Communicating the 'smart' Way to Improve and Support Oral Health Amongst Young Adults in New Zealand: A mHealth in Oral Health Study

Abstract

INTRODUCTION Free dental and oral health care is available to all New Zealanders until their 18th birthday. Despite this, oral disease remains one of the most prevalent, preventable diseases in New Zealand (NZ) communities. The impact of oral disease on individuals and society can be significant. Oral disease is expensive to treat. Therefore disease prevention, through effective oral health promotion messages that incorporate a focus on oral health literacy (OHL), should be a priority in clinical settings. The proliferation of mobile phones in recent years and young people’s fascination with this technology has led to mobile phones being identified as a platform for health promotion initiatives. The use of mobile phones in this way is called mobile health (mHealth). Unlike mainstream media campaigns, mobile phones offer an opportunity to communicate directly and personally with individuals using a variety of mobile phone functions. As young adults are now the largest user group of ‘smart’ mobile phones in NZ, mHealth could provide a novel and innovative platform to improve oral health amongst this group.

AIMS This mixed methods study, amongst 16 (18 to 24 year old) tertiary students in Auckland, had two aims: Aim One: Determine if a mHealth intervention a. could improve their oral health by complementing traditional oral health promotion b. was considered, by this cohort, to be an acceptable way of communicating oral health promotion messages c. could improve their OHL Aim Two: Determine which factors optimised the success of the mHealth intervention

METHOD AND METHODOLOGY This study was undertaken over six months. Participants were randomly allocated to four sample groups: Control and three intervention (Phone, Text, Video). Data was collected on three occasions (visits one to three) with the study aims assessed as follows: • Aim One: Quantitative measures of oral health (OHIP-14, Plaque Control Record) and OHL (REALD-30); Qualitative interview data • Aim Two: Qualitative interview data All participants received standardised oral health education (OHE) at visit one and oral hygiene instruction (OHI) at visits one and two. Monthly mHealth OHE was provided to the intervention groups, between visits one and three, using different smart phone functions: telephone conversation (Phone), SMS (Text) and MMS (Video). Semi-structured interviews were undertaken with all participants at visit three. The quantitative data was analysed, as applicable, statistically and descriptively. The qualitative data was analysed thematically.

STUDY RESULTS Aim One a. Overall oral health was not improved as OHRQoL measures were inconclusive. However, increased participant- reported motivation resulted in improved oral health self-efficacy across all intervention groups: Phone (20%), Text (6.5%), Video (3.5%). b. All intervention groups considered mHealth to be an acceptable health communication platform. c. Two intervention groups showed slight improvements in mean REALD-30 word recognition score: Video (6%), Phone (3%). Text group was unchanged. REALD-30 word comprehension scores were improved in all intervention groups: Text (7%), Video (6%) and Phone (5%)

Aim Two Participants reported increased engagement, trust and rapport with the oral health professional on receipt of monthly ‘personalised’ mHealth messages. The messages however, were perceived more as ‘reminders’, which reinforced the oral health promotion experiences in the clinical setting, than educative interventions.

CONCLUSION mHealth is an acceptable adjunct to improving oral hygiene practises and increasing OHL. The pivotal factor in its success, however, is the provision of regular oral hygiene self-care information using an intraoral demonstration and two-tone disclosing solution as an educative tool.