Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial

Matheus Lotto, Anna Paola Strieder, Patricia Estefania Ayala Aguirre, Thais Marchini Oliveira, Maria Aparecida Andrade Moreira Machado, Daniela Rios, Thiago Cruvinel, Matheus Lotto, Anna Paola Strieder, Patricia Estefania Ayala Aguirre, Thais Marchini Oliveira, Maria Aparecida Andrade Moreira Machado, Daniela Rios, Thiago Cruvinel

Abstract

Objectives: To evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children.

Methods: A single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer's exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05).

Results: Despite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children's consumption of sugar-free sweets and controlling the severity of ECC.

Conclusion: Therefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children's dietary patterns.

Clinical significance: These findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

Keywords: Dental caries; Early childhood caries; Randomized controlled trial; eHealth; mHealth.

Conflict of interest statement

The authors report no declarations of interest.

Copyright © 2020 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Participant flow diagram.

References

    1. Drury T.F., Horowitz A.M., Ismail A.I., Maertens M.P., Rozier R.G., Selwitz R.H. Diagnosing and reporting early childhood caries for research proposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the health resources and services administration, and the health care financing administration. J. Public Health Dent. 1999;59(3):192–197. doi: 10.1111/j.1752-7325.1999.tb03268.x. PMID: 10649591.
    1. Fontana M. The clinical, environmental, and behavior factors that foster early childhood caries: evidence for caries risk assessment. Pediatr. Dent. 2015;37(2):217–225. PMID:26063551.
    1. Kassebaum N.J., Bernabé E., Dahiya M., Bhandari B., Murray C.J.L., Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J. Den. Res. 2015;94(5):650–658. doi: 10.1177/0022034515573272. PMID:25740856.
    1. Phantumvanit P., Makino Y., Ogawa H., Rugg-Gunn A., Moynihan P., Petersen P.E. WHO global consultation on public health intervention against early childhood caries. Community Dent. Oral Epidemiol. 2018;46(3):280–287. doi: 10.1111/cdoe.12362. PMID:29380407.
    1. Tinanoff N., Baez R.J., Guillory C.D., Donly K.J., Feldens C.A., McGrath C. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int. J. Paediatr. Dent. 2019;29(3):238–248. doi: 10.1111/ipd.12484. PMID:31099128.
    1. Rai N.K., Tiwari T. Parental factors influencing the development of early childhood caries in developing nations: a systematic review. Front. Public Health. 2018;6:64. doi: 10.3389/fpubh.2018.00064. PMID:29616206.
    1. Finnegan D.A., Rainchuso L., Jenkins S., Kierce E., Rothman A. Immigrant caregivers of young children: oral health beliegs, attitudes, and eatly childhood caries knowledge. J. Community Health. 2016;41(2):250–257. doi: 10.1007/s10900-015-0090-5. PMID:26370378.
    1. Thwin K.M., Zatsu T., Ueno M., Kawagushi Y. Effects of oral health education in Myanmar prescholl children and guardians, J. Invesig. Clin. Dent. 2018;9(3):e12346. doi: 10.1111/jicd.12346. PMID:29873195.
    1. Smith J.D., George S.M.S., Prado G. Family-centered positive behavior support interventions in early childhood to prevent obesity. Child Dev. 2017;88(2):427–435. doi: 10.1111/cdev.12738. PMID:28195411.
    1. Plonka K.A., Pukallus M.L., Barnett A., Holcombre T.F., Walsh L.J., Seow W.K. A controlled, longitudinal study of home visits compared to telephone contects to prevent early chilhood caries. Int. J. Paediatr. Dent. 2013;23(1) doi: 10.1111/j.1365-263X.2011.01219.x. 23-21 PMID:22251427.
    1. Jiang S., McGrath C., Lo E.C., Ho S.M., Gao X. Motivational interviewing to prevent early childhood caries: a randomized controlled trial. J. Dent. 2020 doi: 10.1016/j.jdent.2020.103349. Online ahead of print PMID:32330548.
    1. Henshaw M.M., Borrelli B., Gregorich S.E., Heaton B., Tooley E.M., Santo W. Randomized trial of motivational interviewing to prevent early childhood caries in public housing. JDR Clin. Trans. Res. 2018;3(4):353–365. doi: 10.1177/2380084418794377. PMID:30238060.
    1. O’Donnell O. Access to health care in developing countries: breaking down demand side barriers. Cad. Saude Publica. 2007;23(12):2820–2834. doi: 10.1590/s0102-311x2007001200003. PMID:18157324.
