Co-Designing an MHealth Intervention Addressing ECC Using the BCW Framework

Objectives: Our objective was to describe the co-design process, development and content evaluation of a text message program that aims to support oral health behaviour change for parents and carers of children diagnosed with Early Childhood Caries (ECC); using the Behaviour Change Wheel (BCW) framework.
Methods: The BCW is a widely used theoretical framework^1,2 recommended by the WHO³ for co-designing oral health literacy mHealth programs. In this mixed-methods study, the intervention was developed in two phases. Phase 1 focused on the three stages of the BCW framework. Through workshops with parents (consumers) and health professionals, we selected target behaviours, identified barriers/enablers, intervention functions and behaviour change techniques (BCTs). In Phase 2, we developed content, evaluated the understandability, usefulness, and acceptability of the messages through surveys, and finalised the program’s features and structure to address target behaviours identified in Phase 1.
Results: In Phase 1, six consumers and 14 health professionals (senior clinicians, health policy, and health promotion managers) participated in the co-design workshops. The workshop participants selected the overall target behaviours and grouped these into three behavioural categories: 1)oral hygiene, 2)food/drink, and 3)bedtime routines. Eleven barriers and 17 enablers were identified, five intervention functions and 15 BCTs were mapped to the target behaviours. Phase 2, 111 draft text messages were developed by workshop participants. Additionally, 2,045 reviews of the draft messages by health professionals (n=17) and consumers (n=14) determined that 56 messages were easy to understand, useful, and accepted by both consumers and health professionals. These messages were incorporated into SMILESup semi-personalised 12-week text message program.
Conclusions: Our study co-designed a text message program using the BCW to address a range of oral health risk behaviours impacting young children. Future research is needed to assess the program's effectiveness in changing oral health risk behaviours.