JMIR Publications

ABSTRACT

Background:

Refugees frequently face language and access barriers to preventive health information, contributing to avoidable oral disease and widening health inequities. Scalable digital micro-learning interventions may offer a pragmatic strategy to reduce health information barriers in settings where conventional health education is difficult to deliver. y

Objective:

This randomized controlled trial aimed to evaluate whether a brief multilingual digital micro-learning intervention improves clinical oral hygiene outcomes and selected oral health literacy–related outcomes compared with delayed access control among adults living in refugee shelters.

Methods:

A two-arm, parallel-group randomized controlled trial was conducted among 86 adults living in two municipal refugee shelters in Germany (November 2023 - February 2024). Participants were randomized (1:1) to a four-minute animated oral-hygiene micro-learning video (“GlobeSmile”; Arabic, Kurdish, Dari, Farsi, Ukrainian) or delayed access. The intervention was viewed once at baseline on a tablet, with optional re-viewing via QR code for two months. Primary outcomes were change in Plaque Index (PI) and Gingival Index (GI) from baseline to two-month follow-up. Secondary outcomes included oral health knowledge, attitudes, perceived self-efficacy, and self-reported behaviours.

Results:

Eighty-three of 86 participants completed follow-up (97%). PI decreased more in the intervention group than in controls (mean change −0.21 ± 0.27 vs −0.04 ± 0.17; p = 0.002). GI decreased in both groups without significant between-group difference. Questionnaire findings indicated improvements in selected knowledge, attitude, and self-efficacy outcomes in the intervention group, while most self-reported behaviours and lifestyle factors changed little. Approximately three-quarters of intervention participants reported re-viewing the video at least once, and re-viewing was associated with larger PI reductions.

Conclusions:

Brief multilingual digital micro-learning may improve plaque control and selected oral health literacy outcomes in refugee shelters, supporting its potential as a scalable, low-cost strategy to reduce health information barriers in underserved settings. Clinical Trial: German Clinical Trials Register (DRKS00032017).