

Data collection was conducted in person by properly trained volunteers. One volunteer was stationed at the campaign entrance to administer the pre-campaign questionnaire, while another was stationed at the exit to conduct the post-campaign survey. A person-to-person survey approach was used to ensure comprehension and accuracy of responses. The study employed a biphasic pre- and post-intervention design during a public chronic kidney disease (CKD) awareness campaign, facilitating direct evaluation of immediate knowledge changes after educational exposure.

The study employed a biphasic pre-/post-intervention design, allowing paired assessment of immediate changes in CKD knowledge after exposure to the educational campaign. Accordingly, the study evaluates immediate educational effects and was not designed to assess long-term knowledge retention, behavioral change, or clinical outcomes.

All adults aged 18 years and above who completed both the pre- and post-campaign questionnaires were included in the analysis. Participants who failed to complete either phase were excluded. Telephone numbers were collected for three purposes: to verify the provided data, to function as a unique identifier for each visitor, and to accurately match and confirm completion of the pre- and post-campaign questionnaires.

2.4. Study Questionnaire

The knowledge component was based on the validated 24-item Chronic Kidney Disease Knowledge Questionnaire (CKD-KQ) [13]. In the original instrument, each statement is answered as True, False, or I do not know. In the present electronic questionnaire, the 24 statements were presented as three single-answer items and four grouped multi-select blocks covering kidney functions, kidney assessment, CKD risk factors, and symptoms. Each original CKD-KQ statement contributed one point. For positively keyed statements, selection was scored as 1 and non-selection as 0; for negatively keyed statements, non-selection was scored as 1 and selection as 0. When the block-level “I do not know” option was selected, all statements in that block were scored as 0. The possible score ranges were 0–24 for total CKD knowledge, 0–6 for kidney functions, 0–4 for kidney assessment, 0–6 for CKD risk factors, and 0–5 for symptoms. Higher scores indicated greater CKD knowledge.

2.5. Statistical Analysis

All statistical analyses were conducted using SPSS version 26. The change in knowledge was measured by calculating the difference between post-intervention and pre-intervention scores for each participant. Descriptive statistics were used to summarize demographic and baseline characteristics.

To assess the effectiveness of the intervention, paired t-tests were used to compare pre- and post-intervention knowledge scores. Additionally, multiple linear regression analyses were performed to identify predictors of knowledge change across specific domains, including overall CKD knowledge, kidney function, diagnostic methods, risk factors, and symptom awareness.

The prespecified primary outcome was the within-participant change in total CKD-KQ score from immediately before to immediately after participation in the campaign. Pre- and post-campaign scores were summarized as mean ± standard deviation (SD). The paired mean difference (post minus pre) was reported with its 95% confidence interval (CI), paired t statistic, degrees of freedom, two-sided p-value, and Cohen’s dz as a standardized within-participant effect size. Domain-level changes in kidney-function, kidney-assessment, risk-factor, and symptom scores were considered secondary analyses. Statistical significance was defined as a two-sided p-value < 0.05.

Independent variables included age, sex, education level, occupation (healthcare vs. non-healthcare), history of kidney disease, diabetes, hypertension, heart disease, arthritis, smoking status, physical activity levels, and the use of analgesics or herbal remedies. Regression coefficients, standard errors, t-values, and p-values were reported. A p-value of less than 0.05 was considered statistically significant.

Due to the convenience sample of eligible attendees participating in the community campaign and completing both assessments, no a priori sample-size or power calculation was performed. Because the number of candidate predictors was large relative to the analytical sample, all multivariable regression analyses were treated as exploratory and potentially vulnerable to overfitting. Multicollinearity was assessed using variance inflation factors (VIFs), and no problematic collinearity was identified. Model assumptions were evaluated using residual-versus-fitted and Q-Q plots, together with a formal assessment of heteroscedasticity and residual normality. Because some bounded domain change scores showed departures from residual normality and because of the modest sample-to-parameter ratio, regression findings were interpreted as hypothesis-generating, with emphasis on coefficient direction and clinical plausibility rather than isolated p-values.

3. Results

A total of 134 responses were initially collected. However, 32 of them were excluded from the final analysis. Fourteen participants completed only the pre-campaign questionnaire, thirteen completed only the post-campaign questionnaire, and the remaining five did not meet the inclusion criteria due to being under the age of 18 or providing incomplete demographic data.

