---
title: "Nurses’ views on a 15‑minute audiovisual aid for oral health education in diabetes care"
id: "plos-one-2-nurses-perceptions-of-an-audiovisual-material-to-support-patient-education-on"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-2-nurses-perceptions-of-an-audiovisual-material-to-support-patient-education-on"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280"
published_at: "2026-10-21T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nurses’ views on a 15‑minute audiovisual aid for oral health education in diabetes care
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-2-nurses-perceptions-of-an-audiovisual-material-to-support-patient-education-on
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280)
- **Published At:** 2026-10-21T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The study evaluated an approximately 15‑minute **audiovisual material** developed to support nurses’ patient education on **oral health management** in outpatient **diabetes** settings. - Eight certified diabetes nurse educators (CDNEs) from institutions where both diabetologists and CDNEs provided care participated in semi‑structured Zoom interviews 2–3 months after using the material. - The audiovisual content included animations, oral cavity photos, narration, a true/false quiz, key assessment points, a nurse–patient teaching vignette, and a closing message promoting medical–dental collaboration. - Qualitative content analysis produced four themes: enhanced individual learning (all 8 participants), professional reflection and development (5/8), new patient‑care insights—especially on motivation strategies (7/8), and practical implementation considerations in outpatient diabetes clinics. - The researchers defined “effect” as perceived changes in nurses’ knowledge, attitudes, and practices rather than direct patient outcomes; the source did not report any patient outcome data. - Recruitment used purposive sampling from 122 eligible institutions; 114 institutions did not provide written consent, leaving 8 nurse participants; the source supplies no additional demographic breakdown. - The study described the three‑phase development process: content determination with clinicians and dental professionals, scripted design with expert feedback, and staged video production with a professional company. - The source reported that participants found the material useful as a complement to an existing evidence‑based nursing guide, but it also identified implementation barriers and the need for settings‑specific adaptation and interprofessional collaboration. - Data confidentiality restrictions prevent public sharing of interview transcripts; access requests are managed by the University of Tsukuba ethics committee per the article’s note. - Funding came from the Japan Association for Diabetes Education and Care and JSPS KAKENHI; the authors declared no competing interests.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0361280) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#citedHeader) * 39 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280#discussedHeader) Open Access Peer-reviewed Research Article # Nurses’ perceptions of an audiovisual material to support patient education on oral health management in diabetes care * Rie Kudoh , Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review & editing * E-mail: riekudou.t@gmail.com Affiliation Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-5692-0701 ](https://orcid.org/0000-0001-5692-0701 "ORCID Registry") ⨯ * Taiga Shibayama Roles Conceptualization, Formal analysis, Supervision, Writing – review & editing Affiliation Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan ⨯ # Nurses’ perceptions of an audiovisual material to support patient education on oral health management in diabetes care * Rie Kudoh, * Taiga Shibayama ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: October 21, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0361280) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0361280) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0361280) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0361280) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#sec001) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#sec002) * [Results and discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#sec013) * [Conclusions](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#sec025) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#sec026) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0361280) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280) ## Abstract Educational support for nurses is essential to promote oral health management education for patients with diabetes. However, few studies have focused on supporting nurses in this context. This study explored the effects of an audiovisual material designed to support nurses’ patient education on oral health management in diabetes care. Semi-structured interviews were conducted with eight certified diabetes nurse educators. Data were analyzed using content analysis. Four main themes emerged: (1) enhancement of nurses’ individual learning (8/8 participants), including improved knowledge of the connection between oral health and diabetes; (2) promotion of professional development and reflection (5/8); (3) provision of new insights into patient care (7/8), particularly regarding patient motivation strategies; and (4) identification of implementation considerations in diabetes outpatient settings. The findings suggest that the audiovisual material, designed to complement an existing evidence-based educational guide, was perceived as useful and may support nurses’ learning and educational practices related to oral health education for patients with diabetes. ## Figures ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t002) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t002) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.t002) **Citation:** Kudoh R, Shibayama T (2026) Nurses’ perceptions of an audiovisual material to support patient education on oral health management in diabetes care. PLoS One 21(10): e0361280. https://doi.org/10.1371/journal.pone.0361280 **Editor:** Yolanda Malele-Kolisa, University of the Witwatersrand Johannesburg Faculty of Health Sciences, SOUTH AFRICA **Received:** June 18, 2026; **Accepted:** October 8, 2026; **Published:** October 21, 2026 **Copyright:** © 2026 Kudoh, Shibayama. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The data underlying this study contain potentially identifying and sensitive information from interview participants and cannot be made publicly available due to ethical restrictions imposed by the Institutional Review Board of the University of Tsukuba. Data access requests can be directed to the Medical Ethics Committee, University of Tsukuba (email: sien.ningenss@un.tsukuba.ac.jp), which oversees data access approval independently of the study authors. Requests should reference the approved study protocol titled “Examination of the Usefulness of Audiovisual Teaching Materials to Support Nurses’ Learning of Care Guidance Related to Oral Care in Diabetes Treatment” (approval number: No. 2039). **Funding:** This work was supported by the Japan Association for Diabetes Education and Care ( ), grant number 2022-FND-002, awarded to RK; and the Japan Society for the Promotion of Science ( ) under JSPS KAKENHI, grant numbers 22K17452 and 26K20650, awarded to RK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Periodontal diseases are chronic inflammatory conditions caused by microbial dysbiosis and an impaired host response, affecting the periodontium [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref001)]. This host response can be influenced by systemic conditions. In particular, poorly controlled diabetes markedly increases the risk, severity, and progression of periodontitis through mechanisms involving oral microbial dysbiosis, chronic inflammation, immune dysregulation, and altered bone metabolism [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref002)]. Disease progression can lead to destruction of the periodontium and tooth loss [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref003)]. In 2021, severe periodontal disease affected over 1 billion people globally, and edentulism affected approximately 353 million, and these numbers are expected to continue increasing [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref004)]. Given the rapidly aging population in Japan, this global