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

基本信息

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
项目类别：
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

项目摘要

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，但牙科疾病是美国最常见的慢性疾病之一并造成巨大的个人和社会损失。与口腔健康素养低下、口腔不良有密切关系。卫生行为 (OHB)。以牙科疾病的高患病率和高负担为代表，有大量关于高质量口腔卫生习惯的知识与个人实践之间的差距。原因有很多，但最终归结为系统性未能传达口腔卫生说明（OHI）有效地或吸引和激励患者进行口腔自我护理。为了解决知识差距，我们首先将所需的刷牙行为提炼为简单的 2x2x4 OHI （每天刷2次，每次2分钟，全部4个牙齿象限）。我们将利用跟踪功能我们创新的 eBrush 平台可远程监控家庭环境中的刷牙活动。使用 2x2x4 以OHI和eBrush为基础元素，我们将开发和评估个性化数字化的有效性口腔健康干预措施 (DOHI) 用于促进高危人群实现理想的 OHB。在UG3阶段，我们将构建建立用于收集刷牙数据和提供 DOHI 的技术基础设施。然后，我们将参与在共同设计口腔自我护理应用程序时以最终用户为目标，并确定该应用程序的可用性和可行性系统。在 UH3 阶段，我们将构建并验证计算模型，以推断 OHB 的质量刷数据并个性化DOHI。我们将使用 130 人的队列进行为期 10 周的微观随机化尝试优化参与策略的适应性定制。最后，我们将评估该方案的有效性计算驱动的自适应 DOHI 促进 2x2x4 OHB 的持续参与。我们假设动态和个性化的 DOHI 将比传统的、静态的、临床医生提供的 OHI 更有效改善口腔健康并遵守 2x2x4 OHB。我们将通过为期 6 个月的务实、随机、对照、平行组临床试验。来自安全网牙科诊所的符合资格的成年人将配备带有电子牙刷和用于跟踪刷牙数据的智能手机应用程序。经过磨合期（4周）为了确保技术熟练程度并建立基线 OHB，260 名高危受试者将接受临床医生提供的 2x2x4 OHI 并随机分配至：(a) 干预组，受试者接受持续的个性化治疗适时开展 DOHI； (b) 受试者缺乏此类反馈的控制臂。受试者将被跟踪 20周。训练有素的牙医将在每次就诊时进行评估（基线、随机化和之后的评估） 20 周）。主要结果是牙齿健康相对于基线的变化（改良牙龈指数和牙菌斑）指数）。次要结果是遵守 2x2x4 OHI 的质量。我们将探索学科层面的特征预测对 DOHI 的响应幅度。我们的团队科学方法提供了一个潜在的范例转变机会，利用数字技术日益普及和影响力来激活、教育和以以前难以想象的方式和规模让患者参与最佳的口腔健康自我护理。