Oral health problems are a global concern particularly among underprivileged groups. This study aimed to use TTM model to assess the flossing behaviour and its determinants among students in a suburb area and compare the flossing behaviour between boys and girls using TTM.


Cluster sampling was employed to recruit 653 high school students from eight schools in Tehran suburban area, Iran. Two self-administrated questionnaires: (i) stage of change questionnaire and (ii) TTM constructs questionnaire including demographic features, decisional balance (perceived benefits and barriers), self-efficacy and process of change were used to assess the flossing behaviour and its psychological determinants. The statistical analysis of the data included Kruskal–Wallis test, t-test, anova, Spearman correlation and binary logistic regression using SPSS ver15 software.


In this study, 301 (46.1%) and 352 (53.9%) of participants were women and men, respectively. Nearly half of the students (51.4%) were in precontemplation stage with the rest distributed among the other stages of flossing behaviour change. There was no statistically significant difference between genders regarding the stages of change (P < 0.05). Flossing behaviour is related to TTM constructs such as self-efficacy, perceived benefits, low perceived barriers and process of changes.


According to the results of this study, TTM is useful in determining the stages of interdental cleaning behaviour among students. However, further interventional researches are suggested to support the potential for eventual use of the TTM as a framework for understanding the determinants of interdental cleaning behaviour.

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