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

English version

Autoři: Wen-Jen Chang ^aff001; Shih-Yin Lo ^aff003; Chen-Li Kuo ^aff001; Yen-Li Wang ^aff003; Hsu-Chuan Hsiao ^aff004
Působiště autorů: Department of Information Management, Chang Gung University, Taoyuan, Taiwan ^aff001; Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan ^aff002; Department of Periodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan ^aff003; Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan ^aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225453

Souhrn

Background

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.

Objective

The objective of this study was to demonstrate the systematic development process and content of the oral self-care mobile application, OSCA.

Methods

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).

Results

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.

Conclusions

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 the designed app.

Klíčová slova:

Patients – Teeth – Behavior – Oral diseases – Oral health – Oral medicine – Apps – Periodontal diseases

Zdroje

1. Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Oral Dis 2016;22:609–19. doi: 10.1111/odi.12428 26704694

2. van der Weijden F, Slot DE. Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontol 2000 2011;55:104–23. doi: 10.1111/j.1600-0757.2009.00337.x 21134231

3. Dörfer C, Benz C, Aida J, Campard G. The relationship of oral health with general health and NCDs: a brief review. Int Dent J 2017;67:14–8. doi: 10.1111/idj.12360 29023744

4. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General—Executive Summary. Rockville, MD: National Institute of Dental and Craniofacial Research; 2000.

5. WHO Oral Health Fact Sheet no.318. (2012). Geneva: World Health Organization, Available at: https://www.mah.se/CAPP/Oral-Health-Promotion/WHO-Oral-Health-Fact-Sheet1/.

6. Tonetti MS, Jepsen S, Jin L, Otomo‐Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol 2017;44:456–62. doi: 10.1111/jcpe.12732 28419559

7. Godha S, Dasar PL, Sandesh N, Mishra P, Kumar S, Balsaraf S, et al. Oral health: a window to your overall health. Int J Oral Health Med Res 2015;2(3):105–8.

8. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res 2015;94(10):1355–61. doi: 10.1177/0022034515602879 26318590

9. Righolt AJ, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. J Dent Res 2018;97(5):501–7.

10. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res 2014;93(7 Suppl):20S–28S. doi: 10.1177/0022034514537828 24947899

11. Petersen PE, Bourgeois D, Ogawa H, Estupinuan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83(9):661–9. 16211157

12. Jepsen S, Blanco J, Buchalla W, Caravalho JC, Dietrich T, Dorfer C, et al. Prevention and control of dental caries and periodontal diseases at individual and population level: Concensus report of group 3 of joint EFT/ORCA workshop on boundaries between caries and periodontal diseases. J Clin Periodontol 2017;44:S85–S93. doi: 10.1111/jcpe.12687 28266120

13. Williams KA, Mithani S, Sadeghi G, Palomo L. Effectiveness of Oral hygiene instructions given in computer‐assisted format versus a self‐care instructor. Dent J 2018;6:2.

14. Yevlahova D, Satur J. Models for individual oral health promotion and their effectiveness: a systematic review. Aust Dent J 2009;54:190–7. doi: 10.1111/j.1834-7819.2009.01118.x 19709105

15. Johansson I, Tidchag P, Lundberg V, Hallmans G. Dental status, diet and cardiovascular risk factors in middle-aged people in northern Sweden. Community Dent Oral Epidemiol 1994; 22:431–6. doi: 10.1111/j.1600-0528.1994.tb00792.x 7882658

16. Schüz B, Sniehotta FF, Wiedemann A, Seemann R. Adherence to a daily flossing regimen in university students: effects of planning when, where, how and what to do in the face of barriers. J Clin Periodontol 2006;33:612–19. doi: 10.1111/j.1600-051X.2006.00967.x 16856896

17. Vatne JF, Gjermo P, Sandvik L, Preus HR. Patients’ perception of own efforts versus clinically observed outcomes of non-surgical periodontal therapy in a Norwegian population: an observational study. BMC Oral Health 2015;15:61. doi: 10.1186/s12903-015-0037-3 25981528

18. Zhou G, Sun C, Knoll N, Hamilton K, Schwarze R. Self-efficacy, planning and action control in an oral self-care intervention. Health Educ Res 2015;30(4):671–81. doi: 10.1093/her/cyv032 26187914

19. Newton JT, Asimakopoulou K. Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management. J Clin Periodontol 2015;42(Suppl 16):S36–S46. doi: 10.1111/jcpe.12356 25639708

20. Thevissen E, De Bruyn H, Koole S. The provision of oral hygiene instructions and patient motivation in a dental care system without dental hygienists. Int J Dent Hygiene 2017;15:261–8. doi: 10.1111/idh.12211 26932773

21. Johnston M. Improving the reporting of behaviour change interventions. Eur Health Psychol 2016;16(5):181–9.

22. Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med 2013;10(1):e1001362. doi: 10.1371/journal.pmed.1001362 23349621

