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Joshi V, Joshi NK, Bhardwaj P, Singh K, Ojha D, Jain YK. The Health Impact of mHealth Interventions in India: Systematic Review and Meta-Analysis. Online J Public Health Inform 2023; 15:e50927. [PMID: 38046564 PMCID: PMC10689051 DOI: 10.2196/50927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background Considerable use of mobile health (mHealth) interventions has been seen, and these interventions have beneficial effects on health and health service delivery processes, especially in resource-limited settings. Various functionalities of mobile phones offer a range of opportunities for mHealth interventions. Objective This review aims to assess the health impact of mHealth interventions in India. Methods This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies conducted in India, and published between April 1, 2011, and March 31, 2021, were considered. A literature search was conducted using a combination of MeSH (Medical Subject Headings) terms in different databases to identify peer-reviewed publications. Thirteen out of 1350 articles were included for the final review. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions tool (for nonrandomized trials), and a meta-analysis was performed using RevMan for 3 comparable studies on maternal, neonatal, and child health. Results The meta-analysis showed improved usage of maternal and child health services including iron-folic acid supplementation (odds ratio [OR] 14.30, 95% CI 6.65-30.75), administration of both doses of the tetanus toxoid (OR 2.47, 95% CI 0.22-27.37), and attending 4 or more antenatal check-ups (OR 1.82, 95% CI 0.65-5.09). Meta-analysis for studies concerning economic evaluation and chronic diseases could not be performed due to heterogeneity. However, a positive economic impact was observed from a societal perspective (ReMiND [reducing maternal and newborn deaths] and ImTeCHO [Innovative Mobile Technology for Community Health Operation] interventions), and chronic disease interventions showed a positive impact on clinical outcomes, patient and provider satisfaction, app usage, and improvement in health behaviors. Conclusions This review provides a comprehensive overview of mHealth technology in all health sectors in India, analyzing both health and health care usage indicators for interventions focused on maternal and child health and chronic diseases. Trial Registration PROSPERO 2021 CRD42021235315; https://tinyurl.com/yh4tp2j7.
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Affiliation(s)
- Vibha Joshi
- Resource Centre Health Technology Assessment All India Institute of Medical Sciences Jodhpur Jodhpur India
| | - Nitin Kumar Joshi
- School of Public Health All India Institute of Medical Sciences Jodhpur Jodhpur India
- Department of Community Medicine and Family Medicine All India Institute of Medical Sciences Jodhpur Jodhpur India
| | - Pankaj Bhardwaj
- School of Public Health All India Institute of Medical Sciences Jodhpur Jodhpur India
- Department of Community Medicine and Family Medicine All India Institute of Medical Sciences Jodhpur Jodhpur India
| | - Kuldeep Singh
- Resource Centre Health Technology Assessment All India Institute of Medical Sciences Jodhpur Jodhpur India
| | - Deepika Ojha
- Resource Centre Health Technology Assessment All India Institute of Medical Sciences Jodhpur Jodhpur India
| | - Yogesh Kumar Jain
- School of Public Health All India Institute of Medical Sciences Jodhpur Jodhpur India
- Department of Community Medicine and Family Medicine All India Institute of Medical Sciences Jodhpur Jodhpur India
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Ihab M, Abdelaziz WEED, Hassan W, El Tantawi M. Development and acceptability of behavioral interventions promoting mothers' brushing of pre-school children's teeth: The preparation phase of the multi-phase optimization strategy framework. BMC Oral Health 2023; 23:616. [PMID: 37653476 PMCID: PMC10470132 DOI: 10.1186/s12903-023-03351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Early childhood caries can be prevented through regular parental-supported toothbrushing, indicating the importance of behavior modification interventions targeting parents. Mobile oral health (m-oral health) interventions are gaining increased popularity although their production is not always based on solid theoretical frameworks and evidence about the efficacy of individual intervention components is not available. The Multiphase Optimization Strategy (MOST) offers a framework to develop complex m-oral health interventions and assessing the efficacy of individual components. AIM This study describes the development and assesses the acceptability of 3 intervention components using MOST to promote mothers' brushing of their preschool children's teeth. METHODS The Theory of Planned Behavior guided the development of 3 components: motivational