Why patients’ knowledge alone isn’t enough: examining behavioral and attitudinal gaps in gestational diabetes management among Chinese women

Background Gestational diabetes mellitus (GDM) prevalence is rising in China, necessitating an understanding of knowledge, attitudes, and practices (KAP) among affected women to inform interventions. Methods This cross-sectional study (June 2020–June 2024) surveyed 3,426 Chinese women with GDM, aged 20–60 years, from urban and rural prenatal clinics across Qingdao city, China. A validated 25-item KAP questionnaire used a three-option response format (yes, no, maybe). Data were collected via WeChat in urban areas and paper-based surveys in rural regions (89% response rate), analyzed using chi-square tests and binary logistic regression. Results Significant KAP gaps emerged: 63% recognized GDM’s link to complications, but only 50% understood its comprehensive management, with 38% aware of eye exams and 40% of foot care needs. Practice adherence was poor—36% monitored blood glucose, 38% limited alcohol, and 53% practiced foot care, despite 59% adhering to medications. Attitudinally, 64% believed health-focused behavior drives management, yet only 36% viewed personal accountability as key, with 39% feeling providers understood their concerns. Intriguingly, younger women (20–30 years) were more open to education (OR 2.67, 95% CI 1.94–3.69, p < 0.001), while illiteracy (OR 88.7, 95% CI 34.7–249, p < 0.001) and older age (51–60 years: OR 12.7, 95% CI 8.79–18.4, p < 0.001) predicted poor outcomes. Positive attitudes were protective (OR 0.19, 95% CI 0.15–0.24, p < 0.001). Conclusion These findings reveal entrenched KAP barriers in GDM management, underscoring the need for innovative, equity-driven interventions—integrating accessible education, community empowerment, and digital tools—to enhance outcomes and reduce the GDM burden in China.