Saudi Journal for Health Sciences

: 2019  |  Volume : 8  |  Issue : 1  |  Page : 17--24

Cognitive mapping of the public's risk perception based on gender and age in Saudi Arabia

Adel F Almutairi, Abdallah A Adlan, Mahmoud Salam, Ala'a BaniMustafa 
 King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

Correspondence Address:
Dr. Adel F Almutairi
Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, 22490, Riyadh 11426
Saudi Arabia


Background: Humans process their lifetime experiences internally as mental images that constitute their cognitive maps, which they employ to recall and assess important features in their relative contexts. This study aims to develop a cognitive map of the public's risk perception based on gender and age in the unique Saudi cultural context. Methods: Data were collected using a self-administered survey measuring the public's perceived risk of nine common life hazards. Differences in gender (bivariate analysis) and age (correlation analysis) over each domain were presented. Cognitive mapping was developed. Results: Of the 317 participants, there were 211 (67.6%) females and 101 (32.4%) males with 32.5 ± 10.7 years as the mean and standard deviation of their age. A series of regression models showed that males had a better perception on the knowledge and control domain compared to females about the hazard of nuclear reactors (β = −0.2, adjusted P < 0.001), yet worse perception on the knowledge and control domain about caffeine intake (β = 0.21, adjusted P < 0.001). Males also had a worse perception of the severity and dread domain in regards to caffeine intake (β = −0.16, adjusted P = 0.005) and pesticides (β = −7.54, adjusted P = 0.002) compared to females, yet females had worse perception of the severity and dread domain concerning bicycles (β = 0.31, adjusted P < 0.001) compared to males. Older study participants had a better perception on the dread and severity domain in regards to caffeine intake (β = −0.26, adjusted P < 0.001) compared to younger participants. Conclusion: Gender and age differences in the risk perception toward some life hazards were observed among Saudi adults, which define the structural features of the Saudi cognitive map.

How to cite this article:
Almutairi AF, Adlan AA, Salam M, BaniMustafa A. Cognitive mapping of the public's risk perception based on gender and age in Saudi Arabia.Saudi J Health Sci 2019;8:17-24

How to cite this URL:
Almutairi AF, Adlan AA, Salam M, BaniMustafa A. Cognitive mapping of the public's risk perception based on gender and age in Saudi Arabia. Saudi J Health Sci [serial online] 2019 [cited 2019 Jun 18 ];8:17-24
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Full Text


The computational view of the mind demonstrated that mental maps or cognitive maps are a form of mental processing called cognition, which helps people acquire, code, store, recall, and decode information about the phenomena that are happening in their lives. Consequently, cognition helps people to perceive, contextualize, simplify, and interpret their experiences, for instance, as difficult, risky, pleasant, irritating, or simply neutral.[1] Cognitive maps have been widely utilized in many disciplines, including psychology, education, archaeology, geography, cartography, and management.[2]

In this study, we adopted the term “cognitive mapping” to denotes a sketch of the public's risk perceptions of a number of health hazards, which are defined as the threats posed to people or things they care about or cherish. Whereas risk refers to one's likelihood of experiencing the effects of a certain hazard.[3] Thus, risk perception is related to the subjective assessments and judgments that people make about the characteristics of risk and the severity of its consequences. Hence, one's risk perception does not necessarily always match the magnitude of the actual hazard.[4] The most influential and comprehensive psychological theory that dominates the field of risk perception is the “psychometric paradigm.”[3],[5] This is a taxonomic scheme using psychological frames to produce quantitative representations of risk perceptions, which fall into a number of domains. The first is the dread domain, which refers to the potential for fatal consequences, catastrophe, or future threat. Unknown risk, the second domain, revolves around characteristics such as unobservable or uncontrollable outcomes, while affect, the third domain, refers to the state of one's emotions.[6],[7]