    1. Bhandari N., Shi Y., Jung K. Seeking health information online: does limited healthcare access matter? J. Am. Med. Inform. Assoc. 2014;21(6):1113–1117. doi: 10.1136/amiajnl-2013-002350. PMID:24948558.
    1. Instituto Paulo Montenegro . 2018. Indicador De Alfabetismo Funcional. (Accessed 01 June 2020)
    1. Batista M.J., Lawrence H.P., Sousa M.L.R. Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health. 2017;18(1):60. doi: 10.1186/s12889-017-4443-0. PMID:28747157.
    1. Berkman N.D., Sheridan S.L., Donahue K.E., Halpern D.J., Vieira A., Crotty K. Health litercy interventions and outcomes: an updated systematic review. Evid. Rep. Assess. Summ. (Summ) 2011;199:1–941. PMID:23126607.
    1. Cruvinel T., Aguirre P.E.A., Lotto M., Oliveira T.M., Rios D., Cruvinel A.F.P. Digital behavior surveillance: monitoring dental caries and toothache interests of Google users from developing countries. Oral Dis. 2019;25(1):339–347. doi: 10.1111/odi.12986. PMID:30270556.
    1. Lotto M., Aguirre P.E.A., Strieder A.P., Cruvinel A.F.P., Cruvinel T. Levels of toothache-related interests of Google and YouTube users from developed and developing countries over time. PeerJ. 2019;7:e7706. doi: 10.7717/peerj.7706. PMID:31616582.
    1. Statista . 2020. Brazil: Mobile Phone Internet Users in Brazil 2017-2023. (accessed 01 June 2020)
    1. Choi W., Zheng H., Franklin P., Tulu B. mHealth technologies for osteoarthritis self-management and treatment: a systematic review. Health Informatics J. 2019;25(3):984–1003. doi: 10.1177/1460458217735676. PMID:29090628.
    1. Otu A., Ebenso B., Okuzu O., Osifo-Dawodu E. Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study. Hum. Resour. Health. 2016;14:5. doi: 10.1186/s12960-016-0100-4. PMID:26872824.
    1. Marcolino M.S., Oliveira J.A.Q., D’Agostino M., Ribeiro A.L., Alkmim M.B.M., Novillo-Ortiz D. The impact of mHealth interventions: systematic review of systematic reviews. JMIR Mhealth Uhealth. 2018;6(1):e23. doi: 10.2196/mhealth.8873. PMID:29343463.
    1. Xiong S., Berkhouse H., Schooler M., Pu W., Sun A., Gong E. Effectiveness of mHealth interventions in improving medication adherence among people with hypertension: a systematic review. Curr. Hypertens. Rep. 2018;20(10):86. doi: 10.1007/s11906-018-0886-7. PMID:30088110.
    1. Wang Y., Xue H., Huang Y., Huang L., Zhang D. A systematic review of application and effectiveness of mHealth interventions for obesity and diabetes treatment and self-management. Adv. Nutr. 2017;8(3):449–462. doi: 10.3945/an.116.014100. PMID:28507010.
    1. Alkilzy M., Midani R., Höfer M., Splieth C. Improving toothbrushing with a smartphone app: results of a randomized controlled trial. Caries Res. 2019;53(6):628–635. doi: 10.1159/000499868. PMID:31132765.
    1. Toniazzo M.P., Nodari D., Muniz F.W.M.G., Weidlich P. Effect of mHealth in improving oral hygiene: a systematic review with meta-analysis. J. Clin. Periodontol. 2019;46(3):297–309. doi: 10.1111/jcpe.13083. PMID:30761580.
    1. Aguirre P.E.A., Lotto M., Strieder A.P., Cruvinel A.F.P., Cruvinel T. The effectiveness of educational mobile messages for assisting in the prevention of early childhood caries: protocol for a randomized controlled trial. JMIR Res. Protoc. 2019;8(9) doi: 10.2196/13656. PMID:31482856.
    1. Schulz K.F., Altman D.G., Moher D., CONSORT Group CONSORT 2010 statement: Update guidelines for reporting parallel group randomized trials. BMC Med. 2010;24:8–18. doi: 10.1186/1741-7015-8-18. PMID:20334633.
    1. Pitts N.B., Ekstrand K.R., Foundation I.C.D.A.S. International caries detection and assessment system (ICDAS) and its International caries classification and management system (ICCMS) – methods for staging of the caries process and enabling dentists to manage caries, Community Dent. Oral. Epidemiol. 2013;41(1):e41–52. doi: 10.1111/cdoe.12025. PMID:24916677.
    1. American Academy of Pediatric Dentistry . first ed. American Academy of Pediatric Dentistry; Chicago: 2019. The Reference Manual of Pediatric Dentistry.
    1. Lotto M., Strieder A.P., Aguirre P.E.A., Machado M.A.A.M., Rios D., Cruvinel A. Parental perspectives on early childhood caries: a qualitative study. Int. J. Paediatr. Dent. 2020;30(4):451–458. doi: 10.1111/ipd.12622. PMID:32011057.
    1. Rosenstock I.M. The Health Belief Model and preventive health behavior. Health Educ. Behav. 1974;2:354–386. doi: 10.1177/109019817400200405.
