Abstract Background Despite National Oral Health Programme launched in India significant knowledge-practice gaps persist in rural populations. This study evaluates oral health literacy, behavioural determinants, and clinical outcomes among rural Odisha residents using contemporary health behaviour frameworks. However, evidence on behavioural pathways and public dental service utilisation under NOHP in rural populations remains limited. Methods A community based cross-sectional study was conducted among 417 adults (≥ 18 years) through two-stage stratified random sampling in Satyabadi Block, Puri District (May-September 2024). Data was collected using a validated 20-item questionnaire assessing knowledge, attitudes and practices (KAP) regarding National Oral Health Programme (NOHP) and WHO 2013 for oral health examination. Statistical analyses included descriptive statistics, regression models, and structural equation modelling (SEM) to examine complex pathways linking knowledge, attitudes, practices, and clinical outcomes. Results Oral health program knowledge was low (6.7%), while attitudes were favourable (75.5–84.7%). Despite this, service utilisation remained minimal (2.4%). Mean DMFT was 3.69 ± 1.80. SEM showed significant pathways from knowledge to practice (β = 0.458, p < 0.001), explaining 34.2% of variance in behaviour. A substantial knowledge–practice gap (95.2%) was observed. Conclusions This study reveals a critical “know-do” gap where favourable attitudes fail to translate into preventive behaviours or service utilization. Structural barriers like geographic isolation, financial constraints, poor infrastructure may play a dominant role in individual-level factors. Multi-level interventions addressing systemic barriers, community health worker training, mobile dental units and behaviour change communication are imperative for NOHP effectiveness. Findings suggest that utilisation is likely influenced by structural barriers such as accessibility and service availability.
Kumar et al. (Fri,) studied this question.