Knowledge, attitudes, and practice towards allergic rhinitis in patients with allergic rhinitis: a cross-sectional study

The results showed that patients with AR in Suzhou, Jiangsu, have poor knowledge and unfavorable attitudes but good practices toward AR. Teaching interventions should be designed to improve knowledge levels. Since the management of AR involves self-management, behaviors, and life habits, better knowledge and attitudes toward AR should translate into better clinical outcomes among patients with AR.

Besides medication, managing AR involves avoiding allergens and having good life habits [2, 6‐8]. Therefore, a high level of KAP plays a major role in the management of AR. The present study revealed poor knowledge and unfavorable attitudes of patients with AR towards AR but active practice. The results also suggested that the knowledge and attitude scores were independently associated with the practice scores, but the correlations were weak. Therefore, the results suggest that even though knowledge and attitudes participate in practice levels, several patients pose actions out of habit or following advice without understanding why they perform those actions. Interestingly, the multinational study by Bhargave et al. [11] revealed important discrepancies among countries regarding the KAP of patients and physicians toward AR. The KAP of patients with AR in Saudi Arabia was reported to be low [12, 14]. Similar results were reported in India [13] and four Southeast Asian nations [15]. Thai patients have poor knowledge of the risks of immunotherapy for AR [20], and similar results were observed in German athletes with AR [21]. A population study in Nigeria showed that 16% of the participants had knowledge of AR symptoms, and 11% had AR [22, 23]. These studies generally support the present study. Indeed, among the knowledge items, only two showed good knowledge: symptoms of AR and dust mites as a cause of AR. All other knowledge items had poor results, with the poorest being the possible side effects of the skin prick test, the efficacy of glucocorticoids, and the use of surgery to cure AR. Previous KAP studies on AR also reported a wide array of misconceptions about the management of AR [11, 12, 14, 24]. The misconceptions mainly regarded the use of corticosteroids and smoking [12], the causative agents [14], AR manifestations [22‐24], and risks of immunotherapy [20, 21]. Previous studies generally support the present one, with variable but generally low/moderate KAP [11‐15, 20‐22]. Differences among studies can be due to the general health literacy of a population, education, and the healthcare system, as well as the tools designed to assess KAP.

The present study in Suzhou showed that a longer course of AR and knowing the culprit allergens were associated with a better knowledge of AR. A longer course of AR, having passed allergen tests, and liking sports were associated with better attitudes. Liking sports and having a non-stable job were associated with better practice. These results could help identify the patients with a higher need for KAP interventions. Alreshidi et al. [14] reported that only a higher education degree was associated with higher KAP, which was also observed in the present study but only in the univariable analysis. Al-Rasheedi [12] showed that AR knowledge was associated with education, follow-up facilities, and smoking. Of course, differences among studies can be due to the variables selected. In addition, the results of KAP studies are only applicable to the specific population that was surveyed, and subsequent recommendations can only be applied to the surveyed population, i.e., Suzhou, for the present study. Of note, the smoking status was not collected in the present study. Smoking is a risk factor for AR and can reduce the effectiveness of corticosteroids [25, 26]. Hence, smoking cessation should be encouraged. Since education can be variable among the patients with AR, care should be taken to deliver information on AR that is understandable to all patients [27, 28]. Lee et al. [28] highlighted that patients must understand the instructions correctly to receive optimal corticosteroid treatments. Participants with an AR history of > 6 years were less likely to have a positive attitude toward AR compared to those with a shorter AR history. In addition, participants who like sports are more likely to have a positive attitude compared with those who do not. Being employed was associated with a lower likelihood of engaging in proactive practices toward AR compared to those who are not employed, probably because of time constraints in everyday life.

The present study showed positive correlations among knowledge, attitudes, and practices, as observed in previous studies [12, 29], indicating that improving knowledge should translate into better attitudes and practices toward AR. Hence, education interventions should be designed and implemented to improve the KAP of patients with AR. Community healthcare professionals in direct contact with the patients are often the main source of medical information, and a study suggested that community pharmacists should actively participate in the KAP of patients with AR by suggesting proper treatments [12].

This study had limitations. The participants were from a single hospital deserving a limited area in China, limiting the generalizability of the results, especially in the context where the allergens can vary with geography and climate. Considering the prevalence of AR, the sample size was small. As for all cross-sectional KAP surveys, the data represent a specific point in time [9, 10]. No previous data were available for comparison. Another limitation inherent to all KAP surveys is the social desirability bias, in which the participants can be tempted to answer the socially correct answer instead of answering what they do [30, 31]. Validity could not be tested on the pretest sample due to the too-small sample size. Nevertheless, validity was evaluated in the whole study population (n = 656), and the KMO was 0.894. Finally, the correlations between KAP dimensions were weak, but statistically significant, indicating that there not due to chance alone. Still, it suggests that several factors are acting together to influence the KAP dimensions.

In conclusion, patients with AR in the Suzhou area have poor knowledge and unfavorable attitudes but good practices toward AR. Continuous quality teaching interventions and education on patients for AR were recommended.