Text4Tots:An Oral Health PromotionText Messaging Program

Rinal PatelPriya Gangolly

Health Problem

Despite improvement in the overall oral health of Americans, the CDC has reported a significant increase in dental caries among children ages 2-5 years, setting the stage for many young children to develop a lifetime of complications from poor oral health.

http://www.cdc.gov/Features/dsUntreatedCavitiesKids/

Target Audience

Parents of children ages 2-5 in the United States.

Health Goal

Decrease the incidence of dental caries in children ages 2-5 by strengthening oral health

education skills and behaviors in parents.

Behavioral Objectives

By the end of our campaign, the number of parents of children ages 2-5 in our sample audience who:

1. supervise their children while brushing their teeth; and

2. perform checks on their children's teeth for white or brown spots

will increase by 30%, for the duration of the program.

Communication Objective

1) By the end of our campaign, 50% of the parents will report having increased their knowledge in oral health promotion for their children. (SCT – Behavior Capability)

2) By the end of our campaign, 50% of the parents will have the confidence, knowledge and skill to perform oral health monitoring of their children (SCT – Self-efficacy)

Text4Tots Participants

Parent 1

Girl – 5 years old

Parent 2

Boy – 2 years old

Parent 3

Girl – 3 years old

Parent 4

Girl – 2 years old

Parent 5

Boy – 3 years old

Parent 6

Girl – 4 years old

Text Messaging Program

• Trial period: 8 days (October 10th, 2011 – October 17th, 2011)

• Pre-Evaluation Survey – October 9, 2011• 3 Questions

• Opt-in Day – October 10, 2011

• Evaluation survey – October 18th, 2011• For parents who were in compliance with our behavioral and

communication objectives received incentives.• Incentives: coupon links for various oral health products

(toothbrushes, floss, toothpaste, mouthwash, etc)

• 3 messages a day targeted by age.

October 10, 2011 – Opt in Day

Welcome Welcome to Text4Tots! Congratulations on taking a step towards making your tot smile! To opt out at any time, text STOP to this number.

First Status How old is your tot? Reply with: 2, 3, 4, or 5.

2 Most of the 20 primary teeth will appear by age 2. By age 1, your child should have made their first trip to the dentist.

3 All of your baby's primary teeth should have erupted by age 3. Make sure to visit your baby's dentist every 6 months.

4 Your child should be developing oral health skills that will last a lifetime! Lead by example by brushing your teeth twice a day and flossing regularly.

5 Your child should be developing oral health skills that will last a lifetime! Lead by example by brushing your teeth twice a day and flossing regularly.

Parent 2Day 1: October 11, 2011Age 2:

Time: Message:

10:30am

You can pass germs that may cause tooth decay to your child through saliva. Rise with anti-bacterial mouthwash to reduce the number of cavity-causing bacteria.

3:00pm Do not share cups or eating utensils, pre-chew your child's food, or put a pacifier in your mouth before giving it to your child.

7:30pm Lift your child’s lip daily and look for white or brown spots on the front and back sides of teeth near the gum line. See a dentist if you notice changes.

Parent 2Day 7: October 17,

2011Age 2:

Time Message:

10:30am

Have your child pick a favorite song to hum while brushing their teeth. Continue this as they get older so they brush for the appropriate amount of time.

3:00pm Don't let children brush their own teeth until around the ages of 7 to 9 — or until they're able to tie their shoes or cut their meat on their plates.

7:30pm You have the tools and skills now to give your child lifelong good oral health habits. Will you be able to remember these tips? Reply with: YES or NO

YES Congratulations on finishing the Text4Tots program and learning how to keep your child smiling! Text END to stop the program.

NO No problem! We will start the program over so you can learn some more tips. Text BEGIN to get started!

What did the Parents Think?

Did you read all of the text messages?:All of them =50%(3/6) Most of them=33%(2/6)

Were the text messages helpful?: 50% Yes 50% Somewhat

How many of the last 7 days did you check your child’s teeth for signs of dental caries? 7 =83% (5/6) 6 =17% (1/6)

During the last 7 days, did you supervise your child every day when they brushed their teeth?: Every day= 67%(4/6)

Did the coupons for dental products help you increase your oral health promotion efforts in your children?

Somewhat= 50%(3/6) Yes= 33%(2/6)

What did the Parents Think?

Rate how much you liked the program (1-5): 3.67

Has this program helped you and your family take better care of your teeth and gums?83%(5/6) Yes (1/6) Somewhat

Would you recommend the program to others?: 83%(5/6) Yes

• Parents preferred an emphasis on dental caries checks and supervision reminders

• Parents appreciated the program catered to their child’s age

Limitations

• 3 messages a day…difficult to send out at the assigned time due to messengers’ busy schedules

• Parents have different schedules – ask for preferred time in revised campaign

• Providing incentive links was difficult for parents who do not use smartphones

• Since we catered the program to different ages, difficult to keep track of what targeted messages to send, but automated system would solve this issue

Final Product

• Update text message library to include an option for parents to ask questions and get tips from us.

• Provide small games to keep the parents engaged in the text message program

• Timed messages based on parent/child’s schedule

• Ask evaluation questions throughout the program and provide incentives for each question the parent answers.

Yay Teeth!