Knowledge Levels, Adherence to Medical Advice Critical in Anemia Care

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Knowledge, attitudes, and practices remain relevant for disease management among patients with anemia.

A self-designed questionnaire in a web-based cross-sectional study was created to evaluate the knowledge, attitudes, and practices toward disease management dynamics in patients with anemia in China.1

The population with anemia demonstrated sufficient knowledge, negative attitudes, and proactive practices toward disease management, given the positive associations observed among knowledge, attitudes, and practice (KAP) scores in path analysis.

“Utilizing path and Pearson correlation analyses, as well as univariate and multivariate statistical methods, it affirmed the relevance of the knowledge, attitudes, and practices of disease management among patients with anemia,” wrote the investigative team, led by Xiaopei Mao, department of nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University.

The global prevalence of anemia is concerning, with approximately one-quarter of the global population affected by the blood disorder, particularly in developing countries.2 Anemia can lead to declines in physical performance, decreases in productivity, and an increased risk of falls or accidents, as well as the risk of severe complications, like heart disease and delays in neurological development.3

Effective anemia care can require active patient engagement in self-management, including knowledge of the condition, remaining on treatment plans, and making lifestyle adjustments.4 A KAP study evaluates the understanding, beliefs, and behaviors of a patient's perspective on a health concern.1

For this content, involving anemia management, Mao and colleagues investigated patient knowledge of anemia, attitude toward the condition, and practices in managing the common blood disorder. They indicated the research could provide valuable information on developing patient-centered interventions, particularly for Chinese patients with anemia.

The cross-sectional analysis was performed between September and December 2023 at the investigators’ medical center. A questionnaire was developed in Chinese and included four dimensions: demographic information, knowledge (possible score range, 0–14), attitudes (1 point [very negative] to 5 points [very positive]; possible range, 7 to 35), and practices (score, 1 point [very inconsistent] to 5 points [very consistent]; possible range, 10 to 50).

Overall, the study successfully attained 396 validated questionnaires among 500 total responses. Participants had a mean age of 57.44 years, and more than half (52.02%) were female. The mean knowledge, attitudes, and practices scores were 11.47, 27.32, and 40.49, respectively.

The highest correctness rates among the three knowledge items were identified for the statement: “Individuals with anemia typically exhibit pale skin”, with 94.44% answering correctly. Multivariate analysis revealed that an education level with a bachelor’s degree or higher was independently associated with sufficient knowledge (odds ratio [OR], 2.372 [95% CI, 1.160 - 4.853]; P = .018).

Both knowledge (OR, 1.350 [95% CI, 1.166 – 1.563]; P <.001) and hemoglobin levels within 60–90 g/L (OR, 1.782 [95% CI, 1.090 – 2.912]; P = .021) were independently associated with positive attitudes. Attitudes (OR, 1.618 [95% CI, 1.454 – 1.799]; P <.001) and a diagnosis of anemia ≥1 year (OR, 1.949 [95% CI, 1.71 – 3.243; P = .010) were independently associated with proactive practices.

In a path analysis evaluating the direct and indirect relationships among KAP scores, knowledge was directly and positively associated with attitude (β = .484 [95% CI, 0.363 - 0.647; P = .008). Attitudes were directly and positively correlated with practices (β = 1.195 [95% CI, 1.062 - 1.332; P = .007), and knowledge was indirectly and positively correlated with practice (β = .579 [95% CI, 0.434 – 0.805]; P = .004).

Most patients with anemia (96.47%) expressed a positive attitude toward adhering to medical advice and regular follow-up visits. However, Mao and colleagues found nearly three-quarters (72.72%) of patients expressed anxiety about the discomfort associated with anemia and the potential for serious complications.

“The finding underscored the importance of integrating both hematologists and mental health professionals into the overall care plan, as proposed by collaborative care models,” they wrote.


  1. Yao B, Xu M, Cheng F, Peng M, Mao X. Knowledge, attitudes, and practices among patients with anemia towards disease management. Front Public Health. 2024;12:1380710. Published 2024 May 21. doi:10.3389/fpubh.2024.1380710
  2. Shah SA, Soomro U, Ali O, et al. The Prevalence of Anemia in Working Women. Cureus. 2023;15(8):e44104. Published 2023 Aug 25. doi:10.7759/cureus.44104
  3. Marcus H, Schauer C, Zlotkin S. Effect of Anemia on Work Productivity in Both Labor- and Nonlabor-Intensive Occupations: A Systematic Narrative Synthesis. Food Nutr Bull. 2021;42(2):289-308. doi:10.1177/03795721211006658
  4. Mildon A, Lopez de Romaña D, Jefferds MED, Rogers LM, Golan JM, Arabi M. Integrating and coordinating programs for the management of anemia across the life course. Ann N Y Acad Sci. 2023;1525(1):160-172. doi:10.1111/nyas.15002