School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China.
Research Unit for General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark.
BMJ Open. 2023 Nov 16;13(11):e076464. doi: 10.1136/bmjopen-2023-076464.
Whether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China.
A cross-sectional study.
Yuhuan City, Zhejiang Province, China.
A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below.
A questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP.
No significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge.
While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.
在中国的基层医疗环境中，常规传递糖尿病相关知识是否能改变患者的态度，从而影响他们的自我管理活动尚不清楚。因此，本研究旨在探索中国某城市糖尿病患者知识、态度和实践（KAP）之间复杂的转化过程。
横断面研究。
中国浙江省玉环市。
共邀请 803 名糖尿病患者参加问卷调查，782 名 2 型糖尿病患者完成了调查。参与者的平均年龄为 58.47 岁，其中 48.21%仅接受过小学或以下教育。
应用基于现有量表和专家咨询的问卷评估患者的社会人口统计学信息（SI）、疾病进展风险和糖尿病相关 KAP。构建结构方程模型分析患者特征与 KAP 之间的关系。
患者的知识与态度之间无显著相关性（β=0.01，p=0.43）。更好的知识和态度均与更好的饮食和体育活动相关（β=0.58，p<0.001；β=0.46，p=0.01）。然而，对糖尿病护理态度更积极的患者足部护理实践更差（β=-0.13，p=0.02），而更好的知识与更好的足部护理实践相关（β=0.29，p<0.001）。此外，SI 较高的患者（β=0.88，p<0.001）和/或疾病进展风险较高的患者（β=0.42，p<0.001）往往具有更高的疾病知识水平。
尽管在饮食和体育活动方面实践中已经实现了成功的 KAP 转化，但需要改进足部护理实践。健康教育还应优先考虑糖尿病足的预防、检测和护理。此外，应采取适当的方法向弱势群体（如老年人、农村地区居民、受教育程度低者、失业者和低收入者）传递健康教育。
