This cross-sectional study was conducted between September 2022 and September 2023 among young Arab adults using convenience sampling. The research protocol was approved by the Institutional Review Board of Princess Nourah Bint Abdulrahman University (number: 22–0406; date: Aug 24, 2022). An online self-administered survey was used, and participants who chose to complete the survey provided their consent by clicking on the “I agree” button. Individuals of both sexes aged 18–25 years, Arab citizens who could read and understand Arabic, and those who resided in an Arabic-speaking country at the time of the study were included. Any health conditions that could affect the dietary intake and choices of participants, such as diabetes, hypertension, cardiovascular or renal diseases, or adherence to a special diet, were excluded from the study.

The study used a convenience-based snowball sampling approach. The online survey was disseminated through social media platforms (e.g., WhatsApp), and participants were encouraged to share the survey link within their networks. While this approach facilitated recruitment across multiple Arab countries, it may have introduced selection bias, including overrepresentation of individuals with internet access, higher digital literacy, or greater interest in health-related topics.

For analytical purposes, participating countries were grouped into three regions based on commonly used regional classifications in Arab and Middle Eastern health research: the Arabian Peninsula (Saudi Arabia, Kuwait, United Arab Emirates, Yemen, Bahrain, Oman, Qatar), North Africa (Morocco, Algeria, Libya, Egypt, Sudan), and the Eastern Mediterranean region outside Africa (Iraq, Syria, Lebanon, Jordan). Data were analyzed using JMP software version 14.2. Categorical variables are presented as frequency tables. One-way analysis of variance (ANOVA) and the post-hoc Scheffé test were conducted to compare self-efficacy and knowledge scores between regions. Cohen’s d test was used to measure the effect size between the study groups. A two-way ANOVA was performed to investigate the cultural effects of different regions in Arab countries on self-efficacy in changing lifestyles across different knowledge levels. A multiple linear regression model was used to assess the association between knowledge and sociodemographic characteristics and self-efficacy regarding lifestyle changes in each region. Statistical significance was set at p < 0.05.

The sociodemographic distribution of the study sample across different regions of Arab countries is presented in Table 1. The Arabian Peninsula had a higher percentage of females than males, and most of the participants were single. The Eastern Mediterranean region has an equal percentage of males and females. Northern Africa had an equal percentage of males and females with a college degree (94%), whereas around 6% had a high school education or less.

Table 2 shows the self-efficacy in lifestyle management and knowledge scores across different regions of Arab countries. Northern Africa had significantly lower scores in self-efficacy in changing weight and total self-efficacy score in managing lifestyle than the Arabian Peninsula and Eastern Mediterranean region (p < 0.001) with moderate effect size for all (Cohen’s d ˃0.5, p < 0.01). Self-efficacy in changing weight was significantly lower in Northern Africa than in the Arabian Peninsula and Eastern Mediterranean (Cohen’s d < 0.5, p < 0.01). Self-efficacy in practicing exercise was highest in the Eastern Mediterranean region and lowest in Northern Africa (p < 0.001) with a moderate effect size for all regions (Cohen’s d ˃0.5, p < 0.01). Knowledge was highest in the Arabian Peninsula and lowest in Northern Africa (Cohen’s d < 0.5, p < 0.001). These findings indicate that North African youth perceive lower self-efficacy and knowledge scores than their Arabian Peninsula and Eastern Mediterranean peers.

Table 3 shows that the effect of culture on self-efficacy in changing lifestyles across different regions of Arab countries differs significantly across knowledge levels. In the Eastern Mediterranean region, the mean self-efficacy score is almost the same across different knowledge levels (11.8 ± 3, 11.8 ± 2.7, and 11.6 ± 2.6). However, in the Arabian Peninsula and Northern Africa region, the mean self-efficacy score is significantly lower at the poor knowledge level compared with that at good levels (10.6 ± 3.3 vs. 11.7 ± 27 in the Arabian Peninsula and 7.6 ± 3.4 vs. 11.6 ± 2·6 in Northern Africa; F = 34.2, p < 0.01). These findings indicate that nutritional knowledge is associated with self-efficacy.

