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Gebremariam KT, Wynter K, Zheng M, Rawstorn JC, Denney-Wilson E, Laws R. Breastfeeding - a survey of fathers' support needs and preferred sources of information. Int Breastfeed J 2024; 19:50. [PMID: 39020376 PMCID: PMC11256481 DOI: 10.1186/s13006-024-00654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 06/27/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Fathers can be a critical source of breastfeeding support for their partner, but little is known about what fathers would like to learn about breastfeeding. Partner's support and encouragement enhances mother's breastfeeding confidence and boost the capacity to address breastfeeding difficulties effectively. The aims of this study were to explore what fathers regard as important to learn around breastfeeding, and their current and preferred sources of information. METHODS A structured online survey was conducted, between September 2022 and November 2022, with fathers containing three sections: (1) sociodemographic variables; (2) perceived importance of 26 breastfeeding topics; and (3) sources of breastfeeding information. A convenience sample of expectant and current fathers aged 18 years or older, who were expecting a baby or had a child aged one year or younger, living in Australia, and able to complete survey in English was recruited. Participants were recruited on Facebook advertisement. RESULTS A total of 174 fathers participated in the study, majority (75%) were aged 30-39 years, current dads (74%), and university educated (69%). The breastfeeding topics that fathers perceived as the most important/ important to learn about were how to work with their partner to overcome breastfeeding challenges, how fathers can be involved with their breastfed baby, the types of support fathers can provide to breastfeeding mothers, what to expect in the first week and the benefits of breastfeeding. The most preferred health professional sources of breastfeeding information were midwives, child and family nurses and doctors. Among non-health professional sources of support, mobile app, friends and family were most popular. CONCLUSION Breastfeeding information to enhance fathers' knowledge and awareness of common breastfeeding challenges, and fathers' role in supporting their breastfeeding partner, appear to be (most) important for fathers. Mobile app appears to be among the most preferred non-health professional ways to provide breastfeeding information to fathers.
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Affiliation(s)
- Kidane Tadesse Gebremariam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia.
| | - Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Jonathan Charles Rawstorn
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, Australia
| | | | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Chua JYX, Choolani M, Chee CYI, Yi H, Chan YH, Lalor JG, Chong YS, Shorey S. Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot-A Digital Healthcare Assistant): Qualitative Process Evaluation. J Med Internet Res 2024; 26:e56894. [PMID: 38905628 PMCID: PMC11226932 DOI: 10.2196/56894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/16/2024] [Accepted: 04/18/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. OBJECTIVE This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA). METHODS A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. RESULTS Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. CONCLUSIONS Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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So JTH, Nambiar S, Byrne R, Gallegos D, Baxter KA. Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops. JMIR Pediatr Parent 2024; 7:e57849. [PMID: 38815260 PMCID: PMC11176881 DOI: 10.2196/57849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. OBJECTIVE This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. METHODS Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. RESULTS A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation-Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies. CONCLUSIONS Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice.
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Affiliation(s)
- Jeffrey Tsz Hei So
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Smita Nambiar
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Rebecca Byrne
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kimberley A Baxter
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Pereira TLB, Rajendran PDO, Nantsupawat A, Shorey S. Fathers' breastfeeding knowledge, attitudes, and involvement in the Asian context: A mixed-studies review. Midwifery 2024; 131:103956. [PMID: 38401252 DOI: 10.1016/j.midw.2024.103956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/17/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Despite numerous initiatives attempting to enhance BF across Asia, recent studies show that exclusive BF rates remain alarmingly low. With globalization, society has shifted from traditional family roles towards more egalitarian marriages, where Asian fathers are now more involved in parenting. As fathers' involvement in breastfeeding is highly complex and context-sensitive, evaluation of a wide range of concepts and evidence within the Asian context is necessary. OBJECTIVE This review aims to consolidate and appraise empirical studies exploring fathers' breastfeeding knowledge, attitude, and involvement within the Asian context. DESIGN A systematic mixed-studies review was conducted. Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and ProQuest Dissertations and Theses Global) were searched from each database's inception date until June 2022. Studies were appraised using the Mixed Method Appraisal Tool and data was synthesised using the results-based convergent integration method. FINDINGS Twenty-two studies were included in this review. The synthesis of findings identified two main themes and six sub-themes. KEY CONCLUSIONS Asian fathers have a varied understanding of breastfeeding and their involvement in breastfeeding is influenced by personal, cultural, religious, social, and environmental factors. IMPLICATIONS FOR PRACTICE Perinatal care professionals play a crucial role in engaging and enhancing fathers' involvement in breastfeeding education programmes. The findings also urge policymakers to introduce more 'father-friendly' breastfeeding guidelines and educate perinatal care professionals to be more aware and sensitive to the needs of fathers. There is also a need to introduce more flexible and economically sensitive paternal leave policies to improve fathers' breastfeeding involvement.
