Journal Article

Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial

Santo, William, Jue, Bonnie, Garza, Jeremiah R., White, Justin S., Ramos-Gomez, Francisco, Kahn, James G., Liu, Jenny X., Gansky, Stuart A., Cheng, Jing, Helman, Sarit, Crawford, Alexandra H., Finlayson, Tracy L.

2020

Overview

To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. A stratified, parallel-group, three-arm individually randomized controlled pilot trial. Two Los Angeles area Early Head Start (EHS) sites. 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. ClinicalTrials.gov identifier NCT03862443.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acceptability / Behavior / Behavioral economics / Biology and Life Sciences / Bluetooth / Child, Preschool / Children / Children & youth / Computer and Information Sciences / Dental Care for Children / Dental Plaque - diagnosis / Dental Plaque - pathology / Dental Plaque - prevention & control / Dental Plaque Index / Dentistry / Engineering and Technology / Feasibility studies / Female / Health promotion / Humans / Incentives / Infant / Lotteries / Low income groups / Male / Medicine and Health Sciences / Methods / Mobile Applications / Monetary incentives / Oral hygiene / Parents / Parents & parenting / Parents - psychology / Pediatrics / People and Places / Physical Sciences / Pilot Projects / Randomization / Reward / Smartphones / Studies / Teeth / Toothbrushing / Toothbrushing - instrumentation / Toothbrushing - methods