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

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.