# Knowledge, attitude, and practice toward pulmonary nodules among patients in Northern China: a multicenter cross-sectional study

## TL;DR

This study explores how patients in Northern China understand and manage pulmonary nodules, finding that better knowledge leads to better practices through improved attitudes.

## Contribution

The study identifies a mediating role of attitudes in linking knowledge to practices regarding pulmonary nodules in a high-risk region.

## Key findings

- Patients showed moderate knowledge and neutral attitudes toward pulmonary nodules.
- Structural equation modeling revealed that attitudes strongly influence practices.
- Education and communication interventions are recommended to improve patient outcomes.

## Abstract

Northern China, characterized by higher rates of lung cancer incidence and pulmonary nodule detection due to elevated air pollution levels and smoking prevalence, necessitates focused assessments. This study aimed to evaluate knowledge, attitudes, and practices (KAP) among pulmonary nodule patients in Northern China.

This multicenter cross-sectional study was conducted across four hospitals in Northern China between August and December 2024.

A total of 500 patients (95.6% response rate) completed questionnaires. The knowledge, attitudes and practices were 13.82 ± 2.72 (0–18), 31.90 ± 3.44 (9–45), and 34.35 ± 7.22 (13–65), respectively. Spearman analysis revealed significant positive correlations between knowledge-attitude (r = 0.271, p < 0.001), knowledge-practice (r = 0.270, p < 0.001), and attitude-practice (r = 0.112, p = 0.013). Structural equation modeling (SEM) showed that knowledge was significantly associated with attitudes (β = 0.553, p < 0.001), and attitudes were strongly associated with practices (β = 0.865, p < 0.001). In addition, a significant indirect association between knowledge and practices through attitudes was observed (β = 0.479, p < 0.001).

Patients in Northern China exhibit moderate knowledge, neutral attitudes, and suboptimal practices toward pulmonary nodules, with attitudes mediating the knowledge-practice relationship. Targeted interventions should prioritize regional education programs and enhanced clinician-patient communication to improve risk perception and follow-up adherence.