Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC

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The iSmile study is part of the NIDCR’s Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children. The prevalence of Early Childhood Caries (ECC) is increasing, disproportionately affecting racial and ethnic minorities. Prevention efforts for high risk groups require multi- level strategies. We will target parents/legal guardians of children (<7 years) during pediatric well-child visits at urban community health centers (CHCs) and a hospital-based pediatric clinic, and provide a text-message based ECC prevention intervention. Eighty five percent of adults use text messaging, with no disparities by race/ethnicity, education or income. The benefits of text message interventions include the use anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs electronically linked locally and >1,100 CHCs nationally). In UH2, we developed a theory-based text message program that is automated, interactive and gamified, and involves behavioral shaping towards better oral health. The content of the texts are consistent with AAP guidelines, and Social Cognitive Theory. We used the Fisher-Owens Model (2007) as an intervention planning framework. In the current UH3 phase, 754 parents/legal guardians of children <7 years attending our target CHCs were randomized to receive one of two dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). All participants have completed the intervention and collection of outcome data is ongoing. The primary outcome variable is ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the OHT intervention at CHCs, and assess changes in both pediatric and parent oral health behaviors. This research has strong potential to be an evidence based program that could easily be adopted at low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children <7 years old. Our text message intervention is innovative because involves system-generated real time support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels. Due to delays in start-up and the unanticipated costs due to COVID-19, this administrative supplement request for funding is necessary to complete the aims of the originally funded research.