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Affiliation(s)
- Travis Lanz-Brian Pereira
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Priyadharshni DO Rajendran
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Zhang J, Li Y, Zhu L, Shang Y, Yan Q. The effectiveness of online breastfeeding education and support program on mothers of preterm infants: A quasi-experimental study. Midwifery 2024; 130:103924. [PMID: 38237419 DOI: 10.1016/j.midw.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/20/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
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.
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Affiliation(s)
- Jun Zhang
- School of Nursing, Wuhan University, Wuhan, China
| | - Yawei Li
- School of Nursing, Wuhan University, Wuhan, China; Henan Provincial Health Publicity and Education Center, Zhenzhou, China
| | - Luyang Zhu
- School of Nursing, Wuhan University, Wuhan, China
| | - Yanyan Shang
- Neonatal Intensive Care Unit, Renmin Hospital of Wuhan University Hubei General Hospital, #238Jiefang Rd, 99 Zhang Zhidong Rd, Wuchang District, Wuhan, Hubei 430060, China.
| | - Qiaoyuan Yan
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xie EB, Jung JW, Kaur J, Benzies KM, Tomfohr-Madsen L, Keys E. Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies. J Med Internet Res 2023; 25:e43219. [PMID: 37494086 PMCID: PMC10413237 DOI: 10.2196/43219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers. OBJECTIVE This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum. METHODS A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool. RESULTS A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall. CONCLUSIONS New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development.
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Affiliation(s)
| | - James Wonkyu Jung
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jasleen Kaur
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Karen M Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Lianne Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Keys
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- School of Nursing, The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
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Laws RA, Cheng H, Rossiter C, Kuswara K, Markides BR, Size D, Corcoran P, Ong K, Denney‐Wilson E. Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app. MATERNAL & CHILD NUTRITION 2023; 19:e13482. [PMID: 36725007 PMCID: PMC10019053 DOI: 10.1111/mcn.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Rachel A. Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Heilok Cheng
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
| | - Chris Rossiter
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
| | - Konsita Kuswara
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Brittany R. Markides
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition ScienceDeakin UniversityGeelongAustralia
| | - Donna Size
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
| | - Patricia Corcoran
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
- Canterbury Hospital Maternity Unit, Sydney Local Health DistrictSydneyAustralia
| | - Kok‐Leong Ong
- Department of Information Systems and Business Analytics, AISSCRMIT UniversityMelbourneAustralia
| | - Elizabeth Denney‐Wilson
- Susan Wakil School of Nursing and MidwiferyThe University of SydneyCamperdownAustralia
- Sydney Institute for Women, Children and their Families, Sydney Local Health DistrictSydneyAustralia
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Till S, Mkhize M, Farao J, Shandu LD, Muthelo L, Coleman TL, Mbombi M, Bopape M, Klingberg S, van Heerden A, Mothiba T, Densmore M, Verdezoto Dias NX. Digital Health Technologies for Maternal and Child Health in African and other LMICs: A Cross-disciplinary Scoping Review with Stakeholder Consultation (Preprint). J Med Internet Res 2022; 25:e42161. [PMID: 37027199 PMCID: PMC10131761 DOI: 10.2196/42161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/16/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. OBJECTIVE This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. METHODS We conducted a scoping review using the 6-stage framework by Arksey and O'Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. RESULTS During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. CONCLUSIONS Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy.
