The results suggest that the parents of children with AR had poor knowledge but positive attitudes and proactive practice toward AR. Residence, biological sibling, and hospital visits for AR were independently associated with adequate knowledge. Knowledge and hospital visits for AR were independently associated with positive attitude. Knowledge, attitude, monthly income per capita and hospital visit for AR were independently associated with proactive practice. It is necessary to enhance education for parents in specific condition.
Besides medication (which constitutes the second treatment used by the children after nasal irrigation in the present study), managing AR involves avoiding the identified allergens (when identified, since only about half of the children had been tested in the present study) and having good life habits [2, 5–7]. Therefore, a high level of KAP plays a major role in the management of AR, but children, especially young children, can have difficulties in self-management because of immature knowledge and attitudes, especially in the face of a non-lethal allergy causing only respiratory symptoms. The present study revealed poor knowledge but positive attitudes and sufficient practice toward AR of parents of children with AR. The knowledge and attitude scores were independently associated with the practice scores. Therefore, the results suggest that even though the knowledge levels were low, the participants were active toward AR out of habit or following medical advice but without understanding them. Nevertheless, due to the direct correlations and independent associations, improving knowledge should also improve attitudes and practice. Therefore, educational interventions (e.g., posters, pamphlets, video capsules, podcasts, etc.) should be created to improve the KAP of patients with AR. Of note, poor scores were observed for knowledge items related to the indications/contraindications of desensitization therapy, allergy skin testing, and the possibility of multiple allergic diseases simultaneously. Knowledge about those items should be enforced, but knowledge pertaining to the other items was not perfect either and should be improved.
Previous studies generally support the present one and show variable KAP in patients with AR [11–15, 22, 23]. Bhargave et al. [11] revealed large discrepancies among countries regarding the KAP of patients and physicians toward AR. In Saudi Arabia, the KAP of patients with AR was low [12, 14]. Similar results were reported in India [13] and four Southeast Asian nations [15]. Thai patients have poor knowledge of the risks of immunotherapy for AR [22], and similar results were observed in German athletes with AR [23]. Some of these studies also included healthcare providers, who also showed relatively poor or moderate KAP. Hence, there is a need to improve the KAP toward AR, especially in healthcare providers, since they are an important source of information for patients, as shown in the present study. Still, these previous studies were not performed specifically on parents of children with AR (although it can be considered that many of the participants in those previous studies had children), and no data are available in the literature regarding the specific population of parents of children with AR. In the present study, 12.29% of the patients had comorbid asthma, and AR is a risk factor for asthma exacerbations [24]. The knowledge scores of parents of children with comorbid AR and asthma were the highest, probably due to the diagnosis of asthma, which is more severe than a diagnosis of AR. Still, the KAP of parents of children with asthma was generally poor in China, including the items on AR [17, 18]. The present study showed that parents with another child besides the one with AR had a lower knowledge, perhaps because of less time to gain knowledge. A history of more hospital visits for AR was associated with higher scores, probably because of more opportunities to gain knowledge from the medical staff, which was also reported by the participants as their main source of AR information. A higher income was associated with better attitudes and practice, probably because of a higher capacity to pay for medical visits and treatments. No previous hospital visits for AR was associated with a low practice score, which supports that the parents follow the medical advice to help manage AR in their children; indeed, participants who did not have the opportunity to receive advice cannot apply them.
This study has limitations. It was performed at a single center, and the resulting sample size was relatively small, considering the high prevalence of AR. The participants’ socioeconomic status was relatively elevated, which does not represent the general Chinese population. It was a cross-sectional study, and causality could not be investigated. Still, the results could serve as a baseline to examine the impact of future educational interventions. There were some differences between mothers and fathers regarding some KAP items, but the over-representation of mothers can bias the results. Finally, all KAP studies are at risk of social desirability bias [25, 26], which can overestimate the scores because some participants might be tempted to answer what they know they should do instead of what they are doing. Since the attitude and practice scores were high, that bias is possible.