However, risk perception is believed to go beyond the individual, as it is partly a social and cultural construct reflecting the values, symbols, history, and ideology of the society in which someone lives.[8] The people in Saudi Arabia, therefore, might have different risk perceptions than those in other countries as a result of their unique daily exposures to events, shared beliefs, and common cultural attributes, all of which can shape their perceptions of the severity of the risks associated with the things around them. The media can also affect the public's perceptions of certain risks based on the method and frequency of their coverage.[3] For example, in the past few years, blood with the human immunodeficiency virus was transfused to a young Saudi girl in the southern region of Saudi Arabia. As this incident was given great prominence in the media, it is still echoing in the minds of the public.[9]

It is argued in the literature, that when people are more aware of certain risks or they know someone who has died from a particular risk (e.g., a disease), they tend to believe such incidents occur more frequently than they actually do.[3] Thus, their risk perceptions are formed by their awareness of the risk, in conjunction with emotions such as dread and fear, which can sometimes make them overestimate the occurrence and severity of hazards.

Before making any health-related decisions, people usually weigh the risks and consequences against the expected benefits. Understanding the public's risk perceptions of certain hazards can help in designing interventions to change health-related behaviors, anticipating their responses to hazards, as well as improving the methods of communicating risk information to laypeople and experts.[10] Experts often assess the risk based on probability, whereas the public evaluates the risk based on consequences.[11] Furthermore, individual characteristics, such as optimistic bias or unrealistic optimism, can lead to the misperception of the likelihood, frequency, and severity of certain risks. For instance, those who smoke and have optimistic bias tend to believe that smoking poses risks to other people but not to themselves.[3]

Two main factors that can play a role in people's risk perceptions in terms of their propensity to take risks are gender and age. Many studies in the literature revealed the existence of gender differences, in particular, that males are more likely to take risks than females.[12],[13] Interestingly, such difference was not uniform in some domains of risk, in which there was no difference or females were more likely to engage in risky behaviors than males in the social domain.[12],[13],[14] For age, while it is often assumed that younger people are less cautious and more likely to take risks, a study conducted in England with 127 participants found no age differences in risk perceptions concerning the most studied behaviors (e.g., skiing, smoking, playing soccer, drinking alcohol, and using illegal drugs).[15] However, other studies indicated that older people perceive more risk in behaviors related to health and ethics domains and less risk in behaviors associated with social domains.[16] Thus, knowledge about the differences in the public's risk perceptions based on gender and age has practical and theoretical significance.

The majority of the studies in the literature were conducted in different contexts to measure people's risk perceptions and health behaviors associated with specific hazards, such as climate change, air pollution, caffeine, sharing injection needles, smoking, pesticides, bicycles, and nuclear waste.[17],[18],[19],[20],[21] However, no studies have been conducted in Saudi Arabia to measure the public's risk perception of such life hazards.

Populations in the Middle Eastern region consist of diverse ethnic, linguistic, sectarian and socioeconomic identities. Although the Saudi Arabian population is an extension of the surrounding Middle Eastern communities, it remains one of the most conservative and possesses distinctive features. For instance, some of the Western cultural norms, such as cinemas, theatres, dancing shows have not been introduced until late 2010. Tribal and religious bonds are widely spread which results in high rates of social desirability. All these factors influence the population's perception towards current life hazards or risks and more importantly newly introduced ones, such as nuclear power. Moreover, the Saudi Arabian landscape is mainly a harsh desert which discourages the public community from adopting eco-friendly and healthy methods of commuting such as bicycle riding. Saudi Arabia is a big importer of groceries from the regional and international markets, some of which are labeled as genetically modified or treated by pesticides. Therefore, some Saudis and based on certain religious reservations might be more suspicious about its quality. These few risks and in addition to others might have been perceived differently across communities with various cultural differences. Thus, the goal of this study is to develop a cognitive map of the public's risk perception based on gender and age in the unique Saudi cultural context. We also aim to determine whether females or males perceive more risks in regard to the nine life hazards and whether risk perception increases positively with age.


Study design

This is a cross-sectional study, which adopted a prevalidated self-administered questionnaire.