23. Newton JT, Asimakopoulou K. Minimally invasive dentistry: enhancing oral health‐related behavior through behavior change techniques. Br Dent J 2017;223(3):147‐50. doi: 10.1038/sj.bdj.2017.659 28798465

24. Edwards EA, Lumsden J, Rivas C, Steed L, Edwards LA, Thiyagarajan A, et al. Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps. BMJ Open 2016;6:e012447. doi: 10.1136/bmjopen-2016-012447 27707829

25. Kao CK, Liebovitz DM. Consumer mobile health apps: current state, barriers, and future directions. PM R 2017;9:S106–15. doi: 10.1016/j.pmrj.2017.02.018 28527495

26. Boulos MNK, Brewer AC, Karimkhani C, Buller DB, Dellavalle RP. Mobile medical and health apps: state of the art, concerns, regulatory control and certification, Online J Public Health Inform 2015;5(3):e229. doi: 10.5210/ojphi.v5i3.4814 24683442

27. Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, et al. A user-centered model for designing consumer mobile health (mHealth) applications (apps). J Biomed Inform 2016;60:243–51. doi: 10.1016/j.jbi.2016.02.002 26903153

28. Brown W III, Yen PY, Rojas M, Schnall R. Assessment of the health IT usability evaluation model (Health-ITUEM) for evaluating mobile health (mHealth) technology, J Biomed Inform 2013;46(6):1080–7. doi: 10.1016/j.jbi.2013.08.001 23973872

29. Michie S, van Stralen M, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42. [URL: http://www.implementationscience.com/content/6/1/42] doi: 10.1186/1748-5908-6-42 21513547

30. Misra S, Daly B, Dunne S, Millar B, Packer M, Asimakopoulou K. Dentist-patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance. Patient Prefer Adherence 2013;7:543–9. doi: 10.2147/PPA.S43255 23814463

31. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. doi: 10.1007/s12160-013-9486-6 23512568

32. Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Soc Psychol 2006;38:69–119.

33. Hagger M.S., Luszczynska A. Planning interventions for behaviour change: a protocol for establishing best practice through consensus. Eur Health Psychol 2014;16(5):206–13.

34. Morville P. User experience honeycomb. 2004. URL: http://semanticstudios.com/user_experience_design/

35. Nielsen J. Finding usability problems through heuristic evaluation. In: Proceedings of ACM CHI92; 1992:372–80.

36. Brooke J. SUS: a quick and dirty usability scale. Edited by: Jordan PW, Thomas B, Weerdmeester BA, McClelland IL. Usability Evaluation in Industry. London: Taylor & Francis; 1996,189–94.

37. Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact 2008;24(6):574–94.

38. Lewis JR. The System Usability Scale: Past, Present, and Future, International Journal of Human–Computer Interaction 2018. doi: 10.1080/10447318.2018.1550177

39. Hoj TH, Covey EL, Jones AC, Haines AC, Hall PC, Crookston BT, et al. How do apps work? An analysis of physical activity app users’ perceptions of behavior change mechanisms. JMIR Mhealth Uhealth 2017;5(8):e114. doi: 10.2196/mhealth.7206 28778846

40. Dugdale S, Ward J, Hernen J, Elison S, Davies G, Donkor D. Using the behavior change technique taxonomy v1 to conceptualize the clinical content of breaking free online: a computer-assisted therapy program for substance use disorders. Subst Abuse Treat Prev Policy 2016;11(1):26. doi: 10.1186/s13011-016-0069-y 27449786

41. Beatty AL, Magnusson SL, Fortney JC, Sayre GG, Whooley MA. VA fitheart, a mobile app for cardiac rehabilitation: usability study. JMIR Hum Factors 2018;25(1):e3. doi: 10.2196/humanfactors.8017 29335235

42. Arweiler NB, Auschill TM, Sculean A. Patient self-care of periodontal pocket infections. Periodontol 2000 2018;76:164–79. doi: 10.1111/prd.12152 29197129

43. Fulton EA, Brown KE, Kwah KL, Wild S. StopApp: using the behaviour change wheel to develop an app to increase uptake and attendance at NHS stop smoking services. Healthcare 2016;4(2):31. doi: 10.3390/healthcare4020031 27417619

44. Underwood B, Birdsall J, Kay E. The use of a mobile app to motivate evidence-based oral hygiene behavior. Br Dent J 2015;219:e2. doi: 10.1038/sj.bdj.2015.660 26315196

45. Clemens C, Taylor S. Toothbrushing to music. Dent Hyg 1980;54:125–6.

46. Newton JT, Asimakopoulou K. Behavioral models for periodontal health and disease. Periodontol 2000 2018;78:201–11. doi: 10.1111/prd.12236 30198131