Hence, the final sample included 102 participants, aged 18 to 65 years (mean ±SD = 33.6 ± 12). The cohort comprised 63 males and 39 females (male-to-female ratio = 1.6:1). Most respondents held either a bachelor’s degree (49.0%) or secondary education (43.1%), and 22.5% were employed in the medical field. Participants reported various clinical conditions, including kidney disease (7.8%), diabetes mellitus (10.8%), hypertension (17.6%), and cardiovascular disease (3.9%). Notably, 73.5% of participants were non-smokers, and 50.0% reported engaging in ≥150 min of physical activity per week (

Table 1. Demographic and characteristics of the participants.

Characteristics
Gender, n (%)
Female	39 (38.2)
Male	63 (61.8)
Age, mean (SD)	33.6 (12)
Educational level, n (%)
Secondary school or lower	44 (43.1)
Bachelor’s degree	50 (49)
Master’s degree or higher	8 (7.8)
Working or studying in the medical field, n (%)	23 (22.5)
History of kidney disease, n (%)	8 (7.8)
Diabetes, n (%)	11 (10.8)
Hypertension, n (%)	18 (17.6)
Heart disease, n (%)	4 (3.9)
Arthritis, n (%)	7 (6.9)
Frequently uses analgesics, n (%)	29 (28.4)
Frequently uses herbal medicine, n (%)	11 (10.8)
Smoking status, n (%)
Current smoker	22 (21.6)
Previous smoker	5 (4.9)
None	75 (73.5)
Physical activity, n (%)
Less than 150 min/week	32 (31.4)
More than 150 min/week	51 (50)
None	19 (18.6)

).

Importantly, 29 participants (28.4%) reported regular use of analgesics, and 11 (10.8%) reported regular use of herbal medicine. These findings identify medication-related behaviors that may be relevant targets for future CKD education. The present study did not assess specific analgesic agents, doses, durations, or indication or causal relationships with kidney disease.

Participants had higher knowledge scores immediately after campaign participation than before participation. Awareness that individuals can live a normal life with a single healthy kidney increased from 74.5% before the intervention to 90.2% afterward. Recognition of the availability of pharmacological treatments to slow the progression of chronic kidney disease (CKD) rose from 52.9% to 78.4%. Belief in the effectiveness of herbal remedies for CKD, however, declined markedly from 19.6% to 8.8%, indicating enhanced understanding and reduced reliance on unproven therapies.

Participants have also demonstrated a higher perception of primary kidney functions both pre- and post-intervention. Urine production remained the most recognized function, though it slightly declined from 89.2% pre to 85.3% post. In contrast, recognition of blood filtration increased from 70.6% to 83.3%, awareness of blood-pressure regulation also rose from 57.8% to 76.5%, and bone health from 20.6% to 37.3%. Participants’ selection of unrelated kidney function items increased, with protein degradation rising from 29.4% to 35.3% and blood-glucose regulation increasing from 31.4% to 40.2%. The proportion of participants who responded with “I don’t know” declined from 6.9% to 2.9% (

Table 2. Pre- and post- knowledge.

