Zusammenfassung Hintergrund Erste Studien heben den Migrationshintergrund von Menschen in Deutschland als eigenständigen Risikofaktor für eine mangelhafte Mundgesundheit hervor. Ein wichtiger Einflussfaktor könnte hierbei eine niedrigere Mundgesundheitskompetenz von Menschen mit Migrationshintergrund sein. Ziel In diesem Artikel werden Ergebnisse zur Mundgesundheitskompetenz und Mundgesundheit aus der MuMi-Studie (Förderung der Mundgesundheit und Mundgesundheitskompetenz von Menschen mit Migrationshintergrund) vorgestellt. Material und Methoden In 40 Hamburger Zahnarztpraxen wurden von Patient*innen mit und ohne Migrationshintergrund Daten zu Soziodemografie, Mundgesundheit und Mundgesundheitskompetenz erhoben. Der Zusammenhang zwischen Mundgesundheitskompetenz und Mundgesundheit wurde mittels logistischer Regressionen berechnet. Potenzielle Einflussfaktoren wurden schrittweise in die Berechnungsmodelle eingefügt. Ergebnisse Die Gruppen mit und ohne Migrationshintergrund unterschieden sich signifikant hinsichtlich ihrer Mundgesundheitskompetenz und ausgewählter klinischer Parameter ihrer Mundgesundheit (Approximalraum-Plaqueindex und Kariessanierungsgrad). Die logistischen Regressionsanalysen zeigen einen deutlichen Zusammenhang zwischen Migrationshintergrund, Mundgesundheitskompetenz und Mundhygiene auch unter Berücksichtigung von Bildung und sozioökonomischem Status. Diskussion Der Migrationshintergrund stellt einen eigenständigen Indikator für eine niedrige Mundgesundheitskompetenz und schlechtere Mundgesundheit dar. Dieser Umstand sollte stärker in den Fokus von Forschung und politischen Entscheidungen rücken, um die mundgesundheitliche Chancengleichheit in Deutschland zu erhöhen.
Background Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. Objective This study aims to describe the development process of the MuMi app. Methods For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. Results On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. Conclusions The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.
BACKGROUND Studies have shown that vulnerable groups, such as persons with migration background, have poorer oral health than the majority population in Germany. Limited oral health literacy appears to be an important factor that affects the oral health of these groups. OBJECTIVE This paper describes the development process of an evidence-based prevention program in form of a health app, the MuMi-App, which aims to improve the oral health literacy of its users. METHODS For the description and analysis of the systematic development process of the MuMi-App, we used the intervention mapping approach (IMA). The approach was implemented within six steps: 1) needs assessment, 2) formulation of intervention goals, 3) selection of evidence-based methods and practical strategies for behavior change, 4) planning and designing the intervention, 5) planning implementation and delivery, and 6) planning the evaluation. RESULTS The needs assessment revealed that persons with migration background tend to have problem-oriented dental care utilization patterns. Language barriers and different healthcare socialization impede the access to health services. Information on the German healthcare system, tooth-friendly diets and efficient daily oral hygiene routines were identified as main educational content to achieve an open, prevention-oriented utilization behavior and therefore improve the oral health of the app users. Current literature was screened to fill the instructional content of the MuMi-App with evidence-based information. The provision of information in a game-like manner through culturally sensitive illustrations and simple expressions was identified as a method to effectively change the behavior of the app users. In total, over 350 evidence-based learning elements were developed and provided in five different languages. CONCLUSIONS The IMA provided a transparent, structured and evidence-based process for the development of our prevention program. The MuMi-App is a scientifically tested app that takes into account cultural and specific determinants of vulnerable groups.
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