JMIR Publications

ABSTRACT

Background:

Access to oral health promotion for older adults is limited, particularly in rural areas of low– and middle-income countries.

Objective:

To develop a telehealth reinforcement strategy for oral health promotion aimed at improving knowledge, attitudes, and self-efficacy in community–dwelling older adults.

Methods:

A single-center, parallel-group randomized controlled trial was conducted across four municipalities (two urban, two rural) in the La Araucanía Region of Chile. Eligible participants were functionally independent adults aged ≥60 years with smartphone and internet access; those with cognitive impairment, complete edentulism, or inability to use WhatsApp were excluded. Participants were recruited from regional databases and completed a baseline clinical assessment using TEGO®, a Chilean teledentistry tool designed to support remote consultations and enhance dental care access for older adults. Participants were randomized (1:1, computer-generated) to receive either a face-to-face oral care instruction session delivered by a dentist (comparator group), or the same session followed by telehealth reinforcement delivered via WhatsApp (telehealth group). The reinforcement, grounded in Social Cognitive Theory (SCT), consisted of four validated educational videos addressing dental caries, periodontal disease, oral cancer, and oral hygiene. Clinicians and statistical advisors were blinded, though participants were aware of the intervention during the reinforcement phase. Primary outcomes were changes in oral health knowledge, attitudes, and oral health self-efficacy measured via a telephone–administered questionnaire at baseline and six weeks after. Secondary outcomes included acceptability of the telehealth strategy and self-reported oral health behaviors. Analyses included hypothesis testing, multiple correspondence analysis, and k–means clustering.

Results:

A total of 120 older adults were randomized (comparator n=59; telehealth n=61), of whom 103 were analyzed (comparator n=51; telehealth n=52). Recruitment and follow-up were completed as planned. Both groups showed substantial within-group improvements in overall oral health knowledge (comparator: d=0.93, 95% CI 0.52-1.34, P<.001 ; telehealth: d=1.07, 95% CI 0.66- 1.48, P<.001) and self-efficacy (comparator: r=0.59, 95% CI 0.38-0.74, P<.001; telehealth: r=0.62, 95% CI 0.43-0.77, P<.001). Between-group differences favored telehealth for dental caries knowledge (r= 0.20, 95% CI 0.10-0.30, P=.03) and attitudes (r= 0.28, 95% CI 0.18-0.37, P=.004). Rural participants exhibited greater improvements in recognizing signs and preventive measures for periodontal disease (P=.01) and oral cancer (P<.001), and in flossing behavior (P<.001). No adverse events were reported. Overall, the telehealth intervention showed considerable acceptability (over 80%).

Conclusions:

Both groups improved in oral health indicators, with SCT-based telehealth reinforcement providing modest added benefits, particularly among rural participants, an underrepresented population in prior telehealth research. This study offers innovation by evaluating telehealth as a theory-driven reinforcement to high-quality preventive care, delivered through a familiar platform to older adults in resource-limited settings. Telehealth was acceptable and showed potential for broader application. Future research should examine long–term effects, adaptability across diverse populations, and cost–effectiveness before public health integration. Clinical Trial: ClinicalTrials.gov NCT05917548; https://clinicaltrials.gov/study/NCT05917548