Mobile Phone Applications to Support Breastfeeding Among African-American Women: a Scoping Review

A Pilot Breastfeeding-Supportive Texting Program for African American and Black Mothers

Background: Exclusive breastfeeding is recommended through age 6 months, and 24.9% of all U.S. mothers, but only 19.8% of African American or Black (AA/B) mothers, achieved this goal (2020). Smartphone technology, specifically short message service (SMS or texting), may provide a strategy to reach and engage AA/B women who otherwise face barriers related to racism in accessing breastfeeding resources. Unfortunately, few mobile health applications are designed for AA/B women. Methods: We created a culturally sensitive breastfeeding promotion and support text message library that begins at 28 weeks prenatally and continues through 10 weeks postpartum. We tested feasibility and acceptability with a proof-of-concept (POC) trial that enrolled 20 AA/B women, and we tested content and perceived usefulness with a pilot study that enrolled 28 AA/B women. Results: In the POC trial, 95% of participants received all messages, demonstrating feasibility, and none requested fewer or to stop messages, demonstrating acceptability. In the pilot, >85% of participants responded positively regarding the number and helpfulness of the texts received, and whether the information was needed. Using a validated measure for online content for parents, >70% of POC and pilot study participants found that the information was very relevant or relevant, completely understandable, taught them something new, and "will help me improve the health or well-being of my child." Conclusion: A new breastfeeding-supportive text messaging program intended for AA/B mothers appears feasible, acceptable, informative, and relevant. This is the first breastfeeding text messaging application of which we are aware that is tailored for the AA/B population.

The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials

Introduction

Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide.

Methods

A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315.

Results

This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers.

Conclusion

Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.

Effects of a mobile application on breastfeeding maintenance in the first 6 months after birth: Randomised controlled trial (COMLACT study)

PROBLEM

It is necessary to continue promoting breastfeeding rates.

BACKGROUND

Information and communication technologies have significantly impacted healthcare services and are transforming the sector. There is little evidence of the usefulness of mobile applications to support breastfeeding and increase its duration.

AIM

To assess whether mobile application-LactApp® (Barcelona, Spain)-usage compared with standard care increases the 6-month postpartum breastfeeding rate.

METHODS

A multicentre, randomised, controlled clinical trial of parallel groups was conducted. The study was conducted in four public hospitals in Spain from January 2022 to January 2023. 270 Women were randomly assigned to each parallel group. The women in the intervention group received free access to the mobile application LactApp®, which provides personalised and convenient support to women about BF. Women in the control group received standard care, which included individual counselling about the benefits of maintaining BF for the first 6 months of the baby's life.

FINDINGS

The rate of breastfeeding abandonment at 15 days was 6.4 % in the control group vs 0.0 % in the intervention group (p = 0.105). LactApp® usage did not increase the 6-month postpartum breastfeeding rate compared with standard care (CG = 41.6% vs. IG = 43.6 %; p = 0.826).

DISCUSSION

Further studies must explore how technologies can help improve long-term breastfeeding maintenance. The mobile app seems to reduce early weaning in the first 15 days slightly.

CONCLUSION

Mobile application usage did not increase the breastfeeding rate compared with standard practice but may reduce breastfeeding abandonment in the first 2 weeks postpartum.

Understanding Breastfeeding Barriers at an Urban Pediatric Practice

Breastfeeding is the optimal nutrition for infants given the numerous health benefits that are conferred on mothers, infants, and society in a dose-dependent manner. However, low breastfeeding rates and racial breastfeeding inequities persist for the African American (AA) community due to historic structural racism. The issue is especially salient at the Rainbow Center for Women and Children, an urban health center in Cleveland, Ohio where approximately 90% of their mothers are AA, WIC-eligible, and publicly insured. Our study aims to elucidate factors contributing to breastfeeding practices and identify supports that could be added for women served at RCWC. The study was conducted within 2 cohorts both of exclusively AA  women. Wave 1 of the study included AA mothers who exclusively breastfed, did mixed feeding, or exclusively formula fed. Wave 2 included expectant women at least considering breastfeeding. Breastfeeding attitudes of those who had exclusively breastfed or practiced mixed feeding were not significantly different than those of expectant participants planning to breastfeed; mean attitude scores, however, were in the "neutral" range. Participants endorsed many sources of support for their feeding choices, including the infant's father, their own parents, and family. However, the data show that even when women feel personally supported in their feeding choices by their partner and family, if additional breastfeeding help is needed, they will benefit from help accessing available resources. Thus, lactation support that helps women achieve their own breastfeeding goals is optimal; customized care ultimately can move the needle on racial inequities in breastfeeding for our society.

Evaluation of Breastfeeding App Features: Content Analysis Study

BACKGROUND

While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings.

OBJECTIVE

This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated.

METHODS

Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings.

RESULTS

On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times.

CONCLUSIONS

Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users.

Infant Feeding Tracker Applications: Cross-Sectional Analysis of Use

OBJECTIVE

Examine the extent to which postpartum patients use infant feeding tracker applications (apps), characteristics of app users, and app features most used and desired.

DESIGN

Cross-sectional survey.

SETTING

An obstetrics/gynecology practice in Northern New Jersey in 2019.

PARTICIPANTS

One hundred twenty-six patients aged ≥ 18 years recruited during their 6-week postpartum visit.

MAIN OUTCOME MEASURES

Self-reported sociodemographics, infant feeding behaviors, and health app use. Respondents were grouped by self-reported use of an infant feeding tracker app.

ANALYSIS

Frequencies were calculated for descriptive analysis, and comparisons were made between user groups. Fisher's exact tests of independence were used to analyze categorical data. Mann-Whitney U tests were employed for continuous variables (significance at P &lt; 0.002).

RESULTS

Fifty-seven percent of respondents reported using an app to track infant feeding. Compared with nonusers, users were more likely to have an infant who was ever breastfed (P = 0.001; Cramer's V = 0.30) and exclusively breastfed (P &lt; 0.001; Cramer's V = 0.44). Users also used significantly more health apps than nonusers (P &lt; 0.001). Most respondents used the app to track infant feeding, diapering, and sleep.

CONCLUSIONS AND IMPLICATIONS

Given their frequency of use-particularly among those who breastfeed-infant feeding tracker apps have the potential to support parents in meeting their infant feeding goals.