Effect of Mobile- Based Educational Program through Bluetooth and WhatsApp. Application on the Oral Health Values, Dental Literacy, and Oral Self-Efficacy among Older Adults.

Document Type : Original Article


1 Department of Gerontological Nursing, Faculty of Nursing, Alexandria University, Egypt.

2 Department of Gerontological Nursing, Faculty of Nursing, Alexandria University, Egypt

3 Department of Geriatric Medicine, Faculty of Medicine, Helwan University, Egypt

4 Department of Geriatric Medicine, Faculty of Medicine, Alexandria University, Egypt


Background: With the advent of preventive dentistry and an expanded array of treatment options, the possibility of maintaining oral health throughout the life span has increased. This interdependence between oral health and general well-being further validates the need to explore factors related to the improvement of the oral health status of community-dwelled older adults. Essential to the process of enhancing the oral health status of this segment is the exploration of the numerous variables which must be considered in the development of mobile-based educational program. Thus, the adequate assessment of the health values, literacy, and perception related to the performance of oral hygiene is of upmost importance. Only then effective elder-specific oral interventions could be developed and implemented. Aim: The purpose of this quasi-experimental study was to measure the effect of mobile- based educational program through Bluetooth and WhatsApp Application on the oral health values, dental literacy, and oral self-efficacy among older adults.Setting: The study was conducted in El-Wafaa club of elderly persons affiliated to the Ministry of Social Solidarity. Subjects: A 67- participant, own smart phones, able to download and deal with related software applications, and capable of reading sent messages were operationalized using four specified tools. Tools: These were (1) Developed Demographic and Oral Health Profile for the Older Adults Structured Interview Schedule, (2) Health Literacy in Dentistry Scale (HeLD- short form), (3) Oral Health Values Scale (OHVS), and (4) Geriatric Self- Efficacy Scale for Oral Health (GSEOH). Results: Initially revealed that the higher prevalence of mouth health problems was related to tooth decay (64.2%) and tooth plaque (62.7%). Oral health problems had mostly a negative impact on satisfaction with fluids drinking and mouth appearance (40.3% each). There was a highly statistical positive significant improvement in the older adults’ oral-related literacy, values, and efficacy post-program than before. A strong positive significant correlation was proved between the studied variables along the whole implementing periods. Oral health literacy was a predicting / independent factor for both Self- Efficacy and values in each period of interventions. Conclusion: The proposed program succeeded in improving the main studied variables’ subscales with different degrees as represented by the mean percent scores, immediately after application that decreased at a 3- week follow up of mobile-based oral care implementation but still significant compared with the pre- intervention period. Recommendations: Digital or e-health interventions to prevent or rectify oral problems of older adults should be wide-ranging and multi-faceted to be conducted via the social networks and invest in mobile health clinics. Design a preventive program to target older adults living in Egypt, through increasing access and minimize barriers to treatment for elderly with low financial standard and collecting systematic data on oral health status as well as general medical conditions to be monitored and included in national oral health promotion plans for older adults.


