Observational Study
Copyright ©The Author(s) 2023.
World J Gastroenterol. Nov 21, 2023; 29(43): 5818-5833
Published online Nov 21, 2023. doi: 10.3748/wjg.v29.i43.5818
Table 1 Characteristics of the participants
Variablesn (%)Knowledge
Attitude
Practice
mean ± SD
P value
mean ± SD
P value
mean ± SD
P value
Total35310.05 ± 3.4641.58 ± 5.2344.20 ± 7.39
Gender0.4680.8300.077
    Male224 (63.5)9.95 ± 3.5741.62 ± 5.0244.72 ± 7.35
    Female129 (36.5)10.2 ± 3.2841.50 ± 5.5943.28 ± 7.40
Age, yr (10 cases missing)< 0.0010.1420.886
    ≤ 2041 (11.6)9.46 ± 3.8740.95 ± 5.1344.00 ± 8.15
    20-30116 (32.9)10.87 ± 2.9442.41 ± 5.2544.37 ± 7.40
    30-4085 (24.1)10.56 ± 3.0341.81 ± 5.2443.89 ± 6.92
    > 40101 (28.6)9.02 ± 3.9140.88 ± 5.2144.70 ± 7.27
Ethnicity (1 case missing)0.0110.0280.609
    Han341 (96.6)10.13 ± 3.3941.69 ± 5.1644.25 ± 7.41
    Minorities11 (3.1)7.45 ± 4.8938.18 ± 6.5143.09 ± 6.85
Residence0.0060.0590.002
    Rural149 (42.2)9.38 ± 3.7244.18 ± 5.1943.76 ± 7.76
    City122 (34.6)10.66 ± 3.0542.48 ± 5.0545.97 ± 6.73
    Suburb/urban-rural combination82 (23.2)10.35 ± 3.8540.95 ± 5.4542.35 ± 7.13
Education< 0.0010.0030.089
    Primary school and below25 (7.1)6.92 ± 3.5340.00 ± 4.9742.88 ± 7.21
    Middle school67 (19.0)7.99 ± 4.1739.99 ± 5.8242.40 ± 8.01
    High school/technical secondary school84 (23.8)10.25 ± 2.8841.42 ± 4.8344.55 ± 6.98
    Junior college/bachelor’s degree and above177 (50.1)11.18 ± 2.7542.47 ± 5.0544.89 ± 7.29
Work status< 0.0010.0020.012
    Employed185 (52.4)10.79 ± 2.9642.39 ± 4.9045.13 ± 6.83
    Other168 (47.6)9.23 ± 3.7840.68 ± 5.4443.17 ± 7.85
Monthly per capita income< 0.0010.0030.074
    < 5000173 (49.0)9.32 ± 3.8740.61 ± 5.2043.29 ± 7.95
    5000-10000104 (29.5)10.88 ± 2.5242.37 ± 4.9645.21 ± 6.59
    > 1000076 (21.5)10.55 ± 3.2742.68 ± 5.3244.87 ± 6.93
Marital status0.0290.9390.201
    Unmarried or other157 (44.5)10.50 ± 3.2141.60 ± 5.2544.76 ± 7.40
    Married196 (55.5)9.69 ± 3.6241.56 ± 5.2343.74 ± 7.37
Smoking habit0.1630.3860.202
    No (no smoking)282 (79.9)10.18 ± 3.3341.45 ± 5.1343.94 ± 7.18
    Yes (smoking or used to smoke)71 (20.1)9.54 ± 3.9242.06 ± 5.6345.20 ± 8.14
Drinking habit0.4610.7440.372
    No (no drinking)240 (68.0)10.14 ± 3.4041.51 ± 5.2743.95 ± 7.36
    Yes (drinking or used to drink)113 (32.0)9.85 ± 3.5941.71 ± 5.1644.71 ± 7.47
Medical insurance type (multiple choices)
    Basic medical insurance for urban employees187 (53.0)10.68 ± 3.06< 0.00143.62 ± 4.98< 0.00144.79 ± 7.140.108
    New cooperative medical insurance112 (31.7)9.16 ± 4.020.00154.18 ± 5.450.00143.34 ± 7.880.138
    Basic medical insurance for urban residents62 (17.6)9.18 ± 3.770.02955.13 ± 4.870.46044.56 ± 6.710.666
    Commercial insurance23 (6.5)10.74 ± 3.370.32356.30 ± 4.760.49045.61 ± 7.240.343
    No insurance3 (0.8)12.33 ± 1.150.25252.00 ± 4.580.23534.67 ± 9.290.025
Which IBD< 0.0010.0050.553
    Ulcerative colitis133 (37.7)9.16 ± 3.6954.57 ± 5.0643.89 ± 7.55
    Crohn’s disease220 (62.3)10.59 ± 3.2156.18 ± 5.2544.38 ± 7.30
Duration of IBD0.9950.9480.248
    < 1 yr239 (67.7)10.05 ± 3.4655.58 ± 5.1744.65 ± 7.36
    1-2 yr59 (16.7)10.08 ± 3.4355.41 ± 5.3043.17 ± 7.72