Question	Type	Response	Pre n (%)	Post n (%)
Can humans live a natural life with one healthy kidney?	Single answer	No	15 (14.7%)	8 (7.8%)
		I do not know	11 (10.8%)	2 (2.0%)
		Yes	76 (74.5%)	92 (90.2%)
Are herbal medicines effective in treating chronic kidney disease?	Single answer	No	39 (38.2%)	71 (69.6%)
		I do not know	43 (42.2%)	22 (21.6%)
		Yes	20 (19.6%)	9 (8.8%)
Are there drugs that can slow the progression of chronic kidney disease?	Single answer	No	13 (12.7%)	14 (13.7%)
		I do not know	35 (34.3%)	8 (7.8%)
		Yes	54 (52.9%)	80 (78.4%)
What are the kidney functions?	Multi-select	Urine Production	91 (89.2%)	87 (85.3%)
		Blood Filtration	72 (70.6%)	85 (83.3%)
		Blood-Pressure Regulation	59 (57.8%)	78 (76.5%)
		Blood-Glucose Regulation	32 (31.4%)	41 (40.2%)
		Protein Degradation	30 (29.4%)	36 (35.3%)
		Bone Health	21 (20.6%)	38 (37.3%)
		“I Don’t Know”	7 (6.9%)	3 (2.9%)
Which tests are used to assess renal function?	Multi-select	Blood Test	53 (52.0%)	82 (80.4%)
		Urine Test	75 (73.5%)	80 (78.4%)
		Blood-Pressure Monitoring	32 (31.4%)	48 (47.1%)
		Stool Test	5 (4.9%)	8 (7.8%)
		“I Don’t Know”	14 (13.7%)	2 (2.0%)
Risk factors for chronic kidney disease	Multi-select	Diabetes	35 (34.3%)	82 (80.4%)
		Hypertension	49 (48.0%)	76 (74.5%)
		Obesity	58 (56.9%)	68 (66.7%)
		Heart Problems/Conditions	33 (32.4%)	45 (44.1%)
		Stress	25 (24.5%)	20 (19.6%)
		Female Gender	8 (7.8%)	7 (6.9%)
		“I Don’t Know”	17 (16.7%)	2 (2.0%)
Symptoms	Multi-select	Edema (Swelling)	64 (62.7%)	74 (72.5%)
		Fatigue	53 (52.0%)	68 (66.7%)
		Loss of Appetite	38 (37.3%)	54 (52.9%)
		Nausea/Vomiting	37 (36.3%)	56 (54.9%)
		Fever	13 (12.7%)	16 (15.7%)
		“I Don’t Know”	19 (18.6%)	3 (2.9%)

).

Moreover, knowledge about diagnostic tests for assessing renal function showed an overall improvement after the campaign. Recognition of blood tests increased from 52.0% to 80.4%, while urine test awareness remained high (73.5% to 78.4%). Participants’ selection of unrelated kidney tests increased, similarly to blood-pressure monitoring rising from 31.4% to 47.1%, and identification of stool tests also increased slightly from 4.9% to 7.8%. The proportion of participants unsure about renal tests dropped sharply from 13.7% to 2.0%.

Post-campaign participants showed stronger identification of key CKD risk factors. Recognition of diabetes increased markedly (34.3% to 80.4%), as did hypertension (48.0% to 74.5%), obesity (56.9% to 66.7%), and awareness of heart problems also improved (32.4% to 44.1%). The reduction in the selection of unrelated risk factors (e.g., stress, female sex) suggests an improved understanding among participants. Stress declined from 24.5% to 19.6% and female sex from 7.8% to 6.9%. Uncertainty dropped from 16.7% to 2.0%, indicating enhanced clarity about CKD risks.

Symptom awareness improved across most categories. Edema recognition rose from 62.7% to 72.5%, and fatigue increased from 52.0% to 66.7%. Notably, nausea/vomiting recognition increased from 36.3% to 54.9%, and loss of appetite from 37.3% to 52.9%. Participants’ selection of unrelated kidney symptoms increased; fever increased from 12.7% to 15.7%. Uncertainty decreased significantly from 18.6% to 2.9%.

Among 102 matched participants, the mean total CKD-KQ score was 12.79 ± 5.40 before the campaign and 18.68 ± 3.22 immediately afterward. The paired mean difference was 5.88 points (95% CI, 4.81–6.95), t(101) = 10.89, p < 0.001 (Cohen’s dz = 1.08). This corresponds to an increase from 53.3% to 77.8% of the maximum possible total score. Immediate post-campaign scores were also higher across the kidney-function, kidney-assessment, risk-factor, and symptom domains (Table S1).

No statistically significant predictors were identified for the total change in knowledge score (all p-values > 0.05) or for changes in knowledge related to kidney function questions (all p-values > 0.05) (

Table 3. Regression analysis for kidney function knowledge questions.

