Inglês (pdf)
Artigo em XML
Referências do artigo
Tradução automática
Enviar este artigo por email
Citado por SciELO 
Similares em
SciELO 
Permalink
Introduction
Oral diseases continue to be a public health problem with a significant social and economic impact due to their high prevalence.1,2 Good oral health includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey countless emotions through facial expressions without any pain or discomfort.
Therefore, the impact of oral diseases on an individual’s daily life can influence their basic needs, which in turn may be reflected in essential psychological, physical, and social attributes.3,4
The daily disorganization and removal of oral biofilm are essential to prevent oral diseases. Thus, one of the most importante functions of the oral health professional is to motivate and provide patients with instructions for its correct removal, reinforcing it regularly. The habit of regularly visiting an oral health professional is still infrequent in the Portuguese population.5 In this scenario, technology can be used to complemente the oral health appointment as a tool to remind patients, frequently and over time, of the instructions given during the appointment.
There has been an intense technological revolution in recente decades,6 further enhanced in recent years by the pandemic.7 Nowadays, technology highly influences the daily routines of populations, especially among young adults.8
Smartphones are extensively used in the daily routines of most individuals, involving numerous mobile software applications (apps).6 By 2021, it was estimated that a total of 230 billion apps had been downloaded globally.9 In 2018, Portugal was the 27th European country with the highest smartphone usage rate.10 In Portugal, smartphone usage increased from 27% in 2012 to 84.2% in July 2020,11 and, in 2022, it was estimated that the number of monthly active smartphone users was 6.51 million individuals - more than half of the Portuguese population.12
The use of health apps to improve and maintain health care, usually called Mobile Health or MHealth, has been increasing.13,14 The adoption and use of apps can be an innovative way to improve health care by promoting good, closer, faster communication with the health professional and, on the other hand, allowing individuals to monitor their own health through quick access to useful information anytime and anywhere.15,16
The use of apps designed to promote oral health seems to have satisfactory results, but there are still few studies on the impact of their use.17 Moreover, one study has reported a lack of rigor among these apps and that they do not always meet the users’ needs.18 There are no published studies assessing the use, effectiveness, and acceptability of this type of app in the Portuguese population. Therefore, this study aims to understand the perception of young Portuguese adults about using apps as a complement to motivate oral health care.
Material and Methods
This cross-sectional descriptive study was approved by the Ethics Committee of a Portuguese Dental School. The target population was young Portuguese individuals aged between 18 and 20 years. Data was collected using an online questionnaire. All individuals who answered the questionnaire, had a smartphone, were responsible for their daily oral hygiene care, and had Portuguese nationality were included in the study. All participants consented to their participation on the first page of the questionnaire, under a brief text explaining the aims and procedures of the study.
The questionnaire was developed based on a literature review19-25 and surveys aimed to evaluate health-oriented mobile applications, such as the Mobile App Rating Scale,26 Jakob Nielsen’s usability heuristics,27 and the Net Promoter Score.28
To test face and content validity, before its application, the questionnaire was reviewed by two oral hygienists with experience in questionnaire research to verify the relevance, clearness, and content of the questions. After that expert validation, a pre-test was made on six individuals who met the inclusion criteria.
The final questionnaire included two sections. The first was created to characterize the sample and collect information about daily oral hygiene behaviors and self-perception of oral health. The second section collected data about the respondent’s opinions on using apps related to oral health.
A link to the questionnaire was shared on social media between March and May 2022 in several groups that could include individuals from the target population. It was shared several times and at different hours to obtain more responses.
Statistical analysis was performed in the Statistical Package for Social Sciences (SPSS® 27.0), and all variables’ absolute and relative frequencies were calculated.
Results
The sample included 213 participants, most female (66.7%) and higher education students (51.6%). Table 1 shows the sample’s characterization according to sociodemographic characteristics and oral health behaviors. Regarding the perception of oral health, most participants considered having “good” oral health (59.6%). About 58.0% reported a previous oral disease, most frequently dental caries (48.8%), followed by gingivitis (14.1%). As for the regularity of oral health appointments, 38.5% of the participants indicated that they visited the oral health professional twice or more a year, and 2.8% never went to an oral health appointment. About 9.0% of the participants said they never received oral health education at dental appointments.
Most participants reported using a manual toothbrush (78.4%), brushing their teeth twice or more a day (81.7%), and using a complementary tool for oral hygiene (62.0%) (Table 1).
Regarding the perception of using apps related to oral health, most participants considered it could be useful to improve oral health care (73.2%). The features most frequently indicated as useful were “Information about oral diseases” (86.9%), “Oral health appointment reminders” (85.4%), and “Toothbrushing timer” (84.5%) (Figure 1). The “Other” category indicated in Figure 1 included “Register how many times we brush and floss our teeth,” “Reminder not to push too hard when brushing my teeth,” and “Show clinics near me.”
Most participants reported never using any app for oral health care motivation (93.9%). All who reported having experience with oral health-related apps used an app associated with a company brand. Most (92.3%; n=12) used the Oral-B® app, and 7.7% (n=1) used the Disney magic timer app. They were asked to rate their experience with the corresponding app, and 46.2% reported it was a good experience, indicating the following as the main positive aspects: toothbrushing monitoring, toothbrushing timer, and gamification. On the other hand, the negative aspect most frequently indicated was that it was not practical (Table 2).
