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Healthcare 2022, 10, 2414. https://doi.org/10.3390/healthcare10122414 www.mdpi.com/journal/healthcare
Article
Awareness and Knowledge of the Effect of Ultraviolet (UV)
Radiation on the Eyes and the Relevant Protective Practices:
A Cross-Sectional Study from Jordan
Mohammad A. Alebrahim
1,
*, May M. Bakkar
1
, Abdulla Al Darayseh
2
, Aya Msameh
1
, Dana Jarrar
1
,
Saja Aljabari
1
and Walla Khater
1
1
Department of Allied Medical Sciences, Faculty of Applied Medical Sciences,
Jordan University of Science and Technology, Irbid 3030, Jordan
2
Emirates College for Advanced Education, Abu Dhabi P.O. Box 126662, United Arab Emirates
* Correspondence: maalebrahim@just.edu.jo
Abstract: Background: Overexposure to ultraviolet (UV) radiation is linked to serious adverse health
effects that are cumulative in nature and affect children more than adults. UV radiation has also
been reported to have serious complications for the eye, particularly in areas with a high UV radia-
tion index. Increasing public awareness about the harmful effects of UV radiation on the eye and
promoting awareness about protection against UV radiation may prevent eye disease related to UV
radiation damage and help in the improvement of public health in general. This study aims to assess
public awareness and knowledge of UV radiation and practices toward UV protection in Jordan,
which is a country recognized as having a relatively high UV index throughout the year. Methods:
A cross-sectional study was performed using an online questionnaire using Google Forms
®
to assess
people’s awareness, knowledge, practices toward eye protection from UV radiation, and the reasons
for not wearing UV-protective eyeglasses in Jordan. Sociodemographic information of participants
including age, gender, education level, and employment status was also acquired. People’s
knowledge on UV protection and harmfulness was measured via rewarding their correctly an-
swered knowledge questions with one mark and zero for incorrectly answered questions based on
key answers defined from the literature. Results: A total of 1331 participants (77% females and 23%
males) with an average age of 26(±10) years completed the online questionnaire. Participants
showed generally high levels of knowledge and awareness about UV radiation and its harmful ef-
fects. Nevertheless, participants showed a low level of knowledge about the link between UV radi-
ation and some of the ocular diseases in the questionnaire. Practices toward UV radiation protection
where inadequate, with 59% of the respondents reporting that they do not use any protective eye-
wear from natural UV radiation. The main reported reason for not wearing UV-protective sun-
glasses was uncertainty in the efficiency of UV protection in sunglasses, as reported by 47% of the
participants who do not wear UV-protective sunglasses. Conclusions: The awareness of UV radiation
and its harmful effects is high in the studied population. Participant knowledge is also relatively
high in relation to nature of solar UV radiation, other synthetic sources of UV radiation, and the
most dangerous UV exposure time. However, low participant knowledge was measured on the
association between UV radiation with ocular disease and the role of UV-protective eyeglasses. Par-
ticipant practice toward UV radiation protection was found to be insufficient. Thus, it is important
to further increase the knowledge of damaging effects of solar and synthetic UV radiation and em-
phasize the benefits of eye protection from UV radiation. Eye care practitioners should target youth
by different strategies including health campaigns, media, and clinics.
Keywords: ultraviolet (UV) radiation; ocular damage; protective eyewear; Jordan
Citation: Alebrahim, M.A.; Bakkar,
M.M.; Al Darayseh, A.; Msameh, A.;
J
arrar, D.; Aljabari, S.; Khater, W.
Awareness and Knowledge of the
Effect of Ultraviolet (UV) Radiation
on the Eyes and the Relevant
Protective Practices: A
Cross-Sectional Study from Jordan.
Healthcare 2022, 10, 2414. https://
doi.org/10.3390/healthcare10122414
Academic Editor: Marco Dettori
Received: 2 November 2022
Accepted: 25 November 2022
Published: 30 November 2022
Publisher’s Note: MDPI stays neu-
tral with regard to jurisdictional
claims in published maps and institu-
tional affiliations.
