Access, Use, and Preferences for Technology-Based Perinatal and Breastfeeding Support Among Childbearing Women

Information work and digital support during the perinatal period: Perspectives of mothers and healthcare professionals

During pregnancy and early motherhood, the perinatal period, women use a variety of resources including digital resources to support social interactions, information seeking and health monitoring. While previous studies have investigated specific timepoints, this study takes a more holistic approach to understand how information needs and resources change over the perinatal period. Furthermore, we include the perspective of maternity healthcare professionals to better understand the relationship between different stakeholders in the information work of perinatal women. A total of 25 interviews with 10 UK based mothers and 5 healthcare professionals (3 Midwives and 2 Health visitors) were conducted. Perinatal women were asked about their information and support needs throughout pregnancy and the postnatal period, healthcare professionals were asked about information and support provision to perinatal women. Information work activities were grouped along stages of the perinatal timeline from pre-pregnancy to the postanal period to illustrate the work and perspectives of the women and the healthcare professionals. Information work varies considerably over the timeline of the perinatal period, shifting back and forth in focus between mother and baby. information work during this period consists of many information related activities including seeking, monitoring, recording, questioning, sharing and checking. The importance of the HCPs as stakeholders in this work is notable as is the digital support for information work. Importantly, paper-based resources are still an important shared resource allowing reflection and supporting communication. Information work for women varies across the perinatal timeline. Particular challenges exist at key transition points, and we suggest design considerations for more integrated digital resources that support information work focused on mother and baby to enhance communication between perinatal women and healthcare professionals.

Resisting stigma: the role of online communities in young mothers' successful breastfeeding

BACKGROUND

Breastfeeding initiation and continuation rates are shaped by complex and interrelated determinants across individual, interpersonal, community, organisational, and policy spheres. Young mothers, however, face a double burden of stigma, being perceived as immature and incompetent in their mothering and breastfeeding abilities. In this study, we aimed to understand the experiences of young mothers who exclusively breastfed for six months and beyond and explore their experiences of stigma and active resistance through social media.

METHODS

In 2020, in-depth telephone interviews about breastfeeding experiences were conducted with 44 young mothers under age 25 in Aotearoa New Zealand who breastfed for six months or longer. Participants were recruited via social media. Interviews were audio-recorded, transcribed and analysed thematically.

RESULTS

Analysis yielded four themes on young mothers' negotiation of breastfeeding and support. The first three themes revealed young mothers' encounters with socio-cultural contexts. They faced negative judgments about maturity and competence, adverse guidance to supplement or cease breastfeeding, and an undermining of their breastfeeding efforts. The fourth theme showed how young mothers sought alternative support in online environments to avoid negative interactions. Online spaces provided anonymity, convenience, experiential knowledge and social connections with shared values. This facilitated identity strengthening, empowerment and stigma resistance.

CONCLUSION

Our research highlights the importance of online communities as a tool for young mothers to navigate and resist the societal stigmas surrounding breastfeeding. Online spaces can provide a unique structure that can help counteract the adverse effects of social and historical determinants on breastfeeding rates by fostering a sense of inclusion and support. These findings have implications for the development of breastfeeding promotion strategies for young mothers and highlight the potential of peer support in counteracting the negative impacts of stigma. The research also sheds light on the experiences of young mothers within the health professional relationship and the effects of stigma and cultural health capital on their engagement and withdrawal from services. Further research should examine how sociocultural barriers to breastfeeding stigmatise and marginalise young mothers and continue to reflect on their socio-political and economic positioning and how it can exacerbate inequities.

A Mobile App to Promote Breastfeeding Self-Efficacy in Preterm Infants' Mothers: Development and Validation

Improving breastfeeding rates is a global goal. To achieve it, actions targeting modifiable factors that influence the breastfeeding experience, such as maternal self-efficacy, could be a promising path, especially with preterm infants' mothers. Considering the current ubiquitous technology, we developed a mobile application for mothers of preterm infants to constitute a breastfeeding information and support platform. The study was developed in three phases: a survey to determine characteristics and preferences of preterm infants' mothers; the app development by an interdisciplinary team, following the principles of Disciplined Agile Delivery; and the face and content validation by 10 professionals. The app contains 80 screens and 11 strategies to address prematurity, lactation, breastfeeding, peer support, maternal emotions, resilience, and motivation. Nurses can apply their expertise by designing mHealth-based interventions, employing scientific evidence, and considering the interests and preferences of the target population. Future studies will assess the user experience, the effect on breastfeeding self-efficacy, and breastfeeding rates, and develop a culturally adapted English version of the app for women in Canada.

