Objective  To investigate the changes in knowledge, attitude, and practice (KAP) regarding the integration of medical care and prevention among medical professionals in medical institutions of pilot cities of the collaboration and integration of medical care and prevention, a national pilot program for infectious disease prevention and control, to examine the effect pathways, and to provide empirical evidence for promoting the implementation of the integration of medical care and prevention and improving relevant policies.

Methods The participants in this study were medical professionals involved in medical care and prevention integration work. The participants were all from medical institutions of pilot cities for the collaboration and integration of medical care and prevention. The study sample was selected through multi-stage sampling. A questionnaire based on the theoretical framework of the KAP model was designed. Two cross-sectional surveys were conducted—once before the initiation of the pilot program (baseline) and again 12 months after implementation (after implementation). After propensity score matching (PSM), descriptive statistics and hypothesis testing were used to statistically analyze the questionnaire data. In addition, a structural equation model (SEM) was applied to assess the current status and effect pathways of the participants' KAP regarding the integration of medical care and prevention.

Results A total of 11472 responses were collected, and 10627 were included in analysis after PSM, including 5007 before the implementation of the policy and 5620 after the implementation of the policy. No significant differences were observed in demographic variables between the two samples. Baseline scores for knowledge, attitude, and practice regarding the integration of medical care and prevention were 13.32 ± 0.05, 15.62 ± 0.04, and 6.37 ± 0.02 respectively, while the scores at the end of the study were 13.69, 15.74, and 6.51, respectively, all show an increase to a certain degree (P < 0.05). Stratified analysis by institution level revealed relatively significant improvements in knowledge and practice (P < 0.05), but no significant improvement in attitudes (P > 0.05) among medical professionals. Medical professionals in primary medical institutions generally demonstrated superior knowledge, attitudes, and practice frequency compared with those in secondary and tertiary hospitals (P < 0.001). No significant changes in KAP were observed among medical professionals in secondary hospitals (P > 0.05). Regarding the integration of medical care and prevention, the effect of knowledge on practice (standardized path coefficient = 0.496, 95% CI: 0.482, 0.508) was stronger than that of attitude on practice (standardized path coefficient = 0.267, 95% CI: 0.244, 0.290). The direct effect of knowledge on practice (78.0%) was greater than the indirect effect mediated by attitude (22.0%).

Conclusion  The national pilot program for the collaboration between and integration of medical care and prevention in infectious disease prevention and control has a positive effect on improving the KAP regarding the integration of medical care and prevention among medical professionals. Knowledge of the integration of medical care and prevention is the primary factor influencing practice.