Designing interventions to improve tooth brushing

Abstract

This paper provides an outline of an industrial approach to behaviour change, which ranges from a process to design and develop behaviour change interventions, to the development and use of technology to shape and measure behaviour (and subsequently changes therein). The focus here is on the normal population (with varying degrees in health status) in developed as well as emerging markets, cutting across a wide range of cultures and nationalities. The key desired behaviours of interest are: tooth brushing twice a day, and if adhered to, brushing for two minutes with a full coverage of all teeth. The approach taken starts with a succinct overview of key theoretical features of behaviour change, which have been assembled into a process for intervention design. Different examples of interventions will be discussed, with the main distinction of group size and scale. In this approach technology is used to provide detailed 1-to-1 feedback, and/ or to measure behaviour in a laboratory setting, and beyond that in the wider setting of people's homes. Finally a case study will be presented on the measurement of brushing behaviour following a simulated public health communication campaign. There is little doubt about how people can contribute to good oral health and hygiene through their own behaviour 1 . In essence this concerns brushing teeth twice a day for at least two minutes with a fluoride containing toothpaste 2 . Still this elementary behaviour is not as widely and fully practiced as dentists and health organisations would like it to be in order to achieve a basic health status worldwide. The premise in this paper is that behaviour change and interventions to evoke change are essential to achieve this.When asked to design a behaviour change intervention that works, the immediate question arises: How? Different theoretical models have identified mechanisms that underpin behaviour change, often each model describing a different facet and emphasising a different mode of action. This can be challenging for designers of interventions as to which is the best route to follow. This paper presents a pragmatic approach rooted in behaviour change theory that provides a framework for the design of behaviour change interventions, these being of a technological nature or in the form of communication. Technology can and should be used to shape behaviour, for example, it can provide insight to the individual about the exact nature of their behaviour which otherwise may remain unknown. It can equally be used to inform the designer of behaviour change interventions of the behaviours subjects (patient or consumer) conduct without having to ask. The type of technology that can be utilised most effectively and efficiently depends on whether the target for behaviour change is an individual, a small cohesive group (e.g. classroom) or a large group of unrelated individuals (e.g. country population). Examples at both ends of this scale, specifically the value of detailed individual feedback and large-scale communication campaigns will be d...

Hand washing promotion for preventing diarrhoea

“…These constitute a range of activities aimed at encouraging individuals and communities to adopt safer practices within domestic and community settings to prevent hygiene-related diseases that lead to diarrhoea (WELL 1999; Ehiri 2001); hand washing is one such intervention. The practice of hand washing and the factors that influence hand washing behaviour among individuals in communities are complex (Whitby 2007); for example, washing hands with water only or with soap may be influenced by both knowledge of best practice and availability of water and soap (Curtis 2011). Also, hand washing may require infrastructural, cultural, and behavioural changes, which take time to develop, as well as substantial resources (for example, trained personnel, community organization, provision of water supply and soap) (Luby 2001a; UNICEF/WHO 2009).…”

“…Also, hand washing may require infrastructural, cultural, and behavioural changes, which take time to develop, as well as substantial resources (for example, trained personnel, community organization, provision of water supply and soap) (Luby 2001a; UNICEF/WHO 2009). Consideration of the wide applicability and sustainability of hygiene interventions have recently come under critical review (Luby 2006 PAK; Ejemot-Nwadiaro 2008; Gould 2010; Curtis 2011; Huis 2012; Madhu 2012). For example, maintenance of the new hand washing behaviours that result from hand washing promotional interventions is vital in maximizing the associated potential health benefits.…”

“…Hand washing promotion employs direct approaches such as training and educating individuals or group of individuals about hygiene, diarrhoea transmission, the relationship between germs and health, demonstrating this relationship through leaflets, posters, drama, and songs (Whitby 2007; Curtis 2011). Washing hands with soap and water removes pathogens mechanically and may also chemically kill contaminating and colonizing flora, making hand washing more effective (Hugonnet 2000).…”

Using smartphone video “selfies” to monitor change in toothbrushing behavior after a brief intervention: A pilot study

“…On an individual level, for a proper TB skills to be adopted, there are a number of separate steps or components-for example, the process of memory formation, coding, retrieval, contextual cueing, association, “muscle memory”, addressing interferences besides sufficient motor skill, and one’s desire to change the old TB habit. [13] It is interesting to note however that, currently, there is no single, universally recommended, proper TB technique that has been shown to be successful in all situations; thus, only tailored approaches have been shown to be successful. [13] Smartphones have permeated almost all walks of human life in the 21 st century and have been recently used for early diagnosis and prognosis of disorders such as Parkinson disease.…”

“…[13] It is interesting to note however that, currently, there is no single, universally recommended, proper TB technique that has been shown to be successful in all situations; thus, only tailored approaches have been shown to be successful. [13] Smartphones have permeated almost all walks of human life in the 21 st century and have been recently used for early diagnosis and prognosis of disorders such as Parkinson disease. [14] This trend, of using mobile technology, has been characterized as a new modality for scientific inquiry and is frequently referred to as mHealth.…”