Perceived knowledge, attitudes, and practices regarding nutrition therapy among people with prediabetes: a structural equation model analysis

Objective To assess nutrition therapy-related perceived knowledge, attitudes, and practices (KAP), identify associated participant characteristics, and examine the relationships proposed by the KAP framework in adults with prediabetes. Methods This cross-sectional questionnaire study included adults with prediabetes at Beijing Anzhen Hospital between June and July 2026. Scores were categorized using modified Bloom cut-offs as low (< 60% of the maximum possible score), moderate (60–79%), or high (≥80%). Linear regression examined factors associated with KAP scores. Structural equation modeling (SEM) with weighted least squares mean- and variance-adjusted estimation evaluated relationships among three latent constructs using ordered questionnaire items. Results A total of 449 valid questionnaires were analyzed, including 257 (57.2%) female participants. Mean scores were 12.03 ± 5.51 for perceived knowledge (possible range: 0–20), 27.21 ± 4.79 for attitude (possible range: 8–40), and 22.71±5.60 for practice (possible range: 7–35). According to modified Bloom cut-offs, low perceived knowledge (53.2%), moderate attitudes (64.8%), and moderate practices (55.7%) predominated. In SEM, perceived knowledge was positively associated with attitude (standardized β = 0.744) and practice (β = 0.226), and attitude was positively associated with practice (β = 0.469; all P < 0.001). The indirect association through attitude was 0.349 (95% CI: 0.257–0.444). Conclusions Participants mainly reported limited perceived knowledge and moderate attitudes and practices. Positive relationships among the constructs may help identify potential targets for nutrition education, but measurement limitations and the cross-sectional design preclude causal or mechanistic conclusions.