Use of new technologies and promotion of breastfeeding: integrative literature review

Objective:

To identify the most used social networks and the most consumed contents by women seeking support and further understanding of breastfeeding/breast milk.

Data source:

An integrative literature review was performed using the Psychology & Behavioral Sciences Collection, MEDLINE Complete, CINAHL Complete, MedicLatina, Academic Search Complete and ERIC databases. The search was conducted in April, 2020. The inclusion criteria were: publications in Portuguese, English or Spanish with several keywords, such as “Breastfeeding”, “Social Networking”, “Social Media”, “Breastfeeding Promotion”, in the title and in the abstract, with the combination of the Boolean operators “AND” and “OR”, in original articles of primary source, which were available in full text and were published between 2015 and 2020.

Data synthesis:

Out of the 93 articles that were first examined, 10 were used in the descriptive summary. Studies from the United States, Sweden, New Zealand, Brazil, Australia, Indonesia, and Switzerland were included in the review. Women were found to use several social networks, which is facilitated by an easy access to the Internet and to its content through several electronic resources, often using more than one device simultaneously. Most issues were universally recognized as some of the most common reasons for interrupting breastfeeding.

Conclusions:

The analyzed studies show that women seek to clarify their doubts outside the traditional health services’ environment, using Facebook, apps, websites, online videos, podcasts and e-mail. We stress the importance of these support groups for promoting breastfeeding and the need for health professionals to introduce themselves in social networks to reach mothers.

Knowledge mobilization tool to promote, protect, and support breastfeeding during COVID-19

Setting

This knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video.

Intervention

This project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada.

Outcomes

This evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic.

Implications

This project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers’ access to healthcare services is compromised.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

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

BACKGROUND

Racial disparities persist with respect to breastfeeding. The use of health e-technology is increasing, with promise for a role in improving breastfeeding outcomes.

OBJECTIVE

We undertook a scoping review of both individual breastfeeding apps and the literature on breastfeeding apps to map the available evidence on app-based breastfeeding support for African-American mothers.

DESIGN

A systematic search of online databases identified 241 English language papers published on or before June 2020 that included e-technology in support of breastfeeding. We included those that (1) described individual human subjects research studies utilizing any research design, (2) described app-based breastfeeding support, and (3) could be pertinent for African-American mothers, and assessed for inclusion and relevance for this population. We also searched app stores for breastfeeding apps, and evaluated features with a rubric. Our aim was to identify if gaps exist relative to breastfeeding support for African-Americans.

RESULTS

Of the 15 publications meeting inclusion criteria, 9 focused on app development, 4 examined user experience, and 3 examined breastfeeding outcomes with use of an app (one study overlapped categories). The percentage of African-American participants ranged from 100% (2 studies) to none (7 studies); 3 studies (20%) focused on African-American mothers' breastfeeding experience. Of 77 apps that met inclusion criteria, just one was both breastfeeding-focused by content and targeted for African-Americans by picture predominance.

CONCLUSIONS

The quality of studies was generally high and many included African-American participants, but research focused on breastfeeding apps specifically for African-American mothers/parents is limited, creating a meaningful gap in the literature.

The Development and Evaluation of a Text Message Program to Prevent Perceived Insufficient Milk Among First-Time Mothers: Retrospective Analysis of a Randomized Controlled Trial

Background

Several recent trials have examined the feasibility and efficacy of automated SMS text messaging to provide remote breastfeeding support to mothers, but these texting systems vary in terms of design features and outcomes examined.

Objective

This study examined user engagement with and feedback on a theory-grounded SMS text messaging intervention intended to prevent perceived insufficient milk (PIM)—the single, leading modifiable cause of unintended breastfeeding reduction and cessation.

