Knowledge, attitudes, and practices related to the association between periodontitis and hypertension: a cross-sectional structural equation modeling study

Abstract This study aimed to assess the knowledge, attitudes, and practices regarding the association between periodontal disease and hypertension among patients with periodontitis. This study included patients treated at Jinan Stomatological Hospital between July and December 2025. A researcher-developed questionnaire collected demographic data and KAP dimensions. Internal consistency was assessed using Cronbach’s alpha for each domain.Confirmatory factor analysis (CFA) was conducted to evaluate the measurement model prior to structural equation modeling (SEM), which was used to examine the associations among the KAP dimensions. The study was approved by the Ethics Committee of Jinan Stomatological Hospital (JNSKQYY-2025-013). Among the 2,937 participants (mean age 43.24 years; 54.85% female), the scores for knowledge, attitude, and practice were 7.20 plus or minus 4.56 (range 0 to 20), 25.79 plus or minus 2.91 (range 6 to 30), and 27.88 plus or minus 6.50 (range 8 to 40), respectively. Knowledge was negatively correlated with attitude( r = − 0.705) and practice ( r = − 0.765), whereas attitude was positively correlated with practice ( r = 0.818; all P < 0.001). SEM indicated that knowledge showed direct negative associations with attitude (beta = − 0.794) and practice (beta = − 0.295), alongside a negative indirect effect on practice via attitude (beta = − 0.555). Conversely, attitude showed a strong positive direct effect on practice (beta = 0.699; all P < 0.05). Patients with periodontal disease exhibited insufficient knowledge and suboptimal practices despite maintaining positive attitudes, highlighting a significant gap between awareness and behavior.