Yanxiao Liu,* Hua Wang,* Huafei Liu, Lei Li

Department of Orthopedics, Quzhou People’s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hua Wang, Department of Orthopedics, Quzhou People’s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China, Tel +8615605705505, Email wh421081@163.com

Introduction: Prolonged sedentary behavior and electronic device use jeopardize university students’ cervical spine health. This study investigated their knowledge, attitudes, and practices (KAP) concerning cervical spine health.
Methods: From May 25 to June 16, 2023, a cross-sectional survey was conducted among students at various Chinese universities. Demographic data and KAP scores were collected using self-developed questionnaires. Using 60% and 80% as cut-off values, KAP levels were categorized into three tiers: knowledge (inadequate: 0– 7, moderate: 8– 11, good: 12– 15), attitudes (negative: 8– 23, neutral: 24– 31, positive: 32– 39), and practices (inappropriate: 7– 20, moderate: 21– 28, proactive: 29– 35).
Results: Of 1,956 valid questionnaires, their mean age was 19.88 ± 1.40 years, with 71.8% of female gender. Notably, 75.9% reported daily electronic device use ≥ 4 hours. Regarding initial device acquisition, 37.1% obtained devices in middle school, 30.6% in high school, 22.5% in elementary school, and 9.9% in college. Mean knowledge, attitudes, and practices scores were 10.4 ± 2.1, 34.1 ± 3.9, and 20.9 ± 4.1. Multivariate logistic regression revealed that female students (OR = 1.39, 95% CI: 1.10– 1.75), non-freshmen (OR = 1.74, 95% CI: 1.42– 2.13), and acquiring knowledge through WeChat (OR = 1.86, 95% CI: 1.47– 2.36) or community hospitals (OR = 1.60, 95% CI: 1.29– 1.99) had higher probability of adequate knowledge. Non-medical majors (OR = 0.47, 95% CI: 0.39– 0.58) and using electronic devices for 3– 4 hours (OR = 0.67, 95% CI: 0.45– 0.99) or ≥ 4 hours daily (OR = 0.64, 95% CI: 0.46– 0.89) were negatively associated with attitudes. Positive attitudes (OR = 1.27, 95% CI: 1.22– 1.31) and obtaining knowledge from medical experts (OR = 1.30, 95% CI: 1.03– 1.63) were associated with better practices, while female students (OR = 0.56, 95% CI: 0.44– 0.72) and frequent cervical discomfort (OR = 0.26, 95% CI: 0.13– 0.53) were the opposite.
Conclusion: University students exhibited moderate knowledge, positive attitudes, and inappropriate practices regarding cervical spine health. Educational interventions are recommended, particularly for non-medical majors, individuals with prolonged digital device use, and freshmen.

Keywords: cervical spine health, knowledge, attitude, practice, university students