Copyright: © 2022 by the authors. Li-
censee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
ativecommons.org/licenses/by/4.0/).
Healthcare 2022, 10, 2414 2 of 12
1. Introduction
Ultraviolet (UV) radiation is a kind of solar radiation with a wavelength that ranges
from 100 nm to 400 nm and is divided into three parts: UV-A (315–400 nm), UV-B (280–
315 nm), and UV-C (100–280 nm), where the shorter the wavelength, the more harmful
the effects [1,2]. All the UV-C and up to 95% of UV-B do not reach the earth because the
ozone layer absorbs them. Therefore, only 5% of UV-B and 95% of UV-A are transmitted
to the land 3. Sunlight is considered the primary source of UV radiation. On the other
hand, there are many secondary sources for UV radiation, such as suntanning beds, elec-
tric sparks, photographic flood lamps, welding arcs, and halogen desk lamps [3–5].
UV radiation is not a part of the visible light spectrum and is not perceived by the
visual system. Therefore, its harmful effects cannot be felt until tissue damage has devel-
oped [6]. The harmful effect of the radiation on human health increases with excessive
cumulative exposure to the UV radiation sources [7] and may be associated with tissue
atrophy, skin pigmentation changes, wrinkles, and malignancies, including melanoma
and basal cell carcinoma [1,8].
Scientific evidence shows that acute, large-dose exposure to UV radiation can cause
serious ocular complications such as photokeratitis and photo conjunctivitis. Further, ex-
posure to small doses of UV, specifically UVB, has been reported as a risk factor in devel-
oping several ocular diseases including cataract, pinguecula, pterygium, and squamous
cell carcinoma of the cornea and the conjunctiva [9–11]. Unprotected exposure to UV rays
can possibly cause significant ocular damage in young children compared to adults, due
to the relatively large pupil size and the more transparent ocular media in children [12].
Hence, it is suggested that up to 80% of a person’s lifetime exposure to UV radiation is
reached before the age of 18 [13]. Thus, it is necessary to provide eye protection from UV
radiation at a young age.
There are several ways of protecting the eye from UV radiation to avoid possible
ocular damage caused by excessive exposure. The most common method is the use of
sunglasses, which are eyewear that contain a UV-protection filter which filters 99–100%
of UV radiation [14]. These types of UV-blocking sunglasses can be supplementarily de-
signed by adding a “wrap-around” frame and using sideway shields on the frame to re-
duce the entry of UV radiation into the eye [14,15]. Other recognized methods to protect
the eyes from UV radiation include contact lenses [16] and implanted intraocular lenses
that contain UV-blockers [15,17].
Several studies have been published to evaluate the knowledge and protection be-
haviors concerning UV radiation among populations. However, to date, there are a lack
of studies that assess awareness levels regarding UV radiation in relation to ocular dam-
age among people in Jordan. Jordan is a Mediterranean country labelled as having a high
intensity of UV radiation, known as UV index (UVI), for most of the year and with a max-
imum UVI level of 12 when measured in the summer season [18]. Therefore, this study
aims to assess the knowledge and public attitudes regarding UV radiation and ocular pro-
tective behaviors in Jordan. The outcomes of the current study essentially recommend
increasing public awareness of possible UV-related ocular damage and alert the public
and healthcare providers to enhance and apply protection strategies for UV exposure.
2. Methods
2.1. Study Design and the Questionnaire
The study is a cross-sectional design that used a structured web-based questionnaire
which was designed and modified based on a previous questionnaire developed by Lee
et al. [19]. The questionnaire was intended to be conducted in Arabic. The comprehension
and scientific appropriateness of the Arabic questionnaire was initially reviewed by a fo-
cus group consisting of three faculty members in the department of Allied Medical Sci-
ences at the Jordan University of Science and Technology (J.U.S.T). The revised version of
Healthcare 2022, 10, 2414 3 of 12
the questionnaire was then administered to 20 participants in order to check the respond-
ents’ comprehension of the questions and the required response time. Responses from the
pilot sample were not included in the final data analysis.
