Using Chatbot as an Alternative Approach for In-Person Tooth Brushing Training During the COVID-19 Pandemic.

<bold>Background: </bold>It is recommended that caregivers receive oral health education and in-person training to improve tooth brushing for young children. To strengthen oral health education before COVID-19, the 21-Day FunDee chatbot with in-person tooth brushing training for caregivers was employed. During the pandemic, however, practical experience was difficult to implement. Therefore, the 30-Day FunDee chatbot was created to extend the coverage of chatbots from 21 to 30 days by incorporating more videos on tooth brushing demonstrations and dialogue. This was a secondary data comparison of two chatbots in similar rural areas of Pattani province, Maikan district (Study I) and Maelan district (Study II).<bold>Objective: </bold>This study aimed to evaluate the effectiveness and usability of two chatbots, 21-Day FunDee (Study I) and 30-Day FunDee (Study II), based on the protection-motivation theory (PMT). Furthermore, the study explored the feasibility of employing 30-Day FunDee chatbot to increase tooth brushing behaviors for caregivers in oral hygiene care for children aged 6-36 months without in-person training during the COVID-19 pandemic.<bold>Methods: </bold>A pre-post design was used in both studies. The effectiveness of each chatbot was evaluated among caregivers in terms of oral hygiene practices, knowledge, and oral health care perceptions based on PMT. In Study I, participants received in-person training and a 21-day chatbot course during October 2018 to February 2019. In Study II, participants received only daily chatbot programming for 30 days during December 2021 to February 2022. Data was gathered at baseline of each study and at 30 and 60 days after the start of Study I and Study II, respectively. Only Study I evaluated the plaque score. Open-ended questions in chatbot programs were used to assess the usability of chatbots at the end of their interventions. Only Study II included an in-depth interview. The two studies were compared to determine the feasibility of using the 30-Day FunDee chatbot by an alternative method of in-person training.<bold>Results: </bold>There were 71 pairs of participants in total, 37 for Study I and 34 for Study II. Both chatbots significantly improved overall knowledge (P<.001; 0.73 (SD 0.21), 0.94 (SD 0.09)) (P=.001; 0.53 (SD 0.26), 0.66 (SD 0.23)), overall oral health care perceptions based on PMT P<.001; 0.58 (SD 0.19), 0.86 (SD 0.16), P<.001; 0.53 (SD 0.26), 0.83 (SD 0.12), and tooth brushing for children by caregivers (P=.02, P=.04) in Study I and Study II, respectively. Only Study I differed statistically significant for frequency of tooth brushing at least twice a day (P=.002) and perceived vulnerability (P=.003; 0.46 (SD 0.51), 0.78 (SD 0.42)). Overall chatbot satisfactions were reported at the highest level at 9.2 (SD 0.9) and 8.6 (SD 1.2) for Study I and Study II, respectively. In Study I, plaque levels differed significantly. (P<0.001; 0.48 (SD 0.33), 0.18 (SD 0.21).<bold>Conclusions: </bold>This was the first study using a chatbot in oral health education. Two chatbot programs established their effectiveness and usability in promoting oral hygiene care of caregivers for young children. The 30-Day FunDee chatbot showed the possibility to improve tooth brushing skills without requiring in-person training. [ABSTRACT FROM AUTHOR]