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TEXT4TOTS: TOOTH BRUSHING
PubH 6570: Advanced Health Communications
Sarah Leonard
Lindsay Wolfe
5 BEST EXISTING SOLUTIONS

1.       School-Based Intervention to
         Promote Tooth Brushing
     •     Supervised tooth brushing with high
           fluoridated toothpaste on school
           days to prevent dental caries among
           high risk children.
     •     Local mothers were trained as
           toothbrushing supervisors.
2.       Playful Toothbrush: UbiComp
         Technology for Teaching Tooth
         Brushing to Kindegarten Children
     •     Vision-based motion tracker:
           recognizes different tooth brushing
           strokes.
     •     Tooth brushing game: child cleans a
           virtual, mirror picture of their dirty
           teeth by physically brushing their
           own.
5 BEST EXISTING SOLUTIONS
3.    Partnering with Pediatricians to Reduce Rates of Early
      Childhood Caries
• Communication skills training for clinicians
• Edits to the anticipated counseling topics
• Creation of an educational brochure
4.    Toothbrushing at school: Effects on toothbrushing
      behaviour, cognitions and habit strength
•    Children in the intervention schools brushed their teeth at school
     under supervision.
•    Brushing teeth at school resulted in a significant increase in frequency
     of toothbrushing. However, these effects had not been maintained at
     one-year follow-up. No effects on cognitions about toothbrushing or on
     habit strength were found.
5.     The Crest Cavity-Free Zone Program
•    Educational oral health program conducted at Boys & Girls Club of
     America Sites.
•    Multi-week program with modules based on age group
•    Self-esteem building and developing positive attitudes toward dentists
OBJECTIVES
   Target Audience
       Primary care takers of toddlers, ages 2-5.

   Health Goal
       To decrease morbidity related to gum disease and tooth decay.

   Behavioral Objectives
       By the end of this campaign at least 33 percent of our target audience will engage
        their children in daily, healthy dental practices (i.e. tooth brushing 2x per day).

   Communication Objectives
       By the end of this campaign at least 33 percent of our target audience will
        demonstrate increased awareness of their toddlers’ susceptibility to gum disease
        and tooth decay through their interaction with the text messaging campaign.
        (perceived susceptibility)
       By the end of this campaign at least 33 percent of our target audience will report
        improved self-efficacy in their ability to incorporating the healthy dental practice
        of tooth brushing twice a day into their daily activities. (self-efficacy)
       By the end of this campaign at least 33 percent of our target audience will
        indicate a reduction in their perceived barriers to initiating and maintaining the
        healthy dental practice of tooth brushing twice a day into their routines.
        (perceived barriers)
THE HEALTH BELIEF MODEL
Modifying             Individual Beliefs
Factors
                 Perceived
               Susceptibility      Perceived
                                    Threat


   Age
                  Perceived
  Gender          Benefits
 Ethnicity                                        Health
   SES                                           Behavior
Personality      Perceived
Knowledge        Barriers




