The Text4Tots program sent text messages to parents with children ages 2-5 to educate them on oral health and encourage brushing. A series of 4 texts were sent daily using the Health Belief Model. Morning and evening texts reminded parents to brush their child's teeth, while afternoon texts provided oral health tips. Parents would text "BRUSH" after brushing and receive positive feedback. Surveys found improved oral health knowledge and most parents brushing twice daily after the program. Suggested improvements included a more customized delivery schedule and adding interactions like pictures, quizzes, and goal setting.

1. Chris Burton
Kristal Dail
Kitty Harding

2. Concept
 Text4Tots is an oral health text messaging campaign
designed to educate parents with children between the
ages of 2-5 on oral health education and information
 The program’s goal is to reduce the incidence of
cavities in the children of our target audience by 10%
over two years
 A series of 4 text messages were sent per day
 The Health Belief Model was used to achieve the
program’s goal

3. Morning Messages
 Morning messages included an encouraging reminder
to brush their child’s teeth.
 Perceived efficacy: Parents self assessment of ability to
successfully adopt the desired behavior
 Cues to action: Text4Tots promoting the desired
behavior
 Morning messages influenced brushing your child’s
teeth as a routine behavior, one of our health objective
goals

4. Morning Messages

5. Afternoon Messages
 The two afternoon messages included oral health
education, information, tips and interactive activities to
encourage good oral health for children.
 Perceived susceptibility: Parents assessment of their child’s
risk of getting cavities
 Perceived severity: Parents assessment of the consequences
of eating sugary foods
 Perceived barriers: Low self efficacy, lack of knowledge
 Perceived benefits: Parents understanding of the health
benefits of good oral health.
 Afternoon messages provided knowledge and awareness of
beneficial oral health practices, one of our communication
objective goals

6. Perceived Susceptibility & Severity

7. Perceived Barriers & Benefits

8. Knowledge and Awareness

9. Evening Messages
 Evening messages included an encouraging reminder
to brush their child’s teeth before bed.
 Perceived efficacy: Parents self assessment of ability to
successfully adopt the desired behavior,
 Cues to action: Text4Tots promoting the desired
behavior
 Evening messages influenced brushing your child’s
teeth as a routine behavior, one of our health objective
goals

10. Evening Messages

11. “BRUSH” Responses
 After every morning and evening reminder text, we
asked participants to text the word “BRUSH” when
done
 We would then respond in the mornings, “ Great job!
Brushing in the morning will set your tot up for a
smile-filled day!” and in the evenings, “ Good work!
Brushing is a great way to end your tot’s day!”
 This provided reinforcement that parents were doing a
good job and helped to motivate them to continue
brushing their child’s teeth every morning and night

12. Survey Data
Pre-Test
How many children do you have an what ages are they?
 1—age 4
 1—age 5
 1—age 2
 1—age 2
 3—ages 5, 4, and 2months
 2—ages 5 and 8
 1—age 3
 1—age 4
 2—ages 3 and 1

13. Survey Data
Pre-Test
Cell Phone Capabilities
 Receive texts- 9/9
 Receive email- 9/9
 Connect to the internet- 9/9
 View video- 8/9
 Click through dial- 9/9

14. Survey Data
When was the last time your child went to the dentist?
1-3 months ago: 2/9
4-6 months ago: 4/9
7-9 months ago: 0
10-12 months ago: 1/9
More than a year ago: 0
Never: 2/9
My child has had:
No cavities: 9/9

15. Survey Data
Do you brush your child’s teeth or supervise their brushing?
Pre-Test Post-Test
Always: 8/9 Always: 7/8
Most of the time: 0 Most of the time: 0
Sometimes: 1/9 Sometimes: 1/8
Rarely: 0 Rarely: 0
Never: 0 Never: 0

16. Survey Data
How often does your child (or you) brush their teeth each day?
Pre-Test Post-Test
Never: 0 Never: 0
1 time: 1/9 1 time: 0
2 times: 7/9 2 times: 6/8
3 times: 1/9 3 times: 2/8
More than 3 times: 0 More than 3 times: 0

