A randomized trial of cognitive vs. behavioral incentives to induce sustained healthy oral hygiene habits and improve oral health

 描述(由申请人提供)：设计具有成本效益、有时间限制的干预措施，导致持续的健康习惯是一项紧迫的公共卫生挑战。这一点在口腔健康领域表现得尤为明显，在口腔健康领域，不良的口腔卫生行为会导致牙周炎、龋齿和最终牙齿脱落等口腔疾病的沉重负担。口腔健康状况不佳导致保险公司和患者本身的成本很高，他们自掏腰包承担了很大一部分牙科保健支出。刷牙是一种关键的口腔卫生行为，其依从性很差(很少有成年人按照美国牙科协会的建议，每天两次刷牙整整两分钟)，而且目前培养持续健康习惯的方法都失败了。行为经济学概念的应用在促进健康和保健方面提供了相当大的希望，特别是在口腔健康领域。此外，保险公司和法人实体 他们越来越愿意也有能力为健康的行为付钱，这使得成功的激励计划在现实世界中是可行的。在这项计划中的随机对照研究中，我们使用创新的无线牙刷作为基于行为经济学的经济激励干预的平台，以解决美国成年人口腔疾病的这一巨大负担。在行为经济学对口腔健康和牙科医学的一种新应用中，我们比较了两种方法-行为激励与认知激励-改变习惯(刷牙)和改善口腔健康结果(牙龈指数)。在宾夕法尼亚牙科诊所进行的一项2X2随机对照试验中，我们旨在回答以下问题：[1]在3个月的时间里，刷牙的行为激励(付费刷牙)是否比对照更有效地实现牙龈指数的改善？[1]在3个月的时间里，刷牙的行为激励是否比认知激励(付费回答基于短信的口腔健康琐事问题)更有效？[3]在取消激励之后，在那些接受行为加认知激励的人中，与仅接受行为激励的人相比，牙龈指数的改善是否更好地持续？计划中的试验结果将为牙科患者激励计划、保险计划、预防性牙齿护理和主席口腔卫生的设计提供参考，最终目的是减轻可预防的口腔疾病的相当大负担。

 DESCRIPTION (provided by applicant): Designing cost-effective, time-limited interventions that lead to persistent healthy habits is a pressing public health challenge. Nowhere is this more evident than in the field of oral health, where poor self-performed oral hygiene behaviors contribute to a high burden of oral disease including periodontitis, dental caries, and eventual tooth loss. Poor oral health leads to high costs for insurers and for patients themselves, who bear a large portion of dental care expenditures out-of-pocket. Toothbrushing is a critical oral hygiene behavior for which adherence is poor (few adults brush twice per day for a full two minutes, as recommended by the American Dental Association), and for which current approaches to creating sustained healthy habits have failed. The application of concepts from behavioral economics offers considerable promise in advancing health and health care generally, and specifically in the oral health domain. In addition, insurers and corporate entities are increasingly willing and able to pay people for healthy behaviors, making successful incentive schemes feasible in real-world settings. In this planned randomized controlled study, we employ innovative wireless toothbrushes as a platform for financial incentive interventions grounded in behavioral economics to address this sizable burden of oral disease in US adults. We compare two approaches-behavioral vs. cognitive incentives-to changing habits (toothbrushing) and to improving oral health outcomes (the gingival index) in a novel application of behavioral economics to oral health and dental medicine. In a 2X2 randomized controlled trial among patients presenting for prophylaxis or recall at the Penn Dental Medicine clinic, we aim to answer the following questions: [1] Are behavioral incentives for toothbrushing (being paid to brush) more effective than control in achieving improvement in the gingival index over a 3-month period? [1] Are behavioral incentives for toothbrushing more effective than cognitive incentives (being paid to answer SMS text-based oral health trivia questions) in achieving improvement in the gingival index over a 3-month period? [3] After the removal of incentives, are improvements in the gingival index better sustained in those who received the behavioral plus the cognitive incentives compared to the behavioral incentives alone? Results from the planned trial will inform the design of dental patient incentive schemes, insurance plans, preventive dental care, and chairside oral hygiene with the ultimate aim of reducing the considerable burden of preventable oral disease.