Population and sampling

The study setting was a major national festival for heritage and culture held annually for 2 weeks in Riyadh city, the capital of Saudi Arabia. This event is a magnet for Saudi Arabians who visit it from different regions and areas of the Kingdom with an annual record exceeding one million visitors. Eligible study participants were members of the Saudi Arabian population, adults (≥18 years), and were willing to take part in the study. The data collection was executed by a team of certified research coordinators who were skilled at approaching study candidates, inviting them to enroll in study, secure informed consent and administer surveys. Data collection booths were designated at the event site so that by convenience visitors were exposed to the surveyors. During the invitation, the study purpose, procedure, and expected benefits were explained to potential participants. Those who agreed to participate received the study package, which contained a copy of the questionnaire and the study's information letter.

A total of 405 participants were invited to participate in this study, yet 317 (78.3%) agreed to enroll and completed the survey. Female participants made up the majority of the sample (n = 211) at 67.6%, whereas male participants formed the minority (n = 101) at 32.4%. Participants had a mean age of 32.5 and standard deviation of 10.7 years. Specifically, 152 (48.7%) were <30 years of age, and the rest of the sample (n = 160, 51.3%) were 30 years or above.

Data collection instrument

The survey was self-administered and questioned the participants about two exposures age and gender. Other variables that might have a potential confounding effect on the study outcomes, such as the level of education, occupation, and marital status were not evaluated since this was beyond the study objectives. Participants self-reported their perceived risk against nine common life hazards which are prescription drugs, caffeine, sharing injection needles, genetically modified foods, blood transfusion, pesticides, nuclear reactors, bicycles riding, and smoking (e.g., cigarettes).[6] Participants responded to 10 statements for each hazard [Table 1], five statements measured the dread and severity toward the hazard (statements 1, 2, 3, 7, and 10) while the other five statements measured the degree of knowledge and control over this hazard (statements 4, 5, 6, 8, and 9). The responses to each of the statements were rated on a 7-point Likert scale with reference to a group of qualitative characteristics.[21]{Table 1}

The risk perception questionnaire was originally developed in English, and it has not been used and tested in other cultures, such as that in Saudi Arabia. Therefore, this tool was subjected to a number of tests to confirm its validity and reliability for utilization in an Arabic community. Specifically, all items for the nine hazards were translated into Arabic, by a professional translator, and then translated back into English with minor revisions. It was also subjected to further scrutiny by an expert in the social sciences to ensure that the wording of these items was appropriate and that they were readable, clear, and relevant to the local context.

Data analysis

The Statistics Package for the Social Sciences (SPSS, version 25, Armonk, NY, USA) was used to perform the data analysis. Age and gender were analyzed using descriptive statistics, including the arithmetic mean, standard deviation, frequency, and percentage. The weighted mean of the sample was calculated to correct for any gender bias based on the male-to-female distribution in the Saudi population.[22] The responses obtained from participants for each of the two domains within the nine hazards were converted into percentage mean scores (PMS). The reliability of each scale was measured using Cronbach's alpha coefficient as follows: nuclear reactor 0.50, caffeine intake 0.59, sharing injected needles 0.64, genetically modified food 0.67, blood transfusion 0.76, pesticide 0.72, bicycle 0.66, prescription drugs 0.64, and smoking 0.70. High PMS of the perceived severity/dread on a certain domain signified more fear of the domain being risky, whereas higher PMS of the perceived knowledge/control signified the level of awareness toward this risk. Since the data were normally distributed, independent Student's t-test was used to identify the gender differences in the PMS of dread/severity and knowledge/control domains in all nine hazards. Hedges' g was presented as an appropriate measure of the effect size between the two groups. Pearson correlation test was used to assess the relationship between the participants' age and the PMS for each hazard. A series of linear regression models were constructed to determine if the sex and age factors were significantly associated with the study outcomes. The level of significance was set at P < 0.05, yet after applying the Holm–Bonferroni correction, the corrected P value was set statistically significant at <0.02. In order to better understand how the public perceived the risk of these hazards, cognitive mapping was developed by plotting mean scores of the two domains (knowledge and control of this risk) against (dread and severity of this risk) for each hazard.