The final version of the questionnaire showed very good psychometric properties
including an acceptable internal consistency and test-retest reliability (interclass correla-
tion coefficient, r = 0.832, p < 0.001). The construct validity for the questionnaire was also
high.
The final Arabic version of the questionnaire was administered online using Google
Forms® (Google Inc., Mountain View, CA, USA) and was shared via social media,
WhatsApp, and LinkedIn for a period of 4 weeks between July 2021 and August 2021. The
estimated time needed to answer the questionnaire was approximately 8 min on average.
Questions included in the questionnaire were divided into five sections: (1) the soci-
odemographic information of participants including age, gender, education level, and em-
ployment status; (2) awareness regarding UV radiation (sources, harm, etc., and im-
portance of wearing UV-protective eyeglasses; (3) knowledge of UV radiation; (4) prac-
tices toward eye protection from UV radiation (solar UV and artificial sources of UV); and
(5) reasons for not wearing UV-protective eyeglasses.
2.2. Data Analysis
Data were analyzed using the Statistical Package for Social Sciences software version
21 (SPSS, International Business Machine Corp. IBM, Chicago, IL, USA). The mean and
standard deviation were used to describe continuously measured variables. The fre-
quency and percentages were used for categorically measured variables. The histogram
and the statistical Kolmogrove–Smirnove test were used to assess the normality assump-
tion of continuous variables and Levene’s test of homogeneity of variance for testing the
equality of statistical variance assumption. The multiple response dichotomies analysis
used for variables with more than one option (e.g., seasons of eyeglasses).
People’s knowledge on UV radiation was measured via rewarding their correct an-
swers to knowledge questions with one mark (point) and with zero for incorrect answers.
First, a total UV protection knowledge score was computed by adding up people’s marked
answers to the thirteen knowledge questions yielding a total UV protection knowledge
score between 0–13 marks. Next, this score was transformed into a percentage via dividing
people’s knowledge score by the maximum possible score (=13), then multiplying the
yielded product by a hundred.
People’s UV knowledge score was dichotomized into low and high knowledge scores
based on the sample median knowledge score (median = 9 points out of 13). Then, a mul-
tivariate binary regression analysis was used to assess the statistical significance of the
predictors of people’s odds of having a high UV-protection knowledge, and their odds of
not wearing UV-protective eyeglasses, the association between the people’s socio-demo-
graphic, and other relevant predictor variables with the analyzed UV knowledge; protec-
tion behaviors were expressed as an odds ratio with an associated 95% confidence inter-
val. The alpha significance level was considered at a level of 0.05.
2.3. Ethics Approval
The study was approved by the Institutional Review Board (IRB) at the Jordan Uni-
versity of Science and Technology (Irbid, Jordan). The ethical reference number was:
25/142/2021.
The aim and importance of the study was explained to the participants. Informed
consent was obtained electronically from all participants before proceeding to the survey
questions. Participation in this study was voluntary. To ensure privacy and confidential-
ity, the anonymity of the participants’ personal information was preserved. The study
protocol complied with the provisions of the Declaration of Helsinki regarding research
on human participants.
Healthcare 2022, 10, 2414 4 of 12
3. Results
3.1. Participants’ Demographics
A total of 1331 participants (77% females and 23% males) completed the online ques-
tionnaire. The mean age (±standard deviation) of the participants is 26 (±10) years with
the majority of the study population was in the age group 18–30. Demographic infor-
mation of all participants is showed in Table 1.
Table 1. Participant characteristics (n = 1331).
Variable n (%)
Gender
Male 302 (23)
Female 1029 (77)
Age
18–25 477 (36)
26–30 560 (42)
31–40 133 (10)
>41 161 (12)
Work status
Employed 227 (17)
Unemployed 242 (18)
Undergraduate student 735 (55)
Postgraduate student 29 (2)
Retired 97 (7)
Nature of work
Outdoor jobs 835 (63)
Indoor jobs 254 (19)
Unemployed 242 (18)
3.2. General Awareness Regarding UV Radiation, Association with Ocular Harm, and UV-Pro-
tective Eyeglasses
The majority of the respondents (97%) reported that they were aware of UV radiation.