trend is particularly relevant in the Japanese context. A recent report found that 40.0% of people aged 45–54 had at least one missing tooth, with the rate rising to 93.5% among those aged 75 and older [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref005)], indicating that tooth loss is highly prevalent among middle-aged and older adults in Japan. Evidence of an interrelationship between diabetes and periodontal disease has been reported in many reviews and epidemiological studies [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref006),[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref007)]. Diabetes mellitus represents a risk factor for developing and worsening periodontal disease, with the risk of progression increasing approximately threefold in diabetic patients compared with non-diabetic patients [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref008)]. The 2017 classification of periodontal and peri-implant diseases and conditions recognizes diabetes, particularly when poorly controlled, as a risk factor for the progression of periodontitis [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref009)]. Periodontal disease can cause tooth loss, impaired mastication, nutritional deficiencies, and reduced quality of life [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref010)]. It can also lead to poor glycemic control and may affect the onset and progression of diabetes complications, such as retinopathy, neuropathy, nephropathy, or cardiovascular disease [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref011)]. Therefore, early detection of periodontal disease from both dental and medical perspectives is essential for effective management and prevention. Effective oral health management in diabetes care has been shown to contribute to improved glycemic control and reduced risk of complications, ultimately enhancing patients’ overall health outcomes and quality of life [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref011)]. Previous studies have shown that many patients with diabetes have insufficient awareness and knowledge of oral health management and rarely consult dental professionals unless symptoms such as gingival bleeding, gingival swelling, pain, or tooth mobility appear [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref012)]. This highlights the need for systematic oral health education as part of diabetes self-management. Certified diabetes nurse educators (CDNEs), who are nurses with advanced and broad expertise in providing self-management education to outpatients with diabetes, can play a vital role in the oral health management of outpatients with diabetes [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref013)]. Given the inadequate oral care practices among diabetic patients and the strong bidirectional relationship between diabetes and periodontal disease [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref006)–[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref008),[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref010),[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref011)], there is a critical need for CDNEs to provide comprehensive oral health education as an integral component of diabetes self-management education. CDNEs are uniquely positioned to reach patients during regular diabetes care visits, providing opportunities for repeated reinforcement of oral health messages and bridging the gap between medical and dental care [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref013)]. Previous research has indicated that CDNEs face several barriers to providing oral health education, including limited training opportunities, uncertainty about appropriate teaching content, and a lack of interprofessional collaboration with dental professionals [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref012)]. These barriers are multifaceted: many CDNEs report that oral health is not adequately covered in their professional training programs, leaving them uncertain about which oral assessment techniques are appropriate for their scope of practice and how to effectively communicate oral health information to patients [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref012)]. The absence of standardized protocols and clear guidance on interprofessional collaboration further compounds these challenges, resulting in inconsistent delivery of oral health education across diabetes care settings [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref012),[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014)]. As a result, nurses may feel unprepared or lack confidence in delivering oral health education effectively. To address this gap, the authors previously developed a nursing guide for oral health management as a self-learning tool that can be used in diabetes outpatient clinics [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014)]. The guide was evaluated positively, helping to increase nurses’ knowledge and confidence in oral assessment and promoting oral health management in patients with type 2 diabetes [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref015)]. While the nursing guide has proven effective in enhancing nurses’ knowledge and confidence [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref015)], feedback from users indicated that written materials alone have limitations in conveying practical skills and techniques. Specifically, nurses expressed the need for visual demonstrations of oral assessment procedures, patient communication strategies, and step-by-step guidance for conducting oral health education sessions in clinical practice [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref015)]. These findings indicated a need for supplementary video-based audiovisual materials, in addition to the existing guide, to support visual learning for practical implementation in clinical settings. Audiovisual materials can provide dynamic demonstrations that are difficult to convey through text and static images alone, allowing learners to observe realistic patient interactions and assessment techniques. Such materials also accommodate diverse learning styles and can be accessed repeatedly for skill reinforcement [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref015)]. Therefore, the authors developed an audiovisual material to complement the existing nursing guide [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014)] and to support nurses in delivering patient education on oral health management in diabetes care. Despite the recognized importance of nurses’ role in oral health education for diabetes care, there is limited research examining effective educational interventions to enhance nurses’ capacity in this area. While previous studies have identified barriers faced by nurses [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref012)], few have evaluated educational programs designed to address these barriers or explored nurses’ learning experiences with such interventions [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref014),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone.0361280.ref015)]. Furthermore, the potential of audiovisual educational materials in supporting nurses’ learning about oral health management in diabetes care remains largely unexplored. This study aimed to explore the effects of audiovisual material, developed to support nurses’ learning about oral health management in diabetes care, on nurses’ patient education practices. ## Materials and methods ### Study design This study adopted a qualitative design to explore nurses’ subjective learning experiences, perceptions, and reflections after using the audiovisual material. This approach was appropriate for capturing in-depth insights into how the material influenced nurses’ understanding and practice regarding oral health management in diabetes care. In this study, the term “effect” was operationally defined as perceived changes in nurses’ knowledge, attitudes, and practices related to oral health management, rather than direct patient outcomes. These changes in nurses are expected to ultimately contribute to improved patient care. The study flowchart is presented in [Fig 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0361280#pone-0361280-g001). [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0361280.g001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0361280.g001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=
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