Class Assignment 1 for Lorien Abroms

1. TEXT4TOTS: TOOTH BRUSHING
PubH 6570: Advanced Health Communications
Sarah Leonard
Lindsay Wolfe

2. 5 BEST EXISTING SOLUTIONS
1. School-Based Intervention to
Promote Tooth Brushing
• Supervised tooth brushing with high
fluoridated toothpaste on school
days to prevent dental caries among
high risk children.
• Local mothers were trained as
toothbrushing supervisors.
2. Playful Toothbrush: UbiComp
Technology for Teaching Tooth
Brushing to Kindegarten Children
• Vision-based motion tracker:
recognizes different tooth brushing
strokes.
• Tooth brushing game: child cleans a
virtual, mirror picture of their dirty
teeth by physically brushing their
own.

3. 5 BEST EXISTING SOLUTIONS
3. Partnering with Pediatricians to Reduce Rates of Early
Childhood Caries
• Communication skills training for clinicians
• Edits to the anticipated counseling topics
• Creation of an educational brochure
4. Toothbrushing at school: Effects on toothbrushing
behaviour, cognitions and habit strength
• Children in the intervention schools brushed their teeth at school
under supervision.
• Brushing teeth at school resulted in a significant increase in frequency
of toothbrushing. However, these effects had not been maintained at
one-year follow-up. No effects on cognitions about toothbrushing or on
habit strength were found.
5. The Crest Cavity-Free Zone Program
• Educational oral health program conducted at Boys & Girls Club of
America Sites.
• Multi-week program with modules based on age group
• Self-esteem building and developing positive attitudes toward dentists

4. OBJECTIVES
 Target Audience
 Primary care takers of toddlers, ages 2-5.
 Health Goal
 To decrease morbidity related to gum disease and tooth decay.
 Behavioral Objectives
 By the end of this campaign at least 33 percent of our target audience will engage
their children in daily, healthy dental practices (i.e. tooth brushing 2x per day).
 Communication Objectives
 By the end of this campaign at least 33 percent of our target audience will
demonstrate increased awareness of their toddlers’ susceptibility to gum disease
and tooth decay through their interaction with the text messaging campaign.
(perceived susceptibility)
 By the end of this campaign at least 33 percent of our target audience will report
improved self-efficacy in their ability to incorporating the healthy dental practice
of tooth brushing twice a day into their daily activities. (self-efficacy)
 By the end of this campaign at least 33 percent of our target audience will
indicate a reduction in their perceived barriers to initiating and maintaining the
healthy dental practice of tooth brushing twice a day into their routines.
(perceived barriers)

5. THE HEALTH BELIEF MODEL
Modifying Individual Beliefs
Factors
Perceived
Susceptibility Perceived
Threat
Age
Perceived
Gender Benefits
Ethnicity Health
SES Behavior
Personality Perceived
Knowledge Barriers
Perceived Self-
Efficacy
Cues to
Action

6. MESSAGE LIBRARY

7. MESSAGE LIBRARY

8. SAM EVALUATION

9. REVISED MESSAGE LIBRARY

10. REVISED MESSAGE LIBRARY

11. TESTED MESSAGE LIBRARY

12. TESTED MESSAGE LIBRARY

13. EVALUATION PLAN
 Baseline Evaluation Questions
 First status: Currently, how many times per day does your child brush his/her teeth? Text 0, 1, or 2
 Self-efficacy Check: It’s day 3 of your healthy habit routine! Rate your ability to brush your child’s teeth twice a
day. Text HIGH, MEDIUM, or LOW
 Barriers Check (open-ended responses): What's the biggest barrier to getting your child to brush their teeth
twice a day for 2-3 minutes?
 Susceptibility Knowledge: FACT – Did you know “Dental Caries” or tooth decay is largely preventable but most
common chronic disease of children aged 6 to 11 years (25%). Text YES or NO
 Mid-Program and Post-Program Assessment (Follow-up to Baseline Questions)
 Did you read the messages? Text YES or NO
 Did you like the messages? Text YES or NO
 Overall, how satisfied with the text messages were you? Text A. Very satisfied, B. Satisfied, C. Dissatisfied, D.
Very Dissatisfied
 Did you find the messages helpful? Text YES or NO
 Overall, what type of text message was the most helpful? Text TIPS or FACTS or BOTH
 Would you recommend Text4Tots to others trying to initiate healthy tooth brushing habits with their toddlers?
Text YES or NO
 Final Status (Compare to baseline First status): Currently, how many times per day does your child brush
his/her teeth? Text 0, 1, or 2
 Self-efficacy Check (compare results to baseline): Txt4Tots: It's been over a week, you're a pro! How would you
rate your ability to brush your child's teeth twice a day? Text HIGH, MEDIUM, or LOW
 Barriers Check (compare results to baseline): Txt4Tots: It's been 2-weeks since you joined this program! Have
you been able to overcome barriers to brushing your child's teeth twice a day? Text YES or NO
 Susceptibility Quiz (compare results to baseline FACT): It's been 1-week since you started this program! Quick
QUIZ - Are children who don't brush their teeth twice a day at risk for chronic disease? Text YES or NO
 Did you learn anything from the Txt4Tots Program? If yes, what did you learn?
 Based on your participation in the Txt4Tots program, do you think you will change your tot’s toothbrushing
behavior? If yes, how?
 Additional Comments about the Text4Tots Program
 Other Assessment: Engagement in the Text4Tots Program
 Track average # of interactions (replies) to Tips, Facts, and Reminders

