{"doi":"10.1371/journal.pone.0236692","title":"Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial","abstract":"AIMS: To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN: A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING: Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS: 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS: Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES: Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS: Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS: Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. 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Finlayson","orcid":"0000-0003-2457-4183","position":4,"is_corresponding":false},{"id":420480,"name":"Jeremiah R. Garza","orcid":"0000-0003-1807-4289","position":5,"is_corresponding":false},{"id":421382,"name":"Alexandra H. Crawford","orcid":null,"position":6,"is_corresponding":false},{"id":420481,"name":"Sarit Helman","orcid":"0000-0002-2997-6977","position":7,"is_corresponding":false},{"id":421383,"name":"William Santo","orcid":null,"position":8,"is_corresponding":false},{"id":232387,"name":"Jing Cheng","orcid":"0000-0002-0417-3713","position":9,"is_corresponding":false},{"id":385789,"name":"James G. Kahn","orcid":"0000-0002-1259-7233","position":10,"is_corresponding":false},{"id":420482,"name":"Stuart A. Gansky","orcid":"0000-0003-3147-0884","position":11,"is_corresponding":false},{"id":310291,"name":"Justin S. 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