Public knowledge, attitudes, and drug purchasing and utilization behaviors under the National Centralized Drug Procurement (NCDP) policy in Yunnan, China: a regional cross-sectional study

The National Centralized Drug Procurement (NCDP), launched in China in 2019, aims to reduce drug costs. However, public concerns affect perceptions and medication-utilization decisions under this scheme. Understanding public knowledge, attitudes, and drug purchasing choices is crucial for improving policy effectiveness and acceptance This study assesses public knowledge, attitudes, and drug purchasing and utilization behaviors (KAB) in Yunnan, China, to identify regional implementation gaps and optimize healthcare strategy recommendations. A cross-sectional survey was conducted from February 7 to March 27, 2023, in urban and rural areas of Yunnan Province using a multi-stage non-probability sampling design (purposive regional selection followed by convenience and snowball sampling), yielding 227 valid responses. Eligible participants were adult residents (aged ≥ 18 years) who had resided in Yunnan for ≥6 months and provided informed consent. Exclusion criteria were: (1) incomplete questionnaires, (2) completion time under 180 seconds, or (3) failure to pass embedded logic-check questions. Data were collected via the online Questionnaire Star platform following ethical approval by Kunming Medical University. Demographics, policy awareness, attitudes, and drug purchasing and utilization behaviors were analyzed using ANOVA, multiple linear regression, Exploratory Factor Analysis (EFA), K-Means clustering, and a Random Forest model. Participants exhibited awareness regarding the policy’s existence (78.0%) and generally positive attitudes toward the NCDP, but a significant knowledge-behavior gap was observed. The majority of respondents were young (78% under 50 years) and female (59%), with medications primarily sourced from retail pharmacies (38%) and hospitals (35%). Regression analysis identified Cost Reduction Choice (Var8; β = 0.26, p < 0.01) and Choosing based on Policy Trust (Var13; β = 0.24, p < 0.01) as positive factors influencing attitudes, whereas Agreement with Switching Drugs (Var3; β = −0.26, p < 0.01) and Drug Shortage Experience (Var5; β = −0.28, p < 0.01) were negative factors. Trust in policy implementation and the quality of selected drugs emerged as critical determinants of patients’ acceptance and medication choices. Further analysis revealed distinct population segments with unique perspectives, underscoring the need for tailored communication strategies to address diverse public concerns. Public trust in the quality and safety of NCDP-selected drugs is the most critical factor for improving policy acceptance and outcomes. This study concludes that the observed knowledge-behavior gap is driven less by a lack of information and more by public apprehension regarding generic drug safety. Therefore, bridging this gap requires targeted communication strategies focused on building trust, rather than simply increasing policy awareness.