Effectiveness of a smartphone-based educational intervention to improve breastfeeding

Evaluating a woman-centred web-based breastfeeding educational intervention in Saudi Arabia: A before-and-after quasi-experimental study

BACKGROUND

Although digital educational resources are used worldwide to educate new parents, the impact of digital resources tailored specifically to women's needs on breastfeeding practices is not well explored.

AIM

The study aimed to evaluate the effectiveness of using a women-centred Web-Based Breastfeeding Educational Resource (WEBBER) in increasing the rate of exclusive breastfeeding at one month after birth.

METHODS

A quasi-experimental study with before and after intervention was conducted in one metropolitan hospital in Saudi Arabia. Participants were primiparous women (n=290) aged 18 or above who intended to breastfeed. The intervention involved introducing the WEBBER to pregnant women and reinforcing its uses as a routine breastfeeding educational resource. Women's characteristics and infant feeding data were collected at one month after birth via an online survey.

FINDINGS

The rate of exclusive breastfeeding at one month postpartum among the women who received the WEBBER intervention was nearly three times higher compared to the women prior to the introduction of the intervention (66 % vs. 26 %, p-value <.001). Furthermore, other predictors of exclusive breastfeeding at one month were the mother being unemployed, the baby not receiving infant formula in the hospital, and the mother having postnatal intention to continue breastfeeding for 6 months or more.

DISCUSSION AND CONCLUSION

Using WEBBER as a routine breastfeeding educational resource increased the rate of exclusive breastfeeding one month after birth. Embedding woman-centred digital resources into routine breastfeeding education is an effective intervention for women in Saudi Arabia.

Hotspots and Global Trends of Nursing Research on Mobile Applications in Nursing From 2012 to 2023: A Bibliometric Analysis

The rapid integration of mobile applications in healthcare has prompted an evolutionary change in nursing domain. This study aimed to systematically analyze the basic publication characteristics, research priorities, emerging trends, and thematic evolutions concerning mobile applications in nursing, providing an overview of the field's developmental trajectory and future directions. This was a descriptive bibliometric study. Data were collected on July 5, 2023, from the Web of Science database and analyzed by using the Bibliometrix package in R software. The search strategy yielded 417 documents authored by 1969 researchers, cited 12 595 references, and featured 1213 author keywords, spanning from 2012 to 2023. Research on mobile applications in nursing exhibited several key trends: (1) substantial collaboration among authors; (2) significant growth in the number of publications; (3) self-management was the most prominent hot topic; and (4) an evolution of research themes from general topics to a more specific focus on people-centered and problem-centered research. The corpus of literature pertaining to research on mobile applications within the nursing domain is anticipated to expand continually. Future research and practice in the nursing field are expected to benefit significantly from multidisciplinary collaboration and advancements in emerging technologies, including artificial intelligence.

The effect of virtual reality on the breastfeeding process: a randomized controlled study

OBJECTIVE

The aim of this study was to determine the effect of breastfeeding training given with virtual reality (VR) to postpartum mothers after cesarean section delivery on breastfeeding success and breastfeeding self-efficacy.

STUDY DESIGN

The research was designed as a prospective randomized controlled study. In total, 66 women were included in the study, with 31 in the control group and 35 in the intervention group. The study included mothers who had no vision or hearing impairments and no neurological disorder, who had received breastfeeding counseling during pregnancy, and who had given birth by cesarean delivery to a healthy baby. The control group received standard breastfeeding training while the intervention group watched a breastfeeding video with VR in the 4th and 24th hours after cesarean delivery. Research data were collected with the sociodemographic information form, LATCH Breastfeeding Charting System and Documentation Tool and the Breastfeeding Self-Efficacy Scale.

RESULTS

As a result of the research, the women in the intervention group were found to have higher mean scores for the Breastfeeding Self-Efficacy Scale in the 4th and 24th hours compared to the control group. Mean LATCH scores were also higher in the intervention group compared to the control group. There were linear correlations between the Breastfeeding Self-Efficacy Scale scores and LATCH Scale scores.