Ethical considerations

Ethical clearance and approval to conduct this study were obtained from the Institutional Review Board at the Ministry of National Guard–Health Affairs (RC16/09). Participation in this study was voluntary and anonymous, as there were no self-identifiers in the questionnaire. After agreeing to participate, informed consents were sought from these participants.


Cognitive mapping of risks

The participants' responses to the two domains, namely (1) knowledge and control and (2) dread and severity, were plotted in for each risk based on gender, as illustrated in [Figure 1] and [Figure 2] respectively.{Figure 1}{Figure 2}

Males (PMS = 63.5 ± 20.2) had a significantly higher perception scores on the knowledge and control domain than females (PMS = 56.8 ± 12.4) in regards of nuclear reactors (P < 0.001). The perceived PMS of dread and severity regarding the caffeine intake was higher among males 36.6 ± 23.4 compared to females 27.4 ± 18.8, P < 0.001, but the perceived knowledge and control score was higher among females PMS 67.8 ± 15.9 compared to males 59.4 ± 21.0 in relation to caffeine intake, P < 0.001. Other weighted means of overall sample scores within each domain were presented in [Table 2]. To examine the relationship between participants' age and their responses to the two domains of each risk, Pearson correlation was used. The analysis showed a significant negative relationship between age and the perception PMS of caffeine (r = −0.29, P < 0.001) for the dread and severity domain as well as a negative relationship between age and the perception PMS of sharing injected needles (r = −0.16, P = 0.004) for the knowledge and control domain. In addition, there was a significant positive correlation observed between age and bicycles (r = 0.188, P = 0.001) as well as age and prescription of drugs (r = 0.143, P = 0.011), both in terms of dread and severity.{Table 2}

A series of regression models showed that males had a better perception on the knowledge and control domain compared to females about the nuclear reactors domain (β = −0.2, adjusted P < 0.001), yet worse perception on the knowledge and control domain about the caffeine intake (β = 0.21, adjusted P < 0.001). Males also had worse perception of the severity and dread domain in regards of caffeine intake (β = −0.16, adjusted P = 0.005) and pesticides (β = −0.18, adjusted P = 0.002) compared to females, yet females had worse perception of the severity and dread domain in regards of bicycles (β = 0.31, adjusted P < 0.001) compared to males. Older study participants had better perception on the dread and severity domain in regards of the caffeine intake (β = −0.26, adjusted P < 0.001) compared to younger participants. However, younger study participants had better perception on the dread and severity domain in regards of prescription drugs (β = 0.16, adjusted P = 0.005) compared to older participants. In regards of the knowledge domain of sharing injected needles, younger participants had better [Figure 3] perception (β = −0.15, adjusted P = 0.009) compared to older participants [Table 3].{Figure 3}{Table 3}

The cognitive map in [Figure 2] illustrates the public perception of the risks of these hazards from the least to most severe and dreadful: caffeine, prescription drugs, bicycle riding, blood transfusions, genetically modified foods, pesticides, nuclear reactors, sharing injections, and smoking. Two interesting factors that played a role in this order were the knowledge that risks could be controlled and that there were benefits associated with the potential health hazards. Thus, looking at the cognitive map reveals that the public regarded smoking and sharing injections as extreme health hazards since they have no benefit.


The strengths and novelty of this study lie in the fact that it provided a snapshot of how the Saudi public has built their perceptions of a number of selected hazards that can affect their health. These health hazards range from potentially mild to extreme. This public's cognitive map of hazards could help decision and policy makers, health educators, and clinicians to understand how the Saudi public perceives these risks and design, for example, educational campaigns accordingly. Decision makers in Saudi Arabia should take into consideration public fears when making choices that will affect the entire population, such as the concerns about genetically modified foods or establishing nuclear reactors as the government is planning to build a number of them in the country.