interviewing (MI), storytelling videos (STVs), and oral health promotion messages (OHPMs). A researcher received training to conduct MI. Twenty-four OHPMs were developed, and 14 STVs scripts were developed based on the "And, But, Therefore" framework. A feasibility pilot study was conducted to determine the optimization objective and assess mothers' preferences regarding the frequency and timing of receiving the intervention components. The mothers participated in a semi-structured interview to assess the acceptability of the components using 7 open-ended questions based on the framework of acceptability and thematic analysis was used to analyze the qualitative data. The mothers also responded to questions assessing the perceived and experienced acceptability of the components using close-ended questions. Descriptive statistics were presented as means and standard deviations for continuous variables and median and interquartile range for categorical variables. RESULTS Sixteen mothers were included. The mothers expressed positive affective attitude towards the interventions. They felt the components served as "good reminders" to brush their children's teeth. However, "time" was a burden for the mothers. 80% of the mothers preferred receiving the OHPMs and STVs once per week, from 8 pm to 2 am (50%), and 60% indicated they can set 15-30 min to receiving the interventions. CONCLUSION The 3 components were acceptable to the mothers. The OHPMs and STVs will be sent to the mothers once per week, between 8 pm to 2 am. The MI and follow-up phone calls will be limited to 15 min.
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Affiliation(s)
- Merna Ihab
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria University, Champollion St, Azarita, Alexandria, Egypt
| | - Wafaa Essam El-Din Abdelaziz
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria University, Champollion St, Azarita, Alexandria, Egypt
| | - Walid Hassan
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria University, Champollion St, Azarita, Alexandria, Egypt.
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Alasmari D, Alkhalaf MS, Alqahtani SM, Alqhtani NR, Alqahtani AS, Gufran K, Alotaibi YK. Effectiveness of Smart Applications of Oral Hygiene Instructions on Periodontal Health Compared to Oral Information: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14703. [PMID: 36429421 PMCID: PMC9689989 DOI: 10.3390/ijerph192214703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
Nowadays, smartphone applications are widely used in different areas of life, including medical science. The present study aimed to assess the effectiveness of a smartphone application of oral hygiene instructions (OHI) on periodontal health compared to the traditional chairside OHI. All the participants (n = 39) were divided into two groups: control group and test group. Participants of the control group were given verbal OHI and participants of the test group were asked to use a smartphone application to upkeep their oral habits. The gingival index (GI) and Quigley-Hein Turesky modification index (QHTMI) were used for scoring the plaque accumulation at baseline and after one month of the periodontal treatment. A paired t-test and an independent t-test were performed to compare the mean of GI and QHTMI between intra-group and inter-group, respectively. The paired t-test showed significant differences in GI and QHTMI improvement after one month in both groups. Moreover, the independent t-test showed no significant differences between the two groups. However, the test group showed a lower mean score in GI and QHTMI assessments compared to the control group. Smartphone applications in oral health applications did not exhibit any superiority in periodontal health over the traditional OHI method in the current study.
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Affiliation(s)
- Dhafer Alasmari
- Department of Periodontology and Oral Medicine, College of Dentistry, Qassim University, Buraydah 52571, Saudi Arabia
| | | | - Saeed Maeed Alqahtani
- Consultant Periodontics, Dental Department Border Guard Center, Riyadh 12211, Saudi Arabia
| | - Nasser Raqe Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdullah Saad Alqahtani
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Khalid Gufran
- Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Yasser Khaled Alotaibi
- Consultant Periodontist, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia
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Effect of electronic reminders on patients' compliance during clear aligner treatment: an interrupted time series study. Sci Rep 2022; 12:16652. [PMID: 36198717 PMCID: PMC9534859 DOI: 10.1038/s41598-022-20820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50–74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients. Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.
