An evidence-based digital prevention program (The MuMi-App) to improve oral health literacy of persons with migration background: Intervention Mapping Approach (Preprint)

Abstract

Studies in Germany have shown that vulnerable groups, such as persons with migration background, have poorer oral health than the majority population. Limited oral health literacy appears to be an important factor that affects the oral health of these groups. To increase oral health literacy and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in form of an app for smartphones or tablets, the MuMi-App.

The objective of this paper is to describe the development process of the MuMi-App.

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.

Based on 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 a different healthcare socialization as main barriers to good oral health. Afterwards, 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 provision of health information, encouragement of self-control/-monitoring, 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 Apple and Android Stores. The effectiveness of the app was evaluated within the MuMi intervention study. The analyses showed that users of the MuMi-App had a significant increase in their oral health literacy and improved oral hygiene (as measured by clinical parameters) after 6 months compared to a control group.

The IMA 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 among the target population. The MuMi-App takes cultural and specific determinants of people with migration background in Germany into account. To our knowledge, it is the first evidence-based app that addresses oral health literacy among people with migration background.