Text4Tots:An Oral Health Promotion

Mobile Messaging Program

Rinal PatelDepartment of Public Health Communications and Marketing

School of Public Health and Health ServicesThe George Washington University

Washington, D.C., USA

CE Advisor: Lorien Abroms, ScD, MA

Health Problem

Despite improvement in the overall oral health of Americans, the CDC has reported a significant increase in dental caries among children ages 2-5 years, setting the stage for many young children to develop a lifetime of complications from poor oral health.

http://www.cdc.gov/Features/dsUntreatedCavitiesKids/

Target Audience

Parents of children ages 2-5 in the United States.

Health Goal

Decrease the incidence of dental caries in children ages 2-5 by strengthening oral health

education skills and behaviors in parents.

Behavioral Objectives

By the end of our campaign, the number of parents of children ages 2-5 in our sample audience who:

1. supervise their children while brushing their teeth;

2. perform checks on their children's teeth for white or brown spots; and

3. whose children brush twice a day

will increase by 50%.

Communication Objective

1) By the end of our campaign, 80% of the parents will report having increased their knowledge and skills on how to properly brush their child’s teeth and how to check for dental caries. (SCT – Behavior Capability)

2) By the end of our campaign, 80% of the parents will have the confidence to perform oral health monitoring of their children (SCT – Self-efficacy)

Project Design:Participant Eligibility

• Eligibility criteria (15 participants)• Primary caregiver to a child ages 2-5• Both child and caregiver live in the United

States;• Has a cellular phone with sending/receiving

text message capabilities;• Has an active email and/or Facebook

account.

*Parents w/ multiple children were asked to enroll one child due to study limitations*

Project Design: Recruitment

• Participant recruitment via Facebook announcement• Facebook Status Update

Are you a parent or caregiver to a child ages 2 through 5?

Are you interested in making your tot's smile shine bright?

Do you own a cellphone that receives and sends text messages? If you answered YES to all of the above questions, then come join Text4Tots, a campaign aimed to decrease the incidence of dental caries in children ages 2 through 5 by strengthening oral health education skills and behaviors in parents.   If you’re interested and would like more information please message or email me (rinalpatel1@gmail.com).

• Interested participants were sent invitation to join the study.• Description of the campaign, an informed consent form,

pre-test survey link, opt-in-day in day information, and conference call-in number.

Participant Demographics

• Income 35k – 75k

• Education level: High school Diploma, Bachelor’s, or Master’s Degrees

• Parent age group (Late 20’s to Early 30’s)

• Child age demographics:

Project Design: Intervention

• Mobile Message Library • By age (2-5)• Created based on oral health literature review• Personalized messages based on pre-survey results• Goal: Tips on how to effectively supervise teeth brushing

and how to check for dental caries.• Additional tips: thumb sucking, relieve stress during

teething, etc.• Reminders sent to parents to schedule 6-month visits with

dentist.

• Mobile Messaging trial period: 14 days• Campaign launch: opt-in Day

• 3 messages a day • Sent based on parent’s schedule (Tailoring); or• sent 7:00am; 3:00pm; and 8:00pm.

Example of Mobile Message Library

Welcome Welcome to Text4Tots! Congratulations on taking a step towards making your tot smile! To opt out at any time, text STOP to this number.

First Status How old is your tot? Reply with: 2, 3, 4, or 5.

2 Most of the 20 primary teeth will appear by age 2. By age 1, your child should have made their first trip to the dentist.

3 All of your baby's primary teeth should have erupted by age 3. Make sure to visit your baby's dentist every 6 months.

4 Your child should be developing oral health skills that will last a lifetime! Lead by example by brushing your teeth twice a day and flossing regularly.

5 Your child should be developing oral health skills that will last a lifetime! Lead by example by brushing your teeth twice a day and flossing regularly.

