Personalized Digital Behavior Change Interventions to Promote Oral Health

个性化数字行为改变干预措施促进口腔健康

• 批准号: 10429895
• 负责人: VIVEK SHETTY
• 金额: $ 71.06万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10429895
• 关键词: Address; Adherence; Adult; Behavior; Behavior Therapy; Behavioral Sciences; Bioethics; Car Phone; Cellular Phone; Chronic Disease; Clinic; Clinical Trials Cooperative Group; Computer Models; Data; Dental; Dental Clinics; Dental Hygiene; Dental caries; Dentistry; Dentists; Drops; Elements; Ensure; Failure; Feedback; Fostering; Foundations; Gingival Indexes; Health behavior; Healthcare; High Prevalence; Home; Individual; Infrastructure; Instruction; Intervention; Knowledge; Link; Machine Learning; Maintenance; Methodology; Oral; Oral health; Patient Recruitments; Patients; Penetration; Periodontal Diseases; Phase; Population; Prevention; Procter Gamble; Proxy; Randomized; Research; Resources; Risk; Running; Science; Self Care; System; Target Populations; Technology; Testing; Theory of Change; Time; Tooth Diseases; Toothbrushing; Training; United States; Visit; Vulnerable Populations; adaptive intervention; arm; base; behavior change; blind; cohort; design; digital; digital health; effectiveness evaluation; evidence base; handheld mobile device; health literacy; health organization; high risk; improved; indexing; industry partner; innovation; personalized predictions; population health; primary outcome; randomized trial; remote monitoring; response; safety net; secondary outcome; smartphone Application; technology development; treatment arm; usability

Although preventable, dental disease is one of the most common chronic diseases in the United States and exacts a substantial personal and societal toll. It is closely linked to low oral health literacy and poor oral hygiene behaviors (OHBs). Using the high prevalence and burden of dental disease as a proxy, there is a large gap between knowledge about quality oral hygiene routines and what is practiced by individuals. The causes are many but ultimately distill down to a systemic failure to communicate oral hygiene instructions (OHIs) effectively or to engage and motivate patients in their own oral self-care. To address the know-do gap, we begin by distilling desired brushing behaviors into a simple 2x2x4 OHI (brushing 2 times a day, for 2 minutes each time, all 4 dental quadrants). We will leverage tracking capabilities of our innovative eBrush platform to remotely monitor tooth-brushing activities in home settings. Using the 2x2x4 OHI and eBrush as foundational elements, we will develop and evaluate the effectiveness of personalized Digital Oral Health Interventions (DOHI) for promoting ideal OHBs in at-risk individuals. In the UG3 phase, we will build out the technologic infrastructure for collecting brushing data and delivering the DOHI. Then, we will engage target end-users in the co-design of an app for oral self-care and establish the usability and feasibility of the system. In the UH3 phase, we will build and validate computational models to infer the quality of OHBs from brushing data and personalize the DOHI. Using a cohort of 130, we will conduct a 10-week Micro-Randomized Trial to optimize the adaptive tailoring of engagement strategies. Finally, we will evaluate effectiveness of the computationally-driven, adaptive DOHI in promoting sustained engagement in the 2x2x4 OHB. We hypothesize that a dynamic and personalized DOHI will be more effective than traditional, static, clinician-delivered OHI in improving oral health and adherence to 2x2x4 OHBs. We will test our hypothesis through a 6-month, pragmatic, randomized, controlled, parallel-group clinical trial. Eligible adults from safety-net dental clinics will be equipped with an electronic toothbrush and the smartphone app for tracking brushing data. After a run-in period (4 weeks) to ensure technical proficiency and establish baseline OHBs, 260 at-risk subjects will receive a clinician-delivered 2x2x4 OHI and randomized to either: (a) an intervention arm where subjects receive ongoing, personalized DOHIs at opportune times; or (b) a control arm where subjects lack such feedback. Subjects will be followed for 20 weeks. Trained dental examiners will conduct assessments at each visit (baseline, randomization and after 20 weeks). Primary outcomes are changes in dental health from baseline (Modified Gingival Index and Plaque Index). Secondary outcome is the quality of adherence to the 2x2x4 OHI. We will explore subject-level features that predict the magnitude of response to the DOHI. Our team science approach presents a potentially paradigm shifting opportunity to leverage the growing ubiquity and reach of digital technologies to activate, educate, and engage patients in optimal oral health self-care in ways and at a scale previously unimaginable.

尽管可以预防，但牙齿疾病是美国最常见的慢性疾病之一 并确定了实质性的个人和社会损失。它与低口服健康素养和口腔差的密切相关 卫生行为（OHB）。将牙齿疾病的高患病率和负担作为代理，有一个很大的 关于质量口腔卫生常规的知识与个人实践的知识之间的差距。原因 有很多，但最终会蒸馏到系统的失败以传达口腔卫生说明（OHIS） 有效或以自己的口腔自我保健来吸引和激励患者。 为了解决知识差距，我们首先将所需的刷牙行为提炼成一个简单的2x2x4 ohi （每天刷2次，每次2分钟，所有4个牙齿象限）。我们将利用跟踪功能 我们创新的eBrush平台，可远程监视家庭环境中的牙刷活动。使用2x2x4 ohi和ebrush作为基础元素，我们将开发和评估个性化数字的有效性 口服健康干预措施（DOHI）用于促进高危人群中理想的OHB。在UG3阶段，我们将建立 用来收集刷牙数据并提供DOHI的技术基础架构。然后，我们将参与 针对口头自我保健的应用程序共同设计的目标最终用户，并确定了可用性和可行性 系统。在UH3阶段，我们将构建和验证计算模型，以推断OHB的质量 刷数据并个性化DOHI。使用130的队列，我们​​将进行为期10周的微型交战 试验以优化参与策略的适应性剪裁。最后，我们将评估 计算驱动的自适应DOHI在促进2x2x4 OHB中持续参与。我们假设 动态和个性化的dohi将比传统的，静态的临床医生更有效 改善口腔健康并遵守2x2x4 OHB。我们将通过6个月的务实测试我们的假设 随机，受控，平行组临床试验。安全网牙科诊所的合格成年人将配备 使用电子牙刷和用于跟踪刷牙数据的智能手机应用程序。磨合期（4周）后 为了确保技术水平并建立基线OHB，260名处于危险的受试者将获得临床医生的服务 2x2x4 ohi，然后随机分配给：（a）受试者接受持续的个性化的干预臂 在适当的时候或（b）受试者缺乏此类反馈的控制臂。将遵循主题 20周。训练有素的牙科检查员将在每次访问（基线，随机分组和之后）进行评估 20周）。主要结果是牙齿健康的变化（修改后的牙龈指数和斑块） 指数）。次要结果是遵守2x2x4 OHI的质量。我们将探索主题级功能 这预测了对DOHI的响应程度。我们的团队科学方法提出了潜在的范式 转移机会来利用数字技术不断增长的普遍性和覆盖范围来激活，教育和 通过以前难以想象的方式使患者与患者进行最佳的口腔健康自我保健。