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Sharma S, Mohanty V, Balappanavar AY, Chahar P, Rijhwani K. Role of Digital Media in Promoting Oral Health: A Systematic Review. Cureus 2022; 14:e28893. [PMID: 36225421 PMCID: PMC9543101 DOI: 10.7759/cureus.28893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Oral disease has affected almost half of the world’s population, causing an enormous economic burden. To overcome this huge problem, oral health promotion is one of the most cost-effective methods. Digital media can play a pivotal role in achieving the goal of reducing this burden by providing a wider platform to reach out to the population even in the areas of deficit oral health care service. The aim of this systematic review is to assess the effectiveness of digital media in oral health promotion. The combinations of terms in the following two broad categories were used to search the literature on PubMed, Cochrane Library articles, WHO guidelines on oral health promotion through digital media, and Google Scholar: Intervention (digital media, Mobile phones, Text messages, social media, Cell phones, MHealth application, Telemedicine, Television, Videos) and Outcome (Oral Health education, Oral health, Oral health promotion, Oral health literacy, Oral health knowledge, Oral health attitude, Oral health practice, Oral hygiene improvement). The review was conducted in two phases, using the standardized checklist applicable to studies. Initially, abstracts were retrieved, followed by the assessment of the full papers against the review criteria. Among the selected studies, digital interventions helped in providing continuity of care and services in seven studies, eight addressed the increase in knowledge, attitude, and practice, and all the studies analyzed oral health needs. The findings concluded that digital media-based interventions can enhance oral health literacy and help in tackling this problem among different age groups.
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Ihab M, El Din WE, Ammar N, Yassin R, El Tantawi M. Using mHealth to promote parents' brushing of preschool children's teeth: a protocol for a randomized factorial trial using the Multi-phase Optimization Strategy (MOST). Trials 2022; 23:17. [PMID: 34991701 PMCID: PMC8733768 DOI: 10.1186/s13063-021-05931-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Early childhood caries is a highly prevalent disease affecting young children. Parental brushing of children's teeth is recommended during preschool years. Interventions to promote parental brushing of children's teeth are assessed as a package in randomized clinical trials and the efficacy of separate components is not known. METHODS AND ANALYSIS The aim of this study is to develop an optimized behavior modification intervention to increase parents' brushing of their pre-school children's teeth using the multi-phase optimization strategy (MOST) guided by the Theory of Planned Behavior. Behavior change will be assessed by the percent reduction in children's dental plaque index after 6 months and parents reporting of toothbrushing frequency. Two phases of MOST will be carried out. First, the preparation phase comprises the development of a conceptual framework, identifying candidate components, conducting a feasibility pilot study to assess the acceptability and the design features of three intervention components (motivational interviewing (MI), and two mobile health (mHealth) components: oral health promotion messages and storytelling videos delivered using WhatsApp messenger) in addition to setting an optimization objective. Second, the optimization phase constitutes a factorial trial assessing the three intervention components and developing the intervention by selecting the most effective components within the optimization constraint. Each component will be set at two levels: yes (the intervention is applied) and no (the intervention is not applied). A linear regression model will be used to assess the effect of the intervention components on the percent reduction in dental plaque index (primary outcome measure). The secondary outcome measure is the change in the frequency of parents' brushing of the child's teeth. The combination of components making up the new optimized intervention will be selected. DISCUSSION This will be the first study to apply the MOST framework in the field of dentistry. The results of this study can guide the development of an optimized behavior modification interventions using mHealth and MI. TRIAL REGISTRATION ClinicalTrials.gov, NCT04923581, Registered 11 June 2021.
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Affiliation(s)
- Merna Ihab
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, Alexandria, 21527, Egypt.
| | - Wafaa Essam El Din
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, Alexandria, 21527, Egypt
| | - Nour Ammar
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, Alexandria, 21527, Egypt
| | - Randa Yassin
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, Alexandria, 21527, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champollion St., Azarita, Alexandria, 21527, Egypt
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Sangalli L, Savoldi F, Dalessandri D, Bonetti S, Gu M, Signoroni A, Paganelli C. Effects of remote digital monitoring on oral hygiene of orthodontic patients: a prospective study. BMC Oral Health 2021; 21:435. [PMID: 34493255 PMCID: PMC8422366 DOI: 10.1186/s12903-021-01793-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged. Methods Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t0), every month for the first 3 months (t1, t2, t3), and at 6 months (t4). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran’s Q-test (significance α = 0.05). Results Study group patients showed a significant improvement in plaque control at t3 (p = 0.010) and t4 (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant. Conclusions Integration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis.