              Perceived Self-
                 Efficacy
                                               Cues to
                                               Action
MESSAGE LIBRARY
MESSAGE LIBRARY
SAM EVALUATION
REVISED MESSAGE LIBRARY
REVISED MESSAGE LIBRARY
TESTED MESSAGE LIBRARY
TESTED MESSAGE LIBRARY
EVALUATION PLAN
   Baseline Evaluation Questions
        First status: Currently, how many times per day does your child brush his/her teeth? Text 0, 1, or 2
        Self-efficacy Check: It’s day 3 of your healthy habit routine! Rate your ability to brush your child’s teeth twice a
         day. Text HIGH, MEDIUM, or LOW
        Barriers Check (open-ended responses): What's the biggest barrier to getting your child to brush their teeth
         twice a day for 2-3 minutes?
        Susceptibility Knowledge: FACT – Did you know “Dental Caries” or tooth decay is largely preventable but most
         common chronic disease of children aged 6 to 11 years (25%). Text YES or NO
   Mid-Program and Post-Program Assessment (Follow-up to Baseline Questions)
        Did you read the messages? Text YES or NO
        Did you like the messages? Text YES or NO
        Overall, how satisfied with the text messages were you? Text A. Very satisfied, B. Satisfied, C. Dissatisfied, D.
         Very Dissatisfied
        Did you find the messages helpful? Text YES or NO
        Overall, what type of text message was the most helpful? Text TIPS or FACTS or BOTH
        Would you recommend Text4Tots to others trying to initiate healthy tooth brushing habits with their toddlers?
         Text YES or NO
        Final Status (Compare to baseline First status): Currently, how many times per day does your child brush
         his/her teeth? Text 0, 1, or 2
        Self-efficacy Check (compare results to baseline): Txt4Tots: It's been over a week, you're a pro! How would you
         rate your ability to brush your child's teeth twice a day? Text HIGH, MEDIUM, or LOW
        Barriers Check (compare results to baseline): Txt4Tots: It's been 2-weeks since you joined this program! Have
         you been able to overcome barriers to brushing your child's teeth twice a day? Text YES or NO
        Susceptibility Quiz (compare results to baseline FACT): It's been 1-week since you started this program! Quick
         QUIZ - Are children who don't brush their teeth twice a day at risk for chronic disease? Text YES or NO
        Did you learn anything from the Txt4Tots Program? If yes, what did you learn?
        Based on your participation in the Txt4Tots program, do you think you will change your tot’s toothbrushing
         behavior? If yes, how?
        Additional Comments about the Text4Tots Program
   Other Assessment: Engagement in the Text4Tots Program
        Track average # of interactions (replies) to Tips, Facts, and Reminders
RESULTS
   Susceptibility Knowledge Checks:
      Did you know “Caries” or tooth decay is largely preventable but the
       most common chronic disease of children aged 6-11 years?
      It's been 5 days since you started this program! Quick QUIZ - Are
       children who don't brush their teeth twice a day at risk for chronic
       disease?
   Self-Efficacy Checks:
      It's day 3 of your healthy habit routine! Rate your ability to brush
        your child’s teeth twice a day. Text HIGH, MEDIUM, or LOW.
      By now you're a pro! How would you rate your ability to brush your
        child's teeth twice a day? Text HIGH, MEDIUM, or LOW.
   Barriers Checks:
      Help us, help you! What is your biggest barrier to getting your tot's
       teeth brushed twice a day for 2-3 minutes?
      It's been 1 week since you joined this program! Have you been able to
       overcome barriers to brushing your child's teeth twice a day? Text
       YES or NO
RESULTS
100% of participants responded
to the program evaluation
survey and indicated that they
read and liked the messages.
   By the end of the campaign 86% of participants were brushing
    their tot’s teeth twice a day.
   Overall, 100% of the participants were either satisfied or very
    satisfied with the messages.
   6 of 7 participants found the messages helpful.
   A majority (86%) of participants would recommend the program to
    others.
   4 out of 7 people indicated that they learned something new from
    the program. Specifically, one participant said they learned the
    “importance of brushing at least twice a day.”
   3 out of 7 participants indicated that as a result of the program,
    they would change their child’s tooth brushing behavior.
RESULTS
   Did you learn anything from the Txt4Tots Program? If yes,
    what did you learn?
       Importance of brushing at least twice a day
   Based on your participation in the Txt4Tots program, do you
    think you will change your tot’s toothbrushing behavior? If
    yes, how?
       Always brushing 2 times per day
       Utilize tips to make it an easier process
   Additional comments:
     “It helped me to remember to help my son brush his teeth. Before I
      wasn't always consistent with night time brushing. it helped to make
      it habitual.”
     “My child has been already brushing his teeth twice (but sometimes
      only once) per day. The program was useful with tips and facts for a
      parent to keep a closer eye on how the toddler brushes teeth but I
      cannot say that it modified anything for us. Our child likes brushing
      his teeth but won't do it for long enough passages of time or clean all
      the surfaces, etc.”
     “Thought it was a great program. Just didn't learn new things and my
      routine so far works since my first 2 kids have never had a cavity in
      13yrs :) Definately really good for first time parents.”
LESSONS LEARNED
 Market to new mothers
 More personalization
       Use keywords to structure program, reduce barriers,
        and meet needs
   Looking forward
     More interactivity
     Web component
     Timing of messages and reminders on personalized
      schedules
REFERENCES
   Curnow, M M T (07/2002). "A randomised controlled trial of
    the efficacy of supervised toothbrushing in high-caries-risk
    children". Caries research (0008-6568), 36 (4), 294.
   Chang, Yu-Chen, et al. “Playful Toothbrush: UbiComp
    Technology for Teaching Tooth Brushing to Kinedegarten
    Children”. Proceeding of the twenty-sixth annual SIGCHI
    conference on Human factors in computing systems, April 05-
    10, 2008, Florence, Italy.
   Kressin, Nancy R (11/2009). "Pediatric clinicians can help
    reduce rates of early childhood caries: effects of a practice
    based intervention". Medical care (0025-7079), 47 (11), 1121.
   Marianne Wind, Stef Kremers, Carel Thijs, Johannes Brug,
    (2005) "Toothbrushing at school: Effects on toothbrushing
    behaviour, cognitions and habit strength", Health Education,
    Vol. 105 Iss: 1, pp.53 – 61
   Biesbrock, Aaron R (2004). "Short-term impact of a national
    dental education program on children's oral health and
    knowledge". The Journal of clinical dentistry (0895-8831), 15
    (4), 93.

