Knowledge, attitudes, and practices regarding constipation among patients with type 2 diabetes mellitus: a structural equation modeling analysis

Background The present study aims to evaluate the knowledge, attitudes, and practices (KAP) related to constipation among patients diagnosed with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted at Gansu Provincial Hospital between October 2024 and May 2025. It aimed to assess the KAP regarding constipation among patients with type 2 diabetes mellitus through a questionnaire. Furthermore, structural equation modeling (SEM) was employed to analyze the relationships among the different KAP components. Results A total of 364 complete and valid questionnaires were included in the final analysis. The median age of the patients was 55 (47, 62) years, with 64.3% being male, and 41.2% having attained at least an associate's or bachelor's degree. The median (interquartile range) scores for knowledge, attitude, and practice were 6 (3.25, 9), 37 (35, 42), and 30 (27, 33), respectively (possible ranges: 0–15, 10–50, and 10–50). SEM results revealed that knowledge had a direct effect on both attitudes (β = 0.298, P = 0.004) and practices (β = 0.235, P = 0.019). Attitudes also had a direct effect on practices (β = −0.188, P = 0.009). Furthermore, knowledge indirectly influenced practices through attitudes (β = −0.056, P = 0.005). Conclusions Patients diagnosed with T2DM generally exhibited insufficient knowledge of constipation. Although they typically held positive attitudes, there was a considerable lack in their self-management practices for constipation, highlighting a significant knowledge-practice gap. This study suggests that healthcare providers should prioritize implementing targeted, evidence-based educational interventions to enhance patients' knowledge and translate positive attitudes into effective self-care behaviors.