Additionally, a high proportion of the participants reported that they were aware that UV
radiation could result in harm to the human body and eyes, as shown in Table 2.
Participants were also asked about UV-protective eyeglasses. The results showed
that although the majority of the participants had heard about UV-protective eyeglasses,
less than half of the participants (48%) agreed that the UV protection featured in eye-
glasses is effective in blocking harmful UV rays and should be considered in any eye-
glasses. A total of 49% reported that they do not have enough information about how UV
protection works and about its effectiveness, and 4% of them believed that UV protection
is a marketing scam used to increase sales and profit of marketed eyeglasses.
Table 2. Participant awareness to UV radiation and protection.
Awareness Questions n (%)
Have you ever heard about UV radiation?
Yes 1289 (97)
No 42 (3)
Do you think that UV radiation may affect human body?
Yes 1198 (90)
No 133 (10)
Do you think that UV harms the eye?
Yes 1080 (81)
Healthcare 2022, 10, 2414 5 of 12
No 251 (19)
Have you ever heard about UV protection in eyeglasses?
Yes 962 (72)
No 369 (28)
What do you think about UV protection in eyeglasses?
- Effective and should be applied 633 (48)
- I do not have enough information.
- It is a marketing scam to increase profit 649 (49)
49 (4)
3.3. Knowledge of UV Radiation, Its Harm for the Human Eye, and Methods of Protection
Participants were asked to answer thirteen questions measuring their knowledge re-
lated to UV radiation, its harm for the eye, and methods of protection. The results from
the analysis of the knowledge assessment of the participants are displayed in Table 3.
Generally, most respondents showed good knowledge regarding UV radiation, the
most dangerous UV exposure time during the day, and other synthetic sources of UV
radiation. Respondents were also asked about their knowledge about some ocular dis-
eases associated with UV radiation, including cataract, pterygium, pinguecula, and AMD.
Respondents were able to define these diseases. However, respondents showed substan-
tial knowledge about the link between UV radiation with the questioned ocular diseases.
Table 3. Descriptive analysis of participants’ knowledge of UV radiation, its harm, and methods of
protection.
Knowledge Question Correct n (%) Incorrect n (%)
1
What time of the day is the most dan-
gerous exposure time to the sun with-
out protection?
(Morning, Noon, afternoon Evening)
1170 (88) 161 (12)
2 Do you know that there are artificial
sources of UV rays beside the sun? 897 (67) 434 (33)
3 Do you know what is cataract/lens
opacification is? 885 (67) 464 (34)
4
Do you know that exposure to harmful
sun rays (ultraviolet radiation) without
protection may lead to cataract?
576 (43) 755 (57)
5
Do you know what pinguecula is (yel-
lowish raised growth on the conjunc-
tiva)?
442 (33) 889 (67)
6
Do you know that exposure to harmful
sun rays (ultraviolet radiation) without
protection may lead to pinguecula?
188 (14) 1143 (86)
7 Do you know what is Age-related mac-
ular degeneration (AMD)? 948 (71) 383 (29)
8
Do you know that exposure to harmful
sun rays (ultraviolet radiation) without
protection may lead to AMD?
190 (14) 1141 (86)
9
Do you know that ultraviolet radiation
has a greater danger to young people
than older people?
583 (44) 748 (56)
Healthcare 2022, 10, 2414 6 of 12
10
Do you know that wearing UV protec-
tive eyeglasses prevents UV harmful
sun rays’ entry to the eye
708 (53) 623 (47)
11
In which season the protection against
UV radiation is necessary? (You can
choose more than one answer) (spring
and summer)
833 (63) 498 (37)
12 Do you think that wearing protective
eyeglasses in winter is important? 812 (61) 519 (39)
13
Do you know that commercial sun-
glasses have a negative effect on the
eyes?
