Abstract
BACKGROUND: To examine the knowledge, attitudes, and practices (KAP) regarding dry eye disease (DED) treatment among patients. METHODS: We conducted a cross-sectional study at the Shanghai Fourth People’s Hospital, affiliated with Tongji University, from December 6, 2023, to March 22, 2024. Data were collected through a self-administered questionnaire. RESULTS: A total of 416 valid cases were enrolled, with 302 (72.6%) being female. The median [25%, 75%] knowledge, attitude, and practice scores were 29.00 [23.00, 32.00], 31.00 [27.00, 35.00], and 29.00 [25.00, 32.00] respectively, out of a possible maximum of 40 points each. In univariable analysis, patients with a bachelor’s degree or above were 2.656 times more likely to exhibit proactive practices compared with those with high school education or below. Multivariable logistic regression showed knowledge (OR = 1.10, P < 0.001) and attitude (OR = 1.19, P < 0.001) were independently associated with proactive practice, SEM revealed that knowledge directly influenced attitude (β = 0.667, P < 0.001) and both knowledge (β = 0.183, P = 0.004) and attitude (β = 0.521, P < 0.001) directly influenced practice, with attitude mediating the effect of knowledge on practice (β = 0.347, P < 0.001). CONCLUSIONS: This study revealed that patients generally possessed adequate knowledge and positive attitudes, which correlated strongly with proactive practices towards managing DED. Enhancing patient education programs could further improve both attitudes and practices, particularly among patients in the later stages of their treatment course, potentially increasing the effectiveness of DED management strategies for those who have shown some improvement but have not yet achieved full resolution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-26151-0.