SmilesUp! Co-designing and testing a mHealth intervention for early childhood dental caries prevention in families

Abstract

Introduction

Early Childhood Caries (ECC) is a common but preventable disease closely linked to family lifestyle behaviours. In Australia, 55% of children aged 0–6 are affected, and ECC remains a leading cause of preventable hospitalisation in young children. Current prevention strategies—such as clinical education and pamphlets—are limited. Mobile health (mHealth) has proven effective in managing other non-communicable diseases, but its use in oral health remains limited. This study explored a co-designed mHealth intervention, SmilesUp! to promote oral health behaviours in families beyond standard care.

Context

This research took place within NSW Health’s public dental services, focusing on families unable to afford private care.

Aims

The study aimed to test in a randomised controlled trial (RCT) whether a co-designed, theory-based mHealth program could improve behaviours related to ECC prevention. The 3-month intervention was developed and tested through a co-design process and addressed oral health literacy, motivation, and parental self-efficacy.

Methods

Large linked datasets were analysed to identify patterns of admissions and at-risk families. A systematic review of existing oral health apps found few high-quality options for parents of young children. SmilesUp! was then co-designed using behavioural theory and mixed methods, then evaluated in an RCT with 154 families.

Results

The RCT showed improved behaviours: more parents in the intervention group reported brushing their child’s teeth twice daily (73.8% vs 66.7%) (aOR, 2.45 [95% CI, 0.95-6.74]). and following oral health-promoting bedtime routines (88.5% vs 71.4%) (aOR, 3.25 [95% CI, 1.15-10.18]).

Conclusion

SmilesUp! shows promise as a scalable, acceptable mHealth tool to improve ECC-related behaviours in high-risk families. Future opportunities include broader implementation and integration with health systems to track long-term outcomes and cost-effectiveness.