Discussion
This study allowed us to assess young Portuguese adults’ perception of oral health-related apps and understand which features they considered the most useful in this type of mobile application. We selected the age range between 18 and 20 years because adolescents/young adults are among the population who most frequently use smartphones in their daily routine,8,29and, thus, are most likely to use an app as a complemente to motivate for oral health care.
Table 1 Characterization of the sample according to sociodemographic characteristics and oral health behaviors (n=213).
Constant motivation is required to eliminate risky behaviors and promote behavior change.1,30 The way knowledge is provided and acquired and the follow-up over time can promote behavior change.31 Some studies indicate that change can be achieved more successfully through a regular and interactive approach, with visually attractive materials that include messages associated with images and demonstrations.31-33Therefore, apps can be valuable tools to motivate individuals for oral disease prevention as they can provide this regular and interactive approach to patients, providing real-time toothbrushing reminders and instructions.18,34,35 The study results reinforce this possibility, as most participants considered useful using na app as a complement to oral health. These apps may have na even more prolific action if they are articulated with the oral health professional, promoting better communication between the professional and the patient and using the various features to the patient’s specific oral health situation.36
These apps may increase adherence and motivation to improve oral hygiene self-care through several features, such as information on oral diseases and oral hygiene, a timer, and a record of toothbrushing frequency. Gamification is highlighted as a feature that can encourage greater frequency of app use and consistency over time.6
In this study, the feature perceived as most useful was the information on oral diseases on the app, which reveals a possible lack of information about oral diseases in the population studied. On the other hand, it indicates young people’s awareness of this fact, showing that they are willing to acquire this type of knowledge and recognize that technology can be an ally for oral health education. Knowledge about diseases and the consequences of poor oral hygiene are referred to as importante factors that favor behavior change due to promoting the individual’s need and motivation to change.37
According to Bandura’s self-efficacy theory,38 behavior change is based on the individuals’ beliefs about their own abilities to exercise control over events that affect their daily lives. In oral health, MHealth apps can be a good tool to improve the self-effectiveness of individuals who use them, particularly in more technical procedures such as toothbrushing and dental flossing. Thus, combining oral health appointments with the use of MHealth apps may improve the understanding of oral hygiene instructions provided by the professional and, consequently, improve oral health self-care.39
The internet is currently widely used for information searches, with oral health being no exception. The 2022 Oral Health Barometer40 found that 7.5% of the Portuguese population used the internet, more specifically generalist websites, as the first option to search for oral health information, 18.5% as the second option, and 21.1% as the third option. It is importante that users are well-informed, and an app, if built based on scientific evidence, can direct its user to credible and correct information.
The problem is that there are no regulations for the development of apps,6 there may be incorrect information, and not all oral health information applies to all cases.
Reminders for oral health appointments, a toothbrushing timer, step-by-step toothbrushing techniques, and instructions on dental flossing were also frequently mentioned as important features by the participants. The high percentage of responses regarding these various features may indicate some lack of confidence in daily oral hygiene self-care and the need to improve the population’s oral health literacy. The role of oral health professionals is essential in this aspect of oral health education, and technology will be useful as a complement to promote oral health.
A study by Mendiola et al.41 concluded that users give importance to apps that are easy to use, save time, and provide specific instructions for maintaining a given condition. This last feature aligns with this study’s results, which indicated that explaining toothbrushing or dental flossing techniques is important. Although social media connection and gamification are present in apps with the highest number of downloads,27,42in this study, these features were not the most highlighted, even though a significant number of participants indicated them.
Despite considering that apps related to oral health are useful, only a few participants in this study reported already using one and, in all cases, an app associated with their electric toothbrush company brand. These results show that young Portuguese adults still do not look for apps to improve their oral health unless they are associated with a purchased product.
The indication by the oral health professional of an app that can support and promote oral health in a more frequente and sustained way might be a path to explore in this population to improve their oral health literacy, behaviors, and other oral health indicators. Moreover, the positive and negative aspects reported by this study’s participants should be considered when developing apps related to oral health motivation and promotion in the Portuguese population.
Some studies that analyzed the impact of oral health motivation apps concluded that using these apps contributed to improved oral health indicators. In a 4-week study, there were significant improvements in the plaque index of adults using an app that provided real-time step-by-step toothbrushing instructions, compared to adults using an app that only recorded toothbrushing frequency.34 Another study43 showed that using a motion-sensing device attached to a manual toothbrush and associated with an app that allowed real-time visualization of step-by-step toothbrushing led to significant improvements in the plaque index.
Despite the results obtained in this study, it should be noted that instructions and information alone do not change behaviors; they are a part of the strategy. Behavior change also depends on internal beliefs38 and the demands and expectations of na individual’s life routine.44 So, the involvement of the oral health professional in oral health behavioral change is fundamental,
and the oral health professional must explain to patients why behavioral changes need to happen and how they can do it.45 Apps can be another method for healthcare professionals to motivate their patients to engage in oral health self-care.
This study has some limitations, namely its convenience sample and the methodology for data collection by online questionnaire, so the extrapolation of its conclusions should be cautious. However, it represents an exploratory study that contributes to the research of this theme in the Portuguese population.
Conclusions
Most participants found oral health MHealth apps a useful complement for oral health motivation. However, only a small minority reported having used these apps before. The features most frequently considered useful were information about oral diseases, oral health appointment reminders, a toothbrushing timer, and step-by-step toothbrushing instructions.
The functionalities highlighted and the positive and negative aspects mentioned by the participants who had already used these kinds of apps may be useful for developing apps more focused on the population’s expectations.
