Co-Designing and Evaluating an mHealth Intervention for Early Childhood Caries: A Multidisciplinary Approach Using Behavioural Theory

Abstract

Background: Early childhood caries (ECC) affects 600 million children worldwide, posing a significant public health issue. Effective parental guidance on oral health can reduce ECC risk factors. Mobile health (mHealth) text message programs, co-designed with a range of health professionals and patients using behaviour theory, have shown promise in promoting sustained behaviour change at scale.   Aim: This study describes the co-design process, development, and content evaluation of a text message program, created by a multidisciplinary team‚ including dental practitioners, policymakers, health promotion experts, IT specialists, and patients to promote oral health behavior change among parents and caregivers of children with early childhood caries (ECC).   Methods: The Behaviour Change Wheel theoretical framework, endorsed by the WHO, guided the program's co-design. The process consisted of two phases: Phase 1 involved workshops with parents and health professionals to identify target behaviours, barriers, enablers, and behaviour change techniques (BCTs) to develop a bank of draft content. Phase 2 focused on evaluating the draft messages developed from Phase 1 findings.   Results: In Phase 1, target behaviours were grouped into categories: oral hygiene, food/drink, and bedtime routines. Five intervention functions and 15 BCTs were identified, resulting in 111 draft messages. In Phase 2, reviews by health professionals (n=17) and consumers (n=14) resulted in 56 clear, useful messages, forming the basis of the SmilesUp semi-personalised 12-week text message program.   Conclusion: The study successfully co-designed a text message program targeting oral health behaviours in young children, with future research needed to evaluate its effectiveness in achieving behaviour change.