11 February 2025: Clinical Research
Evaluation of Knowledge, Attitudes, and Practices Toward Thyroid Nodules in 456 Patients with Thyroid Nodules
Hongbo Ge1ACE, Ying Qian1BCE, Binyi Li1ABDG*DOI: 10.12659/MSM.945732
Med Sci Monit 2025; 31:e945732
Abstract
BACKGROUND: Thyroid nodules, common in adults, especially females and older individuals, are mostly asymptomatic. While the nodules are largely benign, distinguishing malignant lesions is crucial. Overdiagnosis and overtreatment pose risks. Knowledge, attitude, and practice (KAP) surveys can identify knowledge gaps and inform targeted education; however, no studies have explored this in Chinese patients with thyroid nodules. This study aimed to investigate the KAP toward thyroid nodules among patients with thyroid nodules.
MATERIAL AND METHODS: This web-based cross-sectional study was conducted among patients with thyroid nodules, using a self-administered questionnaire.
RESULTS: A total of 456 valid questionnaires were included. The mean knowledge, attitude, and practice scores were 7.07±3.19, 26.39±3.98, and 29.16±4.65, respectively. Knowledge (OR=1.111, P=0.002), junior college (OR=1.933, P=0.035), and bachelor’s degree or above (OR=2.193, P=0.015) were associated with proactive practice. Structural equation modeling showed knowledge directly influenced attitude (β=0.244, P<0.001) and practice (β=0.404, P<0.001). Attitude directly influenced practice (β=-0.129, P=0.020). Occupation (β=-0.279, P=0.038), marital status (β=-0.752, P=0.002), thyroid nodule TIRADS classification (β=-0.699, P=0.004), and education (β=0.501, P<0.001) directly influenced knowledge. Average per capita income (β=0.942, P<0.001) and education (β=0.380, P=0.309) directly influenced attitude. Education (β=0.457, P=0.028) directly influenced practice.
CONCLUSIONS: Patients with thyroid nodules have poor knowledge and unfavorable attitudes but proactive practice toward thyroid nodules. Anxiety-reducing techniques should be incorporated during education sessions, and workplace wellness programs should be explored, to promote healthy practices and early detection.
Keywords: Cross-Sectional Studies, Patients
Introduction
A thyroid nodule is a discrete lesion in the thyroid gland that is radiologically distinct from surrounding normal thyroid tissue [1,2]. In 2020, the Chinese Medical Association published the Chinese Thyroid Imaging Reporting & Data System (TI-RADS) based on medical conditions in China [3]. Thyroid nodules are detected in about 60% of adults [4]. They are 4 times more common in female patients than male patients and occur more frequently with increasing age [5,6]. Most thyroid nodules are asymptomatic [2,4]. Palpable nodules are often discovered on physical examinations, and nonpalpable nodules are frequently detected incidentally on imaging studies performed for unrelated reasons [1,2,7]. Symptomatic patients can report symptoms related to hyperthyroidism or hypothyroidism, compressive symptoms, or cosmetic concerns. Thyroid nodules can be caused by benign (about 90%) and malignant (about 10%) lesions [2]. Risk factors for malignancy include a family history of thyroid cancer and a history of radiation therapy. While thyroid nodules can be associated with thyroid dysfunction or local mass effects, the primary clinical concern is to identify and treat lesions that are malignant or at high risk for malignancy [1,7].
Considering that most thyroid nodules are benign, a potential hazard of screening is overdiagnosis and overtreatment. Proper knowledge, attitudes, and practices (KAP) can help patients deal with their nodules and avoid overtreatment. Determining the KAP of patients with thyroid nodules toward thyroid nodules could help physicians manage the cases of such patients. The KAP survey method is a structured approach that provides quantitative and qualitative data about the knowledge gaps, misconceptions, and misunderstandings that hinder the attitudes and practice of a specific set of actions or behaviors in a specific population [8,9]. The role of KAP surveys is to help design targeted and tailored educational interventions. The gaps and barriers identified by the KAP survey indicate the areas that would warrant education or training. The characteristics of the participants can help determine who might benefit the most from the intervention. Community-based studies from Saudi Arabia showed variable KAP levels toward thyroid diseases, but a previous diagnosis of thyroid disease was associated with better knowledge [10,11]. A study in the United States showed that many patients remained unaware of the risk of malignancy after thyroid nodule biopsy [12]. A study from Korea showed significant gaps in knowledge regarding thyroid diseases among women [13]. A meta-analysis showed that despite good awareness, knowledge, and perception of thyroid cancer, risk factors were poor [14]. Even healthcare providers showed knowledge gaps regarding thyroid nodules [15,16]. No studies are available regarding the KAP of Chinese patients with thyroid nodules toward thyroid nodules.
