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Research Article: Knowledge, attitude, and practice of patients with osteomyelitis: a cross-sectional study using structural equation modeling

Date Published: 2026-07-10

Abstract:
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. 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 ? 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. 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 ? 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 ( ? =?0.694, p <?0.001) and practice ( ? =?0.303, p <?0.001); attitude had a direct theoretical association with practice ( ? =?0.465, p <?0.001). The indirect theoretical association of knowledge with practice via attitude was significant ( ? =?0.357, p <?0.001), accounting for 54.1% of the total effect. 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.

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.

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