JMIR Publications

ABSTRACT

Background:

The prevention of oral health diseases is a key public health issue, and a major challenge for racial and ethnic minorities who often face barriers in accessing dental care. Daily toothbrushing is an important self-care behavior necessary for sustaining good oral health, yet engagement in regular brushing remains a challenge. Identifying strategies to promote engagement in regular oral self-care behaviors among populations at-risk for poor oral health is critical.

Objective:

The formative research described here focused on creating messages for a digital oral self-care intervention targeting a racially and ethnically diverse population. Theoretically grounded strategies were employed to promote engagement in three aspects: the oral self-care behaviors, the oral-care smartphone application, and the digital messages. A virtual participatory co-design approach was used to develop and refine the messages; this approach involved dental experts, individuals from the general population, and individuals from the target population – dental patients, predominantly low-income racial and/or ethnic minorities. Given that many individuals from racially and ethnically diverse populations face anonymity and confidentiality concerns when participating in research, we utilized an approach to message development that aimed to mitigate these concerns.

Methods:

Messages were initially developed with feedback from dental experts and Amazon Mechanical Turk (MTurk) workers. Dental patients were then recruited for two facilitator-mediated group webinar sessions held over Zoom (Session 1: N=13; Session 2: N=7) in which they provided both quantitative ratings and qualitative feedback on the messages. Participants interacted with the facilitator through virtual polls and a chat window that was anonymous to other participants. Participants did not directly interact with each other, and the facilitator mediated sessions by verbally sharing participant message suggestions with the entire group for additional feedback. This approach plausibly enhanced participant anonymity and confidentiality during the sessions.

Results:

Participants rated messages in all categories highly in terms of liking (overall rating M = 2.63, SD = .58; on a scale ranging from 1 = Do not like it to 3 = Like it). Qualitative feedback indicated that participants preferred messages that were straightforward, enthusiastic, conversational, relatable, and authentic.

Conclusions:

Insights gleaned from this formative research have the potential to guide the design of messages for future digital health behavior interventions targeting individuals from diverse racial and ethnic populations. This work emphasizes the importance of identifying the key stimuli and tasks that require engagement, involving multiple stakeholders in the process of message development, and utilizing new approaches for collecting both quantitative and qualitative data while mitigating possible anonymity and confidentiality concerns.