Knowledge, attitudes, and practices toward xylometazoline nasal spray use among adults in Saudi Arabia: a cross-sectional survey

Background Nasal congestion is a frequent symptom of upper respiratory illnesses. Over-the-counter decongestants such as xylometazoline are widely used, providing rapid relief but prone to misuse. In Saudi Arabia, there is limited evidence of public attitudes, practices, and predictors. This study aimed to assess knowledge, attitudes, and practices toward xylometazoline among adults in Saudi Arabia and to identify sociodemographic predictors of appropriate use. Methods A cross-sectional survey, conducted between May and July 2025, included adults (≥18 years) residing in Saudi Arabia. A validated questionnaire was used to collect sociodemographic data, xylometazoline use, and assess KAP scores. Descriptive statistics summarized outcomes. Spearman’s rho assessed correlations among KAP domains. Predictors of knowledge, attitude, and practice were examined using binary logistic regression, reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Two-sided p < 0.05 was considered statistically significant. Results A total of 422 individuals participated; 226 (53.6%) were female, and 185 (43.8%) were aged 18–30 years. Xylometazoline use in the past 12 months was reported by 295 (69.9%). Overall, 217 (51.4%) demonstrated good knowledge, 232 (55.0%) held a positive attitude, and only 37 (8.8%) reported good practice, while 187 (44.3%) reported poor practice. Postgraduate education was significantly associated with good knowledge (aOR 2.78, 95% CI 1.42–5.45), while chronic nasal infections with severe dryness were strongly associated with good practice (aOR 6.29, 95% CI 1.72–22.97). Good practice decreased with higher frequency of use (1–3 times/year: aOR 0.37; 4–6: aOR 0.18; >6: aOR 0.05; all p < 0.001). Regional variations in knowledge and attitudes were also observed. Conclusion Xylometazoline use is highly prevalent in Saudi Arabia, with favorable knowledge and attitudes but suboptimal practices. Younger age and higher education were associated with better knowledge, while female sex and nasal conditions predicted safer practices. Public education and pharmacist-led counseling, particularly on safe duration of use, are essential to close the knowledge–practice gap and reduce misuse.