Methods

We recruited 250 nulliparous individuals intending to breastfeed between 13 and 25 weeks of pregnancy in southwestern Pennsylvania. Participants were randomly assigned with equal allocation to either an SMS intervention to prevent PIM and unintended breastfeeding reduction or cessation (MILK, a Mobile, semiautomated text message–based Intervention to prevent perceived Low or insufficient milK supply; n=126) or a control group receiving general perinatal SMS text messaging–based support via the national, free Text4Baby system (n=124). Participants in both groups received SMS text messages 3 to 7 times per week from 25 weeks of pregnancy to 8 weeks postpartum. The MILK intervention incorporated several automated interactivity and personalization features (eg, keyword texting for more detailed information on topics and branched response logic) as well as an option to receive one-on-one assistance from an on-call study lactation consultant. We examined participant interactions with the MILK system, including response rates to SMS text messaging queries. We also sought participant feedback on MILK content, delivery preferences, and overall satisfaction with the system via interviews and a remote survey at 8 weeks postpartum.

Results

Participants randomized to MILK (87/124, 70.2% white and 84/124, 67.7% college educated) reported that MILK texts increased their breastfeeding confidence and helped them persevere through breastfeeding problems. Of 124 participants, 9 (7.3%) elected to stop MILK messages, and 3 (2.4%) opted to reduce message frequency during the course of the study. There were 46 texts through the MILK system for individualized assistance from the study lactation consultant (25/46, 54% on weekends or after-hours). The most commonly texted keywords for more detailed information occurred during weeks 4 to 6 postpartum and addressed milk volume intake and breastfeeding and sleep patterns. MILK participants stated a preference for anticipatory guidance on potential breastfeeding issues and less content addressing the benefits of breastfeeding. Suggested improvements included extending messaging past 8 weeks, providing access to messaging for partners, and tailoring content based on participants’ pre-existing breastfeeding knowledge and unique breastfeeding trajectory.

Conclusions

Prenatal and postpartum evidence–based breastfeeding support delivered via semiautomated SMS text messaging is a feasible and an acceptable intervention for first-time mothers. To optimize engagement with digital breastfeeding interventions, enhanced customization features should be considered.

Trial Registration

ClinicalTrials.gov NCT02724969; https://clinicaltrials.gov/ct2/show/NCT02724969

Pregnancy and health in the age of the Internet: A content analysis of online "birth club" forums

BACKGROUND

Although studies report that more than 90% of pregnant women utilize digital sources to supplement their maternal healthcare, little is known about the kinds of information that women seek from their peers during pregnancy. To date, most research has used self-report measures to elucidate how and why women to turn to digital sources during pregnancy. However, given that these measures may differ from actual utilization of online health information, it is important to analyze the online content pregnant women generate.

OBJECTIVE

To apply machine learning methods to analyze online pregnancy forums, to better understand how women seek information from a community of online peers during pregnancy.

METHODS

Data from seven WhatToExpect.com "birth club" forums (September 2018; January-June 2018) were scraped. Forum posts were collected for a one-year period, which included three trimesters and three months postpartum. Only initial posts from each thread were analyzed (n = 262,238). Automatic natural language processing (NLP) methods captured 50 discussed topics, which were annotated by two independent coders and grouped categorically.

RESULTS

The largest topic categories were maternal health (45%), baby-related topics (29%), and people/relationships (10%). While pain was a popular topic all throughout pregnancy, individual topics that were dominant by trimester included miscarriage (first trimester), labor (third trimester), and baby sleeping routine (postpartum period).

CONCLUSION

More than just emotional or peer support, pregnant women turn to online forums to discuss their health. Dominant topics, such as labor and miscarriage, suggest unmet informational needs in these domains. With misinformation becoming a growing public health concern, more attention must be directed toward peer-exchange outlets.

Mobile Health for Perinatal Depression and Anxiety: Scoping Review

Background

The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers.

Objective

This study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work.

Methods

Using a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded.

Results

A total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies.

Conclusions

Future work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth.

Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016

IMPORTANCE

Primary care is the foundation of pediatric care. While policy interventions have focused on improving access and quality of primary care, trends in overall use of primary care among children have not been described.

OBJECTIVE

To assess trends in primary care visit rates and out-of-pocket costs, to examine variation in these trends by patient and visit characteristics, and to assess shifts to alternative care options (eg, retail clinics, urgent care, and telemedicine).

