Knowledge, attitude, and practice regarding radiation dermatitis among radiotherapy patients across Shanxi: a cross-sectional study

Abstract This cross-sectional study was conducted at Shanxi Province Cancer Hospital between July and August, 2025, using a self-administered questionnaire. A total of 523 valid questionnaires were analyzed (effective response rate: 87.17%) with a mean age of 59.39 ± 11.66 years. The knowledge, attitude, and practice scores were 11.64 ± 3.51 (possible range: 0–16), 29.77 ± 2.50 (possible range: 8–40), and 42.12 ± 4.82 (possible range: 10–50), respectively. Positive correlations were observed between knowledge and attitude (correlation coefficient r = 0.204, P < 0.001), knowledge and practice (r = 0.144, P = 0.001), and attitude and practice (r = 0.294, P < 0.001). The structural equation modeling (SEM) analysis of mediating effect showed that knowledge directly affected attitude (standardized path coefficient β = 0.160, P < 0.001) and practice (β = 0.110, P = 0.038), while attitude directly affected practice (β = 0.670, P < 0.001). Further, knowledge indirectly affected practice through attitude (β = 0.110, P < 0.001). Radiotherapy patients demonstrated a moderate level of knowledge, a generally neutral attitude, and relatively proactive practices concerning radiation dermatitis. The findings further indicate that attitude plays a mediating role in linking patient knowledge to self-care behaviors, suggesting that educational interventions targeting both knowledge improvement and attitude enhancement may help promote more effective skin care practices during radiotherapy.