eHEALS as a predictive factor of digital health information seeking behavior among Brazilian undergraduate students.

This study aimed to perform the cross-cultural adaptation and validation of the eHealth Literacy Scale (eHEALS) for Brazilian Portuguese. The cross-cultural adaptation was conducted through conceptual equivalence, verbatim translation, semantic, item and operational equivalence, and back-translation. Subsequently, 521 undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14) and sociodemographic and health-related questions. Statistical analysis was performed to determine the dimensionality, internal consistency, stability and concurrent/convergent/discriminant/predictive validities of the eHEALS (p < 0.05). The adequacy of sample size was confirmed by a non-identity correlation matrix (Bartlett's test of sphericity, p < 0.001), without influence of multicollinearity (determinant = 0.026). The confirmatory factor analysis identified four factors in agreement to the constructs namely as online searching self-efficacy, awareness of available sources, information usage ability, and critical analysis of useful information. The eHEALS displayed an excellent internal consistency (Cronbach's alpha = 0.88), a good stability (ICC = 0.71, 95% CI: 0.49-0.84), and it was significantly correlated with GSES (concurrent validity). Higher eHEALS scores were identified among (i) white and (ii) younger students, (iii) from health sciences courses, (iv) with more years of graduation, (v) who their fathers were working in specialized functions (discriminant validity), and (vi) among those who were frequently interested in digital health information (convergent validity). The students with higher eHealth literacy levels were more likely to seek health information in the last 24 h (predictive validity). In conclusion, the eHEALS demonstrated adequate psychometric properties to be applied for the Brazilian population.

The eHealth Literacy Scale (eHEALS) is a self-fulfilling tool designed to determine individuals' levels of electronic health literacy. It helps to determine how people deal with electronic health-related information, being useful to identify potential difficulties of accessing, evaluating and using online health information, with potential to support the planning of educational interventions. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for being applied to Brazilian Portuguese native speakers. Five hundred twenty-one undergraduate students answered the adapted version of the eHEALS, the General Perceived Self-Efficacy Scale (GSES), the Oral Health Impact Profile-14 (OHIP-14), and sociodemographic and health-related questions. The tool showed sufficient consistency and stability, with the detection of higher eHEALS scores among white and younger people who reported a frequent interest for seeking digital health information, students from health sciences courses, those with more years of graduation, and who their fathers were working in specialized functions. Also, the students with higher eHealth literacy scores were more likely to seek health information in the last 24 h. In conclusion, the eHEALS demonstrated being adequate to be applied for the Brazilian population.

Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial.

OBJECTIVES: To evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children. METHODS: A single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer's exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05). RESULTS: Despite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children's consumption of sugar-free sweets and controlling the severity of ECC. CONCLUSION: Therefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children's dietary patterns. CLINICAL SIGNIFICANCE: These findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

Parental perspectives on early childhood caries: A qualitative study.

BACKGROUND: Early childhood caries (ECC) affects about 621 million children worldwide, causing chronic pain, infections, sleeping disorders, and tooth extraction. AIM: To determine perspectives of parents and caregivers of preschoolers regarding ECC. DESIGN: Three focus groups were conducted with attendees of the Clinics of Paediatric Dentistry from the Bauru School of Dentistry. The meetings were video- and audio-recorded, and the contents were transcribed verbatim. Then, textual passages were examined and coded using the software NVivo 12 Plus. RESULTS: The participants associated the presence of dental caries lesions with negative consequences for children, such as problems for permanent dentition, discrimination, and psychological damages. Although regular oral hygiene and healthy diet were recognized as important factors for the prevention of ECC, specific doubts about feeding, toothpaste usage, oral hygiene, and dental eruption were detected among parents. Additionally, they declared that their children brush teeth alone, intake fermentable carbohydrates frequently, and sleep during breastfeeding without dental plaque removal, because uncooperativeness, permissiveness, and convenience. CONCLUSIONS: Based on these results, parents and caregivers understand the unfavourable effects of ECC on children's quality of life; however, their attitudes against the disease seemed to be inaccurate, influenced by their daily routines, doubts, and beliefs.

Analysis of the interests of Google users on toothache information.

BACKGROUND: The knowledge on health interests of a given population of Internet users might contribute to the increase of evidence on community's dental needs, and consequently, to the improvement of public health planning. The frequency of searches for specific issues on Google can be analyzed by the application of Google Trends. AIM: In this study, we aimed to characterize the interests on toothache information of Google users from the United States, United Kingdom, Australia and Brazil. METHODS: The monthly variation of relative search volume (RSV) and the lists of main toothache-related queries were determined from January 2004 through April 2016 using Google Trends. Autoregressive Integrated Moving Average (ARIMA) forecasting models were developed to determine predictive RSV values for toothache for additional 12 months. Autocorrelation plots and general additive model (GAM) were applied to determine trends and seasonality in RSV curves. Through linear regression models, we assessed the association between the variation of annual means of RSV values and national statistics for toothache in the U.S. and U.K. Subsequently, the distribution of main queries according to the identification of endodontic pain, type of searching information, and the interest in self-management of toothache was evaluated for the four countries. RESULTS: The autocorrelation plots showed patterns of non-stationary time series. The monthly variation influenced the data of the U.S. and U.K., with the higher RSV values found respectively in January/July and December. Also, the interest on toothache in the U.K. increases in the second semester and in the fourth quarter, especially in December. Additionally, an annual variation affected significantly all time series, with the increment of RSV means over the years, varying from 265% in the U.S. to 745% in Brazil. In parallel, the increments in RSV values were also observed in all predictive curves. The annual variation of observed and fitted RSV values was directly associated with the increase of toothache visits in the U.S. and urgent dental treatments in the U.K. Moreover, the queries typed on Google were markedly linked to searches on endodontic pain information, especially in Brazil, where the residents usually searched for relief and/or self-management of pain. CONCLUSIONS: Therefore, these findings indicate an increasing interest of Google users on toothache-related topics, regardless of country and season. The Internet activity can be used by policy makers as a complementary source of data for the development and implementation of strategies to control and prevent toothache complications.

