Abstract: The primary aim of the dissertation was to develop and evaluate a smartphone app, the WhiteTeeth app, designed to promote good oral health behaviour and oral hygiene among adolescent orthodontic patients between the ages of 12 and 16. The app's development and evaluation was guided methodically by intervention mapping (IM). Development thus starts with an analysis of the health problem and the identification of the psychosocial factors and health behaviour related to it. To identify the psychosocial factors underlying oral health behaviour in our target group, a systematic literature review with meta-analysis was conducted,a cross-sectional clinical study and semi-structured interviews. Then, to target these psychosocial factors and facilitate continuous behavioural support, various behaviour-changing techniques were incorporated into the app. The app provides feedback on users' oral health behaviour and allows users to evaluate and monitor their behaviour. Finally, a randomised controlled trial was conducted. This showed that the app had improved oral hygiene in adolescent orthodontic patients after 12 weeks.
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De verdediging hiervan was op 26 september. Background: The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. Objective: The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. Methods: For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. Auteurs: Scheerman, J.F.M., van Empelen, P., van Loveren, C., & van Meijel, B. (2018)
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ABSTRACT Objective: To evaluate the effectiveness of the WhiteTeeth mobile app, a theory-based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients. Methods: In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check-ups: at baseline (T0), at 6-week follow-up (T1), and at 12-week follow-up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n=67). The control group received usual care only (n=65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al-Anezi and Harradine plaque Index); and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behavior and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed model analyses to determine the intervention effects. Results: At 6-week follow-up, the intervention led to a significant decrease in gingival bleeding (B=-3.74; 95%CI -6.84 to -0.65), and an increase in the use of fluoride mouth rinse (B=1.93; 95%CI 0.36 to 3.50). At 12-week follow-up, dental plaque accumulation (B=-11.32; 95%CI -20.57 to -2.07) and the number of sites covered. Conclusions: The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017.
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