14. RESULTS
 Susceptibility Knowledge Checks:
 Did you know “Caries” or tooth decay is largely preventable but the
most common chronic disease of children aged 6-11 years?
 It's been 5 days since you started this program! Quick QUIZ - Are
children who don't brush their teeth twice a day at risk for chronic
disease?
 Self-Efficacy Checks:
 It's day 3 of your healthy habit routine! Rate your ability to brush
your child’s teeth twice a day. Text HIGH, MEDIUM, or LOW.
 By now you're a pro! How would you rate your ability to brush your
child's teeth twice a day? Text HIGH, MEDIUM, or LOW.
 Barriers Checks:
 Help us, help you! What is your biggest barrier to getting your tot's
teeth brushed twice a day for 2-3 minutes?
 It's been 1 week since you joined this program! Have you been able to
overcome barriers to brushing your child's teeth twice a day? Text
YES or NO

15. RESULTS
100% of participants responded
to the program evaluation
survey and indicated that they
read and liked the messages.
 By the end of the campaign 86% of participants were brushing
their tot’s teeth twice a day.
 Overall, 100% of the participants were either satisfied or very
satisfied with the messages.
 6 of 7 participants found the messages helpful.
 A majority (86%) of participants would recommend the program to
others.
 4 out of 7 people indicated that they learned something new from
the program. Specifically, one participant said they learned the
“importance of brushing at least twice a day.”
 3 out of 7 participants indicated that as a result of the program,
they would change their child’s tooth brushing behavior.

16. RESULTS
 Did you learn anything from the Txt4Tots Program? If yes,
what did you learn?
 Importance of brushing at least twice a day
 Based on your participation in the Txt4Tots program, do you
think you will change your tot’s toothbrushing behavior? If
yes, how?
 Always brushing 2 times per day
 Utilize tips to make it an easier process
 Additional comments:
 “It helped me to remember to help my son brush his teeth. Before I
wasn't always consistent with night time brushing. it helped to make
it habitual.”
 “My child has been already brushing his teeth twice (but sometimes
only once) per day. The program was useful with tips and facts for a
parent to keep a closer eye on how the toddler brushes teeth but I
cannot say that it modified anything for us. Our child likes brushing
his teeth but won't do it for long enough passages of time or clean all
the surfaces, etc.”
 “Thought it was a great program. Just didn't learn new things and my
routine so far works since my first 2 kids have never had a cavity in
13yrs :) Definately really good for first time parents.”

17. LESSONS LEARNED
 Market to new mothers
 More personalization
 Use keywords to structure program, reduce barriers,
and meet needs
 Looking forward
 More interactivity
 Web component
 Timing of messages and reminders on personalized
schedules

18. REFERENCES
 Curnow, M M T (07/2002). "A randomised controlled trial of
the efficacy of supervised toothbrushing in high-caries-risk
children". Caries research (0008-6568), 36 (4), 294.
 Chang, Yu-Chen, et al. “Playful Toothbrush: UbiComp
Technology for Teaching Tooth Brushing to Kinedegarten
Children”. Proceeding of the twenty-sixth annual SIGCHI
conference on Human factors in computing systems, April 05-
10, 2008, Florence, Italy.
 Kressin, Nancy R (11/2009). "Pediatric clinicians can help
reduce rates of early childhood caries: effects of a practice
based intervention". Medical care (0025-7079), 47 (11), 1121.
 Marianne Wind, Stef Kremers, Carel Thijs, Johannes Brug,
(2005) "Toothbrushing at school: Effects on toothbrushing
behaviour, cognitions and habit strength", Health Education,
Vol. 105 Iss: 1, pp.53 – 61
 Biesbrock, Aaron R (2004). "Short-term impact of a national
dental education program on children's oral health and
knowledge". The Journal of clinical dentistry (0895-8831), 15
(4), 93.