Table 4 shows the multiple linear regression model to measure the factors associated with self-efficacy in lifestyle change across different regions of the Arab regions. In the Arabian Peninsula, knowledge was significantly associated with self-efficacy (R² = 0.013, p = 0.016). In the Eastern Mediterranean region, age and sex were significantly associated with self-efficacy (R² = 0.01, p = 0.007). In North Africa, age, sex, and knowledge explained a larger proportion of the variance in self-efficacy (R² = 0.25; p < 0.001).

Self-efficacy, defined as the belief of an individual in their ability to execute practices necessary to achieve specific outcomes, is a key factor in adopting and maintaining healthy practices, including diet, physical activity, and weight management (19, 20). The importance of self-efficacy in influencing health practices, particularly during adolescence and young adulthood, is well documented (18). Studies have shown that high self-efficacy enhances adherence to healthy dietary patterns, physical activity, and weight management behaviors, and is strongly associated with improved quality of life and better health indicators, consistent with previous research (3). Our findings reaffirm that stronger self-efficacy correlates with healthier lifestyle choices, underscoring the need to foster these beliefs early in life.

The findings also revealed that cultural context is a powerful determinant of self-efficacy across Arab regions, with significant regional differences in lifestyle-related self-efficacy. Young adults in northern Africa showed lower self-efficacy. This may be due to limited access to structured health education, economic disparities, and environmental constraints. These findings align with prior evidence that sociocultural norms, family expectations, and perceived barriers, such as time limitations and lack of motivation, can diminish confidence in adopting healthy behaviors (6, 21–23). In addition, self-efficacy (in all domains except exercise) was higher in both the Arabian Peninsula and Eastern Mediterranean regions. These results highlight the significant influence of the cultural context on self-efficacy beliefs, which is consistent with previous research showing that culture shapes the formation and expression of self-efficacy (21–26). Familial support plays a crucial role in reinforcing self-efficacy beliefs (5).

Self-efficacy in practicing exercise was particularly high in the Eastern Mediterranean, potentially due to community-based sports and social engagement opportunities, while lower scores in the Arabian Peninsula may be related to environmental barriers such as extreme heat (27–29). These regional variations highlight how context, opportunity, and support systems influence the confidence of an individual in engaging in health-promoting practices.

Nutritional knowledge was significantly higher in the Arabian Peninsula than in Northern Africa, followed by the Eastern Mediterranean region, indicating widespread access to health education and awareness campaigns. Nutrition education and awareness initiatives are instrumental in improving nutrition knowledge at school, university, and community levels throughout the Arabian Peninsula and have likely contributed to this outcome (30–32). The strong association between knowledge and self-efficacy aligns with existing literature, thereby emphasizing the role of education in empowering individuals to make informed health decisions (2, 5). These findings support Bandura’s social cognitive theory, which posits that knowledge enhances self-efficacy by providing individuals with the confidence to engage in health-promoting practices. This emphasizes the importance of strengthening knowledge regarding healthy lifestyles as a key strategy for boosting self-efficacy across all regions. Educational campaigns providing clear and accessible information on diet, exercise, and weight management may be particularly effective in empowering young adults to make healthier choices (2). Empowering young adults with practical and culturally relevant nutritional and exercise education can strengthen their confidence to adopt healthy habits. Public health policies should prioritize interactive, skill-based learning approaches such as digital health platforms, workshops, and gamified interventions to bridge knowledge gaps and simultaneously build self-efficacy.

