Development of an intervention tool for precision oral self-care: Personalized and evidence-based practice for patients with periodontal disease

• Published in: PloS one 2019-11, Vol.14 (11), p.e0225453-e0225453
• Main Authors: Chang, Wen-Jen, Lo, Shih-Yin, Kuo, Chen-Li, Wang, Yen-Li, Hsiao, Hsu-Chuan
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adult; Aged; Applications programs; Behavior; Biology and Life Sciences; Chronic illnesses; Completion time; Computer and Information Sciences; Dental caries; Design; Disease prevention; Evaluation; Evidence-based medicine; Evidence-based nursing; Evidence-Based Practice; Female; Gum disease; Health; Health aspects; Hospitals; Humans; Information management; Intervention; Male; Medical research; Medicine and Health Sciences; Middle Aged; Mobile Applications; Mobile computing; Motivation; Oral diseases; Oral health; Oral hygiene; Patients; Periodontal disease; Periodontal diseases; Periodontal Diseases - prevention & control; Population; Problem solving; Program Development; Program Evaluation; Self Care; Self care (Health); Smartphones; Social Sciences; Surveys and Questionnaires; Target recognition; Taxonomy; Telecommunications software; Toiletries industry; Usability; Usability testing; User needs; Wireless telephone software
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0225453

Oral self-care plays an important role in maintaining oral health and preventing the occurrence of oral diseases. The association between good oral care and good oral hygiene is well known. However, the adherence to a proper daily oral hygiene regimen generally remains poor, so the prevalence of oral diseases remains high. Periodontal disease is the most common oral disease in the population. To enhance the adherence to good oral hygiene behaviors for patients with periodontal disease, we developed a personalized and evidence-based mobile application as an intervention tool for the purpose of initiating and improving good oral self-care. The objective of this study was to demonstrate the systematic development process and content of the oral self-care mobile application, OSCA. The systematic development process of OSCA consists of three phases: behavioral diagnosis, intervention design, and assessment of OSCA. Firstly, behavioral problem of oral self-care was identified by the experts in periodontics care. Secondly, the intervention functions and the mode of delivery were designed based on the capability-opportunity-motivation behavioral model, which is the underpinning model behind the behavior change wheel framework. Thirdly, the developed app was evaluated by the experts through a heuristics evaluation checklist by adopting Morville's Honeycomb model, and the final version of OSCA was assessed by the patients with periodontal disease using the System Usability Scale (SUS). The problems of target behavior were identified and incorporated into the design of intervention functions. For the beta version of the OSCA, experts proposed four main suggestions to improve the usefulness. Experts evaluated the beta and final versions of the app using a heuristics evaluation checklist, providing mean scores of 4.38 and 4.62, respectively. For usability testing, 87 participants completed both the specified tasks and the SUS questionnaire, providing an SUS median score of 77.5 (IQR = 12.5) and an overall mean completion time of 12.22 minutes for the specified tasks. The mean scores of the intervention functions for capability establishment, motivation enhancement, and opportunity creation were 6.13, 5.88, and 6.06, respectively. The study presents a rigorous design process of developing an evidence-based and personalized mobile application for oral self-care. The results of the expert evaluation confirmed the validated design and the participants were satisfied with t