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Affiliation(s)
- Linda Sangalli
- Department of Information Engineering, Faculty of Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy.,Division of Orofacial Pain, College of Dentistry, University of Kentucky, 740 S. Limestone, Lexington, KY, 40536, USA
| | - Fabio Savoldi
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, 2/F, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR
| | - Domenico Dalessandri
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Bonetti
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Min Gu
- Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, 2/F, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR.
| | - Alberto Signoroni
- Department of Information Engineering, Faculty of Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
| | - Corrado Paganelli
- Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Toniazzo MP, Nodari D, Muniz FWMG, Weidlich P. Effect of mHealth in improving oral hygiene: A systematic review with meta‐analysis. J Clin Periodontol 2019; 46:297-309. [DOI: 10.1111/jcpe.13083] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/23/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Mirian P. Toniazzo
- Department of PeriodontologyFederal University Rio Grande do Sul Porto Alegre Brazil
| | - Daniela Nodari
- Department of PeriodontologyFederal University Rio Grande do Sul Porto Alegre Brazil
| | | | - Patricia Weidlich
- Department of PeriodontologyFederal University Rio Grande do Sul Porto Alegre Brazil
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Nishi M, Kelleher V, Cronin M, Allen F. The effect of mobile personalised texting versus non-personalised texting on the caries risk of underprivileged adults: a randomised control trial. BMC Oral Health 2019; 19:44. [PMID: 30866895 PMCID: PMC6417196 DOI: 10.1186/s12903-019-0729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 02/25/2019] [Indexed: 01/19/2023] Open
Abstract
Background In the Republic of Ireland (RoI), fluoridation has been effective and efficient for caries prevention at population level, regardless of income status; however, at individual level it still has limitations. This study aimed to compare personalised versus non-personalised text messaging on ‘chance of avoiding new cavities’ with the Cariogram, a computer-based caries risk assessment (CRA) model, in an economically disadvantaged adult population in the RoI. Methods The intervention was via a CRA summary letter plus 24 weekly personalised mobile-phone short text messages (text messages) based on the individual’s CRA, compared with a non-personalised approach via a non-personalised letter and a predetermined, fixed set of 24 weekly text messages. The study was designed as a two-arm parallel-group, single-blinded (assessor), randomised controlled study in County Cork, RoI. The primary outcome was a comparison of ‘chance of avoiding new cavities’ calculated by the Cariogram with clinical examination, interview, CRT® (Ivoclar Vivadent, Liechtenstein) and three-day food diary between the two groups at follow-up. We combined stratified randomisation with blocked randomisation for 171 participants who completed baseline. Of them, 111 completed follow-up and were analysed (56 and 55 from the personalised and non-personalised groups, respectively). Due to protocol violations, both intent-to-treat (ITT) and per-protocol analyses were conducted. Results The ITT analysis did not show a personalised intervention effect on ‘chance of avoiding new cavities’. Of the secondary outcome measures, only the stimulated saliva flow factor showed a personalised intervention effect, p = 0.036, OR = 0.3 (95% CI = 0.1, 0.9). The per-protocol analysis with 21 personalised and 33 non-personalised participants within two-message deviations showed no significant effect on ‘chance of avoiding new cavities’. Conclusions The null hypothesis in regard to the primary outcome for both ITT and per-protocol analyses was not rejected; however, as the minimal clinically important difference was included in the 95% CI for the per-protocol analysis, replication studies will be worth conducting to explore the potential of mobile devices for individual caries risk reduction. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000027253) on 10 May 2017. The study was retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12903-019-0729-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Makiko Nishi
- Non-profit Organisation "Promoting Scientific Assessment in Prevention of Tooth Decay and Gum Disease", Tokyo, Japan.
| | - Virginia Kelleher
- Oral Health Services Research Centre, University College Cork, Cork, Republic of Ireland
| | - Michael Cronin
- School of Mathematical Sciences, University College Cork, Cork, Republic of Ireland
| | - Finbarr Allen
- Prosthodontics and Oral Rehabilitation, Cork Dental School and Hospital, University College Cork, Cork, Republic of Ireland
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Bassi A, John O, Praveen D, Maulik PK, Panda R, Jha V. Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e11440. [PMID: 30368435 PMCID: PMC6229512 DOI: 10.2196/11440] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. Objective We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. Methods A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. Results The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. Conclusions In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.
