Text Message Interventions Could Improve Oral Health of At-Risk Children

Text message interventions have the potential to improve the oral health of at-risk children by positively influencing caregivers’ attitudes and behaviors toward their children’s oral health, according to the results of a randomized pilot feasibility trial published in November 2019 in the Journal of Medical Internet Research- mHealth and uHealth.

“The most effective interventions are those that are integrated into the daily fabric of people’s lives,” said Belinda Borrelli, PhD, the study’s lead co-principal investigator and professor of Health Policy & Health Services Research at Boston University Henry M. Goldman School of Dental Medicine, where she also directs the Center for Behavioral Science Research. “Through text messaging, we can target previously unreachable populations with evidence-based information that they can access in real time — most people carry their cell phones throughout the day – wherever they happen to be when the text comes in.”

The feasibility trial (Borrelli et al.) explored the efficacy of harnessing the power of text messaging – currently used by more than 95 percent of adults, with no disparities in race, ethnicity, and income – to improve pediatric oral health among at-risk populations. These at-risk populations have disproportionate rates of untreated dental decay and lack adequate access to dental care.

Together with Dr. Michelle Henshaw, co-principal investigator and professor of Health Policy & Health Services Research at Boston University Henry M. Goldman School of Dental Medicine, they developed a text-message program focused on motivating adherence to pediatric oral health behaviors. They based the program content and structure on clinical guidelines as well as on feedback from a multidisciplinary scientific advisory board, the medical community, and parents in the target population.

Participants in the study were parents or caregivers of children who were patients of pediatric clinics (patient treatment centers) in two community health centers in an urban and underserved area of Boston. They were randomized to receive either oral health text messages or child wellness text messages. Text message in both groups were interactive, focusing on problem-solving barriers to behavior change.

There were four main findings from the eight-week feasibility trial. First, participants were very satisfied with the program, and second, participants in both the treatment and control groups demonstrated a high level of engagement with the program, as measured by their responsiveness to the texts.  Third, the intervention had a positive influence on parent’s attitudes towards oral health and social-cognitive mediators. Finally, the oral health text message program showed preliminary effectiveness at increasing brushing behaviors in participants randomized to the treatment group as compared to the control group.

These findings indicate first that the intervention, as designed, was effective at reaching and engaging its target audience. They also demonstrate the potential of the intervention to change behavior and beliefs related to oral health.

Based on the results of the feasibility trial, Borrelli and Henshaw secured funding from the National Institute of Dental and Craniofacial Research to conduct a larger trial on the text message intervention; currently, 650 families are enrolled in the study.

“This study demonstrates the potential of text message interventions and provides evidence that a larger, fully powered randomized controlled trial is needed,” Borrelli said. “This is the type of program that, if proven effective, could be disseminated nationally to other federally qualified pediatric clinics (patient treatment centers) and ultimately make a real difference in the oral health of at-risk children.”

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