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Understanding and predicting flossing behavior in a rural Appalachian community using the multi-theory model
Rahib K Islam1, Manoj Sharma2,3, Amanda H Wilkerson4
1LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA, USA.
Scientific Reports
|August 21, 2025
Summary
Improving flossing adherence in rural Appalachia requires interventions targeting behavioral confidence for initiation and emotional transformation for sustenance. These strategies, guided by the Multi-Theory Model, can address oral health disparities.
Area of Science:
- Public Health
- Behavioral Science
- Oral Health
Background:
- Effective flossing is crucial for preventing periodontal disease.
- Low adherence to flossing in rural Appalachia exacerbates oral health disparities.
- The Multi-Theory Model (MTM) offers a framework to understand health behavior change.
Purpose of the Study:
- To conceptualize the intention of initiation and sustenance of flossing behaviors using the MTM.
- To identify predictors of flossing behavior in a rural Appalachian population.
Main Methods:
- A cross-sectional survey was conducted with 228 participants in rural Appalachia.
- The MTM constructs were measured.
- Multiple linear regression models were used for data analysis.
Main Results:
- Behavioral confidence predicted flossing initiation intention in non-daily flossers.
- Emotional transformation predicted flossing sustenance in non-daily flossers.
- For daily flossers, physical environment changes predicted initiation intention, while emotional transformation and practice for change predicted sustenance.
Conclusions:
- The MTM effectively predicts flossing behaviors in rural Appalachian populations.
- Interventions should focus on enhancing behavioral confidence, physical environment, emotional transformation, and practice for change to improve flossing adherence.
- Further research is needed to develop targeted public health strategies.
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