Personalized Digital Behavior Change Interventions to Promote Oral Health

个性化数字行为改变干预措施促进口腔健康

• 批准号: 10610734
• 负责人: VIVEK SHETTY
• 金额: $ 78.12万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610734
• 关键词: Address; Adherence; Adult; Behavior; Behavior Therapy; Behavioral Sciences; Bioethics; Calibration; Cellular Phone; Chronic Disease; Clinic; Clinical Trials Cooperative Group; Communication; Computer Models; Data; Dental; Dental Clinics; Dental Hygiene; Dental caries; Dentistry; Dentists; Drops; Electronics; Elements; Eligibility Determination; Ensure; Failure; Feedback; Fostering; Gingival Indexes; Health behavior; Healthcare; High Prevalence; Home; Individual; Infrastructure; Instruction; Intervention; Knowledge; Link; Machine Learning; Maintenance; Methodology; Oral; Oral health; Patient Recruitments; Patients; Penetration; Periodontal Diseases; Phase; Population; Prevention; Procter and Gamble; Proxy; Randomized; Research; Resources; Risk; Running; Science; Self Care; System; Target Populations; Technology; Testing; Theory of Change; Time; Tooth Diseases; Toothbrushing; Training; United States; Visit; Vulnerable Populations; adaptive intervention; arm; behavior change; blind; cohort; design; digital; digital delivery; digital health; digital technology; effectiveness evaluation; evidence base; handheld mobile device; health literacy; health organization; high risk; improved; indexing; industry partner; innovation; oral communication; patient engagement; population health; primary outcome; randomized trial; remote monitoring; response; safety net; secondary outcome; smartphone application; technology development; treatment arm; usability

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.

虽然可以预防，但牙病是美国最常见的慢性病之一 并对个人和社会造成了巨大的损失。它与口腔健康素养低和口腔健康状况差密切相关。 卫生行为（OHB）。使用牙科疾病的高患病率和负担作为替代， 关于口腔卫生质量的常规知识和个人实践之间的差距。的原因 有很多，但最终归结为系统性的失败，沟通口腔卫生指示（OHIs） 有效地或参与和激励患者在自己的口腔自我护理。 为了解决知与行之间的差距，我们开始将所需的刷牙行为提炼为简单的2x2x4 OHI （每天刷牙2次，每次2分钟，所有4个牙齿象限）。我们将利用追踪能力 我们的创新eBrush平台，远程监控家庭环境中的刷牙活动。使用2x2x4 OHI和eBrush作为基础元素，我们将开发和评估个性化数字化的有效性。 口腔健康干预（DOHI），以促进高危人群的理想OHB。在UG3阶段，我们将构建 收集刷牙数据和提供DOHI的技术基础设施。然后，我们将与 在口腔自我护理应用程序的共同设计中瞄准最终用户，并确定 系统在UH3阶段，我们将建立和验证计算模型，以推断OHB的质量， 刷数据和个性化的DOHI。我们将使用130名患者的队列，进行为期10周的微随机 尝试优化参与战略的适应性剪裁。最后，我们将评估 计算驱动的，自适应的DOHI在促进2x2x4 OHB的持续参与。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， 改善口腔健康和坚持2x2x4 OHB。我们将通过为期6个月的，务实的， 随机对照平行组临床试验。安全网牙科诊所的合格成年人将配备 用一个电动牙刷和智能手机应用程序来跟踪刷牙数据。导入期后（4周） 为了确保技术熟练度并建立基线OHB，260名有风险的受试者将接受临床医生提供的 2x2x4 OHI，随机分配至：（a）干预组，受试者接受持续的个性化治疗 或（B）受试者缺乏这种反馈的对照组。将对受试者随访 20周经过培训的牙科检查员将在每次访视时进行评估（基线、随机化和 20周）。主要结果是牙齿健康较基线的变化（改良牙龈指数和菌斑 索引）。次要结局是对2x2x4 OHI的依从性质量。我们将探索主题级功能 预测对DOHI的反应程度。我们的团队科学方法提供了一个潜在的范例 利用数字技术日益普及和普及的机会， 让患者以前所未有的方式和规模进行最佳的口腔健康自我护理。