The findings of this study illuminated how the Saudi public perceived a number of potentially life-threating hazards, including blood transfusions, nuclear reactors, bicycle riding, caffeine intake, genetically modified foods, pesticides, sharing injection needles, and smoking. People develop such perceptions through experiences accumulated during their lifetimes, such as interactions with those in their community. Significant difference in perception between Saudi males and females could be due to many reasons, including the fear that might have resulted from the fact that it is a cultural taboo for females in Saudi Arabia to ride bicycles in public places.[23] The existing literature has also reported that women are more likely to be concerned about their personal safety and traffic risks than males.[24] A positive association between dread and severity on one side, and age on the other side could be related to the influence of age in general on risk-taking behavior when it comes to health. Previous studies have also shown that people's fears of riding bicycles are related to the perceived possibility of being injured as a result of an accident with a motor vehicle.[25] Concerns about personal security can certainly affect risk perceptions.

Understanding how the public perceives blood transfusion is very important since this life-saving medical procedure could be required at any time by anyone as a result of illness or injury. Males scored higher on the severity and dread domain than females, which was not consistent with the results of previous studies that found that females tend to report higher risk perception than males.[6],[26],[27],[28] This might be due to the fact that the current study included blood transfusion with eight other risks, while the other published studies focused on one domain, either blood transfusion or donation only.

Females had higher scores on the knowledge and control domain of caffeine intake, and lower scores for the severity and dread domain compared to males. This is not surprising as having more knowledge about the effects of caffeine on health should lead women to have a better understating of the magnitude of its risks. Moderate caffeine consumption is generally safe for a healthy adult.[29] Although this study did not examine the consumption of caffeine among groups, many studies have indicated that males consume more caffeine than females, a difference that has been attributed to many factors,[30] and therefore, they are more likely to suffer and fear its consequences.

While many studies have been conducted on people's perceptions of the risk of nuclear reactors, most were carried out in nuclear countries such as Japan. These studies showed high-risk perception among the Japanese about nuclear reactors and low public support and acceptance of nuclear power generation due to radiation risks, in particular after the Fukushima Daiichi nuclear accident in March 2011.[19],[20],[21] Females' responses related to risk perception were associated with cancer incidence and perceived risk of death due to nuclear energy. The Fukushima Daiichi nuclear disaster significantly influenced the public's perception in other countries as well, such as China and Taiwan.[31],[32],[33],[34],[35],[36] Despite the fact that there are currently no nuclear reactors in Saudi Arabia, the public is still influenced by the dreadful reports of nuclear accidents in other countries.

Although pesticides are important in agriculture to control insects and produce crops that are both plentiful and appropriate for human consumption, they are becoming of increasing concern to the public due to their impact on human health and the environment.[37] In regards of the pesticide dread and severity domain, findings in this study were not consistent with those in the literature, as females tended to perceive pesticides as more harmful to the environment and health compared to males.[38],[39]

Even though the sample in the current study was representative of Saudis in all regions, as it was conducted at the primary annual national festival for heritage and culture that attracts people from all over the county, it was still a rather small sample size due to the length of the questionnaire. Therefore, future studies with a larger sample size are recommended to confirm the public's cognitive map of risk perceptions. Another limitation was the unequal gender distribution. According to the report issued by the General Saudi Authority for Population Statistics in 2016, males represent 51% of the population, while females represent 49%, making the percentages nearly equal. To overcome this limitation, the weighted mean was employed. In addition, there are many other life hazards, such as motor vehicle accidents, pollution, and extreme weather conditions that are worth investigating in future studies.


A cognitive map of the public's risk perception is a unique reflection of the Saudi cultural context. Gender and age differences do exist across a number of life hazards. The cognitive map provides a better understanding of the way people perceive common risks, thereby helping decision makers, health educators, and clinicians design their health-related interventions to overcome people's fears and misconceptions.


The authors would like to thank King Abdullah International Medical Research Center, Riyadh, Saudi Arabia for funding this study. Our special thanks go to the study's participants without whom the project would not have been possible.

Financial support and sponsorship

The study was funded by King Abdullah International Medical Research Center.

Conflicts of interest

There are no conflicts of interest.


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