Abstract
AimsTo assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application.DesignA stratified, parallel-group, three-arm individually randomized controlled pilot trial.SettingTwo Los Angeles area Early Head Start (EHS) sites.Participants36 parent-child dyads enrolled in an EHS home visit program for 0–3 year olds.InterventionsEligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks.OutcomesPrimary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child’s teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs.FindingsDigital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16.ConclusionsTrial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration.Trial registrationClinicalTrials.gov identifier NCT03862443.
Highlights
Childhood caries remains the most prevalent chronic childhood disease in the United States [1]
The study was deemed acceptable to Early Head Start (EHS) staff, based on participation in study informational sessions and trainings, as well as EHS staff’s willingness to distribute flyers and introduce the program to families for the program during home visits
The lottery incentive group had more qualifying episodes per week than the control group
Summary
Childhood caries remains the most prevalent chronic childhood disease in the United States [1]. Initiating early prevention may contribute to forming and maintaining healthy dental habits, thereby preventing disease and sequelae [4]. Personal incentives are commonly part of health promotion programs but have not yet been used in dentistry. Over three-quarters of large US employers offer monetary incentives through wellness programs [5]; publicly funded programs often provide subsidies or vouchers for food, family planning services, and other preventive health products. Several studies have shown that incentives can effectively promote a wide range of preventive health behaviors [6, 7]. Despite evidence supporting the effectiveness of incentives and their popularity, their efficacy for encouraging oral health management remains untested
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