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Affiliation(s)
- Abhinav Bassi
- George Institute for Global Health, India, New Delhi, India
| | - Oommen John
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia
| | - Devarsetty Praveen
- University of New South Wales, Sydney, Australia.,George Institute for Global Health, India, Hyderabad, India
| | - Pallab K Maulik
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia.,George Institute for Global Health, Oxford University, Oxford, United Kingdom
| | - Rajmohan Panda
- George Institute for Global Health, India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, India, New Delhi, India.,University of Oxford, Oxford, United Kingdom
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Tiffany B, Blasi P, Catz SL, McClure JB. Mobile Apps for Oral Health Promotion: Content Review and Heuristic Usability Analysis. JMIR Mhealth Uhealth 2018; 6:e11432. [PMID: 30181114 PMCID: PMC6231784 DOI: 10.2196/11432] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There has been an increase in consumer-facing mobile health (mHealth) apps in recent years. Prior reviews have characterized the availability, usability, or quality of popular mHealth apps targeting a range of health behaviors, but none has examined apps that promote better oral health care. Oral disease affects billions of people worldwide and mobile phone use is on the rise, so the market for well-designed and effective oral health apps is substantial. OBJECTIVE We examined the content and usability of popular oral health promotion apps to better understand the current state of these self-help interventions and inform the need and opportunity for future app development. METHODS Between February and March 2018, we identified oral health-focused apps that were designed for Android or iOS, available in English, and targeted adult consumers (as opposed to children or dental health professionals). The sample was limited to the most popular and highly rated apps on each platform. For each app reviewed, we assessed its basic descriptive characteristics (eg, platform, cost), evidence of a theoretical basis or empirical validation, key program functionality, and the extent to which the app addressed diet and tobacco and alcohol use as risk factors for oral disease. We characterized the framing (ie, gain vs loss) of all persuasive messaging and conducted a heuristic analysis to assess each app's usability as a persuasive health technology. RESULTS Thirty-three apps were eligible for review based on the selection criteria. Two-thirds (22/33, 67%) were geared toward the general public as opposed to dental clinic patients, insurance plan members, or owners of specific electric toothbrushes. Most (31/33, 94%) were free to download, and a majority (19/33, 58%) were sponsored by software developers as opposed to oral health experts. None offered any theoretical basis for the content or had been empirically validated. Common program features included tools for tracking or reminding one to brush their teeth and assistance scheduling dental appointments. Nineteen apps (58%) included educational or persuasive content intended to influence oral health behavior. Only 32% (6/19) of these included a larger proportion of gain-framed than loss-framed messaging. Most of the apps did not mention diet, alcohol or tobacco-important risk factors for oral disease. Overall, the apps performed poorly on standard usability heuristics recommended for persuasive health technologies. CONCLUSIONS The quality of the reviewed apps was generally poor. Important opportunities exist to develop oral health promotion apps that have theoretically grounded content, are empirically validated, and adhere to good design principles for persuasive health technologies.
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Affiliation(s)
- Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Paula Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Kumar GS, Kashyap A, Raghav S, Bhardwaj R, Singh A, Guram G. Role of Text Message Reminder on Oral Hygiene Maintenance of Orthodontic Patients. J Contemp Dent Pract 2018; 19:98-101. [PMID: 29358543 DOI: 10.5005/jp-journals-10024-2219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Fixed orthodontic treatment is frequently associated with increased plaque accumulation leading to gingivitis and white spot lesions (WSLs). AIM This study evaluated the role of text message reminder on oral hygiene of orthodontic patients. MATERIALS AND METHODS A total of 60 patients under fixed orthodontic treatment were randomly divided into two equal groups as control group and study (text message) group. Text message group received reminders about oral hygiene, while the control group did not receive any messages. Oral hygiene of both the groups was evaluated at baseline, 2, and 3 months using plaque indices (PIs) along with WSL status. Data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) statistical software, version 19, with chi-square test and t-test. RESULTS At the baseline, plaque score was higher in the study group over control group (p > 0.038), whereas it was decreased after 3 months in the test group (p > 0.001). For WSL, there was no significant difference at baseline, but it was significantly lower in study group (p > 0.003). CONCLUSION Oral hygiene status improved with text message reminder.
