Parents' Perceptions of Backpack Use and Its Impact on Children's Musculoskeletal Health in Saudi Schools Over Three Semesters with Textbook Integration

Background: Musculoskeletal disorders are increasingly common among children, particularly due to heavy backpacks or improper backpack usage in school. In Saudi schools, the integration of heavier textbooks has exacerbated this issue, raising concerns about children's long-term musculoskeletal health. This study explores parents' perceptions of backpack use and its impact on their children's musculoskeletal health during the integration of textbooks over three consecutive semesters. Methods: An observational cross-sectional study was conducted from June 1 to August 11, 2024, in Saudi Arabia. Parents or guardians of students from schools implementing textbook integration for three consecutive semesters were recruited through convenience sampling. Data were collected using an online questionnaire. Descriptive statistics summarized the data, while Chi-square, Fisher's exact tests, and One-way ANOVA were used to analyze the influence of sociodemographic factors on perceptions using SPSS version 28, with a significance level of p < 0.05. Results: The study included 715 participants, primarily mothers (63.9%) and married individuals (86.8%). Most parents had a university education or higher (fathers 68.8%, mothers 65.3%), with fathers mostly employed in the governmental sector (61.9%). Half of the mothers were not working (50.7%), and 38.4% of families had a monthly income over 15,000 SAR. 81.5% of children carrying shoulder bags, 58.0% of which they chose themselves. Half spent under 15 minutes transporting their bags, mainly by private car (69.5%). A significant 81.0% of parents reported their child felt a sense of heaviness with the backpack, and 76.1% observed musculoskeletal issues, including shoulder pain (60.3%), fatigue (54.1%), neck pain (38.6%), upper back pain (39.5%), and low back pain (29.2%). Factors influencing discomfort included carrying shoulder bags (p=0.001), carrying bags for over 15 minutes (p<0.001), and walking to school (p=0.008). Overall, 59.2% exhibited inadequate knowledge, with married parents (p<0.001) and mothers (p=0.008) showing less knowledge. Fathers in the governmental sector had higher knowledge (p=0.041), as did mothers not working (p=0.029). Parents with children complaining of backpack-related heaviness had better knowledge (p=0.001), as did those with children in governmental schools (p=0.031). Conclusion: Heavy backpacks significantly affect children's musculoskeletal health, with prevalent complaints of pain and fatigue. Despite this, parents generally lack adequate knowledge about proper backpack usage. Educational programs are essential to improve awareness and promote proper backpack use, alongside recommendations to reduce textbook loads and integrate e-learning.