Culturally appropriate oral health messages are found to be an effective tool to improve oral health among rural, low-income families. Yet knowledge on how to best achieve such messages is lacking. Based on participatory, learner-based approach, this study examined various oral health messages (varied length, detail, and voice) among 75 rural, low-income mothers in nine states in the theoretical framework of cultural appropriateness model. Specifically, we compared the process of our message creation to the differential effects of linguistic, peripheral, evidential, and sociocultural approaches. Results of qualitative analysis showed that low-income mothers, who represent a “rural culture,” prefer messages that (a) have a clear and concise connection between recommendations presented in the message and future economic consequences of inaction, with sufficient explanation; (b) mention problem-specific economic struggles and inaccessibility of resources; (c) include the sources of fluoride, community barriers, availability of professional resources, and the quality of local water; and (d) contain the voice of a dental authority over the voice of other mothers. The applicability of cultural appropriateness framework and policy implications are discussed.
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