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Affiliation(s)
- Sarina Till
- School of Information Technology, Independent Institute of Education, Durban, South Africa
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Mirriam Mkhize
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
| | - Jaydon Farao
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Londiwe Deborah Shandu
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
| | - Livhuwani Muthelo
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | | | - Masenyani Mbombi
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Mamara Bopape
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Sonja Klingberg
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair van Heerden
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tebogo Mothiba
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Melissa Densmore
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
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Bunik M, Jimenez-Zambrano A, Solano M, Beaty BL, Juarez-Colunga E, Zhang X, Moore SL, Bull S, Leiferman JA. Mother's Milk Messaging™: trial evaluation of app and texting for breastfeeding support. BMC Pregnancy Childbirth 2022; 22:660. [PMID: 36002798 PMCID: PMC9400217 DOI: 10.1186/s12884-022-04976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New mothers experience BF challenges but have limited evidence-based technology-enabled support. OBJECTIVES 1) Determine if using the Mother's Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app. METHOD Randomized Controlled Trial National sample of primiparous, singleton mothers recruited online and then randomized using stratification by language into three arms: 1) BF text messages plus app; 2) BF text messages, app and physician-moderated private Facebook (FB) group; 3) Attention control group who received injury prevention texts. Exclusive breastfeeding rates as primary outcome and knowledge/attitude, confidence, and social support as secondary outcomes. We determined engagement through analysis of app usage metrics. We conducted and content-coded interviews with participants to learn more about app usage and BF experience. Due to the nature of the intervention participants could not be blinded. RESULTS There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study. CONCLUSION MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA.
| | - Andrea Jimenez-Zambrano
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Solano
- Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA
| | - Brenda L Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Xuhong Zhang
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Susan L Moore
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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White BK, Burns SK, Giglia RC, Dhaliwal SS, Scott JA. Measuring User Engagement with a Socially Connected, Gamified Health Promotion Mobile App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5626. [PMID: 35565015 PMCID: PMC9102982 DOI: 10.3390/ijerph19095626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
Participant engagement is an important consideration in mHealth interventions and there are no standardised measurements available to guide researchers. This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information. Participants were recruited from maternity hospitals in Perth, Western Australia. An engagement index with scores ranging from 0 to 100 was calculated. Kaplan Meier survival analysis was used to determine difference in duration of exclusive breastfeeding, and Pearson's chi square analysis was conducted to investigate the association of engagement level with demographic characteristics and exclusive breastfeeding at 6 weeks. While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1-80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level. This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement.
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Affiliation(s)
- Becky K. White
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
| | - Sharyn K. Burns
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth 6845, Australia
| | | | - Satvinder S. Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth 6845, Australia;
- Duke-NUS Medical School, National University of Singapore, Singapore 119077, Singapore
- Institute for Research in Molecular Medicine (INFORMM), University of Science, Pukau Pinang 11800, Malaysia
| | - Jane A. Scott
- School of Population Health, Curtin University, Perth 6845, Australia; (B.K.W.); (S.K.B.)
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth 6845, Australia
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11
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Huo J, Wu X, Gu C, Yu Z, Zhang J, Chen X, Zhu J, Liu F, Liu B, Li Q, Han S. Using a WeChat mini-program-based lactation consultant intervention to increase the consumption of mother's own milk by preterm infants in the neonatal intensive care unit: a study protocol for a cluster randomized controlled trial. Trials 2021; 22:834. [PMID: 34819117 PMCID: PMC8611400 DOI: 10.1186/s13063-021-05731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefits of mother's own milk (MOM) for preterm infants have been widely recognized. Many studies have shown that the rate of breastfeeding of premature infants remains very low. Although many studies use measures to promote breastfeeding, few high-quality cluster randomized controlled studies have evaluated the effectiveness of these measures. WeChat is an instant messaging software for smart terminals, and WeChat mini-programs have been widely used to promote health and self-management in China. Based on this background, we designed a randomized controlled study based on WeChat mini-programs to promote MOM feeding of premature infants in the neonatal intensive care unit (NICU). METHODS/DESIGN This study will evaluate the effectiveness of WeChat mini-programs to increase the consumption of MOM feeding in twelve NICUs in Jiangsu Province, namely, six "intervention" NICUs and six "control" NICUs. The study process is as follows: (1) design and preparation, (2) NICU recruitment and training, (3) interpretation and analysis of baseline data, (4) quality control implementation process, and (5) data analysis feedback and publication of study reports. The primary outcome is the proportion of MOM feeding of premature infants during NICU hospitalization. The secondary outcomes are as follows: (1) time to initiation of MOM feeding (hours) and proportion of first-time MOM feeding (%), (2) duration of parenteral nutrition (days), (3) time to total gastrointestinal feeding (days), (4) hospitalization time and hospitalization cost, and (5) incidence of complications (necrotizing enterocolitis, bronchopulmonary dysplasia, feeding intolerance, late-onset sepsis, retinopathy of prematurity). DISCUSSION This study is the first cluster randomized controlled trial on the intervention of using a WeChat mini-program-based lactation consultant for premature infants in the NICU in China. We hope this study can improve the consumption of MOM by NICU premature infants during hospitalization through the intervention of WeChat mini-programs. TRIAL REGISTRATION ClinicalTrials.gov NCT04383379. Registered on May 5, 2020.
