Hidden Communities of Practice in Social Media Groups: Mixed Methods Study

Internet-based breastfeeding peer support for breastfeeding parents: An integrative review

AIM

To explore what Internet-based breastfeeding peer support offers to breastfeeding parents.

DESIGN

Integrative review.

DATA SOURCES AND REVIEW METHODS

A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted.

RESULTS

The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices.

CONCLUSION

Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging.

IMPACT

These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

This was an integrative review therefore no patient or public contribution was necessary.

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.

Midlife Transition Experiences of South Asian Immigrant Women in Canada: A Qualitative Exploration

BACKGROUND

South Asians make up a significant portion of the immigrant population in Canada, and a large portion of them are in their midlife. To improve the midlife transition of South Asian immigrant women, it is necessary to understand their lived experiences.

PURPOSE

Guided by the transition theory, this study investigates the midlife experiences of South Asian immigrant women in Canada.

METHODS

Twenty-two South Asian midlife, immigrant women were recruited to participate in this study from the Greater Toronto Area, Ontario, Canada. This study consisted of one asynchronous online focus group with 12 participants and ten one-on-one telephone interviews. Qualitative content analysis was guided by transition theory.

RESULTS

South Asian immigrant women experienced many different transitions in their midlife in Canada. These transitions included changes in their (a) lifestyle, (b) career, (c) family, (d) physical health, (e) mental health, (f) social, (g) environment, and (h) personal development. Women actively managed their transitions using strategies such as exercise, socialization, counseling, and religion. Women expressed the need for social, community, and governmental support to facilitate their midlife transitions.

CONCLUSION

To promote healthy midlife transition, governments need to create better employment policies to facilitate immigrant women settlement, transferring skills, and re-employment in Canada. In addition, health care and community services to promote physical and mental health should be emphasized.

Mothers' experiences of using Facebook groups for local breastfeeding support: Results of an online survey exploring midwife moderation

It is established that access to ongoing informational, emotional and social support from trained health professionals including midwives assists mothers in meeting their breastfeeding goals. Social media is increasingly being used to offer this support. Research has demonstrated that support via platforms such as Facebook can improve maternal knowledge and self-efficacy and ultimately breastfeeding duration. One specific form of support that is under researched is the use of Breastfeeding Support Facebook (BSF) groups that are aimed at supporting women in specific local areas, often with links to face to face support. Initial research highlights that mothers' value these groups but the role that midwives play in offering support to local mothers through these groups has not been examined. The aim of this study was therefore to examine mothers' perceptions of midwifery support for breastfeeding delivered through these groups, specifically when midwives played an active role in being a group 'moderator' or leader. An online survey was completed by 2028 mothers who were part of local BSF groups comparing the experiences of those participating in groups moderated by midwives versus other moderators such as peer supporters. Moderation was an important factor in mothers' experiences, with trained support associated with greater engagement and more frequent visits, impacting on perceptions of group ethos, reliability and inclusivity. Midwife moderation was uncommon (5% of groups) but valued: midwife moderators offered a high level of support to mothers in their groups, with 87.5% having received midwife support often or sometimes and 97.8% rating this useful or very useful. Access to a midwife moderated group was also associated with viewing local face to face midwifery support for breastfeeding more positively. This is a significant finding, highlighting that online support complements face-to-face support in local settings (67% of groups were linked to a physical group), and improves continuity of care (14% of mothers who had midwife moderators received care from them). As such midwife moderated or supported groups have the potential to add value to local face to face services and improve breastfeeding experiences in communities. The findings have important implications to support the development of integrated online interventions to improve public health.

The benefits, challenges and impacts of accessing social media group support for breastfeeding: A systematic review

Breastfeeding support is a key component in meeting the public health responsibility of increasing breastfeeding rates, with access to individualised, convenient and linked support across services central to improved outcomes. With the rise of new technology and the COVID‐19 pandemic, social media (SM) support for breastfeeding has become increasingly popular and it is important to understand how and why mothers access such support, and from whom, to optimise services and to meet mothers’ needs. Increasing research is building on women's use and experience of SM for breastfeeding, although there is a paucity of UK data. This systematic review aimed to understand the impacts of SM support for breastfeeding, including benefits and challenges, to establish the evidence for wider provision within maternity services. The search was limited to studies published in English and focused on the self‐directed use of social media groups for breastfeeding (defined as platforms that facilitate group support via interactivity, allowing for user‐generated content and subsequent responses). Of 327 papers retrieved, 13 studies were included for review. The six themes identified were: breastfeeding context, including factors impacting women's decision making; the relational impact of belonging to an online community; increased self‐efficacy; critiques of SM; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. The findings confirm that mothers value SM groups for community support, which normalises breastfeeding and provides the support they attribute to improved outcomes, and highlight that UK research focused on provision linked to wider services is needed.

Joining a social media (SM) group to seek support is common among those mothers intending to breastfeed. For these mothers SM groups have the potential to provide valued support where it is lacking, or in addition to their existing networks.