This study identified several key factors associated with self-efficacy in changing lifestyle practices among young Arab adults. Age and sex were significant factors associated with self-efficacy in the Eastern Mediterranean region and North Africa, consistent with prior literature linking sex and maturity to healthy behaviors. Self-efficacy is interrelated with cultural, environmental, physiological, and psychological factors (4, 33, 34). Efthymiou et al. reported that several sociodemographic factors are associated with self-efficacy, including parental age, educational level, and family income indices (2). Age, female sex, and nutritional knowledge were associated with high self-efficacy scores. Previous studies showed that women have higher dietary self-efficacy than men (2, 35). This finding aligns with existing literature, revealing that women, especially in traditional societies, may be more engaged in health-promoting practices. Greater responsibility is placed on women in numerous Arab cultures to manage their household health, including dietary choices, which may enhance their confidence in making lifestyle changes (36). These sex-influenced roles highlight the importance of designing equitable interventions to empower young men and women to engage in sustained lifestyle changes. Although age, sex, and nutritional knowledge were significantly associated with self-efficacy, the low R² values in some regions (0.01–0.013) indicate that these factors explain only a small part of the variation. This is expected for complex behaviors like self-efficacy, which are shaped by many personal, social, and environmental influences (37).

The findings of the current study have important implications for the design of culturally sensitive health promotion strategies aimed at improving lifestyle practices across Arab regions. Significant regional disparities suggest that interventions should be tailored to address local realities, considering the cultural and sociocultural factors influencing self-efficacy in each region. For instance, programs in Northern Africa may need to focus on providing information and motivation to overcome barriers to healthy eating and physical activity (6), while health authorities could implement school- and community-based campaigns to enhance practical skills and knowledge. Interventions in the Eastern Mediterranean region should leverage existing social support networks to enhance self-efficacy (5) and policymakers can formalize community sports and social engagement programs to sustain healthy habits. In the Arabian Peninsula, where knowledge is relatively high, interventions should focus on translating awareness into action through structured exercise programs and hands-on nutrition workshops.

Future research should explore these relationships using longitudinal designs to better understand the causal pathways between culture, knowledge, sociodemographic factors, and self-efficacy. Qualitative studies may provide deeper insights into the cultural and social factors that influence self-efficacy in different Arab regions, thereby facilitating the development of more effective and culturally sensitive interventions.

The observed regional variations reinforce the need for contextually tailored health-promotion programs. Structured school-based health education can help address low confidence in nutrition and stress management, particularly where service access is uneven (38). National and regional policymakers should prioritize integrating interactive and skill-based health education into curricula and community programs. Digital and gamified interventions may enhance engagement and autonomy among youth, especially when sociocultural norms limit direct access to health resources (39). Community-based and family-inclusive programs are crucial in settings affected by displacement or health system strain, providing psychosocial support and practical health guidance (17). Across all contexts, training and empowering educators and counselors to reinforce health practices can further strengthen the self-efficacy of young Arab adults. Overall, policymakers and public health authorities should consider multi-level, culturally adapted strategies that address both individual and structural determinants of self-efficacy.

This study provides valuable insights into self-efficacy among young Arab adults, but several limitations should be noted. The cross-sectional design prevents establishing causal relationships, as data were collected at a single time point. The use of a convenience sampling approach and online data collection via social media may have introduced selection bias, over-representing educated, urban, and digitally connected participants, and under-representing those from rural or lower socioeconomic backgrounds. These factors limit generalizability to the broader young adult population across the Arab region.

Reliance on self-reported data may have introduced measurement bias, and moderate Cronbach’s alpha values may have attenuated associations and reduced reliability. A gender imbalance, particularly in the Arabian Peninsula sample, may have influenced regional estimates, as women often report higher self-efficacy (35). Future studies should consider region-specific analyses stratified by sex and use probability-based or mixed-method sampling to enhance representativeness.

Relatively low R² values in several regression models suggest that additional factors, such as social support, income, environmental constraints, and other psychosocial influences, were not captured. Furthermore, although grouping countries into the Arabian Peninsula, Eastern Mediterranean, and North Africa facilitated broad cross-cultural comparisons, each region is internally heterogeneous in terms of political, economic, and demographic characteristics, which limits the validity of direct comparisons.

Despite these limitations, the observed cross-regional patterns provide preliminary evidence to guide culturally sensitive public health strategies and inform more methodologically robust future research on self-efficacy and lifestyle practices in Arab young adults.