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Knowledge, attitude, and practice of patients with osteomyelitis: a cross-sectional study using structural equation
Lin Zhang1, Xuan Deng1, Jiaze Peng1
1Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Introduction:
To assess the knowledge, attitude, and practice (KAP) levels among patients with osteomyelitis, analyze their associated factors, and explore the pathways between knowledge, attitude, and practice.
Methods:
A cross-sectional study was conducted in a large tertiary hospital from April 1st to June 1st, 2025, enrolling 405 patients with osteomyelitis. A self-administered questionnaire collected demographic and disease-related information and assessed KAP. Cronbach's α tested questionnaire reliability, and confirmatory factor analysis examined construct validity. Univariate analysis, multivariate binary logistic regression with a two-tailed p < 0.05 as the statistical significance cut-off, and structural equation modeling (SEM) were used to explore factors associated with KAP and their interrelationship mechanisms.
Results:
Mean scores for knowledge, attitude, and practice were 28.56 ± 10.28, 29.08 ± 11.36, and 28.58 ± 11.62, respectively; achievement rates were 32.1, 35.6, and 30.9%. The overall Cronbach's α was 0.962, the KMO value was 0.971, and model fit was good (CMIN/DF = 1.32, RMSEA = 0.028, CFI = 0.984). Multivariate analysis showed that age (p = 0.013), income (p < 0.001), education (p < 0.001), history of diabetes mellitus (p = 0.009), and number of hospitalizations (p = 0.020) were independently associated with knowledge. Knowledge level (p < 0.001), age (p = 0.034), income (p < 0.001), and education (p < 0.001) were associated with attitude. Attitude level (p < 0.001), knowledge level (p < 0.001), income (p < 0.001), and education (p = 0.019) were associated with practice. SEM revealed that knowledge had a direct theoretical association with attitude (β = 0.694, p < 0.001) and practice (β = 0.303, p < 0.001); attitude had a direct theoretical association with practice (β = 0.465, p < 0.001). The indirect theoretical association of knowledge with practice via attitude was significant (β = 0.357, p < 0.001), accounting for 54.1% of the total effect.
Conclusion:
Patients with osteomyelitis showed insufficient knowledge, attitude, and practice. Older age, lower education, and lower income were associated with poorer outcomes. Attitude mediated the knowledge-practice association. Future interventions should focus on attitude change in vulnerable populations, and prospective studies are warranted.
