Text4Tots: A Mobile Oral Health Intervention

Chris BurtonKristal Dail

Kitty Harding

ConceptText4Tots is an oral health text messaging

campaign designed to educate parents with children between the ages of 2-5 on oral health education and information

The program’s goal is to reduce the incidence of cavities in the children of our target audience by 10% over two years

A series of 4 text messages were sent per dayThe Health Belief Model was used to achieve

the program’s goal

Morning Messages Morning messages included an encouraging

reminder to brush their child’s teeth. Perceived efficacy: Parents self assessment of

ability to successfully adopt the desired behavior

Cues to action: Text4Tots promoting the desired behavior

Morning messages influenced brushing your child’s teeth as a routine behavior, one of our health objective goals

Morning Messages

Afternoon MessagesThe two afternoon messages included oral health

education, information, tips and interactive activities to encourage good oral health for children.

Perceived susceptibility: Parents assessment of their child’s risk of getting cavities

Perceived severity: Parents assessment of the consequences of eating sugary foods

Perceived barriers: Low self efficacy, lack of knowledgePerceived benefits: Parents understanding of the health

benefits of good oral health.Afternoon messages provided knowledge and awareness

of beneficial oral health practices, one of our communication objective goals

Perceived Susceptibility & Severity

Perceived Barriers & Benefits

Knowledge and Awareness

Evening MessagesEvening messages included an encouraging

reminder to brush their child’s teeth before bed.

Perceived efficacy: Parents self assessment of ability to successfully adopt the desired behavior,

Cues to action: Text4Tots promoting the desired behavior

Evening messages influenced brushing your child’s teeth as a routine behavior, one of our health objective goals

Evening Messages

“BRUSH” ResponsesAfter every morning and evening reminder

text, we asked participants to text the word “BRUSH” when done

We would then respond in the mornings, “ Great job! Brushing in the morning will set your tot up for a smile-filled day!” and in the evenings, “ Good work! Brushing is a great way to end your tot’s day!”

This provided reinforcement that parents were doing a good job and helped to motivate them to continue brushing their child’s teeth every morning and night

Survey DataPre-Test

How many children do you have an what ages are they?1—age 41—age 51—age 21—age 23—ages 5, 4, and 2months2—ages 5 and 81—age 31—age 42—ages 3 and 1

Survey DataPre-Test

Cell Phone CapabilitiesReceive texts- 9/9Receive email- 9/9Connect to the internet- 9/9View video- 8/9Click through dial- 9/9

Survey DataWhen was the last time your child went to the

dentist?1-3 months ago: 2/94-6 months ago: 4/97-9 months ago: 010-12 months ago: 1/9More than a year ago: 0Never: 2/9

My child has had:No cavities: 9/9

Survey DataDo you brush your child’s teeth or supervise their brushing?

Pre-Test

Always: 8/9Most of the time: 0Sometimes: 1/9Rarely: 0Never: 0

Post-Test

Always: 7/8Most of the time: 0Sometimes: 1/8Rarely: 0Never: 0

Pre-Test

Never: 01 time: 1/92 times: 7/93 times: 1/9More than 3 times: 0

Post-Test

Never: 01 time: 02 times: 6/83 times: 2/8More than 3 times: 0

Survey DataHow often does your child (or you) brush their teeth each day?

Pre-Test

Daily: 2/9A few times a week: 2/9Weekly or less: 2/9 No: 3/9

Post-Test

Daily: 1/9A few times a week: 3/9Weekly: 1/9 No: 3/9

Survey DataDo you floss your child’s teeth? If yes, how often

Pre-Test

Post-Test

Survey DataPlease rate the following statements from 1- not important to 5 very important

1 2 3 4 5

Clean teeth are important to my child’s healthy development

0 0 0 0 9

I think children should go to the dentist every 6 months

0 0 2 0 7

I know where to find information about taking care of my kid’s teeth

0 0 1 2 6

Children should be supervised when brushing and flossing

0 0 0 1 8

1 2 3 4 5

Clean teeth are important to my child’s healthy development

0 0 0 0 8

I think children should go to the dentist every 6 months

0 0 1 1 6

I know where to find information about taking care of my kid’s teeth

0 0 0 0 8

Children should be supervised when brushing and flossing

0 0 0 0 8

Pre-Test9 responses, average 2.5 items Brushing and diet monitoring. (2) Kids have to drink plenty of water and less juice

and definitely NO sodas. Children should also floss at night and brush their teeth at night and in the morning. They also need to see a dentist every six months. (4)

Brush regularly, keep routine dentist appointments. (2)

Minimize sweets. Tooth brushing after every meal. (2)

They eat cheese regularly as I have read that is good for oral care. Brushing themselves and teaching them to brush as well as minimizing sugar/candy intake. No soda. (3)

Try to avoid to much candy, chewy especially and floss after eating. (2)

1. Brushing and flossing. 2. Monitoring candy intake. 3. Dental check ups. (3)

Proper brushing, limited sweets and candy . (2) Make it fun, routine, drink less juice and eat less

sweets. (3)

Post-Test6 responses, average 3.3 items Offering healthy snacks instead of

candy, brushing, flossing and dental check ups. (4)

Brushing at least twice a day, flossing at least twice a week, minimal sweets and diets high in calcium. (4)

Brush after every meal, floss. (2)

Brush twice a day, floss, regular dental check ups, no sodas, and lots of water. (5)

Limit sugars and brush daily. (2) Brushing, flossing, monitoring food

and drink intake. (3)

Survey DataPlease list as many things as you can think of that you can do to keep your child's teeth healthy.

Survey DataI liked the Text4Tots program.Yes: 100%Comments1. I liked the text reminders to brush your toddler's teeth. I used it

as an alarm with my 3yr old son. I would say "ok Bj your tooth brush alarm is ringing, time to brush your teeth & get the stinky out” lol. I enjoyed the text msgs, I thought they were informative. I'm going to set a set a "tooth brush alarm", on my cell phone to motivate my toodler to brush his teeth. As a parent, I'm always trying to find fun and creative ways to promote healthy habits with my son.

2. Texts were sent too early, should adjust per schedule. 3. I liked the program however if it could be customized per family

schedules I think the responses might be better. Such as the first Brush of the day some may sleep in on certain days.

I would continue receiving Text4Tots messages, if it was possible.Yes: 50%No: 50%

I would recommend Text4Tots to a friend.Yes: 88%No: 12%

Text4Tots sends too many messages.Yes: 0%No: 100%

Fill in the blank: I read _____ of the Text4Tots messages.All: 75%Most: 12%Some: 0%Few: 12%None: 0%

Survey Data

Suggested ImprovementsAutomated delivery system to better fit participants

schedules.More reinforcing messages after BRUSH text.Addition of FLOSS response, and corresponding

messaging.Possibility for targeted modules based on tot’s ageEnhanced interaction:

Text pictures of you and your tot brushing.Develop quizzes or oral health games/activitiesGoal setting (# of BRUSH’s per week)Ability to report dentist visits.