Abstract
Primary aldosteronism (PA), though affecting approximately 10% of hypertensive patients, remains significantly underdiagnosed globally, especially in resource-limited healthcare settings. Despite its clinical importance, there is a notable gap in research assessing healthcare professionals' preparedness in diagnosing and managing this condition. This study, the first of its kind in China, aimed to comprehensively evaluate the knowledge, attitudes, and practices (KAP) of healthcare workers regarding PA in Shanxi Province and to identify factors associated with proactive clinical practices, with the goal of identifying specific educational and training needs. From August 1 to 7, 2024, a multi-center cross-sectional study enrolled 337 doctors from cardiology, endocrinology, and urology departments. The cohort comprised 51.63% females, with 61.42% having managed patients with primary aldosteronism. Mean KAP scores were 4.42 ± 1.56 (knowledge), 26.46 ± 2.65 (attitude), and 29.27 ± 7.42 (practice), based on respective scoring ranges. Spearman correlation analysis revealed significant positive correlations among knowledge, attitude, and practice (r = 0.279, P < 0.001; r = 0.347, P < 0.001; r = 0.507, P < 0.001). Mediation analysis indicated that knowledge directly influenced both attitude (β = 0.450, P = 0.012) and practice (β = 0.461, P = 0.006), with an indirect effect on practice (β = 0.095, P = 0.030). This study uniquely demonstrates that knowledge levels directly influence clinical practices both directly and indirectly through attitudinal changes, highlighting the critical importance of targeted educational interventions. Overall, healthcare workers exhibited insufficient knowledge but maintained moderate attitudes and practices regarding primary aldosteronism. Targeted educational programs are essential to enhance their knowledge, consequently improving attitudes and practices, particularly within higher-tier healthcare settings. Our findings provide novel insights into the specific knowledge gaps and practice limitations that may contribute to PA underdiagnosis in China, offering targeted recommendations for improving clinical outcomes through enhanced professional education.