Designing interventions to improve tooth brushing

Abstract

This paper provides an outline of an industrial approach to behaviour change, which ranges from a process to design and develop behaviour change interventions, to the development and use of technology to shape and measure behaviour (and subsequently changes therein). The focus here is on the normal population (with varying degrees in health status) in developed as well as emerging markets, cutting across a wide range of cultures and nationalities. The key desired behaviours of interest are: tooth brushing twice a day, and if adhered to, brushing for two minutes with a full coverage of all teeth. The approach taken starts with a succinct overview of key theoretical features of behaviour change, which have been assembled into a process for intervention design. Different examples of interventions will be discussed, with the main distinction of group size and scale. In this approach technology is used to provide detailed 1-to-1 feedback, and/ or to measure behaviour in a laboratory setting, and beyond that in the wider setting of people's homes. Finally a case study will be presented on the measurement of brushing behaviour following a simulated public health communication campaign. There is little doubt about how people can contribute to good oral health and hygiene through their own behaviour 1. In essence this concerns brushing teeth twice a day for at least two minutes with a fluoride containing toothpaste 2. Still this elementary behaviour is not as widely and fully practiced as dentists and health organisations would like it to be in order to achieve a basic health status worldwide. The premise in this paper is that behaviour change and interventions to evoke change are essential to achieve this. When asked to design a behaviour change intervention that works, the immediate question arises: How? Different theoretical models have identified mechanisms that underpin behaviour change, often each model describing a different facet and emphasising a different mode of action. This can be challenging for designers of interventions as to which is the best route to follow. This paper presents a pragmatic approach rooted in behaviour change theory that provides a framework for the design of behaviour change interventions, these being of a technological nature or in the form of communication. Technology can and should be used to shape behaviour, for example, it can provide insight to the individual about the exact nature of their behaviour which otherwise may remain unknown. It can equally be used to inform the designer of behaviour change interventions of the behaviours subjects (patient or consumer) conduct without having to ask. The type of technology that can be utilised most effectively and efficiently depends on whether the target for behaviour change is an individual, a small cohesive group (e.g. classroom) or a large group of unrelated individuals (e.g. country population). Examples at both ends of this scale, specifically the value of detailed individual feedback and large-scale communication campaigns will be discussed.