Health belief model for empowering parental toothbrushing and sugar intake control in reducing early childhood caries among young children

Abstract

Introduction: Mobile health (mHealth) approaches have been recognized as a promising tool to prevent early childhood caries (ECC). The use of behavior theory can help to better design the mHealth approach. Health belief model (HBM) is one of the most popular behavior theories that could promote a change in health behavior, and eventually prevent disease. Objectives: 1) To investigate the effectiveness of mHealth approach in preventing ECC through the systematic review; 2) to explore the relationship between the behavior and health beliefs by developing and validating an HBM scale for parents with young children; and 3) to evaluate the effectiveness of the mHealth approach empowered by HBM in improving oral health behaviors and preventing ECC. Methods: Studies with mHealth approaches targeting parents/caregivers of children aged 12 or under were included in the systematic review. A randomized controlled trial with the HBM mobile message intervention was designed and conducted. This RCT involved parent-child dyads with children aged 18-30 months in Hong Kong, with the intervention consisting of a set of HBM-based text messages sent regularly over 48 weeks. The primary outcome was the dental caries measured by dmft of the children after 2 years (around 4 years of age). The secondary outcomes were tooth 1 brushing and sugary snack intake. The social demographic characteristics, self-reported oral health behaviors were collected by one questionnaire. A HBM scale on ECC prevention behaviors was developed to collect the health beliefs of the parents. Factor analysis was performed to validate the scale and the reliability of the final model was checked. The behavioral and clinical outcomes were also evaluated. Results: The systematic review found evidence showing that mHealth approach could increase parents’ knowledge and improve their brushing behaviors for children. However, the level of the evidence was low. Altogether 628 parent-child dyads participated at baseline. Results from the factor analysis and interrater reliability test showed that developed HBM scale demonstrated satisfactory reliability and validity. At the first follow-up, parents in the test group had a higher chance to control their children’s sugary snack intake frequency at or within twice a day (OR = 1.53, p = 0.040), and to clean the teeth of their children twice or more frequently per day (OR = 2.03, p = 0.004). Children in the test group were also less likely to have a higher mean d3-6mft increment (IRR = 0.40, P = 0.008). At the second follow-up, parents in the test group had a higher chance of cleaning their children's teeth twice or more frequently per day (OR = 1.61, p = 0.029), while no difference with the control group in their children’s sugary snack intake frequency. No difference in the caries increment was detected. Conclusion: The results suggested that the mobile message based on HBM had short-term effects in helping parents control the sugary snack intake frequency and improve the tooth cleaning frequency of their children. Self-efficacy was consistently the strongest predictor of the two behaviors. However, the effect of HBM message in preventing ECC is weak.