    > 2 yr55 (15.6)10.02 ± 3.5655.73 ± 5.5943.33 ± 7.09
Ostomy0.0140.0880.621
    Yes27 (7.6)8.48 ± 4.3753.93 ± 5.9543.52 ± 10.05
    No326 (92.4)10.18 ± 3.5355.71 ± 5.1544.25 ± 7.14
Comorbidities0.4630.0640.004
    Yes59 (16.7)9.75 ± 3.7254.42 ± 5.1141.71 ± 7.32
    No294 (83.3)10.11 ± 3.4155.81 ± 5.2344.64 ± 7.28
Family history of IBD0.5880.9910.392
    Yes9 (2.5)10.67 ± 4.2155.56 ± 4.9842.11 ± 6.43
    No344 (97.5)10.03 ± 3.4555.58 ± 5.2444.25 ± 7.41
Surgical history0.3400.4870.894
    Yes165 (46.7)10.24 ± 3.3955.78 ± 5.1044.14 ± 7.47
    No188 (53.3)9.88 ± 3.5355.39 ± 5.3544.24 ± 7.34
History of drug allergy0.1100.1200.890
    Yes48 (13.6)10.79 ± 2.7356.67 ± 5.1544.33 ± 7.36
    No305 (86.4)9.93 ± 3.5555.40 ± 5.2344.17 ± 7.41
What kind of treatment is being received?0.0400.0040.276
5-aminosalicylic acid drugs (e.g., mesalazine)19 (5.4)8.63 ± 3.4455.00 ± 4.9945.32 ± 8.87
Glucocorticoids1 (0.3)12.0057.0050.00
Immunosuppressants (e.g., azathioprine, tacrolimus, cyclosporine, etc.)6 (1.7)6.50 ± 3.2751.33 ± 6.3837.83 ± 9.99
Biological agents (e.g., infliximab, vedolizumab, ustekinumab)301 (85.3)10.16 ± 3.4955.97 ± 5.1344.33 ± 7.26
Biological agents + immunosuppressants14 (4.0)9.93 ± 3.3451.36 ± 5.5843.57 ± 6.73
Biological agents + 5-aminosalicylic acid drugs12 (3.4)11.25 ± 1.4853.42 ± 4.3642.50 ± 6.99
Table 2 Knowledge dimension, n (%)
Knowledge
Correct
Wrong
Unclear
IBD is a group of chronic, non-specific recurrent intestinal inflammatory diseases, including UC and CD316 (89.5)2 (0.6)35 (9.9)
At present, many factors, such as heredity, immunity, environment, and microorganisms, are involved in the pathogenesis of the disease74 (21.0)185 (52.4)94 (26.6)
Symptoms of IBD can include abdominal pain, diarrhea, bloody stool, anemia, fever, joint swelling, pain, etc.293 (83.0)13 (3.7)47 (13.3)
Extraintestinal manifestations of IBD include oral ulcers, joint injury, skin injury, eye lesions, hepatobiliary diseases, etc.212 (60.1)32 (9.1)109 (30.9)
IBD often occurs in young adults and is more common between the ages of 20-50 yr267 (75.6)16 (4.5)70 (19.8)
IBD is a lifelong disease, and the patient’s condition is prolonged and repeated. At present, there is no specific and effective medicine or method to cure the disease293 (83.0)11 (3.1)49 (13.9)
Colonoscopy and mucosal biopsy are the best methods to establish the diagnosis and assess the disease’s severity in patients with IBD285 (80.7)6 (1.7)62 (17.6)
Generally, medical treatment is the main treatment for IBD, but surgical treatment is needed when intestinal obstruction, intestinal perforation, and canceration occur275 (77.9)5 (1.4)73 (20.7)
The treatment of patients with IBD varies widely among individuals, with different classifications and severity of the disease leading to different treatment outcomes and efficacy299 (84.7)1 (0.3)53 (15.0)
Drugs for treating IBD include hormones, aminosalicylic acid drugs, immunosuppressants (azathioprine, methotrexate, etc.), and biological agents274 (77.6)5 (1.4)74 (21.0)
There are no side effects after treatment with glucocorticoids, etc.149 (42.2)39 (11.0)165 (46.7)
Currently, the biological agents approved for treating IBD in China include infliximab, vidrizumab, and ustekinumab292 (82.7)6 (1.7)55 (15.6)