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Tooth brushingpart4 final

  • 1. TEXT4TOTS: TOOTH BRUSHING PubH 6570: Advanced Health Communications Sarah Leonard Lindsay Wolfe
  • 2. 5 BEST EXISTING SOLUTIONS 1. School-Based Intervention to Promote Tooth Brushing • Supervised tooth brushing with high fluoridated toothpaste on school days to prevent dental caries among high risk children. • Local mothers were trained as toothbrushing supervisors. 2. Playful Toothbrush: UbiComp Technology for Teaching Tooth Brushing to Kindegarten Children • Vision-based motion tracker: recognizes different tooth brushing strokes. • Tooth brushing game: child cleans a virtual, mirror picture of their dirty teeth by physically brushing their own.
  • 3. 5 BEST EXISTING SOLUTIONS 3. Partnering with Pediatricians to Reduce Rates of Early Childhood Caries • Communication skills training for clinicians • Edits to the anticipated counseling topics • Creation of an educational brochure 4. Toothbrushing at school: Effects on toothbrushing behaviour, cognitions and habit strength • Children in the intervention schools brushed their teeth at school under supervision. • Brushing teeth at school resulted in a significant increase in frequency of toothbrushing. However, these effects had not been maintained at one-year follow-up. No effects on cognitions about toothbrushing or on habit strength were found. 5. The Crest Cavity-Free Zone Program • Educational oral health program conducted at Boys & Girls Club of America Sites. • Multi-week program with modules based on age group • Self-esteem building and developing positive attitudes toward dentists
  • 4. OBJECTIVES  Target Audience  Primary care takers of toddlers, ages 2-5.  Health Goal  To decrease morbidity related to gum disease and tooth decay.  Behavioral Objectives  By the end of this campaign at least 33 percent of our target audience will engage their children in daily, healthy dental practices (i.e. tooth brushing 2x per day).  Communication Objectives  By the end of this campaign at least 33 percent of our target audience will demonstrate increased awareness of their toddlers’ susceptibility to gum disease and tooth decay through their interaction with the text messaging campaign. (perceived susceptibility)  By the end of this campaign at least 33 percent of our target audience will report improved self-efficacy in their ability to incorporating the healthy dental practice of tooth brushing twice a day into their daily activities. (self-efficacy)  By the end of this campaign at least 33 percent of our target audience will indicate a reduction in their perceived barriers to initiating and maintaining the healthy dental practice of tooth brushing twice a day into their routines. (perceived barriers)
  • 5. THE HEALTH BELIEF MODEL Modifying Individual Beliefs Factors Perceived Susceptibility Perceived Threat Age Perceived Gender Benefits Ethnicity Health SES Behavior Personality Perceived Knowledge Barriers Perceived Self- Efficacy Cues to Action
  • 13. EVALUATION PLAN  Baseline Evaluation Questions  First status: Currently, how many times per day does your child brush his/her teeth? Text 0, 1, or 2  Self-efficacy Check: It’s day 3 of your healthy habit routine! Rate your ability to brush your child’s teeth twice a day. Text HIGH, MEDIUM, or LOW  Barriers Check (open-ended responses): What's the biggest barrier to getting your child to brush their teeth twice a day for 2-3 minutes?  Susceptibility Knowledge: FACT – Did you know “Dental Caries” or tooth decay is largely preventable but most common chronic disease of children aged 6 to 11 years (25%). Text YES or NO  Mid-Program and Post-Program Assessment (Follow-up to Baseline Questions)  Did you read the messages? Text YES or NO  Did you like the messages? Text YES or NO  Overall, how satisfied with the text messages were you? Text A. Very satisfied, B. Satisfied, C. Dissatisfied, D. Very Dissatisfied  Did you find the messages helpful? Text YES or NO  Overall, what type of text message was the most helpful? Text TIPS or FACTS or BOTH  Would you recommend Text4Tots to others trying to initiate healthy tooth brushing habits with their toddlers? Text YES or NO  Final Status (Compare to baseline First status): Currently, how many times per day does your child brush his/her teeth? Text 0, 1, or 2  Self-efficacy Check (compare results to baseline): Txt4Tots: It's been over a week, you're a pro! How would you rate your ability to brush your child's teeth twice a day? Text HIGH, MEDIUM, or LOW  Barriers Check (compare results to baseline): Txt4Tots: It's been 2-weeks since you joined this program! Have you been able to overcome barriers to brushing your child's teeth twice a day? Text YES or NO  Susceptibility Quiz (compare results to baseline FACT): It's been 1-week since you started this program! Quick QUIZ - Are children who don't brush their teeth twice a day at risk for chronic disease? Text YES or NO  Did you learn anything from the Txt4Tots Program? If yes, what did you learn?  Based on your participation in the Txt4Tots program, do you think you will change your tot’s toothbrushing behavior? If yes, how?  Additional Comments about the Text4Tots Program  Other Assessment: Engagement in the Text4Tots Program  Track average # of interactions (replies) to Tips, Facts, and Reminders
