Abstract: Objective To investigate the status of medication safety knowledge, attitudes, and practices (KAP) among residents in Zhongshan and to identify associated influencing factors, thereby providing an evidence base for enhancing regional medication safety standards. Methods Between January and February 2024, a stratified sampling method was employed to survey the medication safety KAP of residents in Zhongshan. Descriptive statistics were used to analyze the current status of medication safety KAP. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors. Results A total of 720 questionnaires were distributed, and 683 valid responses were collected, yielding a response rate of 94.86%. The prevalence of adequate knowledge regarding medication safety was 72.62% (496/683). Areas of strength included high adherence to prescribed medication (96.30%) and a high rate of reading drug information leaflets (89.50%). However, significant deficiencies were observed, including low awareness of medication precautions (58.20%) and insufficient understanding of administration methods for special dosage forms (61.70%). The prevalence of favorable attitudes towards medication safety was 68.37% (467/683). Although there was high approval for the national essential medicine system (91.40%), awareness of its specific policies was merely 49.80%. Consciousness regarding reporting adverse drug reactions and periodically organizing home medicine cabinets was relatively low, at 62.10% and 65.30%, respectively. The prevalence of appropriate medication practices was 65.01% (444/683). The compliance rate for correct drug storage was 52.40%, while the rate of improper disposal of expired medications was 58.90%, and 63.20% of participants did not maintain medication records. The rate of reading drug information leaflets, however, was high at 85.70%. Multivariate logistic regression analysis indicated that adequate medication safety knowledge was negatively associated with increasing age (OR=0.784) but positively associated with higher educational attainment (college or above: OR=2.504), urban residence (vs. rural: OR=1.751), and a history of chronic disease (vs. no history: OR=2.056). Favorable attitudes were more prevalent in females (vs. males: OR=1.536), decreased with age (OR=0.894), increased with higher education levels (OR=1.762), and were higher among urban residents (vs. rural: OR=1.441) and those with medical insurance (OR=2.301) or new rural cooperative medical scheme coverage (OR=2.056) compared to self-paying individuals; industrial and agricultural workers exhibited less favorable attitudes than other occupational groups (OR=0.911). Similarly, appropriate practices were more common in females (vs. males: OR=2.013), decreased with age (OR=0.840), improved with higher education (OR=1.652), and were more prevalent among those living with family (vs. living alone: OR=1.843) and those with medical insurance (OR=2.337) or rural cooperative medical coverage (OR=1.926) compared to self-payers. Conversely, individuals with a history of chronic disease demonstrated poorer practices (OR=0.842). Conclusions Utilizing the KAP framework, this study confirms through survey and multivariate regression analyses that individuals who are elderly, have lower educational attainment, live alone, and suffer from chronic diseases should be the primary focus of interventions. The findings suggest that establishing a closed-loop intervention model that integrates digital guidance with health insurance coordination is imperative for achieving a comprehensive enhancement of medication safety levels among the residents of Zhongshan.

Key words: Medication safety, Rational drug use, Knowledge,attitudes and practices (KAP), Adverse drug reactions, Drug storage, Health education