1. Text4Tots:
An Oral Health Promotion
Mobile Messaging Program
Rinal Patel
Department of Public Health Communications and Marketing
School of Public Health and Health Services
The George Washington University
Washington, D.C., USA
CE Advisor: Lorien Abroms, ScD, MA
2. Health Problem
Despite improvement in the overall oral health
of Americans, the CDC has reported a
significant increase in dental caries among
children ages 2-5 years, setting the stage for
many young children to develop a lifetime of
complications from poor oral health.
http://www.cdc.gov/Features/dsUntreatedCavitiesKids/
4. Health Goal
Decrease the incidence of dental caries in children ages
2-5 by strengthening oral health education skills and
behaviors in parents.
5. Behavioral Objectives
By the end of our campaign, the number
of parents of children
ages 2-5 in our sample audience who:
1. supervise their children while
brushing their teeth;
2. perform checks on their children's
teeth for white or brown spots; and
3. whose children brush twice a day
will increase by 50%.
6. Communication Objective
1) By the end of our campaign, 80% of the parents will
report having increased their knowledge and skills on how
to properly brush their child’s teeth and how to check for
dental caries. (SCT – Behavior Capability)
2) By the end of our campaign, 80% of the parents will
have the confidence to perform oral health monitoring of
their children (SCT – Self-efficacy)
7. Project Design:
Participant Eligibility
• Eligibility criteria (15 participants)
• Primary caregiver to a child ages 2-5
• Both child and caregiver live in the United
States;
• Has a cellular phone with sending/receiving text
message capabilities;
• Has an active email and/or Facebook account.
*Parents w/ multiple children were asked to
enroll one child due to study limitations*
8. Project Design:
Recruitment
• Participant recruitment via Facebook announcement
• Facebook Status Update
Are you a parent or caregiver to a child ages 2 through 5?
Are you interested in making your tot's smile shine bright?
Do you own a cellphone that receives and sends text messages?
If you answered YES to all of the above questions, then come join Text4Tots,
a campaign aimed to decrease the incidence of dental caries in children ages 2 through 5 by
strengthening oral health education skills and behaviors in parents.
If you’re interested and would like more information please message or email me (rinalpatel1@gmail.com
).
• Interested participants were sent invitation to join the study.
• Description of the campaign, an informed consent form, pre-test
survey link, opt-in-day in day information, and conference call-in
number.
9. Participant
Demographics
• Income 35k – 75k
• Education level: High school Diploma,
Bachelor’s, or Master’s Degrees
• Parent age group (Late 20’s to Early 30’s)
• Child age demographics:
10. Project Design:
Intervention
• Mobile Message Library
• By age (2-5)
• Created based on oral health literature review
• Personalized messages based on pre-survey results
• Goal: Tips on how to effectively supervise teeth brushing and how
to check for dental caries.
• Additional tips: thumb sucking, relieve stress during teething, etc.
• Reminders sent to parents to schedule 6-month visits with dentist.
• Mobile Messaging trial period: 14 days
• Campaign launch: opt-in Day
• 3 messages a day
• Sent based on parent’s schedule (Tailoring); or
• sent 7:00am; 3:00pm; and 8:00pm.
11. Example of Mobile Message
Library
Welcome Welcome to Text4Tots! Congratulations on taking a step
towards making your tot smile! To opt out at any time,
text STOP to this number.
First Status How old is your tot? Reply with: 2, 3, 4, or 5.
2 Most of the 20 primary teeth will appear by age 2. By
age 1, your child should have made their first trip to the
dentist.
3 All of your baby's primary teeth should have erupted by
age 3. Make sure to visit your baby's dentist every 6
months.
4 Your child should be developing oral health skills that
will last a lifetime! Lead by example by brushing your
teeth twice a day and flossing regularly.
5 Your child should be developing oral health skills that
will last a lifetime! Lead by example by brushing your
teeth twice a day and flossing regularly.
13. Mobile Messaging
Example:
• Day 3 for Parent A of 2 Year Old Child
14. Project Design:
Follow-Up
• Congratulatory email at completion of mobile messaging
intervention
• Provided post-survey link
• Focus group of participants held for feedback on campaign
• Incentives provided at completion of the study
• Goody bags with dentist recommended age-specific oral health
products (toothbrushes, toothpaste, floss, etc.)
