Knowledge, attitudes, and practices regarding ventilator-associated pneumonia among family members of ICU patients

Objective Ventilator-associated pneumonia (VAP) remains a major complication of mechanical ventilation, while the role of family members in preventive care has been insufficiently explored. This study aimed to investigate the knowledge, attitudes, and practices (KAP) regarding VAP among family members of intensive care unit (ICU) patients. Methods This cross-sectional study was conducted among family members of ICU patients receiving invasive mechanical ventilation at the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine from July 1, 2025 to March 31, 2026. Participants were recruited using convenience sampling. Demographic characteristics and knowledge, attitude, and practice scores were collected and assessed using a self-designed structured questionnaire. The cutoff for good knowledge, positive attitudes, and proactive practices was defined as at least 70.0% of the corresponding total score. Descriptive analysis, multivariable regression, and structural equation modeling (SEM) were performed to evaluate factors associated with KAP outcomes and explore relationships among KAP domains. Results A total of 406 participants were included, with 56.9% being female. The mean knowledge, attitude, and practice scores were 3.48 ± 5.26 (possible range: 0–24), 38.94 ± 6.62 (possible range: 10–50), and 19.33 ± 6.50 (possible range: 7–35), respectively. SEM showed direct effects of knowledge on attitude ( β = 0.190, p < 0.001) and practice ( β = 0.222, p < 0.001), as well as a direct effect of attitude on practice ( β = 0.329, p < 0.001). Knowledge also indirectly affected practice through attitude ( β = 0.063, p = 0.001). Conclusion Family members of ICU patients generally held poor VAP-related knowledge, positive attitudes, and poor practices. Knowledge and attitudes were key determinants of preventive practices, with attitude mediating the knowledge–practice pathway. Structured family-oriented education and bedside participation protocols should be integrated into ICU care to improve feasible VAP-prevention behaviors.