Personalized Digital Behavior Change Interventions to Promote Oral Health

虽然牙病是可以预防的，但它是美国最常见的慢性病之一 并造成巨大的个人和社会损失。它与口腔健康素养低和口腔质量差密切相关 卫生行为(OHBs)。以牙病的高患病率和高负担为代表，有很大的 了解高质量的口腔卫生程序和个人实践之间的差距。原因何在 原因很多，但最终归结为系统性地未能传达口腔卫生说明(OHIS) 有效地或使患者参与和激励他们自己的口腔自我护理。 为了解决知识差距，我们首先将所需的刷牙行为提炼成一个简单的2x2x4 OHI (每天刷牙2次，每次2分钟，均为4个牙象限)。我们将利用跟踪功能 我们的创新eBrush平台可以远程监控家庭环境中的刷牙活动。使用2x2x4 OHI和eBrush作为基本元素，我们将开发和评估个性化数字的有效性 口腔健康干预(DOHI)促进高危人群理想的OHBs。在UG3阶段，我们将构建 为收集刷单数据和交付DoHi提供技术基础设施。然后，我们将与 在共同设计口腔自我护理应用程序时以最终用户为目标，并建立 系统。在UH3阶段，我们将建立和验证计算模型，以推断OHBs的质量 刷新数据并对Dohi进行个性化设置。利用130人的队列，我们将进行为期10周的微型随机 尝试优化参与战略的适应性定制。最后，我们将评估 在2x2x4 OHB中促进持续参与的计算驱动、自适应DoHI。我们假设 动态和个性化的DOHI将比传统的、静态的、临床医生提供的OHI更有效 改善口腔健康，坚持2x2x4 OHBs。我们将通过一个为期6个月的务实的 随机、对照、平行分组临床试验。来自安全网牙科诊所的符合条件的成年人将配备 配有电子牙刷和用于跟踪刷牙数据的智能手机应用程序。经过磨合期(4周) 为了确保技术熟练程度并建立基线OHBs，260名高危受试者将接受临床医生的接生 2x2x4OHI并随机分为以下两组：(A)干预臂，受试者在其中接受持续的、个性化的 或者(B)在受试者缺乏这种反馈的情况下使用控制臂。受试者将被跟踪 20周。训练有素的牙科检查员将在每次就诊时进行评估(基线、随机化和之后 20周)。主要结果是与基线相比牙齿健康的变化(修正的牙龈指数和菌斑 索引)。次要结果是对2x2x4 OHI的坚持质量。我们将探索主题级别的功能 它们预测了对Dohi的反应程度。我们的团队科学方法提出了一种潜在的范例 转变机会，利用日益普及的数字技术来激活、教育和 以以前无法想象的方式和规模让患者参与最佳的口腔健康自我护理。

Although preventable, dental disease is one of the most common chronic diseases in the United States and exacts a substantial personal and societal toll. It is closely linked to low oral health literacy and poor oral hygiene behaviors (OHBs). Using the high prevalence and burden of dental disease as a proxy, there is a large gap between knowledge about quality oral hygiene routines and what is practiced by individuals. The causes are many but ultimately distill down to a systemic failure to communicate oral hygiene instructions (OHIs) effectively or to engage and motivate patients in their own oral self-care. To address the know-do gap, we begin by distilling desired brushing behaviors into a simple 2x2x4 OHI (brushing 2 times a day, for 2 minutes each time, all 4 dental quadrants). We will leverage tracking capabilities of our innovative eBrush platform to remotely monitor tooth-brushing activities in home settings. Using the 2x2x4 OHI and eBrush as foundational elements, we will develop and evaluate the effectiveness of personalized Digital Oral Health Interventions (DOHI) for promoting ideal OHBs in at-risk individuals. In the UG3 phase, we will build out the technologic infrastructure for collecting brushing data and delivering the DOHI. Then, we will engage target end-users in the co-design of an app for oral self-care and establish the usability and feasibility of the system. In the UH3 phase, we will build and validate computational models to infer the quality of OHBs from brushing data and personalize the DOHI. Using a cohort of 130, we will conduct a 10-week Micro-Randomized Trial to optimize the adaptive tailoring of engagement strategies. Finally, we will evaluate effectiveness of the computationally-driven, adaptive DOHI in promoting sustained engagement in the 2x2x4 OHB. We hypothesize that a dynamic and personalized DOHI will be more effective than traditional, static, clinician-delivered OHI in improving oral health and adherence to 2x2x4 OHBs. We will test our hypothesis through a 6-month, pragmatic, randomized, controlled, parallel-group clinical trial. Eligible adults from safety-net dental clinics will be equipped with an electronic toothbrush and the smartphone app for tracking brushing data. After a run-in period (4 weeks) to ensure technical proficiency and establish baseline OHBs, 260 at-risk subjects will receive a clinician-delivered 2x2x4 OHI and randomized to either: (a) an intervention arm where subjects receive ongoing, personalized DOHIs at opportune times; or (b) a control arm where subjects lack such feedback. Subjects will be followed for 20 weeks. Trained dental examiners will conduct assessments at each visit (baseline, randomization and after 20 weeks). Primary outcomes are changes in dental health from baseline (Modified Gingival Index and Plaque Index). Secondary outcome is the quality of adherence to the 2x2x4 OHI. We will explore subject-level features that predict the magnitude of response to the DOHI. Our team science approach presents a potentially paradigm shifting opportunity to leverage the growing ubiquity and reach of digital technologies to activate, educate, and engage patients in optimal oral health self-care in ways and at a scale previously unimaginable.