Using Chatbot as an Alternative Approach for Hands-on Tooth Brushing Training During the COVID-19 Pandemic (Preprint)

Abstract

Increase tooth brushing behavior by providing oral health education and hands-on training to caregivers of young children is recommended. To strengthen oral health education before the COVID-19, the 21-Day FunDee chatbot was employed. During the pandemic, however, practical experience was difficult to implement. Therefore, the 30-Day FunDee chatbot was developed to replace hands-on practice by lengthening the message from 21 to 30 days and including more video demonstration and dialogue. This was a secondary data analysis that compared two chatbots in similar rural areas.

This study aimed to assess the effectiveness and usability of two chatbots based on the protection-motivation theory (PMT), 21-Day FunDee (Study I) and 30-Day FunDee (Study II). Furthermore, the study explored the feasibility of employing 30-Day FunDee chatbot to increase tooth brushing behaviors for caregivers in oral hygiene care for children aged 6-36 months without hands-on practice.

A pre-post design was used in both studies. The effectiveness of each chatbot was evaluated among caregivers in terms of oral hygiene practices, knowledge, perceptions based on PMT. In Study I, participants received hands-on training and a 21-day chatbot course; in Study II, participants received only daily chatbot programming for 30 days. Data was gathered at baseline of each study and at 30 and 60 days after the start of Study I and Study II, respectively. Only Study I evaluated plaque score. Open-ended questions in chatbot programs were used to assess the usability of chatbots at the end of their interventions. Only Study II included an in-depth interview. Two studies were compared to determine the feasibility of using the 30-Day FunDee chatbot in an alternative method of hands-on practices.

There were 71 pairs of participants in total, 37 for Study I and 34 for Study II. Both chatbots significantly improved overall knowledges (P<.001; 0.73 (SD 0.21), 0.94 (SD 0.09)), (P=.001; 0.53 (SD 0.26), 0.66 (SD 0.23)) overall perceptions P<.001; 0.58 (SD 0.19), 0.86 (SD 0.16), P<.001; 0.53 (SD 0.26), 0.83 (SD 0.12) and parental tooth brushing (P=.02, P=.04) in Study I and Study II, respectively. Only Study I differed statistically significant for frequency of tooth brushing at least twice a day (P=.002) and perceived vulnerability (P=.003; 0.46 (SD 0.51), 0.78 (SD 0.42)). Overall chatbot satisfactions were reported at highest level at 9.2 (SD 0.9) and 8.6 (SD 1.2) for Study I and Study II, respectively. In Study I, plaque levels were revealed to differ significantly. (P<0.001; 0.48 (SD 0.33), 0.18 (SD 0.21).

This was the first study using a chatbot in oral health education. Two chatbot programs established their effectiveness and usability in promoting oral hygiene care of caregivers for young children. The 30-Day FunDee chatbot shown the possibility to improve tooth brushing skills without requiring hands-on experience.