Abstract
Background: Early childhood caries (ECC) remains a major public health problem in Thailand.
Parental Oral Health Literacy (OHL) is a modifiable determinant of children's oral health
outcomes. An integrated oral health information system can support population-level
surveillance, return of data to parents, and evidence-based decision-making by health system
managers.
Objectives: (1) to develop and validate a Thai OHL instrument for parents of preschool
children; (2) to develop and evaluate the ThaiDER information system; and (3) to develop a
data processing platform for dental public health personnel.
Methods: The study comprised three phases. Phase 1 translated HeLD-14 into ThaiHeLD-14
(self-care) and ThaiPHeLD-14 (childcare) through forward–backward translation and expert
review, and tested validity and reliability among parents of preschool children (n = 111). Phase
2 developed the ThaiDER system, comprising clinic.thaider.net (for dental personnel),
parent.thaider.net (for parents), and a Dashboard for policy decision-making, deployed in five
pilot sites in Samut Prakan Province. Phase 3 evaluated effectiveness using a single-arm prepost design (n = 252 paired for ThaiHeLD-14, n = 237 for ThaiPHeLD-14) and qualitative
assessment via a focus group with dental personnel using the system.
Results: ThaiHeLD-14 and ThaiPHeLD-14 demonstrated good internal consistency (Cronbach's
α = 0.865 and 0.883). ThaiPHeLD-14 showed predictive validity against child dmft (Spearman
ρ = −0.219, p < 0.001); multivariable negative binomial regression indicated that each 10-point
increase in ThaiPHeLD-14 was associated with approximately 21% reduction in child dmft. The
ThaiDER system enrolled 556 children, with 451 oral examinations (81.1%) and 373 treatment
records. ThaiHeLD-14 scores increased significantly post-intervention (46.42 → 48.40, Δ =
+1.99, p < 0.001), particularly in the social/economic constraints and access-to-care
dimensions, while ThaiPHeLD-14 showed no significant change (48.64 → 49.42, p = 0.176),
likely due to ceiling effect. Subgroup analysis revealed that cohorts with lower baseline scores
demonstrated larger gains, suggesting that the application may help narrow literacy gaps in
vulnerable populations. User satisfaction was high (median = 5/5).
Conclusions and Recommendations: ThaiHeLD-14 and ThaiPHeLD-14 demonstrate sound
psychometric properties and are ready for use in research and national-level evaluation. The
ThaiDER system provides a scalable model for primary-care oral health surveillance. Key
recommendations include: incorporating the instruments as national standards; integrating
ThaiDER with the National Health Security Office (NHSO) 43-file standard and existing Health
Information Systems (HIS) (HosXP, MyPCU); enabling offline functionality; and developing
workflows for returning data to parents.