Infodemiology of dental caries / Infodemiologia da cárie dentária

The diagnosis of dental caries can lead people to seek additional information on the Internet, through the use of structured queries in search engine tools. This action generates a considerable volume of data, which can be analyzed to provide a better understanding of public's behavior linked to the consumption of oral health information. Nevertheless, health-related information found on the web is being reported to be misleading and of poor quality. This study aimed (1) to assess the volume and profile of web searches on dental caries-related queries performed by Google's users from different countries, and (2) to evaluate the readability and the quality of dental caries-related information from Brazilian websites. The monthly variation of the Search Volume Index (SVI) for dental caries was obtained in Google Trends, for the period between January 2004 and September 2016. To validate the data, the correlation levels between the variation of SVI and the disability-adjusted life-years (DALYs) for permanent teeth were determined. To assess the quality of information, the websites were selected through Google, Bing, Yahoo!, and Baidu. Two independent examiners evaluated the quality of 75 websites using the DISCERN questionnaire and JAMA benchmark criteria. The scores Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Férnandez-Huerta Readability Formula (FHRF) were used to assess the readability of the websites. The statistical analysis was performed with P<0.05 considered significant. In all countries, results revealed a trend of an increasing interest of Google users in dental caries issues. The most popular queries were markedly associated with symptoms and dental treatment, with little interest in prevention. The content of websites showed a poor quality by the analysis of both DISCERN (x̅=35.68, 19-64) and JAMA (x̅=1.12, 0-3) scores. The websites were classified as high-difficulty reading materials by FRE scores and, in contrast, as simple and accessible by FHRF scores. In conclusion, the Internet data mining could be helpful to establish the dental needs of specific population groups in a near real-time, since the consumption of dental information is increasing in importance and appears to have a direct relation with untreated dental caries. Dental caries-related contents found in Brazilian websites were considered simple, accessible and of poor quality. These findings indicate the need of the development of policies for the production and publication of digital oral health information, encouraging dentists to guide their patients in searching for recommended oral health websites.(AU)

O diagnóstico da cárie dentária pode levar as pessoas a procurar mais informações na internet, por meio de pesquisas estruturadas realizadas em buscadores digitais. Esta ação gera um volume considerável de dados que podem ser analisados para o melhor entendimento do comportamento dos usuários relacionado ao consumo de informações de saúde bucal. No entanto, as informações sobre saúde proveniente da Internet podem ser imprecisas e de baixa qualidade. Este estudo objetivou (1) avaliar o volume e perfil de buscas sobre cárie dentária realizadas pelos usuários do Google de diferentes países, e (2) determinar a leiturabilidade e qualidade da informação relacionada à cárie dentária encontrada em websites brasileiros. A variação mensal do índice Search Volume Index (SVI) relacionado à cárie dentária foi obtida na ferramenta Google Trends para o período compreendido entre janeiro de 2004 e setembro de 2016. Para a validação dos dados obtidos, os níveis de correlações entre as variações do índice SVI e do índice disability-adjusted life-years (DALYs) para cárie dentária em dentes permanentes foram determinados. Para avaliar a qualidade da informação disponível na Internet, websites foram selecionados através dos buscadores Google, Bing, Yahoo! e Baidu. Dois examinadores independentes realizaram a avaliação de 75 websites usando o questionário DISCERN e os critérios de referência JAMA. A leiturabilidade da informação escrita foi avaliada pelo uso dos escores Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL) e Férnandez-Huerta Readability Formula (FHRF). A análise estatística foi realizada com valores de P<0,05 sendo considerados significantes. Em todos os países, os resultados demostraram uma tendência crescente do aumento do interesse dos usuários do Google sobre temas relacionados à cárie dentária. As buscas mais populares foram fortemente relacionadas aos sintomas e tratamentos da cárie dentária, com menor interesse pela prevenção. O conteúdo dos websites mostrou-se de baixa qualidade em ambos os escores do DISCERN (x̅=35.68, 19-64) e do JAMA (x̅=1.12, 0-3). Os websites foram classificados como materiais de alto nível de dificuldade de leitura pelos escores do FRE e, ao contrário, como simples e acessíveis pelos escores do FHRF. Em conclusão, os dados provenientes do uso da internet poderiam auxiliar no estabelecimento das necessidades odontológicas de grupos populacionais específicos, em tempo quase-real. O consumo de informação proveniente da web está se intensificando, parecendo ter uma relação direta com a cárie dentária não tratada. As informações relacionadas à doença disponíveis em websites brasileiros foram consideradas simples, acessíveis e de baixa qualidade. Estes achados indicam a necessidade de desenvolvimento de politicas para a produção e publicação de informações relacionadas à saúde bucal, motivando os dentistas a orientarem seus pacientes na busca por websites recomendados.(AU)