My Smile Buddy Theory and Technology addressing pediatric caries disparities

Abstract Objective: To develop and test a mobile device application for early childhood caries (ECC) intervention by community health workers (CHWs) with low-income Latino at-risk families. Methods: A multidisciplinary team developed “MySmileBuddy” (MSB), a bilingual, low-literacy web application delivered on an iPad for ECC risk assessment and behavioral mitigation by CHWs. MSB utilizes a unique “diet widget” and risk algorithm to assess risk and engages parents in health behavior change planning. CHW training and parent engagement components are predicated on principles of community-based participatory research, Motivational Interviewing, and the Theory of Planned Behavior. Research methods included both quantitative (algorithm development) and qualitative (focus group) approaches. Results: Through focus groups, CHWs reported that despite its high prevalence and frequent emergency room presentations, ECC is not a high priority in the community. They strongly advised that the risk assessment tool be interactive, dynamic, flexible, and “not like a survey.” During development of the risk algorithm, non-clinical and clinical risk factors were assessed, finding that children had higher odds of having ECC if they had a mother with dental caries (aOR=6.2, p<0.001), >3 daily sugar exposures in addition to meals (aOR=35.7, p=0.001), suboptimal topical fluoride exposure (aOR=21.0, p=0.01), plaque scores ≥4 (aOR=6.1, p<0.001), and high salivary levels of mutans streptococci (aOR=35.7, p<0.001). Accuracy (sensitivities and specificities) and utility (predictive values) of each risk factor and combinations of factors were also determined with similar findings. Upon completion of the MSB prototype, a focus group of parent participants revealed high levels of interest, acceptance of length and content, satisfaction with CHW's facilitation, and strong recall of their individualized planned behavioral changes. Conclusions: Educational technology that incorporates motivational interviewing and health behavior theories holds strong promise to reduce ECC disparities through family-level community-based interventions by community health workers.