Abstract / Summary
Abstract Background Hepatocellular carcinoma and cirrhosis due to viral hepatitis is a severe menace to global community health and is financially and medically significant. Despite the low level of adherence to follow-up, standardized follow-up at the long term is essential to postpone the disease development and enhance the patient outcomes. In spite of the fact that health literacy is a significant determinant of health behaviors, there is a lack of understanding on how it is associated with adherence in individuals with viral hepatitis. Objective This study intends to review the variables which influence hepatitis knowledge awareness and the relationship between adherence and hepatitis knowledge in patients with viral hepatitis. Methods This study involved 30,012 individuals in the community-based viral hepatitis screening cohort, whereby serological testing was conducted on the sample, and 1,676 individuals were found to be positive of viral hepatitis.After excluding participants with incomplete baseline questionnaires ( n = 516), the final valid sample was 1,160. Patients were identified into two groups, namely, an observation group (285 cases, 24.57%) and a control group (875 cases, 75.43%) on the basis of whether they returned to certified viral hepatitis treatment facilities to receive standardized follow-up after they were screened positive. All the participants were asked to fill in a self-developed 6-item standardized questionnaire on knowledge of prevention and treatment of viral hepatitis; a total score ≥ 3 points (over half of the 6-item scale) was defined as adequate hepatitis knowledge. Basic demographic and clinical data were collected to determine the differences in groups in demographic characteristics, clinical characteristics, and knowledge levels. Subgroup comparisons, stratified χ²analysis, multivariate linear regression, binary logistic regression with interaction terms, and 1:3 propensity score matching (PSM) were then conducted to explore moderating effects. Results No significant overall correlation was observed between hepatitis knowledge level and follow-up adherence among all screening-positive patients; the overall knowledge qualification rate was 53.33% in the observation group versus 52.11% in the control group ( P = 0.720). Although no statistically significant intergroup differences were observed in terms of gender, ethnicity, marital status, education, occupation, and hepatitis type, significance tests indicated group differences for age ( P = 0.016) and family history ( P < 0.001). SMD assessment demonstrated adequate balance for age (0.022), while family history showed severe baseline imbalance (0.718). Nonetheless, stratified analysis identified prominent subgroup heterogeneity stratified by family history: among participants with definite liver disease family history, the knowledge qualification rate of the observation group was significantly higher than that of the control group; an opposite reversed gap was found in participants with unknown family history (observation group: 6.58% vs. control group: 41.45%). Subgroup analyses restricted to the observation group further demonstrated that family history ( P = 0.001) and educational attainment ( P = 0.016) were associated with hepatitis knowledge qualification status; participants with confirmed liver disease family history and college-and-above education exhibited higher knowledge qualification rates. Multivariate logistic regression analysis confirmed that the interaction term between family history and total knowledge score lacked statistical significance (OR = 0.953, P = 0.729). Stratified analyses revealed divergent associations: the positive association between knowledge score and follow-up compliance was only detected among patients with a definite liver disease family history (OR = 1.118, P = 0.015). Conclusion Among community viral hepatitis screening-positive populations, no overall association exists between hepatitis knowledge level and standardized follow-up adherence. Higher educational attainment correlates with better hepatitis knowledge status, though global interaction testing does not support family history as a formal moderator of the knowledge–adherence relationship; heterogeneity in this association was observed across subgroups: a positive knowledge-adherence association was detected solely in participants with confirmed liver disease family history. Universal health education alone cannot improve follow-up compliance. Targeted strategies including risk-stratified health education based on family history and integrated screening-treatment linkage with case management are required for grassroots hepatitis prevention. Further multi-center longitudinal studies and randomized controlled trials are warranted to validate subgroup findings and evaluate stratified intervention effects.