Sub-optimal Health Status (SHS) has subjective complaints about early manifestations or discomforts that are not confirmed by laboratory or radiological examinations due to negative or unclear results of clinical investigations [1-3]. Further, SHS is not only associated with various CVD risk factors, but it contributes to its development as well. CVD risk factors include tobacco smoking, family history of cardiovascular diseases such as hypertension, obesity measured by body mass index, no or limited practicing of exercises, unhealthy diet choices such as consuming high daily caffeine, and limited intake of fruits and vegetables [1, 3].

Literature showed an association between SHS and poor lifestyle habits such as consuming tobacco, physical inactivity, and poor dietary habits [3]. These poor lifestyle habits are believed to be major contributors to clinical manifestations in patients with SHS [1-3]. Since these clinical manifestations in the participants with SHS are less noticeable than among those with diseases, such manifestations are often ignored. Failure to identify these warning signs amplifies the risk for developing chronic diseases [4].

Many Arab countries, particularly Jordan and Saudi Arabia, have a high prevalence of non-communicable diseases (NCDs) such as CVD, diabetes mellitus, and cancer [5]. NCDs are a global burden health problem. CVD is one of the leading causes of death. Nonetheless, the prevalence of behavioral risk factors for CVD and NCDs is very high in Jordan and Saudi Arabia [5-8]. Despite the increasing numbers of NCDs in Arab countries, there are still weaknesses in implementing assertive preventive interventions and policies to control NCDs in the Arab world [5, 8].

The literature revealed a lack of published research studies that examined the association between lifestyle factors and physical SHS or poor health status among Jordanians and Saudis.

Table 1 shows significant differences between means of Jordanian and Saudi participants in rating their physical health conditions, including satisfied appetite (t = 6.47, p = 0.03), satisfied sleeping pattern (t = 3.78, p = 0.02), and hair growth (t = 6.57, p < 0.001). Although the Saudis had better appetite and sleeping pattern than Jordanians, they had significant worsened organ dysfunction than Jordanians, including thoracic health problems (t =10.75, p <0.001), gastrointestinal discomfort (t = 4.19, p = 0.04), abnormal urine (t = 7.55, p < 0.001), and head discomfort (t = 4.03, p < 0.001). However, Jordanian participants had significant worsened impairment in body movement function than Saudi participants, including difficulty with knees bending (t = 5.03, p <0.001), difficulty in climbing 3-5 floors (t = 6.24, p < 0.001), and difficulty in walking 1500 meters (t = 5.15, p < 0.001). Furthermore, there was a significant difference in scores’ means of Saudi sample (3.78 ± 1.28) and Jordanian sample (3.19 ± 1.09) in responding to alleviating of fatigue by rest (t = 0.084, p = 0.022).

Chi-square analyses showed a significant difference in proportions between Jordanian and Saudi participants in rating their overall physiological health status (χ² = 12.57, p = 0.03). About half of the Jordanians (55.8%) and Saudis (41.1%) rated their physiological health status as sub-optimal (i.e., SHS). Only 37.1% of the Saudi sample and 20.4% of Jordanian participants rated their overall physiological health status as healthy (Table 2).

Table 3 shows significant differences in proportions between the participants who have ‘high school grade or less’ vs. ‘diploma, bachelor, and higher’ level of education (χ² = 14.7, p < 0.001), were male vs. female (χ² = 9.30, p = 0.03), married vs. not married (χ²=29.3, p = 0.01), employed vs. retired or not employed (χ² = 12.6, p <0.001), ≥ 45 years old vs. < 45 years old (χ² = 14.2, p < 0.001), current tobacco user vs. not tobacco user (χ² = 4.17, p =0.04), practicing regular exercise vs. not practicing regular exercise (χ² = 60.9, p < 0.001), eating five cups or more of fruits and vegetables daily vs. who do not (χ² = 8.33, p = 0.004), and overweight/obese vs. normal/under-weight [per BMI values] (χ² = 65.5, p <0.001) in rating their health status as either sub-optimal or disease “poor” vs. healthy.

Although not all the participants of this study had a chronic disorder, the results showed only one-quarter of the participants perceived their health status as healthy. In addition, there was a significant positive relationship between the participants’ demographic (including those who were female, married, employed, and had low educational level) and negative lifestyle and high cardiovascular risks (including using tobacco, > 45 years old, physical inactivity, and unhealthy diet), and rating their health status as sub-optimal or poor. These results are consistent with the results in previous studies among several societies [2, 10-13]. For example, in a previous Saudi study, about 75% of Saudi adults rated their health status as “excellent/very good.” Female gender, older age and restricted practicing vigorous exercises were significantly associated with rating their health condition as “poor/fair”. However, there was no significant relationship between tobacco use, obesity/overweight, and engaging in regular exercises and participants’ perception of better health status [12].

The results of this study are in line with previous research findings that show significant relationships between better individuals’ satisfaction about health status and their positive lifestyle such as participating in regular exercise, eating a healthy diet, and not using tobacco [6, 7, 14]. However, Arab communities believed that eating habits and tobacco use were higher risk factors for CVD than physical inactivity. They believed that physical inactivity was not potentially life-threatening when compared with other CVD risk factors. Also, they reported that they might participate in regular physical activity if they consider physical inactivity as a direct lifestyle behavior for causing CVD [6, 15].

The study results showed that the perception about poor/sub-optimal physical health status was associated with many CVD risk factors. Using a brief screening tool to assess physical health status is recommended at each clinical visit. In addition, periodic physical assessment, full check-up, and follow-up with healthcare providers were done for those who perceived poor physical health status in order to prevent further CVD. In the same light, it is very important to improve the awareness of Arab communities about the hazards of physical inactivity and its consequence in increasing individuals’ weight and the risk of CVD [5, 14, 15]. Likewise, health education is pressingly recommended to improve the awareness of Arab communities regarding the prevention of CVD risk factors to enhance their positive lifestyle behaviors.

The literature shows the importance of early identification of clinical symptoms in helping in the prevention of NCDs risk factors and providing treatments. Visiting healthcare settings by clients to seek healthcare services is an important opportunity for health professionals to screen them and detect health disorders. Further, it is a venue to provide health education and counseling about positive lifestyle behaviors. Using a brief valid and reliable structured scales such as SHMS, self-rated health scale, and Framingham Risk Score (to estimate the risk of a heart attack in 10 years) are suggested to be used in health care settings, particularly in PHC centers to determine individuals’ perception about their health condition and identify their risks of CVD [2, 4, 5, 15]. Moreover, periodically assessing clients’ health status and doing physical assessments and laboratory checkups are recommended for early identification of the health problems and prevention of further complications [4, 5].

Conducting health education programs is recommended among Arab societies to promote their health well-being and to enhance their positive lifestyle. Also, using broadcast media (e.g., TV and radio) and online recourses are effective strategies in enhancing public awareness about NCDs risk factors and improving their positive lifestyle [5, 8].

Using cross-sectional design is limited to assess the causality and effectiveness of the relationships. Using convenience sampling and recruiting the participants from two cities in Jordan and Saudi Arabia could limit the generalization of the results to all Saudi and Jordanian regions.

The majority of the participants rated their physiological health status as sub-optimal. Therefore, full health assessment and using brief assessment tools is very vital in order to comprehensively investigate the health status of individuals who visit the healthcare settings. Health education is very important to improve the awareness of Arab communities about the prevention of NCD and to enhance their positive lifestyle behaviors. Conducting health education programs and utilizing social media and broadcast media should be considered as supportive, effective strategies to enhance public lifestyle and improve community welfare.