ASSESSMENT OF CAREGIVER KNOWLEDGE AND ANTICIPATED ACCEPTABILITY OF AN EMOTION ADAPTIVE ROBOTIC ORAL-CARE DEVICE (EMOSMILE BOT) FOR CHILDREN WITH DISABILITIES: A MULTICENTRIC CROSS-SECTIONAL STUDY IN INDIA, BANGLADESH, AND SAUDI ARABIA

Abstract

Background. Children with disabilities frequently experience substantial difficulty in maintaining adequate oral hygiene. Conditions such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), cerebral palsy, intellectual disability, and sensory-processing difficulties are associated with sensory hypersensitivity, behavioral resistance, fear and anxiety, impaired motor coordination, and dependence on caregivers during toothbrushing. Conventional oral-care devices are designed primarily for typically developing users. EmoSmile Bot is a proposed emotion-adaptive robotic oral-care system providing personalized, engaging, and caregiver-supported assistance through emotion recognition, adaptive brushing, pressure regulation, interactive guidance, and monitoring. Aim. To assess caregiver knowledge and awareness of oral-care devices for children with disabilities and to evaluate the anticipated acceptability, perceived usefulness, perceived safety, willingness to use, willingness to recommend, and perceived potential of EmoSmile Bot to reduce caregiver burden. Methods. A multicentric cross-sectional survey was conducted among 1,000 caregivers of children with disabilities recruited from departments of pediatric dentistry and selected special-care and residential settings in India (n = 510), Bangladesh (n = 380), and Saudi Arabia (n = 110). A structured questionnaire assessed sociodemographic characteristics, knowledge and awareness, difficulties encountered during routine oral hygiene, perceived need, and anticipated acceptability. Participants received a standardized description of the device before completing the acceptability section. Group differences were analysed using one-way ANOVA and chi-square tests; multivariable logistic and linear regression identified independent correlates of willingness to use and acceptability. Results. The mean caregiver knowledge score differed significantly across countries (Saudi Arabia 7.8 ± 1.5; India 6.9 ± 1.8; Bangladesh 6.5 ± 1.9; p < 0.001). The overall anticipated acceptability score was high at 4.12 ± 0.60 on a 5-point scale (Saudi Arabia 4.30 ± 0.44; India 4.08 ± 0.62; Bangladesh 3.98 ± 0.67; p < 0.001). Perceived usefulness was reported by 88.0% of caregivers overall, perceived safety by 86.3%, willingness to use by 86.5%, and willingness to recommend by 83.4%; 76.9% considered that the device could substantially reduce caregiver burden. The anticipated acceptability score was the strongest independent predictor of willingness to use (adjusted OR 2.39, 95% CI 1.75–3.27; p < 0.001). Acceptability was uniformly high across disability types and severities. Conclusion. This multicentric study provides user-centered evidence of high caregiver-anticipated acceptability, perceived need, and willingness to use an emotion-adaptive robotic oral-care system across three countries. The findings can inform refinement of the functional, ergonomic, behavioral, and caregiver-support components of EmoSmile Bot before prototype fabrication and usability testing.