Hence, this study aimed to examine the KAP toward thyroid nodules among patients with thyroid nodules. The results could help design interventions to improve the KAP of the patients and avoid overtreatment.
Material and Methods
STUDY DESIGN AND PARTICIPANTS:
This cross-sectional study was a single-center study that was conducted from November 2022 to May 2023 in Danyang People’s Hospital, the largest county-level hospital and a tertiary class A hospital in Danyang City, Jiangsu Province. This study was approved by the Ethics Committee of Danyang People’s Hospital (approval #2022 No. 226), and informed consent was obtained from all patients before completing the questionnaire.
The patients with thyroid nodules who participated in the study were mainly outpatients with thyroid nodules, patients with thyroid nodules who visited the ultrasound department for examination, patients with thyroid nodules who were hospitalized in the hospital, and patients with thyroid nodules who were family members, relatives, friends, and acquaintances of medical staff. The inclusion criteria were (1) age 16–85 years old and (2) TI-RADS 0–1. The exclusion criteria were (1) answer time less than 120 s or (2) consciousness impairment or cognitive impairment. Disclosing the nature of the nodules is part of routine clinical practice, as well as informed decision-making for thyroid nodule management. Therefore, the information was disclosed to all patients in the course of thyroid nodule management.
QUESTIONNAIRE:
The questionnaire of 4 dimensions was designed by the investigators, based on the relevant literature [1,2,4–7]. The first draft was reviewed by experts to ensure content validity. Duplicated or similar questions were removed, and unclear statements were revised and refined. Prior to formal implementation, a small-scale pilot study (65 participants) was conducted, yielding a Cronbach α of 0.701, indicating acceptable internal consistency. To ensure face validity, the participants of the pilot test were asked to indicate any questions they considered unclear.
The final questionnaire was in Chinese (an unvalidated English translation is shown in Table 1 for informative purposes only) and included (1) the demographic characteristics of participants, including age, sex, residential type, education, and income; (2) the knowledge dimension, comprising 12 questions scored as 1 for correct, 0 for incorrect or unclear answers; (3) attitude dimension, consisting of 10 questions using a 5-point Likert scale, ranging from “very positive” (5 points) to “very negative” (1 point); (4) practice dimension, including 8 questions also using a 5-point Likert scale, ranging from “always” (5 points) to “never” (1 point); and (5) the Depression Anxiety Stress Scale-21 (DASS-21) to evaluate depression, anxiety, and stress [17]. Depression scores of ≤9 were considered normal, scores of 10–13 were mild, 14–20 were moderate, 21–27 were severe, and ≥28 were very severe. Anxiety scores of ≤7 were considered normal, 8–9 were mild, 10–14 were moderate, 15–19 were severe, and ≥20 were very severe. Stress scores of ≤14 were considered normal, while scores of 15–18 were considered mild, 19–25 were moderate, 26–33 were severe, and scores ≥34 were very severe. Higher KAP scores indicated better knowledge, more positive attitudes, and more proactive practices. The results of the confirmatory factor analysis (Figure 1) showed that the comparative fit index was 0.837 (>0.800 is good), the incremental fit index was 0.839 (>0.800 is good), the Tucker-Lewis index was 0.818 (>0.800 is good), and the minimum discrepancy function divided by degrees of freedom was 3.192 (>1; 1–3 is excellent, 3–5 is good), indicating that the questionnaire had good reliability.
An online questionnaire was created using the Wen Juan Xing (WJX) platform (https://www.wjx.cn), and a quick response (QR) code was generated for data collection via WeChat. WeChat was used only to distribute the QR code. Once the participant scanned the QR code and completed the questionnaire, there was no means to associate a specific questionnaire with a specific WeChat account. The eligible patients who visited the hospital during the study period were asked to participate; if they accepted, they were referred to one of the two research assistants who completed the informed consent process and invited them to scan the QR code sent to them via WeChat to log in and complete the questionnaire. One research assistant was a junior medical student, and the other was an ultrasound doctor, both of whom had systematically studied the relevant knowledge of KAP research.
To ensure the quality and completeness of the questionnaire responses, all items were made mandatory, except for “date of diagnosis”. The research team members examined the integrity, internal consistency, and validity of all questionnaires.