338 (25) 993 (75)
3.4. Participant Practices toward Protection from UV Radiation
Participants were further asked about their practices toward ocular protection from
natural UV radiation emitted from the sun. Responses were distributed as the following:
59% of the respondents reported that they do not use any protective eyewear when they
go outside, 30% of the participants reported wearing quality sunglasses with full, tested
UV protection bought from optical shops, and 11% of the participants reported that they
wear c heap, d ark cosmet ic sung lasses bou ght from accessory shops and they are uncertain
if they have UV protection.
Participants were also asked whether they use UV radiation protection (eyeglasses
or protective screens) to protect their eyes from artificial sources of UV radiation emitting
from light-emitting diodes (LEDs), tanning booths, mercury vapor lamps, and electronic
devices such as computers and mobile phones. The majority (92%) of participants re-
ported not using any protection from artificial sources of UV radiation.
3.5. Multivariate Logistic Regression Analysis of Participants Knowledge of UV Harm and Pro-
tection
A multivariate binary logistic regression was performed to assess factors correlated
with measured levels of participant knowledge. Table 4 shows that sex is correlated sig-
nificantly with the odds of having a high UV knowledge; male respondents have a signif-
icantly lower (62% times less) UV knowledge level compared to females, p < 0.001. Fur-
thermore, the age of participants is correlated significantly and negatively with the odds
of having a high UV knowledge. As participant age tends to rise by one year, the likely
odds of being highly knowledgeable about UV harm and protection tends to decline by a
factor equal to 3% times less, p < 0.001. Participant work status and work environment
(indoor or outdoor) does not converge significantly on the odds of participants having a
high UV knowledge. However, participants with a former awareness about UV rays were
found to be significantly more likely (2.4 times more) for a high UV knowledge compared
to those with a low level of awareness of UV radiation, p = 0.036.
People perceived time of best eyeglass use did not converge significantly on their UV
knowledge, but people who use protective eyeglasses during electronic device use were
significantly more likely to UV high knowledge than those who do not wear such protec-
tion on average, p = 0.047. In addition, people previously made aware of the importance
of eye UV-protective measures were significantly more likely for high UV knowledge than
others unaware of the usefulness of the eye protection, p < 0.001.
The analysis model findings showed that people who were keen to buy eyeglasses
with UV protection were found to be significantly more likely (1.4 times more) to have a
high UV knowledge compared to people who are not keen to buy eyeglasses with UV
protection, p < 0.001. Nonetheless, people who believed in the effectiveness of UV-protec-
tive features in eyeglasses were found to be significantly more (1.7 times more, p < 0.001)
Healthcare 2022, 10, 2414 7 of 12
likely to have had a high knowledge of UV harmfulness and protection compared to oth-
ers who believed the UV protection in sunglasses is a marketing scam or those who do
not even use eyeglasses. Interestingly, people who bought their eyeglasses from optics
shops were found to be significantly more likely (2.0 times higher, p < 0.001) to have a high
UV knowledge on average compared to those who buy eyeglasses from accessory shops
or those who had never bought them. However, people who advised that they do not
wear protective eyeglasses or any eyeglasses with featuring UV-protection were found to
be significantly less likely (39% times less, p = 0.001) for having a knowledge of high UV
harmfulness and protection on average compared to those who do use protective eye-
glasses or features of UV protection in general.
Table 4. Multivariate logistic regression analysis of participant knowledge of UV protection and
harm.
Multivariate Ad-
justed Odds Ra-
tio
95% C.I. for OR p-Value
Lower Upper
Sex (Male) 0.38 0.28 0.52 <0.001
Age (years) 0.97 0.95 0.98 <0.001
Employment 1.1 0.97 1.2 0.16
Nature of work 1.1 0.81 1.6 0.46
Previously heard of UV 2.4 1.06 5.2 0.036
Time of sunglasses use 1.0 0.82 1.2 0.99
Use of protective eye-
glasses during TV/PC use 1.7 1.0 2.7 0.047
Previously aware of ultra-
violet ray protection 2.0 1.4 2.7 <0.001
Buys eyeglasses with UV
protection 1.4 1.0 1.8 0.044
Believes protective eye-
glasses are UV effec-
tive/protective
1.7 1.3 2.3 <0.001
Buys eyeglasses with UV
protection from optics
shops
2.0 1.5 2.7 <0.001
Does not wear eye glasses
at all 0.61 0.45 0.82 0.001
Constant 0.15
0.017
Dependent variable = high UV knowledge (no/yes).
