Empowered Smiles Through Education and Motivation (e-SEM): A Theory-Driven Digital Oral Health Behaviour Intervention

Background: Oral health conditions, particularly dental caries and periodontal diseases remain highly prevalent yet preventable global public health concerns. School-based oral health education can improve knowledge and behaviours, but traditional approaches often lack engagement and sustainability. Digital media offers an opportunity to deliver interactive, theory-driven, and culturally appropriate interventions. This study developed and validated empowered smiles through education and motivation (e-SEM), a digital oral health behaviour intervention for Filipino schoolchildren based on the information-motivation-behavioural skills (IMB) model. Methods: A methodological design was used in 3 phases: (1) elicitation through literature review and situational analysis; (2) development of culturally tailored digital materials including learning modules, animated storytelling, parent education content, and behavioural skills tools; and (3) expert content validation using Lawshe's Content Validity Ratio (CVR) and Content Validity Index (CVI), supplemented by qualitative feedback. Acceptability and usability were also assessed among parents and children using structured questionnaires. Results: Expert validation demonstrated strong content validity across all components, with scale-level CVI ranging from 0.83 to 0.95. Digital learning modules and behavioural skills tools achieved the highest validity (CVI = 0.95), while animated storytelling videos showed comparatively lower scores (CVI = 0.83), indicating areas for refinement. Qualitative feedback supported the relevance and educational value of the intervention while highlighting the need to simplify language, improve pacing and enhance visual clarity. End-user evaluation showed high acceptability among parents (mean = 3.76/4.00) and high usability and engagement among children (mean = 2.77/3.00). Conclusion: The e-SEM programme demonstrated strong content validity and high acceptability, supporting its feasibility as a theory-driven digital oral health intervention for schoolchildren. Further refinement and effectiveness testing are recommended to evaluate its impact on oral health behaviours and outcomes.