DESIGN, SETTING, AND PARTICIPANTS

Observational cohort study of claims data from 2008 to 2016 for children 17 years and younger covered by a large national commercial health plan. Visit rate per 100 child-years was determined for each year overall, by child and geographic characteristics, and by visit type (eg, primary diagnosis), and trends were assessed with a series of child-year Poisson models. Data were analyzed from November 2017 to September 2019.

MAIN OUTCOMES AND MEASURES

Visits to primary care and other settings.

RESULTS

This cohort study included more than 71 million pediatric primary care visits over 29 million pediatric child-years (51% male in 2008 and 2016; 37% between 12-17 years in 2008 and 38% between 12-17 years in 2016). Unadjusted results for primary care visit rates per 100 child-years decreased from 259.6 in 2008 to 227.2 in 2016, yielding a regression-estimated change in primary care visits across the 9 years of -14.4% (95% CI, -15.0% to -13.9%; absolute change: -32.4 visits per 100 child-years). After controlling for shifts in demographics, the relative decrease was -12.8% (95% CI, -13.3% to -12.2%). Preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9% change in visit rate; 95% CI, 9.0%-10.9%; absolute change: 8.3 visits per 100 child-years), while problem-based visits per 100 child-years decreased from 184.7 in 2008 to 144.1 in 2016 (-24.1%; 95% CI, -24.6% to -23.5%; absolute change: -40.6 visits per 100 child-years). Visit rates decreased for all diagnostic groups except for the behavioral and psychiatric category. Out-of-pocket costs for problem-based primary care visits increased by 42% during the same period. Per 100 child-years, visits to other acute care venues increased from 21.3 to 27.6 (30.3%; 95% CI, 28.5% to 32.1%; absolute change: 6.3 visits per 100 child-years) and visits to specialists from 45.2 to 53.5 (16.4%; 95% CI, 14.8% to 18.0%, absolute change: 8.3 visits per 100 child-years).

CONCLUSIONS AND RELEVANCE

Primary care visit rates among commercially insured children decreased over the last decade. Increases in out-of-pocket costs and shifts to other venues appear to explain some of this decrease.

An investigation into the use of infant feeding tracker apps by breastfeeding mothers

Sufficient information and support for breastfeeding mothers is vital to encourage optimal infant feeding practices. Infant feeding apps give breastfeeding instructions and access to information however, little is known about mothers' perceptions about these resources. This study investigated mothers' use and experiences of infant feeding apps with a feeding tracker component, including how information within these apps is used, initial reasons for downloading, the role of the app in infant feeding, and perceived benefits and disadvantages of infant feeding apps. In-depth interviews were conducted with nine Australian breastfeeding mothers who had used an infant feeding app in the last year. Interviews were recorded, transcribed verbatim and coded prior to thematic analysis. The findings revealed that infant feeding apps provide mothers with objective information to guide their breastfeeding decisions and other aspects of baby care. This objective approach to infant feeding gives mothers a perception of greater control, confidence and efficacy at a time of transition and stress in the early stages of parenting an infant. While, overall, the mothers were positive about infant feeding apps, they also expressed concerns regarding overreliance on the app, feeling overwhelmed with the data and questioning the credibility of the information.

Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory

BACKGROUND

Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production.

OBJECTIVE

The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production.

METHODS

Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience.

RESULTS

Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively.

CONCLUSIONS

Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery.

Consumer Engagement in Mobile Application (App) Interventions Focused on Supporting Infant Feeding Practices for Early Prevention of Childhood Obesity

Background and Aims: There has been increasing interest in using mobile applications ("apps") for innovative health service delivery and public health interventions. This paper describes two independent studies investigating mothers' or pregnant women's perceptions of, interest in and experiences with technological devices, apps and websites about infant feeding practices. Methods: Study 1 was a cross-sectional survey conducted with 107 pregnant women in their third trimester in late 2016 and early 2017. Multiple logistic regression analyses were conducted to examine factors associated with their app usage. The second was a qualitative study of 29 mothers of infants aged <1 year conducted in 2014. Thematic network analysis was used to explore the themes from the transcribed interviews. Results: Study 1 found that the use of apps was common among the pregnant women, with 100% having previously downloaded an app on their phone either free or paid. About 60% had used an app for health purposes. The majority reported that they were likely to use an app promoting healthy infant feeding practices, including 30% extremely likely and 53% very likely. Women with university or other tertiary level of education were more likely to use an app for promoting healthy infant feeding practices than those with other levels of education (adjusted odds ratio 3.22, 95% confidence interval 1.28-8.13). The qualitative interviews found that all the mothers were interested in a mobile program to support them with infant feeding practices. Participants felt they would benefit from individualized messages although did not want them to be sent too frequently. Further, participants also expressed the importance of having non-judgmental information and they were interested in receiving information using different modes such as videos, SMS or an app. Conclusions: Both studies suggest that using apps for promoting healthy infant feeding practices is acceptable from the perspective of mothers. There is great potential for health promotion practitioners to be engaged in app development for the purpose of promoting health in early years and health promotion in general.

