Diabetes Related Knowledge, Attitudes and Practice – A Survey Among Oral Health Professionals in Victoria, Australia

Figures & data

Table 1 Group Difference of Independent Variable to KAP Variables

Sociodemographic Variable	n	%	Knowledge		Attitude		Practice Behaviour		Barriers
			Mean ± SD	Test Value p value	Mean ± SD	Test value p value	Mean ± SD	Test Value p value	Mean ± SD	Test Value p value
Gender
Female	119	(60.6)	2.6 ±0.23	U = 5064.0	2.8 ±0.27	U = 5189.0	2.4 ±0.43	U = 4672.5	2.1±0.40	U = 4367.5
Male	77	(38.9)	2.5 ±0.28	0.213	2.7 ±0.27	0.01	2.3 ±0.52	0.41	2.1±0.35	0.35
Practice location
Regional	38	(19.2)	2.6 ±0.30	K = 0.2	2.7 ±0.29	K = 2.7	2.3 ±0.50	K = 8.4	2.1±0.31	K = 7.9
Rural	12	(6.1)	2.5 ±0.29	0.97	2.6 ±0.37	0.43	2.57±0.38	0.03	2.3±0.46	0.04
Suburban	102	(51.5)	2.6 ±0.21		2.7 ±0.24		2.3 ±0.49		2.0±0.37
Inner city	42	(21.2)	2.5 ±0.27		2.8 ±0.27		2.6 ±0.36		2.2±0.42
Practice type
Private	145	(73.2)	2.5 ±0.24	K = 1.0	2.7 ±0.28	K = 6.2	2.3 ±0.48	K = 5.7	2.1±0.33	K = 14.0
Public	43	(21.7)	2.6 ±0.29	0.60	2.8 ±0.21	0.04	2.5 ±0.43	0.05	2.2±0.47	0.001
Other, please specify	9	(4.5)	2.6 ±0.32		2.8 ±0.34		2.4 ±0.44		2.6±0.50
Type of OHP
Dental hygienist & therapist	47	(23.7)	2.5 ±0.30	K = 1.3	2.8 ± 0.26	K = 1.3	2.5 ±0.43	K = 1.9	2.3±0.50	K = 25.1
General Dentist	128	(64.6)	2.6 ±0.24	0.52	2.7 ±0.26	0.52	2.4 ±0.47	0.37	2.0±0.31	0.001
Specialist Dentist	21	(10.6)	2.5 ±0.21		2.6 ±0.33		2.3 ±0.56		2.0±0.27
Primary dental qualification
In Australia	159	(80.3)	2.5 ±0.25	U = 2666.5	2.5 ±0.25	U = 2546.0	2.4 ±0.47	U = 2087.0	2.1±0.39	U = 2587.5
Overseas	33	(16.7)	2.5 ±0.27	0.882	2.5 ±0.27	0.872	2.5 ±0.42	0.158	2.1±0.32	0.489
Work experience in years
10 or less	75	(38)	2.5 ±0.26	U = 4173.0	2.8 ±0.24	U = 4353.50	2.3 ±0.47	U = 3634.0	2.3±0.49	U = 5079
Over 10	113	(57)	2.6 ±0.24	0.860	2.7 ±0.28	0.507	2.4 ±0.46	0.300	2.0±0.26	0.001

Abbreviations: U, Mann–Whitney U-test; K, Kruskal Wallis Test.

Table 2 OHP Response to Knowledge Variables

Knowledge Variable	N	Level of Agreement in n (%)
Scale 1		Strongly Disagree/Disagree	Neutral	Agree/Strongly Agree	Mean	SD
DM may go unrecognized by the patient for many years from the actual onset	197	3(1.5)	4(2)	190(196.4)	2.94	0.28
Early identification of “at-risk individuals” can delay or prevent the onset of the disease, with minimal complications	197	3(1.5)	7(3.6)	187(94.9)	2.93	0.30
Treatment of periodontal disease by scaling and root surface debridement may improve glycaemic control in people with DM	194	19(9.6)	35(17.8)	140(71.1)	2.62	0.65
Some ethnic groups such as Aboriginals and Torres Straits Islanders are at increased risk of DM	197	1(0.5)	14(7.1)	182(92.4)	2.91	0.29
Recognizing uncontrolled DM is difficult because patients with DM respond to periodontal therapy similarly to non–diabetics*	196	15(7.7)	34(17.3)	147(75)	2.59	0.83
There is good evidence to support the bi-directional link between periodontal disease and poor glycaemic control(F)	196	5(2.6)	24(12.2)	167(85.2)	2.82	0.44
Patients reporting a glycated haemoglobin level (HBA1c) of less than 5.7% is indicative of good glycaemic control	196	7(3.6)	71(36.2)	118(60.2)	2.56	0.56
Scale 2	N	Risk Factors for Type 2 DM in n (%)
		Strongly Disagree/Disagree	Neutral	Agree/Strongly Agree	Mean	SD
Genetics	197	11(5.6)	18(9.1)	168(85.3)	2.79	0.52
Periodontitis	195	19(9.7)	51(26.2)	125(64.1)	2.54	0.66
Increasing age	194	17(8.8)	23(11.9)	154(79.4)	2.70	0.62
Physical inactivity	197	3(1.5)	5(2.5)	189(95.9)	2.94	0.28
High blood pressure	197	26(13.2)	61(31)	110(55.8)	2.42	0.71
Increased stress	196	18(9.2)	56(28.6)	122(62.2)	2.53	0.65
Smoking	197	30(15.2)	52(26.4)	115(58.4)	2.43	0.74
Alcohol use	196	17(8.7)	52(26.5)	127(64.8)	2.56	0.64
Systemic inflammation	197	4(2)	36(18.3)	157(79.7)	2.77	0.46
Scale 3	N	DM Complication in n (%)
		Low	Moderate	Significant	Mean	SD
Cardiovascular disease	192	7(3.6)	60(31.3)	125(65.1)	2.61	0.55
Foot ulcers	194	16(8.2)	55(28.4)	123(63.4)	2.55	0.64
Blindness	194	13(6.7)	58(29.9)	123(63.4)	2.56	0.61
Kidney failure	193	12(6.2)	69(35.8)	112(58)	2.51	0.61
Tooth mobility	194	18(9.3)	93(47.9)	83(42.8)	2.33	0.64
Stroke	194	30(15.5)	86(44.3)	78(40.2)	2.24	0.70
Osteoporosis	192	98(51)	71(37.0)	23(12)	1.60	0.69

