WhatsApp Messages to Improve Mothers' Oral Health Knowledge and Children's Toothbrushing
Effectiveness of WhatsApp-Based Messages as an Adjunct to Oral Health Education on Maternal Oral Health Knowledge and Child Toothbrushing Behavior: A Randomized Controlled Trial
Tooth decay is one of the most common health problems in young children in Saudi Arabia. Brushing twice a day with fluoride toothpaste is one of the most effective ways to prevent it, but preschool children cannot do this properly on their own and depend on their mothers to brush for them and to supervise them. Mothers usually receive oral health advice only once, during a dental visit, and a single session may not be enough to change daily habits at home.
This study will test whether short oral health messages sent to mothers on WhatsApp, in addition to the usual face-to-face advice, help mothers know more about toothbrushing and help their children brush better.
Mothers of children aged 3 to 6 years attending the Pediatric Dentistry Clinics at King Abdulaziz University Hospital in Jeddah will be invited to take part. All mothers will first answer a short questionnaire about what they know about toothbrushing and how their child currently brushes. All mothers will then receive the same 10 to 15 minute face-to-face oral health education session. After the session, each mother will be placed into one of two groups by chance, like flipping a coin. Mothers in the first group will also receive two WhatsApp messages a week for eight weeks, sixteen messages in total, covering how often to brush, how much fluoride toothpaste to use, correct brushing technique, and how to help and supervise their child. Mothers in the second group will not receive these messages.
After eight weeks, all mothers will answer the same questionnaire again, and the answers of the two groups will be compared. Taking part involves no dental treatment or procedures beyond the child's normal care, and mothers may withdraw at any time.
Study Overview
Status
Detailed Description
This is an open-label, two-arm, parallel-group randomized controlled trial with 1:1 allocation, conducted at the Pediatric Dentistry Clinics of King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Mothers of children aged 3 to 6 years will be approached in the clinic waiting area. After electronic informed consent, participants will complete a baseline self-administered questionnaire delivered through Google Forms on their own smartphones, covering demographic characteristics, maternal oral health knowledge, and child toothbrushing behavior. All participants will then receive a standardized 10 to 15 minute individual face-to-face oral health education session delivered in Arabic by the principal investigator, using visual materials from the American Academy of Pediatric Dentistry and the Saudi Ministry of Health.
Randomization will follow the baseline questionnaire and education session. A computer-generated block randomization sequence with varying block sizes of 4, 6, and 8 will be prepared in advance by an independent person not involved in recruitment or data collection, and concealed in sequentially numbered, opaque, sealed envelopes opened only after baseline assessment and education are complete.
Participants allocated to the intervention arm will additionally receive individually delivered WhatsApp messages twice weekly for eight weeks, sixteen messages in total, reinforcing the same toothbrushing content covered in the education session. Messages will be delivered in Arabic and may include text, images, or short videos drawn from evidence-based sources; all content will be reviewed by a pediatric dentist before delivery. Participants allocated to the control arm will receive the face-to-face education session only, with no further contact during the intervention period.
At eight weeks, all participants will be invited by WhatsApp to complete the same questionnaire through a secure Google Forms link, omitting the demographic and eligibility sections. Non-responders will receive up to three reminders at 3 to 5 days, 7 to 10 days, and 14 days after the initial invitation, after which they will be classified as lost to follow-up.
Blinding of participants and of the investigator is not feasible given the nature of the intervention, so the trial is open-label. Analysis will follow the intention-to-treat principle and will use analysis of covariance comparing eight-week scores between arms with the corresponding baseline score as covariate; results will be reported as adjusted mean differences with 95% confidence intervals. Missing follow-up data will be handled by multiple imputation under a missing-at-random assumption, with estimates pooled using Rubin's rules.
The target sample size of 106 participants, 53 per arm, was derived for ANCOVA with alpha of 0.05, power of 0.80, effect size f of 0.31, and one covariate, giving 42 per arm before inflation for 20 percent anticipated attrition.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Mona Talal Rajeh, PhD
- Phone Number: +966502500888
- Email: mtrajeh@kau.edu.sa
Study Contact Backup
- Name: Afnan Ahmed Kamarani, BDS
- Phone Number: +966557580988
- Email: mtrajeh@kau.edu.sa
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Mother of at least one child aged 3 to 6 years
- Aged 18 years or older
- Able to read and understand Arabic
- Owns a smartphone with an active WhatsApp account
- Attending the Pediatric Dentistry Clinics at King Abdulaziz University Hospital at the time of recruitment
- Willing to participate and provide informed consent
Exclusion Criteria:
- Dental professional or dental student
- Currently participating in another oral health education program targeting child oral health or toothbrushing practices
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Oral Health Education Plus WhatsApp Messages
Participants receive a single standardized face-to-face oral health education session and, in addition, WhatsApp-based oral health messages delivered twice weekly for eight weeks (16 messages total) reinforcing toothbrushing recommendations. Assigned interventions: Behavioral: Standardized Face-to-Face Oral Health Education; Behavioral: WhatsApp-Based Oral Health Messages |
A single individual education session of 10 to 15 minutes delivered in Arabic by the principal investigator immediately after baseline assessment, covering the importance of toothbrushing, recommended frequency and timing, use of fluoridated toothpaste, proper brushing technique, parental assistance and supervision, and toothbrush selection and maintenance, supported by standardized visual materials. Arms: Both arms Sixteen oral health messages delivered individually via WhatsApp in Arabic, two per week for eight weeks, reinforcing the toothbrushing content of the education session. Messages may include text, images, or short videos from evidence-based sources including the American Academy of Pediatric Dentistry and the American Dental Association, and are reviewed by a pediatric dentist before delivery. Arms: Experimental arm only |
|
Active Comparator: Oral Health Education Alone
Participants receive the same single standardized face-to-face oral health education session and no additional oral health education or messages during the eight-week study period. Assigned intervention: Behavioral: Standardized Face-to-Face Oral Health Education |
A single individual education session of 10 to 15 minutes delivered in Arabic by the principal investigator immediately after baseline assessment, covering the importance of toothbrushing, recommended frequency and timing, use of fluoridated toothpaste, proper brushing technique, parental assistance and supervision, and toothbrush selection and maintenance, supported by standardized visual materials. Arms: Both arms |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Maternal oral health knowledge score
Time Frame: Baseline and 8 weeks after the education session
|
Maternal knowledge of toothbrushing-related oral health recommendations, measured by an eight-item multiple-choice questionnaire covering timing of toothbrushing, initiation of toothbrushing, parental positioning during brushing, fluoride toothpaste use, recommended fluoride concentration, parental supervision, consequences of inadequate toothbrushing, and toothbrush selection.
Each correct answer scores 1 point; incorrect and "I do not know" answers score 0. Total score ranges from 0 to 8, with higher scores indicating greater oral health knowledge.
|
Baseline and 8 weeks after the education session
|
|
Child toothbrushing behavior score (maternal report)
Time Frame: Baseline and 8 weeks after the education session
|
Toothbrushing behavior of the designated study child as reported by the mother, measured by an eight-item questionnaire covering brushing frequency, fluoride toothpaste use, amount of toothpaste, parental involvement during brushing, brushing of all tooth surfaces, brushing duration, toothbrush replacement practices, and post-brushing behavior.
Responses consistent with current evidence-based recommendations score 1 point and all other responses score 0. Total score ranges from 0 to 8, with higher scores indicating more favorable toothbrushing practices.
Children reported as not brushing are assigned a score of 0.
|
Baseline and 8 weeks after the education session
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: MONA Talal RAJEH, PhD, King Abdulaziz University
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 96-05-26
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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