3.6. Reasons for Not Wearing UV-Protective Sunglasses
Respondents who do not wear any protective sunglasses (790, 59% of the study pop-
ulation) were further questioned about their chief reason for not wearing UV-protective
eyeglasses. A total of 7% of the respondents reported that they have never heard about
UV-protective eye glasses; 18% reported that the appearance and weight of sunglasses on
the nose and face is the main reason for not wearing sunglasses; 14% of the respondents
stated that the high price of quality sunglasses prevents them from buying protective eye-
glasses; 14% of respondents suggested that UV-protective sunglasses affected their per-
ception of colors; and 47% of the participants reported that they do not believe in the effi-
ciency of the UV protection of sunglasses.
A further statistical analysis was performed to study factors affecting people’s choice
for not wearing protective eyeglasses, as shown in Table 5. First, the use of protective
eyeglasses was dichotomized as follows (0 = wears UV-protective eyeglasses and 1 = does
Healthcare 2022, 10, 2414 8 of 12
not wear UV-protective eyeglasses); this outcome was then regressed using the multivar-
iate logistic binary regression model against people’s socio-demographic characteristics
and their practices as well as knowledge of UV and other UV protection attitudes.
The results from the multivariate analysis model showed that people’s sex correlated
significantly with their odds of not using UV-protective eyeglasses. Males were signifi-
cantly more likely (1.4 times more, p-value = 0.046) for not using UV-protective eyeglasses
than female respondents on average. Moreover, people’s age converged significantly, p <
0.001, but negatively on their odds of not using UV-protective eyeglasses. Denoting that
as people’s age tended to rise by one year, their odds of lacking UV protection declined
by a factor equal to 2% times less on average.
The analysis model also showed that retired people were significantly more likely
(1.6 times more, p = 0.002) to not use UV-protective eyeglasses than people in other occu-
pations. Furthermore, university students were found to be significantly more likely (1.7
First, p9 times more, p = 0.02) to not use UV-protective eyewear as well. However, re-
spondents who bought their eyeglasses from opticians were found to be significantly less
(85% times less) likely to lack UV protection compared to people who bought their eye-
glasses from accessories shops and those who do not use protective eyeglasses in general
<0.001. Moreover, the multivariate analysis model showed that people’s UV protection
and harm knowledge mean score has correlated significantly but negatively with their
odds of not using UV-protective eyeglasses, as people’s knowledge score tended to rise
by 1% on average their likely odds of not using the protective eyeglasses declined by a
factor equal to 1.5% times less, p = 0.001.
Table 5. Multivariate Logistic Regression Analysis of not using UV-protective eyeglasses.
Multivariate Ad-
justed Odds Ra-
tio
95% C.I. for OR
p-Value
Lower Upper
Sex (Male) 1.4 1.0 1.9 0.046
Age (years) 0.98 0.96 0.99 0.005
Occupation = Retired person 1.6 1.1 2.5 0.020
Occupation = University student 1.7 1.2 2.3 0.002
Buys eyeglasses from optics shops 0.15 0.11 0.19 <0.001
Ultraviolet rays Protection and Harm
knowledge score 0.99 0.98 0.99 0.001
Constant 11
<0.001
Dependent outcome variable = Does Not use UV-protective eyeglasses (No/Yes).
4. Discussion
Ultraviolet radiation is considered a main cause of ocular surface disease and cata-
ract, especially in geographical areas with high UVI. Jordan is labeled as a country with a
relatively high UVI, with an average UVI of 11 on most days of the year [18]. This study
provides an insight into the awareness, the knowledge, and the attitude of people in Jor-
dan toward UV radiation harm to the eye as well as UV protection. Awareness merely
refers to an understanding of the general information on a certain topic. Thus, in the cur-
rent study, it was substantially required to assess people’s knowledge of UV harm and
the methods of protection.