  • 14. RESULTS  Susceptibility Knowledge Checks:  Did you know “Caries” or tooth decay is largely preventable but the most common chronic disease of children aged 6-11 years?  It's been 5 days since you started this program! Quick QUIZ - Are children who don't brush their teeth twice a day at risk for chronic disease?  Self-Efficacy Checks:  It's day 3 of your healthy habit routine! Rate your ability to brush your child’s teeth twice a day. Text HIGH, MEDIUM, or LOW.  By now you're a pro! How would you rate your ability to brush your child's teeth twice a day? Text HIGH, MEDIUM, or LOW.  Barriers Checks:  Help us, help you! What is your biggest barrier to getting your tot's teeth brushed twice a day for 2-3 minutes?  It's been 1 week since you joined this program! Have you been able to overcome barriers to brushing your child's teeth twice a day? Text YES or NO
  • 15. RESULTS 100% of participants responded to the program evaluation survey and indicated that they read and liked the messages.  By the end of the campaign 86% of participants were brushing their tot’s teeth twice a day.  Overall, 100% of the participants were either satisfied or very satisfied with the messages.  6 of 7 participants found the messages helpful.  A majority (86%) of participants would recommend the program to others.  4 out of 7 people indicated that they learned something new from the program. Specifically, one participant said they learned the “importance of brushing at least twice a day.”  3 out of 7 participants indicated that as a result of the program, they would change their child’s tooth brushing behavior.
  • 16. RESULTS  Did you learn anything from the Txt4Tots Program? If yes, what did you learn?  Importance of brushing at least twice a day  Based on your participation in the Txt4Tots program, do you think you will change your tot’s toothbrushing behavior? If yes, how?  Always brushing 2 times per day  Utilize tips to make it an easier process  Additional comments:  “It helped me to remember to help my son brush his teeth. Before I wasn't always consistent with night time brushing. it helped to make it habitual.”  “My child has been already brushing his teeth twice (but sometimes only once) per day. The program was useful with tips and facts for a parent to keep a closer eye on how the toddler brushes teeth but I cannot say that it modified anything for us. Our child likes brushing his teeth but won't do it for long enough passages of time or clean all the surfaces, etc.”  “Thought it was a great program. Just didn't learn new things and my routine so far works since my first 2 kids have never had a cavity in 13yrs :) Definately really good for first time parents.”
  • 17. LESSONS LEARNED  Market to new mothers  More personalization  Use keywords to structure program, reduce barriers, and meet needs  Looking forward  More interactivity  Web component  Timing of messages and reminders on personalized schedules
  • 18. REFERENCES  Curnow, M M T (07/2002). "A randomised controlled trial of the efficacy of supervised toothbrushing in high-caries-risk children". Caries research (0008-6568), 36 (4), 294.  Chang, Yu-Chen, et al. “Playful Toothbrush: UbiComp Technology for Teaching Tooth Brushing to Kinedegarten Children”. Proceeding of the twenty-sixth annual SIGCHI conference on Human factors in computing systems, April 05- 10, 2008, Florence, Italy.  Kressin, Nancy R (11/2009). "Pediatric clinicians can help reduce rates of early childhood caries: effects of a practice based intervention". Medical care (0025-7079), 47 (11), 1121.  Marianne Wind, Stef Kremers, Carel Thijs, Johannes Brug, (2005) "Toothbrushing at school: Effects on toothbrushing behaviour, cognitions and habit strength", Health Education, Vol. 105 Iss: 1, pp.53 – 61  Biesbrock, Aaron R (2004). "Short-term impact of a national dental education program on children's oral health and knowledge". The Journal of clinical dentistry (0895-8831), 15 (4), 93.