All patients were ensured of the confidentiality of their data. The online questionnaire did not ask for any identifying information and was, therefore, completed anonymously. All data about the patients were stored on a secure server of Danyang People’s Hospital and were accessible only to the study team members. Upon study completion and publication, all data will be archived and restricted to the corresponding author only.
SAMPLE SIZE:
Due to the lack of relevant literature, the sample size was calculated based on an anticipated proportion of 50% of patients with thyroid nodules understanding thyroid nodules, with a 95% confidence level and a 5% margin of error [18,19]. As a result, we determined that a sample size of 384 was required.
STATISTICAL ANALYSIS:
Statistical analysis was performed using Stata 17.0 (Stata Corporation, College Station, TX, USA). Continuous variables were tested for normal distribution using the Kolmogorov-Smirnov test and were found to be non-normally distributed. Therefore, the continuous variables are described as median (P25, P75) and were compared using the Wilcoxon-Mann-Whitney U test or the Kruskal-Wallis H test. Categorical variables are presented as n (%). Logistic regression was used to perform univariable and multivariable analyses in knowledge, attitude, and practice scores, with a score of 70% as the cut-off value for dichotomization. Conditional logistic regression was used to perform univariable and multivariable analyses of the DASS-21. Variables with
Results
DEMOGRAPHIC CHARACTERISTICS:
A total of 578 questionnaires were collected, but 23 had extremely short response times (<120 s), 11 had abnormal age values, 1 reported an age younger than the disease onset age, 6 were with all KAP questions answered with the same option, 52 reported TI-RADS 0 lesions, and 29 reported TI-RADS 1 lesions. Therefore, 456 valid questionnaires were included for analysis.
The mean patient age was 49.53 (13.11) years old, with female sex (75.66%), urban residents (59.21%), bachelor’s degree or above (32.02%), administrative and technical professionals (27.85%), income of <5000 yuan/month (59.43%), married (85.96%), with medical insurance (93.86%), and TI-RADS 3 lesions (68.20%). The mean DASS-21 depression, anxiety, and stress scores were 7.07±3.19, 26.39±3.98, and 29.16±4.65, respectively (Table 2).
KNOWLEDGE:
The mean knowledge score was 7.07±3.19 from a maximum of 12 (58.92%). Higher knowledge scores were observed with urban residence (P<0.001), higher education (P<0.001), administrative and technical profession (P<0.001), income of 2000–5000 yuan/month (P<0.001), married status (P=0.019), with medical insurance (P=0.012), and TI-RADS 2 lesion (P<0.001) (Table 2). The knowledge item with the lowest score was K10 (18.64%; “Malignant thyroid nodules [thyroid cancer] must undergo surgery”), while the item with the highest score was K5 (80.92%; “Asymptomatic nodules should be regularly monitored after self-diagnosis”) (Table 1).
ATTITUDE:
The mean attitude score was 26.39±3.98 from a maximum of 50 (52.78%). Higher attitude scores were observed in rural residence (P<0.001), higher education (P<0.001), professional work (P<0.001), and income >10 000 yuan/month (P<0.001) (Table 2). More than half (58.55%) of the participants “strongly agreed” with A1: “I am willing to learn more about thyroid nodules and related information”, but for A8: “Thyroid nodules make me feel emotionally down” and A10: “I believe all thyroid nodules need a thyroid fine-needle aspiration biopsy”, only a small number of participants (both 12.94%) expressed the same attitude. Table 3 presents the distributions of the responses to the attitude items.
PRACTICE:
The mean practice score was 29.16±4.65 from a maximum of 40 (72.90%), indicating good practice. Higher practice scores were observed with higher education (P=0.003) and professionals (P=0.039) (Table 2). Table 3 presents the distributions of the responses to the practice items. During follow-up visits, the examinations that the patients would consider were ultrasound (76.32%), thyroid function test (75.88%), palpation (52.85%), and needle biopsy (22.81%) (Figure 2).
MULTIVARIABLE ANALYSES:
Only a bachelor’s degree or above was independently associated with knowledge (OR=2.238, 95% CI: 1.023–4.895, P=0.044). The knowledge scores (OR=1.183, 95% CI: 1.067–1.313, P=0.001) and high school or technical secondary school (OR=0.271, 95% CI: 0.097–0.757, P=0.013) were independently associated with attitude. Knowledge scores (OR=1.111, 95% CI: 1.040–1.186, P=0.002), junior college (OR=1.933, 95% CI: 1.049–3.564, P=0.035), and bachelor’s degree or above (OR=2.193, 95% CI: 1.164–4.131, P=0.015) were independently associated with practice (Table 4).