• Method of distribution: mail
• Goal: Encourage parents to be more proactive in caring for their
child’s teeth.
15. Pre-Test Survey Results
2) When was your child's last visit to the dentist?
( ) 1-3 months ago
( ) 4-6 months ago
( ) 7-9 months ago
( ) 10-12 months ago
( ) More than 1 year ago
( ) More than 2 years ago
( ) Never
• Only 26.6% of the study population had taken
their child to the dentist within the last 6
months.
• By age 1, all children should have made their
first trip to the dentist.
16. Pre-Test Survey Results
4) How often do you check your child's teeth for 5) How often do you brush your child's teeth or supervise
dental caries, or cavities? their teeth brushing?
( ) Always ( ) Always
( ) Very Often ( ) Very Often
( ) Sometimes ( ) Sometimes
( ) Rarely ( ) Rarely
( ) Never ( ) Never
• 73.4% reported “sometimes,” “rarely,” or
“never.”
17. Pre-Test Survey Results
6) How many times does your child (or you) brush their
teeth each day?
( ) One time
( ) Two times
( ) Three times
( ) More than three times
( ) Never
• 20% of the children brush their teeth 2 times a
day; 80% only brush once a day.
18. Pre/Post-Test Survey
Results
Pre- and Post-Test Question(s) Pre-Test Post-Test
Results Results
Pre-Test: How often do you check your child's teeth for 33.4% 93.0%
dental caries, or cavities?
Post-Test: During the last 14 days, how often did you
check your child’s teeth for dental caries?
Pre-Test: How often do you brush your child's teeth or 39.9% 93.4%
supervise their teeth brushing?
Post-Test: During the last 14 days, how often did you
brush your child’s teeth or supervise their teeth brushing?
Pre-Test: How many times does your child (or you) brush 20% (2x) 80.0% (2x)
their teeth each day? 6.7% (3x)
Post-Test: During the last 14 days, how many times did
your child (or you) brush their teeth each day?
19. What did the Parents
Think?
Post-Test Survey Question Post-Test Results
How often did you read Text4Tots mobile 60.0% Always (n=9)
messages? 26.7% Very Often (n=4)
6.7% Sometimes (n=1)
0.0% Rarely (n=0)
6.7% Never (n=1)
Please rate the following statement. 53.0% Strongly Agree (n=8)
Text4Tots has increased my oral health 40.0% Agree (n=6)
knowledge and skillsets for my child’s 0.0% Neutral (n=0)
well-being. 0.0% Disagree (n=0)
6.7% Strongly Disagree (n=1)
Please rate the following statement. 40.0% Strongly Agree (n=6)
Text4Tots has increased my confidence 53.3% Agree (n=8)
to perform routine oral health monitoring 0.0% Neutral (n=0)
of my child. 0.0% Disagree (n=0)
6.7% Strongly Disagree (n=1)
20. Strengths
• Personalized messages based on child’s age.
• Use of tailoring for sending messages based on
parent’s schedules.
• Goody bag incentives to encourage oral health
monitoring post-intervention.
• Use of mobile technology to reach parents across
the US.
21. Limitations
• 3 messages a day without automated messaging
service.
• Automated service could also help track previously
sent messages
• Survey did not address participant demographics;
this data was collected through Facebook and
general email and phone conversations.
• Only used 1 type of social media to recruit
participants (i.e., Facebook)
• This could create sample bias
22. Future Directions
• Expert panel review of mobile messaging library
• Ask evaluation questions throughout the program and provide incentives
for each question the parent answers.
• Update mobile message library to include an option for parents to ask
questions and get tips.
• Create a blog or Facebook page for parents to interact with each other.
• Provide small games to keep the parents engaged in the text message
program.
• Create a smartphone app to along with the mobile message intervention
• Include games and activities for children to become involved in their oral
health
23. Acknowledgements
Thank you to all that have made my educational
experience a success!
•CE Advisor: Dr. Lorien Abroms
•Academic Advisor: Jerry Franz
•All GWU SPHHS Faculty
•My Friends and Family
