Development of a Protection Motivation Theory–Based Health Education Program for Patients with Diabetes and Periodontitis

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Abstract

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia, with a prevalence of approximately 11.2% in China that continues to rise. Periodontitis is a microorganism-initiated, multifactorial infectious disease and is regarded as the sixth complication of diabetes. Nearly 90% of individuals with diabetes are affected by periodontitis. The relationship between these two conditions is bidirectional: periodontitis worsens glycemic control, increases insulin resistance, and contributes to the development of diabetic complications, including higher mortality from ischemic heart disease and diabetic nephropathy. Conversely, sustained hyperglycemia, longer disease duration, and inadequate self-management increase the risk of periodontitis. In addition, severe periodontitis and tooth loss impose a substantial social and economic burden. However, oral-health knowledge among diabetic patients remains limited. This study aimed to develop a Protection Motivation Theory (PMT)-based health education program for patients with diabetes and periodontitis. Objective: To develop a PMT-based health education program for patients with diabetes and periodontitis and provide a replicable intervention for clinical practice. Methods: Guided by PMT, this study used evidence synthesis and Delphi expert consultation. Literature retrieval, screening, quality appraisal, evidence extraction, and grading were conducted to develop a draft program, which was then refined through expert consultation on content, delivery, intervention cycle, and expected outcomes. Results: Of 448 records identified, 22 studies were included, yielding 31 best-evidence items. Evidence confirmed the bidirectional relationship between diabetes and periodontitis and the importance of health education in improving glycemic and periodontal outcomes. After two Delphi rounds, the final program included 7 primary and 48 secondary items. Expert participation was 100% in both rounds; the authority coefficient was 0.87; coefficients of variation ranged from 0.10 to 0.25; Kendall’s W values were 0.466 and 0.301 (p < 0.01), indicating good agreement. Conclusion: A structured PMT-based health education program with sound scientific basis and feasibility was developed for patients with diabetes and periodontitis.

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