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Co-designed SMS intervention for parents of children with early childhood caries: A randomised controlled trial
ABSTRACT
Background:
Early childhood caries (ECC) significantly impacts young children's health and quality of life and is preventable through behavioural modification. The WHO Global Health Action Plan (2023-2030) advocates for mHealth programs to support sustained oral health behaviour change.
Objective:
The aim of this study was to assess the effect of a 12-week text message education and support program for parents on managing their child’s oral health compared to standard clinical care.
Methods:
We conducted a multi-site, single-blinded, parallel design randomised controlled trial among parents of children aged 0–6 years who had ECC who accessed services from one of six public dental clinics in metro, regional, and rural locations in NSW, Australia. Participants were randomly assigned to either an intervention group, receiving the fully automated 12-week SMS intervention (SmilesUp), a co-designed program addressing oral health literacy delivered three times a week, or a control group. Both groups continued to receive usual clinical dental treatment. The primary outcome was meeting the target behaviour of the child having their teeth brushed twice a day with fluoride toothpaste, assessed on parental self-report questionnaire. Secondary outcomes included: healthy bedtime routines, frequency of consumption of child’s sugar sweetened beverages, and diets low in sugars.
Results:
154 participants were enrolled and randomised across six sites, with 124 (80%) completing the follow-up assessment. 96% [73 /76] of intervention participants completed the program. More SmilesUp participants reported brushing their child’s teeth twice daily (73.8% vs 66.7%; aOR 2.45 [95% CI, 0.95-6.74], p=.07), following bedtime routines (88.5% vs 71.4%; aOR 3.25 [95% CI, 1.15-10.18], p=.03), and having greater knowledge on tooth brushing (92.0% vs 78.8%; aOR 5.47 [95% CI, 1.48-25.19], p=.016) and knowledge about bedtime routines (91.8% vs 80.8%; aOR 5.76 [95% CI, 1.38-32.16], p=.03). A reduction in sugar-sweetened food consumption in the intervention group, with borderline significance (16.4% vs 6.3%; aOR 3.72 [95% CI, 1.02, 17.14], p=.06). No significant differences were found in sugar-sweetened beverage consumption (41.0% vs. 42.9%; aOR 1.08 [95% CI, 0.49, 2.30], p=0.85).
Conclusions:
Most participants completed the SmilesUp mHealth program and together with the findings, suggestive of behavioural changes indicate such a program may have positive benefits if provided at scale to parents of children with dental caries. Clinical Trial: Registration with the Australia New Zealand Clinical Trials Registry, ACTRN12623000325606.
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