title: Application of the theory of planned behavior to nurse practitioners' understanding of the periodontal disease-systemic link.
abstract: BACKGROUND
  Mounting evidence supports a connection between periodontal disease and coronary heart disease, ischemic stroke, and diabetes. This theoretically grounded study examines the knowledge, attitudes, and screening and referral behaviors of primary care nurse practitioners (NPs) in relation to the periodontal disease-systemic link.
  
  
  METHODS
  A questionnaire based on the theory of planned behavior was administered to 200 primary medical care providers, mostly NPs, to determine their practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link. A total of 137 partially and fully complete questionnaires were used for data analyses. Data were analyzed for the reported frequency of screening for periodontal disease and the knowledge of the relationship between periodontal and systemic disease. Oblimin rotation was used to explore the underlying factor structure of 10 practice-behavior items. Bivariate analyses were conducted to determine which factor subscales and demographic characteristics were significantly associated with screening and referral behaviors.
  
  
  RESULTS
  Twenty-two percent of the respondents reported that they always or routinely screened patients for periodontal disease. When providers felt good about their training and continuing education (attitude), they were significantly more likely to screen patients for periodontal disease. If providers believed it was within their scope of practice (social norm) to screen for periodontal disease, and they had control over the establishment of office protocols (control), the likelihood of screening for periodontal disease increased.
  
  
  CONCLUSIONS
  Professional and social norms, the perceived control over one's practice site, and reimbursement were significantly related to NPs engaging in periodontal screening and the subsequent referral for care. These results support the importance of interprofessional and collaborative education between medicine/nursing and dentistry.
authors.affiliation: Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
authors.forename: Audra S
authors.initials: AS
authors.lastname: Ward
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cobb
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Kelly
authors.forename: Mary P
authors.initials: MP
authors.lastname: Walker
authors.forename: Karen B
authors.initials: KB
authors.lastname: Williams
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004194:Disease; D004506:Education, Nursing; D004509:Education, Nursing, Continuing; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009042:Motivation; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology; D010510:Periodontal Diseases / Q000150:complications*; D057184:Practice Patterns, Nurses'; D011364:Professional Practice; D011365:Professional Practice Location; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms; D012649:Self Concept; D011795:Surveys and Questionnaires