SM groups offer reciprocity of knowledge sharing and esteem support. Belonging to a supportive online community promotes emotional wellbeing and self‐efficacy, improving breastfeeding outcomes.

Online peer support is valued and trusted as a complementary source of information and shared experience. Mothers are aware of issues of reliability, lack of regulation and the need to be discerning of online advice.

Perceptions of online informational social support among mothers in a lactation-focused virtual community: A survey study

Background:

Peer support, also described as woman-to-woman support, has been well established as an effective intervention for overcoming barriers to breastfeeding duration. To access support and receive information, mothers are likely to access social media platforms, especially given the challenges to healthcare access presented by the COVID-19 pandemic. Previous research has established that virtual communities can promote peer-to-peer support similar to that seen in communities of practice.

Research Aim:

The aims of this study were to describe levels of perceived informational social support among mothers in an online virtual community and to determine which features of the virtual community were perceived most favorably by breastfeeding mothers.

Methods:

The study design was a cross-sectional survey of members of an existing social media community of breastfeeding mothers with use of the Online Social Support Scale–Informational subscale, Breastfeeding Self-Efficacy Short Form, and additional open-ended questions during the early phases of the COVID-19 pandemic. Participants were recruited within a single, lactation-focused virtual community that was moderated by lactation support professionals.

Results:

In regard to online social support specific to information seeking, the reported social support was moderate to high (M = 35.53, range = 17–48). Most items had a score average of approximately 3, indicating that participants perceived informational support “Pretty often” from their group interactions. Participants in this study had an average Breastfeeding Self-Efficacy–Short Form score of 57.91, indicating a moderately high level of breastfeeding self-efficacy. Content analysis of open-ended items regarding favorable characteristics of the virtual community indicated participants appreciated the immediacy of feedback and the presence of lactation support professionals within the community.

Conclusion:

Mothers in the lactation professional-led virtual community perceived moderately high support in health information seeking and experienced moderately high breastfeeding self-efficacy. Additional work is needed to determine the impact of participation in virtual communities on breastfeeding outcomes.

Exclusive breastfeeding promotion policies: whose oxygen mask are we prioritizing?

Provision of human milk is crucial for maternal and infant health. However, exclusive breastfeeding may exacerbate mood disorders in women unable to achieve this goal. A nuanced approach that considers all aspects of maternal and infant health is needed. In this paper, we bring attention to the potentially negative consequences on maternal and infant health that may be associated with exclusive breastfeeding in the setting of significant challenges. We discuss recent literature exploring the relationship between breastfeeding and maternal mental health, and contextualize it with our first-hand experiences as healthcare professionals who aimed to exclusively breastfeed and encountered difficulties. Given existing evidence and our collective anecdotal experience, we advocate for a balanced approach when supporting parents struggling to breastfeed. Timely recommendations are offered for healthcare providers, medical educators and hospital administrators seeking to balance maternal and infant child health considerations while continuing to promote breastfeeding. PRéCIS STATEMENT: Exclusively promotion of breastfeeding impacts maternal mental health and consequently, infant health. We advocate for balanced considerations of maternal and infant child health while promoting breastfeeding. CLINICAL IMPLICATIONS: Singular promotion of exclusive breastfeeding may exacerbate adverse maternal mental health outcomes. A balanced consideration of maternal and infant child health is vital as breastfeeding is encouraged. Clinicians who provide front-line support to breastfeeding parents must be taught and expected to provide nuanced breastfeeding support that anticipates both physical and mental health challenges.

Attitudes Toward Cannabis Use During Labor in the United States

Objective: Little is known about women's attitudes toward cannabis use during labor. We aim to address this gap by (1) reporting on attitudes toward cannabis use during labor, including cannabis use during most recent childbirth; and (2) examining the extent to which attitudes, willingness to use cannabis during labor, and cannabis use during most recent childbirth vary across state-level cannabis policies.

Methods: In Spring 2021, we recruited biological women of reproductive age (18–40 years) for an online survey. We collected sociodemographic information and asked women about their attitudes toward cannabis use during labor, willingness to use cannabis during labor, and prior cannabis use during most recent childbirth. We ran descriptive statistics and used Fisher's exact tests to examine the association between state cannabis policies and attitudes toward cannabis use during labor, including willingness to use cannabis during labor.

Results: In our sample (N = 163), most women reported they would either consider using (47.85%) or previously used (3.07%) cannabis during labor. Compared with women who would not use, women who reported willingness to use or prior use of cannabis during labor were more likely to report a lower annual household income (p = 0.001) and education level (p < 0.001). Women willing to consider cannabis use were also more likely to report prenatal cannabis use (p < 0.001) and reside in a state with recreational cannabis legalization (p = 0.003). Women who would not consider using cannabis during labor were more likely to perceive one or more risks of use compared with women who would consider using cannabis during labor (90.00% vs. 72.29%, respectively; p = 0.005). In fully illegal states, 66% of women reported they would be more likely to use cannabis during labor if it were legal.

