title: Keep on brushing: a longitudinal study of motivational text messaging in young adults aged 18-24 years receiving Work and Income Support.
abstract: OBJECTIVE
  Using text messaging, underpinned by the Health Belief Model, this study aimed to improve tooth brushing frequencies among unemployed young adults aged 18-24 years.
  
  
  METHODS
  Set within Work and Income's Linwood Community Link office (one Christchurch branch of the New Zealand Government's employment and beneficiary services), unemployed young adults aged 18-24 years with access to a mobile phone were recruited using either a purpose-built computer kiosk or Work and Income's Facebook site. Participants completed a baseline survey and then received and responded to a series of motivational text messages over 10 weeks. Self-reported tooth brushing frequency was the primary outcome variable. Important socio-demographic (age, gender, ethnicity, employment status) and method-specific (level of attrition, distribution of successful text messages deliveries, active withdrawal) variables were also collected. Longitudinal analyses of these responses employed generalized estimating equation (GEE) models.
  
  
  RESULTS
  Four hundred and three registered for the trial, of whom 171 (42%) were eligible. Self-reported tooth brushing twice or more per day increased from 51% at baseline to 70% at week 3, 74% at week 6, and 73% at week 9 - an increase significant in crude (P<0.001) and adjusted (P<0.001) GEE analyses. No important differences were noted between age, gender, or ethnic groups, although attrition was relatively high with only 26% participating by week 9. However, no evidence of differential attrition was observed.
  
  
  CONCLUSIONS
  Invention through motivational text messaging improved the measured oral health self-care behavior in a hard-to-reach group carrying a disproportionately heavy oral health burden. This intervention warrants further investigation.
authors.affiliation: School of Health Sciences, University of Canterbury, Christchurch, New Zealand.|School of Nursing and Midwifery, The University of Queensland, Brisbane, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Schluter
authors.affiliation: Community Dental Service, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.affiliation: Division of Planning and Funding, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Greg
authors.initials: G
authors.lastname: Hamilton
authors.affiliation: New Zealand Institute of Community Health Care, Christchurch, New Zealand.
authors.forename: Gill
authors.initials: G
authors.lastname: Coe
authors.affiliation: St. David's Round Rock Medical Center, Round Rock, TX, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Messer-Perkins
authors.affiliation: Community Dental Service, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: Belinda
authors.initials: B
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D009042:Motivation; D009520:New Zealand; D060145:Text Messaging; D014099:Toothbrushing; D055815:Young Adult
keywords: Health Belief Model; epidemiology; hard-to-reach people; oral health behaviors; population health; text messaging; young adults