Attitude scores (OR=0.882, 95% CI: 0.839–0.929, P<0.001) and practice scores (OR=0.958, 95% CI: 0.919–0.998, P=0.040) were independently associated with DASS-21 stress scores. Knowledge scores (OR=0.921, 95% CI: 0.867–0.979, P=0.008), attitude scores (OR=0.846, 95% CI: 0.805–0.890, P<0.001), practice scores (OR=0.955, 95% CI: 0.919–0.994, P=0.023), age (OR=1.036, 95% CI: 1.017–1.053, P<0.001), general employees (OR=1.902, 95% CI: 1.168–3.099, P=0.010), income <5000 (OR=1.972, 95% CI: 1.089–3.572, P=0.025), and income 2000–5000 (OR=3.127, 95% CI: 1.718–5.692, P<0.001) were independently associated with DASS-21 anxiety scores. Knowledge scores (OR=0.905, 95% CI: 0.828–0.989, P=0.028), attitude scores (OR=0.809, 95% CI: 0.733–0.892, P<0.001), practice scores (OR=0.929, 95% CI: 0.872–0.988, P=0.020), age (OR=1.041, 95% CI: 1.012–1.069, P=0.004), junior high school and below education (OR=0.271, 95% CI: 0.088–0.833, P=0.023), and married (OR=0.425, 95% CI: 0.184–0.983, P=0.046) were independently associated with DASS-21 depression scores (Table 5).
STRUCTURAL EQUATION MODELING:
As shown in SEM (Table 3 and Figure 3), knowledge directly influenced attitude (β=0.244, P<0.001) and practice (β=0.404, P<0.001). Attitude directly influenced practice (β=−0.129, P=0.020). Occupation (β=−0.279, P=0.038), marital status (β=−0.752, P=0.002), thyroid nodule TI-RADS classification (β=−0.699, P=0.004), and education (β=0.501, P<0.001) directly influenced knowledge. Average per capita income (β=0.942, P<0.001) and education (β=0.380, P=0.309) directly influenced attitude. Education (β=0.457, P=0.028) directly influenced practice. Table 6 shows that the model had a good fit.
Discussion
Patients with thyroid nodules had poor knowledge, unfavorable attitudes, and active practice toward thyroid nodules. This study identified KAP items that would warrant educational interventions and patient populations that should be more actively targeted by education. The KAP scores were also negatively associated with DASS-21 stress, anxiety, and depression scores, suggesting that a higher KAP score was associated with fewer negative emotions.
Improper knowledge about thyroid nodules and the modifiable risk factors of thyroid cancer (eg, diet, radiation exposure, and environmental factors) could contribute to the growing incidence of thyroid cancer [20]. In addition, besides controlling the modifiable risk factors, self-management is an important component of managing thyroid nodules since it can involve self-examination, looking for symptoms, and deciding when to consult. Such knowledge is essential to avoid overdiagnosis and overtreatment. Of note, a Korean study showed that most women attending thyroid screening were unaware of the risk of overdiagnosis [21]. The present study showed that knowledge about thyroid nodules was poor among Chinese patients with thyroid nodules. This is supported by studies from Saudi Arabia that reported poor knowledge about thyroid cancer in many of their participants (>90%) [10,11,22]. However, Alhazmi et al [10] also reported that a previous diagnosis of thyroid disease was associated with better knowledge, which could explain the better knowledge scores observed in the present study compared with Saudi participants [10,11,22]. A study from the United States revealed that most patients remained unaware of the thyroid cancer risk factors despite a history of thyroid biopsy [12]. A recent meta-analysis of 10 studies showed that the KAP toward thyroid cancer was poor among the general population and patients with thyroid cancer [14]. Of note, even healthcare providers have knowledge gaps regarding thyroid nodules [15,16]. Since several patients consider healthcare providers a reliable source of health-related knowledge [23], efforts should be taken to rectify the knowledge of healthcare providers about thyroid lesions. However, a study in China suggested that the knowledge of medical students about thyroid cancer was appropriate [24]. Future studies could examine the KAP of healthcare providers in relation to the patients’ KAP.
According to the KAP theory, knowledge is the basis for attitude and practice, and attitude is the force driving practice [8,9]. Hence, improving knowledge should also improve attitudes and practice. Of note, in the present study, knowledge was poor, attitudes were unfavorable, but the practice was active, and the attitude and practice scores were not correlated or associated. It could suggest that the patients tended to follow the physicians’ advice without understanding them or irrespective of their motivation.