Conclusions: Future research is urgently needed to guide clinical practice. To mitigate adverse health outcomes, prenatal care providers should discuss cannabis use during labor with their patients.

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face-to-face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.

Accessing local support online: Mothers' experiences of local Breastfeeding Support Facebook groups

The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation-overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face-to-face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers. Findings identified that local BSF groups are widely used and highly valued for their connection with local face-to-face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self-efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well-being, motivation and breastfeeding duration. As such, they have the potential to add value to local face-to-face services and improve breastfeeding experiences and knowledge in communities. The findings have important implications to support the development of integrated online interventions to improve public health.

Using Social Media for Qualitative Health Research in Danish Women of Reproductive Age: Online Focus Group Study on Facebook

BACKGROUND

Social media platforms provide new possibilities within health research. With Facebook being the largest social network in the world, it constitutes a potential platform for recruitment and data collection from women of reproductive age. Women in Denmark and in other Western countries postpone motherhood and risk infertility due to their advanced age when they try to conceive. To date, no study has explored Danish women's reflections on the timing of motherhood within a social media setting.

OBJECTIVE

The aim of this study was to explore the challenges and opportunities of using Facebook as a platform for qualitative health research in Danish women of reproductive age.

METHODS

This study was a qualitative study based on 3 online focus groups on Facebook with 26 Danish women of reproductive age discussing the timing of motherhood in January 2020.

RESULTS

Conducting online focus groups on Facebook was successful in this study as the web-based approach was found suitable for developing qualitative data with women of reproductive age and made recruitment easy and free of charge. All participants found participating in an online focus group to be a positive experience. More than half of the women participating in the online focus groups found it advantageous to meet on Facebook instead of meeting face-to-face.

CONCLUSIONS

Conducting online focus groups on Facebook is a suitable method to access qualitative data from women of reproductive age. Participants were positive toward being a part of an online focus group. Online focus groups on social media have the potential to give women of reproductive age a voice in the debate of motherhood.

Child feeding practices and concerns: Thematic content analysis of Thai virtual communities

Parents' child feeding practices are influenced not only by family but also by a broader circle of networks, including online groups. Peer-to-peer platforms such as Facebook groups facilitate a learning environment and may influence the transmission of user-generated content into practice. These digital data not only benefit participants but also offer new opportunities for researchers to study related phenomena. Therefore, this study employs thematic content analysis to investigate peer-exchanging discourse conveyed in Facebook peer-support groups in children's diets in Thailand. To identify the area of interest, we classified and quantified the initial posts and investigated the relationship between initial posts' contents and community engagement. Thematic analysis was used to qualitatively describe the peer-exchanging content that responded to the initial posts. Of the five approved Facebook groups, 200 initial posts with their 1964 comments were extracted anonymously. Results revealed that Facebook groups devoted to diets for children have become a platform for Thai parents to seek informational and emotional support. The top-ranked initial posts were related to requesting knowledge and skills about age-appropriate food and meal preparation. Parents have also expressed anxiety about feeding and tension related to food fussiness which created the need for emotional support. Age-appropriate feeding, homemade baby foods, concerns about food seasonings and food allergy awareness were observable within online groups. However, a shift from traditional child feeding practices to new ideas created cultural gaps which lead to arguments in some families. Understanding these views would help guide to address parental concerns better.

Facilitators and Barriers to Healthy Midlife Transition among South Asian Immigrant Women in Canada: A Qualitative Exploration

Background: South Asian immigrant women make up the largest visible minority in Canada, where visible minorities include persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in colour, and approximately half of these women are above the age of 35. Few studies have investigated the factors that impact the midlife transition for these women. This study aims to identify the facilitators and barriers experienced by South Asian immigrant women during the midlife transition. Methods: Two focus groups and ten one-on-one interviews about the midlife transition were held with South Asian first-generation immigrant women in the Greater Toronto Area, Ontario, Canada; discussions were analyzed thematically. Findings: Personal facilitators to the midlife transition included being employed and possessing adequate life skills. Personal barriers consisted of financial strain, overwhelming demands, and limited life skills. Familial facilitators were stable financial status and support. Familial barriers included limited understanding and support and high expectations. Community facilitators included a close social circle and adequate healthcare. Community barriers were limited social support and cultural expectations. Fair and respectful societies were a facilitator, whereas inadequate policy support and acculturative stress were societal barriers. An environmental barrier was the colder Canadian climate. Discussion: Employment and education programs for South Asian immigrant women need to be prioritized to help them integrate into society. Family-centred assessment and education can improve familial support. Communities need to foster peer support groups and culturally sensitive healthcare. Social and employment policies should accommodate the midlife transition. Conclusions: South Asian immigrant women experience unique facilitators and barriers to their midlife transition that should be considered by healthcare providers, policymakers and society to support them.