Graduation Date

Spring 5-7-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Paraskevi A. Farazi

MeSH Headings

Nonalcoholic fatty liver disease, questionnaire development, survey, randomized controlled trial, intervention, health education


The prevalence of nonalcoholic fatty liver disease (NAFLD) among Chinese young adults (CYA) aged 18-25 years ranges from 4.7% to 15.1% and has kept increasing in recent years. Previous studies reported limited awareness and knowledge of NALFD among middle-aged and older Chinese populations, however, they have not investigated awareness in CYA, for which there is no well-validated questionnaire. There is currently no efficacious educational intervention on NAFLD for CYA.

The objectives were 1) to develop and validate a questionnaire which can be used to assess the awareness and knowledge of NAFLD among CYA; 2) to assess the awareness and knowledge of NAFLD, and to identify the factors associated with the awareness and knowledge of NAFLD among CYA; 3) to compare the impact of two formats (pamphlet, video presentation) of NAFLD educational interventions with no intervention control on the improvement of awareness and knowledge of NAFLD among CYA immediately following the intervention and 30 days post-intervention.

Validation of the questionnaire showed good content validity and clarity indexes. The face validity and construct validity were established. The test-retest reliability (Pearson’s r) was 0.62. The internal consistency (KR20) was 0.92. Among 1,373 participants, 26.2% reported they had heard of NAFLD, 11.1% received ≥ 20 points in the knowledge section of NAFLD. Factors associated with having awareness and knowledge (≥ 20 points) of NAFLD included medical background, high medical knowledge level, and family history of NAFLD. The pamphlet and video interventions showed improvement of awareness of NAFLD immediately post-intervention (pamphlet, +46.0%; video, +44.3%; control, +18.7%) and knowledge score of NAFLD immediately post-intervention (pamphlet, +64.2%; video, +68.9%; control, -1.0%) and at 1-month post-intervention (pamphlet, +36.7%; video, +50.0%; control, +15.1%).

The study has potential to increase awareness and knowledge of NAFLD among CYA, encourage them to adopt a healthy lifestyle, and reduce the NAFLD morbidity and mortality among them in the future. The early-stage disease prevention strategies will positively impact prevention efforts to NAFLD and reduce the NAFLD and NAFLD-related disease burden substantially. This novel approach of implementing educational interventions through the WeChat app could be applied to a broader spectrum of lifestyle-related chronic diseases.

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