The multivariable and SEM analyses suggested that education and income were associated with better KAP scores. It is supported by the fact that higher socioeconomic status is generally associated with higher healthcare literacy [25].
Screening and diagnostic procedures for possible cancer are associated with stress, anxiety, and depression [26,27]. In the present study, higher DASS-21 anxiety scores were also associated with lower attitude scores. Of note, the mean DASS-21 anxiety score in the present study was ≥20, which represents extremely severe anxiety [28], while the mean DASS-21 depression score was in the normal range, and the mean DASS-21 stress score was in the severe range [28]. Hence, the extremely severe anxiety could have affected the patients’ attitudes and clouded the relationship usually seen between attitude and practice. On the other hand, the KAP scores were inversely associated with the DASS-21 scores for all 3 negative emotions. Hence, a better understanding, more positive attitude, and more proactive practice toward thyroid nodules was conducive to lower negative emotions, which was shown in other diseases, such as COVID-19 [29]. Future studies should investigate that point, but the results strongly support the fact that a better KAP score toward thyroid nodules could be associated with better quality of life and coping.
Comparisons with previous similar studies show that the present findings align with some existing research, further supporting the validity of our results. However, discrepancies with certain studies warrant further investigation to identify potential reasons for the differences observed.
This study had limitations. It was performed at a single center, resulting in a relatively small sample size when considering the high prevalence of thyroid nodules in the population. In addition, the patients were from a single geographical area, limiting generalizability. The questionnaire was designed by the authors based on their experience, local practice, local policies, and guidelines, which also limited generalizability and exportability. The study was cross-sectional, preventing causality determination. However, a SEM analysis was performed, although the causality results of such analyses must be taken with caution, because they were inferred statistically. In addition, the results represent a single point in time, but they could serve as a historical baseline to evaluate the impact of future educational interventions. The imaging diagnosis was clear and complete for all patients, and the physicians were aware of the TI-RADS results; however, a biopsy was not indicated for all patients and had not necessarily been performed or analyzed when the patients participated in the study. Because different patients have different demographic information, many patients still have limited knowledge of their diagnostic results. Many patients were in the process of investigating the thyroid lesion, and many had limited health literacy. The study was a survey based on the patients’ responses. The protocol and the ethical approval did not allow us to consult the patient charts to extract data to determine the exact nature of the lesion (eg, primary, secondary, metastatic, benign, malignant). All KAP studies are at risk of the social desirability bias, in which the participants are tempted to answer what they know they should think or do instead of what they really think or do [30,31].
Conclusions
Patients with thyroid nodules have poor knowledge, unfavorable attitudes, and active practice toward thyroid nodules. A higher KAP score was associated with fewer negative emotions. It is recommended that tailored education using simple language and visuals be provided to improve patient understanding and management of thyroid nodules. We recommend integrating anxiety-reducing techniques during education sessions and introducing workplace wellness programs, to promote healthy practices and early detection.
Availability of Data and Materials
All data generated or analyzed during this study are included in this published article.
Figures



Tables
Table 1. Items for measuring the knowledge, attitude, and practice (KAP) of the patients.





