Nurses’ knowledge, attitudes, practices, and educational needs regarding frailty: a multicenter cross-sectional survey in southwestern China
Abstract
Background Population aging has made frailty a major public health concern. Frailty is potentially reversible when identified and managed early, and nurses are well positioned to deliver such care; however, nurses’ frailty-related competencies vary considerably, and evidence remains scarce in southwestern China, where the aging burden is disproportionately high. We therefore conducted a multicenter study to assess nurses’ knowledge, attitudes, and practices (KAP) regarding frailty, explore their associated factors, and clarify their educational needs. Methods An anonymous online survey was administered to a convenience sample of nurses at 41 tertiary general hospitals in Chongqing Municipality and Sichuan Province, China, between January and March 2025. Frailty-management competency was measured with a validated 31-item KAP questionnaire (total score 31–127; higher indicates better competency), and educational needs with an 11-item questionnaire. Associations were assessed using linear mixed-effects models with a random intercept for hospital; multivariable models entered 11 prespecified covariates, and reporting followed STROBE. Results Of 637 nurses recruited, 610 (95.76%) provided valid questionnaires. The mean total KAP score was 103.07 ± 12.65 (81.16% of maximum). Attitude scored highest (88.53%), followed by knowledge (81.38%) and practice (74.40%), with practice corresponding to the lowest percentage of its maximum. In fully adjusted mixed-effects models, more recent frailty education was independently associated with the total KAP score (overall p = 0.019; never-trained vs. trained within the past month, β = −6.820, 95% CI − 13.220 to −0.430, p = 0.036), whereas the association with recency of frailty-related reading was borderline (overall p = 0.051). Geriatric nurse specialist certification was independently associated only with knowledge (β = 2.070, 95% CI 0.660 to 3.490; p = 0.004), not with overall KAP, attitude, or practice; sociodemographic characteristics were not associated. Conclusion Nurses held positive attitudes, whereas self-reported practice corresponded to the lowest percentage of its maximum. Recency of frailty education was the factor most consistently associated with KAP and represents a potentially modifiable correlate. Given the cross-sectional design, these associations are consistent with a potential role for regularly refreshed, blended, and practice-oriented training. Longitudinal and interventional studies are needed to confirm clinical benefit.