Abstract / Summary
Aim: To assess knowledge, attitudes, and practices (KAP) among family caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods: This cross-sectional survey recruited caregivers through Yizheng People’s Hospital and associated community settings in Jiangsu Province, China, from July to September 2024. A self-developed questionnaire was administered online, on paper, or with staff assistance. Associations were examined using Spearman correlations, multivariable logistic regression, and structural equation modeling (SEM). Psychometric properties were additionally evaluated using a six-expert content-relevance assessment and a three-factor measurement model. Results: Among 500 caregivers, 278 (55.6%) were female. Mean knowledge, attitude, and practice scores were 14.07 ± 5.15, 33.08 ± 3.71, and 36.14 ± 4.10, respectively. Using a standardized-score threshold > 70%, 231 (46.2%) met the operational knowledge criterion, 401 (80.2%) met the positive-attitude criterion, and 338 (67.6%) met the proactive-practice criterion. Higher knowledge (adjusted odds ratio [OR] = 1.093, 95% confidence interval [CI]: 1.043– 1.144) and attitude scores (OR = 1.255, 95% CI: 1.164– 1.353) were associated with proactive practice; higher age was inversely associated (OR = 0.974, 95% CI: 0.950– 0.998). SEM showed knowledge–attitude (β = 0.488, P = 0.001) and attitude–practice associations (β = 0.714, P = 0.001). The indirect knowledge–practice association through attitude was significant (β = 0.349, P = 0.001), whereas the direct path was not (β = 0.179, P = 0.064). Model fit and convergent-validity evidence were mixed. Conclusion: The surveyed caregivers reported limited knowledge but generally positive attitudes and proactive practices. The indirect statistical relationship through attitude does not establish causal mediation. Prospective studies are needed to validate the questionnaire further and evaluate caregiver-support interventions. Keywords: chronic obstructive pulmonary disease, acute exacerbation, knowledge, attitudes, practices, family caregivers, structural equation modeling