Work

Co-Designed Text Messaging Intervention for Parents of Children With Early Childhood Caries: Randomized Controlled Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Background Early childhood caries (ECC) is a prevalent yet preventable disease that significantly impacts young children’s health and quality of life. The World Health Organization’s Global Strategy and Action Plan on Oral Health 2023–2030 highlights the potential of mobile health programs to enhance engagement and support sustained oral health behavior change. Objective The aim of this study was to assess the effectiveness of the SmilesUp 12-week SMS text messaging–based education and support program to improve parents’ management of their children’s oral health behaviors compared to standard clinical care. Methods We conducted a multisite, assessor-blinded, parallel-design randomized controlled trial among parents of children aged 0 to 6 years who had an ECC diagnosis and attended 1 of 6 public dental clinics in metropolitan, regional, and rural New South Wales, Australia. Participants were randomly assigned to either an intervention group receiving the fully automated 12-week SmilesUp program (3 SMS text messages weekly) or a control group. Both groups continued to receive usual standard dental clinical treatment. The primary behavioral outcome was parent-reported twice-daily toothbrushing with fluoride toothpaste. Secondary outcomes included adherence to oral health–promoting bedtime routines and child consumption of sugar-sweetened foods and beverages. Oral health self-efficacy was measured using 6 behavioral theory–mapped items across oral hygiene, diet, and bedtime routines. Results A total of 154 participants were enrolled and randomized (n=78, 50.6% in the control group; n=76, 49.4% in the intervention group) across 6 sites, with 80.5% (124/154) completing the follow-up assessment. High program adherence was observed, with 96.1% (73/76) of intervention participants completing the program. At 12 weeks, a greater proportion of SmilesUp participants reported brushing their children’s teeth twice daily (45/61, 73.8% vs 42/63, 66.7%; adjusted odds ratio [aOR] 2.45, 95% CI 0.95-6.74; P =.07), though this difference was not statistically significant. Significant improvements were observed in adherence to bedtime routines (54/61, 88.5% vs 45/63, 71.4%; aOR 3.25, 95% CI 1.15-10.18; P =.03) as well as oral health knowledge on toothbrushing (46/50, 92.0% vs 41/52, 78.8%; aOR 5.47, 95% CI 1.48-25.19; P =.02). No statistically significant differences were found in sugar-sweetened food (10/61, 16.4% vs 4/63, 6.3%; aOR 3.72, 95% CI 1.02-17.14; P =.06) or beverage (25/61, 41.0% vs. 27/63, 42.9%; aOR 1.08, 95% CI 0.49-2.30; P =.85) consumption. Conclusions These findings suggest that co-designed SMS text messaging–based programs show promise and may represent a feasible strategy for oral health behavior change. However, larger-scale and longer-term studies are needed to confirm sustained effectiveness using clinical outcomes. Future research should also explore ways mobile health can be scaled and cost-effectively embedded into comprehensive, interdisciplinary primary models of care.

Source: JMIR mhealth and uhealth

DOI: 10.2196/91720