CONCLUSION

Breastfeeding self-efficacy and breastfeeding success of mothers who received breastfeeding training with VR at 4th and 24th hours after cesarean delivery were higher than mothers who received standard breastfeeding training.

CLINICAL TRIALS NUMBER

NCT06256822.

Effects of Face-to-Face Education Followed by Mobile Messaging to Primiparas on Maternal-Neonatal Care, Breastfeeding, and Motherhood Experience: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of education on breastfeeding and basic maternal-neonatal care and mobile message support given to primiparous women in the postpartum period on breastfeeding and motherhood experiences.

METHODS

This prospective randomized controlled study was conducted in a hospital located in a city in Turkey, with 130 primiparous patients in the postpartum period (65 individuals in the experimental group and 65 individuals in the control group). Participants in the experimental group were provided with education on breastfeeding and basic maternal-neonatal care at the hospital, and mobile messages were sent with the same content as an education program for six weeks after discharge.

RESULTS

Mean scores of the breastfeeding self-efficacy (58.95 vs. 54.87; P<.05) and breastfeeding attitude (60.80 vs. 57.55; P<.05) are significantly higher in the experimental group compared to the control group. Similarly, the mean score of satisfaction with the motherhood experience is significantly improved in the experimental group compared to the control group (22.95 vs. 26.46; P<.05). It was determined that 89.2% of the women in the experimental group were still breastfeeding; 93.8% of them did not have nipple problems, and 60% of them did not use a bottle or pacifier in the six-month postpartum period (P<.05).

CONCLUSION

Education on breastfeeding and basic maternal-neonatal care given in the early postpartum period and mobile messages sent for six weeks after discharge may help to improve breastfeeding self-efficacy, breastfeeding attitude, and maternal experience satisfaction among primiparous women.

Innovative continuum of care to promote exclusive breast feeding in Pakistan: protocol of a pilot randomised controlled trial

BACKGROUND

Breastmilk being the ideal nutrition from birth to 2 years and beyond has many health benefits for both newborn and mothers. This study will assess the feasibility and acceptability of a continuum of care programme, which is a health facility and community based till 6 months post partum to encourage ideal breastfeeding practices.

METHODS AND ANALYSIS

A pilot randomised control trial having two-parallel arms of intervention and control groups was conducted in gynaecology and obstetrics department of Aziz Bhatti Shaheed Teaching Hospital with a community outreach component of 6 months. 50 women between 28 and 32 weeks of gestation fulfilling inclusion criteria will be allocated in 1:1 randomly into intervention and control groups through computer-generated random number generator software. 25 participants in intervention group will receive counselling and training on breast feeding during antenatal visits along with a family member of support by a trained female doctor within the hospital, at birth by a trained nurse and at home for 6 months by a trained lady health worker. It will be supported by reading materials and videos through a mobile phone WhatsApp application. The 25 participants in control group will receive the support already provided within the hospital and at home. The primary outcomes feasibility and acceptability will be determined at 6 months post partum from participants and providers by a semistructured questionnaire. The secondary outcomes are rates of infant early initiation and exclusive breast feeding at 2 weeks, 1, 3 and 6 months, Infant Feeding Attitude at 1 month and Breastfeeding Self-Efficacy at 3 months. Quantitative and qualitative data will be analysed via SPSS software V.20 and thematic analysis, respectively.

CONCLUSION

This pilot randomised controlled trial (RCT) will guide the interventions for the definite RCT.

ETHICS AND DISSEMINATION

Approved by institutional ethical committee, informed consent from all participants and results will be disseminated in peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05951868.

Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review

BACKGROUND

Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years.

METHODS

A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures.

RESULTS

From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive.

CONCLUSIONS

This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.

The effectiveness of online breastfeeding education and support program on mothers of preterm infants: A quasi-experimental study

OBJECTIVE

To develop a WeChat-mini-program-based Online breastfeeding education and support program and explore its impacts on promoting mothers of preterm infants' breastfeeding knowledge, attitudes, self-efficacy, and rates.