World Health Organization (WHO). Active ageing: A policy framework. Geneva, Switzerland: WHO; 2002.
2.       Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Alipour V, et al. Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res. 2020;99(4):362-73.
3.       Al-Nasser L, Lamster IB. Prevention and management of periodontal diseases and dental caries in the older adults. Periodontology. 2020;84(1):69-83.
4.       World Health Organization (WHO). Oral Health: Information sheet. Geneva, Switzerland: WHO; 2012.
5.       Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017;11(2):72-80.
6.       Razak PA, Richard KM, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: a review article. J Int Oral Health. 2014;6(6):110-6.
7.       Wong FMF, Ng YTY, Leung WK. Oral Health and Its Associated Factors Among Older Institutionalized Residents-A Systematic Review. Int J Environ Res Public Health. 2019;16(21).
8.       Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015;10:461-7.
9.       Maeda K, Mori N. Poor oral health and mortality in geriatric patients admitted to an acute hospital: an observational study. BMC Geriatr. 2020;20(1):26.
10.     Nazir MA, Izhar F, Akhtar K, Almas K. Dentists' awareness about the link between oral and systemic health. J Family Community Med. 2019;26(3):206-12.
11.     Göstemeyer G, Baker SR, Schwendicke F. Barriers and facilitators for provision of oral health care in dependent older people: a systematic review. Clin Oral Investig. 2019;23(3):979-93.
12.     Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102(3):411-8.
13.     Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequality in oral healthcare coverage: results from the World Health Survey. J Dent Res. 2012;91(3):275-81.
14.     Al-Sinaidi AA. Periodontal health and oral hygiene practice of elderly Saudis living at Riyadh Nursing Home. King Saud University Journal of Dental Sciences. 2012;3(1):1-5.
15.     McQuistan MR, Qasim A, Shao C, Straub-Morarend CL, Macek MD. Oral health knowledge among elderly patients. J Am Dent Assoc. 2015;146(1):17-26.
16.     Das D, Menon I, Gupta R, Arora V, Ashraf A, Ahsan I. Oral health literacy: A practical strategy towards better oral health status among adult population of Ghaziabad district. J Family Med Prim Care. 2020;9(2):764-70.
17.     Boynes S, Nelson J, Diep V, Kanan C, Pedersen DN, Brown C, et al. Understanding value in oral health: the oral health value-based care symposium. J Public Health Dent. 2020;80 Suppl 2:S27-s34.
18.     Listl S. Value-Based Oral Health Care: Moving Forward With Dental Patient-Reported Outcomes. J Evid Based Dent Pract. 2019;19(3):255-9.
19.     Schwarzer R, Antoniuk A, Gholami M. A brief intervention changing oral self-care, self-efficacy, and self-monitoring. Br J Health Psychol. 2015;20(1):56-67.
20.     Zhou G, Sun C, Knoll N, Hamilton K, Schwarzer R. Self-efficacy, planning and action control in an oral self-care intervention. Health Educ Res. 2015;30(4):671-81.
21.     Mariño RJ, Marwaha P, Barrow SY. Web-based oral health promotion program for older adults: Development and preliminary evaluation. Int J Med Inform. 2016;91:e9-e15.
22.     Catteau C, Faulks D, Mishellany-Dutour A, Collado V, Tubert-Jeannin S, Tardieu C, et al. Using e-learning to train dentists in the development of standardised oral health promotion interventions for persons with disability. Eur J Dent Educ. 2013;17(3):143-53.
23.     Ab Malik N, Zhang J, Lam OL, Jin L, McGrath C. Effectiveness of computer-aided learning in oral health among patients and caregivers: a systematic review. J Am Med Inform Assoc. 2017;24(1):209-17.
24.     Mohsen MM, Abd EL Megeed HA, Elsayed DM, Abd El-Rhaman ME. Quality of dental care among elderly in Benha city. J Nurs Health Sci. 2017;6(4):64–76.
25.     Jones K, Parker E, Mills H, Brennan D, Jamieson LM. Development and psychometric validation of a Health Literacy in Dentistry scale (HeLD). Community Dent Health. 2014;31(1):37-43.
26.     Jones K, Brennan D, Parker E, Jamieson L. Development of a short-form Health Literacy Dental Scale (HeLD-14). Community Dent Oral Epidemiol. 2015;43(2):143-51.
27.     Edwards CB. Development and validation of an oral health values scale: West Virginia University; 2014.
28.     Ohara Y, Yoshida N, Kawai H, Obuchi S, Yoshida H, Mataki S, et al. Development of an oral health-related self-efficacy scale for use with older adults. Geriatr Gerontol Int. 2017;17(10):1406-11.
29.     Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don KR, et al. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res. 2020;31(1):22-5.
30.     Michele Lolita Y, Ashu Michael A, Hubert N, Florence D, Jacques B. Oral Health Status of the Elderly at Tonga, West Region, Cameroon. Int J Dent. 2015;2015:820416.
31.     Minja I, Astrøm A, Masalu J. Prevalence and distribution of oral health knowledge according to sociodemographic, behavioural and clinical characteristics in selected coastal districts of Tanzania. Tanzan J Health Res. 2016;18:1-13.
32.     Eman Shokry AA, Rehab Adel M, Rashad AE-sA. Educational program to improve quality of life among elderly regarding oral health. Future Dental Journal. 2018;4(2):211-5.
33.     Kwan SY, Holmes MA. An exploration of oral health beliefs and attitudes of Chinese in West Yorkshire: a qualitative investigation. Health Educ Res. 1999;14(4):453-60.
34.     Niesten D, van Mourik K, van der Sanden W. The impact of frailty on oral care behavior of older people: a qualitative study. BMC Oral Health. 2013;13:61.
35.     Mariño R, Calache H, Wright C, Schofield M, Minichiello V. Oral health promotion programme for older migrant adults. Gerodontology. 2004;21(4):216-25.
36.     Pirograd P, Keeratisiroj O. The Effects of a Self-Efficacy Application Program on Dental Health Care Behavior Among Older Adults in an Elderly Club, Lablae District, Uttaradit Province. J Health Educat. 2019;42(2):110-22.
37.     Lowe O, Rossopoulos E. Assessment of oral health status of elderly population living in residential care facilities. Ann Dent Oral Health. 2018;1:1-4.
38.     Borreani E, Wright D, Scambler S, Gallagher JE. Minimising barriers to dental care in older people. BMC Oral Health. 2008;8:7.