The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.</jats:p> </jats:sec>

Development and evaluation of a gamified smart phone mobile health application for oral health promotion in early childhood: a randomized controlled trial

“…In 2018, one-third of the world’s population had smartphones [ 2 ]. The increasing use of smartphones led to explosive growth in usage of smartphone applications (apps) aiming to promote the health status and hygienic behaviors, In 2019, a systematic search in app stores found 612 apps related to oral health [ 3 ]. Another systematic review showed that Mobile-health strategies could work as additional tool for enhancing oneself oral hygiene, in particular to manage gingivitis, and to improve oral health knowledge [ 4 ].…”

A Review of Mortality Risk Prediction Models in Smartphone Applications

“…The quality of apps was evaluated using a standardized methodology, including the uMARS tool, and the overall uMARS app quality score was 3.66 (SD = 0.65), which is considered as a moderate overall quality in comparison to the other studies [42][43][44][45][46]. Overall, 33.3% (n = 11) of the apps were developed by small or medium-sized enterprises, 6.1% (n = 2) by healthcare-related agencies, and 3% (n = 1) by an educational organization (Table 1).…”

Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis

“…We conducted a systematic search of commercially available apps using a rigorous methodology that has been previously published [33,34]. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist [35] is available in Multimedia Appendix 1.…”

“…The total score for the SUS is 100 points, which is divided into six usability categories including worst imaginable (0-25 SUS score), poor (25.1-51.6 SUS score), ok (51.7-62.6 SUS score), good (62.7-72.5 SUS score), excellent (72.6-84.0 SUS score), and best imaginable (84.1-100 SUS score) [42][43][44]. The uMARS and SUS have been used in similar studies [31,32,34,[45][46][47].…”