Geographic Access to International Board-Certified Lactation Consultants in Pennsylvania

BACKGROUND:

Availability of professional lactation support has been associated with increased breastfeeding rates; however, data about access to international board-certified lactation consultants are limited.

RESEARCH AIMS:

The aims were (a) to assess geographic access to international board-certified lactation consultants in Pennsylvania, (b) to compare access in rural/urban counties, and (c) to compare access by county-level breastfeeding initiation rates.

METHODS:

Using geographic information systems methodology and a cross-sectional observational design, we calculated the proportion of young children living within 15, 30, and 60 miles of international board-certified lactation consultants in Pennsylvania. We calculated these proportions for all children in Pennsylvania, for children in urban and rural counties, and for children in counties with low, medium, and high breastfeeding initiation rates. Comparisons were done to answer the research aims.

RESULTS:

Over 90% of young children live within 30 miles of an international board-certified lactation consultant. Compared to children in urban counties, fewer children in rural counties live within 15 and 30 miles of these providers. In counties with high breastfeeding initiation rates, a larger percentage of children live within 15 miles of an international board-certified lactation consultant than in counties with low breastfeeding initiation rates.

CONCLUSION:

While most Pennsylvania children live in proximity of an international board-certified lactation consultant, this was true for a lower percentage of children in rural counties and in counties with lower breastfeeding rates.

Evaluation of a Breastfeeding App in Rural Australia: Prospective Cohort Study

BACKGROUND

New mothers often need support to establish and maintain breastfeeding, and rural women may find it difficult to access breastfeeding resources locally. There are many smartphone applications for breastfeeding mothers; however, very few have been developed by health professionals. We evaluated a smartphone application, Breastfeeding Solutions, developed by U.S. IBCLC Nancy Mohrbacher. Research aims: The aims were (a) to explore usability of the application among rural Australian breastfeeding women and (b) to describe participants' infant feeding outcomes compared with the general population.

METHODS

A prospective longitudinal self-report survey design was used. Data were collected via online questionnaires at baseline and at 3 and 6 months from a convenience sample of new mothers. The setting was southwest Victoria, Australia, from 2016 to 2017. Descriptive statistics were used to answer research aims.

RESULTS

Of the initial 46 participants who received the app, 63% ( n = 29) completed surveys at 3 and 6 months. Usability was assessed at 3 months: 93.5% of participants (29 of 31) rated the application favorably, whereas 96.8% (30 of 31) found the application helpful and 87.1% (27 of 31) would recommend it to other mothers. At the 6-month survey, 79% of participants ( n = 23) were breastfeeding; 10% ( n = 3) had stopped breastfeeding during the first 3 months. The local breastfeeding rate at 6 months was approximately 50% according to routinely collected data; however, we cannot infer that the application was responsible for the difference.

CONCLUSION

The smartphone application was acceptable to breastfeeding women in an Australian rural setting. Further evaluation using a user-centered design could improve rural postpartum women's access to reliable, evidence-based information.

Environmental Scan of Breastfeeding Resources in Canadian NICUs

We conducted an environmental scan using a mixed methods approach to determine the types and frequencies of breastfeeding resources available to mothers of infants in Canadian NICUs. Through interviews with key informants from 29 Level 3 NICUs, we identified six categories of resources: breastfeeding-friendly layout, breastfeeding support personnel, breastfeeding education for mothers, breast pump-related resources, coordination of postdischarge breastfeeding support, and breastfeeding-related policies. Findings from this national study indicate that a wide range of breastfeeding resources were reportedly available in Canadian Level 3 NICUs. NICU professionals are encouraged to connect with other units across Canada to facilitate the exchange of breastfeeding resources and best practices.