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

• Published in: PloS one 2020-07, Vol.15 (7), p.e0236692
• Main Authors: White, Justin S, Ramos-Gomez, Francisco, Liu, Jenny X, Jue, Bonnie, Finlayson, Tracy L, Garza, Jeremiah R, Crawford, Alexandra H, Helman, Sarit, Santo, William, Cheng, Jing, Kahn, James G, Gansky, Stuart A
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236692

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.