The current study reports a good level of awareness of UV radiation, its harmful ef-
fects on the eyes, as well as the usage of UV-protective eyewear. However, participants
showed substantially moderate awareness of the important purpose of the UV protection
feature in eyeglasses. Our findings were comparable to those reported by other countries,
where studies also showed a high level of public general awareness of UV radiation and
Healthcare 2022, 10, 2414 9 of 12
its harm. To mention a few, a study in Saudi Arabia reported that the majority of the pop-
ulation have heard about UV radiation and its associated ocular diseases [20]. Similarly,
in a study in South Africa, most participants knew that sunlight has adverse effects on the
eyes [21]. Likewise, a high level of awareness was reported in Australia regarding expo-
sure to ultraviolet radiation when engaging in outdoor activities [22].
In the second part of the study, we assessed participants’ knowledge of UV radiation
harm and protection against it more specifically on the basis of a number of questions that
measured in-depth knowledge about the topic. The overall estimated level of knowledge
was found to be average (51.38%) among the residents of Jordan. The research sample
showed their apprehension of the different sources of UV radiation such as natural solar
UV radiation and synthetic sources of UV radiation as well. They also showed awareness
about the most dangerous times of the day and season/s of the year to be exposed to UV
radiation, when UV eye protection is highly recommended. However, respondents were
unaware of the role of UV-protective eyeglasses in preventing eye disease and damage
caused by UV radiation and the greater consequences of UV radiation on younger people
in comparison to older people. Additionally, a substantive proportion of the respondents
lacked knowledge about the link between UV radiation and specific ocular diseases. Fur-
thermore, the majority of the respondents could not differentiate that commercial (cheap)
sunglasses may pose a risk to human eyes due to a lack of UV-protective features. This
may be attributed to the deficient medical background of participants and low exposure
of medical material displayed by various media platforms. Another explanation of low
levels of knowledge about harm from UV radiation among the study population may also
be linked to the low prevalence of sun-related skin cancers in Jordan [23], as high levels
of UV knowledge have been reported in populations of countries with higher incidence
of skin cancer [24].
Similar to our findings, low levels of knowledge on the relation of UV radiation and
ocular harm were also reported in many countries. A study in Northeast China reported
that whereas the majority of the studied population knew the harmful effect of UV radia-
tion on the skin, a low percentage of people could identify the harmful effect of UV radi-
ation on the eye [25].
A further analysis reveals that females have more knowledge of UV harm and pro-
tection. This may be explained by the interest of women in self-care and body image that
is promoted by society and the media [26]. Predictably, participants who are more aware
of UV radiation were found to significantly have more UV radiation related knowledge
compared to those with less awareness of UV radiation. Moreover, it was found that age
of the participants negatively correlated with level of knowledge in the study.
In regard to preventive measures taken toward ocular UV protection, only a third of
the respondents reported using certified UV-protective eyewear. Whereas the majority of
the study population do not wear UV-protective eyeglasses at all, or they wear low quality
sunglasses with no certified built-in UV filter. Additionally, the majority of the partici-
pants reported not using protective eyewear for artificial sources of UV radiation. Similar
levels of adherence to wearing protective sunglasses was also reported in Melbourne,
Australia (36%) [27], Florida, USA (27%) [28], and Northwest Ethiopia [29]. Even lower
level of wearing protective sunglasses was reported in Shenyang, China (9%) [25]. In con-
trast to our finding, 80% of adults in Kuwait [30] and 60.2% in Saudi Arabia [20] reported
using protective sunglasses.
In the current study, a further analysis showed that people who are adherent to wear-
ing eyeglasses with UV protection significantly also had high UV-related knowledge.