All patients with IBD can’t normally absorb the nutrients they intake232 (65.7)60 (17.0)61 (17.3)
Emotion, smoking, drinking, and other behaviors will not affect IBD286 (81.0)36 (10.2)31 (8.8)
Table 3 Attitude dimension, n (%)
Attitude
Strongly agreeAgreeNeutralDisagreeStrongly disagree
I am confident in the treatment of IBD158 (44.8)134 (38.0)58 (16.4)3 (0.8)0
I think patients with IBD need to avoid certain foods186 (52.7)144 (40.8)22 (6.2)1 (0.3)0
I think that patients with IBD combined with malnutrition need to use a combination of intestinal and extra-intestinal nutrition support according to the disease situation if necessary171 (48.4)151 (42.8)29 (8.2)1 (0.3)1 (0.3)
I think scientific dietary guidance and management are key to managing IBD193 (54.7)141 (39.9)18 (5.1)1 (0.3)0
I think developing a specific treatment plan for IBD needs to be tailored to the individual’s situation and developed jointly by the IBD medical specialist and the patient208 (58.9)129 (36.5)15 (4.2)1 (0.3)0
I think the adjustment of IBD medication needs to be carried out under the guidance of specialists, and patients should not adjust their own medication228 (64.6)112 (31.7)13 (3.7)00
I believe that during IBD medication, patients need to monitor the side effects of their medication and provide timely feedback to their specialists216 (61.2)128 (36.3)9 (2.5)00
I think treatment can be stopped when the colonoscopy shows mucosal healing (i.e., complete healing of colonic erosions and ulcers)37 (10.5)47 (13.3)92 (26.1)134 (38.0)43 (12.2)
I think the early application of biologics, in conjunction with specialist advice, will allow early control of disease activity to change the course of the disease and minimize complications and disability in the bowel171 (48.4)147 (41.6)30 (8.5)3 (0.8)2 (0.6)
I think patients with IBD should reduce their intake of saturated fatty acids (animal oil, cream, fatty meats, meat soups, etc.)137 (38.8)156 (44.2)52 (14.7)7 (2.0)1 (0.3)
I think that IBD patients should try to drink plain hot water and freshly squeezed juices and need to avoid strong tea, sugary drinks, coffee, alcohol, etc.177 (50.1)148 (41.9)24 (6.8)2 (0.6)2 (0.6)
I think the IBD disease has obviously increased the family’s financial burden172 (48.7)133 (37.7)42 (11.9)5 (1.4)1 (0.3)
I think I can get married, get pregnant, and give birth normally if my IBD disease is controlled125 (35.4)166 (47.0)52 (14.7)8 (2.3)2 (0.6)
I think IBD has affected my normal work, study, and social interaction98 (27.8)134 (38.0)86 (24.4)30 (8.5)5 (1.4)
Table 4 Practice dimension, n (%)
Practice
Always
Often
Sometimes
Seldom
Never
I will actively cooperate with the medical staff for my treatment and nursing244 (69.1)93 (26.3)15 (4.2)1 (0.3)0
I will communicate with specialists regularly and follow up regularly166 (47.0)116 (32.9)62 (17.6)9 (2.5)0
I will vent my bad emotions correctly, such as through exercise relaxation, music relaxation, and implied adjustment, to relieve mental stress106 (30.0)125 (35.4)92 (26.1)25 (7.1)5 (1.4)
I will communicate with family members, close friends, and patients and gain encouragement and emotional support94 (26.6)117 (33.1)92 (26.1)41 (11.6)9 (2.5)
