Effectiveness of an interactive smartphone application compared with an electronic booklet for oral health education among primary health care personnel: a cluster randomized controlled trial

Primary healthcare personnel (PHCP) play a crucial role in oral health promotion but often lack oral health knowledge and training; evidence comparing smartphone application (SPA) with an electronic booklet (EB) among PHCP remains limited. This study compared SPA with EB for improving oral health knowledge, attitude, practice, and self-care oral health behavior among primary healthcare personnel. A cluster randomized controlled trial was conducted in Tehran, Iran. Health service units were recruited before randomization and allocated using computer-generated random numbers to SPA or EB for four months. Outcomes were assessed using a validated questionnaire, and GEE compared changes over time between groups. Among 84 clusters, 208 PHCPs were enrolled and 194 completed follow-up. Knowledge, attitude and practice scores increased in both groups, whereas self-care oral health behavior changed little. Between-group changes favored SPA for knowledge (β = 1.37, 95% CI 0.90–1.83; p < 0.001) and practice (β = 5.51, 95% CI 4.18–6.84; p < 0.001), with no significant between-group differences for attitude (β = 0.45, 95% CI − 0.06–0.97; p = 0.086) or self-care oral health behavior (β=−0.09, 95% CI − 0.47 − 0.30; p = 0.665). Compared with EB, SPA-based education may be more effective for improving reported oral health knowledge and practice but not attitude or self-care behavior. Longer-term studies are needed to promote sustainable behavioral change.