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Peer-reviewedCC BY 4.0JMIR mHealth and uHealth

Co-Designed Text Messaging Intervention for Parents of Children With Early Childhood Caries: Randomized Controlled Trial

  • Rebecca Chen1,2
  • Michelle Irving2
  • Harleen Kumar3,4
  • Neeta Prabhu4,5
  • Bradley Christian1,6
  • Woosung Sohn1
  • Heiko Spallek4
  • Simone Marschner2
  • Clara K Chow2
6 affiliations
  1. 1Population Oral Health, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, New South Wales, Australia
  2. 2Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Hawkesbury Road, Westmead, New South Wales, 2145, Australia, +61 28671444
  3. 3Paediatric Dentistry Department, Sydney Dental Hospital, Oral Health Services, Sydney Local Health District, Surry Hills, New South Wales, Australia
  4. 4School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, New South Wales, Australia
  5. 5Paediatric Dentistry Department, Oral Health Services, Western Sydney Local Health District, Westmead, New South Wales, Australia
  6. 6Australian Centre for Integration of Oral Health, Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, Australia
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Abstract

Background: Early childhood caries (ECC) is a prevalent yet preventable disease that significantly impacts young children’s health and quality of life. The World Health Organization’s Global Strategy and Action Plan on Oral Health 2023–2030 highlights the potential of mobile health programs to enhance engagement and support sustained oral health behavior change.

Objective: The aim of this study was to assess the effectiveness of the SmilesUp 12-week SMS text messaging–based education and support program to improve parents’ management of their children’s oral health behaviors compared to standard clinical care.

Methods: We conducted a multisite, assessor-blinded, parallel-design randomized controlled trial among parents of children aged 0 to 6 years who had an ECC diagnosis and attended 1 of 6 public dental clinics in metropolitan, regional, and rural New South Wales, Australia. Participants were randomly assigned to either an intervention group receiving the fully automated 12-week SmilesUp program (3 SMS text messages weekly) or a control group. Both groups continued to receive usual standard dental clinical treatment. The primary behavioral outcome was parent-reported twice-daily toothbrushing with fluoride toothpaste. Secondary outcomes included adherence to oral health–promoting bedtime routines and child consumption of sugar-sweetened foods and beverages. Oral health self-efficacy was measured using 6 behavioral theory–mapped items across oral hygiene, diet, and bedtime routines.

Results: A total of 154 participants were enrolled and randomized (n=78, 50.6% in the control group; n=76, 49.4% in the intervention group) across 6 sites, with 80.5% (124/154) completing the follow-up assessment. High program adherence was observed, with 96.1% (73/76) of intervention participants completing the program. At 12 weeks, a greater proportion of SmilesUp participants reported brushing their children’s teeth twice daily (45/61, 73.8% vs 42/63, 66.7%; adjusted odds ratio [aOR] 2.45, 95% CI 0.95-6.74; P=.07), though this difference was not statistically significant. Significant improvements were observed in adherence to bedtime routines (54/61, 88.5% vs 45/63, 71.4%; aOR 3.25, 95% CI 1.15-10.18; P=.03) as well as oral health knowledge on toothbrushing (46/50, 92.0% vs 41/52, 78.8%; aOR 5.47, 95% CI 1.48-25.19; P=.02). No statistically significant differences were found in sugar-sweetened food (10/61, 16.4% vs 4/63, 6.3%; aOR 3.72, 95% CI 1.02-17.14; P=.06) or beverage (25/61, 41.0% vs. 27/63, 42.9%; aOR 1.08, 95% CI 0.49-2.30; P=.85) consumption.

Conclusions: These findings suggest that co-designed SMS text messaging–based programs show promise and may represent a feasible strategy for oral health behavior change. However, larger-scale and longer-term studies are needed to confirm sustained effectiveness using clinical outcomes. Future research should also explore ways mobile health can be scaled and cost-effectively embedded into comprehensive, interdisciplinary primary models of care.