Predictor	Contrast/Level	Estimate	SE	t	p
Intercept	–	1.8609	0.723	2.5749	0.01 *
Age	(per year)	−0.0242	0.018	−1.3210	0.19
Sex	Male–Female	0.2255	0.376	0.5993	0.55
Education level	Bachelor’s degree–Secondary school or lower	0.1583	0.348	0.4545	0.65
Education level	Bachelor’s degree–Master’s degree	0.7183	0.694	1.0357	0.3
Student/HCW	Yes–No	−0.8637	0.443	−1.9510	0.054
History of kidney disease	Yes–No	0.2325	0.658	0.3533	0.73
Diabetes	Yes–No	−0.3868	0.649	−0.5960	0.55
Smoker	Previous smoker–No	−0.6742	0.774	−0.8710	0.39
Smoker	Yes–No	−0.1817	0.451	−0.4030	0.69
Hypertension	Yes–No	−0.0298	0.502	−0.0590	0.95
Heart disease	Yes–No	1.1522	0.906	1.2720	0.21
Arthritis	Yes–No	0.7104	0.661	1.0742	0.29
Physical activity	>150 min/week–<150 min/week	−0.6852	0.385	−1.7790	0.08
Physical activity	No–<150 min/week	0.8168	0.527	1.5505	0.13
Regular analgesic use	Yes–No	−0.1543	0.414	−0.3730	0.71
Herbal medicine use	Yes–No	0.5867	0.530	1.1072	0.27

Notes: Intercept, regular analgesic use, physical activity in min/week, and degree or knowledge questions are associated with higher change scores relative to the reference level shown after the dash. * significant (* p < 0.05).

). However, for changes in knowledge regarding diagnostic methods, participants reporting no physical activity (vs. <150 min/week: β = 0.97, p-value = 0.01) demonstrated significantly greater improvements in knowledge (

Table 4. Regression analysis for diagnosis methods and knowledge questions.

Predictor	Contrast/Level	Estimate	SE	t	p
Intercept	–	1.1619	0.502	2.3136	0.02 *
Age	(per year)	−0.01637	0.013	−1.2840	0.2
Sex	Male–Female	0.0053	0.261	0.0203	0.98
Education level	Bachelor’s degree–Secondary school or low	−0.19023	0.242	−0.7860	0.43
Education level	Bachelor’s degree–Master’s degree	0.22372	0.482	0.4642	0.64
Student/HCW	Yes–No	−0.34704	0.308	−1.1280	0.26
History of kidney disease	Yes–No	−0.16614	0.457	−0.3630	0.72
Diabetes	Yes–No	−0.14978	0.451	−0.3320	0.74
Smoker	Previous smoker–No	−0.40582	0.538	−0.7540	0.45
Smoker	Yes–No	0.62128	0.314	1.9819	0.051
Hypertension	Yes–No	0.17954	0.349	0.5145	0.61
Heart disease	Yes–No	0.05739	0.629	0.0912	0.93
Arthritis	Yes–No	0.05275	0.460	0.1148	0.91
Physical activity	>150 min/week–<150 min/week	−0.26217	0.268	−0.9800	0.33
Physical activity	No–<150 min/week	0.97239	0.366	2.6562	0.009 *
Regular analgesic use	Yes–No	0.12246	0.288	0.4260	0.67
Herbal medicine use	Yes–No	−0.01972	0.368	−0.0540	0.96

Notes: Higher change scores indicate greater improvement relative to the reference level shown after the dash. * Significant (p < 0.05).

). Similarly, for knowledge of CKD risk factors, lower educational attainment (Bachelor’s vs. secondary/low: β = −0.84, p-value = 0.022) and no physical activity (β = 1.26, p-value = 0.022) were significantly associated with greater improvements in knowledge (

Table 5. Regression analysis for risk factors and knowledge questions.

Predictor	Contrast/Level	Estimate	SE	t	p
Intercept	–	2.621	0.743	3.5260	<0.001 *
Age	(per year)	−0.0272	0.019	−1.4390	0.154
Sex	Male–Female	−0.0816	0.387	−0.2110	0.833
Education level	Bachelor’s degree–Secondary school or low	−0.8364	0.358	−2.3360	0.022 *
Education level	Bachelor’s degree–Master’s degree	0.8559	0.713	1.1999	0.234
Student/HCW	Yes–No	−0.7484	0.455	−1.6440	0.104
History of kidney disease	Yes–No	0.4129	0.677	0.6100	0.544
Diabetes	Yes–No	−0.9323	0.667	−1.3970	0.166
Smoker	Previous smoker–No	−0.7085	0.797	−0.8900	0.376
Smoker	Yes–No	0.0567	0.464	0.1222	0.903
Hypertension	Yes–No	−0.0792	0.517	−0.1530	0.879
Heart disease	Yes–No	−0.026	0.932	−0.0280	0.978
Arthritis	Yes–No	1.1958	0.680	1.7579	0.082
Physical activity	>150 min/week–<150 min/week	−0.6781	0.396	−1.7120	0.091
Physical activity	No–<150 min/week	1.2604	0.542	2.3261	0.022 *
Regular analgesic use	Yes–No	−0.5069	0.426	−1.1910	0.237
Herbal medicine use	Yes–No	1.0558	0.545	1.9371	0.056

Notes: Higher change scores indicate greater improvement relative to the reference level shown after the dash. * Significant (p < 0.05).

