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

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

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

Evaluation of Breastfeeding App Features: Content Analysis Study

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Data handling practices and commercial features of apps related to children: a scoping review of content analyses

BACKGROUND

Child interaction (including via parent proxy) with mobile apps is common, generating concern about children's privacy and vulnerability to advertising and other commercial interests. Researchers have conducted numerous app content evaluations, but there is less attention to data sharing or commercial practices.

OBJECTIVE

This scoping review of commercial app evaluation studies describes the nature of such evaluations, including assessments of data privacy, data security and app-based advertising.

METHODS

We searched Scopus, PubMed, Embase and ACM Digital Library (2005-2020). We included studies that evaluated the properties of apps available through commercial app stores and targeted children, parents of a child (0-18 years) or expectant parents. Data extracted and synthesised were study and app user characteristics, and app privacy, data sharing, security, advertisement and in-app purchase elements.

RESULTS

We included 34 studies; less than half (n=15; 44.1%) evaluated data privacy and security elements and half (n=17; 50.0%) assessed app commercial features. Common issues included frequent data sharing or lax security measures, including permission requests and third-party data transmissions. In-app purchase options and advertisements were common and involved manipulative delivery methods and content that is potentially harmful to child health.

CONCLUSIONS

Research related to the data handling and the commercial features of apps that may transmit children's data is preliminary and has not kept pace with the rapid expansion and evolution of mobile app development. Critical examinations of these app aspects are needed to elucidate risks and inform regulations aimed at protecting children's privacy and well-being.

Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

Audiovisual and printed technology to prevent childhood diarrhea: A clinical trial

OBJECTIVE

To compare the effect of using an educational booklet and a video alone or together in promoting maternal self-efficacy to prevent childhood diarrhea.

DESIGN AND SAMPLE

Randomized multicenter clinical trial with 522 mothers of children under 5 years of age from northeastern Brazil. They were allocated into eight groups, according to the city: metropolis - video alone (N = 61), booklet alone (N = 60), booklet and video along (N = 60), without intervention (N = 60); countryside - booklet alone (N = 70), video alone (N = 70), booklet and video along (N = 71), without intervention (N = 70).

MEASUREMENTS

A sociodemographic form and the Maternal Self-Efficacy Scale for preventing early childhood diarrhea.

RESULTS

Increases in self-efficacy scores were observed in all experimental groups after the educational intervention. Urban mothers living had greater self-efficacy than rural mothers. This result was verified in the video alone group (p = .036) and without intervention group (p = .003). Mothers in all intervention groups, regardless of the educational intervention used, had higher self-efficacy scores than the comparison group mothers (p < .05).

CONCLUSION

The tested educational technologies promoted maternal self-efficacy to prevent childhood diarrhea, regardless of whether they are applied alone or in combination.

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.