Yes, n (%)No, n (%)
I will take care to quit smoking and drinking346 (98.0)7 (2.0)
I will take care to avoid staying up late and overworking120 (34.0)119 (33.7)87 (24.6)23 (6.5)4 (1.1)
I will take care to choose appropriate physical exercise according to my physical condition96 (27.2)95 (26.9)105 (29.7)50 (14.2)7 (2.0)
If there is an ostomy, I will go to an IBD specialist for standard treatment336 (95.2)17 (4.8)000
If I am treated with biological agents, I will pay attention to monitoring the related side effects179 (50.7)107 (30.3)52 (14.7)11 (3.1)4 (1.1)
If a food allergy is identified, I will take care to avoid it in my daily diet210 (59.5)105 (29.7)30 (8.5)5 (1.4)3 (0.8)
I will use a “diet diary” to identify foods that may cause discomfort, such as abdominal pain or diarrhea, and try to avoid them in my future diet106 (30.0)94 (26.6)67 (19.0)42 (11.9)44 (12.5)
I will improve my understanding of diseases and treatment through WeChat groups, networks, and popular science lectures100 (28.3)85 (24.1)104 (29.5)52 (14.7)12 (3.4)
I will insist on taking medicine or receiving infusion treatment of biological agents as prescribed by my physician247 (70.0)86 (24.4)16 (4.5)3 (0.8)1 (0.3)
I will encourage and help other people with IBD as much as I can135 (38.2)78 (22.1)93 (26.3)37 (10.5)10 (2.8)
Table 5 Correlation analysis

Knowledge dimension
Attitude
Practice
Knowledge dimension1
Attitude0.371 (P < 0.001)1
Practice0.100 (P < 0.001)0.452 (P < 0.001)1
Table 6 Univariate and multivariate analysis of knowledge
VariablesUnivariate analysis
Multivariate analysis
OR (95%CI)
P value
OR (95%CI)
P value
Gender
    Male1.09 (0.62-1.92)0.751
    FemaleRef
Age
    ≤ 20RefRef
    20-302.80 (1.10-7.09)0.0303.01 (0.97-9.38)0.057
    30-402.17 (0.84-5.63)0.1114.06 (1.04-15.82)0.043
    > 400.76 (0.33-1.75)
Ethnicity
    Han3.83 (1.13-12.94)0.0313.70 (0.80-16.97)0.093
    MinoritiesRefRef
Residence
    RuralRefRef
    City3.08 (1.56-6.07)0.0011.69 (0.74-3.84)0.213
    Suburb/urban-rural combination1.95 (0.97-3.90)0.0601.33 (0.58-3.03)0.496
Education
    Primary school and belowRef
    Middle school2.99 (1.15-7.76)0.0253.98 (1.29-12.33)0.017
    High school/technical secondary school11.80 (4.20-33.17)< 0.00114.06 (3.92-50.38)< 0.001
    Junior college/bachelor’s degree and above20.70 (7.75-55.28)< 0.00115.20 (4.15-55.65)< 0.001
Work status
    Employed4.07 (2.23-7.41)< 0.0011.34 (0.63-2.85)0.444
    OtherRefRef
Monthly per capita income
    < 5000RefRef
    5000-100003.94 (1.84-8.43)< 0.0012.04 (0.81-5.18)0.133
    > 100002.46 (1.17-5.18)0.0180.90 (0.34-2.36)0.823
Marital status
    Unmarried or otherRefRef
    Married0.61 (0.35-1.07)0.0830.85 (0.33-2.16)0.734
Smoking habit
    No (no smoking)Ref
    Yes (smoking or used to smoke)0.60 (0.33-1.12)0.10
Drinking habit
    No (no drinking)Ref
    Yes (drinking or used to drink)0.85 (0.49-1.50)0.584
What kind of IBD is being diagnosed
    Ulcerative colitis0.50 (0.29-0.85)0.0110.57 (0.28-1.18)0.132
    Crohn’s diseaseRefRef
Duration of IBD
    < 1 yr1.14 (0.54-2.39)0.729
    1-2 yr0.98 (0.39-2.45)0.964
    > 2 yrRef
Ostomy?