). For symptom-related knowledge, being a student or healthcare worker (β = −1.02, p-value = 0.03) was associated with smaller improvements, whereas no physical activity (β = 1.72, p-value < 0.001) was associated with greater improvements in symptom knowledge (

Table 6. Regression analysis for symptoms and knowledge questions.

Predictor	Contrast/Level	Estimate	SE	t	p
Intercept	–	2.2639	0.736	3.0773	0.003 *
Age	(per year)	−0.0353	0.019	−1.8916	0.06
Sex	Male–Female	0.3173	0.383	0.8286	0.41
Education level	Bachelor’s degree–Secondary school or low	−0.4113	0.354	−1.1604	0.25
Education level	Bachelor’s degree–Master’s degree	0.9343	0.706	1.3234	0.19
Student/HCW	Yes–No	−1.0242	0.451	−2.2731	0.026 *
History of kidney disease	Yes–No	−0.43	0.670	−0.6419	0.52
Diabetes	Yes–No	−0.1944	0.661	−0.2944	0.77
Smoker	Previous smoker–No	−1.2449	0.788	−1.5793	0.12
Smoker	Yes–No	0.1331	0.459	0.2898	0.77
Hypertension	Yes–No	−9.74 × 10−4	0.511	−0.0019	1
Heart disease	Yes–No	0.2855	0.922	0.3096	0.76
Arthritis	Yes–No	0.8348	0.673	1.2400	0.22
Physical activity	>150 min/week–<150 min/week	−0.2894	0.392	−0.7381	0.46
Physical activity	No–<150 min/week	1.7177	0.536	3.2031	0.002 *
Regular analgesic use	Yes–No	−0.2757	0.421	−0.6547	0.51
Herbal medicine use	Yes–No	0.9376	0.539	1.7381	0.09

Notes: Positive estimates indicate greater improvement, whereas negative estimates indicate smaller improvement relative to the reference level. HCW, healthcare worker. * Significant (p < 0.05).

).

4. Discussion

Community health education campaigns are currently more prevalent in health promotion. They play a tremendous role in enhancing disease prevention and cure. This is attributed to their influence in shaping and changing the community population’s perception to achieve a certain objective in health promotion [14,15]. Targeted outreach associated with point-of-care screening and streamlined referrals converts awareness into uptake across diverse groups. These may include adolescents, older adults, pregnant women, and even healthcare professionals themselves [16,17,18].

This study assessed the effectiveness of a local educational campaign in improving knowledge regarding chronic kidney disease (CKD) within the local community. Our biphasic pre-/post-activity questionnaire showed significant gains across most CKD knowledge domains. This notion is supported by the well-known effect of feedback in promoting community health education. Such feedback provides crucial insights into the health problem concerned to enhance the effectiveness of any health campaign results [19]. The paired pre/post findings demonstrate immediate within-participant differences in CKD knowledge after campaign participation; because there was no concurrent control group, these differences cannot establish a causal campaign effect.