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Cite

BibTeXRIS
BibTeX
@article{chen2026codesigned,
  title = {{Co-Designed Text Messaging Intervention for Parents of Children With Early Childhood Caries: Randomized Controlled Trial}},
  author = {Rebecca Chen and Michelle Irving and Harleen Kumar and Neeta Prabhu and Bradley Christian and Woosung Sohn and Heiko Spallek and Simone Marschner and Clara K Chow},
  journal = {JMIR mHealth and uHealth},
  year = {2026},
  month = nov,
  doi = {10.2196/91720},
  url = {https://doi.org/10.2196/91720},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Co-Designed Text Messaging Intervention for Parents of Children With Early Childhood Caries: Randomized Controlled Trial
AU  - Rebecca Chen
AU  - Michelle Irving
AU  - Harleen Kumar
AU  - Neeta Prabhu
AU  - Bradley Christian
AU  - Woosung Sohn
AU  - Heiko Spallek
AU  - Simone Marschner
AU  - Clara K Chow
PY  - 2026
DA  - 2026/11/03
JO  - JMIR mHealth and uHealth
DO  - 10.2196/91720
UR  - https://doi.org/10.2196/91720
AB  - Background: Early childhood caries (ECC) is a prevalent yet preventable disease that significantly impacts young children’s health and quality of life. The World Health Organization’s Global Strategy and Action Plan on Oral Health 2023–2030 highlights the potential of mobile health programs to enhance engagement and support sustained oral health behavior change.  Objective: The aim of this study was to assess the effectiveness of the SmilesUp 12-week SMS text messaging–based education and support program to improve parents’ management of their children’s oral health behaviors compared to standard clinical care.  Methods: We conducted a multisite, assessor-blinded, parallel-design randomized controlled trial among parents of children aged 0 to 6 years who had an ECC diagnosis and attended 1 of 6 public dental clinics in metropolitan, regional, and rural New South Wales, Australia. Participants were randomly assigned to either an intervention group receiving the fully automated 12-week SmilesUp program (3 SMS text messages weekly) or a control group. Both groups continued to receive usual standard dental clinical treatment. The primary behavioral outcome was parent-reported twice-daily toothbrushing with fluoride toothpaste. Secondary outcomes included adherence to oral health–promoting bedtime routines and child consumption of sugar-sweetened foods and beverages. Oral health self-efficacy was measured using 6 behavioral theory–mapped items across oral hygiene, diet, and bedtime routines.  Results: A total of 154 participants were enrolled and randomized (n=78, 50.6% in the control group; n=76, 49.4% in the intervention group) across 6 sites, with 80.5% (124/154) completing the follow-up assessment. High program adherence was observed, with 96.1% (73/76) of intervention participants completing the program. At 12 weeks, a greater proportion of SmilesUp participants reported brushing their children’s teeth twice daily (45/61, 73.8% vs 42/63, 66.7%; adjusted odds ratio [aOR] 2.45, 95% CI 0.95-6.74; P=.07), though this difference was not statistically significant. Significant improvements were observed in adherence to bedtime routines (54/61, 88.5% vs 45/63, 71.4%; aOR 3.25, 95% CI 1.15-10.18; P=.03) as well as oral health knowledge on toothbrushing (46/50, 92.0% vs 41/52, 78.8%; aOR 5.47, 95% CI 1.48-25.19; P=.02). No statistically significant differences were found in sugar-sweetened food (10/61, 16.4% vs 4/63, 6.3%; aOR 3.72, 95% CI 1.02-17.14; P=.06) or beverage (25/61, 41.0% vs. 27/63, 42.9%; aOR 1.08, 95% CI 0.49-2.30; P=.85) consumption.  Conclusions: These findings suggest that co-designed SMS text messaging–based programs show promise and may represent a feasible strategy for oral health behavior change. However, larger-scale and longer-term studies are needed to confirm sustained effectiveness using clinical outcomes. Future research should also explore ways mobile health can be scaled and cost-effectively embedded into comprehensive, interdisciplinary primary models of care.
SN  - 2291-5222
ER  -