    Yes0.51 (0.21-1.23)0.135
    NoRef
Comorbidities
    Yes0.62 (0.32-1.19)0.149
    NoneRef
Family history of IBD
    Yes1.86 (0.23-15.16)0.560
    NoRef
Surgical history
    Yes1.15 (0.67-1.97)0.613
    NoRef
History of drug allergy
    Yes1.40 (0.60-3.29)0.433
    NoRef
What kind of treatment is being received?
5-aminosalicylic acid drugs (e.g., mesalazine)Ref
Glucocorticoids--
Immunosuppressants (e.g., azathioprine, tacrolimus, cyclosporine, etc.)0.46 (0.07-2.99)0.418
Biological agents (e.g., infliximab, vedolizumab, ustekinumab)2.11 (0.77-5.80)0.148
Biological agents + immunosuppressants1.69 (0.34-8.40)0.520
Biological agents + 5-aminosalicylic acid drugs--
Table 7 Univariate and multivariate analysis of attitude
VariablesUnivariate analysis
Multivariate analysis
OR (95%CI)
P value
OR (95%CI)
P value
Knowledge score (as continuous variables)1.24 (1.14-1.34)< 0.0011.23 (1.11-1.36)< 0.001
Gender
    Male1.42 (0.73-2.74)0.300
    FemaleRef
Age
    ≤ 20Ref
    20-301.49 (0.52-4.25)0.461
    30-401.29 (0.43-3.82)0.651
    > 401.27 (0.44-3.65)0.656
Ethnicity
    Han4.69 (1.31-16.80)0.0173.21 (0.66-15.59)0.149
    MinoritiesRefRef
Residence
    RuralRefRef
    City2.47 (1.06-5.76)0.0371.63 (0.61 4.32)0.329
    Suburb/urban-rural combination1.12 (0.51-2.44)0.7790.98 (0.39-2.47)0.968
Education
    Primary school and belowRefRef
    Middle school0.95 (0.30-2.97)0.9250.85 (0.23-3.08)0.803
    High school/technical secondary school2.37 (0.70-8.05)0.1650.87 (0.22-3.49)0.841
    Junior college/bachelor’s degree and above2.91 (0.95-8.94)0.0620.82 (0.20-3.26)0.774
Work status
    Employed2.65 (1.32-5.30)0.0061.54 (0.64-3.70)0.338
    OtherRefRef
Monthly per capita income
    < 5000RefRef
    5000-100002.22 (0.97-5.09)0.0601.10 (0.42-2.89)0.850
    > 100002.16 (0.85-5.46)0.1051.06 (0.35-3.17)0.924
Marital status
    Unmarried or otherRef
    Married0.97 (0.51-1.88)0.937
Smoking habit
    No (no smoking)Ref
    Yes (smoking or used to smoke)0.88 (0.40-1.94)0.755
Drinking habit
    No (no drinking)Ref
    Yes (drinking or used to drink)1.16 (0.57-2.36)0.689
What kind of IBD is being diagnosed
    Ulcerative colitis0.75 (0.39-1.44)0.383
    Crohn’s diseaseRef
Duration of IBD
    < 1 yr0.92 (0.36-2.35)0.866
    1-2 yr0.91 (0.29-2.90)0.873
    > 2 yrRef
Ostomy?
    Yes0.55 (0.19-1.53)0.250
    NoRef
Comorbidities
    Yes0.68 (0.31-1.51)0.341
    NoneRef
Family history of IBD
    Yes1.05 (0.13-8.64)0.962
    NoRef
Surgical history
    Yes1.14 (0.59-2.19)0.698
    NoRef
History of drug allergy
    Yes1.52 (0.52-4.47)0.448
    NoRef
What kind of treatment is being received?