Prior to the intervention, knowledge gaps were apparently evident, especially when risk factors and treatment were concerned. Less than one-third of participants identified diabetes as a major CKD risk factor, although comparable baseline deficits were reported in the literature. A study has found that only 32% initially recognized diabetes as a CKD risk factor before initiating structured awareness efforts [20]. Similarly, other reports have stated that more than half of the participants in similar studies identified diabetes as a contributory factor [21,22]. Moreover, another local study reported identical awareness results as regards the diabetes–CKD link [23]. This variability suggests that baseline recognition of diabetes as a real risk factor remains suboptimal globally, particularly among non-medical personnel. A study from the same local setting showed that the chronicity of diabetes duration significantly increases CKD risk. This may indicate the clinical importance of ongoing education and early recognition of this pathway [24]. These observations suggest that inadequate awareness signifies not only informational deficiencies but also may influence a constrained understanding of the progressive nature of diabetic nephropathy. Targeted educational protocols emphasizing the connection between diabetes and kidney health are crucial for the prevention and early detection of this complication. In alignment with previous local and regional studies, public awareness of chronic kidney disease (CKD) continues to be relatively low [23,25]. Post-campaign, knowledge improved markedly, as most respondents identified diabetes mellitus as a risk factor, as well as its pharmacologic treatments. These rates exceed those in prior similar local studies [23,25,26]. They surpass international reports in which roughly half had recognized diabetes as a risk factor [21,22,27]. On the other hand, others speculated far lower outpacing levels [28]. Such gains highlight the effectiveness of well-designed, targeted education, suggesting that outcomes vary with the intensity, quality, and tailoring of the educational approach. Beliefs in herbal and alternative remedies also declined substantially. Before the campaign, about half of the participants endorsed potential benefits; this proportion fell notably afterward. Baseline beliefs were comparable to those reported in studies from other developing countries [29,30,31]. Yet, other reports have shown lower averages [32,33,34], contrary to another study from a similar geographical area [35]. The breadth of these figures indicates that cultural context, the education system, and health literacy may actively shape attitudes towards alternative therapies. Such culturally sensitive, evidence-based educational campaigns may help counter these misconceptions.

The regression analyses stated no significant demographic or clinical predictors of overall improvement, indicating generally uniform benefits. Greater gains among participants with lower education and limited physical activity suggest that such campaigns could effectively address knowledge gaps in populations with lower health literacy. These findings support the notion that education and socioeconomic status may affect baseline knowledge of chronic kidney disease (CKD) [22,23].

Therefore, the current study reinforces the value of inclusive, accessible campaigns in approaching local community populations.

The campaign’s emphasis on diabetes, hypertension, and obesity should not be interpreted as implying that CKD in Saudi Arabia is restricted to cardiometabolic etiologies. Saudi registry data demonstrate clinically important contributions from glomerulonephritis, hereditary and congenital kidney disorders, obstructive disease, and kidney disease of unknown cause. Broader public-health messaging may therefore be particularly important for younger adults and for individuals without diabetes or hypertension who may otherwise underestimate their kidney-disease risk.

Participants with health-related backgrounds showed smaller improvements in symptom recognition, likely due to a ceiling effect given their higher baseline knowledge. Comparable patterns were observed in similar local health interventions, in which individuals with prior medical exposure showed modest incremental gains following awareness activities [36,37]. Hence, ceiling effects should be anticipated and interpreted as evidence of prior high baseline literacy rather than limited program efficacy.

Baseline awareness in the local region was similar to findings reported in other similar geographical provinces [26]. Following the intervention, the post-education outcomes surpassed those of prior cross-sectional surveys in the local area, though they were comparable to post-intervention results reported in the literature [21,38]. The notable decrease in misconceptions about herbal therapies highlights the necessity for culturally relevant, evidence-based communication. The efficacy of direct engagement demonstrates that community events and healthcare collaborations can successfully reach individuals who are less inclined to encounter or trust online information [38].

The campaign’s results support the necessity for continuous and ongoing public health initiatives to enhance awareness of CKD in the local community. Due to the increasing prevalence of diabetes, hypertension, and obesity, the incorporation of chronic kidney disease (CKD) education into community programs and primary care is essential for facilitating earlier diagnosis and improving disease management [39]. The significant decrease in misconceptions about herbal therapies underscores the need for culturally relevant, evidence-based communication. The effectiveness of direct engagement indicates that community events and healthcare partnerships can reach individuals who are less likely to encounter or trust reliable online information.

The current study results highlighted the need for ongoing public health efforts to raise awareness of chronic kidney disease (CKD). Emphasizing common risk factors, including diabetes, hypertension, and obesity, could lead to earlier identification and better disease management in the local population [5]. The increasing global and national prevalence of chronic kidney disease (CKD) demands ongoing and precise public education as an essential element of prevention [40,41,42]. The current campaign effectively clarifies misconceptions about herbal therapies. This illustrates the importance of employing evidence-based, culturally relevant education to combat misinformation across several domains.