Note: *Reverse coded.

Table 3 OHP Response to Attitudes and Beliefs Variables

Attitude and Beliefs of OHP	N	Level of Agreement in n (%)			Mean	SD
		Strongly Disagree/Disagree	Neutral	Agree/Strongly Agree
OHP knowledge of a patient’s overall health is important for achieving optimal oral health outcomes	196	2(1.0)	6(3.0)	190(96.0)	2.94	0.26
Screening patients for DM risk in the dental setting could offer new opportunities to identify patients with possible undiagnosed DM or pre-DM	196	4(2.0)	19(9.6)	175(88.4)	2.86	0.39
Screening for DM in the dental setting will help patients to understand the link between uncontrolled DM and poor periodontal health	196	5(2.5)	19(9.6)	174(87.9)	2.85	0.42
It is appropriate for OHP to screen patients for DM in the dental setting	196	15(7.6)	44(22.2)	139(70.2)	2.62	0.62
It is important for OHP to perform or conduct chair side screening for T2DM	196	15(7.6)	69(34.8)	114(57.6)	2.5	0.63
Dental Health Professionals feel comfortable providing oral health care to patients with DM	196	9(4.5)	24(12.1)	165(83.3)	2.78	0.50
Patients with undiagnosed type 2 DM/pre-DM may benefit from blood glucose screening in a dental setting	196	13(6.6)	43(21.7)	142(71.7)	2.65	0.60
Periodontal screening and subsequent follow up may facilitate conversation with medical practitioners when patients seek their care	196	3(1.5)	27(13.6)	168(84.8)	2.83	0.41

Table 4 Frequency Table for Practice Behaviour Variable

Practice	N	Level of Agreement in n (%)			Mean	SD
		Never/Rarely	Sometimes	Often/Very Often
I ask detailed follow-up questions to “Yes” answers on the medical history form	196	–	27(13.6)	171(86.4)	2.86	0.34
I thoroughly assess my patients for DM risk factors as this may have important implications for their oral health	196	37(18.7)	71(35.9)	90(45.5)	2.26	0.75
I adjust the frequency of dental visits as needed for patients with DM	196	28(14.1)	65(32.8)	105(53.0)	2.38	0.72
I provide thorough periodontal therapies to my patients (scaling and root surface debridement, etc.)	196	11(5.6)	29(14.6)	158(79.8)	2.74	0.55
I am interested in collaborating more with physicians and nurses to improve the coordination of care for my patients	196	11(5.6)	56(28.3)	131(66.2)	2.60	0.59
My dental staff’s knowledge about DM is up-to-date	196	53(26.8)	90(45.5)	55(27.8)	2.01	0.74
OHP enquiring patients about regimens to control blood glucose	N	Never/Rarely	Sometimes	Often/very often	Mean	SD
Diet control	196	30(15.2)	64(32.3)	104(52.5)	2.37	0.73
Insulin control	196	35(17.7)	60(30.3)	103(52.0)	2.34	0.76
Self-monitoring of glucose levels	196	37(18.7)	70(35.4)	91(46.0)	2.27	0.75
Medication control	196	24(12.1)	60(30.3)	114(57.6)	2.45	0.70
Patients perceived level of glycaemic control	196	50(25.3)	60(30.3)	88(44.4)	2.19	0.81

Table 5 Level of Importance OHP Foresee for Incorporating DM Screening

	N	Level Importance in n (%)			Mean	SD
		Not Important	Not Sure	Important
Patient willingness	179	47 (26.3)	15 (8.4)	117 (65.4)	2.39	0.87
Legal liability	179	52 (29.1)	26 (14.5)	101 (56.4)	2.27	0.88
Cost	178	59 (33.1)	49 (27.5)	70 (39.3)	2.06	0.85
Time	178	56 (31.5)	52 (29.2)	70 (39.3)	2.07	0.84
Insurance coverage	186	80 (43)	27 (14.5)	79 (42.5)	1.99	0.92

Table 6 Level of Importance OHP Foresee Incorporating DM Screening

Variable	B	SE (95% CI)	P value	β	t	p
(Constant)	0.41	0.40 (−0.38–1.21)	0.308	0.00	1.02	0.308
Knowledge	0.33	0.14 (0.06–0.60)	0.018	0.18	2.38	0.018
Attitude	0.42	0.13 (0.17, 0.67)	0.001	0.24	3.28	0.001

Figure 1 Comparison of OHP Knowledge and attitude with other countries.