JMIR Publications

ABSTRACT

Background:

House dust mite (HDM) sensitization commonly begins in early life and contributes to persistent allergic airway inflammation and asthma chronicity. Primary prevention via early-life environmental control is a key pathway to reduce HDM sensitization and asthma risk.

Objective:

To characterize child caregivers’ knowledge, attitudes, and practices (KAP) regarding pediatric HDM control using a hybrid literature/expert-driven and social media-driven approach, and examine associations between KAP levels, child age and caregiver social media activity.

Methods:

This cross-sectional study comprised two interconnected components: (1) mining of content published between August 2023 and July 2025 from five major Chinese social media platforms, analyzed via Latent Dirichlet Allocation (LDA); and (2) a social media-enhanced web-based KAP survey administered in November 2025 to child caregivers in Chongqing, a warm-humid region where HDMs dominate indoor allergens, with participants recruited via local child health facilities. In total, 132,341 social media documents and 2,275 caregivers of children <18 years were included in the analysis. The main outcomes included social media discourse patterns and domain-specific KAP levels across five dimensions: foundational knowledge (K1), recommended control knowledge (K2), attitude toward social media topics (A1), attitude toward recommended methods (A2), and control practices (P). Stratified analysis was conducted by two exposure variables: child age (≤3 years vs >3 years) and caregiver social media activity (active vs. inactive).

Results:

LDA topic modeling identified five distinct topic clusters in the social media content. Commercial, emotional, and misleading content collectively dominated the information landscape, accounting for 83.3% of included documents, with commercial content often systematically conflating the concepts of “disinfection” and “mite elimination”. Only 16.7% was classified as health educational content focusing on HDM allergy prevention. The average KAP levels of K1, K2, A1, A2, and P domains were 62.9%, 84.7%, 57.0%, 37.8%, and 25.8%, respectively. Social media emerged as the primary knowledge source (80.7%), with methodological knowledge gaps (47.5%) being the top implementation barrier. Caregivers of children ≤3 years had significantly lower self-rated knowledge (23.5% vs. 28.3%, P=.01), stronger endorsement of recommended methods, but also greater information overload (OR 1.39, 95% CI 1.15-1.67, P<.001) and decision difficulties (OR 1.23, 95% CI 1.01-1.52, P<.001). Socially active caregivers showed better performance across multiple items in five domains, but also increased non-recommended practices (ultraviolet irradiation: OR 1.85, 95% CI 1.35-2.53, P<.001) and misconception acceptance (allergy impact exaggeration: OR 1.39, 95% CI 1.04-1.87, P=.03).

Conclusions:

Complex and suboptimal KAP levels exist, particularly among caregivers of young children (≤3 years). Social media activity associates with both enhanced implementation of control practices and elevated misconception endorsement. These findings reveal critical educational gaps and the necessity of social media intervention. Clinical Trial: Not applicable.