5-aminosalicylic acid drugs (e.g., mesalazine)RefRef
Glucocorticoids----
Immunosuppressants (e.g., azathioprine, tacrolimus, cyclosporine, etc.)0.24 (0.02-2.22)0.2060.38 (0.03-4.43)0.438
Biological agents (e.g., infliximab, vedolizumab, ustekinumab)1.10 (0.24-5.02)0.8990.88 (0.17-4.53)0.878
Biological agents + immunosuppressants0.21 (0.03-1.32)0.0960.16 (0.02-1.17)0.070
Biological agents + 5-aminosalicylic acid drugs0.35 (0.05-2.51)0.2980.17 (0.02-1.51)0.113
Table 8 Univariate and multivariate analysis of practice
VariablesUnivariate analysis
Multivariate analysis
OR (95%CI)
P value
OR (95%CI)
P value
Knowledge score (as continuous variables)1.10 (1.02-1.19)0.0200.96 (0.87-1.06)0.412
Attitude score (as continuous variables)1.21 (1.13-1.30)< 0.0011.20 (1.11-1.30)< 0.001
Gender
    Male1.62 (0.86-3.04)0.134
    FemaleRef
Age
    ≤ 20Ref
    20-301.25 (0.45-3.50)0.672
    30-401.65 (0.53-5.11)0.386
    > 401.16 (0.41-3.30)0.780
Ethnicity
    Han0.65 (0.14-3.11)0.589
    MinoritiesRef
Residence
    RuralRefRef
    City2.41 (1.08-5.40)0.0332.01 (0.80-5.04)0.139
    Suburb/urban-rural combination1.12 (0.53-2.38)0.7681.12 (0.49-2.58)0.788
Education
    Primary school and belowRef
    Middle school0.66 (0.20-2.22)0.503
    High school/technical secondary school2.10 (0.56-7.84)0.272
    Junior college/bachelor’s degree and above1.58 (0.49-5.11)0.441
Work status
    Employed2.76 (1.41-5.40)0.0031.93 (0.88-4.21)0.099
    OtherRefRef
Monthly per capita income
    < 5000RefRef
    5000-100002.42 (1.06-5.51)0.0361.31 (0.51-3.33)0.578
    > 100001.71 (0.74-3.94)0.2070.86 (0.32-2.28)0.755
Marital status
    Unmarried or otherRef
    Married0.65 (0.34-1.25)0.200
Smoking habit
    No (no smoking)Ref
    Yes (smoking or used to smoke)0.86 (0.41-1.84)0.706
Drinking habit
    No (no drinking)Ref
    Yes (drinking or used to drink)1.18 (0.60-2.35)0.631
What kind of IBD is being diagnosed
    Ulcerative colitis0.80 (0.43-1.52)0.501
    Crohn’s diseaseRef
Duration of IBD
    < 1 yr1.39 (0.59-3.27)0.445
    1-2 yr0.74 (0.27-2.01)0.558
    > 2 yrRef
Ostomy
    Yes0.62 (0.22-1.72)0.354
    NoRef
Comorbidities
    Yes0.43 (0.21-0.88)0.0220.50 (0.23-1.09)0.082
    NoneRefRef
Family history of IBD
    Yes--
    NoRef
Surgical history
    Yes1.11 (0.59-2.09)0.741
    NoRef
History of drug allergy
    Yes0.83 (0.35-1.99)0.682
    NoRef
What kind of treatment is being received?
5-aminosalicylic acid drugs (e.g., mesalazine)Ref
Glucocorticoids--
Immunosuppressants (e.g., azathioprine, tacrolimus, cyclosporine, etc.)0.19 (0.02-1.41)0.104
Biological agents (e.g., infliximab, vedolizumab, ustekinumab)1.38 (0.38-4.97)0.622
Biological agents + immunosuppressants2.44 (0.23-26.30)0.463
Biological agents + 5-aminosalicylic acid drugs0.94 (0.13-6.63)0.948