Campaign Launch: Opt-in Day for Parent

A

Mobile Messaging Example:

• Day 3 for Parent A of 2 Year Old Child

Project Design: Follow-Up

• Congratulatory email at completion of mobile messaging intervention• Provided post-survey link

• Focus group of participants held for feedback on campaign

• Incentives provided at completion of the study• Goody bags with dentist recommended age-specific oral

health products (toothbrushes, toothpaste, floss, etc.)• Method of distribution: mail• Goal: Encourage parents to be more proactive in caring

for their child’s teeth.

Pre-Test Survey Results

• Only 26.6% of the study population had taken their child to the dentist within the last 6 months.• By age 1, all children should have made

their first trip to the dentist.

2) When was your child's last visit to the dentist?( ) 1-3 months ago( ) 4-6 months ago( ) 7-9 months ago( ) 10-12 months ago( ) More than 1 year ago( ) More than 2 years ago( ) Never

Pre-Test Survey Results

• 73.4% reported “sometimes,” “rarely,” or “never.”

4) How often do you check your child's teeth for dental caries, or cavities?( ) Always( ) Very Often( ) Sometimes( ) Rarely ( ) Never

5) How often do you brush your child's teeth or supervise their teeth brushing?( ) Always( ) Very Often( ) Sometimes( ) Rarely ( ) Never

Pre-Test Survey Results

• 20% of the children brush their teeth 2 times a day; 80% only brush once a day.

6) How many times does your child (or you) brush their teeth each day?( ) One time( ) Two times( ) Three times( ) More than three times( ) Never

Pre/Post-Test Survey Results

Pre- and Post-Test Question(s) Pre-Test Results

Post-Test Results

Pre-Test: How often do you check your child's teeth for dental caries, or cavities?

Post-Test: During the last 14 days, how often did you check your child’s teeth for dental caries?

33.4% 93.0%

Pre-Test: How often do you brush your child's teeth or supervise their teeth brushing?

Post-Test: During the last 14 days, how often did you brush your child’s teeth or supervise their teeth brushing?

39.9% 93.4%

Pre-Test: How many times does your child (or you) brush their teeth each day?

Post-Test: During the last 14 days, how many times did your child (or you) brush their teeth each day?

20% (2x) 80.0% (2x)6.7% (3x)

What did the Parents Think?

Post-Test Survey Question Post-Test Results

How often did you read Text4Tots mobile messages?

60.0% Always (n=9) 26.7% Very Often (n=4)6.7% Sometimes (n=1)0.0% Rarely (n=0)6.7% Never (n=1)

Please rate the following statement. Text4Tots has increased my oral health knowledge and skillsets for my child’s well-being.

53.0% Strongly Agree (n=8)40.0% Agree (n=6)0.0% Neutral (n=0)0.0% Disagree (n=0)6.7% Strongly Disagree (n=1)

Please rate the following statement. Text4Tots has increased my confidence to perform routine oral health monitoring of my child.

40.0% Strongly Agree (n=6)53.3% Agree (n=8)0.0% Neutral (n=0)0.0% Disagree (n=0)6.7% Strongly Disagree (n=1)

Strengths

• Personalized messages based on child’s age.

• Use of tailoring for sending messages based on parent’s schedules.

• Goody bag incentives to encourage oral health monitoring post-intervention.

• Use of mobile technology to reach parents across the US.

Limitations• 3 messages a day without automated

messaging service.• Automated service could also help track

previously sent messages

• Survey did not address participant demographics; this data was collected through Facebook and general email and phone conversations.

• Only used 1 type of social media to recruit participants (i.e., Facebook)• This could create sample bias

Future Directions• Expert panel review of mobile messaging library

• Ask evaluation questions throughout the program and provide incentives for each question the parent answers.

• Update mobile message library to include an option for parents to ask questions and get tips.

• Create a blog or Facebook page for parents to interact with each other.

• Provide small games to keep the parents engaged in the text message program.

• Create a smartphone app to along with the mobile message intervention• Include games and activities for children to become involved in

their oral health

Acknowledgements

Thank you to all that have made my educational experience a success!

•CE Advisor: Dr. Lorien Abroms

•Academic Advisor: Jerry Franz

•All GWU SPHHS Faculty

•My Friends and Family

Questions?

Thank You!