Family monetary incentives as a value-based care model for oral hygiene: rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial

Abstract

Background: Effective prevention-focused, value-based strategies are needed to improve oral health. Despite evidence that monetary incentives can motivate healthy behavior, well-powered studies have yet to examine incentives for improving children's oral hygiene.

Aim: Describe the rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial, which tests lottery-based monetary incentives as a consumer-oriented, value-based care model for improving children's oral hygiene.

Design: Phase II, stratified, permuted block randomized, controlled, two-arm, parallel groups, prevention trial.

Setting: Study visits occur at three Los Angeles, CA health clinics.

Participants: Two hundred and forty-four parent-child dyads with a child aged 6-48 months.

Interventions: Eligible dyads were randomized in equal allocation to one of two groups: lottery incentive group or waitlist (delayed incentive) control group. Weekly lottery incentives were offered for 6 months based on Bluetooth-recorded toothbrushing frequency. Both groups received weekly text message feedback on toothbrushing performance.

Outcomes: The primary outcome was toothbrushing performance from baseline to 6 months, measured as the mean number of qualifying half-day Bluetooth-recorded episodes per week when the child's teeth were brushed. Secondary outcomes included toothbrushing performance sustainability through 12 months and dental caries status.

Conclusions: BEECON offers a consumer-oriented approach to promoting value-based oral health care. We hypothesize that lottery-based incentives can improve oral hygiene in young children. Study results will inform programming efforts to enhance oral disease prevention in young children.

Trial registration: ClinicalTrials.gov identifier NCT03576326.

Keywords: behavioral; child; dentistry; economics; incentives; lottery; oral hygiene; value‐based care.

Conflict of interest statement

Conflict of interest

Dr. Gansky’s brother is a 3M employee, in a different division than the one that provided in-kind product.

© 2020 American Association of Public Health Dentistry.

Figures

Figure 1

Conceptual model of how incentives can affect toothbrushing.,

Figure 2

Schematic of study design.

Figure 3

Flow of toothbrushing data.