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Affiliation(s)
- Jie Huo
- Department of Neonatology, Yangzhou Maternity and Child Health Care Hospital, Yangzhou, 225002, China
| | - Xinping Wu
- Department of Neonatology, Yangzhou Maternity and Child Health Care Hospital, Yangzhou, 225002, China
| | - Chuanli Gu
- Department of Neonatology, Yangzhou Maternity and Child Health Care Hospital, Yangzhou, 225002, China
| | - Zhangbin Yu
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Jun Zhang
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Xiaohui Chen
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Jingai Zhu
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Feng Liu
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Beibei Liu
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China
| | - Qianqian Li
- Department of Neonatology, Xuzhou Maternity and Child Health Care Hospital, Xuzhou, 221009, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, 210004, China.
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12
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How do women, men, and health providers perceive interventions to influence men's engagement in maternal and newborn health? A qualitative evidence synthesis. Soc Sci Med 2021; 291:114475. [PMID: 34695645 DOI: 10.1016/j.socscimed.2021.114475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
Globally, there is growing awareness of the important contributions men can make as key stakeholders in maternal and newborn health (MNH), and increased investment in interventions designed to influence men's engagement to improve MNH outcomes. Interventions typically target men, women, couples or health providers, yet how these stakeholders perceive and experience interventions is not well understood and the fact that women may experience these interventions as disempowering has been identified as a major concern. This review aims to synthesise how women, men, and providers perceive and experience interventions designed to influence men's engagement in MNH, in order to identify perceived benefits and risks of participating in interventions, and other key factors affecting uptake of and adherence to interventions. We conducted a qualitative evidence synthesis based on a systematic search of the literature, analysing a purposive sample of 66 out of 144 included studies to enable rich synthesis. Women, men and providers report that interventions enable more and better care for women, newborns and men, and strengthen family relationships between the newborn, father and mother. At the same time, stakeholders report that poorly designed or implemented interventions carry risks of harm, including constraining some women's access to MNH services and compounding negative impacts of existing gender inequalities. Limited health system capacity to deliver men-friendly MNH services, and pervasive gender inequality, can limit the accessibility and acceptability of interventions. Sociodemographic factors, household needs, and peer networks can influence how men choose to support MNH, and may affect demand for and adherence to interventions. Overall, perceived benefits of interventions designed to influence men's engagement in MNH are compelling, reported risks of harm are likely manageable through careful implementation, and there is clear evidence of demand from women and men, and some providers, for increased opportunities and support for men to engage in MNH.
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13
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Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res 2021; 23:e30390. [PMID: 34505840 PMCID: PMC8463952 DOI: 10.2196/30390] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. OBJECTIVE This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. METHODS We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. RESULTS Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. CONCLUSIONS Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.
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Affiliation(s)
- Simon Warsinsky
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Sascha Rank
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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14
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Scott JA, Burns SK, Hauck YL, Giglia RC, Jorgensen AM, White BK, Martin A, Robinson S, Dhaliwal SS, Binns CW, Maycock BR. Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e24579. [PMID: 33843604 PMCID: PMC8076985 DOI: 10.2196/24579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. OBJECTIVE The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. METHODS The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. RESULTS A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. CONCLUSIONS This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12884-015-0601-5.