DESIGN, SETTING, AND PARTICIPANTS

This was a quasi-experimentation with two-group comparisons. The eligible preterm mother-infant pairs were recruited from the NICU within seven days postpartum. The first 25 mothers admitted to the NICU during the study period were included in the control group, and the following 25 mothers were in the intervention group according to the admission order of their preterm infants. A generalized linear mixed model was used to detect the effects of the online intervention program and the interaction effects of group and time.

INTERVENTIONS

The participants received a 3-month online breastfeeding intervention from a WeChat mini program for the intervention group.

MEASUREMENTS

Mothers of preterm infants' breastfeeding knowledge, attitudes, self-efficacy, and breastfeeding rates of different patterns were respectively evaluated by the Breastfeeding Knowledge Questionnaire (BKQ), Iowa Infant Feeding Attitude Scale (IIFAS), and Breastfeeding Self-Efficacy Scale (BSES) at three different points of times including before intervention (T0), at one month postpartum (T1) and three months postpartum (T2).

FINDINGS

The breastfeeding knowledge significantly differed between the two groups but without differences between different time points and in the grouping*time interaction. Within the intervention group, significant improvements were observed from T0 to T2 and T1 to T2. No significant differences in breastfeeding attitudes, self-efficacy, and breastfeeding rates were found between and within groups.

KEY CONCLUSIONS

The WeChat-mini-program-based online breastfeeding intervention may improve the breastfeeding knowledge level of mothers of preterm infants but has no significant impact on mothers' breastfeeding attitudes, breastfeeding self-efficacy, and breastfeeding rates.

IMPLICATIONS FOR PRACTICE

The WeChat mini program can be used to improve the breastfeeding knowledge level of mothers of preterm infants. Future interventions need to target both mothers of preterm infants and their family members by combing online and offline approaches.

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.

Effectiveness of a breastfeeding promotion intervention model based on Society ecosystems Theory for maternal women: a study protocol of randomized controlled trial

BACKGROUND

Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months.

METHODS/DESIGN

The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum.

DISCUSSION

This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community.

TRIAL REGISTRATION

Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.

Effect of online intervention mode on breastfeeding results: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of Internet based intervention model on breastfeeding knowledge, attitude, self-confidence and breastfeeding rate.

METHODS

An electronic literature search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang, CBM and VIP database was performed using combinations of the keywords "Breastfeeding," "Breastfeeding, Exclusive," "Internet," "Online," and "Website". The retrieval period was from their inception to March 31, 2023. Quality appraisal was performed using the Cochrane 5.1 for randomized controlled trials (RCTs). RevMan5.3 was used for data analysis.

RESULTS

Thirty-two studies were included in the review, with a total of 9514 samples. The results of Meta-analysis showed that, compared with routine nursing, the intervention model based on the Internet can effectively improve breastfeeding knowledge and attitude of pregnant women, improve breastfeeding self-confidence (P < 0.05), and improve the rate of exclusive breastfeeding in the short term (within 6 weeks) and the long-term postpartum (3-6 months) had a positive effect on the rate of exclusive breastfeeding (P < 0.05).

CONCLUSIONS

The Internet breastfeeding intervention model may be an effective intervention to improve the effect of exclusive breastfeeding. In the future, more high-quality, large-sample randomized controlled trials can be carried out to further explore the effect of the Internet intervention model on breastfeeding.

A Technological Approach to Improved Breastfeeding Rates and Self-Efficacy: A Randomized Controlled Pilot Study

BACKGROUND

Breastfeeding confers significant maternal and infant benefits; however, breastfeeding rates remain suboptimal in the United States. A parent's decision to breastfeed is influenced by non-modifiable and modifiable factors, including breastfeeding knowledge and self-efficacy. There is a positive correlation between high maternal self-efficacy and breastfeeding duration. Parents increasingly rely on technology for health information.

RESEARCH AIM

To determine if a smartphone application affected maternal self-efficacy and breastfeeding exclusivity rates.

METHOD

This study was a randomized, controlled pilot study examining the effect of an educational program, included in a smartphone application, on breastfeeding self-efficacy (assessed in postpartum Week 1 and Weeks 4-6) and breastfeeding rates (assessed in postpartum Weeks 4-6). Forty participants were recruited using block randomization to intervention (17 of 20 completed the study) and usual care (19 of 20 completed the study) groups. To examine the pre-test/post-test difference in the Breastfeeding Self-Efficacy Scale - Short Form total scores, a change in score (post-intervention minus pre-intervention) was calculated for each parent.