17. Survey Data
Do you floss your child’s teeth? If yes, how often
Pre-Test Post-Test
Daily: 2/9 Daily: 1/9
A few times a week: 2/9 A few times a week: 3/9
Weekly or less: 2/9 Weekly: 1/9
No: 3/9 No: 3/9

18. Survey Data
Please rate the following statements from 1- not important to 5 very important
Pre-Test
1 2 3 4 5
Clean teeth are important to my child’s healthy development 0 0 0 0 9
I think children should go to the dentist every 6 months 0 0 2 0 7
I know where to find information about taking care of my 0 0 1 2 6
kid’s teeth
Children should be supervised when brushing and flossing 0 0 0 1 8
Post-Test
1 2 3 4 5
Clean teeth are important to my child’s healthy development 0 0 0 0 8
I think children should go to the dentist every 6 months 0 0 1 1 6
I know where to find information about taking care of my 0 0 0 0 8
kid’s teeth
Children should be supervised when brushing and flossing 0 0 0 0 8

19. Survey Data
Please list as many things as you can think of that you can do to keep your child's teeth healthy.
Pre-Test Post-Test
9 responses, average 2.5 items 6 responses, average 3.3 items
 Brushing and diet monitoring. (2)  Offering healthy snacks instead of
 Kids have to drink plenty of water and less juice and candy, brushing, flossing and dental
definitely NO sodas. Children should also floss at
night and brush their teeth at night and in the check ups. (4)
morning. They also need to see a dentist every six
months. (4)  Brushing at least twice a day, flossing
 Brush regularly, keep routine dentist appointments. at least twice a week, minimal sweets
(2) and diets high in calcium. (4)
 Minimize sweets. Tooth brushing after every meal. (2)
 They eat cheese regularly as I have read that is good for  Brush after every meal, floss. (2)
oral care. Brushing themselves and teaching them to  Brush twice a day, floss, regular dental
brush as well as minimizing sugar/candy intake. No
soda. (3) check ups, no sodas, and lots of water.
 Try to avoid to much candy, chewy especially and floss (5)
after eating. (2)
 1. Brushing and flossing. 2. Monitoring candy intake.
 Limit sugars and brush daily.
3. Dental check ups. (3) (2)
 Proper brushing, limited sweets and candy
(2)
.  Brushing, flossing, monitoring food
 Make it fun, routine, drink less juice and eat less and drink intake. (3)
sweets. (3)

20. Survey Data
I liked the Text4Tots program.
Yes: 100%
Comments
1. I liked the text reminders to brush your toddler's teeth. I used it as an
alarm with my 3yr old son. I would say "ok Bj your tooth brush alarm
is ringing, time to brush your teeth & get the stinky out” lol. I enjoyed
the text msgs, I thought they were informative. I'm going to set a set a
"tooth brush alarm", on my cell phone to motivate my toodler to
brush his teeth. As a parent, I'm always trying to find fun and
creative ways to promote healthy habits with my son.
2. Texts were sent too early, should adjust per schedule.
3. I liked the program however if it could be customized per family
schedules I think the responses might be better. Such as the first
Brush of the day some may sleep in on certain days.

21. Survey Data
I would continue receiving Text4Tots messages, if it was possible.
Yes: 50%
No: 50%
I would recommend Text4Tots to a friend.
Yes: 88%
No: 12%
Text4Tots sends too many messages.
Yes: 0%
No: 100%
Fill in the blank: I read _____ of the Text4Tots messages.
All: 75%
Most: 12%
Some: 0%
Few: 12%
None: 0%

22. Suggested Improvements
 Automated delivery system to better fit participants
schedules.
 More reinforcing messages after BRUSH text.
 Addition of FLOSS response, and corresponding
messaging.
 Possibility for targeted modules based on tot’s age
 Enhanced interaction:
 Text pictures of you and your tot brushing.
 Develop quizzes or oral health games/activities
 Goal setting (# of BRUSH’s per week)
 Ability to report dentist visits.