Motivational interviewing in improving adolescents’ oral health : face-to-face individual counselling vs. online groups

Abstract

Background: Oral health highly depends on one’s adoption of dentally healthy behaviors. Prevailing health education (HE) focuses on information/advice giving but usually fails to generate sustainable behavioral changes. Motivational interviewing (MI) has demonstrated its effectiveness in changing a wide range of health-related behaviors. Besides the traditional face-to-face individual counseling, MI can also be delivered through media (e.g., online) and in group setting. Objective：This randomized controlled trial aimed to compare the effectiveness of three interventions in improving adolescents’ oral health: HE, face-to-face individual MI, and online group MI. Methods：Twelve secondary schools were recruited and randomized into three groups, receiving HE (Group I), face-to-face individual MI (Group II) and online group MI (Group III) respectively. A total of 484 adolescents with unfavorable dental behaviors, defined as toothbrushing less often than twice daily and/or snacking more than twice daily, were recruited. There were 156, 169 and 159 participants in Groups I to III respectively. At baseline and after 6, 12, and 24 months, questionnaires were administered to collect information on socio-demographic factors, oral health self-efficacy, and oral health behaviors. Silness & Löe Plaque index and the International Caries Detection and Assessment System (ICDAS) were employed to record participants’ oral hygiene and caries status, respectively. Intention-to-treat analysis was performed. Mixed-effects logistic regression and generalized linear mixed models were constructed to adjust for confounding factors and address the clustering effect (by “school”). Results: 437 (90.3%) participants completed the whole trial. After 6 months, Group II had significantly higher likelihood of increasing their toothbrushing frequency [OR(95%CI): 3.50(1.15-10.68); p=0.032] than Group I; no significant difference was found between Group III and the other two groups (p>0.05). After 12 months, significantly lower plaque score was found in Group III [β(95%CI): -0.55(-1.04,-0.05); p=0.034] as compared with Group I, whereas Group II did not differ from the other two groups (p>0.05). Taking Group I as reference, significantly lower increment of cavitated surfaces (△DICDASII3-6MFS) was found in Group III [β(95%CI): -0.30(-0.59,-0.02); p=0.042], with no significant difference between Group II and the other two groups (p>0.05). However, there was no significant difference among the three groups in the increment of cavitated teeth (△DICDASII3-6MFT) (all p>0.05). The total increment of carious surfaces (△DICDASII1-6MFS) was significantly lower in Group II [β(95%CI): -3.09(-5.48,-0.70); p=0.017] and Group III [β(95%CI): -3.50(-5.90,-1.10); p=0.009], with no significant difference between Group II and Group III (p>0.05). The total increment of carious teeth (△DICDASII1-6MFT) followed the similar trend. After 24 months, multivariate analysis showed no significant difference in oral health self-efficacy and behaviors, plaque score and caries status among the three groups (all p>0.05). Conclusion：Both face-to-face individual MI and online group MI outperformed HE in changing adolescents’ oral health behaviors or oral hygiene status in 6 and 12 months and preventing dental caries in 12 months. Compared with HE, MI in both modes did not generate greater effect in changing adolescents’ oral health behaviors and oral hygiene status and preventing dental caries in 24 months.