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Affiliation(s)
- G Sujay Kumar
- Department of Orthodontics, Sharavathi Dental College and Hospital, Shimoga, Karnataka, India, e-mail:
| | - Arpita Kashyap
- Private Practitioner, Crystal Smile Care, Department of Orthodontics, Guwahati, Assam, India
| | - Shweta Raghav
- Department of Orthodontics and Dentofacial Orthopedics College of Dental Sciences, Indore, Madhya Pradesh, India
| | - Rishibha Bhardwaj
- Department of Orthodontics, I.T.S. Dental College, Muradnagar Uttar Pradesh, India
| | - Arunesh Singh
- Department of Orthodontics, Rama Dental College, Hospital & Research Centre, Kanpur, Uttar Pradesh, India
| | - Guneet Guram
- Department of Orthodontics, Adesh Institute of Dental Sciences & Research, Bathinda, Punjab, India
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13
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Cunha-Cruz J, Huebner CE, Ludwig S, Dysert J, Mitchell M, Allen G, Shirtcliff RM, Scott JM, Milgrom P. Everybody Brush! Consumer Satisfaction with a Tooth Decay Prevention Program. Front Public Health 2017; 5:264. [PMID: 29021979 PMCID: PMC5623708 DOI: 10.3389/fpubh.2017.00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/14/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Twice-daily caregiver-supervised toothbrushing with fluoridated toothpaste is an effective and widely recommended strategy to prevent tooth decay in children. Qualitative research suggests that low-income caregivers know the recommendation but would benefit from toothbrushing supplies and advice about how to introduce this health behavior especially as the child becomes older and asserts autonomy to do it “myself.” Our objective is to assess consumer satisfaction with the evidence-based theory-informed campaign and usefulness of materials that were home delivered. The focus of the evaluation was families with children <36 months of age because of the high incidence of disease in this population. Methods A dental care organization designed and implemented Everybody Brush! in three counties of Central Oregon. Participants were families of Medicaid-insured children <21 years of age. Participants were randomly assigned to one of the three study groups: test (supplies, voice/printed messages, telephone support), active (supplies), and a waitlist control. Program materials were in English and Spanish. Caregivers of children <36 months were interviewed at the beginning and end of the program. Results A total of 83,148 toothbrushing kits were mailed to 21,743 families. In addition, 93,766 printed messages and 110,367 recorded messages were sent to half of the families. Caregivers were highly satisfied. On a global rating scale from 0 to 10 (worst to best program possible), they rated the program 9.5 on average (median: 10, SD 0.9). On a scale from 0 to 10 (not at all to very useful), mean ratings for usefulness of the toothbrushing supplies was 9.5 (SD = 1.5), for the printed postcard messages was 7.2 (SD 3.6), and for the voice telephone messages was 6.5 (SD 3.9). Discussion A dental care organization carried out a complex community intervention designed to address excess tooth decay among low-income children. Caregivers were highly satisfied with the Everybody Brush! program and toothbrushing supplies were considered the most useful, followed by printed messages. Voice telephone messages were rated least useful. Further evaluation of the impact of the program on toothbrushing behavior and dental-care utilization is underway.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
| | - Colleen E Huebner
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - Sharity Ludwig
- Advantage Dental Services, LLC, Redmond, OR, United States
| | - Jeanne Dysert
- Advantage Dental Services, LLC, Redmond, OR, United States
| | | | - Gary Allen
- Advantage Dental Services, LLC, Redmond, OR, United States
| | | | - JoAnna M Scott
- Research and Graduate Programs, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
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