Knowledge, Attitudes, and Practices to Periodontal Health of the Northeast Chinese Public: Cross-Sectional Study

Abstract

Background: Periodontitis affects approximately 50% of adults in China and is a leading cause of tooth loss in this population. However, there is a notable paucity of research on knowledge, attitudes, and practices (KAP) related to periodontitis among patients in Northeast China.

Objective: This study aimed to investigate the KAP regarding periodontitis among populations in Northeast China, focusing on 5 demographic factors: gender, age, income, education level, and region.

Methods: A cross-sectional survey was conducted by convenience sampling over a period of 1 week. A structured questionnaire was used to collect detailed responses on periodontitis-related KAP. Descriptive statistics (means, SDs, frequencies, and percentages) were used. Normality was assessed by Shapiro-Wilk tests. Nonparametric Kruskal-Wallis and multivariate regression analyses were conducted to examine demographic influences and interactions on periodontal KAP scores. Statistical significance was defined at P<.05.

Results: A total of 619 questionnaires were distributed, resulting in 562 valid responses comprising 242 (43.06%) males and 320 (56.94%) females, with a mean participant age of 41.27 (95% CI 37.4-45.1) years. The overall awareness of periodontal disease was relatively low in Northeast China, with the mean KAP scores being 3.88/8, 5.28/7, and 5.19/11. Age and educational level were both significantly associated with individuals' KAP regarding periodontitis (P<.05), whereas gender showed a significant association with knowledge only (P<.05). Regional and income-related differences were generally significant, with only a variable showing marginal effects (P=.05). Multiple regression analysis indicated that both knowledge and attitude scores tend to increase with age. The increase in knowledge was most pronounced in the age group of 41-50 (Nagelkerke Pseudo Coefficient of Determination (Nagelkerke R2)=1.58, 95% CI 0.83-2.33; P<.01) years. Attitude scores exhibited a more consistent upward trend across all age groups. In contrast, practice scores declined with age. In terms of interactions, young females exhibited significantly higher awareness than males, whereas no significant gender differences were observed among older populations. In addition, higher education levels and economic status were strongly associated with improved awareness. Notably, the presence of gingival bleeding significantly enhanced public awareness of periodontitis, especially knowledge score (Nagelkerke R2 =1.07, 95% CI 0.69-1.44; P<.01).

Conclusions: This study provides a comprehensive understanding of the KAP regarding periodontitis among populations in Northeast China. The findings offer valuable insights for the formulation of targeted policies and underscore the importance of improving periodontal KAP in the region.

Keywords: KAP; Knowledge, Attitudes, and Practices; gingival bleeding; periodontal health awareness; sociodemographic factors.

Figure 1.. Frequency distribution of scores across Knowledge, Attitude, and Practice categories on periodontitis (Northeast China, Dec 31, 2024 – Jan 7, 2025). This line chart illustrates the frequency distribution of scores for Knowledge (orange), Attitude (blue), and Practice (purple) regarding periodontitis prevention and awareness. The x-axis represents the score values while the y-axis indicates frequency, measured as the number of participants who achieved each score. The maximum possible scores vary by category: Knowledge (0‐8), Attitude (0‐7), and Practice (0‐11). Shaded areas represent 95% CIs, reflecting variability in score distributions across the population. Statistical tests (Shapiro-Wilk and D’Agostino-Pearson) showed significant deviations from normality in all 3 domains (P<.01).

Figure 2.. Mean scores of Knowledge, Attitude, and Practice (KAP) on Periodontitis Across Demographic Groups in Northeast China (Dec 31, 2024 – Jan 7, 2025). This figure shows the mean scores of Knowledge (purple line), Attitude (red line), and Practice (blue line) related to periodontitis. Error bars represent SEs of the mean. Statistical significance of differences between groups can be inferred from nonoverlapping error bars.

Figure 3.. Regression coefficients for the Knowledge, Attitude, and Practice scores across various predictor variables (unstandardized estimates). Error bars represent the 95% CIs. **P<.05 and **P<.01.