The rise in use of mobile devices has seen them utilised for and increasing number of functions including a number of mHealth initiatives in both industrialised and developing countries. The past decade has seen the publication of studies and reviews relating to the use of mHealth to improve oral health behaviours.
The aim of this review was to evaluate the effectiveness of the mHealth-delivered oral health education to parents regarding the improvement of parents’ knowledge, behaviours and children’s oral health status compared to the alternative oral health education approach or the negative control.
Methods
A protocol was registered in the PROSPERO database. Searches were conducted in the PubMed, Cochrane Library, Embase, Web of Science; Global Health, Engineering Village 2, The World Health Organisation (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov databases. Randomised controlled trials (RCTs) and quasi RCTs of oral health promotion delivered via mobile devices to parents or caregivers of children aged 12 or under were considered. Two reviewers independently selected studies and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 or The ROBINS-I tool or NIH tool for pre-post studies. The main outcomes were parental oral health behaviours and children’s oral health status. Parents oral health knowledge and attitude were secondary outcomes.
Results
- 12 studies (8 RCTs,4 pre-post quasi-experiments) were included
- 6 studies used mobile messages or reminders to deliver oral health education (OHE), 5 studies used mobile apps to deliver OHE with 4 including reminders.
- Communication was one-way in most studies although 3 studies allowed feedback and one used read receipts.
- 4 studies used behaviour change theories.
- The 8 RCTs were considered to be at high risk of bias and the 4 pre-post studies were considered to be of poor quality.
- Comparison between mHealth and control groups was made regarding parental oral health knowledge, attitude, oral health behaviours, and children’s oral health status. Comparisons were made between mHealth and negative control and mHealth and printed materials.
- Study findings were variable with some demonstrating benefit and some no benefit
- The certainty of the evidence of all the outcomes was judged as low or very low.
Conclusions
The authors concluded: –
The mobile apps and the mobile messages were the most frequently used mHealth approaches in oral health promotion. Low/very low certainty of evidence existed that the mHealth approach could improve parents’ oral health knowledge. However, there lacks evidence to show the effects of mHealth intervention exerted on parents in improving their attitude, parental oral health behaviours and their children’s oral health. Limited to a low level of evidence, more well-designed RCTs on mHealth oral health promotion are needed to be conducted to verify its effects on these outcomes.
Comments
The authors pre-registered a protocol and searched a broad range of databases to identify relevant studies. 12 studies were included, 8 of which were RCTs although all of these were at a high risk of bias. Previous reviews have suggested an oral health benefit from the use of mobile apps (Dental Elf – 13th Dec 2021, Dental Elf – 20th Sep 2019, Dental Elf – 29th Mar 2019) although these have largely been directed to the patients rather than a parent of guardian. Evidence from previous reviews has only been of a low or very low quality as is the case with this new review. Only 4 of the studies in this review based the design of the application on any behavioural change theory and this is the case with studies included in other reviews. The widespread availability of mobile devices does mean that there is potential to deliver oral health messaging this way. However additional well conducted and reported studies based on behavioural change theory are needed that also address medium to long term benefits in addition to short term gains.
Links
Primary Paper
Wang K, Yu KF, Liu P, Lee GHM, Wong MCM. Can mHealth promotion for parents help to improve their children’s oral health? A systematic review. J Dent. 2022 Aug;123:104185. doi: 10.1016/j.jdent.2022.104185. Epub 2022 Jun 9. PMID: 35691452.
Other references
Dental Elf – 13th Dec 2021
Mobile applications and behaviour change in orthodontic patients
Dental Elf – 20th Sep 2019
Oral hygiene advice: Use of mobile phone applications in children and adolescents
Dental Elf – 29th Mar 2019
Picture Credits
Photo by Daniel Korpai on Unsplash