Thus, the lower motivation of the participants toward wearing protective sunglasses may
be attributed to low levels of participants’ knowledge about UV radiation-associated
harm. Furthermore, females were found to be more compliant toward wearing UV-pro-
tective eyeglasses. This may be explained by the fact that women are more informed about
skin care and sun protection forms including sunscreen products and protective sun-
glasses via women’s magazines and media [24]. The finding that women are more aware,
Healthcare 2022, 10, 2414 10 of 12
knowledgeable, and adherent to sun protection compared to men has also been reported
by many studies [24,31–33]. Surprisingly, older people in this study were found to be less
adherent to using protective eyeglasses. This contradicts the fact that elderly people
should take more precautions as they are more susceptible to sun-related ocular condi-
tions such as cataract [34].
The high price of quality UV-protective sunglasses could be a possible reason for
refraining from the use of protective sunglasses in the study population. The price of the
sunglasses usually increases in brands that use good quality material and innovation to
enhance maximum protection and durability. Furthermore, the practice of using protec-
tive sunglasses may depend on the nature of the profession as those who work and stay
indoors may have a lower interest in using protective sunglasses as such people may
spend less time outdoors.
To the best of our knowledge this is the first study to assess people’s awareness and
knowledge on the exposure to UV radiation and their preventive behaviors against UV
radiation in Jordan.
The study used an online survey, which may have resulted in self-report bias, as par-
ticipants are often biased when reporting their personal opinions and attitudes. Further-
more, there is a large difference in the number between female and male participants that
does not match with the female-to-male ratio of the national population in Jordan. This is
an expected bias because of a lack of random sampling when using the online survey.
Furthermore, the questions used in the questionnaire were closed-ended with one or two
choices to select from, which might cause a bias in the responses. Future work is recom-
mended to reveal a more in-depth insight of the level of knowledge about UV radiation
and precise protective behaviors. This could be performed using qualitative research
methods using semi-structured individual interviews, with a smaller sample size being
recruited. Finally, the study investigated the level of knowledge and practices of the par-
ticipants and related them to influencing factors such as age, gender, and occupation. Al-
beit it is recommended in a future work to study participants’ perception of possible bar-
riers for not using UV-radiation-protective sunglasses such as the cost of quality sun-
glasses, cultural and social beliefs about sunglasses that they may hide the wearer’s feel-
ings and beauty features, or if wearing sunglasses may be considered as disrespectful be-
havior when covering the eyes to avoid eye contact with other people.
5. Conclusions
Exposure to UV radiation is a risk for ocular disease. This study assessed the aware-
ness, knowledge, and protective behaviors of UV radiation and its associated ocular harm,
and also assessed the influencing factors such as age, gender, and occupation. The study
revealed a good level of awareness; however, knowledge of UV radiation was poor in
relation to its associated ocular harm and means of protection. Knowledge and protection
from UV radiation were positively associated with people of a younger age and in fe-
males. These findings suggest that more efforts are required to enhance knowledge and
promote the use of protective sunglasses besides using other methods of protection from
UV radiation such as hats and umbrellas. This could be promoted at a younger age
through health education in schools and health-promotion campaigns through media and
by ophthalmologists to reduce the risk of ocular damage due to excessive unprotected
exposure to UV radiation.
Author Contributions: M.A.A.: Conceiving research idea, study design, data analysis, writing-up
the manuscript and submission to Journal, M.M.B.: study design, data collection, writing up the
manuscript, A.A.D.: Statistical Analysis, A.M., D.J., S.A. and W.K.: Collecting data. All authors have
read and agreed to the published version of the manuscript.
Funding: This research received no external funding
Healthcare 2022, 10, 2414 11 of 12
Institutional Review Board Statement: The study was conducted in accordance with the Declara-
tion of Helsinki, and approved by the Institutional Review Board (IRB) at the Jordan University of
Science and Technology (Irbid, Jordan). The ethical reference number was: 25/142/2021.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study
Data Availability Statement: Data is available by emailing the corresponding author
Acknowledgments: The authors would like to thank all participants who participated in this study.
Conflicts of Interest: The authors declare no conflict of interest.
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