Evaluation of a digital media-based oral health behavior intervention program for Filipino schoolchildren: An information-motivation-behavioral skills (IMB) model approach

Abstract

Background: Oral diseases significantly impact schoolchildren, particularly in low- and middle-income countries with limited oral health education. Objective: This study evaluates a digital health intervention using the Information–Motivation–Behavioral Skills (IMB) model to enhance oral health behaviors among Filipino schoolchildren. Methods: Conducted in Baguio City, Philippines, the study involved Grade 5 and 6 students aged 9–13 years. It consisted of a baseline assessment, development of an IMB-based questionnaire, and a cluster randomized controlled trial of a digital intervention called Empowered Smiles through Education and Motivation (e-SEM). The intervention included animated videos, storytelling videos, digital learning modules, behavioral skills training, gamified activities, and parent education materials aligned with IMB construct, while the comparison group received conventional education. Data was analyzed using descriptive statistics, repeated measures ANOVA, linear mixed models, chi-square tests, and pairwise comparisons. Results: The IMB-based questionnaire demonstrated good psychometric properties among 299 participants, with Cronbach’s alpha: 0.80-0.84. Exploratory factor analysis supported the three-factor structure. A total of 276 students participated, with 58% female and a mean age of 10.59 years. The digital intervention significantly improved oral health knowledge, IMB constructs (information, motivation and behavioral skills), hygiene status. Tooth brushing performance skills showed a progressive improvement in the intervention group, increasing from 1.53 ± 1.28 to 4.66 ± 1.10 after one month. These improvements were statistically significant and sustained across all follow-up periods (all p