Several limitations should be considered in light of our results. First, the final sample consisted of only 102 participants recruited from a single mall-based campaign, limiting statistical precision and generalizability. Recruitment was based on convenience sampling of campaign attendees rather than population-based probability sampling, which creates the possibility of selection bias. Voluntary participants in health campaigns might differ from the general community in health awareness or motivation. Second, we did not do a power calculation a priori because the sample was limited by attendance and completion of both assessments during the campaign. Therefore, the regression analyzes should be considered exploratory, and small subgroup sizes may have limited the ability to detect modest associations. Third, the post-intervention assessment was administered immediately after the educational exposure. Therefore, the study assessed immediate knowledge acquisition rather than long-term retention. We did not assess whether the knowledge gained was retained in subsequent weeks or months or whether it led to behavioral changes, healthcare utilization, participation in screening, earlier diagnosis, or clinical outcomes. Fourth, interviewer-administered questionnaires are prone to social desirability or response bias. The use of a validated instrument and standardized administration helped to strengthen internal consistency, but these methods cannot eliminate such biases. Fifth, the use of analgesics and herbal medicines was self-reported and was not characterized by specific products, indications, dosages, duration, frequency or concomitant kidney function. Thus, these results should not be considered as evidence of analgesic or herbal-induced kidney injury in the participants. Sixth, the multivariable models included many candidate predictors relative to the analytical sample, creating a risk of overfitting and unstable coefficient estimates, particularly for infrequent comorbidities. Accordingly, the regression analyses are exploratory and should not be interpreted as confirmatory evidence of subgroup effects. Although multicollinearity was not problematic, some bounded domain change-score models showed departures from residual normality. Future studies should prespecify a smaller predictor set and recruit a sample sized specifically for multivariable modeling. Finally, the study did not assess the operational costs, cost-effectiveness and long-term organizational sustainability of the campaign. Such considerations will be increasingly important if community CKD campaigns are scaled up to multiple sites or repeated regularly.

Future studies should include larger, more demographically diverse samples from multiple community venues and regions. Sample sizes should be calculated a priori on the basis of a predefined primary endpoint and expected intervention effect. Longitudinal assessment is particularly relevant. Surveys conducted at predetermined follow-up intervals could determine whether knowledge gains are retained and whether repeated or booster education is needed. Further research should go beyond knowledge outcomes to explore behavioral endpoints, such as a reduction in inappropriate self-medication, healthier lifestyle practices, attendance for kidney function assessment, primary care engagement and earlier clinical presentation. Future campaigns should include explicit medication-safety education about the frequent or inappropriate use of analgesics and the use of potentially harmful or unproven herbal preparations. These messages should be culturally appropriate and promote consultation with qualified healthcare professionals rather than merely discouraging traditional practices without explanation. Educational material should also explain that CKD is not only due to diabetes and hypertension. Messages about primary kidney diseases, hereditary conditions, glomerular disease, and other causes may be especially relevant for younger populations and those who otherwise think they are at low risk. Wherever possible, community awareness programs should be linked to primary care pathways for appropriate kidney assessment. The increased-risk participants could be referred for evidence-based evaluation, including kidney-function and urine testing, when clinically indicated, with appropriate follow-up and referral. Future implementation studies should determine whether these pathways can improve detection while being feasible and cost-effective. Lastly, formal collaborative networks or consortia that link universities, nephrology specialists, primary-care services, public-health authorities, community organizations and other appropriate partners may help to enable sustainable development. Such a framework could help standardize educational content, share resources, coordinate campaigns, create referral pathways, and help support longitudinal monitoring of program effectiveness.

5. Conclusions

In this uncontrolled paired pre/post study, CKD knowledge scores were higher immediately after participation in a structured community campaign. The largest immediate differences involved risk-factor, kidney-assessment, and symptom knowledge, and fewer participants endorsed herbal remedies as effective CKD treatment. Because no concurrent control group or delayed follow-up was included, these findings should be interpreted as short-term within-participant changes rather than proof of a causal or sustained campaign effect. The program closed key knowledge gaps in risk factors, diagnosis, and prevention, as well as corrected prevalent misconceptions about unproven remedies. These results support scaling inclusive, one-to-one educational strategies in regions with high burdens of lifestyle-related diseases. To enhance early detection and management of CKD, it is important to maintain public communication that is factual, culturally pertinent, and conducive to primary care and community collaborations.