Exploring the potential of a school brushing program using a connected brush in underserved areas: a feasibility cluster randomised trial.

BACKGROUND

The main aim of this cluster randomised controlled trial is to explore the feasibility of a school-based brushing program utilising a smart, connected brush in children.

METHODS

Students aged 8 to 11 years in 6 primary schools across Manchester, UK were approached for this study. All children received a smart, connected toothbrush which captured information on coverage, duration and frequency of brushing. Teachers had access to class-level digital dashboards summarising brushing habits to set challenges for the students. Additionally, children in schools randomised to the toothbrush plus text messaging trial arm received text message support (delivered to their parents' mobile phones). Outcomes included: (a) consent rate, (b) recruitment rate recorded as the number of participants who completed at least one of the study surveys post-consents, and (c) acceptability of the interventions on schools and parents through a mixed methods approach.

RESULTS

Average age of parents was 39.8 years (SD5.94) while the average age of children was 9.7 years (SD1.56). Most parents and children came from households in the most deprived decile based on their Index of Multiple Deprivation (IMD) scores with 77 households (52.4%) scoring 1 (most deprived). Out of 753 eligible participants across all 6 schools, 409 were consented (54.3% consent rate) with 148 participants completing baseline measurements (36.8%). During the study, there was only 1 drop out. In terms of acceptability, parents found the study very enjoyable (average score of 8.9/10), and found the brush and app easy to use (average score of 8.7/10). Those parents who additionally received the text messages found them easy to understand and useful (average score of 8.9/10). In total, 91.6% of parents would recommend the brush and the intervention to family and friends. Three key facilitators ((a) enhancing children's self-reliance, (b) increased engagement through the use of visual cues and (c) increased motivation (due to gamification) potentially supported children's engagement with the brush and app.

CONCLUSIONS

Low dropout rates and very positive feedback highlight the potential of this intervention. Future studies should consider how to quantify changes in children's oral health, address loss of questionnaire completion and harness the opportunities this study provided.

TRIAL REGISTRATION

The study was registered at ISRCTN registration number ISRCTN77803149 on the 28th December 2023.