RESULT

The intervention group (phone application and usual care) showed greater change in self-efficacy scores (M = 7.6, SD = 7.8) compared to the control group (usual care; M = 1.2, SD = 3.7, p = .001). The rate of exclusive breastfeeding was nearly twice as high in the intervention group as in the control group, but did not reach statistical significance (p = .093).

CONCLUSION

The investigators found enhanced breastfeeding self-efficacy and breastfeeding rates among postpartum women receiving a smartphone educational program in the first 6 weeks postpartum. Further studies on smartphone interventions will develop our understanding of this technology in improving breastfeeding rates.

Usability and Quality Evaluation of the "E- Midwife" Mobile Application for Nurse-Midwives in Obstetric Complications: A Randomized Controlled Trial

Background

Obstetric complications are illnesses that develop during childbirth. Smartphones, which facilitate the use of prompt features in the early diagnosis of challenges and quick delivery of respectful maternity care, are one of the most recent advances in health technology. The key objective of this project is to evaluate the usability and quality of the "E-Midwife" mobile application for nurse-midwives, which focuses on obstetric complications.

Methods

This study is a component of a randomized controlled trial on nurse-midwives. This project followed a four-step approach: content development phase, app design phase, app development phase, and usability testing phase. The app was developed using extensive flowcharts, a definition of the navigational framework, a structured database, and user-friendly software. 140 out of the 196 nurse-midwives were allocated to the intervention (n=70) and control group (n=70), using random allocation. The intervention group used the application for 8 weeks. Usability and quality of the application were assessed using the system usability scale and the mobile application rating scale, respectively. SPSS statistical software, version 17, was used to analyze the dat.

Results

The overall score of the usability testing of E-Midwife was 82.75±0.68. The total mean score of quality was 3.77±0.86. Therefore, it was shown to have good usability and quality.

Conclusion

The E-midwife mobile application has a high usability and quality which makes its usage effective and efficient. It is recommended that these similar mobile apps should be used along with other educational methods for educating the nurse-midwives.Trial Registration Number: CTRI/2022/03/040857.

The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis

BACKGROUND

Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries.

OBJECTIVE

The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries.

METHODS

Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane's risk of bias tool was used to assess the quality of included articles.

RESULTS

The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69-2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90-8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46-3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73).

CONCLUSIONS

The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.

Effect of Mobile-Based Counselling on Breastfeeding in Spain: A Randomized Controlled Trial Protocol (COMLACT Study)

PURPOSE

The primary aim of this study is to determine the influence of an intervention in women based on a free mobile application (LactApp^®, Barcelona, Spain) in maintaining breastfeeding (BF) up to 6 months postpartum. The secondary aim is to assess the effect of health literacy (HL) on breastfeeding duration.

METHODS

A multicenter, randomized controlled clinical trial of parallel groups will be carried out. Women will be randomly assigned to each of the parallel groups. In the control group, usual clinical practice will be followed from the third trimester of pregnancy to promote BF. In the intervention group, and in addition to usual clinical practice, the women will use a free mobile application (LactApp^®) from the third trimester to 6 months postpartum. The type of BF at birth, at 15 days and at 3 and 6 months postpartum and the causes of cessation of BF in both groups will be monitored. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. The study protocol was approved by the Clinical Research Ethics Committee of Hospital de la Ribera (Alzira, Valencia, Spain) in February 2021. A per protocol analysis and an intention-to-treat analysis will be performed.

DISCUSSION

This study will identify the influence of a mobile application on improving BF rates. If the application proves effective, we will have a tool with free information available to any user at any time of day, which may be complemented by normal clinical practice and be integrated into our health care system.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05432700.

Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app

Despite the well-known benefits of breastfeeding, breastfeeding rates remain suboptimal, particularly for women with lower socioeconomic position. Although popular, breastfeeding apps are often poor quality; their impact on breastfeeding knowledge, attitudes, confidence and intentions is unknown. A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education. The My Baby Now app was offered to pregnant women 20-30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36-38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8-12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1-T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1-T2 and T1-T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions. Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

Spanish version of the mHealth App Usability Questionnaire (MAUQ) and adaptation to breastfeeding support apps

INTRODUCTION

Mobile applications (apps) are increasingly used during pregnancy, postpartum and lactation. To ensure the utility and usability of breastfeeding support apps, they need to be evaluated using a reliable scale specific to mHealth apps and breastfeeding users.

OBJECTIVE

To translate the original the mHealth App Usability Questionnaire (MAUQ) questionnaire into Spanish and to adapt it to breastfeeding support apps environment.

MATERIALS AND METHODS

The questionnaire was translated by one high English proficiency translator and was back translated. The items of the questionnaire were modified for Spanish readers and for breastfeeding users. The modified questionnaire was assessed for content validity with a panel of 5 experts and 12 users and the modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the questionnaire was assessed in a mobile application for breastfeeding support (LactApp) by 202 users. The structure of the questionnaire was validated using exploratory factor analysis.

RESULTS

All items of the questionnaire were relevant, clear or comprehensible with content validity index values higher than 0.79. The modified kappa agreement for each item of the modified MAUQ (m-MAUQ) proved an excellent agreement (κ = 0.9-1.0). Factor analysis of the m-MAUQ showed four subscales. The internal consistency of the complete questionnaire was high (Cronbach α = 0.89).

CONCLUSIONS

The Spanish and modified MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility and acceptability of mHealth apps aiming to support lactating women.

Effectiveness of a mobile app, KhunLook versus the maternal and child health handbook on Thai parent’s health literacy, accuracy of health assessments and convenience of use: A randomized controlled trial (Preprint)

BACKGROUND

Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents' HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child's health in complement to the standard Maternal and Child Health Handbook (MCHH).

OBJECTIVE

This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents' HL. Data on accuracy of parents' assessment of their child's health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2).

METHODS

Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child's handbook to assess their child's growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire.

RESULTS

A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child's head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit.

CONCLUSIONS

Our results suggest the potential of a smartphone app (KhunLook) to improve parents' HL as well as to promote superior accuracy of parents' assessment of their child's head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood.

TRIAL REGISTRATION

Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003.

Effects of mHealth on the psychosocial health of pregnant women and mothers: a systematic review

OBJECTIVE

To investigate the roles of mobile health, or mHealth, in the psychosocial health of pregnant women and mothers.

METHODS

A systematic search was conducted in databases and grey literature including MEDLINE, Web of Science, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, SocINDEX, Central Register of Controlled Trials, The Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Health Technology Assessment, UNICEF and WHO databases. Two searches were conducted to include original research articles published in English until 15 November 2021. Several tools were used to assess the risk of bias: revised Cochrane risk of bias tool for randomised trials, Risk of Bias in Non-randomized Studies of Interventions, National Heart, Lung, and Blood Institute quality assessment tool for cohort and cross-sectional studies, Critical Appraisal Skills Program checklist for qualitative studies and Mixed Methods Appraisal Tool for mixed-methods studies. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. Due to the high heterogeneity and variability of the included studies, data synthesis was conducted narratively.

RESULTS

44 studies were included among 11 999 identified articles. Most studies reported mixed findings on the roles of mHealth interventions in the psychosocial health of pregnant women and mothers; mHealth improved self-management, acceptance of pregnancy/motherhood and social support, while mixed results were observed for anxiety and depressive symptoms, perceived stress, mental well-being, coping and self-efficacy. Furthermore, pregnant women and mothers from vulnerable populations benefited from the use of mHealth to improve their psychosocial health.

CONCLUSIONS

The findings suggest that mHealth has the potential to improve self-management, acceptance of pregnancy/motherhood and social support. mHealth can also be a useful tool to reach vulnerable pregnant women and mothers with barriers to health information and facilitate access to healthcare services. However, the high heterogeneity limited the certainty of evidence of these findings. Therefore, future studies should identify the context under which mHealth could be more effective.

Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care

The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.