References
1. Haugen BR, Alexander EK, Bible KC, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer: Thyroid, 2016; 26; 1-133
2. Durante C, Grani G, Lamartina L, The diagnosis and management of thyroid nodules: A review: JAMA, 2018; 319(9); 914-24 [Erratum in: JAMA. 2018;319(15):1622]
3. Dong W, Wu Y, Cai T, Wang X, Comparison of diagnostic performance and FNA management of the ACR-TIRADS and Chinese-TIRADS based on surgical histological evidence: Quant Imaging Med Surg, 2023; 13(3); 1711-22
4. Grani G, Sponziello M, Pecce V, Contemporary thyroid nodule evaluation and management: J Clin Endocrinol Metab, 2020; 105(9); 2869-83
5. Fisher SB, Perrier ND, The incidental thyroid nodule: Cancer J Clin, 2018; 68; 97-105
6. Ospina NS, Papaleontiou M, Thyroid nodule evaluation and management in older adults: A review of practical considerations for clinical endocrinologists: Endocr Pract, 2021; 27; 261-68
7. Gharib H, Papini E, Garber JR, American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules – 2016 update: Endocr Pract, 2016; 22; 622-39
8. Andrade C, Menon V, Ameen S, Kumar Praharaj S, Designing and conducting knowledge, attitude, and practice surveys in psychiatry: Practical guidance: Indian J Psychol Med, 2020; 42(5); 478-81
9. World Health Organization: Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys Available from: http://whqlibdoc.who.int/publications/2008/9789241596176_eng.pdf
10. Alhazmi RA, Alobaid AM, Althunayyan SM, A cross-sectional assessment of knowledge, awareness of risk factors, and perceptions of thyroid disease (TD) among adults living in Saudi Arabia – a community based study: Front Public Health, 2022; 10; 1041745
11. Alyahya A, AlNaim A, AlBahr AW, Knowledge of thyroid disease manifestations and risk factors among residents of the Eastern Province, Saudi Arabia: Cureus, 2021; 13(1); e13035
12. Singh Ospina N, Castaneda-Guarderas A, Ward R, Patients’ knowledge about the outcomes of thyroid biopsy: A patient survey: Endocrine, 2018; 61(3); 482-88
13. Lee B, Park JY, Shin HY, What do Korean women know and want to know about thyroid cancer? A qualitative study: Asian Pac J Cancer Prev, 2016; 17(6); 2901-7
14. Li Y, Wang L, Ni J, Gu J, Knowledge, awareness and perception towards thyroid cancer in general population: A systematic review: Iran J Public Health, 2023; 52(2); 219-29
15. Isik A, Firat D, Yilmaz I, A survey of current approaches to thyroid nodules and thyroid operations: Int J Surg, 2018; 54; 100-4
16. Alfonso E, Sanabria A, Castillo M, Surgeons overestimate the risk of malignancy in thyroid nodules, evaluation of subjective estimates using a bayesian analysis: Biomedica, 2011; 31; 590-98
17. Osman A, Wong JL, Bagge CL, The Depression Anxiety Stress Scales-21 (DASS-21): Further examination of dimensions, scale reliability, and correlates: J Clin Psychol, 2012; 68(12); 1322-38
18. Serdar CC, Cihan M, Yücel D, Serdar MA, Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies: Biochem Med (Zagreb), 2021; 31(1); 010502
19. Thirunavukkarasu A, Al-Hazmi AH, Dar UF, Knowledge, attitude and practice towards bio-medical waste management among healthcare workers: A northern Saudi study: PeerJ, 2022; 10; e13773
20. Iqbal A, Azhar S, Ibrahim NA, Thyroid cancer risk factors and Pakistani University students’ awareness towards its preventive practice: J Oncol Pharm Pract, 2021; 27(3); 570-78
21. Park SH, Lee B, Lee S, A qualitative study of women’s views on overdiagnosis and screening for thyroid cancer in Korea: BMC Cancer, 2015; 15; 858
22. Alibrahim IS, Alnafei KH, Atwah RH, Thyroid cancer knowledge and awareness among women in Makkah Region, Saudi Arabia: Cureus, 2023; 15(4); e37739
23. Alduraywish SA, Altamimi LA, Aldhuwayhi RA, Sources of health information and their impacts on medical knowledge perception among the Saudi Arabian population: Cross-sectional study: J Med Internet Res, 2020; 22(3); e14414
24. Liu P, Lin J, Nie Y, Awareness of thyroid cancer among medical students: A questionnaire-based study: Sci Prog, 2021; 104(2); 368504211023654
25. Svendsen MT, Bak CK, Sørensen K, Associations of health literacy with socioeconomic position, health risk behavior, and health status: A large national population-based survey among Danish adults: BMC Public Health, 2020; 20(1); 565
26. Wadsworth LP, Wessman I, Björnsson AS, The half-painted picture: Reviewing the mental health impacts of cancer screening: Medicine (Baltimore), 2022; 101(38); e30479
27. Chad-Friedman E, Coleman S, Traeger LN, Psychological distress associated with cancer screening: A systematic review: Cancer, 2017; 123(20); 3882-94
28. Lovibond SH, Lovibond PF: Manual for the Depression Anxiety & Stress Scales, 1995, Sydney, Psychology Foundation
29. Jia JY, Qi Y, Bai L, Knowledge-attitude-practice and psychological status of college students during the early stage of COVID-19 outbreak in China: A cross-sectional study: BMJ Open, 2021; 11(2); e045034
30. Bergen N, Labonté R, “Everything is perfect, and we have no problems”: Detecting and limiting social desirability bias in qualitative research: Qual Health Res”, 2020; 30(5); 783-92
31. Latkin CA, Edwards C, Davey-Rothwell MA, Tobin KE, The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland: Addict Behav, 2017; 73; 133-36
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