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Affiliation(s)
- Jane Anne Scott
- School of Population Health, Curtin University, Perth, Australia
| | - Sharyn K Burns
- School of Population Health, Curtin University, Perth, Australia
| | - Yvonne L Hauck
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Roslyn C Giglia
- School of Population Health, Curtin University, Perth, Australia
| | | | - Becky Kate White
- School of Population Health, Curtin University, Perth, Australia
| | - Annegret Martin
- School of Population Health, Curtin University, Perth, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Perth, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Colin W Binns
- School of Population Health, Curtin University, Perth, Australia
| | - Bruce R Maycock
- School of Population Health, Curtin University, Perth, Australia
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15
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Cheng H, Tutt A, Llewellyn C, Size D, Jones J, Taki S, Rossiter C, Denney-Wilson E. Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation. JMIR Mhealth Uhealth 2020; 8:e17300. [PMID: 32459187 PMCID: PMC7287747 DOI: 10.2196/17300] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.
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Affiliation(s)
- Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia
| | - Alison Tutt
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Catherine Llewellyn
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Donna Size
- Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia.,Lactation Clinic, Royal Prince Alfred Hospital, NSW Health, Camperdown, Australia
| | - Jennifer Jones
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Child and Family Health Nursing, Sydney Local Health District, NSW Health, Camperdown, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, Australia
| | - Sarah Taki
- Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia.,Health Promotion, Population Health Research & Evaluation Hub, Sydney Local Health District, NSW Health, Camperdown, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, NSW Health, Camperdown, Australia
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16
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Ekambareshwar M, Taki S, Mihrshahi S, Baur LA, Rissel C, Wen LM. Participant Experiences of an Infant Obesity Prevention Program Delivered via Telephone Calls or Text Messages. Healthcare (Basel) 2020; 8:E60. [PMID: 32188139 PMCID: PMC7151095 DOI: 10.3390/healthcare8010060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/01/2023] Open
Abstract
A 3-arm randomised controlled trial implemented in 2017, recruited participants from four Local Health Districts (LHDs) in New South Wales (NSW) to test an early obesity prevention program delivered via telephone calls (telephone) or text messages (SMS). This sub-study explored participants' experience and satisfaction with the program. A multimethod design was used. Quantitative satisfaction questions were completed by participants when their child was six-months old. A purposive sample of participants with varying satisfaction levels was invited for in-depth qualitative interviews. Data were analysed using Excel (quantitative) and inductive thematic analysis (qualitative). Of the 1155 participants recruited: 947 (293 telephone; 338 SMS; 316 control) completed the six-month survey; 34 (14 telephone; 13 SMS; 7 control) were interviewed. Participants' overall program satisfaction was 100% (telephone) and 85% (SMS). Participants' qualitative responses demonstrated appreciation of: personalised stage-based information; opportunity to communicate with health professionals (telephone); linked Healthy Beginnings booklets and SMS mostly as nudges (SMS). There is a clear need for stage-based information, and supplemented modes of delivery i.e., text messages along with telephone calls; with text messages solely seen as nudges or reminders. However, individual preferences vary according to information needs at any given time, time constraints on new mothers and hence, multiple modes of information provision are recommended in order to reach a wider population and for better engagement. Choice and flexibility in mode of delivery has the potential to provide equitable access to information, empowering women with infants to practice recommended health behaviours for infant obesity prevention.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Health Promotion Unit, Sydney Local Health District, Camperdown 2050, Australia
| | - Seema Mihrshahi
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
| | - Louise A. Baur
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- Sydney Medical School, The University of Sydney, Camperdown 2006, Australia
| | - Chris Rissel
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- New South Wales Office of Preventive Health, Ministry of Health, Liverpool 2170, Australia
| | - Li Ming Wen
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, Camperdown 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown 2006, Australia
- Health Promotion Unit, Sydney Local Health District, Camperdown 2050, Australia
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17
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Manohar N, Hayen A, Bhole S, Arora A. Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study. Nutrients 2020; 12:E258. [PMID: 31963864 PMCID: PMC7019241 DOI: 10.3390/nu12010258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.
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Affiliation(s)
- Narendar Manohar
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Sameer Bhole
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW 2010, Australia;
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010, Australia
- Oral Health Alliance, Oral Health Centre, University of Queensland, Brisbane, QLD 4072, Australia
- Metro North Oral Health Services, Stafford, QLD 4053, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia;
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW 2010, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney Faculty of Medicine and Health, Westmead, NSW 2050, Australia
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