Knowledge, Attitude, and Practice Regarding Water Intake Among University Students in China’s Seven Geographical Divisions: A Cross-Sectional Analysis

TL;DR

This study examines how Chinese university students from different regions know, feel, and behave regarding water intake, revealing significant regional differences and poor habits.

Contribution

The study provides the first nationwide cross-sectional analysis of water-related KAP among Chinese undergraduates across seven geographical regions.

Findings

South China students showed the lowest awareness of regular water intake but highest awareness of daily recommended intake.

South and Northeast China students exhibited weaker recognition of water's importance and lowest prevalence of thirst-driven drinking.

Regional disparities highlight the need for targeted, multilevel health interventions beyond knowledge dissemination.

Abstract

Background: Inadequate water intake is prevalent among Chinese college students, a group at a critical stage for establishing lifelong health habits. However, nationwide data on their knowledge, attitudes, and practices (KAP) regarding water intake remain scarce. This study aims to describe regional variations in water-related KAP among undergraduates across seven major geographical regions of China, providing evidence for developing targeted health promotion strategies. Methods: A cross-sectional survey employed multistage stratified convenience sampling to recruit undergraduate students (N = 3161) from one university in each of China’s seven regions. Participants completed a KAP questionnaire. Data analysis utilized chi-square tests with Bonferroni correction, reporting effect sizes and confidence intervals. Results: A total of 3161 valid responses were obtained (response rate: 98.3%). Students in South China demonstrated the lowest awareness of regular water intake (52.0%) but the highest awareness of daily recommended water intake (32.9%). South China and Northeast China exhibited weaker recognition of water’s importance (65.6% and 94.0%, respectively) and the lowest prevalence of “thirst-driven” drinking behavior (21.7% and 32.4%, respectively). Conclusions: The knowledge, attitude, and practice (KAP) status regarding water consumption among Chinese university students is concerning and exhibits significant regional disparities. Key issues include knowledge gaps, disconnect between attitudes and behaviors, and deeply ingrained unscientific drinking habits. Analysis based on KAP theory indicates that future health promotion strategies must move beyond mere knowledge dissemination and adopt region-specific, multilevel comprehensive interventions.