    1. Parandeh L., Shafaie F.S., Mlajouti J., Mirghafourvand M., Asghari-Jafarabadi M. The effect of educational text message based on health belief model on osteoporosis preventive behaviors in women: a randomized controlled clinical trial. Women Health. 2019;59(10) . PMID:30955478.
    1. Ainamo J., Bay I. Problems and proposals for recording gingivitis and plaque. Int. Dent. J. 1975;25(4):29–35. PMID:1058834.
    1. Norman C.D., Skinner H.A. eHEALS: the eHealth literacy scale. J. Med. Internet Res. 2006;8(4):e27. doi: 10.2196/jmir.8.4.e27. PMID:17213046.
    1. Llena C., Forner L. Dietary habits in a child population in relation to caries experience. Caries Res. 2008;42(5):387–393. doi: 10.1159/000154784. PMID:18781067.
    1. Zotti F., Dalessandri D., Salgarello S., Piancino M., Bonetti S., Visconti L. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86(1):101–107. doi: 10.2319/010915-19.1. PMID:25799001.
    1. Dallal’s Jerry. 2020. Randomization Plans: Randomizing Subjects to a Single Treatment. (accessed 01 June 2020)
    1. Borrelli B., Henshaw M., Endrighi R., Adams W.G., Heeren T., Rosen R.K. An interactive parent-targeted text messaging intervention to improve oral health in children attending urban pediatric clinics: feasibility randomized controlled trial. JMIR Mhealth Uhealth. 2019;7(11) doi: 10.2196/14247. PMID:31710306.
    1. Ross M.C., Campbell P.M., Tadlock L.P., Taylor R.W., Buschang P.H. Effect of automated messaging on oral hygiene in adolescent orthodontic patients: a randomized controlled trial. Angle Orthod. 2019;89(2):262–267. doi: 10.2319/040618-260.1. PMID:30516416.
    1. Scheerman J.F.M., van Meijel B., van Empelen P., Verrips G.H.W., van Loveren C., Twisk J.W.R. The effect of using a mobile application (“WhiteTeeth”) on improving oral hygiene: a randomized controlled trial. Int. J. Dent. Hyg. 2020;18(1):79–83. doi: 10.1111/idh.12415. PMID:31291683.
    1. Cho J., Park D., Lee H.E. Cognitive factors of using health apps: systematic analysis of relationships among health consciousness, health information orientation, eHealth literacy, and health app use efficacy. J. Med. Internet Res. 2014;16(5):e125. doi: 10.2196/jmir.3283. PMID:24824062.
    1. Richtering S.S., Hyun K., Neubeck L., Coorey G., Chalmers J., Usherwood T. eHealth literacy: predictors in a population with moderate-to-high cardiovascular risk. JMIR Hum. Factors. 2017;4(1):e4. doi: 10.2196/humanfactors.6217. PMID:28130203.
    1. Ernsting C., Stühmann L.M., Dombrowski S.U., Voigt-Antons J., Kuhlmey A., Gellert P. Associations of health app use and perceived effectiveness in people with cardiovascular diseases and diabetes: population-based survey. JMIR Mhealth Uhealth. 2019;7(3):e12179. doi: 10.2196/10.2196/12179. PMID:30920383.
    1. Nunes A.M.M., Silva A.A.M., Alves C.M.C., Hugo F.N., Ribeiro C.C. Factors underlying the polarization of early childhood caries within a high-risk population. BMC Public Health. 2014;14:988. doi: 10.2196/10.1186/1471-2458-14-988. PMID:25245978.
    1. ElSalhy M., Ali U., Lai H., Flores-Mir C., Amim M. Caries reporting in studies that used the international caries detection and assessment system: a scoping review. Community Dent. Oral Epidemiol. 2019;47(1):92–102. doi: 10.1111/cdoe.12430. PMID: 30334280.
    1. Fisberg M., Kovalskys I., Gómez G., Rigotti A., Sanabria L.Y.C., Garcia M.C.Y., Torres R.G.P. Total and added sugar intake: assessment in eight Latin American countries. Nutrients. 2018;10(4):389. doi: 10.3390/nu10040389. PMID:29565308.
    1. Sedgwick P., Greenwood N. Understanding the hawthorne effect. BMJ. 2015;315:h4672. doi: 10.1136/bmj.h4672. PMID:26341898.
    1. McCarney R., Werner J., Iliffe S., van Haselen R., Griffin M., Fisher P. The Hawthorne effect: a randomized, controlled trial. BMC Med. Res. Methodol. 2007;7:30. doi: 10.1186/1471-2288-7-30. PMID:17608932.
    1. Strieder A.P., Aguirre P.E.A., Lotto M., Cruvinel A.F.P., Cruvinel T. Digital behavior surveillance for monitoring the interests of Google users in amber necklace in different countries. Int. J. Paediatr. Dent. 2019;29(5):603–614. doi: 10.1111/ipd.12500. PMID:30920686.
    1. Hyde S., Gansky S.A., Gonzalez-Vargas M.J., Husting S.R., Cheng N.F., Millstein S.G. Developing an acceptability assessment of preventive dental treatments. J. Public Health Dent. 2009;69(1):18–23. doi: 10.1111/j.1752-7325.2008.00088.x. PMID:18662256.
    1. Vidyasagar D. Digital divide and digital dividend in the age of information technology. J. Perinatol. 2006;26(5):313–315. doi: 10.1038/sj.jp.7211494. PMID:16598298.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다